Abdo pain and diarrhea high yield

Question 1

____ is the principal signal in the ENS

Answer 1

Mechanical stretch

Question 2

C fibers are ____ and mainly responsible for; A delta fibers are ____ and responsible for

Answer 2

unmyelinated; transmission of visceral sensation;

small and myelinated, parietal pain transmission

Question 3

Descending fibers modulating pain are

Answer 3

predominantly inhibitory; can project on dorsal horn and modify or control the afferent input from the gut

Question 4

Referred pain:

Answer 4

visceral afferent neurons and somatic afferent neurons converge on second order neurons in spinal cord (central convergence)

Question 5

Hyperalgesia and allodynia come about from; hyperalgesia often accompanied by

Answer 5

sensitization of secondary neurons from chronic visceral impulses;
spasm

Question 6

Kehr’s sign:

Answer 6

subdiaphragmatic irritation-ipsilateral shoulder or supraclavicular pain

Question 7

Carnett Test:

Answer 7

Ask patient to raise head and tense the abdo musculature; if greater tenderness on repeat palpation, test is positive and suggests abdo wall pathology

Question 8

Hypoactive/absent bowel sounds are;

Hyperactive is

Answer 8

peritonitis;

enteritis, colitis, early part of obstruction

Question 9

Peptic ulcer:

Answer 9

1. epigastric, can radiate to BACK
2. gnawing, burning
3. gastric: food can aggravate it
4. duodenal: nocturnal, relieved by eating

Question 10

Pancreatitis:

Answer 10

1. epigastric, can radiate to back
2. deep boring, severe, longer lasting than peptic ulcer
3. meals aggravate
4. relived by sitting UPRIGHT
5. N/V usually positive

Question 11

Obstruction of hollow viscera described as

Answer 11

colicky pain (small bowel obstruction either supra or periumbilical; chronic obstruction infraumbilical with lumbar rad)

Question 12

Intestinal angia:

Answer 12

1. post prandial (not enough blood flow to meet mesenteric visceral demands)
2. sitophobia (aversion to food)
3. tenesmus
4. frequent and often painful inclination to evacuate bowels with feeling of incomplete evacuation

Question 13

Biliary pain:

Answer 13

referred pain in right infrascapular region; (Boa’s sign with hyperesthesia in right infrascapular region) with ongoing inflamm, becomes more localized in RUQ;
acute cholecystitis with pos Murphy’s sign

Question 14

Hepatic pain can be caused by; splenic pain can be caused by

Answer 14

stretching of Glisson capsule;

stretching of capsule or splenic infarct (sickle cell)

Question 15

Appendicitis:

Answer 15

symptoms are pain, anorexia, nausea, tenderness (PANT); initially periumbilical and then becomes more localized in RLQ

Question 16

In young female with acute abdo pain;

with upper abdo pain,

Answer 16

rule out ectopic pregnancy;

keep cardiac and respiratory differentials in mind

Question 17

Median arcuate ligament syndrome (MALS)/Celiac artery compression syndrome

Answer 17

Here, ligament is anterior, leading to compression and irritation of celiac ganglion;
bruit in epigastric region and can have pain after eating

Question 18

IBS:

Answer 18

recurrent abdo pain or discomfort greater than 3 days/mo in last 3 mos with 2 or more of improvement with defecation, onset associated with change in frequency/form of stool

Question 19

Thera approach for abdo pain:

Answer 19

opiates, NSAIDs, topical like lidocaine patch or injections;

TCA’s, anticonvulsants, baclofen

Question 20

Secretion occurs primarily in; absorption in

Answer 20

crypts;

apical epi cells

Question 21

Two key components in colon ion transport mechs:

Answer 21

electroneutral NaCl absorption, and electrogenic Na absorption

Question 22

Short chain fatty acids absorbed in colon by

Answer 22

diffusion or anion exchange; BUTYRATE the preferred energy source for colonocytes

Question 23

Some NT’s released by enteric neurons:

Answer 23

VIP and ACh (both can stim epi cells to secrete Cl)

Question 24

Acute diarrhea is; chronic diarrhea is

Answer 24

less than 4 wks; greater than 4 weeks (if chronic, unlikely infectious)

Question 25

Osmotic diarrhea:

Answer 25

Increased osmotic load, no component of increased secretion; think maldigestion and malabsorption syndromes with no nocturnal episodes

Question 26

What two numbers can tell you secretory vs. osmotic diarrhea?

Answer 26

Sec: stool osmolar gap less than 50, stool Na over 90; could see nocturnal episodes
Osmotic: over 125, less than 60

Question 27

Two examples of osmotic diarrhea; also includes:

Answer 27

1. Cholestasis
2. Pancreatic insufficiency;
   celiac disease, lactose intolerance, infections;
   lactulose, miralax, acarbose, colchicine, PEG

Question 28

Intestinal secretory mechs:

Answer 28

Electroneutral: Cl/bicarb exchanger at apical membrane;
electrogenic mech: through CFTR channels;
bicarb secretion most prominent at prox duodenum

Question 29

Bile salt diarrhea induces

Answer 29

secretory diarrhea, or fat malabsorption and steatorrhea (former with normal serum bile acids and high fecal bile acids; latter with low serum bile acids and low fecal bile acids, with stool having fat)

Question 30

What can cause secretory diarrhea?

Answer 30

Lubiprostone (activates Cl channel), linaclotide (cGMP mediated activation of CFTR channels)

Question 31

Inflamm diarrhea:

Answer 31

secretion/reabsorption balance affected (toxin-mediated with cytotoxins with abdo pain and can be watery with occasionally bloody diarrhea, enteroadherent, invasive)

Question 32

V cholera with

Answer 32

cAMP mediated toxin action (increases Cl channel secretion)

Question 33

Enterohemorrhagic E coli: what is contraindicated?

Answer 33

Antibiotics

Question 34

Spurious diarrhea

Answer 34

most common cause of diarrhea in practice

Question 35

For treatment of diarrhea, think

Answer 35

rehydration as the priority (oral as good as IV);
maybe antimotility agents like loperamide (opiate with high first pass effect);
adsorbents like bismuth that can bind enterotoxins;
antibiotics shouldn’t be used with EHEC