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    Gastrointestinal System - Block 6 (MedicalBooksVN - Com)

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    Gastrointestinal System - Block 6 (MedicalBooksVN - Com)

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    Gastrointestinal System - Block 6 [MedicalBooksVN.com]

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    31 views51 pages

    Gastrointestinal System - Block 6 (MedicalBooksVN - Com)

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    ELIO

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    © All Rights Reserved
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    > on | sya oldman eras othe emergency department beaut of buting aa mucotal pan chest pn and shrtest ‘of beat that tated one hour go Me report thet he pans wose when sowing To Years ago, he nes ighosed ‘th aor degree order bu dts noc adhere os meeaton regimen. Hees elone and wor are We ote: | pack of eguettes and dina 6 oof homemade vedka duly. The pate none person, place and tne HS pulse 15 95,min respirations are 16/m,an loc pressures 130/85 mm Hs Pulse oxime oa a shows an ‘oxygen Seturaion of 65% Examination ofthe oropanyns shows profuse alvaton wth mid rye ofthe buccal Tere re wel poe hepa a sr eh cts Ey ic cli FR Feussum maronse Morphine Ethene acl ») amnpiyine be a R & ouns al Pepebennenieeien ce ‘th aor deresve order bu dts noc adhere os mediation regen, Helves done and wots saree feb a of ores Weeks ert eel ke aye ee HS pulse 15 95 min respirations are 18/m,an loc pressures 130/85 mH, Pulse oxime on ean ar shaw an Seen ncn ieee ee es on, evan complications fam pooning by ie sbetance include evopnagelpiforaton or ai lt obtucton (cased by sears ete pln aa 2a Bosra) v Pasian Wyaroude aston aa commonly presen dai ad lt Bow! canes. Ks Ingestion can manifestly ‘sth ees pin, han alatonosyrophapa a dyphagi wih are enn th pata, ewe at sbdorinal pin and ‘emt ich he des not have Ultmatey atssum hyeopide gestion can case esophages iury y hauetce retest 1k of peroracn. needle wean aes econaminaton away Managemen, an Mid resuseaton ‘ore exephagel ry on san eganophosphate area an raed, xgonte to whch is cammon acupatonal hazard for eres such sth pater. Hover, eganophosphateporenng would manfert wth CNS eymptoms ate, sal ad ema) nd, ott, chlinegic css, nape of wich ate sen here. ouns al ‘Parathion sm organophosphate wed aban nsec, expose towhich common occupational hard fo farmers uch sth pater. Hover, eganophosphateporenng would manfert wth CNS eymptoms ate, sal ad ema) nd, ott, chlinegic css, nape of wich ate sen here. ‘A morphine overdose Casicaly manifests wh aes mera status, moss, and espatory depression. TS patent Mas @ normal ment tats and arn presentation carn stherwise Se explained by morphine sero. Lamlene eyo poisoning maness wih tered mental satus, haluceatons,Se.zues, dspren and Nhe ay. Eye ‘yo cul potently gested a sli tempo, ely, na mingled ater a sengthen the impact f fthano This peter as 2 story of ermking, an nreased isk of ste because of hs MOD, and sores, HONEer, Ne does hot have CRS syngtoms ands cial presenan cannot otherwise be explana by chan gol ngeston. Methar!posonng man‘ests wth tured ment tus, allumauons, sures, ard ayspre. and can potemaly Dns ethanel can be a contamina homemade alesha hic hepato drinks However, ough ‘rsp, he doesnot have CNS smptoms ana ns cal presentation cannot othe be exlaned By metnacl Ingest. Ammipnine eye amideprotie wid toast MD, which he pata hat Wht concabe that he nat rested amtpine a vestments Soret, an overdose woul pa Mates th CNS HvobEMEN 0 (deceased level of conscouenes, ai sau) cardiac molvemer e.g achycaa, hypotension, syed sigs of anichlnerpe ony, none of whch are seen here wots 15 35.yar old man comet to the pyictan because of progsth and means winaryhegusncy for he Her appetites normal and she has nt hed ay nausea oF vomiting Se has 2 ison of ‘Sheis sexual acve with rer boylen, at thay use condoms Soft ard there tenderness opapston inthe ef lover guaran tere sno guarding or rebound. Theres tenderness aay ie ere brovmales hich of he fallaung the ot likly agns? “his woman wt poorly convo cubes presen with subacute Rank pan fvet, and pan with extension othe hp, Pfc suggest aceran aprons Her phar due to ghcorura fam her poor cone abet 2a Lnnary vac nteaon cuss pyelonepvcs, shoud aaa be consdere a pavers presenting With fever, ukcetois, tery eee meyer eek UT is te lived etal er or increases tek of ecto, Rewer, his patents unas net consistent wh UT fea a aoc esterase, ates, Neveoweratiough psonepis cou cas adomial pain, ths pai scaly lcied the lambar eon Mankpat rather than nthe eft ower quran snot aggravte by hip extension. Her nny symptoms cou be exaned onthe bat of gucouri flom her uncontled dabets pregnancy should amas econsisered, A normal absomialvbascund doesnt rl ut hs lagnos, but her reoatve thine pregnancy est makes ectopic reghancy very ule epoca als rent win rina Compl nd ak i, However, pan am nepali play of hin arg mangers gharcasc asia ail ace teuvshrdhypets caldnsap komik amma tse ee oua ] epoca als rent win rina Compl nd ak i, However, pan am nepali play of Caley nature, wating ard waning du o ureteral contacto. urhermere, wna woul play show amature 8 posse leukcevtes andor ental The dranon of atet’symotoms@ weeks aso longer han woul be ape or nepivothass “This patent’ combinavon of subacue atk pain, postive sos sion eer, ad ekocross suggests a psoas abscess. A soa abscess ca hr be clasiied as a primary abscess caused by hematogenous Spread fection (ebay ndocardte) or secondary abscess, hh is dat loa spend of fection e.g osteitis pyelonepht,teuma ‘Prmary abscesses are most commen, ane elabetes san important rsk facto for primar abscess tomato. Define agnosis egies imaging wir MR CT ulasound may alin for dentition ef age absces. Bi Osteonyeitis ‘bois may pest wt svbacae abstomina lor ack pan ans can so cause inary Hequency deo exter Compression oe Bidder. They af wan dagrsed wa pei traound bods appear as converte, porch, heterogereaus mots he ulus eid would no cave fever leuko, mange a aly lagen 2 eS ‘th sera pan fom vasa secre. Ths pavet has fever ana leukocytes howe, whens NE consent ‘ih amertoreatansous mere entrapment Append classical presets wi eet, leuko, and ght ener quadrant ps. The BSS Sign may ao be poste epee, epoca the ear fs atroracl append: Honver, saps appends aay devel more sctely ‘nn hours o a) ane left-sided pan would be unusil Meo, is BEER doesnot how oe Ea SIMBLOMS, wos s 1332:yar-old man cas othe physctan cant of prograshe abdominal dtamon and weight ga ove the st 2 mors te nas lagnosed eh alcohol Ive oss wth age ascies Tyr ag. He has congestive hear Fle wh ‘deptssed econ Macon eae hs alcool se For east S mens, He has bsaed om aol a as dum det Hi cirentmadiestons cde propranlol spionsatone, and fare Hs teipertie pulse le 90/min and loo pressure e308 Senn i. Psa examination shows redenng oe ‘alms tlanjectsias onthe Face an unk nd prominen blood vesss arcu the umblcs, te abdomen est ‘arte etende, a ery, Happng main of te hand seen, Mei! as xaranation shows a gecesee enon San, Serum suds stow Sedum 126 mean Tot ibn 1.9 mgt Which of eflonng te most aporopate mex step i trextmen? (© |e fr tmsgaarerahepe petarten shat Sat oa woloxacin (©) Rater tr partoneoverous shunt (©) change prorat! wo cant (© vin vgevolame paracentesis be a aos al Siete ove the let x 2 mors te was egnosed eh alcohol Ive cess wh age ascies 1 yet age. He nas congestive heart Flre wth ‘depiessedejecion Macon reat hs alcool se For he ast S ments, he has sated om aol a has lscren mcitns clade prone spronsatn, nd frei renee rhspases 90‘ end wood prenes 19 sv mrva: rac crannmen stew ecdewna fe Pe alae et wr ced etd ere seed er re eee Tot ae Fons fon yee cpu ara ac eet pone ce ‘rev ener, oping mt ofthe bands ee anal sts earmton shws a eee een eee Sedum 126 mean Focal bib 1.8 mg. Which of eflonng te most aporopate mex step i trextmen? “spate hs signa of adtanced choi par enthema, langle, caput ede) well a epic encepaloaty (shor attention san asters He as asxes dese miami 2 low-Soclum dk and weamen wth OL ati, 2a joule nrahepit orotic samt cn be ordered patients wth ratory etic. The TPs procedure loners pot tessure and prevents accumulation oases, ravers receing TH are at ease nk oF fevloping hepatic enceptalopathy due tovoxin bul in the syste crcl, ah hea fate because sharing Increases ccatory pela Thi patent easy has 20 of ade ll hepatic encephalopathy ad depressed jection ouney ish irre el Wa ened el rind ne corde ‘ertons SSP Inpatients wn sees and as Secondary propria pst wha por epsode of ap. Th patent does hot havea istry of EP and does not me: the ctf primary propels imped eal fton or Chid-righ ‘lore > wth ebm 2 ng. ‘User transplmation shouldbe cnedeed at me genie eaunert ns patent wth cnfoss complicate by reracry feds CHG ae es ese pe ecco bene id pea: tet coy eee a besa “Seaver thi stints teoe woul be gut ou gues he nana eesnine, brn, Asana toda nel et. therapy Should be cosiered nhs patent. Surgical pertneovenous shunts ate na longer used or the west of eae ass as they are associate wh Reguent Propraoll general considered ale i patent ith apes and some sie show asia ene: However, igh aes sf propanol shed not be aed patrs wih renal hafuncon or ypotensan ars ure shoul be earfll conde ‘in patents wth reactor ates, Te use of beta blocker, suc a5 carves in pet WE cross and rehatory aces 18 conroveral. Cavell assoctes wih higher ko etal ana sould ezetore not be edi pater Fefatory ces Angiotensin eapor locker, seh a lara, shu be aveded in paters wth coos and efactary acs The ompensetry sen agitesin cial to mating adequate bloodpressure in pen’ wth thos andbecking te [RAAS system can ead oypowerson ad ren falure hough this paves loed pressures lin he normal range es {hgh ik of destoping compleaton rm hs eros Lostan ant recone, Om Ds al 2 i> Sl eae Se lee eR eS eomplcavons ana have not een shown to Rave sural benef Propranolol genoa considered afm patent thats and some suds show 2 sl Benet, Howser, gh dosee of propanol shoud not be sen paiets wth renal function or paterson an use shoul be careful corsidered ‘in ptt wh taco aces, Meuse a bea thc, Sud ac crv in pallets iE Cosi and ean aces eee Corie Weed wef rth neil ect cline reatry sees. ‘Angiotensin receptor locke, sucha satan, shou be avoed in pacers wth cnhoss and etc ass. The Compensatory ren angiotensin cc manning adequate blood pressure in patents th crisis nd Becing se |RAAS syst can lea hypotension and eral aur. hough this patent's loo postures lin the normal range ee 3c hgh isk of Geelong cmplcatens rom Ms errnsis, Losartan isnt recormmende. ‘he poten har efractor acter whch ether oeeure dept low-sodium det and adogusta duet prnalctone, fuse dosing, reer apy fe lrge-volure paracentesis perform. Stl age-olane palacenets (> 5 ‘remove nicatd for we ese of eacoy acces tat as not esponded to adequate dose of dures, sacl fet cope pst reo nts rele Barc eed age epee brevent compleatons gy elecwahteebnormaitis Q By Antes ‘She repre hat the pan radiates wo the back and associated with nase. She has hypertension ana pelea, Fr hic she takes eal arsed and sash He teperatures275C 99.5 7) od pressure 14/50: gan pulse 115 ru The ngs af deat aneltaon. Examinaon shows aor dite ‘epigasne tenderness and qurang wel sounds are deceased, Eremmes ae War Labortoy Sues show eukacyte count 13/00/n? Pateet count 175,00! GGlaum 5.0 mai Urea uogen 22mg ‘Amyse 250i ‘an £6 shows snus chad Which ofthe flowing hemos Bly undring cause of ths paents tal san (@) decease sympahene tone (© Deceased ain conenraton (©) Aevermaleaguttion ane Abonehie (P) Inceneexcreton of water Coote esage be omnes al < ee o serene she reports that the pain | and is associated with nausea. She has hypertension and hyperlipidemia, for = ‘asus tar unpwnels i730 80? need pte _ CERES rer cin grrr or UE eerie q eel ro cued earn co hea ee doe = emacs tabeeereer . a calcum aE ent stow ee 2 sn 06 shows snus cca. Wich fie len thems ly nrhing cas of hs patents via San eee eg ear ee pe w purge sso sas ctr thug ans pana yaa o mean sce ee aoe esi ar ee eee es ao -orevlatory collapse. a 2a . ® etic sneer aa ‘wth Sil ore psy Sal neste, or traumatic ra yn adetion to hypotension, pil fetes mcude rather and neurologic es. This pans sory an chy is et conssten wth aunoen sock ypoveemic sock secondary to Me-resterng beans an important complication of aa pancreatic hamorthai panceatish bsp acer andhypetenin, heater lotta heats neoien ath ere bemarmnage,makeng hypowelemie soc an une etelogy other curent vtsl sgn abormalnes. ouns al Severe hpodbumiemia may present wth hypotension and acycrda rom ck of cot aressure, third space Floss, fd subsequent mvavescila wire depletion Hypostbuminemi usualy cron process and an be Seen n patents wth epi ee tire re ct Ts Fated iy eyes ‘Sturn lovle and hor al sgn sbrarmalie ae rolated to hr act presataon, ‘ic iar complication of acute pancreas, and in severe ces can resent wth hypotension and tachycardia @ue to Temormage or eran cross, However, the pat lacks ee etures oF sch a anemia, embocropens, vaing at Catlogenic stock sould be considered ial patents who present wat enya and mypeerson,especally In parts ‘thik factors fr CAD as mths pate. Mowever, hs patent aks other asi Fatt of earsloge hack, sch as (rsp, pulmonary esema, nd elevated VD, ASA Re Warn SXTMMeS ae NOt COME Wh rIeNENE SHOCK Large elu drei an occur n patents aking cares ands often a gol or vestmen of some conditions, including CHF td crost. wile oer-Ouresi can led to hypotension nd ahycard rom nara volume gepado, duet use Sone woul wy oe suff enought caure uch sever al sgn sbacrmaies and wouldnt acount for the cate oF ‘er ote smptoms tat nda ace pancreas Psncreme poudoeyat 3 eon (=¢ wast) complstn of pancteatis hate ual aeymplomate But can pretnt th ‘edominal pan hypotension, and acca veto oc Wile hypotension ad ecycada could be Sen Uarectea pancreat pseusocst th cite nature a Ws pales presertauon snot conser Ps agnosis an eet ouns al Severe hpodbumiemia may present wth hypotension and acycrda rom ck of cot aressure, third space Floss, fd subsequent mvavescila wire depletion Hypostbuminemi usualy cron process and an be Seen n patents wth epi ee tire re ct Ts Fated iy eyes ‘Sturn lovle and hor al sgn sbrarmalie ae rolated to hr act presataon, ‘ic iar complication of acute pancreas, and in severe ces can resent wth hypotension and tachycardia @ue to Temormage or eran cross, However, the pat lacks ee etures oF sch a anemia, embocropens, vaing at Catlogenic stock sould be considered ial patents who present wat enya and mypeerson,especally In parts ‘thik factors fr CAD as mths pate. Mowever, hs patent aks other asi Fatt of earsloge hack, sch as (rsp, pulmonary esema, nd elevated VD, ASA Re Warn SXTMMeS ae NOt COME Wh rIeNENE SHOCK Large elu drei an occur n patents aking cares ands often a gol or vestmen of some conditions, including CHF td crost. wile oer-Ouresi can led to hypotension nd ahycard rom nara volume gepado, duet use Sone woul wy oe suff enought caure uch sever al sgn sbacrmaies and wouldnt acount for the cate oF ‘er ote smptoms tat nda ace pancreas Psncreme poudoeyat 3 eon (=¢ wast) complstn of pancteatis hate ual aeymplomate But can pretnt th ‘edominal pan hypotension, and acca veto oc Wile hypotension ad ecycada could be Sen Uarectea pancreat pseusocst th cite nature a Ws pales presertauon snot conser Ps agnosis an eet Om Ds wl Ses + zed: 1 ses etches, anor ecaymeses Caslogeni shock should be considered ial pater who present with chad and hypeenson,especaly n patents uh st actos Tor CAD a nis ple. However, spat acs ote das eure of clog stack, Suh as rsp, pulmonary ema, nd loved VD. additonal, har warm erties aot cones with cardiogene shock arg lune duress an accurm pavens aking cures ans often a gel for westmen of some condtons cluding CAF ‘scrote oer-dresi ca ea a hypotension and ahycrda rom nvarascl volume depen, ret use le nd th bce can teat ch eer es arabs el Wd wl ra cae Iheroter symptoms that nda atte panos I aes fe enc sete ey epee at ep shasmna pan ypetension an sehyari tivation seu he hypotension an teehycnda cola ber Infcted paren pseudocyst the acute nature of is pate’ preseratin wot consistent wi Ss agnosis and Fee would be expected ‘hs patent presents wth acute pancreas ap alps of mperang dstibuve shock eg tehyara, hypotension, war ‘xremres le most peters wh act pancreas wt have aml course, m moderate to severe cases the release of {kines and itanmatry ears willed caplay leage, vest, and hypotesion, In severe csc, tet Spacing of fd Fo ths larson response can lad to hyve shot. ogy of cue pancreas cases ‘Rot kay ag-nduce al thee of her maciestns ar atrocatad uth ate partie By Acme pancreas Sel | procul hasty 21-year-old woman come ote emctgancy department beaut of sue, eves opgste pla ‘ar vomiting forthe past 4 nuts. she repos tha he pal aats fo the back ad began when se mashing ner Gra ins at aca brenpub, Her vemperatute 379°C (100.2), uses G4 mi, respratons ae 18 and Dood [resaures 110/60: ig Abdominal examination shows epigarnitrderess and guarding but No rebound. el Seunds are decrease, Latoratory studies show {euheyte count S000)? me sao meqit « 45 meait oe So moa Lipsse YouLe= | procul heathy 31-year-old woman ome ote emtgency department ecait of x for te pasts hous she reports hat the RESROTAEDR ord egan when she was havng ner ra us at aca brenpub, Her vempertute le 372°C (10027) uses 28min fespratons ae 18 iy an bood Pressures 110,60 mm hig Abdornal examination shows epigainctencemess a BUNA but no rebou oul Seunds are decrease, Latoratory studies show ematont ox {euheyte count Stooinmnt me sao meqit Inernenous id rsuetaton x bogan. Whe ofthe allowing i the most apropit est top im management Sa 2a “ ‘a 6 sno nace Yor suspected acute pancteanns uta patents > 5 yt of age wh suspctd pop ule ease those ith any alarm syptoms Le, west ss anemia, hemateres, djphagi) hough PUB Spel eaes faasne pam, a seen in hs patent the pas usbaly Wscous in onset ntermmtet evaerbsted ty mea ard doesnot Fadia the back Examination wuld rac show epigastric guarding ures there nee a perforation inwhich ase Quaang ‘ould be tne ante acompaned by rebound enernes ‘A abdominal CECT sans insets for suspected acute pancreatitis ony when the agnosis is uncertain minal, a pene pea eg green er ere el celine neste peer or pancreat absess pers fever an leukoyoss, no cnc impronemen or elence of organ are S'50-72 nous o rap Furthermore, CECT Scan ony mogeatly Seine m evaluating the cause of ate panceass Do ‘Tis pave presens wn cnc atures of cue panceantssupgrcd by laboratory edence. Av hyraton th nxt steps to evaluate the eur open futher treatment and prevent recurece, The moat comma cau fate pares ‘he Unted Sate bila punctesteAdomana lraronography ra hight rene maging madaty fr detecting ilstones the ir and pancreatic uct and shoud be performed nal patents pesening with acte panes ‘plain yo the abdomen ad a chest ray ae recomended a5 an ntl imaging medal in paces wh cute ‘omen wth suspected bel proton or esta bern. An Xa emt, however, the peered ging modly ‘oconfim te dagnon of eute pancreatitis, hich hs patent met Mel hs nora evauste the ndering bol igen ERCP ana spincstorm kun 28 hous of symatom ons is ecommended acute pancreas ony when ees sodeee of choledochethiis ie ised CRO ardor stone nthe CED, eevated sain, ALP and CT) ano arate hang ever, jaune, Murphy lp uhortoni, sete btn, Lf ang CCT The patente requ fame alton before 3 decion perform ERC canbe made Om Dia lees rz Bo ‘A plan sry ofthe abdomen and a ches ray ae recommenced ata ntl ming medal in patents wth eat ‘tomer with suspacted bowel perforation or trstnal abstructn. An xray snot, however, the peered imaging madly {oon me aagnosis of aut pancreas, hich ns patent mast Mal as, na a ewauae he wnderying oly igen ERCP an spinctstoxon thn 25 hous of symotom ons Is ecommended In acute pancreas ony when hee is fidence of coedochettais ie, lated CRO ator Stns the CED, eevated ein, AP, and Ca) ano ace holon ever, jaune. Murphy gn lukorton, lette itn LP and OCT, Ths patent rege farther tealuatn before 3 deason to pererm ERC canbe mace. ° Sever hyperuigyeridemi (elves usualy» 1000 mg/L she hr most common cause of acute pancreas. Serum ghee level shoud be evaluate nl pent prasring wi he st esede of cule pancreas, a iste case tre As ngetion food shor tn arr eel of teria, shuld be neared fate» peried of ort tn. Since this patent recently had mea evaluation of serum tlicende fev would ne ean appropriate nent 5, ‘Akaho consumption sone ofthe most common caus of cae pancreas However, earn pant Who prevent th 3 ‘stor of abdominal pain afer while consuming alcohol, sother more conmon cause Should est be ed ut wo determine dette eatment Accel induced pancreatitis cagnose based on a stay of excessive alcohol censumpion n ples moses = |3.45.yareld woman comer tothe emergency deparimen becaue of ight upper sbominl pan and nausea that have become romessiely worse sce eating lage mea 8 hows ago, She as ha interme pan st tts before, but Chas eve stad slong. he has 2 tty of rypertnson and pe? eabees melts. she does fot smoke o ink blood pressure 130/80 mmm Ha. The abdomen s sft and bowel sounds are normal, The Patt has suden nspIratny ‘are Guring right wpper quadrant palpation Labora sts show aaukecyte coum o 13000 /mn. Serum ataline Phosphatase total run nae, and arpa ariotaafrae lel ae tn the ference anges agg i (@) Bia consmon il ct within ary acon (© emargement of he pancreas wh penpenceatc Ad (© Gein he galled wal (@ isla formation berneen the alba and bowel (©) Decreases eaogenaty oF me er wos s < become romessiely wore ‘hous ago, he has bad inermiere pin sil 0s before, BA "Chas ever sted slong. he has 2 istty Myerson and pe? eabees melts. she does fot smoke or ink lesbo Curent medications mele metformin and eralar Her tomperatre = ABSSETION pulse 90/rn, and eas prsrire 130 80 rma The Sodom an howe unde ae nora. Te pte hs aresoung GNC upp quaAepEpBIDH Lr seas Show e ‘seumaltane Phoephtee total bran anae, and aspartate amiotaafrae lhl af tn the ference anges: agg i “Ths mda aged woman presents ih postprandial RUD par, ever, ukoetOs, and aposive MUP igh, 2a 1 (B) Died common ie dct wth intahopate ilar ataton ‘he presence faded conman be duct and nahepate bry lataton on ultsound suggests calesonottass Choledochal yell potent th RUQ pai auees, and ocaonaly junc. levator seam ALP arte emo. Fever an levkcross woul be anusval ara ae Rypcly on Seen patents th complication of ‘holedocntmass sin as acute pancreas or autecolangts =a ema ofthe pares on ether uvasound or CT s4agests acu pancreas ales wth pancreatis often presen with dora pun and rausea that may be worse ater meas Howe, pn om pancreas cassie ocd ee Inseam amine and pare wou lobe expected naa pancreas © Gorn pate nal as within te galbladier wal so refered wo a5 emphysematous chleests, suggest ete galladder necrosis or Infection wih gus-fetming bacteria ei pall a complesion of nested cols inducing aalclus éokests) ae en ee a eget cette ae err ee ee eee eee es ouns a as within te galbladier wal so refered wo a5 emphysematous chleests, suggest ete galladder necrosis or Jatecion na 92s-orming bata. is pial 2 complain of uavealedéhlejeuusituing sales cholesti) sndcan be vesslzed on both tatu ind CT Honster, te pata nat eel land radon pln ee, ‘making san une tgnoss ns pater Cartons deur vey are compleaton of gallstone choles and ocats wher iar atte atl formed hat lade {oa palsoneenering the small inestie and obscing the leur Patents can presen with symptoms of smal bow sbarucon, nding nase, vorting ote ius), rampy abdominal par an ebsnpaton. pyc examination would Show admin atertion and igh-ptened rapa) Bowel sounds. CT's the prefered imaging modality areas, Shows bowel obsacton wth aly ener Ata andor preurcbls “The vest mao of eases of aut cheese ue Co obseucing gastos in he ste duct. 2 patent wth cna Tenures of acute ctleqsts (a. RU put astng ovr 6 Rous, eve, and leukocyte) ulzasanogapy the RDS Inaetes Feng ha suppor he dag nelade gallate wal thekanng guladder wal edema, bescing Gilson, andor postive Moro i on uitascund calstones are 2 common meena ning on uascund but mts omext woud aso be suggestive face cholecst 9 Scholls, choedochoihiass, cholecytis, nd cholangitn Decreased echogeriy af th nar o lraround ie 2 nope ding seen patents with acuta Ine inflentin, ch ‘hose wth aati hepa Whie acute val heats may aso preset wi RUA abdominal ain, nase and vorsng, fepeced nraings wouls ncude jaundice and ender hepatomegaly, Ler Vansaniases AST a ALT af ually elated, ‘makings apron une nth per wots < > 12-year-old allege ude comes tothe emergency department becaus of 2 to-day hoy of vemting nd “paz pan tat atest the back, He has a sar of atopic Sexmatts and Hashiero thrid. Hs ony Ieican i evotonie He has ot ceed ay ouunevaccnatens Me ns 1-7 bees an he weekends 2nd ‘eesnonally ses manana, The paint epear dntated an is phorte Hs temperature 37-96 (100.18 pulses 105/mn respratons are 167m, ae blond pressures 150,78 mm Ho, Physical earnaton shows domi! ‘Sisteniton with tenderess to papain inthe epsgastium, Thee sno guarding ot rebound ender skin examination Eee ee ogee es eed bans ee cern be (© Nessie serum mumps oar (D) outa an uganeactay of te abdomen (© measure serum pi ives ouns ul <7im> ol callege student comes tothe emergency department becats of 40-day utr af venting 2nd He hase story of atop dermal and Hshimoto hyd. Hi ony Iekca votyroxie He has fot ceed ay ouUnevaccatens He ns 1-2 bes an he weekends nd ort His epereue 37.9 (100.79, buls 105 mn respretons are 167mm, aa bleed pressures 150,76 mm iq. Pysal examination snows ASI rth “Tete so guarding or rebound endenes, kin exarnaon ipsa “a fibrosis more often assocated wrth exocrine pancreane msuficeny, and is unlikely that the fest manifestation of este firs would bean ede of cue panes a age 21 aaah, the patent euanaouswentorss make acter agy fr mare ey Measutement of mos arbody evel can be wed to deter aca mumps ifecton, a ae cause of cite sc of choo vcination Geng the MMR ari) puts i tak of contacting mumps, Fatt oak incidences 5-14 years of ape. Moreover, eas othe moms 0 SUBDESaate MUTE ACR ey aoa Towsgrad ees, male headache of Oc sophagogatvoduederescopy (E0) an vse et hc be vel in the evaluation of patents th ep ee eer eet ee gee te ee ee eee eee Ou Rew is 7 Ina ute peak ncioence 1s E25 o age Moreover eas No ore HMMS SUogeS ACE MUMPS ECO uot, ov-grade fev, male, headache, 2 oft ep ene late ernst a eli mel of pets et ‘aynophags tomate tomatochela anor mela. An ED canbe uted osaghote pepe lear eat, Ach cat tis present wth acute epigasic pan radiating to the back, However, this pet’ hypoalemia ahd eruptive xanthomas 2 note consent wth ate panceais fr which ED would no beep ‘an wpe ory ofthe acon is piclly usd to assess for ptforation ofthe lac oro visualize pacrec arene veer pre eect ea pt ie fl ern ee ide ances The pation ar doesnot hve sgn fan ate oman sacha abdominal iy, ebourd Searing ‘hdomnal ray Woe therefore ust expose him to unecessary radiaton. ‘Tis ponents cutaneous eruptive antomes ae a Malina inaing oF hyperighcadeia whi can cause acute pereatls ie Bere ies ree 00 fgets reais mc ery pty le ono onsncion ofthe ampulla f Ve col ur, ae meetin a slforare, var aca tay, tra). The ‘nil iagosti workup in patents suspected of hein pancreas shoud include ipese andor amas lel, hepa pena, ted some form of abaomina imaging eg, abooraralutasound of T- Tenet ds?eihc anges ci ambacaieaada el ntti. stnecenaa re anemia cian ne treaa nacre aan acca eens eer erred cee ened ee en ean Se Pourennipeereinertiny omnes al <7 in> rophayepetiodendenescpy (20) ean ese fet ct be ual he wahnton of ptt mth ep cynophagahematemess,Wematochela, aor melee. An ECD canbe used wo daghose pec uke seas, arch can fis present win acute epgasie put aang to the back, However, hs pants Mypealema afd eruptive xarthomas ae ‘nore consistent with aut pancreatitis for whch 6 woald nt Bela Depry of i en pea ees eps fr Clb fc ve Pancreas The patent here does rot have signs ofan cate abdomen sucha abdominal iy, bounds or grag Baomina ray ous Werefore st xaose hi to unecessary radiation. ‘Ths patents etanous eruptive anthoras ae ahlimark fing of hyperighcendemia hen can cause ate pecreatis ‘atone evel once 1000 mg/d. Other cama forte pants chads fy pathology fe, gator, eonsvcion af the ampul of vate coe! us, and means ea, slfenardes,vaprl ac tetacycline, tras). The Ina aprosue workup n patents spaced of having parcecis Should includ lipase andor anise lel, eau pal, snd some form of abdominal imaging eg, sbsorsnalltaround of 7 Stoo eustse levels af used 1 aS or exci pancreate nsuilecy i pabers wth sympfons of chore pancreatis. Iai not eit en the cae of cue pancreas Bs al ' previously hesiy 2-year oy i brought tthe emargency deparmens because of 36-hour hutory af fle ard pyofse watery area Several len athe child's aayeare cere have Geveloed Sila roms ove the pas Fe {ays Te paent tas no eceved any route chihood vaccines because Ns pues were atta assocued sce ‘fest appears Ietarge Hs temperatures 28.1 (100.67) pulp 115) respration re 25m, a loos ressre 5 9058 mm Hg, Exar shows sui eys and ry mucous membranes Caplan el Ome 3 seconds {aboratorystuces show Hamatccnt 52% ue 1st meat Hoy Noma Ureenvogen S8meq/L Crenaine 1.0 megiL "ich of flowing is most appropriate sep mansgmeno za @ecsrage aa an (@ Aerie avenue 058 sine oon (© Aarne ol eperenae (©) Perel Ror mn igen (©) Aarne ravenous 0.45 sine solution [o) (© Admin incravenous 5 detroue in water ouns al a z ‘provi ay yes boy rete be emagenySeprmant ncn fs s8-houratnyaf fer ant ad sever cen ate cs dere cone ave Gecped slr yon eh pat ow {dye epee rasrxecoved ay ve cheng aces care i pes ere eid abcd ie _ ‘tec esppews HE ompeate 28. (0D.SP pe 15 reaps we 25min od & pressor 90/38 rm Hg: Exarsnat on; A RERTERGRE capday vil ore 13 seconds = Uaboray ss how emai S28 Ietkone cout 5000/02 one “ 1st mea toy img 2 Ueamiogen S80 ie Crating M0 mca "ich of flowing is most appropriate sep mansgmeno (efi The laboraory ndings of hyperaemia and BUN/C rato > 20 farther Supports agnosis Wal ysToetets = oe eee Tek most ey udering aca, wih rota sce he mas net vacated rns beng the mos aly pathogens eee ri (ral rehydration mould be appropriate ina child wih mi to madera dean. However, sinc ths patents ysl ‘stam segs severe deyerasan, = fferant hers eae ‘he frst step in the management of ay cio with severe denyorston naeate by lethargy orcaplary refill» 3 seconde Onns al ‘The fst step nthe management fan chil wth severe dehyéranen nacte by tara or capil fl > 3 second) 5 Inrverous yarn han ck ctl soon, e098 Saline trl Se). This ate’ hypematema ‘eprom etng of il entre 3 dayeare wdess rota (nce hea ot bon variate moron fection. artes ges ee no recommended the westmenof children wth fetus gosoemeris Because hey can cave adverse fects (ea setary, para Hes) and protng ie cute of baci rhe (as 2 eso aye wars meh This patient of ete fer and watery rhe in the eting of contact a dene suggests ota ine eas Dts poets severe dehyratonequtes Veatment before conducting diagnose estg- " ‘Ths panen as hypovolemic hyperemia secondary to severe dehydration from fu losses lated hs gastontestal ress ile hypeone saline could be used a tet tne to covet ths patent ee water dete would nob the ital valour ea colli slstion ued to generate oncte presi wn th auc astm nd hat ava ofc 2opcatons le BP reacery edema, cthoss,hepatreral syndrome) We thre culd be sme ena for Seg tour in te eae of Pypovcemia, 5 net recommender Mud Yesuscatonm chien With Seyerae, ouns al etng of il entre 3 dayeare wdess rota (nce hea ot bon variate moron fection. artes ges ee no recommended the westmenof children wth fetus gosoemeris Because hey can cave adverse fects (ea setary, para Hes) and protng ie cute of baci rhe (as 2 eso aye wars meh This patient of ete fer and watery rhe in the eting of contact a dene suggests ota ine eas Dts poets severe dehyratonequtes Veatment before conducting diagnose estg- " ‘Ths panen as hypovolemic hyperemia secondary to severe dehydration from fu losses lated hs gastontestal ress ile hypeone saline could be used a tet tne to covet ths patent ee water dete would nob the ital valour ea colli slstion ued to generate oncte presi wn th auc astm nd hat ava ofc 2opcatons le BP reacery edema, cthoss,hepatreral syndrome) We thre culd be sme ena for Seg tour in te eae of Pypovcemia, 5 net recommender Mud Yesuscatonm chien With Seyerae, “This atin has povlemichyperatemia secondary to severe deysration fom Md loses related this oastoicstina rss we aypotan Sldlon could be ued at later pot Cet is pales ee wae GACH, would Na Bete + < ee ‘spots tha the pan loated in thea uperabdoren and that does ox change wih fod imate. Se has had 0 ‘ausea, worth, chang neg Ste nasa MStor of hypertension and hyperipdem, She des wot sake Se salem mass nthe right upper auadart Laboratory studies are within the reference range. ACT scan ofthe abdomen iSsnoan Ths patents cndion pusher at inceseed ak of developing which ofthe following? Galbinade adencencnoms (© Fronenienersbeeee ao a < ‘spots tha the pans loeated in thers uper abdomen and that ‘asa, worth, chang neg Se nasa nso of hypertension and Myeripde ‘hea had 99 eberstr studless urna the reference range, ACT seen ote ebgomen sted ak of Govsiping whch ofthe following? ‘Ths patents abdominal x-1ay shows an opaque lesion the gh pps quatarsuopesve of glblasae’calrcaton 2a ‘= @) sonal econ Common tsk 2c fe Bowel easton nude pit abdominal Surgery suing in searing ad Bowe adhesions), Se(@) Gabiater adenoewcnora ile se exact pt sllogy of porcelain gable is know, assacaed wth colitis and craic alba mea ouns a ‘Wl th enact patopintloy of pect plas unknown, anocaed wth collate and croc gl Inflammation ts fen ented ice on abdominal magia, athough may presen wh right Upper auacrant can, aS mis part. Tees a smal but signin ko" deeoping galbade adenocarcinoma, Se recommendes vreament is chaleeystectom B Callaader perforin potenti compication of hoes and chlecstis While Doh chek and cleo fan ao present ath interment RUG par ances answer option ave dea scaestes the major nk af porcelain The two greatest nk factors for pancretc cancer ae smoking and conc pancreates. CT's general the bal maging ody Used To agnosis of eheoncpurcres, and cal nings scudepurcreaeavophy, aut dizer, {alfieaton, and/or paeudora oration ne of whieh aem ere Petes galbladder no anak facto fr pancteate "haters ask feos fr heptocearcacioma ae ver costs aed chron rl Rept sal HEV or HEV Ths patent doesrtnave any history to suoges underinng envi wal hepets (dn und, hepato MSW OF NOU) or sow any gmat of cos, abdominal astern, Nepslomega aces, eames, pepe ‘ema Porclam abd ot nak ie or epatesiar cana, C) ened mee ened ary oua al Calbia perforation potenti compcaion of choiethiasis and chleqstis, Wile bth choles and chleqsts fa abo present ath interment RO pan nates answer option ave des scaestes the major nk af porcelain ‘The two greatest nk factors for panretc cancer ae smoking and conc pancreatts. CT's general the mal maging ody Use or hagnoss of ehronc pares, and CaS inaings nae pares avepry, Bul ditatOn, {afiaton, and/or pease oration, ne of wes sem here Perea galbladder no ara faro fr panceate ‘etre eset ok feos fr hepetoceder carcinoma ae rer ess aed chon rl Repatsosal HBV oF HE Ths ponent doesrchave any history to sunges underng enon Wal hepats (em und, hepato MST OF NOU) er show any stgmatz of cross, abdominal Aste, hepstomega aces, der agiomes, pipet {ema Porcla aller ot x nak cor or putes cxcnome, ‘he mort common tk factor for sete pacreatie ar excettwe alcool consumption and colette alas, as sean this patents ot assocated wt creased nk of acute pares, Als, hs patents amount of ‘cael consimpoon woul be ulney to rsa in ace pancreas ‘Foner ne abscess ees wo th Formation ofa bcterl ascss within thee. Ths pave doesnot exhib ary ofthe Comme risk aces forte development oa pyogenic ve abscess, suc slay obstucton, gases! es, ouns a < win > ‘eat and patton, ich worsen on ysl eaten an impove wth est He has had itermiten constipation low-grade eve, an gnetaized mya or We pst 3 mons. He has had @ 104-49 23-1) weight los ve the pst ‘months despite nochange in appebte Hs temperatures 37. (8.57 pulses 108/mn,reaprators ae 16/min and ‘eed pressoe 5130/76 rr Ho. Examination shows ple comunethee. Hs RemonlobncOrcetatn (Sle, EEN ‘epuszlerslunes 70 yn? ad eum erin 512 ng/mL Test of he tol fo ce bod is poste, Clonescopy shows 2 1.7-em weds encphyi ules with regula, bleding edges nthe ascending colon, Which of he etoning easy 2a (@) A ssomucosl omyomanus poly | submucosal pemstous pop (© A psduncueed tarmatoy poWp be > & ouns al < win > |5 year-old man cma otha physetan cant of 2 2-monh ory of a akohae hoomens ot — GI beat and patton, which worsen on ysl eaten end improve wth ese hes ha Tasha ove te past ceipte nochange m appetite. os temperature 237 GBF, pulse 108 in respaton re 16m ae 600 pressoes 130/76 rm Ho. Examination shows ple conuethge Hs PemoglobcOrceaton 1S! /eL, MEEN ‘puszlrvlunes 70 yn? and serum erin 512 9g mL. caloscopy ‘ange the gratestpectepning facts forthe part cenctan? “ni pain ees wih constavtional ymptons and Won dsiGenc ane, ie seing ofan irate, bie dg gown inthe colo, Thee findings are highly suggeke of clrectal ances 2a ‘A lomjomatousgoye cost oten a benign lesion ote muscularis pop or muscularis mucesa Gmooth muscle of he setts rad wth x ey om pte fr malignancy. although hey ean presen th pas. corepaton ight ot {nd ekood m sto bleeang, 5 Seen hs ater, sunk f have been a precspesing fer 85 Ise oF POND ‘hie tects young women and g's Regus of ize, a submucosal pomatus pop caesar fo rk of malignant wansermation, Lipase most Commoniy urd subastaneoui. Honest when fourd ithe con thy ca become le, ungated raed, Which fanmimic the appearance of primary cloetalancer. Ths puters anemia cou the eu an erated poy ot Jord but woul not exlan hs consentonal smetoms. sx) Avon adams poy v “Th suongetpresspesing fair for malignant wansfrmaton sth histlogia subtype of th lon, flowed by ks 6, locaton and cossappeatance.Adenomateus pps (ecubuat adenoma, vbuloulous adenoma ofits aderora catty ees cer a cee ea ee ed re nr eee ee eee eae Ee oua "he stonges pretsparing fcr for malignant ensormatin ithe itolgil subtype ofthe leo, allowed by 2, locaton, and goss appearence. adenomatous plps (ie, tubular adenoma, tubules adenoma of ilus adeno) catty the ghec kof algae artormation fa yes of alone poy. Avil adeomatus pop haste highest ek {@'209 of malign aneormaton fu tne yes of snort ple. The ager he ce poh, tebe he nek ages fi, peduncle inlsrnsory Bly des nok at any k of neoplastic wanstrmaton nee However, me ‘eto srounng these pop ie prone > oyplsia and thotfore = ghar Fak of nop arefrmaton duc tthe ensteenflarnation i he are, Regarlss, ts 195 of OIDs en een advanced TD, whieh pater aro Story Seat pbs trys eee of nape arin Of i eae emo creel abe: Doct ‘Suse svat and aol erated) 2 ingle .4-2m hpaplste pop cartes he owes rk of malgnancy beraute there sno dla present “abun adanoma ie the mast common hitalagil vant of cli aderoms, comprising ~ SD of ll alnaratous pole. “These common polyps cary lately Smal sk of malignant ansformaton (= 5 ceasing seis associted witha ghar ko maignarcy Howes, another ype of poy a gear pressing Tact for ths pales conan ed Tubulovillous Villous Lamina propria Muscuars mucosae Submucosa — Mir - is | | | Pedunculated Mixture of Broad-based/ apes San pneel nflarnhy fi se a a re o ep eeron oe Meori ‘eso raraunang thers payer prone aye and tarfore = ghar ra ot popactwaretrmavon) ue tee onstaeinfianeration inthe are, Ragarlss, sis typeof polyps only sem advanced ID, whichis pat asm story Sead pbs enya moderate ak of alga rarer. he es mal pes sere pobre Operate, Sessile sree, and vaational sate) a single 042m hperplstepONp carries he owes rk of mabgnancy because ‘heres ese. Tubvar adenomas the most common hstogicl vat of clonic adenome, comprising ~ 60% of al adenomatous hes. These common pops car altvely smal sk of malignant wansfovmadn - 59. nceasng Ss assocated wth 2 higher ak of malgnancy Hower, anther ype of polyps a greater predisposing factor for ths pate conan aged of si sete harartamatcus polyps ae generally = beng fading ard unaly 0 result in malignant {tarsfoaton.snovghhanarematus pols fund the cnt of cea conto (Le, Pet2Jegerssaome, ene polyp, and conden syndroms) havea creased ik of malignant vaneoration, ts pee acs ote igs ot Epes ter err es hous The avert ates the pain a5 an 8 09 ona 10-poi scale. she has had an elsode of nonbleodyvomng Sine the fain sariea Stetas«NStovy of pe 2 dabetes mali, pension, aa osteoporosis. The patent has Smoked Epes of inet daly for 40 yes She drinks 5-6 aca bereages daly. Crest means include shure, Ison and oa amin 0 supplements er tmperatures 385° (01.57 ules 110mm, and ood pressures 138/86 mig Examinaon shows severe epgastic tenderness o palpation with guarding bat Ne rebound Utretnograpy ofthe absoren shows fae enlargement fhe pares no galbtnes ate vauahzed The paints iit tthe hosp for pan corral and avenou hyetion. hich ofthe fllwng ie the Mos Spproprae net Step nme mananement of hs pater’ ai? ‘ral hyocadone on request (© oral acetaminophen every hours (© Tansee fentanyl every 72 hows & She has had an esode of nonbloaéy vomtingsmeethe pain sara Stetas«Mscry of ype 2 dabetes malts, ypstesion, nd osteoporosis The pati has smoked B pacs of inte daly or 40 ys She drinks 5-6 alco bereages daly Crrent means include shure, Ison and oa amin 0 supplements er tmperatures 385° (01.57 ules 110mm, and ood pressures 135/86 mig, xarinaon shows severe epgasc tenderness o palpation with quardig tno bound Utretnograpy ofthe absoren shows fae enlargement fhe pares no galbtnes ate vauahzed The paints {emieed ote hoepal for pan contra and imrsanoue Ryan. Which of he flowing ithe ox ppropiae Mest Step nme mananement of hs pater’ ai? ae 2a “ ‘rl ocadone es potent alge hat i appro for tenting ever pln Pas wih act pancreas and vomiting are ofen Kp: PO, and they hae an maeased nk of ceva dyed gas ervng and an es. Thertoe, Inraverous analgesia would be mote appropiate or i pain marageren. aven-convold analgesia (PCA wth invaveneus hytomerphone ithe most appropiate nex step the management of {hs patents pain om acute parceatcs,Iravenoushytome/phare sary eecv anaes a! 2a. Darnatring hs rug ning = fC protocol allows the pater to iat he mediation based on her pan which meniizes the sk of unereosing te analgesic whe the pavers experencng severe pan. To Nod respirator depression om pois ‘overdose, Fes pumps init he amount of poi thas dled nd pate are monored cosh A Fan meager Om Dera {he nk of underoosng oe analgesic wine the pave is experiencg Severe pa. To ao respiration depression Nom pois ‘rerdose PCA jumps it he amount of pit that dele nd patent are manned cee Transdermal bupacain provides pare in the region surrounding ts pom of appar paint nh cate ances and severe abldomnlpa, a more pote systemic analgesi woul Be nested ata play ay olen emergency meckne bacave of song cocaine, ympatimaet, and rales ‘tough hs dup prowdes potent wansent pan eit, continuous intravenous Ketamine nusion causes profound easton ‘mat requresconinvous moon na crea cave uni. woud Wot the mst appropriate Westen pln fre patent rl astaminophen ard analgesic and auf ajunet for ontling avers pn especially when omisned wth a opi Ths patent has seer pa (0 on the pain cle) hare amare poten analgei for acest pa al id eget ec ere fel te prc eee wal re trelfp Ts aa hat ves sete pin 6-9 an hepa tae ana rquer amore poten analgeri frases panel “Trensderalfenanis aneffectve aun or pin contin indus wth chon pan vequitng olds, However, hs rg is not used ia he il menagarent fate severe ple because as aes slow ose f acon and delNes fed dose of pai making dose tan ae Bs al _ previously heaiy 33-year-old man ces tthe physician because of -monih str f progres worsening Substernal chest an after meal The pan eccarsaost dal worst after eating spe food a ning coffee en ‘ten wakes im up roe gpa night He nas ne Rad any Weg oss. He as smoked 1 pack of garets dy or Esopnagogastosvodenscopy shows ert of th al esophagus wn vo small mUcOal =fsions, Bopsy secmens obtained om the esophagus show Wo endence of metaplasia, Wout vest hs aie at etek or which za @ ophagea adenocarcinoma phages squamous al nena © sorhagel cure (© state ma ea ©) Pee eros a ouns al ke | procul hua 35-yatold man comes tthe phscanbeaute af S-month matory of “The pam occurs aot dls worst after eng oy food or dking coffee and ‘ten wakes im up om sleep a night He tas no Rad any Weg oss. He as smoked 1 pack of ares dy or 25 yeas ane dink | 12 gises of wine day ith dine. Pryseal examination i unremarkable Esopnagogastosvodenescopy shows we evo small mucosa erosions Bonsy specmens ‘bain om the sophaps thou eaten hs pet sa eae for whch “This pata has clssc symptoms of GERD with endenceofesophaglson ECD esoheaeal ervthema and erosions. 2a Ssopagea erocrcnoma i rare complication of Bae esophagus (6) wth dysplasia, wich can develop incduals ‘th conc uneste GERD However, nselogcl evidence o metaplastic cura pel in eophagel Bossy ‘ech are pocet ne pte. doen factors nce ahaa and cout wophaged nary Mower, ie Dent’ GERD wth fun esophats doesnot crease the risk of him devlonng esophageal SCC. Moreover, esophageal SCC Sypealy occus ia me uppa 22 of he esophagus, whereas Is puUeA as endoscopic Gece of ta sopragea tmeking sc alcahal consumption, hich ae Soh preseaeimhepatent fe etre or nyngea caenoms nl ae omer, ahough ffi of ges ai it the layne can cause Croi yigis and i severe case, nye andor ‘thal Senos Layngel carcinomas rot aroun complication of urate CERD wih esophapls OUD s a

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