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Gastro 10 (Biliary)

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QuestionAnswer
At what point do pts w/ chronic COPD qualify for home O2? Pulse ox
An 8 yr old child was in a MVA and now requires an emergency blood transfusion. Her parents are not present, but the child states she is a Jehovah's Witness. What do you do? Treat the child immediately b/c we have implied consent (even if the kid tells you not to treat her)
Which lung cancer is associated with SIADH? Small cell lung cancer
In ability to visualize a gallbladder with a HIDA scan indicates what? cystic duct obstruction usually form acute cholecystitis or an obstructing stone
What type of patient is at high risk of acaclculous cholecystitis? pts on TPN or in the ICU
What are Charcot's triad and Reynold's pentad? Charcots triad is fever, RUQ pain, and Jaundice. Reynold's pentad is Charcot's triad + mental status changes and hypotension
How does the interventional component of treatment of cholecystitis differ form that of cholanitis? Cholecystitis gets cholecystectomy. Cholangitis gets ERCP to drain bile ducts first then gets cholecystectomy.
Which physical exam findings would lead you to suspect primary biliary cirrhosis as a diagnosis? Female age 30-65, fatigue and pruritis, skin changes (hyperpigmentation, xerosis, dermatographism), xanthelasma, hepatomegaly, steatorrhea(from less bile acide secretion)
What lab findings would lead you to suspect PBC as a primary diagnosis? Elevated anti-mitochondrial antibodies (AMA) (>95%,hallmark finding), also elevated ANA(70%), elevated alk phos and GGT, elevated serum direct and indirect bili, elevated cholesterol.
What is the treatment of PBC? Ursodeoxycholic acid (UDCA), which delays dz progression and enhances survival. Only approved therapy for PBC. Can also give Colchicine. Otherwise definitive treatment is liver transplantation
What distinguishes PBC from PSC? PBC= F>M, +AMA, Associated w/ AI disorders, +ANA. PSC= M>F, +pANCA, Associated with UC, ERCP shows "beads on a string".
Match the appropriate sign and disease to the following description: deep palpation of RUQ leads to arrest of inspiration due to pain Murphy's sign, cholecystitis
Match the appropriate sign and disease to the following description: Charcot's triad + hypotension, AMS Reynold's pentad, cholangitis
Match the appropriate sign and disease to the following description: RLQ pain on passive extension of the hip Psoas sign, appendicitis
Match the appropriate sign and disease to the following description: RLQ pain on passive internal rotation of flexed hip obturator sign, appendicitis
Match the appropriate sign and disease to the following description: LUQ pain and referred left shoulder pain Kehr's sign, splenic rupture
Match the appropriate sign and disease to the following description: ecchymosis of the skin overlying the flank Grey turner's sign, pancreatitis
Match the appropriate sign and disease to the following description: ecchymosis of the skin overlying the periumbilical area Cullen's sign, pancreatitis
An abdominal XRAY shows a calcified gallbladder, what is the likely diagnosis? highly suggestive of cancer, and biopsy should be performed promptly
Created by: shelybel
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