41: GI Primary Care - Kolbinger Flashcards
order of PE in GI
auscultation
percussion
palpation
unpleasant sensation of being about to vomit
nausea
forceful expulsion of gastric contents
vomiting
absence of expulsion of gastric contentnt
retching
return of esophageal contents to the hypopharynx w ith little effort
regurgitation
heartburn, regurgitation and dysphagia, laryngitis and chronic cough
reflux
abdominal pain with vomiting
often an organic etiology (cholelithiasis)
abdominal distension and tenderness
suggest bowel obstruction
vomiting of food eaten several hrs earlier
think of a possible gastric obstruction
heartburn and nausea
GERD
early AM vomiting
pregnancy
neurogenic vomiting
may be positional or projectile
cullen’s sign
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
grey turner’s sign
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
kehr sign
abdominal pain radiating to the l. shoulder
classic for pain associated with an insult to the spleen
costovertebral angle tenderness (Lloyd’s sign)
pain is usually in the region of the 12th rib
caused by kidney problem
peritoneal signs
obturatior, iliopsoas, rebound, hell jar test, rovsing’s sign, dont forget the hx
ulcerative colitis vs. crohn’s disease
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
possible causes of gi bleeding
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
neuropathic v. nociceptive pain
from abnormal neural activity
originating in damaged tissues outside the nervous system (visceral pain)
s/s peritonitis
look sick, lie very still, abdominal wall rigidity, diminished bowel sounds
pain with an
pain might be…
RUQ
epigastirc
Upper abdominal pain
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
left sided pain?
diverticulitis
pain out of proportion to physical findings suspect…
acute mesenteric ischemia or infarction
