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First Hour Conference Intraining Exam Review November 8, 2006

First Hour Conference Intraining Exam Review November 8, 2006. Gastrointestinal Emergencies. Liver. Infectious/inflammatory disorders Viral hepatitis hepatitis B serologic markers HBsAg HBsAB HBcAB IgM recent infection (often in the “window” period) HBcAB IgG

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First Hour Conference Intraining Exam Review November 8, 2006

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  1. First Hour ConferenceIntraining Exam ReviewNovember 8, 2006 Gastrointestinal Emergencies

  2. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • serologic markers • HBsAg • HBsAB • HBcAB IgM recent infection (often in the “window” period) • HBcAB IgG • HBeAg = very high infectivity

  3. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • serologic markers • HBsAg = active/infective • HBsAB = immunity • HBcAB IgM = recent infection (often in the “window” period) • HBcAB IgG = remote infection • HBeAg = very high infectivity

  4. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAg • HBcAB IgM

  5. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAg = active/infective • HBcAB IgM = recent infection

  6. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAg = active/infective • HBcAB IgM = recent infection Acute infection! (uncertain whether patient will become immune or chronic)

  7. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAg • HBcAB IgG

  8. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAg = active/infective • HBcAB IgG = remote infection

  9. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAg = active/infective • HBcAB IgG = remote infection Chronic carrier!

  10. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBcAB IgM • all other markers negative

  11. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBcAB IgM = recent infection • all other markers negative

  12. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBcAB IgM = recent infection • all other markers negative Recent infection, in the window period!

  13. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAB • HBcAB IgG

  14. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAB = immunity • HBcAB IgG = remote infection

  15. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAB = immunity • HBcAB IgG = remote infection Past infection but now immune!

  16. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAB • all other markers negative

  17. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAB = immunity • all other markers negative

  18. Liver • Infectious/inflammatory disorders • Viral hepatitis • hepatitis B • Example • HBsAB = immunity • all other markers negative Successful immunization!

  19. GI Emergencies • What is the most common cause of massive (> 40% blood volume) UGIB?

  20. GI Emergencies • Esophageal variceal bleeding

  21. GI Emergencies • What two drugs should be considered (usually use one or the other) in variceal bleeding?

  22. GI Emergencies • Octreotide • Vasopressin

  23. GI Emergencies • What additional drug should generally be used in conjunction with vasopressin to diminish side effects?

  24. GI Emergencies • NTG • To diminish hypertension, cardiac and splanchnic vasoconstriction

  25. GI Emergencies • What is the most common cause of lower esophageal dysphagia (due to luminal narrowing)?

  26. GI Emergencies • Carcinoma

  27. GI Emergencies • What are the most common sites for FBs to lodge in the esophagus? • (one point for each)

  28. GI Emergencies • C6--cricopharyngeus muscle (most common sige in kids < 4yo) • T4--at level of aortic arch • T10-11--at lower esophageal sphincter/diaphragmatic hiatus (most common site in adults)

  29. GI Emergencies • At child is brought to the ED by parents stating that he swallowed an alkaline calculator battery. The child is asymptomatic. You get an xray and find it in the stomach. What do you do?

  30. GI Emergencies • If in stomach and child asymp., can follow with xrays to and stool checks (parents do this!) to make sure it passed • If in esophagus, this is a true emergency requiring endoscopic retrieval

  31. GI Emergencies • What FBs in the stomach need to be removed endoscopically? (what characteristics of the FB)

  32. GI Emergencies • Sharp/pointed • Objects longer than 5 cm X 2 cm • Sharp ones are at high risk to cause perf, usually at region of ileocecal valve • Large ones are unlikely to pass

  33. GI Emergencies • What organism is often associated with peptic ulcer disease?

  34. GI Emergencies • Helicobacter pylori

  35. GI Emergencies • Which PUD medication is contraindicated in pregnancy because it is associated with spontaneous miscarriage?

  36. GI Emergencies • Misoprostol (synthetic PGE1 analogue; works by stimulating local mucus and bicarb secretion, enhancing mucosal blood flow and inhibiting gastric acid secretion)

  37. GI Emergencies • What is the most common abdominal surgical emergency in pregnancy?

  38. GI Emergencies • Acute appendicitis

  39. GI Emergencies • In what % of cases of appendicitis is an appendecolith found on plain xray?

  40. GI Emergencies • 2-22% (but probably on the lower end of that)

  41. GI Emergencies • What is the most common cause of SBO in adults? • What is the second most common cause?

  42. GI Emergencies • Most common is adhesions from prior surgeries • Second most common is hernia

  43. GI Emergencies • What is the most common cause of LBO?

  44. GI Emergencies • Tumors

  45. GI Emergencies • Describe the typical patient with a sigmoid volvulus.

  46. GI Emergencies • Elderly, bed-ridden patients with chronic debilitating comorbid diseases or profound neuro/psychiatric conditions; patients have severe chronic constipation, leading to elongated, redundant sigmoid colon

  47. GI Emergencies • What is the diagnostic test of choice for patients with suspected mesenteric ischemia?

  48. GI Emergencies • Angiography

  49. GI Emergencies • Which type of hernia is least likely to incarcerate: • Direct • Indirect • Femoral

  50. GI Emergencies • Direct--rarely incarcerates • Indirect--frequently incarcerates, esp. in infancy • Femoral--frequently incarcerates

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