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Physical Assessment > Chapter 20, Module 7; Heartburn and Indigestion > Flashcards

Chapter 20, Module 7; Heartburn and Indigestion Flashcards

1
Q

Infants: Spitting up 3-5 times a day
Adults: Pain occurs after a meal and lasts a few minutes
No other symptoms

A

GER

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2
Q

PHYSICAL FINDINGS OF GER?

A

NONE

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3
Q

DIAGNOSTIC STUDIES FOR GER?

A

NONE

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4
Q

Heartburn, pyrosis Possible extraesophageal symptoms, laryngitis, wheezing, cough Infants: Weight loss, arching of back, vomiting, irritability

A

GERD

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5
Q

PHYSICAL FINDINGS OF GERD ARE?

A

None
Possible wheezing with asthma
Obesity
Growth chart change

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6
Q

DIAGNOSTIC STUDIES FOR GERD?

A

Trial of antacids
Trial of PPI
pH monitoring
Endoscopy for refractory symptoms to rule out erosions

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7
Q

Odynophagia, dysphagia, retrosternal pain; possible fever, nausea, and vomiting

A

Infective esophagitis

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8
Q

PHYSICAL FINDING OF Infective esophagitis?

A

None

Possible fever

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9
Q

DIAGNOSTIC STUDIES FOR Infective esophagitis?

A

Endoscopy: ulcerations, exudates

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10
Q

Young children and adolescents: Dyspepsia, heartburn, vomiting, irritability, food refusal, early satiation
Adults: Heartburn, epigastric or chest pain, dysphagia, and food impaction
Personal or family history of allergic disorders

A

AEE

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11
Q

PHYSICAL FINDINGS ARE AEE?

A

None

Possible allergic rhinitis, atopic dermatitis

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12
Q

DIAGNOSTIC STUDIES FOR AEE?

A

Endoscopy: linear furrowing and multiple rings

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13
Q

Medication history: tetracycline, potassium chloride, ferrous sulfate, NSAIDs, and bisphosphonates Takes medication at bedtime with insufficient water, and/or lying down directly after taking Acute discomfort followed by progressive retrosternal pain

A

Pill esophagitis

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14
Q

PHYSICAL FINDINGS FOR Pill esophagitis?

A

NONE

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15
Q

DIAGNOSTIC STUDIES FOR Pill esophagitis?

A

Endoscopy: focal lesion

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16
Q

Burning retrosternal discomfort or pain Symptoms present for the last 3 mo

A

Functional heartburn

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17
Q

PHYSICAL FINDINGS FOR Functional heartburn?

A

NONE

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18
Q

DIAGNOSTIC STUDIES Functional heartburn ?

A

Endoscopy

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19
Q

Pain in epigastrium or lower chest that worsens on reclining; relieved on standing Pain may be retrosternal with radiation down left arm

A

Hiatal hernia

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20
Q

PHYSICAL FINDINGS FOR Hiatal hernia?

A

None
Large hernia may create dullness on percussion over the left lung base, absent breath sounds, or bowel sounds resent in the chest

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21
Q

DIAGNOSTIC STUDIES Hiatal hernia?

A

UGI

22
Q

Episodic gnawing or epigastric pain usually 2-5 hr after meals or on empty stomach Nighttime awakening because of pain; symptom relief with food intake, antacids, or antisecretory agents Fullness, bloating, early satiation, vomiting, indigestion, loss of appetite, heartburn, hematemesis, back pain, and unexplained weight loss Medication history: NSAIDs, aspirin, high dose corticosteroids, bisphosphonates, mycophenolate, potassium chloride, and fluorouracil Children may present with generalized abdominal pain Older patients may be asymptomatic, but may also present with nonspecific complaints including confusion, restlessness, abdominal distention, and falls

A

PUD

23
Q

PHYSICAL FINDINGS OF PUD?

A

NONE

24
Q

DIAGNOSTIC STUDIES PUD

A

Endoscopy: ulcers; H. pylori testing CBC if suspect anemia FOBT for bleeding

25
Q

Alarm symptoms: dysphagia (solids or liquids), odynophagia, anorexia, and unintentional weight loss Repeated exposure to irritants such as smoking, alcohol History of Barrett esophagus

A

Esophageal cancer

26
Q

PHYSICAL FINDINGS Esophageal cancer?

A

Advanced disease: cachexia, ipsilateral Horner syndrome (miosis, ptosis, absence of sweating on ipsilateral face and neck), supraclavicular adenopathy, hoarseness, halitosis

27
Q

DIAGNOSTIC STUDIES Esophageal cancer?

A

Endoscopy

28
Q

Dyspepsia unrelieved by antacids, epigastric discomfort, usually lessened by fasting, and exacerbated by food intake and early satiation Alarm symptoms of dysphagia, anorexia, and weight loss

A

Gastric cancer

29
Q

PHYSICAL FINDINGS Gastric cancer?

A

Epigastric swelling or mass may be present on palpation Advanced disease: cachexia, palpable left supraclavicular (Virchow) node, palpable hard lymph node in umbilicus A hard, nodular liver indicates metastatic disease May be pale from anemia Ascites, pleural effusions may indicate metastasis

30
Q

DIAGNOSTIC STUDIES Gastric cancer?

A

Endoscopy + FOBT

31
Q

Dyspepsia with abdominal pain, indigestion, heartburn, and epigastric discomfort that is worse after eating, loss of appetite, sense of fullness, nausea, occasional vomiting, burning or gnawing feeling in the stomach between meals or at night Excessive alcohol use, chronic vomiting, stress, or the ingestion of aspirin, NSAIDs, or steroid. Bile gastritis can occur after partial gastrectomy, truncal vagotomy and pyloroplasty for peptic ulcer reflux, or cholecystectomy Bile reflux can cause severe epigastric abdominal pain, accompanied by bilious vomiting, and weight loss

A

Gastritis

32
Q

PHYSICAL FINDINGS Gastritis?

A

Possible epigastric tenderness

33
Q

DIAGNOSTIC STUDIES Gastritis

A

Endoscopy for patients with alarm features or persistent symptoms
Additional workup may include testing for H. pylori CBC if anemia suspected
FOBT for bleeding

34
Q

Epigastric pain or burning with postprandial fullness, early satiation Symptoms for 3-6 mo

A

Dyspepsia

35
Q

PHYSICAL FINDINGS Dyspepsia ?

A

Dyspepsia

36
Q

DIAGNOSTIC STUDIES Dyspepsia?

A

Endoscopy: for patients 55 yr and older, those with weight loss, progressive dysphagia, recurrent vomiting, evidence of Gl bleeding, or family history of cancer, new-onset dyspepsia H. pylori testing: patients 55 yr and younger with¬ out alarm features

37
Q

Risk factors: excessive amounts of caffeine or alcohol, smoking, steroids, NSAIDs, living in an area with high prevalence of H. pylori

A

Functional dyspepsia (nonulcer dyspepsia)

38
Q

PHYSICAL FINDINGS Functional dyspepsia (nonulcer dyspepsia)?

A

NONE

39
Q

DIAGNOSTIC STUDIES Functional dyspepsia (nonulcer dyspepsia)?

A

H. pylori testing Testing for structural disease, negative findings

40
Q

Abdominal discomfort, vague feelings of indigestion; abdominal bloating, belching, chest pain Ingestion of flatulogenic foods, Gl stasis, constipation, malabsorption, air swallowing (aerophagia), hurried eating or drinking, smoking or chewing gum, poorly fitting dentures, or dry mouth from anxiety or anticholinergics Pain worsens by bending over or wearing tight garments and is relieved by passage of flatus

A

Gas/gas entrapment

41
Q

PHYSICAL FINDINGS OF Gas/gas entrapment?

A

Possible distended abdomen with hyperresonance on percussion

42
Q

DIAGNOSTIC STUDIES OF Gas/gas entrapment?

A

NONE

43
Q

Severe, oppressive, constricting, retrosternal discomfort lasting longer than 30 min Possible prior history of Ml or angina

A

Acute coronary insufficiency

44
Q

PHYSICAL FINDINGS OF Acute coronary insufficiency?

A

Possible abnormal heart sounds such as paradoxical S2 during pain; transient S3 (ventricular gallop) or mitral regurgitation murmur at the apex; S4 (atrial gallop)

45
Q

DIAGNOSTIC STUDIES OF Acute coronary insufficiency?

A

ECG: intermittent ischemic changes or normal Cardiac isoenzymes normal

46
Q

Chest pain typically described as substernal chest pressure or heaviness, radiating to the left shoulder and arm, neck, or jaw Onset brought on and exacerbated by exercise and stress; typically lasts 2 to 10 min Alleviated with rest and/or nitroglycerin

A

Stable angina

47
Q

PHYSICAL FINDINGS OF Stable angina?

A

Possible diaphoresis and shortness of breath Transient S4 gallop during an episode of pain

48
Q

DIAGNOSTIC STUDIES OF Stable angina?

A

ECG during an episode of pain; ST segment depression and T wave inversions, or the findings can be normal

49
Q

Sudden onset of pain at rest Persistent, often severe, deep, central chest pain; and may radiate to the throat or neck, across both sides of the chest to the shoulder, and/or down the medial aspect of either or both arms Nitroglycerin does not relieve the pain Possible sense of impending doom Risk factors: Men 45 yr and older; women 55 yr and older; cigarette smoker; hyperlipidemia; hypertension; diabetes; obesity; history of CAD; family history of CAD

A

Ml

50
Q

PHYSICAL FINDINGS OF Ml?

A

Skin pallor, cool diaphoretic skin Hypertensive or hypotensive Possible transient paradoxical S2 or abnormal rhythms including tachycardia and bradycardia

51
Q

DIAGNOSTIC STUDIES OF Ml?

A

ECG: ST segment elevations, T wave inversions, and Q waves Cardiac enzymes elevated

Physical Assessment (27 decks)

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