Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the majority of visits to the ED for?

A

stomach and abdominal pain, cramps, or spasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what drives the evaluation of pain?

A

location

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the 3 types of pain?

A
  1. visceral
  2. parietal
  3. referred
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

visceral pain

A

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

ex: bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

parietal pain

A

sharp, very well localized

arises from paritoneal irritation

Ex: appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

refferred pain

A

aching, perceived to be near body surface

EX: cholecystitis referred to right scapula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A
  1. ectopic pregnancy
  2. appendicitis (starts periumbilically)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are 4 things tht can appeare as epigastric pain?

A
  1. myocardial infarction
  2. reptured aortic aneurysm
  3. esophagitis
  4. PUD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

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

A
  1. ruptured aortic aneurysm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

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

A
  1. ectopic pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are 2 important things that can cause diffuse pain?

A
  1. mesenteric ischemia
  2. peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A
  1. cholecystitis
  2. hepatitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pain radiating to the back suggests…

A

pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pain radiating to the R shoulder indicates….

A

cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

pain radiating to the groin suggests…

A

renal colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

steady, rapid increase in pain suggests…

A

pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

several days pf pain prior to presentations suggestsion

A

diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

sudden, abrupt onset, severe pain suggests…

A

appendix rupture

aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

buring or gnawing pain suggests….2

A

GERD

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

colicky may suggest….3

A
  1. gastroenteritis
  2. bowel obstruction
  3. nephrolithiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

high intensity pain could suggest….

A

biliary or renal colic

mesenteric infarcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

lower intensity pain coud suggest

A

gastroenteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

pain with empy stomache

AND

pain relieved with eating could suggest

A

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

pain with any movement

AND

COUGH PAIN

AND

relief with lying on back and not moving could suggest.

A

peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

pain worse with eating any fatty food could suggest…

A

cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

pain relieved with sitting up and leaning forward could suggest

A

pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what do you need to exclude in all women of childbearing age presenting with abdominal pain?

A

PREGANCY!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what are 3 vital signs that are important to note in abdominal complaints?

A
  1. temp (infection)
  2. HR
  3. orthostatic BP (GI blood loss or dehydration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are 3 things that can cause increased 3rd spacing of fluid and intravascular volume depletion or overt shock?

A
  1. bowel obstruction
  2. peritonitis
  3. bowel infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

what do you want to look at the eyes for?

A

scleral icterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what do you look at the skin for? seen in?

A

jaundice

  • hepatitis
  • cholgangitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how often do normal bowel sounds occur?

what do they sound like?

A

5-10 seconds

clicks and gurgles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how long should you listen for bowel sounds?

A

2 minutes!! must listen for this long to say that they have NO BOWEL SOUNDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

if high pitched bowel sounds…suspect

A

small bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what are 4 things that can cause decreased bowel sounds?

A
  1. peritonitis
  2. ileus
  3. mesenteric
  4. narcotic use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are 2 things that can cause friction rub?

A
  1. splenic infarction
  2. hepatitic metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what are 4 places you listen for bruits?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what are 6 organs that are usually not palpable?

A
  1. stomach
  2. spleen
  3. gallbladder
  4. duodenum
  5. pancreas
  6. kidneys
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

what are two things you should suspect if the pt has rebound tenderness “guarding”?

A
  1. peritonitis
  2. appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q
A

spleen palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q
A

kidney palpation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what are 4 tests you do for appendicitis?

A
  1. McBurneys point
  2. Rovsings sign
  3. psoas sign
  4. obturator sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what is the test you do for gallbladder disease?

A

murphys sigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

what are two tests you do for ascites?

A
  1. shifting dullness
  2. fluid wave
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q
A

McBurneys point

for appendicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q
A

rovsing’s sign

appendicitis

if you deep press in RLQ and then lift up they haverebound pain as you lift up

57
Q
A

psoas sign

appendicitis

pain with pushing down

58
Q
A

obturator sign

appendicitis

pain with this motion

59
Q
A

murphys sign

gallbladder/cholecystitis

slide hand under right rib while breathing out and causes pain

60
Q
A

shifting dullness

ascites

61
Q
A

fluid wave

acities

push on one side and see if you feel wave on other side

62
Q

what is this?

caused by?

A

caput medusa

varicose veins of the liver

63
Q

spider angiomata

A

little telangestasis that is indicative of liver disease

64
Q

what are 2 signs that are can be indicative of liver disease?

A
  1. spider angiomata
  2. caput medusa
65
Q

***what do you need to consider in any patient over 50 years old with pain out of proportion to PE findings**

A

mesenteric ischemia

66
Q

what are 5 conditions that are more common in elderly?

A
  1. cholecystitis
  2. diverticulitis
  3. mesenteric ischemia
  4. small bowel obstruction
  5. ruptured aortic aneurysm
67
Q

if woman has adnexal pathology, what should you think of?

A
  1. ovarian cyst
  2. torsion
  3. neoplasm
68
Q

when presentation would you consider for ectopic pregnancy?

A

vaginal bleeding 6-8 weeks after LMP

69
Q

what are two things you need to do in all women of childbearing age who present with abdominal pain?

A
  1. HCG

if postitive

  1. transvaginal US
70
Q

what is the HCG level know as the discriminatory zone that allows you to see gestational sac of the IUP on US?

A

1,500

71
Q

what are 4 sxs other than pain that children can present with?

A
  1. vomiting
  2. fever
  3. irritibaility
  4. lethargy
72
Q

what does stillness in a child indicate?

A

irritation of the peritoneum like appendicitis

73
Q

what does writhing for a comfortable positions suggest in a child?

A

obstruction or renal colic

74
Q

what are 2 symptomatic reliefs for abdominal pain?

A
  1. opoid analgesia
  2. antiemetics (zofran)
75
Q

amylase

A

pacreatitis if lipase not avaliable

76
Q

lipase

A

pancreatitis

77
Q

coagulation studies

A

GI bleeding

end stage liver dxs

coagulopathy

78
Q

electrolytes

A

dehydration

metabolic disorder

79
Q

glucose

A

diabetic ketoacidosis

pacreatitis

80
Q

plain radiograph

3 indications

A

flat and upright views

screening for obstruction “dilated looks of

sigmoid volvus perforation (free air)

severe constapation

81
Q

US

2 preferences

A

preferred for:

  1. biliary tract-cholecystitis
  2. GYN-ectopic pregnancy
82
Q

CT

pros?

cons?

A

pros: sensitive and specific
cons: delay in surgery, radiation, cost and must check creatine with contrast

83
Q

patients with unclear diagnosis at end of the visit shoud…

A

reevalation within 12 hours

and return if sxs change with increased pain, fever, vomiting, syncope, bleeding etc

84
Q

what should you make sure to document?

A

pertinent negatives

85
Q

what should you make sure to do for the radiologist?

A

provide clinical information

86
Q

what are the majority of abdominal plain view films?

A

AP view

87
Q

on a xray, how dose gas appeare?

A

black

88
Q

on a xray, how does fat appeare?

A

dark grey

89
Q

on a xray, how dose soft tissue or fluid appeare?

A

light grey

90
Q

on a xray how does bone/calcification appeare?

A

white

91
Q

on a xray how does metal appear?

A

intense white

92
Q

pelvic phelboliths is…..

A

calcificaiton within the mesentary

this is normal finding

93
Q

what is wrong with this?

A

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
Q

how large is the diametere of the SI?

A

2.5-3 cm

95
Q

how large is the diameter of the LI?

A

3-5 cm

96
Q

what are 6 things you should look at when examining the bone?

A

Cortical Outline

Joint and Disc Space

Trabecular Pattern

General Bone Density

Lysis, Fracture, Sclerosis

Epiphyseal Lines

97
Q

conventional CT scan

how are the scans taken?

what must patient do?

A

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
Q

spiral/helical CT

HOW ARE THE IMAGES TAKEN?

A

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
Q

housefield units

what are they?

scale?

A

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
Q

explain the difference between clotting blood and free running blood on a hemmorage using housefield units?

A

clotting: 45-70 HU
free: 20-45 HU

101
Q

what are two rxns you worry about when giving contrast for CT?

what is the new type less likely to do this?

A

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
Q

what is the insoluble powerd that is suspecnded in water that is used as a common radiocontrast for the gastrointestinal tract during CT?

alternative?

A

barium sulfate

alternative: water soluble iodine

103
Q

what can prevent the risk associated with giving contrast dye?

A

good hydration

104
Q

what do you withhold before a CT scan?

A

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
Q

when reading CT how should it be done?

A

head to toe

superficial to deep

106
Q

Shifting dullness test to assess for ascites

A

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
Q

Fluid wave test to assess for ascites

A

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
Q

McBurney’s point

tenderness to assess for appendicitis

A

Find point (lies 2” from ASIS on an imaginary line drawn to umbilicus)

Positive if tender w/ guarding, rigidity and rebound tenderness

109
Q

Rovsing’s sign

to assess for appendicitis

A

Press deeply and evenly in LLQ then quickly withdraw your fingers

Positive if pain in RLQ during left-sided pressure

110
Q

Psoas sign

to assess for appendicitis

A

Place hand just above patient’s right knee and ask patient to raise thigh against your hand

Positive if pain increases

111
Q

Obturator sign

to assess for appendicitis

A

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
Q

Murphy’s sign

to assess for acute cholecystitis

A

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
Q

Ventral hernia assessment

(umbilical or incisional)

A

Ask patient to raise the head and shoulders off the table

Bulge of hernia will usually appear

114
Q

Mass in abdominal wall assessment

A

Ask patient either to raise the head and shoulders off the table or bear down

Mass in abdominal wall remains palpable

115
Q

what are the four liver enzymes you check for liver function?

A
  1. aspartate aminotransferase (AST)
  2. alanine aminotransferase (ALT)
  3. gamma-glutamyl transpeptidase (GGT)
  4. alkaline phosphatase
116
Q

what are the 3 things you check for liver function?

A
  1. albumin
  2. bilirubin, total and direct
  3. prothrombin time
117
Q

what would you expect to see for LFTs with hepatocellular damage? 2 examples?

A

increased ALT/AST

increased alkaline phosphate

118
Q

what would you expect to see on LFTs with cholestasis?

A

increases ALT/AST, increase alkphos

119
Q

what would you expect to see for labs with jaundice?

A

increased total bilirubin…but can’t differentiate wb etween hepatocellular damage or cholestasis

120
Q

what does low albumin suggest?

A

chronic procress

121
Q

what does a prolonged PT/INR suggest?

A

significant hepatocellular damage

122
Q

what should these values of AST to ALT ratios make you think of?

AST:ALT

2:1 …

4x greater

25x normal

50x normal

A

2:1 alcohol liver disease, cirrohosis

x4 greater nonalchoholic fatty liver disease

25x greater hepatitis, toxin related

50x greater ischemic hepatopathy

123
Q

unconjugated indirect Bilirubin

how is this produced?

2 things cause increase?

3 sxs?

A

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
Q

conjugated direct bilirubin

where is this made?

what do increased levels come from?

3 S&S?

A

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
Q

inclass activity:

bowel obstruction

2 key word findings

imaging 1st and second

A

dilated loops of bowel on xray standing and supine

**air fluid levels on xray**

if need surgery, do ct

126
Q

mesenteric ischemia

when does pain occur?

3 KEY FINDINGS

TEST

A
  1. worst 10-30 mins after eating with pain out of proportion to exam

TEST: CT ANGIOGRAM

**focal and segmental bowel wall thickening with gas infiltration into the liver**

127
Q

cholecystitis

IN CLASS

3 tests to check/order

A

Tests:

  1. CBC
  2. MURPHYS SIGN with guarding

test- color flow US

stones (doppler)

128
Q

acute cholangitis

4 tests to check?

how to tx?

A

Tests:

  1. CBC
  2. LFT hyperbilirubin

3. increase alkaline phosphatase

4.2 blood cultures

ECRP for DX and TX

129
Q

what is the earliest indicator of acute infection for hepatits B?

A

hepatitis B surface antigen

130
Q

when does hepatitis A IgM antibody typically develop?

A

2-3 weeks after being infected

131
Q

when is a unique time hepatitis B IgM core antibody can occur, outside of initial infection

A

in hepatitis flares in people with chronic hep B

132
Q

what is important to keep in mind regarding the hepatitis C antibody?

A

you can’t distinguish between active or previous infection

133
Q

hepatitis

test you want to check? 1 finding?

2 sxs?

A

hepatitis panel

LFTs in 1,000s

jaudice

itchy

check glucose

134
Q

PUD

how to describe the pain?

3 tests, which absolute?

A

urease breath test

fecal stool antigen

endoscopy NEEDED

BURNING OR GNAWING

135
Q

how do you test for H. pylori if there is no acute bleed?

A
  1. upper endoscopy with bx

others;

urease breth test

fecal stool antigen

136
Q

how do you test for H. pylori if presence of acute upper GI bleed?

A

urea breath test

137
Q

pancreatitis

<span>where does pain go?</span>

<span>2 tests?</span>

<span>2 findings?</span>

A

epigastic pain that radiates to back

1.amylase/lipase

2. abdominal CT

“heterogenous with multiple colors or FAT STRANDING”

138
Q

appendicitis

pain location

3 positive findings

test and tx?

A

periumbilical FOLLOWED BY RLQ

postiive:

ROVSINGS

PSOAS
MCBURNEYS

CT AND REMOVE

139
Q

diverticularis

type of pain?

3 tests?

A

LLQ with progressive pain

CBC

GUIAC TEST

CT

Module 9: Mali: GI (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions