41: GI Primary Care - Kolbinger

Question 1

order of PE in GI

Answer 1

auscultation
percussion
palpation

Question 2

unpleasant sensation of being about to vomit

Answer 2

nausea

Question 3

forceful expulsion of gastric contents

Answer 3

vomiting

Question 4

absence of expulsion of gastric contentnt

Answer 4

retching

Question 5

return of esophageal contents to the hypopharynx w ith little effort

Answer 5

regurgitation

Question 6

heartburn, regurgitation and dysphagia, laryngitis and chronic cough

Answer 6

reflux

Question 7

abdominal pain with vomiting

Answer 7

often an organic etiology (cholelithiasis)

Question 8

abdominal distension and tenderness

Answer 8

suggest bowel obstruction

Question 9

vomiting of food eaten several hrs earlier

Answer 9

think of a possible gastric obstruction

Question 10

heartburn and nausea

Answer 10

GERD

Question 11

early AM vomiting

Answer 11

pregnancy

Question 12

neurogenic vomiting

Answer 12

may be positional or projectile

Question 13

cullen’s sign

Answer 13

sign of subcutaneous intraperitoneal bleed, usually from acute hemorrhagic pancreatitis - ruptured ectopic pregnancy, a periumbilical ecchymosis

Cullen’s sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus

Question 14

grey turner’s sign

Answer 14

a bilateral reddish - purplish discoloration of the flanks - hemorrhagic pancreatitis

Grey Turner’s sign refers to bruising of the flanks, the part of the body between the last rib and the top of the hip

Question 15

kehr sign

Answer 15

abdominal pain radiating to the l. shoulder

classic for pain associated with an insult to the spleen

Question 16

costovertebral angle tenderness (Lloyd’s sign)

Answer 16

pain is usually in the region of the 12th rib

caused by kidney problem

Question 17

peritoneal signs

Answer 17

obturatior, iliopsoas, rebound, hell jar test, rovsing’s sign, dont forget the hx

Question 18

ulcerative colitis vs. crohn’s disease

Answer 18

UC: recurring episodes of inflammation limited to the mucosal layer of colon
s/s = diarrhea with blood, frequent small volume bowel movements, colicky abdominal pain, urgency, tenesmus and incontinence

Crohns: transmural inflammation of GI tract - 80% of pts have small bowel involvement
s/s = fatigue, prolonged diarrhea with abdominal pain, weight loss, fever, with or without gross bleeding
fib

Question 19

possible causes of gi bleeding

Answer 19

20-30% have a colorectal source

29-56% have a upper GI souce

29-52% no source founds

a small bowel source is likely with recurrent bleeding and negative findings on EGD and colonoscopy studies

Question 20

neuropathic v. nociceptive pain

Answer 20

from abnormal neural activity

originating in damaged tissues outside the nervous system (visceral pain)

Question 21

s/s peritonitis

Answer 21

look sick, lie very still, abdominal wall rigidity, diminished bowel sounds

pain with an

Question 22

pain might be…

RUQ

epigastirc

Upper abdominal pain

Answer 22

liver of biliary tree, pain may radiate to the back, liver capsule needs to be stretched for pain, viral drug induced hepatitis

sudden onset think of pancreatitis esp. with pain in back, dysepsia, ulcers, GERD

cardiac, pneumonia, PE, emphyzema

Question 23

left sided pain?

Answer 23

diverticulitis

Question 24

pain out of proportion to physical findings suspect…

Answer 24

acute mesenteric ischemia or infarction