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Nelson - The Digestive System > Ch. 306 - Major Signs and Symptoms of Digestive Tract Disorders > Flashcards

Ch. 306 - Major Signs and Symptoms of Digestive Tract Disorders Flashcards

1
Q

The sensation of something stuck in the throat without a clear etiology

A

Globus

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2
Q

Swallowing is a complex process that starts where

A

In the mouth with mastication

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3
Q

Occurs when transfer of food bolus from mouth to esophagus is imapired

A

Oropharyngeal dysphagia

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4
Q

Oropharyngeal dysphagia is aka

A

Transfer dysphagia

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5
Q

Structures affected in oropharyngeal dysphagia

A

Striated muscles of the mouth, pharynx, and UES

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6
Q

Most serious complication of oropharyngeal dysphagia

A

Life-threatening aspiration

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7
Q

Occurs when there is difficulty in transporting food bolus down the esophagus

A

Esophageal dysphagia

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8
Q

Causes of esophageal dysphagia

A

1) Neuromuscular disorders 2) Mechanical obstruction

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9
Q

T/F Primary motility disorders causing impaired peristaltic function and dysphagia is common in children

A

F, rare

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10
Q

Cause a fixed impediment to the passage of food bolus because of a narrowing within the esophagus, as in a stricture, web, or tumor

A

Intrinsic structural defects

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11
Q

Caused by compression from vascular rings, mediastinal lesions, or vertebral abnormalities

A

Extrinsic obstruction

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12
Q

T/F Structural defect cause more problems in swallowing solids than liquids

A

T

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13
Q

A thin ring of mucosal tissue near the lower esophageal sphincter that is a mechanical cause of recurrent dysphagia

A

Schatzki ring

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14
Q

Esophageal symptoms are usually referred to what anatomic landmark

A

Suprasternal notch

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15
Q

The effortless movement of stomach contents into the esophagus and mouth

A

Regurgitation

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16
Q

T/F Infants with regurgitation are often hungry immediately after an episode

A

T

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17
Q

A result of GER through an incompetent or immature LES

A

Regurgitation

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18
Q

T/F Regurgitation or “spitting” resolves with maturity

A

T

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19
Q

Prolonged lack of appetite

A

Anorexia

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20
Q

Satiety is stimulated by

A

Distention of the stomach or upper small bowel

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21
Q

A highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching

A

Vomiting

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22
Q

Vomiting, as a reflex process is coordinated in the

A

Medullary vomiting center

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23
Q

2 causes of bile-stained vomitus

A

1) Obstruction below 2nd part of duodenum 2) Repeated vomiting in the absence of obstruction when duodenal contents are refluxed into stomach

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24
Q

A syndrome with numerous episodes of vomiting interspersed with well intervals

A

Cyclic vomiting

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25
Q

2 criteria that must be present for cyclic vomiting in children as defined by Rome III criteria

A

1) 2 or more periods of intense nausea and unremitting vomiting 2) Retching lasting hours to days and return to usual state of health lasting weeks to months

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26
Q

Onset of cyclic vomiting is usually

A

Between 2 and 5 years of age

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27
Q

Average frequency of vomiting episodes in cyclic vomiting

A

12 episodes per year, each episode lasting 2-3 days and 4 or more emesis episode per hour

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28
Q

Episodes of vomiting in cyclic vomiting usually comes during what time of the day

A

Early hours or upon wakening

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29
Q

Precipitants of cyclic vomiting

A

1) Infection 2) Physical stress 3) Psychologic stress

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30
Q

T/F More than 80% of children with cyclic vomiting have a 1st-degree relative with migraines

A

T

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31
Q

T/F Many patients with cyclic vomiting develop migraines later in life

A

T

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32
Q

Diarrhea is best defined as

A

Excessive loss of fluid and electrolyte in the stool

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33
Q

Acute diarrhea is defined as a sudden onset of excessively loose stools of ___mL/kg/day in infants and ____g/24 hrs in older children

A

> 10, >200

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34
Q

By definition, acute diarrhea lasts for how long

A

Less than 14 days

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35
Q

Chronic or persistent diarrhea lasts for how long

A

> 14 days

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36
Q

Normally, a young infant has approximately ___ /day stool output

A

5mL/kg

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37
Q

The greatest volume of intestinal water is absorbed in which part of the GIT

A

Small intestine

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38
Q

T/F The colon concentrates intestinal contents against a high osmotic gradient

A

T

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39
Q

T/F Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea

A

T

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40
Q

Small-volume, frequent bloody stools with mucus, tenesmus, and urgency

A

Dysentery

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41
Q

The predominant symptom of colitis

A

Dysentery

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42
Q

Basis of all diarrhea

A

Disturbed intestinal solute transport and water absorption

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43
Q

Secretory vs osmotic diarrhea: Cholera

A

Secretory

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44
Q

Secretory vs osmotic diarrhea: Large volume

A

Secretory

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45
Q

Secretory vs osmotic diarrhea: Stops with fasting

A

Osmotic

46
Q

Secretory vs osmotic diarrhea: Occurs after ingestion of a poorly absorbed solute

A

Osmotic

47
Q

Secretory vs osmotic diarrhea: Stool osmolality predominantly indicated by electrolytes

A

Secretory

48
Q

Secretory vs osmotic diarrhea: Lactulose

A

Osmotic

49
Q

Secretory vs osmotic diarrhea: Ion gap of 100 mOsm/kg or less

A

Secretory

50
Q

Secretory vs osmotic diarrhea: Sorbitol

A

Osmotic

51
Q

Secretory vs osmotic diarrhea: Lactase deficiency

A

Osmotic

52
Q

Secretory vs osmotic diarrhea: Rotavirus diarrhea

A

Osmotic

53
Q

Secretory vs osmotic diarrhea: Anion gap will not be explained by electrolyte content

A

Osmotic

54
Q

Secretory vs osmotic diarrhea: Anion gap is >100 mOsm

A

Osmotic

55
Q

Secretory vs osmotic diarrhea: No stool leukocytes

A

Both

56
Q

Secretory vs osmotic diarrhea: Bile salt malabsoprtion

A

Secretory

57
Q

Secretory vs osmotic diarrhea: Toxigenix E. coli

A

Secretory

58
Q

Secretory vs osmotic diarrhea: Neuroblastoma

A

Secretory

59
Q

Secretory vs osmotic diarrhea: C. difficile

A

Secretory

60
Q

Secretory vs osmotic diarrhea: Cryptosporidiosis in AIDS

A

Secretory

61
Q

Formula for ion gap of stool

A

Stool osm - [(Stool Na + stool K) x2]

62
Q

Secretory vs osmotic diarrhea: Increased breath hydrogen with carbohydrate malabsorption

A

Osmotic

63
Q

T/F A hard stool passed with difficulty every 3rd day should be treated as constipation

A

T

64
Q

T/F A soft stool only every 2nd or 3rd day without difficulty should be treated as constipation

A

F

65
Q

True constipation during the neonatal period is most likely secondary to what 3 entities

A

1) Hirschprung disease 2) Intestinal pseudo obstruction 3) Hypothyroidism

66
Q

Watery content from the proximal colon might percolate around hard retained stool and pass per rectum unperceived by the child. This is called

A

Involuntary encopresis

67
Q 
T/F A child with functional abdomi-
nal pain (no identifiable organic cause) may be as uncomfortable as one with an organic cause.
A

T

68
Q

Reassuring PE findings in a child who is suspected of having functional abdominal pain

A

1) Normal growth and PE 2) Absence of anemia or hematochezia

69
Q

Types of nerve fibers that transmit painful stimuli in the abdomen

A

1) A fibers: Sharp, localized, skin and muscle 2) C fibers: Dull, poorly localized, viscera, peritoneum, and muscle

70
Q

In the gut, the usual stimulus provoking pain is

A

Tension or stretching

71
Q

Pain that suggests a potentially serious organic etiology is associated with (14)

A

1) Younger than 5 y/o 2) Weight loss 3) Fever 4) Bile or blood-stained emesis 5) Jaundice 6) Hepatosplenomegaly 7) Back or flank pain or pain in a location other than the umbilicus 8) Awakening from sleep in pain 9) Referred pain to shoulder, groin, or back 10) Elevated ESR, WBC, or CRP 11) Anemia 12) Edema 13) Hematochezia 14) Strong family history of IBD or celiac disease

72
Q

Pain that tends to be dull and aching and is experienced in the dermatome from which the affected organ receives innervation

A

Visceral pain

73
Q

Referred pain: Liver

A

Epigastrium

74
Q

Referred pain: Pancreas

A

Epigastrium

75
Q

Referred pain: Distal small bowel

A

Umbilicus

76
Q

Referred pain: Distal large bowel

A

Suprapubic

77
Q

Referred pain: Appendix

A

Umbilicus

78
Q

Referred pain: Biliary tree

A

Epigastrium

79
Q

Referred pain: Stomach

A

Epigastrium

80
Q

Referred pain: Upper bowel

A

Epigastrium

81
Q

Referred pain: Cecum

A

Umbilicus

82
Q

Referred pain: Urinary tract

A

Suprapubic

83
Q

Referred pain: Proximal colon

A

Umbilicus

84
Q

Pain from the cecum, ascending colon, and descending colon sometimes is felt at the site of the lesion because

A

Short mesocecum and corresponding mesocolon

85
Q

Pain from the transverse cool is usually felt in the

A

Suprapubic region

86
Q

Pain that is intense and is usually well localized

A

Somatic pain

87
Q

Pain from extraintestinal locations, from shared central projections with the sensory pathway from the abdominal wall, can give rise to abdominal pain, as in pneumonia when the parietal pleural pain is referred to the abdomen

A

Referred pain

88
Q

Hematemesis is bleeding that originates from

A

Esophagus, stomach, or duodenum

89
Q

Hematochezia signifies bleeding from as far as

A

Distal ileum

90
Q

Melena signifies

A

Mild to moderate bleeding from sites above the distal ileum

91
Q

Black tarry stool is aka

A

Melena

92
Q

MCC of GI bleeding

A

Erosive damage to the mucosa of the GIT

93
Q

T/F Vascular malformations are a common cause of GI bleeding in children

A

F

94
Q

Capsule endoscopy facilitates evaluation of bleeding from

A

Small intestines

95
Q

Useful means of locating the site of bleeding if it is brisk and intestinal in origin

A

Tagged RBC scan

96
Q

Guaiac test is very sensitive but can miss ___

A

Chronic blood loss

97
Q

T/F GI hemorrhage can produce hypotension and tachycardia but rarely causes GI symptoms

A

T

98
Q

Ascitic fluid is usually: Transudate vs exudate

A

Transudate

99
Q

Ascitic fluid is usually: High in protein vs low in protein

A

Low

100
Q

Ascitic fluid results from (2)

A

1) Reduced plasma colloid osmotic pressure from hypoalbuminemia 2) Raised portal venous pressure

101
Q

What happens to serum Na excretion in the urine as the ascitic fluid accumulates

A

Decreases

102
Q

When ascitic fluid is high in protein, it is usually secondary to

A

1) Inflammation 2) Neoplastic lesion

103
Q

Nonspecific pain, often periumbilical

A

Functional ab pain

104
Q

Intermittent cramps, diarrhea, and constipation

A

IBS

105
Q

Peptic ulcer–like symptoms without abnormalities on evaluation of the upper GI tract

A

Nonulcer dyspepsia

106
Q

Bloating, gas, cramps, and diarrhea, not associated with lactose intake

A

Parasite infection, especially Giardia

107
Q

Burning or gnawing epigastric pain; worse on awakening or before meals; relieved with antacids

A

PUD

108
Q

Epigastric pain with substernal burning

A

Esophagitis

109
Q

Periumbilical or lower abdominal pain; may have blood in stool (usually painless)

A

Meckel diverticulum

110
Q

RUQ pain, might worsen with meals

A

Cholelithiasis

Nelson - The Digestive System (24 decks)

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