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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
» HBeAg = very high infectivity
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
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAg
» HBcAB IgM
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAg = active/infective
» HBcAB IgM = recent infection
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)
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAg
» HBcAB IgG
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAg = active/infective
» HBcAB IgG = remote infection
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAg = active/infective
» HBcAB IgG = remote infection
Chronic carrier!
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBcAB IgM
» all other markers negative
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBcAB IgM = recent infection
» all other markers negative
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBcAB IgM = recent infection
» all other markers negative
Recent infection, in the window
period!
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAB
» HBcAB IgG
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAB = immunity
» HBcAB IgG = remote infection
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAB = immunity
» HBcAB IgG = remote infection
Past infection but now immune!
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAB
» all other markers negative
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAB = immunity
» all other markers negative
Liver
• Infectious/inflammatory disorders
– Viral hepatitis
• hepatitis B
– Example
» HBsAB = immunity
» all other markers negative
Successful immunization!
GI Emergencies
• What is the most common cause of
massive (> 40% blood volume) UGIB?
GI Emergencies
• Esophageal variceal bleeding
GI Emergencies
• What two drugs should be considered
(usually use one or the other) in
variceal bleeding?
GI Emergencies
• Octreotide
• Vasopressin
GI Emergencies
• What additional drug should generally
be used in conjunction with vasopressin
to diminish side effects?
GI Emergencies
• NTG
• To diminish hypertension, cardiac and
splanchnic vasoconstriction
GI Emergencies
• What is the most common cause of
lower esophageal dysphagia (due to
luminal narrowing)?
GI Emergencies
• Carcinoma
GI Emergencies
• What are the most common sites for
FBs to lodge in the esophagus?
– (one point for each)
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)
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?
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
GI Emergencies
• What FBs in the stomach need to be
removed endoscopically?
(what characteristics of the FB)
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
GI Emergencies
• What organism is often associated with
peptic ulcer disease?
GI Emergencies
• Helicobacter pylori
GI Emergencies
• Which PUD medication is
contraindicated in pregnancy because it
is associated with spontaneous
miscarriage?
GI Emergencies
• Misoprostol
(synthetic PGE1 analogue; works by
stimulating local mucus and bicarb
secretion, enhancing mucosal blood
flow and inhibiting gastric acid
secretion)
GI Emergencies
• What is the most common abdominal
surgical emergency in pregnancy?
GI Emergencies
• Acute appendicitis
GI Emergencies
• In what % of cases of appendicitis is an
appendecolith found on plain xray?
GI Emergencies
• 2-22% (but probably on the lower end
of that)
GI Emergencies
• What is the most common cause of SBO
in adults?
• What is the second most common
cause?
GI Emergencies
• Most common is adhesions from prior
surgeries
• Second most common is hernia
GI Emergencies
• What is the most common cause of
LBO?
GI Emergencies
• Tumors
GI Emergencies
• Describe the typical patient with a
sigmoid volvulus.
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
GI Emergencies
• What is the diagnostic test of choice for
patients with suspected mesenteric
ischemia?
GI Emergencies
• Angiography
GI Emergencies
• Which type of hernia is least likely to
incarcerate:
– Direct
– Indirect
– Femoral
GI Emergencies
• Direct--rarely incarcerates
• Indirect--frequently incarcerates, esp. in
infancy
• Femoral--frequently incarcerates
GI Emergencies
• Compare Crohn’s disease vs. ulcerative
colitis in terms of:
– Which layers of the bowel they typicall
involve
GI Emergencies
• Compare Crohn’s disease vs. ulcerative
colitis in terms of:
– CD--all layers (full wall of bowel)
– UC--only the mucosal and submucosal
layers of the bowel wall; muscular layers
and serosa are spared usually
GI Emergencies
• Compare Crohn’s disease vs. ulcerative
colitis in terms of:
– Areas of GI tract involved
GI Emergencies
• Compare Crohn’s disease vs. ulcerative
colitis in terms of:
– CD--any area, from esophagus to anus,
though ileum is usually involved;
skip/discontinuous areas common
– UC--isolated to colon and rectum (always
begins in rectum); continuous and uniform
involvement of bowel
GI Emergencies
• What is, overall, the most common
cause of rectal bleeding?
GI Emergencies
• Hemorrhoids
GI Emergencies
• What is the “line of demarcation” that is
used to distinguish between internal
and external hemorrhoids?
GI Emergencies
• The dentate line
GI Emergencies
• What are the typical ages that are most
commonly infected with Rotavirus?
• Same question for Norwalk virus.
GI Emergencies
• Rotavirus  children 6-24 mos.
• Norwalk virus  school-aged children
and adults
GI Emergencies
Name the organism:
• Bloody diarrhea, crampy abdominal
pain, renal failure in children
GI Emergencies
Name the organism:
• E.coli 0157:H7
(HUS in kids, TTP in elderly)
GI Emergencies
Name the organism:
• Kids with bloody diarrhea, fevers to
105, febrile seizure
GI Emergencies
Name the organism:
• Shigella
GI Emergencies
Name the organism:
• Diarrhea bug that is associated with the
following high-risk groups:
– Extremes of age
– Immunocompromised
– Splenectomized patients
– Patients with sickle cell anemia
GI Emergencies
Name the organism:
• Salmonella
GI Emergencies
Name the organism:
• Diarrhea bug that is associated with
Guillain-Barre syndrome as a late
sequela
GI Emergencies
Name the organism:
• Campylobacter
GI Emergencies
Name the organism:
• Diarrhea bug that mimics appendicitis
• Recent exposure to farm animals
GI Emergencies
Name the organism:
• Yersinia enterocolitica
GI Emergencies
Name the organism:
• Onset of GI symptoms within just a few
hours of ingesting food
• Food is usually protein rich (ham, eggs,
mayonnaise)
GI Emergencies
Name the organism:
• Staph aureus
GI Emergencies
Name the organism:
• Onset of GI symptoms within just a few
hours of ingesting food
• Food is classically fried rice
GI Emergencies
Name the organism:
• Bacillus cereus
GI Emergencies
Name the organism:
• Bug associated with drinking untreated
water from a well or spring
• Usually affects ISup.
GI Emergencies
Name the organism:
• Aeromonas
GI Emergencies
Name the organism:
• Ingestion of fish
• SSx--red itchy skin, wheezing, N/V/D,
throbbing HA and abd cramps
GI Emergencies
Name the organism:
• scombroid
GI Emergencies
Name the organism:
• The most common intestinal parasite in
the U.S.
GI Emergencies
Name the organism:
• Giardia
GI Emergencies
Name the organism:
• Most common cause of chronic diarrhea
in patients with AIDS
GI Emergencies
Name the organism:
• cryptosporidium
Pop-Culture Trivia
Britney Spears has (finally) filed for
divorce with Kevin Federline…
Pop-Culture Trivia
What year were they married?
Pop-Culture Trivia
2004
Pop-Culture Trivia
What is the name of their newborn?
(born Sept. 12, 2006)
Pop-Culture Trivia
Jayden James
(first son--Sean Preston)
Pop-Culture Trivia
What was the name of Britney’s first
album?
Pop-Culture Trivia
“Baby One More Time”
Pop-Culture Trivia
What movie did K-Fed appear in?
Pop-Culture Trivia
“You Got Served”
Pop-Culture Trivia
In which former former Mousketeer’s
band did K-Fed serve as a backup
dancer?
Pop-Culture Trivia
Justin Timberlake
(also a former boyfriend)
Pop-Culture Trivia
What other current “diva” was a former
Mousketeer with Britney and Justin?
Pop-Culture Trivia
Christina Aguilera
Pop-Culture Trivia
Britney has had 2 #1 songs in the U.S.
The first was “Baby One More Time.”
What was the other?
Pop-Culture Trivia
“Oops! I Did It Again”
(2000)
Pop-Culture Trivia
Britney has appeared in 3 films. Name
them…
One point for each.
Pop-Culture Trivia
2002 Crossroads
2002 Austin Powers in Goldmember
(played the role of a Fembot/herself)
1999 Longshot (played the role of a
flight attendant)