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PANCE GI/nutrition 1

PANCE Review

QuestionAnswer
Fat, forty, female, fertile w/ RUQ pain Cholelithiasis or Cholecystitis
Fever, RUQ pain, radiation to back Cholecystitis
Elevated Alkaline phosphatase, urinary bilirubin Cholecystitis
F, RUQ pain, Jaundice, gallstones & dilated common duct on US Ascending cholangitis (Charcot’s triad)
Hx IBD, progressive RUQ pain, wt loss, F, jaundice & pruritis. Elevated bilrubin & alkaline phosphate. ERCP with bile duct stenosis, dilatation Primary sclerosing cholangitis (diffuse intra- and extrahepatic duct sclerosing and dilatation)
Elevated AST, ALT, indirect bilirubin Hepatitis
Isolated elevated indirect bilirubin Gilbert syndrome
Elevated indirect bilirubin w/ defective glucuronyl transferase Crigler-Najjar Dz
Photosensitivity, abd pain w/ neurologic dysfunction, erythema or skin fragility Porphyria
Chronic cough, bitter taste in mouth or throat, dyspepsia GERD
Multiple or constant GI ulcer pain despite medications Zollinger-Ellison Syndrome
N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion, or following fatty meals Acute pancreatitis
peri-umbilical or flank ecchymosis Acute pancreatitis (Cullen & Grey Turner Sign)
Abdominal distension, bloating, intermittent, colicky pain, high-pitched rushes & tinkles SBO
Air fluid levels on upright abd plain film SBO
Air under diaphragm, rigid board-like abdomen Perforated viscus, perforated ulcer
>60yo F, LLQ pain Diverticulitis. IV Abx, fluids, NPO.
Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial Mesenteric ischemia
Neonate w/ projectile vomiting. Olive sized mass. Pyloric stenosis
Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life Tracheoesophageal fistula
Painless rectal bleeding in pediatrics Meckel diverticulum
Alcoholic with massive hemoptysis Esophageal varicies (Tx w/ octreotide)
Female with recurrent abdominal pain, alternating diarrhea, constipation; pain relieved with defecation = IBS. TCAs (nortriptyline) good if diarrhea predominant symptom
Bloody Diarrhea = Ulcerative colitis
Supraclavicular LAD (L > R) Virchow node: metastatic abdominal cancer
Hard periumbilical nodule Sister Mary Joseph nodule; indicates metastatic gastric and pancreatic cancers
PUD, Pernicious anemia (Type A Gastritis), H. pylori are RFs for: Gastric Ca
Apple core lesion = Colon Cancer
Elderly pt with positive hemoccult: poss dx & next step: Colon Cancer: get colonoscopy
CEA to dx: Colon Carcinoma
Family history of young age colon cancer, multiple polyps found on colonoscopy Familial adenomatous polyposis (Gardner syndrome)
AFP to dx: Hepatocellular carcinoma (also high alk phos), testicular seminoma (germ cell tumor)
CA 19-9 to dx: Pancreatic Ca
CA-125 to dx: Ovarian Carcinoma
Traveler’s Diarrhea is caused by: E. coli (ETEC); tx is hydration & Cipro
Greasy, foul smelling, floating stools. Pear-shaped flagellated protozoan w/ 2 “eyes”. Water, travel, camping history Giardia
Afebrile, watery or loose stool. No blood or mucus Viral Gastroenteritis
Abdominal pain, diarrhea after picnic/party. Eaten ham, cream, custards, mayonnaise Staphylococcus aureus infectious diarrhea
Acute bacterial diarrhea w/ prodrome of HA, F, then crampy abd pain & diarrhea Campylobacter jejuni (most common cause of acute bacterial diarrhea)
Painless rectal bleeding. Bulging perianal mass w/ straining Internal hemorrhoids
Pediatric with perianal pruritis esp at night; positive cellophane tape test Pruritis ani: Pinworms (enterobiasis). Tx is Mebendazole
Weight loss, recurrent greasy stools (steatorrhea) mixed with diarrhea after certain foods Celiac Sprue
Anti-endomysial antibodies Celiac Sprue
Beriberi Thiamine (B1) deficiency; Alcoholics, Neuro Sx +/- cardiomyopathy, CHF
Pellagra (raw skin) Niacin (B3) (4D’s dermatitis, diarrhea, dementia, death), bright red tongue
Scurvy Vit C (easy bleeding, bruising, hair & tooth loss, joint pain and swelling)
Rickets; hsm, lg skull, genu varus/ valgus Vit D (Osteomalacia)
Night blindness; Xerosis, Hyperkeratinization, Loss of taste, Bitot spots (white spots on conjunctiva) Vit A deficiency; secondary causes antiseizure meds, low Ca
Magenta tongue Riboflavin deficiency (B2)
s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding Dumping syndrome
IBD and smoking smoking decreases UC sxs; increases crohn dz sxs
decreased proprioception and vibratory sense, gait disturbance, possibly 2/2 deficiency of: Vit E; secondary causes CF, biliary atresia, Cholestatic liver dz
Dermatitis, Neuropathy, Stomatitis, Cheilosis vit B complex def (most often 2/2 EtOH)
uncommon causes of B3 def INH use, Hartnup dz, carcinoid
palmar erythema, spider angiomata EtOH dz (folate / B12 def)
petechiae, purpura, peri-follicular hemorrhage vit C def
B1 (thiamine)def sxs impaired jejunal/ileal absorption; beri beri; Wernicke-Korsakoff
Spontaneous bacterial peritonitis (SBP) = infected ascites
Hep B transmission Sex; bloodborne (1 in 63K risk); perinatal (c-section does not lower risk): vax+HBIG
acute hep B eval 1-4 mo incubation; 70% subclinical; ALT/AST 1000-2000
HCV infxn sources IVDU (most common); sex; bloodborne
histological pattern of advanced fibrosis in liver = cirrhosis
Most common cause of abnormal liver tests fatty liver dz
Asterixis = encephalopathy assoc w/cirrhosis
HLA-DQ2, HLA-DQ8 association celiac dz
assoc w/celiac dz dermatitis herpetiformis; Type 1 DM; autoimmune thyroid dz; RA; Sjögren; Down syndrome; poss CHD, sarcoid, CF, IBD, autoimmune hep, MG
celiac dz physical exam check for loss of enamel; mx atrophy; kyphosis; bruises; +abdominal signs
villous atrophy, lymphocytic infiltration of lamina propria, crypt hyperplasia, inc intraepithelial lymphocytes = celiac dz
Courvoisier sign, Sister Mary Joseph nodule = panc ca
Dietary requirement of Ca: 1000-1500 mg/day
Created by: Abarnard on 2011-03-18



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