coloquium 2: 1-50

A 53-year-old man, who is being treated for arterial hypertension and type 2 diabetes, was referred to the Emergency Department of Internal Medicine (EDI) for 3 days of cramping pain under the right rib cage. The pain appeared in spurts, lasts a few minutes and subsides spontaneously. He says that the pain also spread to the right shoulder, but otherwise it does not depend on the body position. He vomited once, passes stool normally. In the status, apart from mild palpation sensitivity in the epigastrium and below the DRL, there are no peculiarities. What type of abdominal pain is it?. A.Functional pain is typically associated with vomiting. B. Visceral pain, most characteristic is colic. C.Parietal pain, most characteristic is colic. D.Referred pain during acute inflammation of the gallbladder.

A 55-year-old man came to the emergency room with severe, sudden pain in the upper abdomen. At the same time, he had nausea, vomited, was sweaty, pale, but hemodynamically stable. During the clinical examination, the defense of the upper part of the abdomen was expressed. He had a gastroscopy 5 years ago due to hematemesis. A bleeding stomach ulcer was found. Bleeding was stopped endoscopically. Due to a recent injury, he was taking an NSAID tbl.X-ray of the abdomen showed air under the diaphragm. Lab. Find out bp.Diagnostic procedure. A.Gastroscopy. B. Abdominal CT. C.Observation in the Intensive Care Unit. D.Exploratory laparotomy.

An 85-year-old female patient came to the emergency surgery clinic for a check-up because of sudden abdominal pain lasting 6 hours. At the same time, she had nausea, vomited several times and passed liquid, normal-colored stool a few times. She had a heart attack years ago. of chronic atrial fibrillation is on permanent oral anticoagulant therapy. On examination, she is bloated, her abdomen is bloated and painful. Palpation does not increase the pain. Peristalsis is quieter but audible, there are no other peculiarities in the status. In the laboratory results, elevated indicators of inflammation stand out, the other values are within normal limits, the urine examination shows the presence of bacteria and individual erythrocytes. X-ray imaging of the abdomen shows an abundance of stool in the course of the large intestine and a slightly dilated meander of the small intestine. Abdominal ultrasound shows moderately dilated loops of the small intestine with impaired peristalsis. How will you act?. A. At the hospital, the focus is on constipation, which is common in older people. We prescribe her a high enema, after which she discharges profusely, she feels better, so we discharge her to home care. B.The clinical picture suggests cystitis, which is why the patient is prescribed an antibiotic and discharged to home care. The patient is referred to the gynecological clinic for examination. D.The patient is referred for a CT scan of the abdomen with contrast.

A 25-year-old female patient comes for an examination from the gynecological clinic, where she was examined for suspected inflammation of the genitals. A gynecological examination was performed without any specifics, the test for possible pregnancy was negative, she had her last period 14 days ago. When you talk to the patient, you learn that she fell ill yesterday with cramping pains around the navel. Six days ago, she had bilateral lumbar pain, and she also had a fever. At that time, the urine was examined, including a urine culture, which was sterile. So far, she has not been operated on, but she overcame leukemia when she was young. The examination reveals a very painful abdomen on palpation, most pronounced in the lower part, especially suprapubic. You have the feeling that during palpation of this area, the patient tightens the abdominal muscles ("defans"). In the laboratory findings, elevated CRP (87) and leukocytosis (25) stand out. Please circle the correct answer: A.The patient is currently in the middle of her menstrual cycle, the fever problems she had are almost certainly the result of a virus. Additional diagnostics, no action required. Rest in home care, enough fluids and ev. control at the selected doctor. B.We have to refer the patient back for a gynecological examination. Her problems are of gynecological origin, despite the initial findings, which ruled them out. C.Given the pronounced suprapubic pain and elevated inflammation indicators, the patient is most likely suffering from urinary tract infection. We prescribe her the antibiotic Ciprobay and advise her to drink enough fluids and have a follow-up visit with the selected doctor. D. The patient is admitted to the ward, and we refer her to an emergency ultrasound of the abdominal cavity.

A 56-year-old woman with known AH and new-onset atrial fibrillation comes to the PPI because of sudden severe periumbilical pain VAS 10/10, vomiting and diarrhea. Th : ASA and ACE inhibitor. Breathing frequency 20 min, RR 90/60, clinically affected, nausea, vomiting , abdomen mildly sensitive to palpation , melena can be found rectally. The pain is: A. Transferred. B. Parietal. C. Visceral.

A 56-year-old woman with known AH and new-onset atrial fibrillation comes to the PPI because of sudden severe periumbilical pain VAS 10/10, vomiting and diarrhea. Th : ASA and ACE inhibitor. Breathing frequency 20 min, RR 90/60, clinically affected, nausea, vomiting , abdomen mildly sensitive to palpation , melena can be found rectally. Clinical definition: 1. Acute pain. 2. Acute abdomen. 3. Chronic pain.

A 21-year-old patient, who is otherwise healthy, without regular therapy, was referred to PPI because of severe pain in the right lower quadrant of the abdomen. The pain appeared suddenly, in physical education at school. The pain is dull, constant, radiating to the right thigh and groin, at the same time she feels sick, she does not vomit. RR 150/90 mmHg, cardiac fr. 100/min. Which of the following combinations makes the most sense?. A. ovarian torsion/ectopic pregnancy, beta-HCG, abdominal ultrasound, gynecologist. B.Renal colic, X-ray/US abdomen, urologist. C.Acute appendicitis, abdominal surgeon. D.Diverticulitis with perforation, abdominal surgeon.

Man , 64 years old, temperature 38.5 0 C, chills for 2 daysconstantpain in the leftthe lower onequadrant , 3 daysit is notwentonstool , dysuricproblemsdoesn't have Normotensive , unaffected . Sensitivityonpalpation in the leftthe lower onequadrant . Leukocytosis , elevated CRP, ultrasound of the abdomen is bp. What is furtherdiagnosticprocess: A. We doenema. B. Let's starttreat with an antibiotic. C. Let's orderMrsonurgentsigmoidoscopy. D. D. We refer him to the abdominalto the surgeon. E. Let's referMrsonurgentcomputerizedtomography (CT).

Female 28 years, 2 year lasting chronic abdominal pain.​ Because chronic back ache​is receiving morphine analgesics . Before one she was years ago hospitalized becauses severe abdominal pain , constipation , nausea and vomiting .​ At that time , there were lab tests , gastroscopy , colonoscopy , CT scan of the abdomen and small pelvis and anorectal manometry are bp. Laxatives are partially reduced pain . The pain in the abdomen increased when due to pain sincreased doses morphine analgesics . What is the most believable diagnosis?. A.Syndrome irritable intestines. B.Celiac disease. C.Crohn's disease. D. Narcotic syndrome thick intestines.

A 64-year-old lady, who is being treated for arterial hypertension, type 2 diabetes and has known gallstones, is referred to the emergency internist clinic because of pain under the right rib arch lasting 3 days. The pain is dull and constant and does not depend on body position. He has no appetite. She has not passed stool for 2 days, but she notices darker urine. On the day of the hearing, she was shaking with a fever, and she had an elevated body temperature (38.9 degrees Celsius). Relatives noticed that she turned yellow. On examination, she is generally weak, febrile, icteric, RR 100/80 mmHg, heart rate 110/min. Amylase lipase 1 times above normal values. What is the most likely diagnosis?. A. Acute cholangitis. B. Acute cholecystitis. C. Acute biliary pancreatitis. D. Stomach ulcer.

A 45-year-old healthy woman fell ill 12 months ago while traveling (nausea, vomiting, diarrhea for 4 days). After that -at least once a week painful stomach cramps, bloating, bloating, flatulence and 4-5 times a week diarrhea. It is also occasionally closed. He denies nausea, vomiting, gastrointestinal bleeding and weight loss. Laboratory and endoscopic findings and abdominal CT are bp. The diet didn't help her. What is the most likely diagnosis. A.Celiac disease. B. Dyspepsia. C. Chronic inflammatory bowel disease. D. Irritable bowel syndrome.

A 65-year-old female patient comes for examination because of a bloated abdomen and profuse vomiting that lasts for 2 days. Only this was bilious at first, and then became dirty, smelly-like intestinal contents. He does not report any particular pain or other problems. During the examination, you find that the patient is clinically dehydrated, blood pressure 80/60, pulse 130/minute. The abdomen is bloated, the patient has a BMI of 35, which makes the examination difficult, but you feel that in the right inguinal region, or even a little lower, you feel a large resistance for a small lump, which is not particularly painful, and the skin above it is already red. Laboratory results: CRP 300, L 28, creatinine 350, urea 45. How do you proceed?. A. In the case of the patient, it is a septic event (of unknown origin for the time being), which also results in kidney failure with vomiting. Palpable resistance is an increased lymph node as part of inflammation. We refer the patient to the infectious disease clinic. B. We refer the patient to internal medicine first aid due to low blood pressure and kidney failure. C. We order the patient for an abdominal ultrasound and at the same time arrange for a puncture of the reddened resistance. D. The patient is admitted to the surgical department. We start with intravenous fluid therapy, introduce a urinary catheter, a nasogastric tube and empiric antibiotic therapy. Let's make an appointment for an abdominal ultrasound, probably surgical therapy will be needed.

A 22-year-old female student comes to the emergency department because of acute abdominal pain. The pain of the session started as a sudden, dull pain in the navel area. After 3 hours, the greatest pain was in the DSK. The pain after defecation did not go away. She had her last period 2 weeks ago. She was inappetite. Clinical examination -tenderness on palpation, Mc Burney, Rovsing, ileopsoas. Raised Leo, temperature, pat. Urine. Next to the stomach was bp. Diagnoses: A.Outside uterine pregnancy. B.Pain because taking cocaine. C.Acute infection urinary tract. D. Acute appendicitis.

A 30-year-old patient is referred to the surgical clinic because of 5 days of malaise and fever. After a very strenuous physical activity a few days ago, he also vomited twice at the beginning, he had the feeling that he got a little bit of food poisoning. After vomiting and passing profuse stools, he was largely relieved, then the next day he developed a fever, started to have pain on the right side of his abdomen, and has generally felt weak ever since. During the examination, you notice a painful abdomen on the right, where there is greater resistance. The patient has an elevated TT, CRP 150 and L 18 in the findings. Abdominal ultrasound shows a 5x4x3cm nodule near the ascending colon, the appendix is not visible, there are no other peculiarities. How do you act?. A. In the case of the patient, it is very likely a perforation of the appendicitis, which is still limited for the time being -immediate surgical therapy is necessary due to the risk of perforation of the abscess and life-threatening diffuse peritonitis. B.The patient is very likely to have a punctured appendicitis, which is still limited for the time being -admission and antibiotic therapy are required. C. In the patient, it is very likely a perforation of appendicitis, which is still limited for now -admission and antibiotic therapy are required, as well as simultaneous percutaneous drainage of the abscess, if the abscess is accessible to drainage. D.The patient is very likely to have a punctured appendicitis, which is still limited for the time being -antibiotic therapy is required, which the patient can also receive at home if he wishes.

A 59-year-old female patient comes to the clinic because of a one-day pain in the epigastrium and right hypochondrium. She is sick, she has vomited 3 times in the last 24 hours. The problems started after she ate 2 pieces of cake. Years ago, she was treated for a peptic ulcer of the duodenum. She is hemodynamically stable, jaundice is present. Which investigation will you do first?. A.Gastroscopy. B. Abdominal ultrasound. C. Breath test for evidence of H.pylori infection. D. CT abdomen.

A 35-year-old man complains of dysphagia for solid food, painful swallowing and acid reflux and epigastric pain. Endoscopic and histological examination confirmed eosinophilic esophagitis. How do we treat this patient?. A. prescribe a diet of 6 food groups. B. Standard-dose PPIs are initiated along with a phased-elimination diet. C. If elimination diet and proton pump inhibitors are not effective, treatment with systemic glucocorticoids is added. D. If proton pump inhibitors are not effective, add treatment with topical glucocorticoids, then a gradual elimination diet.

On examination, a 30-year-old man complains of dysphagia, regurgitation, and chest pain. He lost 12 kilograms in 2 months, despite a good appetite. You have suspected achalasia. What tests do you use to make a diagnosis?. A. Esophagogastroscopy B. Esophageal manometry C. Endoscopic ultrasound of the esophagus D. CT of the chest and abdomen E. X-ray contrast imaging of the esophagus. A. abc. B. bcd. C. aec. D. abe. E. cde.

A 28-year-old man is suing because of abdominal pain lasting 2 months. He gets some relief when taking medicines that reduce stomach acid (H-2 blockers). He had no black stools or blood in his stools. He has not lost weight and has no other known health problems. The laboratory findings that he brings with him include a normal blood count and biochemical tests. He is scared, worried that he has cancer. What is the most appropriate next step?. A. We reassure the patient and advise him to stop taking the drugs, as they are not helping him. B. We test for H. pylori infection and treat according to the result. C.We suggest gastroscopy to the patient. D.A diagnosis of functional dyspepsia can be made. E.We order a CT scan of the abdomen.

In a 33-year-old woman with hypothyroidism, despite a normal diet, hypovitaminosis B12 and macrocytic anemia were found. Gastroscopy revealed normal duodenal mucosa and mild antral gastritis. Biopsies of the gastric mucosa showed atrophy of the corpus mucosa and intestinal metaplasia, and normal mucosa in the antrum. What is the most likely diagnosis?. A. Autoimmune gastritis. B. Allergic gastritis. C. Acute gastritis due to H. pylori infection. D. Chronic gastritis with atrophy and intestinal metaplasia due to H. pylori infection.

A 48-year-old man, who is being treated for COPD and smokes up to 35 cigarettes a day, visited his chosen doctor because he noticed that he had bad breath, in addition, hard food stuck to him when he swallowed, and occasionally he also had pain when swallowing. He lost 7 kg in the last month, his appetite is good. What is the correct course of action?. A.Referral for gastroscopy under the level of urgency Very fast. B. X-ray of the esophagus with contrast. C.pH measurement and manometry of the esophagus. D.Therapy with a proton pump inhibitor in two daily doses for 14 days and if there is no improvement, referral to gastroscopy.

A 55-year-old man, with no known comorbidities, is brought to the IPP by ambulance due to syncope. He says that two days before the syncope he was passing black, greasy stools. On the last day, he had pain in the epigastrium, he was sick, but he did not vomit. On examination, he is talkative, hypotensive (80/50), tachycardic (130/minute), pale, otherwise unremarkable. In the laboratory, the following values stand out: Hb 90 g/L, urea 29 mmol/L, creatinine 90 mmol/L. We stabilize the gentleman hemodynamically, he receives a bolus of a proton pump inhibitor, we make an appointment for an emergency gastroscopy. Gastroscopy shows an actively bleeding ulcer of the duodenal bulb. The bleeding is controlled endoscopically with the application of combined therapy (injection therapy + hemostatic clips), biopsies are taken to prove H. Pylori infection, which excludes it. The gentleman is hemodynamically stable and transferred to the Intensive Care Unit for further observation. On admission, he is normotensive (130/75), normocardine (80/min), in the laboratory we see a slight drop in hemoglobin: Hb 85 g/L. What is the most appropriate next course of action?. A. The gentleman is prescribed an intravenous proton pump inhibitor in a continuous infusion (8 mg/h) for 72 hours, then we switch to bolus oral doses (40 mg/12h). B.The duodenal ulcer was most likely caused by an infection with the H. Pylori bacteria, so we immediately start empirical treatment. At the same time, he receives a continuous infusion of a proton pump inhibitor (8 mg/h). C.A proton pump inhibitor (40 mg/12h) orally is prescribed according to the bolus scheme. D.He receives two transfusion bags and a proton pump inhibitor in a continuous infusion.

A 49-year-old patient is suing for several years of frequent postprandial pain in the epigastrium, which is partly relieved by antacids. Not worse, no dysphagia, no melena. My father was diagnosed with stomach cancer at the age of 72. What is the most appropriate diagnostic procedure?. A. On the 14th day, empiric treatment with proton pump inhibitors is introduced. B. We refer him to a breath test to determine H. pylori infection. C. We refer him for emergency gastroscopy and rapid urease test. D. We refer him to a regular gastroscopy with biopsies according to the Sydney protocol.

In a 48-year-old asymptomatic H. pylori neg. atrophic chronic gastritis and intestinal metaplasia were confirmed in the patient during gastroscopy. The pathologist assessed that it is OLGA4 and OGIM 4. What will you advise the patient. A. Regular gastroscopies every 6 months. B. Regular gastroscopies every 3 years. C. Total gastrectomy due to increased risk of cancer. D. Regular endoscopic controls are not necessary unless alarming signs appear.

A 73-year-old gentleman with known arthrosis of both hips, who is awaiting operative treatment, is referred to the IPP because of general weakness and dizziness. For the last two days, he has been passing black stools and has no abdominal pain. He is taking NSAIDs for hip pain. On examination, tachycardia with fr. 125/min, RR 80/50 mmHg. Hb from the finger is 60 mg/l. Which order of action is correct?. A.It is melena, we immediately refer him to emergency gastroscopy. B. It is melena, ZPČ 80 mg is administered in a bolus, hemodynamic stabilization is required, then referral to gastroscopy. C.It is melena, we apply ZPČ 80 mg in a bolus, we refer him to emergency gastroscopy. D.It is an unspecified bleeding from the gastrointestinal tract, hemodynamic stabilization and referral to CTA is required.

41 years old, distinctlyexcessivelyoverfeda patientsue for 3 monthslastingchest pains .​ The pain intensifies after eating , it is worst in the early hoursmorningshours . Longertimedrycoughs . Smoke up to 5 cigarettesdaily . Dailyconsume 1 to 2 scoopsalcohol . He denies itweaknesses , orvomiting . Physicalthe weight is stable . He doesn't haveproblemsatswallowing . The cardiologist ruled it outischemicdiseasehearts .The most appropriatea further stepconsideratthe patient has: A.Gastroscopy. B.Determination antigen against H. pylori in stool. C.Urea breath test. D. Therapeutic experiment with inhibitors protonic pumps.

A 51-year-old man with known gastroesophageal reflux disease and arterial hypertension comes to the gastroenterology outpatient clinic for examination because of chest pains that have been occurring for the past month. Since therapy, he is currently taking amlodipine and antacids as needed. He is otherwise healthy. He describes the chest pain as pressing or burning pain behind the sternum, radiating to the back, jaw and left arm. His vital signs and clinical status are unremarkable. What is the best first step in treating chest pain?. A. Esophagogastroduodenoscopy for evaluation of reflux esophagitis. B. Abdominal CT. C. Examination by a cardiologist. D. Esophageal manometry.

A 32-year-old woman is suing because of a 2-month-long feeling of early satiety after a meal. At the same time, he also has pain in the epigastrium, he feels very bloated. Antacids do almost nothing. He is being monitored by his physician for hypothyroidism, which is well controlled with current levothyroxine therapy. He also prescribed her 4 weeks of proton pump inhibitor therapy, which did not resolve the problems. She had a self-pay ultrasound of the abdomen, which showed several small gallstones in the upper right quadrant. She has already undergone a gastroscopy, which showed no deviations from normal, and a biopsy of the gastric and duodenal mucosa were also normal. Her grandfather died of colon cancer at the age of 76. What is the most likely diagnosis?. A. Irritable bowel syndrome. B. Functional dyspepsia. C. Chronic pancreatitis. D. Choledocholithiasis.

He was a 34-year-old patientacceptedondepartmentdue to 3 weekslastingpain in the epigastrium . It says that it was 1 week 3 days agolaxativesblackmud . It was donegastroscopy , where he wasvisible 2 cm largeulcerantrumstomach . By specifyingof antigens in the stool was provenH. pylori infection . He received eradicationtherapythe firstorder , after which there are problemscompletelygone out . After 4 weeksis comingoncontrol in the infirmary. Then it is necessary : A. Because he is a patient completely asymptomatic , further treatment it is not necessary. B.Patient will be submitted control sample mud to determine antigen against H. pylori. C. Patient needs control gastroscopy for evaluation healing ulcer and with drawal biopsies for control performance eradication of H. pylori. D.Patient should cancel inhibitor protonic pumps and in 2 weeks submits sample mud to determine antigen against H. pylori.

A 60-year-old patient is hospitalized on intense units because respiratory cancellations in the set difficult on going pneumonia . He is intubated and mechanically ventilated . After insertion nasogastric probes after it it flows smaller quantity cafes sediments similar liquids. Gastroscopy shows diffuse edematous and erythematous stomach mucosa with many shallow ones erosions along of the whole stomach . What is most likely the cause of the found changes?. A. H. pylori. B. Injury caused by insertion nasogastric probes. C. Stress gastritis. D. With medication induced gastritis.

A 50-year-old patient with known alcoholic liver cirrhosis, after several bleedings from large esophageal varices, is again brought to the IPP because of profuse hematemesis. On arrival he is hypotensive, anemic. The gentleman is adequately hemodynamically stabilized and an emergency gastroscopy is arranged. Which of the medicines should be administered before gastroscopy?. A. Somatostatin 250 mcg or terlipressin 2 g iv and broad spectrum antibiotic. B. Proton pump inhibitor. C. Norepinephrine 250 mcg iv. D. All of the above.

A 68-year-old woman comes to the IPP because of hematemesis and melena. It is about a lady who receives acetylsalicylic acid in therapy for primary preventive cardiovascular disease and Ibuprufen for knee pain, otherwise she has no associated diseases. On a PPI, he receives a bolus of a proton pump inhibitor (80 mg iv). Gastroscopically, a shallow stomach ulcer with a visible blood vessel was found, appropriate hemostasis was performed, and she was admitted to the Intensive Care Unit for observation. What is the most appropriate course of action?. A. Due to the severe pain in the knees, which, according to her, is not alleviated by other drugs, we are forced to continue the therapy with Ibuprufen, the acetylsalicylic acid is discontinued, and a proton pump inhibitor is prescribed in continuous infusion. B. We observe the lady for three days and discharge her home with the same medications, without the proton pump inhibitor due to the side effects it can cause when taking it for a long time. C. We prescribe a proton pump inhibitor in a continuous infusion for 72 hours, then switch to oral dosing. We check the indications for taking acetylsalicylic acid, if there are none, we discontinue it, otherwise we continue with it, we replace Ibuprufen with an analgesic that is not from the NSAID group. D. We prescribe a proton pump inhibitor in a continuous infusion for 72 hours, then switch to oral dosing. We check the indications for taking acetylsalicylic acid, if there are none, we discontinue it, otherwise we continue with it, we replace Ibuprufen with an analgesic that is not from the NSAID group, we take a stool sample to prove the Helicobacter pylori antigen, if it is positive, we treat the infection empirically.

A 68-year-old lady was brought to the IPP with an ambulance because of profuse hemohesia. He has known coronary heart disease, diabetes on oral therapy, hypertension and hyperlipidemia. In therapy, he receives antihypertensives, Aspirin 100 mg/day, metformin and a statin. On examination, she is afebrile, hypotensive (80/50 mmHg), tachycardic (125/min), the abdomen is soft and painless. In the laboratory, hemoglobin 80 g/L, the rest of the laboratory is within normal limits. After hemodynamic stabilization, an urgent gastroscopy is performed, which does not show the origin of the bleeding. After the gastroscopy, the patient begins to bleed profusely and develops a state of shock. Which investigation is most appropriate?. A. Urgent colonoscopy. B. Consultation with surgeons, referral to CTA and attempted embolization. C. Emergency surgery. D. Repeat gastroscopy.

A 55-year-old woman with fecal incontinence has a weaker anal sphincter on anorectal manometry, but no sensory deficits. What is the most appropriate treatment?. A. Surgical repair of the sphincter. B. Botox injection. C. 'Biofeedback' therapy. D. Colostomy.

A 50-year-old man, otherwise healthy, came for examination due to problems with flatulence lasting a year. He has to excuse himself and leave the room at work several times every day due to the discharge of strongly smelly winds. He has already tried eating a gluten-free diet and probiotic yogurts. He describes his eating habits: he eats a bowl of cereal with milk every morning, and only lean meat and vegetables for lunch and dinner. He had a colonoscopy done last year, the results were said to be normal. What is the most likely cause of his problems?. A. Lactose intolerance. B. Celiac disease. C. Functional flatulence. D. Sorbitol.

A 34-year-old female patient is being treated for gallstones. She underwent an abdominal ultrasound due to pain in the lower abdomen, which coincidentally revealed gallstones. He is being treated for arterial hypertension and dyslipidemia. She will receive new medication for high cholesterol. She is interested in the connection between high cholesterol and the formation of gallstones. An increase in which of the lipidogram parameters is associated with the formation of gallstones?. A. LDL. B. Triglyceride. C. HDL. D. Total cholesterol.

Choose the correct statements that apply to cholecystolithiasis: T1. it is usually asymptomatic and is discovered incidentally, T2. can lead to colic with obstructive jaundice, T3. we find it with ultrasound, T4. asymptomatic cholecystolithiasis is treated with surgery, T5. characteristic is the Courvoiser sign: a. T3, T4, T5. b. T2, T4, T5. c. T2, T3, T4. d. T1, T2, T3.

A 26-year-old woman is being examined in the clinic before an elective cholecystectomy for gallstones. Before surgery, she is concerned about the side effects of cholecystectomy. She has already looked up on the Internet that she may have problems with diarrhea after the operation. She is also interested in where the bile collects after the gallbladder is removed. Which of the following statements regarding bile acid collection and diarrhea after cholecystectomy is true?. A. Bile collects in the liver during fasting; diarrhea develops in a small number of patients. B. Bile collects in the bile ducts during fasting; some patients develop diarrhea that can treated with bile acid adsorbents. C. Bile collects in the small intestine during fasting; some patients develop diarrhea that can treated with bile acid substitutes. D. Bile collects in the small intestine during fasting; some patients develop diarrhea that can treated with bile acid adsorbents. E. Bile continuously flows into the duodenum; diarrhea is not the result of continuous secretion of bile.

A 76-year-old patient with hypertension and hypertriglyceridemia came to the PPI because of a 3-day history of pain under the right rib cage, nausea, vomiting, abdominal distention, and constipation. He denies fever or jaundice. Laboratory: Leukocytes 13x10^9; AST 1.07 ucat/L; ALT 0.95 ukat/L; Total bilirubin: 25.6 umol/L; alkaline phosphatase 2.67 ucat/L; lipase 1.34 ucat/L. Abdominal CT showed gallstones, aerobilia, and diffusely dilated small bowel loops. Based on the history and investigations, which complication of gallstones is most likely?. A. Acute biliary pancreatitis. B. Ileus of the small intestine (gallstone ileus). C. Paralytic ileus. D. Mirizzi syndrome.

What is considered acute cholangitis? T1. It is characterized by the Charcot triad (pain, fever and jaundice), T2. Thus, sepsis originating from the bile duct is called T3. He is treated with antibiotics and endoscopic intervention (ERCP), T4. It is a result of portal hypertension and liver cirrhosis, T5. patients are usually treated on an outpatient basis. a. T1, T4, T5. b. T2, T4, T5. c. T2, T3, T4. d. T1, T2, T5. e. T1, T2, T3.

A 24-year-old overweight patient presents to PPI for right upper quadrant pain lasting 4 hours. Vital signs: temperature 37.2C, pulse 98/min, RR 118/78 mmHg. On examination, icteric sclerae are observed. The abdomen is mildly painful on deep palpation in the right upper quadrant. Murphy's sign is negative. Laboratory: Leukocytes 9x10^9, ALT 6.8 uct/L, AST 10, uct/L, alkaline phosphatase 4.17 uct/L, total bilirubin 92 umol/L, lipase 0.4 uct/L. Cholecystolithiasis without cholecystitis is visible on ultrasound, the common bile duct measures 8 mm. He has less pain the next day. Control laboratory: ALT 5.9 ukat/L, AST 6.9, ukat/L, alkaline phosphatase 3.6 ukat/L, total bilirubin 90 umol/L. Which suggestion makes the most sense for the next step in the treatment of the patient?. A. ERCP. B. MRCP/EUZ. C. Abdominal CT. D. Laparoscopic cholecystectomy without cholangiography.

Which of the following statements regarding gallbladder cancer is correct?. A. The risk of gallbladder cancer is increased in patients with diffusely calcified gallbladder compared to a partially calcined gallbladder. B. Screening for gallbladder cancer is recommended in patients with primary sclerosing cholangitis. C. 50% of patients with gallbladder cancer do not have gallstones. D. There is a higher risk of developing gallbladder cancer with cholesterol stones than with pigmented.

A 70-year-old man with a history of several years of risky alcohol consumption suffers from severe pain in the epigastrium, which spreads in a band to the back. In the laboratory results, hemoglobin is 170 g/L, urea 10.2 mmol/L, triglycerides 7.2 mmol/L, AF 1.25 μkat/L, AST 0.56 μkat/L, ALT 1.2 μkat/L. Amylase, lipase 3 times above normal values. Abdominal X-ray shows the sentinel gyrus, and abdominal ultrasound shows diffuse parenchymal liver damage, cholecystolithiasis, normally wide bile ducts and a trace of free fluid next to the pancreas. What is the most likely diagnosis?. a) acute biliary pancreatitis. b) hyperlipemic pancreatitisMachine Translated by Google. c) alcoholic pancreatitis. d) decompensation of liver cirrhosis.

She had no fever or chills. The problems started six hours ago. Among associated diseases, he has known arterial hypertension, and has been taking perindopril for a long time. On examination, the abdomen is tense, and on deep palpation, the epigastrium is painful.A 35-year-old woman is examined in the emergency center because of nausea, vomiting, and epigastric pain. Vital signs on examination: TT 36.1 °C, heart rate 105/min, respiratory rate 15/min, blood pressure 120/65. Laboratory results: leukocytes 11 x 109 /L, hemoglobin 140 g/L, calcium 1.8 mmol/L, urea 9 mmol/L, bilirubin 74/56 μmol/L, AF 2.5 μkat/L, ALT 4.2 μkat/L, AST 3.5, amylase 30 μkat/L, lipase 45 μkat/L, CRP 10 mg. Abdominal ultrasound shows cholecystolithiasis and choledocholithiasis. Which is the most likely diagnosis: a) acute biliary pancreatitis. b) initial cholecystitis. c) cholangitis. d) hypercalcemic pancreatitis.

A 35-year-old woman who gave birth three months ago is sick with pain in the epigastrium, nausea and vomiting. The problems last for 6 hours. During the examination, he denies smoking, but says that he drinks a few beers on weekends. Vital signs: TT 38.3 °C, heart rate 110/min, respiratory rate 14/min, blood pressure 100/55 mmHg The abdomen is tense, painful on deep palpation in the epigastrium, percussion is tympanic. Laboratory values: leukocytes 14 x 109 /L, hemoglobin 150 g/L, lipase 8.3 μkat/L, AST 0.67, ALT 0.58 μkat/L, bilirubin 34/14 creatinine 70 μmol/L. Which of the investigations will you do first?. a) Abdominal CT with KS. b) MR with MRCP. c) Abdominal ultrasound. d) endoscopic ultrasound.

A 67-year-old man is brought by paramedics to the emergency center due to massive hematemesis. Recently , due to weight loss, he underwent a CT scan of the abdomen with KS, which showed a tumor formation in the body of the pancreas. The formation has a CT appearance of adenocarcinoma. The gentleman has been healthy until now. On arrival, his blood pressure is 90/50 mmHg, pulse 110/min, and respiratory rate 14/min. On clinical examination, you find that he has icteric sclera. The abdomen is sensitive to palpation in the epigastrium.D. pancreatico-duodenal. His laboratory values are as follows: hemoglobin 80 g/L, platelets 150 x 109 /L, leukocytes 11 x 109 /L. The patient is admitted to the intensive care unit. After hemodynamic stabilization, an emergency gastroscopy was performed. There is a lot of blood in the stomach, varicose veins are visible in the fundus of the stomach. The patient's condition is most likely the result of pressure on: A. superior mesenteric vein. B. inferior vena cava. C. splenic vein. D. pancreatico-duodenal artery. E. Left gastric artery.

A 60-year-old woman with a history of risky alcohol drinking has had epigastric pain for the past two days. The abdomen is sensitive to palpation in the epigastrium. In the laboratory, amylase and lipase are elevated more than three times the upper limit of normal, so make a diagnosis of acute pancreatitis. The patient is admitted to KO for gastroenterology, where they continue with aggressive hydration, IV English therapy and waiting period. Which of the following scorecards will help you identify patients at higher risk of in-hospital mortality in the first 12 hours after admission. Circle the incorrect answer. A. Ranson indices, age >55 years, L>16, Kslad >11, lactate>5, AST> 2. B. Bedside Index for Severity in Acute Pancreatitis (BISAP) (Urea <8.9, GCS <15, age >65 years. C. Glasgow-Blatchford scal. D. Hematocrit >44, elevated urea. E. Apache pointers greater than 8 points.

A 49-year-old woman is hospitalized for severe acute biliary pancreatitis. Five days after admission, she still has severe abdominal pain. The abdomen is distended and painful to palpation in the epigastrium. Vital signs: TT 37.8 °C, heart rate 95/min, respiratory rate 18/min, blood pressure 100/65 mmHg. Laboratory values: leukocytes 9 x 109 /L, AF 0.67 μkat/L, AST 1.67, ALT 0.67 μkat/L, lipase 5.8 μkat/L, bilirubin 26 μmol/L. Abdominal CT with KS shows necrosis of more than 50% of the pancreas without CT evidence of infection. Which of the measures is the most appropriate?. a) continuation of supportive treatment. b) the introduction of a broad-spectrum antibiotic. c) endoscopic necrosectomy. d) percutaneous drainage of necrosis. e) Immediate ERCP and splint insertion.

A 55-year-old patient suffers from severe pain in the epigastrium, which spreads to the back. Vomits brownish contents. He has known arterial hypertension and mixed hyperlipidemia, takes ramipril and atorvastatin and some nutritional supplements. He denies smoking and drinking alcohol. In the laboratory results, amylase 3.5 μkat/L, lipase 6 μkat/L, leukocytes 11 x 109 /L, hemoglobin 150 g/L, AF 0.67 μkat/L, AST 0.55 μkat/L, ALT 0, 67 μkat/L, bilirubin 16/8 μmol/L, triglycerides 65 mmol/L. Which is the most likely diagnosis: a) acute biliary pancreatitis. b) alcoholic pancreatitis. c) hyperlipemic pancreatitis. d) Pancreatitis caused by ramipril and dietary supplements.

A 60-year-old patient suddenly became ill with severe pain in the epigastrium, which reached its peak after an hour and radiated under both costal arches. She vomited at the same time. In laboratory results, amylase and lipase, aminotransferases and alkaline phosphatase were 3 times above normal values. Bilirubin was 2 times above the normal value. Leukocytosis was present, CRP was moderately elevated. An ultrasound showed gallstones. How will you act?. A. Glucosalone solutions more than 250 mL/hour are prescribed. B. Prescribe an antibiotic. C. We refer her for ERCP. D. Prescribe analgesics.

A 50-year-old patient with known gallstones is referred to the hospital for acute abdominal pain. In laboratory results, amylase and lipase, aminotransferases and alkaline phosphatase were 3 times above normal values. An ultrasound scan shows gallstones. Bilirubin was 2 times above the normal value. What is the most sensible next course of action: A. Endoscopic ultrasound to confirm choledocholithiasis. B. MRCP. C. Emergency cholecystectomy. D. Diagnostic endoscopic cholangiopancreatography (ERCP).