APRN Review - GI

Question 1

Cullen’s sign

Answer 1

Bruising/discoloration around the peri umbilicus due to retroperitoneal bleeding.

Question 2

Cullen’s sign can be a sign of what?

Answer 2

Pancreatitis, splenic rupture, ruptured aortic aneurysm (AA), or ruptured ectopic pregnancy.

Question 3

Grey-Turner sign

Answer 3

Bruising on the flanks.

Question 4

Grey-Turner sign suggests what?

Answer 4

Hemorrhage/trauma.

Question 5

Murphy’s sign

Answer 5

Elicited by palpating the gallbladder (RUQ) while the patient inhales. Tenderness/pain at the sight during palpation is a + Murphy’s sign.

Question 6

A positive Murphy’s sign is indicative of what?

Answer 6

Cholecystitis.

Question 7

Rovsing’s sign

Answer 7

Deep palpation at the LLQ increases pain in the RLQ.

Question 8

Rovsing’s sign suggests what?

Answer 8

Appendicitis.

Question 9

Symptoms of appendicitis

Answer 9

Pain that begins at the umbilicus and travels to the RLQ, rebound tenderness, N/V, and fever.

Question 10

Psoas test/obturator test

Answer 10

+ result if c/o abdominal pain.

Question 11

+ psoas is indicative of what?

Answer 11

This indicates that the psoas muscle is irritated by an inflammatory process. A positive psoas sign on the right side is a classic sign of appendicitis. Other conditions that may cause a positive psoas sign include: pyelonephritis, pancreatitis, and psoas abscess.

Question 12

How is the psoas test performed?

Answer 12

1. Have the patient lie on their back.
2. Place their hand just above the patient’s knee.
3. Ask the patient to lift their right leg against the examiner’s hand.
4. If the patient experiences pain, the test is positive.

Question 13

Obturator sign is a clinical sign of what?

Answer 13

Acute appendicitis.

Question 14

How do you perform the obturator test/assess for obturator sign?

Answer 14

To assess for the obturator sign, position the patient supine with their right knee bent and leg bent at the hip. Rotate the leg internally at the hip, causing the internal obturator muscle to stretch providing indirect pressure over the appendix.

Question 15

Markle sign (heel jar test)

Answer 15

Patient stands on toes and when forcefully dropped, abdominal pain occurs.

Question 16

+ Markle sign is indicative of what?

Answer 16

Peritonitis/appendicitis.

Question 17

With LUQ palpation, you should not be able to palpate the spleen. What size spleen would be suggestive of splenomegaly?

Answer 17

> 20 cm is suggestive of an enlarged spleen.

Question 18

What is the size of a normal adult liver.

Answer 18

6 to 15 cm in the midclavicular line.

Question 19

LLQ pain is indicative of what?

Answer 19

Diverticulitis.

Question 20

What are the leading causes of inflammatory diarrhea?

Answer 20

Salmonella, campylobacter, shigella, and C. difficile.

Question 21

Which common mediations cause diarrhea?

Answer 21

Antibiotics, metformin, colchicine, and chemo drugs.

Question 22

What are the most common causative agents for Clostridium difficile colitis?

Answer 22

Clindamycin, 2nd/34d generation cephalosporins, fluoroquinolones, and amoxicillin.

Question 23

How do you treat Clostridium difficile?

Answer 23

Stop the antibiotic, evaluate/treat for dehydration, avoid anti-motility agents, and prescribe oral vancomycin.

Question 24

What are the leading causes of non-inflammatory diarrhea?

Answer 24

Adults & pediatric patients: norovirus.
Pediatrics: rotavirus.

Question 25

Diarrhea is described as what?

Answer 25

3 or more episodes of watery stools within a 24 hour period.

Question 26

What are the symptoms of norovirus/rotavirus?

Answer 26

Onset of symptoms in 24-48 hours (vomiting, diarrhea, dehydration, myalgias, possible low grade fever). Generally resolves in 3-5 days.

Question 27

How do you treat norovirus/rotavirus?

Answer 27

Supportive care - oral rehydration (Pedialyte), probiotics, antiemetics if indicated, anti-motility meds if indicated (loperamide [Imodium] or diphenoxylate [Lomotil] for 1-2 days. Refer to the ER if they have intractable vomiting/concern for dehydration, severe hematochezia, severe abdominal pain, symptoms unresponsive to treatment > 7 days, 65 years and older with commorbidities, and pregnancy.

Question 28

What is celiac disease?

Answer 28

A small bowel disorder causing mucosal inflammation, atrophy of the intestinal villi (which are hairlike projections that line the small intestine and are needed for absorption of vitamins and nutrients and crypt hyperplasia (elongated grooves in the intestines due to changes in the villi) when exposed to gluten.

Question 29

What foods should patients with celiac disease avoid?

Answer 29

Foods with gluten (wheat, rye, and barley).

Question 30

What are the symptoms of malabsorption?

Answer 30

Diarrhea, steatorrhea, gas, bloating, difficulty gaining weight, and abdominal pain.

Question 31

Which vitamin deficiencies are seen with celiac disease?

Answer 31

Folate, ferritin, and vitamin B 12.

Question 32

What are the risk factors for celiac disease?

Answer 32

1s and 2nd degree relative with celiac disease, diabetes, autoimmune thyroiditis, and Down & Turner syndromes.

Question 33

How do you diagnose celiac disease?

Answer 33

Low suspicion: serologic testing with tissue transglutaminase (tTG)-IgA antibody.
High suspicion: serologic testing and small bowel biopsy.
Refer to GI.

Question 34

What are the symptoms of constipation?

Answer 34

Straining, hard stools, sensation of incomplete evacuation, 3 or less BM’s per week, lasting 3 or more months for a minimum of 25% of BM’s.

Question 35

Which medications cause constipation?

Answer 35

Anticholinergics, iron supplements, CCB’s, opiods.

Question 36

Wich conditions increase the risk for constipation?

Answer 36

DM, Parkinson’s disease, multiple sclerosis, hypothyroidism, and pregnancy.