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Kaplan / Davis / HELP Explanation PANCE GI
Terms in this set (95)
what occurs with calcium level with severe pancreatitis?
-hypocalcemia due to sponification of calcium by free fatty acid and un-digested fat
Acute pancreatitis: Other Pancreatic digestive enzymes that leak into the systemic circulation and are elevated in serum include trypsin, phospholipase, carboxypeptidase, carboxylester lipase, colipase, and pancreatic isoamylase.
phospholipase circulate the blood stream and damages the alveolar capillary membrane in the lungs predisposing for adult respiratory distress syndrome. L
The most common corrosive substance ingested by children include household cleaners, detergent, beaches, coins, disc battery. What should be done for this child if the substance were taken in?
The child should be stabilized, flexible esophagoscopy is indicated to directly visualized the esophagus. It might be prudent to perform a chest radiograph first to rule out overt perforation and mediastinitis.
what is the tumor marker for patriotic carcinoma?
hepatocellular carcinoma, tumor of the testes, and malignant teratoma is often seen with what lab result
Patient has right upper quadrant abdominal pain triggered with the ingestion of fatty foods and relieved with anti-cholinergic medication. The pain is spasmodic radiate to the right shoulder and around the back accompanied by nausea and vomiting. Patient is afebrile and physical examination is unremarkable. What is the most appropriate next step in management?
Sonogram of the biliary tract and gallbladder. ERCP Would be inexpensive, invasive, and totally unjustifiable way to take a look at the gallbladder.
Primary sclerosing cholangitis often occurs with
primary biliary cirrhosis often occurs with
. this disease is autoimmune.
primary biliary cirrhosis is often seen in individuals who have other autoimmune disease such as
Sjogren Syndrome, pernicious anemia, and Hashimoto thyroiditis.
Crohn's disease. in both partially destroyed as a normal bowel and constricts it with thick bands of fibrosis. Other important intestinal complication can include fistula formation and chronic abscesses.
In addition, a wide variety of exit intestinal complication can include autoimmune disease such as arthritis, erythema Nodosum, and ankylosing spondylitis,
and children, with no obvious anal pathology and negative gastric aspirate, the leading cause of Gastro intestinal bleeding is
meckel diverticulum. the specific source is ulceration of the normal ileal mucosa by acid produced by gastric mucosa in the diverticulum.
The techetium scan identifies that ectopic gastric mucosa.
patient with abdominal pain during the palpitation in all four quadrants with severe rebound tenderness in the examiner cannot make much of the identation. Radiographs show free air under both diaphragm which are the following does this man most likely have?
perforation of the G.I. tract
A communication between an arteriole and venule in the cecum is a description of a vascular ectasia, also known as an arteriovenous (AV) malformation.
This is a common cause of painless colonic bleeding in the elderly and may present with acute gastrointestinal bleeding (as in this case), chronic gastrointestinal bleeding, or iron-deficiency
A variety of antireflux procedures have been described for the treatment of GERD (figure 1A-B). The most common procedures:
Cardiogenic shock is due to dramatic reduction in scope volume. Findings will be:
low blood pressure, low urine volume, disorientation, skin will be cold and clammy
septic shock is due to an infection; release of cytokines. The findings will be:
low blood pressure, low urine volume, disorientation, skin will be warm and flesh vasodilation; later, vasoconstriction may occur. Respiratory alkalosis, early; metabolic acidosis, later.
The signature of septic shock in the normovolemic patient is high cardiac output and low peripheral resistance.
patient started on NSAIDs and report bright red blood on the school paper when he wipes after a bowel movement. And hemorrhoids are ruled out what is the next appropriate step in management?
normal colonic mucosal does not believe in response to anticoagulation, but lesions with a predisposition to do so may be more likely to become symptomatic at such time. The bleeding lesion in this case may indeed be the internal hemorrhoid but that was ruled out. The patient needs a 60 cm examination with a flexible endoscope proctosigmoidoscopy. if one answer choice was colonoscopy, that will be the next best step.
Celiac sprue Is one of the causes of
iron deficiency anemia
a clinical diagnosis of chronic pancreatitis can be done with
CT scan this is the most sensitive test for picking up chronic pancreatitis.
Patient with a history of ulcerative colitis complicated by primary sclerosing cholangitis. He develops steatorrhea as a result of poor delivery of:
bile salt into the small intestines.
Patient with end-stage renal disease with a ambulatory peritoneal dialysis for the past two months is brought to the ER for fever, abdominal pain, and cloudy dialysis fluid. White blood cells is elevated, low hemoglobin, peritoneal fluid is cloudy. What do you think this patient has?
Patient has Staphylococcus aureus due to the dialysis tubing. treat pt with Intravenous ceftriaxone and vancomycin
patient presents with pain with defecation and blood streak on the outside of her stool. The clinical picture is classic for anal fissure which is a split in the skin of the anatl canal. patient has been placed on a stool softener and appropriate topical agents but without success. What is the most appropriate next steps?
lateral internal sphincterotomy
diarrhea that occurs shortly after meals and improve with fasting is another sign that diarrhea is osmotic.
the only answer choice listed is osmotic is lactose intolerance. lactose intolerance is very common it is an osmotic diarrhea, which means that undigested food causes the symptoms.
What is colonized the colon after eradication of the normal microflora by a course of antibiotic?
pseudomembranous colitis, caused by the toxins produced by Clostridium difficile. Symptoms typically occur 7-10 days after initiation of the antibiotic; in rare cases, pseudomembranous colitis can occur up to 6 weeks after antibiotic initiation.
What is the treatment for Clostridium difficile?
Oral metronidazole is the treatment of choice but another option
is oral vancomycin
Clostridium difficile presents with
watery, bloody, diarrhea with mucus, crampy abdominal pain, and fever
what is an indication of rectal cancer?
the combination of red blood coating and a change in bowel habits in stool caliber spells out cancer of the rectum
honey is avoided in in the first year of life, because there is an increased risk of
infantile botulism. E
What causes ascites in patients with history of alcoholism and liver disease ?
portal hypertension play an important role in the production of ascites by raising the capillary hydrostatic pressure within the splanchnic bed.
Esophageal spasm presents with noncardiac chest pain usually described as a squeezing chest pain. It typically present with a motility type dysphasia.
Mallory Weiss tear occur in the lower esophagus after forceful or protracted vomiting and involve only the superficial mucosa in the lower esophagus.
In most cases, bleeding is painless and resolve once the insulting incident resolves.
In classic appendicitis the pain shift to the right lower quadrant, where it becomes more localized in the area known as
McBurney's point. in most patient IQ obstruction of the appendiceal orifice by a fecalith initiates the acute appendicitis.
A patient with history of severe peptic ulcer disease, as manifested by multiple also, ulcers and unusual sites such as jejunum, and Olson are complicated by bleeding. Patient is not taking NSAIDs and H. pylori is negative. This suggests that he really does have a high acid secretion by the stomach which should raise the possibility that he has a gastrin secreting neuro endocrine tumor that is triggering the high level of acid release. This tomorrow sometime called:
Zollinger-Ellison Syndrome causing autonomous production of gastrin
Patient with weight loss and bloody bowel movement within her caliber school are more suggestive of
a patient with hepatitis B, that has hepatitis B antibody can be given where vaccination?
hepatitis A vaccination
Wernicke's encephalopathy symptoms of
dementia, ataxia, ophthalmoplegia.
Wernicke's encephalopathy typically occurs in
alcoholics and is the result of thiamine (vitamin B1) deficiency.
Diagnostic tests for gastrinomas:
injection of secretin is the most specific and easiest tests this causes and increase serum gastrin.
a newborn has not passed meconium after 30 hours. The pregnancy was uncomplicated. They fit appears well with no respiratory distress. Slight abdominal distention is noted. Rectal examination revealed a slight tight rectum and result in a greenish gush of stool. which the following tests will probably confirm the likely diagnosis?
rectal biopsy. patient probably have Hirschsprung's disease or congenital aganglionic megacolon is caused by a congenital absense of the ganglion cells of both the Meissner and Auerbach plexuses. it is the most common cause of lower intestinal obstruction in the neonatal period. The diagnosis is confirmed by section biopsy that can be easily perform without general anesthesia. The biopsy specimen will reveal in absent of going beyond cells and thus submucosa and myenteric plexuses.
work virus produces disease or sequelae that is/ are more severe if the infection occurs at a very young age?
hepatitis B virus. Infection with the hepatitis B virus at birth or a very young age associated with chronic hepatitis B virus infection in the development of hepatocellular carcinoma later in life. In fact, infants born to hepatitis B surface antigen positive mother are commonly infected, and approximately 90% become chronic carriers of the virus. In chronic carriers, about a carcinoma developed as an incident morning 200 times higher than in non-carrier. The current recommendation for infants born to HBsAg positive mother is administration of hepatitis B immunoglobulin in the delivery room, with the first dose of the hepatitis B vaccine given at the same time or within one week. The second and third dose of the vaccine are given at one in six months. With this protocol, 94% protection is achieved.
Fever.starts about 10 days after contaminated of abdominal surgical procedure is most likely caused by a deep abscess, either pelvic or subphrenic.
former has been ruled less likely by the patient having a normal rectal exam; the latter can best be demonstrated by CT scan.
pancreatic adenocarcinoma may also occur in patients but is generally present in older individuals. Pancreatic adenocarcinoma is independent of the patient having chronic pancreatitis. It presents with
painless obstructive jaundice, weight loss epigastric abdominal pain.
Patient with epigastric pain radiating to the back, nausea, and vomiting. Patient recovers. Over the next five years, he has repeatedly admitted for symptoms. Patient present with gradual onset of weight loss, mid- abdominal pain radiating to the back, and steatorrhea. what condition does he have?
exocrine insufficient of the pancreas
patient has a colonoscopy that shows extensive or continuous lesion. Has a history of bloody diarrhea they instrument in abdominal pain, and a 13 pound weight loss. You should be thinking
what is the treatment for ulcerative colitis?
five-year-old boy present with abdominal pain, vomiting, and bloody mucus in stool (currant jelly stool, a late finding that is hemoccult positive). on examination you find positive guaiac, a palpable "sausage shape" in the right upper quadrant abdominal mass. What is his patient have?
what is a treatment for Intussusception?
in air contrast barium enema is both diagnostic and therapeutic.
Intussusception diagnostic test
Patient undergoes total gastrectomy because the reports more located gastric cancer. After surgery which the following digestive enzyme will be produced in inadequate amounts
Ulcerative colitis has ________ Compared to Crohn's disease.
when varices are seen, the immediate appropriate management is endoscopic banding of these varices, which usually immediately leads to cessation a leading
acute cholecystitis is a result of
cystic duct obstruction
this will be best demonstrated by what type of diagnostic tests?
patient has crashed his car in and up having a ruptured in his spleen. Which of following is the best most important problem associated with this type of injury?
internal blood loss.
Tropical sprue is a chronic diarrheal disease, possibly of infectious origin, that involves the small intestine and is characterized by malabsorption of nutrients, especially folic acid and vitamin B12
Most patients have steatorrhea, typically in the range of 10 to 40 g of stool fat per day (normal less than 5 g/day). The chronic diarrhea is sometimes accompanied by cramps, gas, fatigue, and, with time, progressive weight loss.
Intussusception Most likely a crime or age group
3 to 12 months of age.
in elderly woman who has a history of atherosclerotic vascular disease as demonstrated by a history of a myocardial infarction and exertional angina has developed colitis symptoms, as demonstrated by the left lower courts in pain and bloody diarrhea. This is a typical caused by ischemia of small branches of the exterior mesenteric artery. The bleeding is caused by poor blood flow to the bowel, which leads to mucosal sloughing that can cause blood loss to the bowel lumen.
the diagnosis is expected clinically and generally confirm what a flexible sigmoidoscopy, because many cases involved the rectosigmoid region.
Acetylcysteine alone is not sufficient to prevent the toxic effects of acetaminophen that has already been absorbed. What can be added with acetylcysteine to treat acetaminophen overdose?
adsorbs almost all drugs and poisons in the gut. It is effective in the first few hours after acetaminophen ingestion and does
not interfere with administration of acetylcysteine.
the double bubble sign is a pathognomonic for Duodenal atresia, which is a congenital anomal associated with :
Duodenal atresia presents with two large guys collection, one in the stomach and one in the proximal duodenum are the only radiographic lucencies visible in the G.I. tract.
Duodenal atresia Is associated with bilious vomiting
Patient waking up in the middle of the night complaining of made epigastric pain. She is not taking NSAIDs. What is the most likely cause?
Treatment for diverticulitis
increased fiber such as psyllium, bran powder, methylcellulose.
patient undergoes endoscopy he has acute interscapular pain radiating into the neck. chest radiography shows pneumomediastinum. what is the most likely diagnosis?
Patient with continuous duodenal ulcer. Should be tested for
patient has history of non progressive dysphasia only with solid foods. drinking liquid reduces discomfort. Barium swallow demonstrate symmetrical concentric narrowing of the lower esophagus. What is the most likely diagnosis
patient has continuous diarrhea but no vomiting what organism can cause this?
anti-cholinergic medication does not cause
what should be taken what methotrexate to prevent liver damage
what is a common thing that occurs with chronic pancreatitis in patients who have alcohol abuse?
patients having diabetes mellitus. this causes loss of all of Alpha cell. patients can have a weight loss with this.
A hormone secreted by the pancreatic alpha cells that increases blood glucose concentration
Dupuytren's contracture are caused by fibrosis of Palmar fascia resulting in contractions in fingers.
These contractures are associated with with alcohol abuse, diabetics, and whose work is associated with repetitive handling task for vibration. Associated with cirrhosis.
diagnostic tests for C diff.
rapid enzyme immunoassay (EIA)
the purpose of phototherapy in newborn
cover Bilirubin to lumirubin
What can PRECIPITATE after a major surgery if patient has increased uric acid?
What should be given as a prophylactic?
Give: Usodeoxycholic acid
RUQ pain, fever, N/V, no jaundice think!
Patient taking Warfarin should be counseled on:
Green leaf vegetable because they contain Vitamin K that can interfere with the anticoagulation action of warfarin.
becareful with multivitamin
left supraclavicular adenopathy suggest
what will elevated with chronic hepatitis associated with Hep C?
H. Pylori is associated with 45%
Patient has a ulcer and dyslipidemia what should be avoided other than NSAIDS?
Niacin bc increase gastric production
Appox. 15% of pt with Down syndrome will have
Sensitive diagnostic test for celiac disease
Anti tissue transglutaminase and IgA Endomysial
Sickle cell disease. Pt present with RUQ associated with N/V is due to :
bilirubin gallstone formation
Reye syndrome is characterized by encephalopathy following what condition?
To treat localized ulcerative colitis what should you give
You can give sulfasalazine and steroid for more extensive ulcerative colitis
Premenopausal osteoporosis in women or osteoporosis in a man should should arouse suspicion of
another cause of acute pancreatitis:
passed gallstone in common bile duct
NSAIDs causes heartburn and and small amount of red blood:
pt has chronic alcohol abuse take Naltrexone for therapy. what is the MOA?
acts as a opiate antagonist
A normal GGT level suggests such elevation stems from
The sharpest increases in GGT levels indicate obstructive jaundice and hepatic metastasis
Alkialine phosphastase is produced by
bone and liver
Standard therapy for Hep C
Pegylated interferon and ribavirin
PPI causes malaborption of
Mechanism causing edema and patient who has cirrhosis
decreased oncotic pressure
the most important cause of chronic cirrhosis is
Chronic fissure is treatment with
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