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NPTE Study > 4.3 - PPT GI System & Electrolytes > Flashcards

4.3 - PPT GI System & Electrolytes Flashcards

Week 4, Wednesday

1
Q

Which of the following exercises in MOST likely to cause a worsening of symptoms of a umbilical hernia?

Abdominal crunches
BIL shoulder flexion
Deep diaphragmatic breathing
Seated knee extension

A

Abdominal crunches

AVOID strong abdominal contractions & Valsalva maneuver w/ any hernia

“umbilical” = belly button

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2
Q

A patient is receiving chemotherapy to treat metastatic bone cancer. What type of room would the patient be placed in? Why?

Positive-pressure room
Negative-pressure room

A

Positive-pressure room

Increased air pressure in room than outside
When door opens –> air is pushed out of the room

Reduces chances of air from outside (that contains pathogens, etc.) from entering the room

Because patient is likely immunocompromised, would want to decrease risk of infection

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3
Q

Describe the common GI symptoms

A

Nausea
Vomiting
Diarrhea
Constipation
Heartburn
Abdominal pain

Anorexia - decreased appetite
Cachexia - muscle wasting

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4
Q

Describe each of the following types of GI bleeds and their potential sources

Coffee-ground emesis
Hematemesis
Melena
Hematochezia

A

Coffee-ground emesis - blood that has been in contact w/ stomach acid
- Ex: Peptic ulcer

Hematemesis (“bloody vomit”) - vomiting of bright red blood
- Ingested blood (ex: nose bleed)

Melena - black, tarry stools
- Upper GI bleed

Hematochezia - maroon-colored stools; bleeding from rectum
- Lower GI bleed

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5
Q

Define emesis

A

Vomiting

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6
Q

What are some of the major causes of upper GI tract bleeding?

A

Trauma
NSAID’s
Peptic ulcers
Chronic alcohol abuse

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7
Q

What are some indicators of GI bleeding?

A

Low Hb
Low Hct
Positive fecal blood test

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8
Q

Describe how food can affect symptoms of the following:

Gastric ulcers
Duodenal ulcers

A

Gastric ulcers
- Pain begins w/in 30-90 min after eating

Duodenal uclers
- Pain begins 2-4 hours after eating
- Food could relieve pain (it is unclear why)

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9
Q

Describe what viscera commonly refer to the following areas:

Epigastric
Periumbilical
Hypogastrium

A

Epigastric:
- Esophagus
- Heart
- Stomach
- Duodenum
- Liver
- Pancreas

Periumbilical
- Pancreas
- Small intestine
- Appendix
- Proximal colon

Hypogastrium
- Large intestine
- Colon
- Bladder
- Uterus

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10
Q

Describe the common referral pattern for each of the following

Esophagus
Stomach/duodenum
Liver / gallbladder
Small intestine
Appendix
Pancreas
Large intestine / colon

A

Esophagus - epigastric
Stomach/duodenum - epigastric, R shoulder
Liver / gallbladder - RUQ, R shoulder
Small intestine - periumbilical
Appendix - RLQ
Pancreas - LUQ; L shoulder
Large intestine / colon - hypogastric

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11
Q

Describe GERD

Clinical Presentation
Clinical considerations

A

GERD - reflux of stomach acid beyond the lower esophageal sphincter back into the esophagus

Clinical Presentation:
- heartburn (epigastric pain)
AGG: eating certain foods, lying supine, bending forward, belching
ALLEV: antacids, sitting upright, L sidelying

Clinical Considerations:
- Avoid exercise that involve lying supine or bending over
- Avoid Valsalva maneuver
- L sidelying can be helpful due to curve of lower esophagus
- Schedule PT before meals or at least 90 minutes after eating

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12
Q

Describe hiatal hernia

Clinical Presentation
Risk Factors
Clinical Considerations

A

Hiatal hernia - herniation of the upper portion of the stomach beyond the opening in the diaphragm

Clinical Presentation:
- Similar presentation as GERD (heartburn 30-60 min after meal)

Risk Factors:
- Anything that weakens the diaphragm
- Increased in intra-abdominal pressure

Clinical Considerations:
- Avoid supine, Valsalva maneuver, or exercises that increase intra-abdominal pressure
- May require surgery

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13
Q

Describe gastritis

Common causes

A

Gastritis - inflammation of the gastric (stomach) lining

Common Causes:
- NSAIDs
- Stress induced
- Infection

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14
Q

Describe Peptic Ulcer

Cause
Clinical Presentation
Treatment

A

Peptic ulcer - ulcer in the gastric (stomach) lining
- Breakdown in mucosal lining of stomach, exposing submucosal areas to gastric secretions

Cause:
- Heliobacter pylori (H. pylori) (90% of ulcers)
- Chronic NSAID use
- Increasing age

Clinical Presentation:
- Referred pain: midthoracic back, epigastric region, R shoulder
- Burning pain
- Symptoms WORSE on an EMPTY STOMACH
- Flare-ups at night are common
- Sx may come and go for few days to weeks
- Coffee-ground emesis

Treatment:
- ABX for H. pylori
- Reduce level of acid (histamine blockers, PPIs, antacids)

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15
Q

Describe Crohn’s disease

Pathophysiology
Clinical Presentation
Potential Complications

A

Crohn’s disease - inflammatory bowel disease

Clinical Presentation:
- Remissions & exacerbations of s/sx
- Abdominal pain
- Diarrhea
- Weight loss
- Arthralgias

Potential Complications:
- Bowel obstruction
- Ulcers
- Malnutrition
- Increased risk of colon CA

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16
Q

What are the 2 subtypes of IBD? Describe each

A

Crohn’s disease
- Inflammation occurs DISCONTINUOUSLY; often in lower part of small intestine or colon; involves ALL bowel layers

Ulcerative colitis
- Inflammation occurs UNIFORMLY beginning in rectum, extends proximally and abruptly stops; involves MUCOSA & SUBMUCOSA layers

17
Q

Describe the treatment for IBD

A

Treatment directed toward reducing inflammation
- Anti-inflammatories, immune system suppressors

CD: INCURABLE, chronic, debilitating; periodic remission & exacerbations; may require surgery to address complications

UC: CURABLE - colon resection

18
Q

Describe IBS

Clinical Presentation
Treatment

A

IBS - collection of s/sx that are NOT attributed to an identifiable bowel abnormality; a functional GI disorder

Clinical Presentation:
- Abdominal pain / cramping
- Diarrhea
- Constipation
- Bloated feeling
- Flatulence

Treatment: focus is on symptom relief
- Drugs - antidiarrheal, antispasmodics
- Lifestyle changes - diet (fiber, probiotics); stress reduction

19
Q

Describe peritonitis

A

Inflammation of the walls of the abdominal cavity (peritoneum)

20
Q

Define a hernia

What are the most common types of hernias?
Describe reducible vs irreducible vs strangulated
Clinical Presentation

A

Hernia - bowel pushes through weakened abdominal wall

Common types:
- Inguinal (most common)
- Femoral
- Umbilical
- Incisional
- (Hiatal)

Reducible - contents can be replaced back into the abdominal cavity w/ manual manipulation
Irreducible - cannot be replaced by manipulation
Strangulated - protruding organ is constricted to the extent that circulation is impaired (EMERGENT referral!)

Clinical Presentation:
- Intermittent or persistent bulge
- Bulge increases w/ increases in intra-abdominal pressure

21
Q

Describe the s/sx of a strangulated hernia

A

Persistent pain
Systemic signs - vomiting, fever, tachycardia

22
Q

Describe the following types of hernias

Inguinal
Femoral
Umbilical

A

Indirect Inguinal - herniation through inguinal ring
- May protrude into scrotum

Direct inguinal - herniation above inguinal ligament

Femoral - herniation through enlarged femoral ring / canal
- More common in multiparous women
- High risk of becoming irreducible and strangulated

Umbilical

23
Q

Describe diverticulitis

Clinical presentation
Clinical considerations

A

Diverticula - small pouches in wall of colon
Diverticulitis - inflammation of diverticula

Diverticuli fill w/ stagnant fecal material leading to infection & inflammation

Clinical Presentation:
- Severe pain
- Abrupt onset
- LLQ pain
- Pain steadily worsening over time
- Fever, n/v, constipation

Clinical Considerations:
- Daily exs moves bowels!
- Avoid exercises that increase intraabdominal pressure

24
Q

Describe appendicitis

Clinical Presentation
Special Tests
Clinical considerations
Treatment

A

Appendicitis - inflammation of the appendix (tube that connects to the end of the cecum)

Clinical Presentation:
- Peak incidence 15-20 yrs
- RLQ PAIN
- Migration of pain from periumbilical area to RLQ
- Nausea, vomiting
- Symptoms progress in <48 hrs typically

Special Tests
- McBurney’s point
- Rebound tenderness
- Iliopsoas test

If appendicitis is suspected –> emergent referral
- Instruct patient not to eat / drink in case of surgery

Treatment:
- Appendectomy (removal of appendix)
- Preop ABX

25
Q

Colorectal Cancer

How common is it?
Clinical Presentation

A

3rd most common CA in USA

Clinical Presentation:
- May be asymptomatic
- CHANGE in bowel habits (diarrhea, constipation, narrow stools)
- Blood in stool - melena or frank blood
- Bloating, fullness, cramps
- Unintended weight loss
- Fatigue

26
Q

Pancreatitis

Risk Factors
Pathogenesis
Clinical Presentation
Clinical considerations - position of comfort?

A

Risk factors:
- Heavy alcohol use
Gallstones

Alcohol –> increased permeability of ducts –> causes digestive enzymes to be released sooner into pancreatic tissue

Gallstones –> lodge & obstruct pancreatic duct –> back up of enzymes into pancreatic tissue

Clinical Presentation:
- , Mid-epigastric & LUQ pain, L SHOULDER pain
- CONSTANT & SEVERE pain (hours to days)
- AGG: eating, alcohol intake, walking, lying supine (EVERYTHING LOL)
- Bluish discoloration of abdomen
- Tachycardia
- Fever, n/v

Position of Comfort: bending forward in sitting; L sidelying fetal position

27
Q

Define steatorrhea

A

Excessive amounts of fat in feces

28
Q

Describe how the liver affects each of the following body systems

GI
Integumentary
Hepatic
MSK
Neurologic

A

GI
- sense of fullness
- Anorexia
- n/v

Integumentary
- Jaundice
- Spider angioma
- Pallor, bruising

Hepatic:
- Dark urine
- Light / gray-colored stool (not producing bile)
- Ascites

MSK
- R shoulder pain
- Rhabdomyolysis

Neurologic
- Confusion, sleep disturbances
- BIL tarsal tunnel syndrome & carpal tunnel syndrome

29
Q

Define ascites

A

Abnormal accumulation of fluid in the peritoneal cavity

30
Q

Describe potential viscera sources of pain in each of the abdominal quadrants

A

RUQ: Liver, gallbladder
LUQ: spleen, pancreas, stomach
RLQ: appendix, psoas, ascending colon
LLQ: descending colon, sigmoid colon

31
Q

Describe how to identify a psoas abscess

A

RLQ pain
Pain w/ active hip flexion; passive hip extension of involved side

“Psoas Sign” - L sidelying, move hip passively into extension
- typically used for appendicitis

32
Q

A patient reports RLQ pain taht is exacerbated with stair climbing. Which special test is likely to reproduce the symptoms?

Psoas sign
Scour test
SLR test
Thompson test

A

Psoas sign

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