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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)