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Module 9: Mali: GI > CA-lecture facts > Flashcards

CA-lecture facts Flashcards

1
Q

what are GI complaints difficult to evaluate? 3

A
  1. frequently benign
  2. often nonspecific
  3. occasionally serious
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2
Q

what are the majority of visits to the ED for?

A

stomach and abdominal pain, cramps, or spasms

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3
Q

what is often required to make a specific diagnosis for abdominal complaints?

A

imaging

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4
Q

what drives the evaluation of pain?

A

location

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5
Q

what do the pain receptors in the abdomen respond to?

4

2

A
  1. mechanical stimuli-stretch, distention, traction, compression torsion

  1. chemical stimuli-inflammation or ischemia
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6
Q

what are the 3 types of pain?

A
  1. visceral
  2. parietal
  3. referred
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7
Q

visceral pain

A

dull, aching, can be colicky, poorly localized and arises from distention of hollow organs

ex: bowel obstruction

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8
Q

parietal pain

A

sharp, very well localized

arises from paritoneal irritation

Ex: appendicitis

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9
Q

refferred pain

A

aching, perceived to be near body surface

EX: cholecystitis referred to right scapula

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10
Q

what is the key to formulating the dif Diagosis list?

A

location of the pain is KEY!!!!

so have them point to the area that hurts

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11
Q

what are the 5 organs in RUQ?

A
  1. liver/gallbladder
  2. pylorus/duodenum
  3. head of pancreus
  4. ascending/transverse colon
  5. right kidney/adrenal
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12
Q

what are 5 organs in the right lower quadrant?

A
  1. right kidney/ureter
  2. cencum/appendix
  3. ovary/fallopian tube
  4. spermatic cord
  5. uterus/bladder
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13
Q

what are 6 organs in the upper left quadrant?

A
  1. liver (left lobe)
  2. spleen
  3. stomach
  4. body of pancreus
  5. descending/transverse colon
  6. left kidney/adrenal
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14
Q

what are the 5 organs in the LLQ?

A
  1. left kidney and ureter
  2. sigmoid/descending colon
  3. ovary/fallopian tube
  4. spermatic cord
  5. uterus/bladder (if enlarged)
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15
Q

what are 2 key things that can be reasons for pain in the left upper quadrant?

A
  1. myocardial infarction
  2. splenic rupture
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16
Q

what is 1 key thing that can appear in the RLQ?

A
  1. ectopic pregnancy
  2. appendicitis (starts periumbilically)
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17
Q

what is 1 important thing that can appeare in the left lower quadrant?

A
  1. ectropic pregnancy
  2. diveriticularis can be midline too
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18
Q

what are 4 things tht can appeare as epigastric pain?

A
  1. myocardial infarction
  2. reptured aortic aneurysm
  3. esophagitis
  4. PUD
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19
Q

what is 1 imporant thing you can see in the periumbilical area?

A
  1. ruptured aortic aneurysm
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20
Q

what is 1 important thing that can be in the suprapubic area?

A
  1. ectopic pregnancy
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21
Q

what are 2 important things that can cause diffuse pain?

A
  1. mesenteric ischemia
  2. peritonitis
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22
Q

what are 2 things that are key patterns for pain in RUQ?

A
  1. cholecystitis
  2. hepatitis
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23
Q

pain radiating to the back suggests…

A

pancreatitis

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24
Q

pain radiating to the R shoulder indicates….

A

cholecystitis

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25
pain radiating to the groin suggests...
renal colic
26
steady, rapid increase in pain suggests...
pancreatitis
27
several days pf pain prior to presentations suggestsion
diverticulitis
28
sudden, abrupt onset, severe pain suggests...
appendix rupture aortic dissection
29
buring or gnawing pain suggests....2
GERD PUD
30
colicky may suggest....3
1. gastroenteritis 2. bowel obstruction 3. nephrolithiasis
31
high intensity pain could suggest....
biliary or renal colic mesenteric infarcation
32
lower intensity pain coud suggest
gastroenteritis
33
pain with empy stomache AND pain relieved with eating could suggest
PUD
34
pain with any movement AND COUGH PAIN AND relief with lying on back and not moving could suggest.
peritonitis
35
pain worse with eating any fatty food could suggest...
cholecystitis
36
pain relieved with sitting up and leaning forward could suggest
pancreatitis
37
what do you need to exclude in all women of childbearing age presenting with abdominal pain?
PREGANCY!!
38
what are 3 vital signs that are important to note in abdominal complaints?
1. temp (infection) 2. HR 3. orthostatic BP (GI blood loss or dehydration)
39
what are 3 things that can cause increased _3rd spacing of fluid_ and _intravascular volume depletion_ or overt _shock_?
1. bowel obstruction 2. peritonitis 3. bowel infarction
40
what do you want to look at the eyes for?
scleral icterus
41
what do you look at the skin for? seen in?
_jaundice_ - hepatitis - cholgangitis
42
how often do normal bowel sounds occur? what do they sound like?
5-10 seconds clicks and gurgles
43
how long should you listen for bowel sounds?
2 minutes!! must listen for this long to say that they have NO BOWEL SOUNDS
44
if high pitched bowel sounds...suspect
small bowel obstruction
45
what are 4 things that can cause decreased bowel sounds?
1. peritonitis 2. ileus 3. mesenteric 4. narcotic use
46
what are 2 things that can cause friction rub?
1. splenic infarction 2. hepatitic metastasis
47
what are 4 places you listen for bruits?
48
what are 6 organs that are usually not palpable?
1. stomach 2. spleen 3. gallbladder 4. duodenum 5. pancreas 6. kidneys
49
what are two things you should suspect if the pt has rebound tenderness "guarding"?
1. peritonitis 2. appendicitis
50
spleen palpation
51
kidney palpation
52
what are 4 tests you do for appendicitis?
1. McBurneys point 2. Rovsings sign 3. psoas sign 4. obturator sign
53
what is the test you do for gallbladder disease?
murphys sigh
54
what are two tests you do for ascites?
1. shifting dullness 2. fluid wave
55
McBurneys point for appendicitis
56
rovsing's sign appendicitis if you deep press in RLQ and then lift up they haverebound pain as you lift up
57
psoas sign appendicitis pain with pushing down
58
obturator sign appendicitis pain with this motion
59
murphys sign ## Footnote gallbladder/cholecystitis slide hand under right rib while breathing out and causes pain
60
shifting dullness ascites
61
fluid wave acities push on one side and see if you feel wave on other side
62
what is this? caused by?
caput medusa ## Footnote varicose veins of the liver
63
spider angiomata
little telangestasis that is indicative of liver disease
64
what are 2 signs that are can be indicative of liver disease?
1. spider angiomata 2. caput medusa
65
\*\*\*what do you need to consider in any patient over 50 years old with pain out of proportion to PE findings\*\*
**_mesenteric ischemia_**
66
what are 5 conditions that are more common in elderly?
1. cholecystitis 2. diverticulitis 3. mesenteric ischemia 4. small bowel obstruction 5. ruptured aortic aneurysm
67
if woman has adnexal pathology, what should you think of?
1. ovarian cyst 2. torsion 3. neoplasm
68
when presentation would you consider for ectopic pregnancy?
vaginal bleeding 6-8 weeks after LMP
69
what are two things you need to do in all women of childbearing age who present with abdominal pain?
1. _HCG_ if postitive 2. _transvaginal US_
70
what is the HCG level know as the _discriminatory zone_ that allows you to see gestational sac of the IUP on US?
1,500
71
what are 4 sxs other than pain that children can present with?
1. vomiting 2. fever 3. irritibaility 4. lethargy
72
what does stillness in a child indicate?
irritation of the peritoneum like appendicitis
73
what does writhing for a comfortable positions suggest in a child?
obstruction or renal colic
74
what are 2 symptomatic reliefs for abdominal pain?
1. opoid analgesia 2. antiemetics (zofran)
75
amylase
pacreatitis if lipase not avaliable
76
lipase
pancreatitis
77
coagulation studies
GI bleeding end stage liver dxs coagulopathy
78
electrolytes
dehydration metabolic disorder
79
glucose
diabetic ketoacidosis pacreatitis
80
plain radiograph 3 indications
flat and upright views ## Footnote **_screening for obstruction "dilated looks of_** **_sigmoid volvus perforation (free air)_** **_severe constapation_**
81
US 2 preferences
preferred for: 1. biliary tract-cholecystitis 2. GYN-ectopic pregnancy
82
CT pros? cons?
pros: sensitive and specific cons: delay in surgery, radiation, cost and _must check creatine with contrast_
83
patients with _unclear diagnosis_ at end of the visit shoud...
reevalation _within 12 hours_ and _return if sxs change_ with increased pain, fever, vomiting, syncope, bleeding etc
84
what should you make sure to document?
pertinent negatives
85
what should you make sure to do for the radiologist?
provide clinical information
86
what are the majority of abdominal plain view films?
AP view
87
on a xray, how dose gas appeare?
black
88
on a xray, how does fat appeare?
dark grey
89
on a xray, how dose soft tissue or fluid appeare?
light grey
90
on a xray how does bone/calcification appeare?
white
91
on a xray how does metal appear?
intense white
92
pelvic phelboliths is.....
calcificaiton within the mesentary this is normal finding
93
what is wrong with this?
the marking of L isn't right.....it was marked on the wrong side by looking at the anatomy (look at the heart and the somach)
94
how large is the diametere of the SI?
2.5-3 cm
95
how large is the diameter of the LI?
3-5 cm
96
what are 6 things you should look at when examining the bone?
Cortical Outline Joint and Disc Space Trabecular Pattern General Bone Density Lysis, Fracture, Sclerosis Epiphyseal Lines
97
conventional CT scan ## Footnote how are the scans taken? what must patient do?
scan taken **slice by slice** after each scan it stops and move to the next place **requires the pt to hold still without movement** **ON THE WAY OUT AS A MEHTOD FOR CT**
98
spiral/helical CT HOW ARE THE IMAGES TAKEN?
**_CONTINUOUS SCAN taken in spiral fashion_** DUH, hence the name **MUCH FASTER PROCESS AND IMAGES ARE CONTINUOUS** **REPLACING THE CONVENTIONAL CT SCANNERS** **IT ROTATES AROUND THE PATIENT AND PRODUCES A BLOCK IMAGE IN ONLY A SECOND**
99
housefield units ## Footnote what are they? scale?
allows radiologist to differntiate between different types of tissues on CT, **measure of density** air-1000 units (minimum) water=0 bone +1000 the numerical number allows the radiologist to determine the type of tissue/fluid it is
100
explain the difference between clotting blood and free running blood on a hemmorage using housefield units?
clotting: _45-70 HU_ free: _20-45 HU_
101
what are two rxns you worry about when giving contrast for CT? what is the new type less likely to do this?
anaphylaxsis-bronchospasm/laryngeal edema renal failure \*\*injections can make patient feel warm, or even severe pain\*\* non-ionic options are less likely to cause severe allergic rxns but $$$
102
what is the _insoluble_ powerd that is suspecnded in water that is used as a common radiocontrast for the gastrointestinal tract during CT? alternative?
barium sulfate alternative: water soluble iodine
103
what can prevent the risk associated with giving contrast dye?
good hydration
104
what do you withhold before a CT scan?
metformin \*\*want to insure if person does get renal failure they don't have this in their system because it can cause a toxic accumlation if their kidneys can't filter it out\*\* _LACTIC ACIDOSIS_
105
when reading CT how should it be done?
head to toe superficial to deep
106
Shifting dullness test to assess for ascites
After percussing border of tympany and dullness w/ patient supine, ask patient to turn onto one side then percuss and mark borders again In ascites, dullness shifts to the more dependent side, whereas tympany shifts to the top
107
Fluid wave test to assess for ascites
Ask patient or assistant to press edges of both hands firmly down the midline of abdomen. While you tap one flank sharply w/ your fingertips, feel on the opposite flank for a “wave” transmitted through the fluid An easily palpable “wave” suggests ascites
108
McBurney’s point ## Footnote tenderness to assess for appendicitis
Find point (lies 2” from ASIS on an imaginary line drawn to umbilicus) Positive if tender w/ guarding, rigidity and rebound tenderness
109
Rovsing’s sign ## Footnote to assess for appendicitis
Press deeply and evenly in LLQ then quickly withdraw your fingers Positive if pain in RLQ during left-sided pressure
110
Psoas sign ## Footnote to assess for appendicitis
Place hand just above patient’s right knee and ask patient to raise thigh against your hand Positive if pain increases
111
Obturator sign ## Footnote to assess for appendicitis
Flex patient’s right thigh at hip, w/ knee bent, and rotate leg internally at hip (swing lower leg laterally) Positive if right-sided pain
112
Murphy’s sign ## Footnote to assess for acute cholecystitis
Hook your left thumb or fingers of your right hand under costal margin of RUQ and ask patient to take deep breath Positive if sharp increase in pain w/ sudden stop in inspiratory effort or wincing. Less pronounced pain may indicate liver inflammation
113
Ventral hernia assessment ## Footnote (umbilical or incisional)
Ask patient to raise the head and shoulders off the table Bulge of hernia will usually appear
114
Mass in abdominal wall assessment
Ask patient either to raise the head and shoulders off the table or bear down Mass in abdominal wall remains palpable
115
what are the four liver enzymes you check for liver function?
1. aspartate aminotransferase (AST) 2. alanine aminotransferase (ALT) 3. gamma-glutamyl transpeptidase (GGT) 4. alkaline phosphatase
116
what are the 3 things you check for liver function?
1. albumin 2. bilirubin, total and direct 3. prothrombin time
117
what would you expect to see for LFTs with hepatocellular damage? 2 examples?
increased **ALT/AST** ## Footnote **increased alkaline phosphate**
118
what would you expect to see on LFTs with cholestasis?
increases **ALT/AST, increase alkphos**
119
what would you expect to see for labs with jaundice?
increased total bilirubin...but can't differentiate wb etween hepatocellular damage or cholestasis
120
what does low albumin suggest?
chronic procress
121
what does a prolonged PT/INR suggest?
significant hepatocellular damage
122
what should these values of AST to ALT ratios make you think of? **AST:ALT** 2:1 ... 4x greater 25x normal 50x normal
2:1 **alcohol liver disease, cirrohosis** x4 greater **nonalchoholic fatty liver disease** 25x greater **hepatitis, toxin related** 50x greater **ischemic hepatopathy**
123
unconjugated indirect Bilirubin ## Footnote how is this produced? 2 things cause increase? 3 sxs?
a product of RBC break down when the cell dies, naturally or not naturally if increased: **1. hemolytic anemia** **2. imparied bilirubin uptake and storage** S&S: 1. mild jaundice 2. stool and urine abnormal 3. splenomegaly (in hemolysis)
124
conjugated direct bilirubin ## Footnote where is this made? what do increased levels come from? 3 S&S?
becomes conjugated in the liver **if this accumulates i nthe blood it means tha:** **1. liver isn't functioning** **2. billiary obsruction causing it to backup into blood** S&S 1. jaundice, pruritis 2. dark urine, light colored stool 3. RUQ pain (hepatomegaly)
125
inclass activity: bowel obstruction 2 key word findings imaging 1st and second
**_dilated loops of bowel on xray standing and supine_** \*\*air fluid levels on xray\*\* if need surgery, do _ct_
126
mesenteric ischemia ## Footnote when does pain occur? 3 KEY FINDINGS TEST
1. worst 10-30 mins after eating **_with pain out of proportion to exam_** ## Footnote TEST: CT ANGIOGRAM \*\*_focal and segmental bowel wall thickening with gas infiltration into the liver_\*\*
127
cholecystitis IN CLASS 3 tests to check/order
Tests: 1. CBC 2. **MURPHYS SIGN with guarding** test- color flow US stones (doppler)
128
acute cholangitis ## Footnote 4 tests to check? how to tx?
Tests: 1. CBC 2. LFT **hyperbilirubin** **3. increase alkaline phosphatase** **4._2 blood cultures_** ECRP for DX and TX
129
what is the earliest indicator of acute infection for hepatits B?
hepatitis B surface antigen
130
when does hepatitis A IgM antibody typically develop?
2-3 weeks after being infected
131
when is a unique time hepatitis B IgM core antibody can occur, outside of initial infection
in hepatitis flares in people with chronic hep B
132
what is important to keep in mind regarding the hepatitis C antibody?
you can't distinguish between active or previous infection
133
hepatitis ## Footnote test you want to check? 1 finding? 2 sxs?
_hepatitis panel_ ## Footnote **_LFTs in 1,000s_** **jaudice** **itchy** **check glucose**
134
PUD ## Footnote how to describe the pain? 3 tests, which absolute?
urease breath test fecal stool antigen **_endoscopy NEEDED_** **BURNING OR GNAWING**
135
how do you test for H. pylori if there is no acute bleed?
1. **_upper endoscopy with bx_** others; urease breth test fecal stool antigen
136
how do you test for H. pylori if presence of acute upper GI bleed?
**_urea breath test_**
137
pancreatitis where does pain go? 2 tests? 2 findings?
epigastic pain that radiates to **_back_** ## Footnote 1.amylase/**_lipase_** **_2. abdominal CT_** **_"heterogenous with multiple colors or FAT STRANDING"_**
138
appendicitis ## Footnote pain location 3 positive findings test and tx?
_periumbilical FOLLOWED BY RLQ_ postiive: ROVSINGS PSOAS MCBURNEYS **_CT AND REMOVE_**
139
diverticularis ## Footnote type of pain? 3 tests?
LLQ with **_progressive pain_** ## Footnote CBC GUIAC TEST **_CT_**

Module 9: Mali: GI (6 decks)

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