Ranson’s Criteria for prediction of mortality in pancreatitis at presentation
Age >55yr WBC > 16,000 Glucose >200 LDH >350 AST >250
Ranson’s Criteria for prediction of mortality in pancreatitis at 48h
Fall in HCT >10%
Increase in BUN >5mg/dL
Calcium 4
Fluid deficit >6
Salmonella bacterial diarrhea characteristic
-gram negative rods
-occurs after ingestion of contaminated eggs, dairy or poultry
-diarrhea is bloody and is accompanied by tenesmus, fever, abdominal pain
(Symp resolve spontaneously in 10-14 days)
Shigella bacterial diarrhea characteristics
- highly pathogenic, as few as 10 organisms can cause disease
- typically pred by fecal-oral contact or contaminated foods
- severe bloody profuse diarrhea
Campylobacter jejuni diarrhea characteristics
acquired from eating undercooked poultry or contaminated natural water sources
- abdominal cramping and profuse bloody diarrhea begin
- myalgias, headache, and vominting also commonly accompany infection
- causative agent of Guillian-Barre Syndrome
Yersenia diarrhea characteristics
- spread via fecal oral route
- fever, abdominal pain, profuse watery or bloody diarrhea and vomiting
- clinical syndrome is commonly mistaken for acute appendicitis
E. Coli diarrhea characteristics
- eating undercooked beef = most common
- hemolytic uremic syndrome and rhrombotic thrombocytopenic purpura are two of the most serious complications of infection
Giardia lamblia diarrhea characteristics
-spread by ingestion of contaminated water sources
-protozoa
-common in rocky mountain areas of US
-frequent, explosive, foul smelling diarrhea commonly lasts 7-10 days and reinfection is common unless antibiotic therapy is initiated
Tx: Metronidazole
Rx for bacterial diarrhea
Quinolones BID
Rx for variceal bleeding
Vassopressin and octreotide constrict dilated esophageal vessels (but no proven reduction in mortality)
Diagnostic procedure of choice in upper GIB
endoscopy
What rx is a risk factor for ischemic bowel?
Digoxin: potent splanchnic vasoconstrictive effects
Mesenteric ischemia on imaging
Gold standard = angiography (may provide route for infusion of vasodilatory drugs)
Plain x-ray = bowel wall thickening or pneumatosis intesinalis
Ct = pneumatosis and bowel thickening
CT angio w/ IV contrast = sensitive and specific
Tx of mesenteric ischemia
- supplemental o2, cardiac monitor, IV access
- volume resuscitation w/ NS or Lr
- broad spectrum abx
- NG to decompress stomach
Most common type of stones in cholecystitis
Cholesterol stones
-formed when cholesterol is supersaturated in bile and precipitates out
Most common cause of symptomatic cholelithiasis
obstructing stone
Typical pathogens of cholecystitis
gram negatives
streptococci
anaerobes
Most common cause of appendicitis
obstruction by fecaliths or tumor (older patients)
viral (children)
Most common bacteria when necrosis of appendix
- bacteroides fragilis
- e.coli
Diagnostic procedure of choice for appendicitis
CT w/ IV plus oral or rectal contrast
