Acute GI Flashcards
Appendicitis Types
Acute appendicitis is described as simple, gangrenous, or perforated on the basis of operative findings. In simple appendicitis, the appendix is viable and intact. Gangrenous appendicitis is characterized by necrosis of the appendiceal wall. Perforated appendicitis refers to disruption of the appendix.
Appendicitis Symptoms
Initial epigastric / umbilical pain that migrates to RLQ (McBurney’s point)
Abd rigidity comes later, rebound tenderness may occur
Anorexia, fever, elevated WBC may occur
CT scan or Ultrasound needed to confirm
Treatment is surgical, perioperative antibiotics (cephalosporin or flagyl)
Most common cause of N/V
Uncomplicated viral gastroenteritis (without metabolic imbalance or dehydration) can be managed with nonpharmacologic interventions including increased fluid intake and diet restrictions. A clear liquid diet should be followed for 24 hours, followed by 24 hours of the BRAT (banana, rice, applesauce, and toast) diet. This regimen will provide the bowel with sufficient rest. A bland diet may be necessary the following week if the patient is still symptomatic.
Small Bowel Obstruction
Common cause of acute abdominal pain - Partial or complete or paralytic ileus
Fluids, gas, accumulate and cause N/V, pain, eventual vascular compromise
Abd pain often intermittent and crampy, N/V, abdomen distension, fever, hypoactive bowel
Exclude other causes. Xray may show SBO but CT scan better
Markle Test
Stand on tip toes and drop heels down hard. Pain = appendicitis or perotonitis
Obturator Test
Supine, knes at 90 degrees with foot on bed. Rotate hip = pain then appendicitis or abscess
Psoas Test
Place patient on left side, flex right thigh. Pain = positive for perotonitis
Rovsing Test
Palpating left lower abdomen causes pain in right lower abdomen
Suggestive of appendicitis or peritonitis
Murphy Sign
Place hand on right costal margin and have patient take deep breath. Apply slight pressure. Pain or halting breaths is positive and suggests cholecystitis
Vomit Types
Fecal = small bowel obstruction
Gastric liquid = peptic ulcer
Coffee grounds = duodenal ulcer
Parietal Pain
Steady, sharp, knife-like
Increases with cough, movement
AAA, Appendix, Diverticulitis, Perotonitis, Gallbladder, Pancreas
Visceral Pain
Dull, poorly localized, crampy, burning
Mesenteric ischemia, spleen, pancreas, kidney, gastroenteritis, small bowel obstruction
Constipation Red Flags
Refer if sudden change in bowel habits, patient is older than 50, weight loss, bloody stool, family history of colon cancer or IBS
Hemorrhoids
External = below dentate line, Internal = above dentate
1-4th degree classifications
3rd degree are prolapsed during defecation, 4th degree permeant prolapse and require referral
Treat 1-3 with high fiber, stool softeners (refer if no improvement)
Anal Fissures
Most occur due to hard/large stool
Atypical or suspicious - suspect STI
Severe sharp rectal pain during and after bowel movements, minute bleeding
Treat with fiber, stool softeners
Pruritus Ani
Anal itching, most often idiopathic, usually worse at night
Cellophane tape to check for pinworms
Treat with 1% hydrocortisone cream and antihistamines
Anorectal Abscess / Fistula
Infection from obstruction of anal gland, fistula can result from chronic
Perineal pain, swelling increasing with movement/sitting, purulent drainage
Requires I&D, antibiotics
Causes of Pancreatitis
Alcohol Autoimmune Blunt trauma, biliary obstruction CongenitalDrugs Formations / Tumors Cholesterol Infectious Idiopathic
Pancreatitis Types
Mild = no organ dysfunction
Moderate severe = transient dysfunction / systemic complications
Severe = persistent organ failure
Interstitial edematous (enhanced on CT) or Necrotizing (non-enhanced on CT)
Pancreatitis Symptoms
sudden sharp poorly localized abd pain radiates to back
N/V
Pain so severe that deep breaths are difficult
Elevated serum amylase / lipase (lipase 3x more than normal is highly suggestive)
CT scan (x-ray to rule out other abdominal)
-Always rule out cardiac first!
Chronic Pancreatitis
amylase and lipase may be normal
morphologic and histologic changes resulting in endocrine and exocrine dysfunction
Pain occurs within 15 min of eating, greasy stool
Secretion test for diagnosis, patients are often chronic alcohol users
Cholecystitis
Biliary colic
RUQ pain radiating to right shoulder within an hour of eating
Cholecystitis = pain doesn’t taper and fever, chills, anorexia while cholelithiasis pain tapers off
Treat with fluids, antiemetics, antibiotics, antispasmodics (Ketorolac is analgesia of choice)
Surgical removal may be indicated
Cholelithiasis
3 types of stones
- Cholesterol
- Pigmented (bilirubin)
- Mixed
RUQ pain radiating to back that tapers off
Diarrhea Types
Osmotic - Water and salt is drawn into colon
Secretory - absorptive function of gut is compromised, fatty stools more common, can occur with long term use of levadopa
Diarrhea Assessment
Stool habits, frequency, abdominal pain? Abdominal assessment,
Many cases medication related
Rule out infectious cause
If stools ^+ in 24 hours and fever = suspect C. Diff
ROME IV Criteria for Constipation
2+ of the following for 3 months
- < 3 bowel movements per week
- hard/lump stools
- Straining in 25% or more of bowel movements
- Need to use manual maneuvers in 25% or more of bowel movements
perforated peptic ulcer
abrupt onset of severe abdominal pain followed rapidly by peritoneal signs. Pain begins in the epigastrium and spreads rapidly throughout the abdomen with frequent early radiation of pain to the scapular areas. Vomiting of coffee-ground emesis, hematemesis, or melena or hematochezia occurs in some patients. The abruptness, severity, and rapid progression of symptoms lead the patient to seek prompt medical attention. Clinically, patients often demonstrate signs of improvement, such as decreased pain and vomiting, 6 to 12 hours after perforation. However, peritoneal signs remain, the clinical improvement does not last long. nclude boardlike abdominal rigidity
Pancreatitis Signs
Fever
N/V
Rapid onset of pain - RUQ radiates to back or upper
Pain lessened when leaning forward
