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Exam (elaborations)

ACNP Gastrointestinal- Questions and Answers

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ACNP Gastrointestinal- Questions and Answers

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  • November 11, 2024
  • 22
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • ACNP
  • ACNP
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ACNP Gastrointestinal- Questions and
Answers
PE findings in Pancreatitis Correct Ans-Upper abdomen tender to palpation, usually
WITHOUT guarding, rigidity, or rebound (helps r/o acute abdomen)

Distended abdomen

Absent bowel sounds

Fever

Tachycardia

Pallor, cool skin

Mild jaundice common

If hemorrhagic--Grey Turner's sign and Cullen's sign



Cullen's Sign Correct Ans-Umbilical discoloration, commonly seen in acute pancreatitis




Grey Turner's Sign Correct Ans-Flank discoloration, commonly seen in acute pancreatitis




Labs and Diagnostics of Acute Pancreatitis Correct Ans-WBC elevation: degree depends
upon severity

Hyperglycemia

Serum LDH and AST elevation

**Serum amylase (50-180) and lipase (14-280) elevated in 90% of cases

BUN and coags may be elevated

,Hypocalcemia, levels <7 may be associated with tetany; watch for Chvostek's sign and/or
Trousseau's sign

Elevated C-reactive protein suggests pancreatic necrosis

CT scan MORE useful than US



Ranson's Criteria

George

Washington

Got

Lazy

After

He

Broke

C-A-B-E Correct Ans-Used to evaluate prognosis (5-6 risk factors= 40% mortality; >7 risk
factors= approximately 100% mortality)

Signs at Admission:

1. Greater than 55 YO

2. WBCs >16,000

3. Glucose > 200

4. LDH >350

5. AST> 250

Signs during the 1st 48 hours:

1. Hct drop of >10

, 2. BUN increases >5

3. Calcium <8

4. Arterial O2 <60

5. Base deficit >4

6. Estimated fluid sequestration>6,000 mL



Management of Acute Pancreatitis Correct Ans-Ranson's Criteria

Bedrest

NPO

Aggresive IVF volume repletion

NG suction

Pain control

Once patient is pain free and has bowel sounds, may begin clear liquid diet



Bowel obstruction Correct Ans-Blockage of the lumen of the intestine that impedes passage
of gas and contents through the bowel



Major causes of Bowel Obstruction Correct Ans-1. Adhesion--look @ surgical hx for scar
tissues

2. Hernia

3. Volvulus

4. Tumors

5. Fecal Impaction--can lead to perforation

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