Bio Med TCM Gastrointestinal Flashcards
diffused abdominal pain
acute pancreatitis, diabetic ketoacidosis, gastroenteritis, peritonitis (any cause melon sound on abdomen), sickle cell crisis, typhoid fever
Right or Left UQ pain
acute pancreatitis - esp. after consume alcohol
RUQ pain (hand below rib cage)
*cholecystitis and *biliary colic (after eating a fatty meal start getting pain in this region), hepatitis, perforated duodenal ulcer, active pancreatitis retrocecal appendicitis (rare) LRQ referring up to RUQ, retro = behind, cecal = colon)
RLQ pain
appendicitis, cecal diverticulitis, Meckel’s diverticulitis, Crohn’s
LLQ pain
sigmoid diverticulitis, ulcerative colitis
Right or Left LQ pain
abdominal or psoas abscess, cystitis, endometriosis, IBD, pelvic inflammatory disease (PID), renal calculi, ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy,
Body Mass Index
Underweight
Below 18%
Body Mass Index
Healthy
18.5 - 24%
Body Mass Index
Overweight
25 - 30%
Body Mass Index
Obese
31 %- up
Antacids
Meds: Calcium carbonate (Tums), esomeprazole (Nexium), Lansoprazole (Prevacid), Pantoprazole sodium (Protonix)
Antihelmintic
for parasitic worms,
Meds: Mebendazole (vermox)
Antibiotic
Meds: amoxicillin (amoxil), ciprofloxacin (cipro), levofloxacin (levaquin)
Antidiabetic
Meds: Metformin (glucaphage), glipizide (glucotrol),
Antidiarrheal
Bismuth subsalicylate (pepto-bismol) black tongue coat
Primary organ nutrient absorption
ST - alcohol, water, some fat soluble drugs
SI - nutrients primarily
LI -reabsorption of water, electrolytes
Nutrient absorption accessory organs
Liv - Vit A&D, B12, iron
Pancreas - no real absorption but produces Alpha cells respond to low blood sugar by stimulating the Liv to release glucose
Mouth - some trace minerals and electrolytes
Type 1 Diabetes
S/s - ketoacidosis, polydipsia (poly = many, dipsia = thirst), polyuria, polyphagia (clear urine, urinating out vitamins / minerals so your body make you hungry), fatigue, parasthesia (B vitamins cause numbness/tingling distal body)
prob - hypertension, neuropathy, ulcerations, frozen shoulder, foot, mouth vagina infections from bacteria
Type 2 Diabetes
S/s - dry flushed skin, ketonic breath, nausea/vomit, cramping, polyuria (clear urine loosing potassium), blurred vision, confusion
prob - retinopathy, loss of vision, nephropathy, neuropathy, ulceration of the feet, infections
meds - metformin
Hypoglycemia
sweating, nausea, warmth, anxiety, constant hunger, *H/A, decreased body temperature (warm/cold back and forth)
meds - glucagon
GERD
lower esophageal sphincter reflux
usually high alkaline in the persons body
Gastritis
Pain, nausea, fullness, bleeding, due to NSAIDs or ethanol, smoking, proton pump inhibitor can be a cause as well as a temporary cure
Peptic ulcer
common Hispanic / African A, due to H. Pylori weaken stomach lining
Gastric ulcer
stomach bleeding ulcer - *REFER to physician ASAP w/in 72 hours
*Duodenal ulcer
H. Pylori or NSAIDs, - *consistent pain which usually awakens patient at night
Thrush
Candida albicans (fungus) causes - immune compro, antibiotic or steroid, autoimmune, AIDS meds: anti-fungals
Gastric Cancer
indigestion, anorexia, abdominal pain often metastasizes to lymph, liver, peritoneum, chest, brain **refer to physician STAT - that DAY
Melena
Black tarry stool due to long term stomach or duodenum bleeding
Rotavirus
*Virus: Young children, severely dehydrating, contagious via fecal oral rout *Bacteria virus
most common cause of diarrhea in children and day care workers
transmission: toys, bathroom fixtures, changing tables, diaper pails, public swimming pools
prevention: 14days
Adenovirus
4th most common childhood gastroenteritis disease *DNA virus
Salmonella
*Bacterial diarrhea due to undercooked poultry, milk, eggs or reptiles contact
Shigella
3rd most common *bacterial diarrhea in U.S. transmitted person to person
Escherichia coli
*blood in diarrhea from undercooked beef, unpasteurized milk, etc *watery diarrhea found commonly in nurseries: bacteria - so treated with antibiotic
Vibrio
diarrhea caused by undercooked seafood: bacteria
Poke bowls
Listeria
food born and usually found in cheese: bacteria
soft cheeses
Constipation
*Red flag if patient is taking opioids
Diarrhea (all)
**Red flag: long term diarrhea can lead to dehydration - decreased potassium
Dyspepsia
upper abdominal distention with postprandial fullness that is gnawing or burning, epigastric pain with nausea and vomiting
H2 blockers, proton pump inhibitors
alcohol can do this
***CNT Incubation Hep A Hep B Hep C Hep D Hep E
Hep A = 15-50 AVG: 28 Hep B = 45-160 AVG: UNK Hep C = 14-180 AVG: 5-10 wks Hep D = UNK Hep E = 15-160 AVG: 40
Liver Pathology
Hepatitis Transmission in A,B,C,D,E,
Hep A = Fecal/oral Hep B = Blood Hep C = Blood Hep D = Needle Hep E = Water
Most common Hepatitis in medical field
Hep B
Most common Hepatitis in the world
Hep A
Deadliest Hepatitis
Hep C
S/S of Hep A, B, C
S/s = fever, fatigue, loss of appetite, nausea and vomiting, abdominal pain, dark urine, clay colored bowel movement, joint pain, jaundice
Hep A post exposure
HAV vaccine preferred over immune globulin
Note: has a vaccine but usually people end up getting better before the vaccine takes i.e. eat out and feel like you got stomach flue for about 7 days - you probably had Hep A
Hep B post exposure
**HBIG vaccine
Note: its the law to have the employee get a series of vaccines if they get stuck with a needle you can get stuck with fines and penalties, if the employee declines to get vaccine it needs to be documented. Lab test for HBV titer can be done to see if a booster is required.
Crohn’s Disease
SI is involved in 80% of cases (esophagus to anus can also be affected)
Location - right side
s/s - 75-85% have rectal bleeding, 25-35% perianal lesions
imaging - asymmetrical and segmental (skip areas) on x-ray, barium swallow
*Asymmetrical - Ulcerative colitis symmetrical
Ulcerative Colitis
inflammation and ulceration of the LI bloody diarrhea, cramping pain, weight loss, electrolyte imbalance
LI primarily in the descending section
Location - left side
S/s - *rectal bleeding is alway present
*symmetrical and uninterrupted bowel wall (crohn’s asymmetrical
Meckel’s Diverticulum
intestinal obstruction manifesting by cramping, abdominal pain, nausea and vomiting. abdominal pain either below or to the left of the umbilicus
- *Adults may bleed with more of a melena result
- Children may have bright red rectal bleeding with painless symptoms
Appendicitis
*McBurney’s point - LRQ with rebound tenderness
Rovsing’s Sign - press on LLQ causing more pain on LRQ
Diverticulosis
small pouch bulging outward LI - usually has low fiber diet, caused by heavy pressing due to constipation
Diverticulitis
inflamed diverticuli due to low fiber diet
Treatment liquid diet, oral antibiotics sometime surgery
Irritable bowel Syndrome (IBS)
usually due to stress however etiology unknown, *gas, *bloating, *cramping, bowel changes, *constipation or diarrhea, *relief of pain post BM
Treatment; diarrhea producing foods, increase fiber, for constipation
tricyclic antidepressants
Cholecysitis
complication to Cholelithiasis - localized pain RUQ with rebound and guarding tenderness, positive Murphy sign, diaphoresis, fever, hypo activity bowel (constipation)
Note: often misdiagnosed as pancreatitis (after alcohol) i.e. ask patient if they feel worse after a fatty meal!
cholelithiasis
lith = stone (gallstone)
sporadic (comes and goes) pain epigastrium or RUQ, **sometimes radiating to the right scapular tip.
Pain post Prandial (after eating) intense or dull pain lasting 1-5 hours. pain constant not relieved emesis (vomiting) defecation, flatus, belching (lack of bile as we get old)
Acute Pancreatitis
Ingested medicines (ACE, Diuretic, Opioids, high triglyceride (fatty diet) high blood calcium, alcoholism typically after having sweets or alcohol
Chronic Pancreatitis
Fat soluble vit deficiency A,D,E,K
steatorrhea, pancreatic adenocarcinoma
Note: stool can be unusually foul, greasy or light color, with oil droplets
imaging: *****CT Scan - MRI would be a followup to see if adenocarcinoma
Pancreatic Adenocarcinoma
Jewish, African heritage
Cancer *Whipple procedure - treats tumors and disorders of the pancreas (operation to remove the head of the pancreas, pancreaticoduodenectomy) first part of the SI (duodenum)
Abdominal Aortic Aneurysm
long term smoker (men 65-75), atheroscerosis, HBP
s/s - abdominal or back pain that feels like a ***tearing sensation, radiates to the back or legs, calmness, low blood pressure, fast pulse RED FLAG (HBP now LBP esp. pulse is fast)
Anorexia Nervosa
Blotchy yellow skin, fine hair, poor memory or judgement (lack of B vit) depression (B vit and copper)
Tests: Albumin (protein), Dexa (osteoporosis), EKG(Ht), TSH (thyroid), Kid, Urine, Electrolytes, LFT (liver function)
Bulemia
vomit after binge eating - falls under bulemia may not vomit up food but over exercise, may have ridges in teeth.
S/s - ridged exercise behavior, calluses on back of hands, discoloration or staining of teeth,
Flag: electrolyte imbalances (heart), rupture of esophagus, tooth decay, irregular BM
Red flag - immediate referral to GB - 72 hours if not been diagnosed yet
Thrush causes
antibiotic treatment, babies, autoimmune, immune compromised, AIDS
Irritable Bowel Disease
*extreme fatigue, joint pain, rectal bleeding, mostly in females. IBS little less extreme
Giardia
*Parasite: day care centers, international travelers, hikers (person coming back from hiking in a foreign country with diarrhea think Giardia parasite), unfiltered or untreated water.
Transmission: uncooked food that has been contaminated, swallowing water from pools, water exposed to wildlife
Prevention: 14days
Cyptosporidium
Parasite: water borne and resistant to chlorine
transmission: pool water, day care settings
Prevention: 14 days swimming in pools where children hav had diarrhea with in 14 days
Roundworm
S/s: intestinal blockage, bloating, large round worms in bowel movement, vomiting or crawling from nose
Location: SI
TX: antihelminics
Hookworm (common in U.S)
*loss of appetite, *weight loss, *abdominal distention, anemia, intestinal bleeding
Location: *infests billiard tract, *pancreas
TX: antihelminics
Pinworm
very common in schools and daycare centers
**itchy perineum
TX: antihelminics
Tapeworm
*abdominal distention, pain, diarrhea, malnutrition, *weight loss
TX: antihelminics
Trichinosis
*Stomach pain, *extreme fatigue, *nausea and vomiting, *diarrhea, *fever, *H/A, *chills, *muscle aches, *may have constipation, heart palms, dyspnea, mimics syphillis
TX: antihelminics
B1
Thiamin
deficiency: *Beriberi, Wernicke-Korsakoff syndrome
B2
Riboflavin
deficiency: cheilosis, angular stomatitis (crust side of mouth), tender tongue (red), mouth ulcers, corneal vascularization
B3
Niacin
stocking sensation like wearing stockings
deficiency: pellagra (dermatitis, glossitis, GI and CNS dysfunction) Liver fire symptoms (red edged tongue) Toxicity: flushing face
B6
Pyridoxine
deficiency: seizures, anemia, neuropathies, seborrheic dermatitis (looks like eczema on the face)
B12
Cobalamin
deficiency: *megaloblastic anemia
Tongue = glossy/red/no taste buds (lack of taste) so not hungry
Folate
Folic Acid
deficiency: *Megaloblastic anemia, * neural tube defect
Vit C
ascorbic acid
collagen formation, bone/blood vessel health, wound healing
deficiency: *scurvy (bone defects), *gingivitis (gum erosion around teeth), Tongue peeled, *loose teeth, hemorrhages
Vit A
Retinol
cataracts, **night blindness, skin disorders, xerophthalmia, keratomalacia, goose flesh skin (not absorbing Vit A appropriately, hepatic disfunction, liver failure
Vit D
deficiency: bone, osteoarthritis (herberden’s nodes, swelling of joints, *osteomalacia, anorexia, rickets(weakening and softening of the bones because of extreme calcium loss)
toxicity: renal failure (check if deficient don’t over take supplement)
increased immunity
Vit E
deficiency: **red blood cells, hemolysis, neurologic deficits, dry, scaly, leathery skin with erythema (redness), follicular hyperkeratosis (raised bumps from hair follicles), grey early, alopecia
Vit K
deficiency: bleeding, osteopenia
Common Vitamin Deficiencies
Protein, Vit B3 (Niacin), Folic Acid, B12 = diarrhea
Zinc = diarrhea and dysgeusia (distortion of taste)
Iron = dysphagia (difficult swallowing)
Common Dietary Deficiencies
Vegan = B12 (unless eating yeast or fermented food) low calcium, iron, zinc
vegetarian = iron
fruitarian = protein, sodium (effects pancreas and muscles
very low calorie diet = wasting syndrome when in long term i.e. feeble muscle tone, brain
fad diets = protein and mineral deficiencies leading to renal, cardiac or metabolic disorders, Kid problems
Alcoholism = protein, mineral deficiencies leading to renal, cardiac, metabolic disorder
**Manual Test and Names
McBurney’s point = Appendicitis, look for rebound tenderness (pressing LRQ)
Murphy’s Sign = Cholelithiasis, cholecystitis
Obturator Muscle Test = Rule out appendicitis
Psoas Sign = Rule out appendicitis
Rovsing’s sign = Rule out appendicitis (press on LLQ causing more pain on LRQ)
A patient has a deficiency in Vit B12. You would suspect that their tongue would be.
- smooth
- rough and very tender
- bleeding
- swollen and small
-Smooth
reduces nerve endings which would reduce papillae of tongue
A patient with “chicken / goose skin” would most likely have a deficiency of which vitamin?
- B3
- C
- K
- A
- Vit A
Vit A deficiency treats goos bumps that do not dissipate with weather changes or pressure changes.
Which type of ulcer commonly wakes a person up late at night?
- peptic
- gastric
- duodenal
- esophageal
- Duodenal
This area usually is covered with food or oily beverages during the day, a long fasting will commonly add more acid to this section during the fast that occurs during sleep.
Which manual examination is most resourceful when diagnosing cholecystitis?
- McBurney’s Point
- McMurray’s Test
- Obturator’s Muscle Test
- Murphy’s Sign
- Murphy’s Sign
inspects for increased tenderness in RUQ area.
A patient who has Abdominal Aortic Aneurysm (AAA) is most likely going to be ……
- Male, 65-75 yrs old
- Male, 35-45 yrs old
- Female, 65-75 yrs old
- Female, 35-45 yrs old
- Male, 65-75 yrs old
AAA primarily focuses on patients who are chronic smokers with many of the long term effects of smoking.
A patient with dark tarry stool as a result of an ulceration would have what diagnostic name?
- Melinda
- Melena
- Monet
- Mineu
- Melena
Melena is the name for dark tarry stools
A patient presents with severe right lower quadrant pain, nausea and vomiting, and a fever of 101 degrees. Bowel sounds are evident in all four quadrants. Her WBC count is elevated and she tests positive when you perform McBurney’s test. Your patient’s most likely diagnosis is
Irritable Bowel Disease
Cholelithiasis
Abdominal obstruction
Apendicitis
Apendicitis
A 36-year-old female has come to your clinic because she has been diagnosed with Cachexia and fatigue. She wants you to make her feel better at any cost. What condition does she have?
Trichimoniasis
Epstein Barr Virus
Wasting syndrome
Norovirus
Wasting Syndrome
A lack of which vitamin is associated with Pernicious Anemia?
B12
Upper GI and Lower GI divided by which of the following anatomical sites?
Ligament of Treitz
Esophageal sphincter
Pyloric sphincter
Ampulla of Vater
Ligament of Treitz (suspensory muscle of the duodenum)
A 24-year-old male patient enters your office. He is of northern European ancestry, and complains of chronic diarrhea with fatty streaks in his stools. He seems quite thin and complains of being tired. He claims his doctor gave him a diagnosis of dermatitis herpetiformis for his skin rash. A biopsy of his intestines revealed a flattening and loss of villi. Which condition best represents this patient?
Carcinoid syndrome
Celiac disease
Duodenal ulcers
Irritable bowel syndrome
Celiac disease
Which of the following conditions is possible to be the cause of LLQ (left lower quadrant) pain?
Diverticulitis
Appendicitis
Cholecystitis
Pancreatitis
Diverticulitis
It is common to prescribe colorectal cancer screening such as Fecal Occult Blood Tests for patients over the age of 50 with average risk:
Every two years
Every three years
Every year
Every six months
every year
What is the incubation period for Hepatitis C?
18-60 days
15-50 days
14-180 days
40-160 days
14-180 days
Your patient, who is 47 years old, is coming in with acute lower GI Bleeding. Knowing that the most common cause of acute lower GI bleeding in patients above age 40 is ________________________, you would refer out for what test?
Diverticulosis, Colonoscopy
Diverticulitis, Colonoscopy
Esophageal ulcer, Endoscopy
Colon Cancer, MRI
diverticulitis, colonoscopy
A 22 year-old female patient presents to you with severe lower abdominal pain that radiates to the low back. She states that the pain came on suddenly this morning. When you examine her, she has rebound tenderness in the left lower quadrant. She reports no changes in bowel patterns and no difficulty with urination. She states that she is sexually active, and that she and her boyfriend use condoms most of the time. She says that she couldn’t be pregnant because she started spotting this morning and that she missed her period last month. What is the most likely diagnosis for this patient?
Crohn’s Disease
Appendicitis
Ectopic pregnancy
Cholecystitis
ectopic pregnancy
Which of the following forms of hepatitis is transmitted along fecal-oral routes and presents the highest rate of mortality in pregnant women?
Hepatitis E Hepatitis C Hepatitis B Hepatitis A Hepatitis D
Hep E
Which of the following forms of hepatitis have abrupt onset?
Hepatitis A, Hepatitis D
Hepatitis B, Hepatitis D
Hepatitis A, Hepatitis E
Hepatitis E, Hepatitis D
Hep A, Hep E
A 45-year-old male comes into your clinic complaining of RUQ pain, nausea that comes and goes, and a strange tenderness in his costovertebral region. Which of the following conditions presents clinically as such?
Pyelonephritis
Cholecystitis
Esophageal spasm
Unstable Angina
Cholecystitis
A 44-year-old female presents to you with moderately severe epigastric pain that radiates to her right shoulder. She is concerned that it may be a side effect from the Lipitor that her MD prescribed recently. The pain seems to come and go, but is worse when she eats fatty foods. What is her most likely diagnosis?
Cholelithiasis
Angina
Duodenal ulcer
Pancreatitis
Cholelithiasis
A 40-year-old male patient enters your office complaining of diarrhea with a history of recent antibiotic use. Which of the following is most likely implicated?
Clostridium difficile
Parasitic infection
Virus infection
Osmotic disease
Clostridium difficile - spore forming bacterium (antibiotic associated diarrhea)
Which of the following pathogens is the major cause of acute diarrhea in the U.S. during the winter months. (Note: It is found at high rates in daycare centers and kindergartens)
Rotavirus
Dengue virus
Norovirus
Cytomegalovirus
Norovirus
Which of the following statements about Portal Hypertension is not true?
It can cause Caput Medusae or purple veins that can be seen around the umbilicus.
It can be caused by cirrhosis of the liver.
It is due to an increase in pressure in the Hepatic Portal artery.
It can lead to ascites.
It is due to an increase in pressure in the Hepatic Portal artery.
Which of these inflammatory bowel diseases presents with oral ulcers, involves portions of the terminal ileum, colon, abdominal pain, non-bloody diarrhea, and perirectal abscess/fistula?
Crohn’s disease
Ulcerative colitis
Irritable bowel syndrome
Diverticular disease
Crohn’s disease
Vaccines are available for which of the following varieties of Hepatitis?
Hepatitis A, Hepatitis D
Hepatitis A, Hepatitis B
Hepatitis B, Hepatitis C
Hepatitis D, Hepatitis E
HepA, HepB
Which of the following forms of hepatitis are bloodborne?
Hepatitis A, Hepatitis D
Hepatitis A, Hepatitis C
Hepatitis D, Hepatitis E
Hepatitis B, Hepatitis C
HepB, HepC
What is the expected incubation period of Hepatitis B?
45-160 days
20-90 days
15-50 days
50-90 days
45-160 days
A patient taking acetaminophen should be monitored for any bleeding, bruising, nosebleeds as well as:
Right upper quadrant pain
Respiratory problems
Chest pain
Black tongue mass
Right upper quadrant pain
Which of the following regions of the GI tract is the site of enzyme release for Fat digestion?
Stomach
Small Intestine
Large Intestine
Directly below the esophageal sphincter
SI
Your patient of ten years, a 55-year-old female, enters the clinic frantically complaining that her HbA1c blood count scared her. You want to help her understand whether or not she has diabetes, but she left her lab work at home. For a diagnosis of diabetes to be rendered, what lab values for the HbA1c must there be?
6.5% or over
126% or over
Below 6.5%
Between 6.0% - 6.4%
6.5% or over
A 56-year-old woman was recently diagnosed with osteomalacia of the knees. She spent the last four months going to various specialists so that she could get the most cutting edge approach to treatment. Last week, upon visiting your office, she complained of having abdominal pain that worsens with the consumption of food. What is the likely diagnosis?
Crohn’s disease
Gastric ulcer
Duodenal ulcer
Pellagra
Gastric ulcer
Which of the following organisms can cause diarrhea and life-threatening inflammation of the colon?
Streptococcus bovis
Basillus clausii
Lactobacillus helveticus
Clostridium difficile
Clostridium difficile
All of the following statements about Crohn’s disease are correct, except:
It affects only partial thickness of bowel tissue.
It can produce cramping and severe abdominal pain.
It can cause fistulae and abscesses.
It may cause significant weight loss.
It affects only partial thickness of bowel tissue.
