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Emergency Medicine EOR Exam (GI_Pulm_Neuro 28) Questions With Correct Answers.
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Emergency Medicine EOR Exam (GI_Pulm_Neuro 28) Questions With Correct Answers.
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10/22/24, 10:25 AMEmergency Medicine EOR Exam (GI/Pulm/Neuro 28%)
Terms in this set (338)
Gallstones in the biliary tract WITHOUT Describe Cholelithiasis
inflammation
Gallstone form from:
• Ratio of cholesterol too high
• Ratio of bilirubin too high
• Gallbladder not emptying bile
Types: Cholesterol gallstones (MC!)
Risks: 5 F: fat, female, fertile, fair, forty
Asymptomatic
Symptomatic (biliary colic)
• RUQ pain (hallmark)
-follow fatty meals
-may radiate to back and
right shoulder blade!
*don’t typically see N/V, fever, chills with
biliary colic
• Ultrasound
*procedure of choice
• CT
Symptomatic (Biliary Colic):
• Laparoscopic cholecystectomy
No surgery:
Ursodeoxycholic acid
Complications: choledocholithiasis, acute
cholangitis, acute cholecystitis
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Gallstones in common bile duct (CBD); Describe Choledocolithiasis
symptomatic
-passes are “uncomplicated”
-typically symptomatic
• Intermittent RUQ pain, prolonged
• Jaundice
• Intermittent N/V
PE: normal
Labs: elevated LFTs, ALP, GGT
• IV fluids, pain control, NPO
• ERCP w/ stone extraction &
sphincterotomy
Gallstone lodged and obstruction in CBD Describe Cholangitis
--> infection
-Bacterial infection or hepatic injury
*when become a problem
Bugs: E. coli, Klebsiella, Enterobacter, B.
fragilis
• Charcot Triad
-RUQ pain, Fever, jaundice
• Reynolds Pentad:
-Charcot + low BP/shock
+ mental status changes
PE: RUQ pain & hepatomegaly
Labs:
• Leukocytosis
• high alk phos, GGT, bilirubin
Diagnostics:
• US/CT (FIRST!)
• ERCP-diagnostic test of choice
GOLD STANDARD
• IV fluids, pain control, NPO
• ERCP w/ stone extraction &
sphincterotomy
• ABX with acute cholangitis
-mild-moderate: Cipro + Flagyl
-severe: Zosyn (Pip/Tazo) + Flagyl
Complications:
• liver damage
• septic shock with acute cholangitis
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Inflammation and infection of the Describe Cholecystitis
gallbladder due to obstruction of the
cystic duct by gallstones
Bugs: E. coli (MC), Klebsiella, Enterococci
Chronic:
• fibrosis and thickening due to chronic
inflammatory cell infiltration
• RUQ Pain
-steady, sharp pain, continuous
-precipitated by meal
• N/V & Fever
• precipitated by fatty or large meals
Exam:
• (+) Murphy Sign
• (+) Boas: referred pain to R shoulder -->
irritation of the phrenic nerve
Labs:
• Leukocytosis
• increased bilirubin, ALP, LFTS
Imaging:
• Ultrasound-1st line
-thick gallbladder, sludge, stones
• HIDA scan: MOST ACCURATE
(+): no visualization of gallbladder
Management: NPO, IVF, ABX
• Ceftriaxone +/- Metronidazole
• IV Morphine or Demerol for pain
• Lap cholecystectomy in 24-72hr
Complications:
• Gangrene
• Chronic Cholecystitis
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• Necroinflammatory disease of the Describe Acute Acalculous Cholecystitis
gallbladder NOT due to gallstones
Pathophysiology:
• gallbladder stasis and ischemia -->
inflammation reaction --> concentration of
bile salts, distention, perforation
Risks: hospitalization, critically ill
• fever
• jaundice
• sepsis
• vague abdominal discomfort
Labs: leukocytosis
Ultrasound: INTIAL TEST
• distended gallbladder
• without calcifications
CT: if dx uncertain after US
HIDA: is uncertain after CT
Supportive Care
• IV fluids
• Bowel rest
• Pain control
• Correct electrolytes
• Broad spectrum ABX
• Linear tears/ulcerations around anus Describe Anal Fissure
*MC posterior midline
• Due to trauma to anal canal during
defecation --> constipation/hard, straining
Causes: low fiber, large & hard stools,
constipation, anal trauma
• Tearing pain with defecation
• Bleeding
*small amount with bright red blood
(streaking on TP)
Inspection
• longitudinal tear in anoderm
-extends proximally than the
dentate line
• skin tags seen as chronic
>80% resolve spontaneously
• 1st line: toileting, Sitz bath, Fiber
Chronic fissures:
• Topical NTG, Botulinum injection
• Surgery- sphincterotomy
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