APRN Review - GI Flashcards
Cullen’s sign
Bruising/discoloration around the peri umbilicus due to retroperitoneal bleeding.
Cullen’s sign can be a sign of what?
Pancreatitis, splenic rupture, ruptured aortic aneurysm (AA), or ruptured ectopic pregnancy.
Grey-Turner sign
Bruising on the flanks.
Grey-Turner sign suggests what?
Hemorrhage/trauma.
Murphy’s sign
Elicited by palpating the gallbladder (RUQ) while the patient inhales. Tenderness/pain at the sight during palpation is a + Murphy’s sign.
A positive Murphy’s sign is indicative of what?
Cholecystitis.
Rovsing’s sign
Deep palpation at the LLQ increases pain in the RLQ.
Rovsing’s sign suggests what?
Appendicitis.
Symptoms of appendicitis
Pain that begins at the umbilicus and travels to the RLQ, rebound tenderness, N/V, and fever.
Psoas test/obturator test
+ result if c/o abdominal pain.
+ psoas is indicative of what?
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.
How is the psoas test performed?
- Have the patient lie on their back.
- Place their hand just above the patient’s knee.
- Ask the patient to lift their right leg against the examiner’s hand.
- If the patient experiences pain, the test is positive.
Obturator sign is a clinical sign of what?
Acute appendicitis.
How do you perform the obturator test/assess for obturator sign?
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.
Markle sign (heel jar test)
Patient stands on toes and when forcefully dropped, abdominal pain occurs.
+ Markle sign is indicative of what?
Peritonitis/appendicitis.
With LUQ palpation, you should not be able to palpate the spleen. What size spleen would be suggestive of splenomegaly?
> 20 cm is suggestive of an enlarged spleen.
What is the size of a normal adult liver.
6 to 15 cm in the midclavicular line.
LLQ pain is indicative of what?
Diverticulitis.
What are the leading causes of inflammatory diarrhea?
Salmonella, campylobacter, shigella, and C. difficile.
Which common mediations cause diarrhea?
Antibiotics, metformin, colchicine, and chemo drugs.
What are the most common causative agents for Clostridium difficile colitis?
Clindamycin, 2nd/34d generation cephalosporins, fluoroquinolones, and amoxicillin.
How do you treat Clostridium difficile?
Stop the antibiotic, evaluate/treat for dehydration, avoid anti-motility agents, and prescribe oral vancomycin.
What are the leading causes of non-inflammatory diarrhea?
Adults & pediatric patients: norovirus.
Pediatrics: rotavirus.
Diarrhea is described as what?
3 or more episodes of watery stools within a 24 hour period.
What are the symptoms of norovirus/rotavirus?
Onset of symptoms in 24-48 hours (vomiting, diarrhea, dehydration, myalgias, possible low grade fever). Generally resolves in 3-5 days.
How do you treat norovirus/rotavirus?
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.
What is celiac disease?
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.
What foods should patients with celiac disease avoid?
Foods with gluten (wheat, rye, and barley).
What are the symptoms of malabsorption?
Diarrhea, steatorrhea, gas, bloating, difficulty gaining weight, and abdominal pain.
Which vitamin deficiencies are seen with celiac disease?
Folate, ferritin, and vitamin B 12.
What are the risk factors for celiac disease?
1s and 2nd degree relative with celiac disease, diabetes, autoimmune thyroiditis, and Down & Turner syndromes.
How do you diagnose celiac disease?
Low suspicion: serologic testing with tissue transglutaminase (tTG)-IgA antibody.
High suspicion: serologic testing and small bowel biopsy.
Refer to GI.
What are the symptoms of constipation?
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.
Which medications cause constipation?
Anticholinergics, iron supplements, CCB’s, opiods.
Wich conditions increase the risk for constipation?
DM, Parkinson’s disease, multiple sclerosis, hypothyroidism, and pregnancy.
