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GIR Test 1 > B5-015 Big Case: Abdominal Pain > Flashcards

B5-015 Big Case: Abdominal Pain Flashcards

1
Q

transmitted by C fibers in muscle, peritoneum, mesentery, periosteum, and viscera

A

visceral pain

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2
Q

highly sensitive to distension (stretch) or ischemia

A

visceral pain

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3
Q

dull, cramping, burning, gnawing, squeezing, deep, sickening

A

visceral pain

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4
Q

poorly localized, gradual onset

A

visceral pain

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5
Q

foregut pain localizes to

A

epigastric area

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6
Q

midgut pain localizes to

A

periumbilical area

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7
Q

hindgut pain localizes to

A

suprapubic area

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8
Q

what type of secondary autonomic effects accompany visceral pain?

A

sweating, nausea, vomiting, restlessness, pallor

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9
Q

mediated by alpha gamma fibers that are distributed to skin and muscle

A

somatic-parietal pain

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10
Q

sharp, stabbing, well localized

A

somatic parietal pain

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11
Q

why is lateralization of parietal pain possible?

A

only one side of the nervous system innervates that part of the parietal peritoneum

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12
Q

diaphragmatic irritation from a subphrenic hematoma or splenic rupture perceived as shoulder pain

A

Kehr’s sign

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13
Q

PMH of cardiovascular disease may raise suspicion for

A

mesenteric ischemia

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14
Q

patient lying still in bed, fetal position, reluctant to move, appears distressed

A

peritonitis

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15
Q

bluish periumbilical discoloration indicates

A

intrabdominal bleeding

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16
Q

high pitched tinkling bowel sounds may indicate

A

early bowel obstruction

intestinal fluid and air under pressure

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17
Q

decreased bowel sounds may indicate

2

A

peritonitis or paralytic ileus

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18
Q

normal amount of bowel sounds per minute

A

5-30

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19
Q

friction rub, high pitched bowel sounds associated with inspiration, may indicate

A

inflammation of peritoneal surface

tumor, infection, infarct

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20
Q

bruits in aorta, renal, iliac, femoral artery may indicate

A

abdominal aneurysm

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21
Q

absence of bowel sounds is established after […] minutes of continous listening

A

5

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22
Q

tympany throughout the abdominal area may indicate

A

obstruction/distension in ileus

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23
Q

dullness to percussion of the liver may indicate

A

ascites, hepatomegaly

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24
Q

outpouchings that grow in the colon as we age

A

diverticula

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25
Q
  • LLQ abdominal pain
  • middle age man
  • pain constant over a few days
  • change in bowel habits
  • may be able to palpate fullness

classical presentation of…

A

acute diverticulitis

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26
Q

nutrition management of diverticulitis

A

high fiber, low fat diet

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27
Q

painless, hematochezia suggests

A

bleeding diverticulosis

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28
Q

one third the distance from anterior superior iliac spine toward the umbilicus

A

McBurney’s point

29
Q

what does the imaging indicate?

A

obstruction

30
Q

high BUN
normal creatinine

may indicate

A

upper GI bleed

31
Q
  • gradual onset achey pain in the periumbilical area
  • localizes to RLQ
A

appendicitis

32
Q

acute RUQ constricting pain localized to scapula

A

cholecystitis

33
Q
  • acute onset epigastric boring pain
  • may radiate to midback
A

pancreatitis

34
Q

gradual LLQ achey pain

A

diverticulitis

35
Q

sudden burning epigastric pain

A

perforated peptic ulcer

36
Q

gradual cramping periumbilical pain

A

small bowel obstruction or gastritis

37
Q

sudden agonizing periumbilical pain

A

mesenteric ischemia

38
Q

sudden tearing abdominal, back or flank pain

A

ruptured AAA

39
Q

gradual spasmodic periumbilical pain

A

gastroenteritis or obstruction

40
Q
  • gradual achey LQ/pelvis pain
  • may radiate to upper thigh
A

PID

41
Q

sudden, sharp LQ/pelvic pain in women

A

ruptured ectopic pregancy

42
Q

pain relieved by food

A

duodenal ulcer

43
Q

pain worsened by food

A

gastric ulcer, mesenteric ischemia

44
Q

pain relieved by sitting up or leaning forward

A

pancreatitis

45
Q

PMH of recent surgery/procedure may raise suspicision for

A

obstruction, abcesses, complication of surgery

46
Q

NSAIDS increase the risk of

2

A

ischemia
peptic ulcer disease

47
Q

what type of pain does this describe?

  • poorly localized
  • referred pain
  • increased autonomic response
  • likely to be remembered
A

visceral

48
Q

what type of pain does this describe?

  • well localized
  • minimally referred
  • decreased autonomic response
A

somatic parietal

49
Q

pain is almost exclusively conducted by […] fibers

A

sympathetic

50
Q

in the GI tract, visceral receptors that are distal to the midway point of the sigmoid colon convey both physiologic and nociceptive signal back to the CNS via […] nerves

A

parasympathetic pelvic nerves

51
Q

visceral receptors inferior to the […] convey both physiologic and nociceptive signals via […] nerves

A

pelvic pain line
parasympathetic

52
Q

positive Carnett’s is associated with

A

MSK pain

53
Q

positive McBurney’s is associated with

A

appendicitis

54
Q

Grey Turner is a bruising that occurs on the flank indicating

A

retroperitoneal hemorrhage

55
Q

positive McMurphy’s indicates

A

cholecystitis

56
Q

in IBS, the colonoscopy results are usually

A

normal

57
Q
  • unintentional weight loss
  • abdominal pain
  • rectal bleeding
  • changes in bowel pattern

typical presentation of

A

colon cancer

58
Q
  • rectal bleeding
  • diarrhea
  • abdominal pain
  • maybe: bloating, nausea, gradual weight loss

typical presentation of

A

Chron’s/ulcerative colitis

59
Q
  • abrupt onset peritonitis
  • rigid flat abdomen

indicates

A

perforated peptic ulcer

60
Q
  • pain beginning in midline, transitioning to lower quadrant
  • progressively worse pain
A

appendicitis

61
Q

progressive RUQ pain
may be associated with nausea and vomiting

A

acute cholecystitis

62
Q

progressive pain with nausea and vomiting
tinkling bowel sounds

A

small bowel obstruction

63
Q

melena is most consistent with a bleed in what part of GI tract?

A

upper

64
Q

what diagnostic test is appropriate for peptic ulcer disease?

A

EGD

65
Q

what diagnostic imaging is appropriate for gallstones?

A

US

66
Q

symptoms of dyspepsia

A

epigastric pain and bloating after meals

67
Q

heartburn
regurgitation
sour taste in mouth
chest pain
dysphagia

A

GERD

68
Q

nausea, vomiting
food particulate seen on endoscopy
reflux symptoms

A

gastroparesis

GIR Test 1 (16 decks)

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