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Differential Diagnosis > 3] GI, Hepatic And Biliary System > Flashcards

3] GI, Hepatic And Biliary System Flashcards

1
Q

GI disease can also appear to be

A

MSK disease

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2
Q

What is GI disease?

A

Ulceration of mucosal lining of GI tract

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3
Q

Primary GI pain pattern

A

Epigastric
Periumbilical
Lower abdomen (hypogastric)

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4
Q

What’s th epigastric region

A

Midsternum to xiphoid process

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5
Q

Where does pain in epigastric regions adiare

A

Around ribs or straight through chest

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6
Q

Structures in the epigastric region

A

Stomach
Esophagus
Duodenum
Pancreas

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7
Q

Innervation of epigastric region

A

T3-T5 sympathetic

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8
Q

DDx of epigastric region

A

HEart
Liver
Gallbladder

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9
Q

Structures in periumbilical region

A

Small intestine
Pancreas
Appendix
Proximal colon

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10
Q

Innervation of periumbilical region

A

T9 - T 11 sympathetic

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11
Q

Lower ab region structures

A

Large intestine

Colon

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12
Q

Innervation of Lower ab

A

T10 - L 2 sympathetic

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13
Q

DDx for lower ab region

A

Bladder

Uterus

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14
Q

Dermatomes associated with nerve roots innervating organs

A

Referred GI pain

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15
Q

Associated signs and sx for GI

A

Melena
Dysphagia
Etc

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16
Q

NMS signs and Sx

A

Paresthesias in UE, B&B signs, etc

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17
Q

Primary pain pattern for GI

A

Epigastric
Periumbilical
Lower ab
Chest

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18
Q

Referred pain pattern

A

Dermatomes of nerve roots associated with levels innervating diseased organs OR those having pressure/tension applied to them

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19
Q

Mid back, low back, shoulder, peri-scapular

A

Referred pain pattern for GI disease

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20
Q

With the GI system there is referred pain to…

A

MS system at the same level

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21
Q

Quality of visceral pain

A 
Deep ache
Boring
Burning
Cramping
Gnawing
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22
Q

Associated signs and symptoms with GI

A

Dysphagia
Odynophagia
Bleeding (melena)

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23
Q

What is the Kehrs sign

A

Referred pain when you place pressure on upper abdomen

24
Q

3 special tests for appendicitis

A

Rebound tenderness
Rovsings sign
Pinch an inch test

25
Q

Rebound tenderness

A

Pain happens after you let go.

RLQ

26
Q

Rovsings sign

A

+ is palpation of the LLQ of abs increases the pain felt in the RLQ

27
Q

Pinch an inch test

A

McBurney’s point

+ pain with release

28
Q

What is McBurney’s point

A

1/3 from ASIS to umbilical (where appendix is)

29
Q

Possible extension of infection into peritoneum, kidneys, lumbar IVD or vertebra

A

Iliopsoas abscess

30
Q

4 tests for Iliopsoas abscess

A

Heel tap
Hop test
Iliopsoas uscle test- active SLR
Palpation at appendix

31
Q

3rd most common CA

A

Colorectal cancer

32
Q

Colorectal cancer is more common in?

A

Males

Older age

33
Q

Action of NSAIDs

A

Analgesic, anti-inflammatory, antipyretic, antithrombotic

34
Q

Adverse drug reaction of NSAIDs

A

GI bleed, may lead to death

35
Q

Other adverse rxns of NSAIDs

A 
Renal toxicity
Increased BP
CNS problems 
Hepatoxicity 
CV
36
Q

Signs and Sx of using NSAIDS

A

Indigestion
Increased BP
Tinnitus

37
Q

Risk factors of NSAID induced gastric ulceration

A

More than 65 years

Corticosteroid, anticoagulant, antidepressant use

38
Q

Hepatic means

A

Liver

39
Q

Innervation of liver

A

T5 - T 11 ANS

40
Q

Primary location

A

Midepigastrium or RUQ

41
Q

Referred pain location of hepatic disease

A

T7-T10

R shoulder and upper trap

42
Q

1 cause of sudden liver failure in the USA

A

Non-viral drug induced hepatitis

43
Q

Innervation of gall bladder for biliary disease

A

T5-T11 ANS

44
Q

Location of bile duct/gallbladder

A

RUQ

45
Q

Referred pain of biliary disease or gallbladder

A 
R shoulder, upper trap
R interscapular (T4-T8) and R subscap
46
Q

Cholelithiasis

A

Presence or formation of gall stones

47
Q

Blockage or cystic duct by gallstones

A

Cholecystitis

48
Q

Additional Sx of hepatic and biliary disease

A

Rhabdomyolysis
Joint aches
NM Sx

49
Q

Liver flap

A

Asterixis

50
Q

How do you do asterixis?

A

Pt raises arm to 90 flex, elbows ext and forearms pronated —> add wrist ext with finger ext and ABD and observe for any large amplitude tremors at the wrist (flapping)

51
Q

Signs of hepatic and biliary disease

A

Skin and nail changes, asterixis, referred shoulder pain, ascites, cholecystitis test

52
Q

Gallbladder special test

A

Murphys sign

53
Q

What does Murphy’s sign indicate

A

Cholecystitis

54
Q

How do you perform Murphy’s sign?

A

Hook fingers under lower R costal border. Ask pt to take a deep breath in, palpate liver and ask about pain while watching the face

55
Q

Risk factors for ADRs

A 
More than 65 years old
Polypharmacy
Hyperpharmacotherapy
Alcohol
Small
Women

Differential Diagnosis (7 decks)

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