Abdominal Pain Pt 2

Question 1

Documenting Abnormal Findings

Answer 1

-Abd distended, obese, diminished bowel sounds

Question 2

Constipation

Answer 2

-Symptom not a disease!

Question 3

Rome Criteria

Answer 3

• GI symptoms that are GI nature with no evidence of organic disease
• Questionnaires aid in diagnosis

Question 4

Rome III Criteria

Answer 4

At lease 2 of the following over 3 months

• fewer than 3 bowels a week
• straining
• lumpy or hard stools
• sensation of incomplete defecation
• manual maneuvering required to defecate

Question 5

Bristol Stool Scale

Answer 5

-pt and doc can agree to look and feel of feces and passage of fecal matter
type 3 and 4 close to normal
type 1 and 2 are more likely constipation
Type 1: separate hard lumps-hard to pass
Type 2: sausage shaped lumpy
Type 3: sausage shaped with cracks on surface
Type 4: sausage or smooth
Type 5: soft blobs with clear cut edges, easy to pass
Type 6: fluffy pieces with ragged edges, mushy
Type 7: watery, no solid pieces

Question 6

Constipation Associated Symptoms

Answer 6

• rectal bleeding
• abdominal pain
• inability to pass flatus
• vomiting
• pain on defecation
• abdominal bloating

Question 7

Constipation Pelvic Exam for Females

Answer 7

-palpate posterior vaginal wall at rest and while straining to check internal prolapse

Question 8

Constipation Anorectal Exam

Answer 8

• perianal excoriation
• skin tags/hemorrhoids
• anal fissure
• anorectal masses
• prolapse during straining
• tone of anal sphincter
• presence of gross blood

Question 9

Lifestyle Modifications for Constipation

Answer 9

• increase fiber and water
• use bathroom when have urge
• increase exercise
• squatty potty 35 degree angle

Question 10

Diarrhea versus Gastroenteritis

Answer 10

Diarrhea
-universal definition doesnt exist
-can reach epidemic
Gastroenteritis
-nonspecific term, primary manifestation is diarrhea but nausea, vomit, abdominal pain can accompany
-"Stomach flu"

Question 11

Gastroenteritis Etiology

Answer 11

-infection
-viral 50-70%
-bacterial 15-20%
-parasitic 10-15%
food born toxigenic
drug associated

Question 12

Viral Gastroenteritis

1. Norovirus
2. Rotavirus

Answer 12

1. Norovirus
   - sudden onset uncontrolled vomitting 12-48 hrs after exposure
   - more vomit than diarrhea
   - resolves in 36 hrs
2. Rotavirus
   - immunized by 5
   - leads to severe dehydration

Question 13

Bacterial Gastroenteritis

1. Salmonella
2. Difficile
3. Ecoli

Answer 13

1. Salmonella
   - eating contaminated
   - onset 12-36 hrs after eating
2. Difficile
   - most common hospital acquired GI
   - exposure to antibiotics
3. Ecoli
   - food, water, person to person transmission
   - traveler’s diarrhea: starts within 5 days, lasts 2 wks

Question 14

Parasitic Gastroenteritis

1. Giardia

Answer 14

• causes diarrhea, bloating, cramping

- transmission: person to person, animal to human through fecal oral route, infected H20

Question 15

Diarrhea: drug associated

Answer 15

• Antibiotics
• laxatives
• colchicin
• quinidine
• Sorbitol
• PPIs

Question 16

IBS

Answer 16

-NOT IBD
Manifestations: altered bowel habits, abdominal pain & bloating
-alteration bw constipation and diarrhea, intractability to laxatives
-defecation only improves abdominal pain

Question 17

Associated symptoms for Diarrhea

Answer 17

• nausea
• vomiting
• abdominal cramping
• abdominal bloating
• fever

Question 18

Osteopathic Considerations for Constipation

Answer 18

• Mesenteric Release

- Ganglion Inhibition