What are examples of things that can cause visceral pain? - ANSWER Intestine, biliary
tree, liver disease
What are examples of things that can cause parietal pain? - ANSWER Appendicitis,
peritonitis
What are examples of things that can cause referred pain? - ANSWER Cholecystitis
What are examples of things that can cause colicky pain? - ANSWER Renal stones
What is the order in which you should perform an abdominal physical exam? - AN-
SWER 1. inspection
2. auscultation
3. percussion
4. palpation
What diagnosis would you consider for a 30 year old with heart burn, early satiety, burping
and generalized abdominal pain? - ANSWER Dyspepsia related to gastritis
What diagnosis would you consider for a 50 YEAR OLD SMOKER with heart burn and ab-
dominal pain? - ANSWER Colon cancer
How high is the bilirubin level when the patient is starting to develop physical jaundice? -
ANSWER 2.5 or higher
1
,______________ bilirubin is unconjugated, which means that it has not been metabolized
by the liver or made into a water soluble form of bilirubin - ANSWER Indirect bilirubin
________________ is processed bilirubin that is water soluble - ANSWER Direct biliru-
bin
What are some of the causes of elevated indirect bilirubin levels? - ANSWER - hemoly-
sis
- heart failure
- Gilbert syndrome
- neonates
- hyperthyroidism
- chronic hepatitis & advanced liver cirrhosis
What are some of the causes of elevated direct bilirubin levels? - ANSWER - chole-
docholithiasis
- tumors
- AIDS
- acute/chronic pancreatitis
- viral hepatitis
- alcoholic hepaitits
- biliary tree cholangitis
- sepsis
- TPN
- postoperative cholestasis
- sickle cell disease
- pregnancy
- end stage liver disease
2
,What does a history of fever, chills and RUQ pain indicate? - ANSWER Acute cholangi-
tis
What does RUQ pain with a history of anorexia, malaise and myalgias indicate? - AN-
SWER Viral hepatitis
What is the terminology for when the gallbladder is so distended that you can palpate it? -
ANSWER Courvoiser Sign
What is the terminology for inspiratory arrest that occurs when you are putting pressure on
the RUQ due to inflammed gallbladder? - ANSWER Murphey's Sign
Which liver enzyme is specific for hepatocytes? - ANSWER ALT
Which liver enzyme is more specific to alcohol, statins and tylenol use? - ANSWER AST
If the ratio of AST to ALT is 2 to 1, what does this indicate? - ANSWER Liver damage
due to alcohol, statins or tylenol
If the ratio of ALT is twice as high as AST, what does this indicate? - ANSWER Viral hep-
atitis
What is the normal range for ALT and AST? - ANSWER 30-40
What does an elevated ALT, AST and Alk Phos indicate? - ANSWER Gallbladder obstruc-
tion
What are the signs and symptoms in a patient that has MILD melena? - ANSWER Rest-
ing tachycardia
3
, What are the signs and symptoms in a patient that has melena with a blood volume loss of
at least 15%? - ANSWER Orthostatic hypotension
What are the signs and symptoms of a patient that has melena with a blood volume loss of
at least 40%? - ANSWER Supine hypotension + abdominal pain
What type of anemia would someone with melena have? - ANSWER Iron deficiency
anemia
What is the gold standard diagnostic test for a patient with Melena? - ANSWER Endos-
copy
What are the leading causes for dysphagia? - ANSWER Alzheimer disease + stroke
This type of dysphagia is due to a tumor that is obstructing the passage of food - AN-
SWER Mechanical dysphagia
This type of dysphagia is due to a neurological deficit resulting in the inability to swallow -
ANSWER Functional dysphagia
What is the gold standard diagnostic test for dysphagia? - ANSWER Video fluoroscopic
swallow study
IF a patient over the age of 50 comes in with dysphagia, what would you assume? - AN-
SWER Esophegeal cancer
If a patient comes in with SUDDEN dysphagia, what would you assume? - ANSWER Pa-
tient had a stroke
4
tree, liver disease
What are examples of things that can cause parietal pain? - ANSWER Appendicitis,
peritonitis
What are examples of things that can cause referred pain? - ANSWER Cholecystitis
What are examples of things that can cause colicky pain? - ANSWER Renal stones
What is the order in which you should perform an abdominal physical exam? - AN-
SWER 1. inspection
2. auscultation
3. percussion
4. palpation
What diagnosis would you consider for a 30 year old with heart burn, early satiety, burping
and generalized abdominal pain? - ANSWER Dyspepsia related to gastritis
What diagnosis would you consider for a 50 YEAR OLD SMOKER with heart burn and ab-
dominal pain? - ANSWER Colon cancer
How high is the bilirubin level when the patient is starting to develop physical jaundice? -
ANSWER 2.5 or higher
1
,______________ bilirubin is unconjugated, which means that it has not been metabolized
by the liver or made into a water soluble form of bilirubin - ANSWER Indirect bilirubin
________________ is processed bilirubin that is water soluble - ANSWER Direct biliru-
bin
What are some of the causes of elevated indirect bilirubin levels? - ANSWER - hemoly-
sis
- heart failure
- Gilbert syndrome
- neonates
- hyperthyroidism
- chronic hepatitis & advanced liver cirrhosis
What are some of the causes of elevated direct bilirubin levels? - ANSWER - chole-
docholithiasis
- tumors
- AIDS
- acute/chronic pancreatitis
- viral hepatitis
- alcoholic hepaitits
- biliary tree cholangitis
- sepsis
- TPN
- postoperative cholestasis
- sickle cell disease
- pregnancy
- end stage liver disease
2
,What does a history of fever, chills and RUQ pain indicate? - ANSWER Acute cholangi-
tis
What does RUQ pain with a history of anorexia, malaise and myalgias indicate? - AN-
SWER Viral hepatitis
What is the terminology for when the gallbladder is so distended that you can palpate it? -
ANSWER Courvoiser Sign
What is the terminology for inspiratory arrest that occurs when you are putting pressure on
the RUQ due to inflammed gallbladder? - ANSWER Murphey's Sign
Which liver enzyme is specific for hepatocytes? - ANSWER ALT
Which liver enzyme is more specific to alcohol, statins and tylenol use? - ANSWER AST
If the ratio of AST to ALT is 2 to 1, what does this indicate? - ANSWER Liver damage
due to alcohol, statins or tylenol
If the ratio of ALT is twice as high as AST, what does this indicate? - ANSWER Viral hep-
atitis
What is the normal range for ALT and AST? - ANSWER 30-40
What does an elevated ALT, AST and Alk Phos indicate? - ANSWER Gallbladder obstruc-
tion
What are the signs and symptoms in a patient that has MILD melena? - ANSWER Rest-
ing tachycardia
3
, What are the signs and symptoms in a patient that has melena with a blood volume loss of
at least 15%? - ANSWER Orthostatic hypotension
What are the signs and symptoms of a patient that has melena with a blood volume loss of
at least 40%? - ANSWER Supine hypotension + abdominal pain
What type of anemia would someone with melena have? - ANSWER Iron deficiency
anemia
What is the gold standard diagnostic test for a patient with Melena? - ANSWER Endos-
copy
What are the leading causes for dysphagia? - ANSWER Alzheimer disease + stroke
This type of dysphagia is due to a tumor that is obstructing the passage of food - AN-
SWER Mechanical dysphagia
This type of dysphagia is due to a neurological deficit resulting in the inability to swallow -
ANSWER Functional dysphagia
What is the gold standard diagnostic test for dysphagia? - ANSWER Video fluoroscopic
swallow study
IF a patient over the age of 50 comes in with dysphagia, what would you assume? - AN-
SWER Esophegeal cancer
If a patient comes in with SUDDEN dysphagia, what would you assume? - ANSWER Pa-
tient had a stroke
4
