Diagnosis and management of Gastrointestinal disorders Flashcards
1
Q
Peptic Ulcer Disease
Cause/ Incidence:
1. ___ ____ (present in > 90% of duodenal ulcers and > 75% of gastric ulcers)
A
H. pylori
2
Q
Peptic Ulcer Disease
Cause/ Incidence:
2. Medications such as ____, ASA, and glucocorticoids
A
NSAIDs
3
Q
Peptic Ulcer Disease
Cause/ Incidence:
3. More common in ____ (3:1)
A
men
4
Q
Peptic Ulcer Disease
Cause/ Incidence:
4. ____ ulcers between ages 30 to 55
A
Duodenal
5
Q
Peptic Ulcer Disease
Cause/ Incidence:
5. ______ ulcers between ages 55 to 65
A
Gastric
6
Q
Peptic Ulcer Disease
Cause/ Incidence:
6. More common in > ½ PPD ____
A
smokers
7
Q
Peptic Ulcer Disease
Cause/ Incidence:
7. ____ and dietary factors do not appear to cause ulcer disease
A
Alcohol
8
Q
Peptic Ulcer Disease
Cause/ Incidence:
8. The role of ____ is uncertain: Type A personalities?
A
stress
9
Q
Peptic Ulcer Disease
Signs/ Symptoms
1. Gnawing _____ pain
A
epigastric
10
Q
Peptic Ulcer Disease
Signs/ Symptoms
2. Relief of pain with eating (______)
A
duodenal
11
Q
Peptic Ulcer Disease
Signs/ Symptoms
3. Pain worsens with eating (____)
A
gastric
12
Q
Peptic Ulcer Disease
Physical Findings
1. Often unremarkable; may note some mild epigastric ______
A
tenderness
13
Q
Peptic Ulcer Disease
Physical Findings
2. GI bleeding (20% of cases) Melena, hematemesis, or ____-ground emesis
A
coffee
14
Q
Peptic Ulcer Disease
Physical Findings
3. _____ (5 to 10% of cases)” Severe epigastric pain, “board-like” abdomen, quiet bowel sounds, rigidity, and other sigmas of an acute abdomen
A
Perforation
15
Q
Peptic Ulcer Disease
Laboratory/Diagnostics
1. Normal; may note anemia on the ____
A
CBC
16
Q
Peptic Ulcer Disease
Laboratory/Diagnostics
2. Consider endoscopy after __ to __ weeks of treatment
A
8 to 12
17
Q
Peptic Ulcer Disease
Laboratory/Diagnostics
3. Consider ___ -___ testing Out-Patient Management
A
H. pylori
18
Q
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
1. ______ (Tagamet) 800 mg/hours sleep
A
Cimetidine
19
Q
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
2. ______ (Zantac) 300 mg/hours sleep
A
Ranitidine
20
Q
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
3. _____ (Pepcid) 40 mg/hours sleep
A
Famotidine
21
Q
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
4. ________ (Axid) 300 mg/hours sleep
A
Nizatidine
22
Q
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
1. _____ (Prevacid) 15 mg/day
A
Lansoprazole
23
Q
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
2. ________ (Aciphex) 20 mg/day
A
Rabeprazole
24
Q
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
3. ______ (Protonix) 40 nag/day
A
Pantoprazole
25
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
4. __________ (Prilosec) 20 mg/day
Omeprazole
26
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
5. __________ (Dexilant) 30 mg/day
Dexlansoprazole
27
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
6. _________ (Nexium) 20 mg/day
Esomeprazole
28
Mucosal Protective Agents
(Give 2 hours apart from other medications)
1. ____ _____ (Pepto-Bismol)
a. Has direct antibacterial action against H. pylori
b. Promotes prostaglandin production/stimulates
gastric bicarbonate
Bismuth subsalicylate
29
Mucosal Protective Agents
(Give 2 hours apart from other medications)
2. ________ (Cytotec): Four times daily with food
a. Used as prophylaxis against NSAID-induced ulcers
b. Stimulates mucous and bicarbonate production
c. May stimulate uterine contraction and induce
abortion
d. Discontinue offending agent if possible
e. Proton pump inhibitor in patients who cannot
discontinue NSAIDs
Misoprostol
30
Mucosal Protective Agents
(Give 2 hours apart from other medications)
3. _____ (Mylanta, Maalox, MOM, etc.)
a. Do not reduce the amount of gastric acidity
Antacids
31
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
1. Popular proton pump inhibitor regimen recommendations
a. MOC
Metronidazole (Flagyl) 500 mg twice a day with
meals, ______ (Prilosec) 20 mg twice a day
before meals, and clarithromycin (Biaxin) 500 mg
twice a day with meals for 7 days
omeprazole
32
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
1. Popular proton pump inhibitor regimen recommendations
b. AOC
_________ (Amoxil) 1 g twice a day with meals,
omeprazole (Prilosec) 20 mg twice a day before
meals, and clarithromycin (Biaxin) 500 mg twice a
day with meals for 7 days
amoxicillin
33
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
1. Popular proton pump inhibitor regimen recommendations
c. MOA
__________ (Flagyl) 500 mg twice a day with
meals, omeprazole (Prilosec) 20 mg BID before
meals, and amoxicillin (Amoxil) 1 g twice a day with
meals for 7 to 14 days
Metronidazole
34
H. pylori Eradication Therapy
Combination Options
2. Bismuth regimens require four times a day dosing
a. BMT: _____ _____ 2 tabs four times a day,
metronidazole (Flagyl) 250 mg four times a day, and
tetracycline (Tetracyn) 500 mg four times a day (all
with meals and at bedtime)
Bismuth subsalicylate
35
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
b. BMT + _________ (Prilosec): The above regimen +
omeprazole (Prilosec) 20 mg twice a day before meals
for 7 days
omeprazole
36
3. Antiulcer therapy is recommended following the previous regimens for __ to ___ weeks to ensure symptom relief and ulcer healing
3 to 7
37
Antiulcer therapy
a. For duodenal ulcer: _____ (Prilosec) 40 mg
every day or lansoprazole (Prevacid) 30 mg/day
continued for 7 additional weeks
Omeprazole
38
Antiulcer therapy
| b. H2 blockers can be given for ___ to ___weeks
6 to 8
39
Peptic Ulcer:
Urgent Care/Emergent Initial Management for PUD:
1. Baseline lab studies: _____, PT/PTT, basic metabolic panel (BMP)
CBC
40
```
Peptic Ulcer:
Urgent Care/Emergent Initial Management for PUD:
2. Refer for:
a. O2
b. _______
c. Urinary catheterization
d. Nasogastric tube for lavage
e. NPO
f. IV H2 Blockers
g. GI/surgical evaluation
```
Endoscopy
41
A disorder characterized by backflow (reflux) of acidic gastric contents into the esophagus
Gastroesophageal Reflux Disease (GERD)
42
Causes/Incidence GERD:
1. The _______ lower esophageal sphincter (LES)
2. Delayed gastric emptying
incompetent
43
```
GERD
Signs/Symptoms
1. ______ "burning"
2. Bitter taste in the mouth
3. Belching, hiccoughs, dysphagia
4. Excessive salivation
5. Frequently occurs at night and/or in a recumbent
position
6. May be relieved by sitting up, antacids, water or food
```
Retrostemal
44
GERD
Physical Exam Findings
1. N_______
Noncontributory
45
GERD
Diagnostics
1. Consider referral for esophagogastroduodenoscopy (EGD) Rule out cancer, ______ esophagus, peptic ulcer disease, etc.
Barrett's
46
GERD
Management
1. Non-pharmacologic measures
a. Elevate the head of the bed
b. Avoid alcohol, caffeine, spices, peppermint, etc.
c. Stop ______
d. Weight reduction if obese
2. Antacids PRN
3. H2 blockers ("-tidines") in high doses at fight or divided twice a day dosing
4. Proton pump inhibitors ("-zoles") if H2 blockers are ineffective
5. GI/surgical consult PRN
smoking
47
A nonspecific term usually applied to a syndrome of acute nausea, vomiting, diarrhea, and cramping resulting from an acute inflammation/irritation of the gastric mucosa
Gastroenteritis
48
Causes/Incidence of Gastroenteritis:
1. Viruses: More common during the winter
2. Bacterial
3. _______
4. Emotional stress
Parasitic
49
Signs/Symptoms of Gastroenteritis:
1. Nausea/vomiting
2. Watery ______
3. Anorexia
4. Abdominal cramping
5. General "sick" feeling
diarrhea
50
Physical Exam Findings of Gastroenteritis:
1. Hyperactive bowel sounds
2. Abdominal _______
3. Fever
4. Tachycardia
5. Hypotension
distention
51
Diagnostics of Gastroenteritis:
1. Not indicated timeless symptoms persist > ___ hours or blood is noted in stool
2. Stool for culture, WBCs and O and P
3. The stool may be guaiac positive if a bacterial infection is present
72
52
Management of Gastroenteritis:
1. Supportive care
2. Fluids for ________: Clear liquids progressing
3. In adults, antimotility medications are not recommended for mild disease; contraindicated in patients with bloody stool or fever
4. Antibiotics are only indicated when an organism is isolated and symptoms are not resolved
5. Traveler's diarrhea prophylaxis: Bismuth subsalicylate (Pepto-Bismol)
rehydration
53
Inflammation of the liver with resultant liver dysfunction
Hepatitis
54
Causes/Incidence of Hepatitis:
1. Viral: subtypes A, B, C (non-A, non-B), D, E, G
2. _________
3. Alcoholic
Autoimmune
55
Hepatitis ____
| Enteral virus, transmitted via the oral-fecal route and, rarely, parenterally
A
56
Hepatitis A
1. Common source outbreaks result from contaminated water and food (e.g., _______, hurricane-stricken areas with poor sewage), as well as intimate sexual contact (body secretion exchange).
shellfish
57
Hepatitis A
| 2. Blood and stool are infectious during the two to six week ______ period.
incubation
58
Hepatitis A
| 3. The mortality rate is very ____, and fulminant hepatitis A is rare.
low
59
Hepatitis ____
Bloodborne DNA virus present in serum, saliva, semen, and vaginal secretions
1. Transmitted via blood and blood products, sexual activity, and mother-fetus
B
60
Hepatitis ____
Bloodborne RNA virus in which the source of infection is often uncertain
1. Traditionally associated with blood transfusion
2. 50% of cases are related to intravenous drug use
C
61
Signs/Symptoms Hepatitis:
| 1. ______: Fatigue, malaise, anorexia, n/v, headache, aversion to smoking, and alcohol
Pre-icteric
62
Signs/Symptoms Hepatitis:
2. _____: Weight loss, jaundice, pruritus, right upper quadrant pain, clay-colored stool, dark urine
a. Low-grade fever may be present
b. Hepatosplenomegaly may be present
Icteric
63
Laboratory/Diagnostics Hepatitis:
| 1. WBC ___ to ____
low to normal
64
Laboratory/Diagnostics Hepatitis:
| 2. UA: ______, bilirubinemia
Proteinuria
65
Laboratory/Diagnostics Hepatitis:
| 3. ____ AST and ALT (500-2000 IU/L)
Elevated
66
Laboratory/Diagnostics Hepatitis:
| 4. LDH, bilirubin, alkaline phosphatase and PT ____ or slightly elevated
normal
67
Serology Tests
Hepatitis A
1. Anti-HAV (antibody for hepatitis A) and IgM (antibody to HAV which implies recent infection) peak during the first week of clinical illness and disappear in _____ months. These are diagnostic of acute Hepatitis A.
3-6 months
68
Serology Tests
Hepatitis A
2. ____ (antibody to HAV) implies previous exposure and confers immunity. The presence of ____ alone is not diagnostic of acute HAV infection; it indicates previous exposure, non-infectivity, and immunity to recurring HAV infection.
IgG
69
Hepatitis B surface antigen (HBsAg) is the first evidence of HBV infection. It will remain positive in asymptomatic carriers and chronic hepatitis B patients.
_____ (antibody to HBcAg) and IgM appear shortly after HBsAg disappears and before anti-HBc (antibody specific to HBsAg) appears.
Anti-HBc
70
Hepatitis B surface antigen (HBsAg) is the first evidence of HBV infection. It will remain positive in asymptomatic carriers and chronic hepatitis B patients.
______ (antibody to HBcAg) and IgM appear shortly after HBsAg disappears and before anti-HBc (antibody specific to HBsAg) appears.
Anti-HBc
71
Hep B:
_________ (a protein derived from HBV core, indicating circulating HBV and highly infectious sera) is found only in HBsAg positive sera. Its presence indicates viral replication and infectivity.
HBeAg
72
Hep B:
| ______ often appears after HBeAg disappears, It signifies diminished viral replication and decreased infectivity
Anti-HBe
73
This is what virus?
| Anti- HCV, HCV RNA
Active Hep B
74
This is what virus?
| Anti- HCV, HCV RNA
Chronic Hep B
75
This is what virus?
| Anti- HBc, Anti- HBsAg
Recovered Hep B
76
An enzyme _______ detects the presence of antibodies to hepatitis C.
immunoassay
77
Hepatitis C
| Sensitivity and specificity are ____, and when highly suspected, RIBA assay detects antibodies to HCV antigens.
low
78
Hepatitis C
| ____ ____ ___ (PCR) is used to differentiate prior exposure from current
Polymerase chain reaction
79
Hepatitis C
Summary:
a. Virus Serology
ii. ___ Hep C Anti- HCV, HCV RNA
iii. Chronic Hep C Anti- HCV, HCV RNA
Active
80
Hepatitis C
Summary:
a. Virus Serology
ii. Active Hep C Anti- HCV, HCV RNA
iii. _____ Hep C Anti- HCV, HCV RNA
Chronic
81
Management Hep C:
| 1. Generally supportive: ____ during the active phase
Rest
82
Management Hep C:
| 2. Increase fluids to ____ to 4,000 cc/day
3,000
83
Management Hep C:
| 3. Avoid _____ or other drugs detoxified by the liver
alcohol
84
Management Hep C:
| 4. Low to ____ protein diet
no
85
Management Hep C:
| 5. _____ (Serax) if sedation is necessary
Oxazepam
86
Management Hep C:
| 6. Vitamin ___ for prolonged PT (> 15 sec)
K
87
Management Hep C:
| 7. _______ 30 ml orally or rectally for elevated ammonia levels: Hepatic encephalopathy
Lactulose
88
Inflammation or localized perforation of diverticula with abscess formation
Diverticulitis
89
Diverticulitis
Causes/Incidence:
1. More common in _______
women than men
90
Diverticulitis
Causes/Incidence
2. Higher incidence in those with low dietary ____
fiber
91
Symptoms Diverticulitis:
1. Mild to moderate aching abdominal pain in ___ lower
quadrant
2. Constipation or loose stools may be present
3. Nausea and vomiting
left
92
Symptoms Diverticulitis:
| 2. ______ or loose stools may be present
Constipation
93
Symptoms Diverticulitis:
| 3. Nausea and _______
vomiting
94
Physical Finding Diverticulitis:
1. Low-grade ____
2. Left lower quadrant tenderness to palpation
3. Patients with perforation present with a more dramatic picture and peritoneal signs
fever
95
Physical Finding Diverticulitis:
2. Left lower quadrant _____ to palpation
3. Patients with perforation present with a more dramatic picture and peritoneal signs
tenderness
96
Physical Finding Diverticulitis:
| 3. Patients with perforation present with a more dramatic picture and ______ signs
peritoneal
97
Diverticulitis:
Laboratory/Diagnostics
1. Mild to moderate _________
2. Elevated ESR
3. Stool heme + in 25% of cases
4. Sigmoidoscopy shows inflamed mucosa
5. May consider CT scan to evaluate abscess
6. Plain. abdominal films are obtained on all patients to look for evidence of free air
leukocytosis
98
Management Diverticulitis:
1. NPO dependent upon the condition
2. Refer for:
a. Intravenous fluids to maintain hydration
b. GI/surgical consultation: _____ to ___% of patients
will require surgical management
20 to 30
99
A clinical syndrome of uncertain etiology characterized by lower abdominal pain and alternating diarrhea and/or constipation
Irritable Bowel Syndrome
100
```
Causes/General Comments
Irritable Bowel Syndrome:
1. Stress theory
2. Greater incidence among ______
3. Affects approximately 10 to 12% of the population
```
women
101
```
Signs/Symptoms
Irritable Bowel Syndrome:
1. Abdominal cramping
2. Abdominal pain may be _____ by defecation; rectal
tenesmus common
```
relieved
102
Signs/Symptoms
Irritable Bowel Syndrome:
4. Changes in stool _______ and/or pattern
consistency
103
Signs/Symptoms
Irritable Bowel Syndrome:
3. The patient may be _______ with bowel symptoms
4. Changes in stool consistency and/or pattern
5. Dyspepsia
6. Fatigue
7. Complaints of anxiety and/or depression are common
preoccupied
104
```
Diagnostics
Irritable Bowel Syndrome:
1. The following may be considered, but usual findings are normal:
a. __________
b. Barium studies
c. Rectal exam
```
Sigmoidoscopy
105
Management
Irritable Bowel Syndrome:
1. _______ support: Refer for counseling and therapy as
needed
2. Recommend a high fiber diet
3. SSRIs for patients who are depressed
4. For severe cases, may employ anticholinergics,
antidiarrheals, and/or antidepressant agents is
warranted
Emotional
106
Management
Irritable Bowel Syndrome:
2. Recommend a high____ diet
3. SSRIs for patients who are depressed
4. For severe cases, may employ anticholinergics,
antidiarrheals, and/or antidepressant agents is
warranted
fiber
107
___________
| Inflammation of the gallbladder, associated with gallstones in > 90% of cases
Cholecystitis
108
Signs/Symptoms Cholecystitis:
| 1. Often precipitated by a large or ____ meal
fatty
109
Signs/Symptoms Cholecystitis:
| 2. The sudden appearance of steady, severe pain in the epigastrium or _____ hypochondrium
right
110
Signs/Symptoms Cholecystitis:
| 3. Vomiting in many clients affords _____
relief
111
Physical Findings Cholecystitis:
1. _____ sign: Deep pain on inspiration while fingers
are placed under the right rib cage
Murphy's
112
Physical Findings Cholecystitis:
2. ____ upper quadrant tenderness to palpation; palpable gallbladder in 15% of cases
3. Muscle guarding mid rebound pain
4. Fever
Right
113
Laboratory/Diagnostics Cholecystitis:
| 1. WBCs, serum bilirubin, AST, ALT, LDH, and amylase may be ______
elevated
114
Laboratory/Diagnostics Cholecystitis:
2. Plain films may show gallstones
3. ________: Gold standard (most effective imaging test)
Ultrasound
115
Management Cholecystitis:
| 1. ____ management
Pain
116
Management Cholecystitis:
2. For acutely ill patients, refer for:
a. NGT for gastric ________
b. IV crystalloids and broad-spectrum antibiotics
c. GI/surgical consult
decompression
117
_____ ______
| Blockage of the intestinal lumen impeding the passage of bowel contents
Bowel Obstruction
118
```
Bowel Obstruction
Causes/Incidence/ Bowel Obstruction:
a. Hernia
b. Adhesions
c. Volvulus
d. tumors
e. fecal _______
f. Ileus (functional obstruction)
```
impaction
119
Signs/Symptoms Bowel Obstruction:
| 1. Cramping _______ pain initially: Later becomes constant and diffuse
periumbilical
120
Signs/Symptoms Bowel Obstruction:
| 2. Vomiting within minutes of pain (_____)
proximal
121
Signs/Symptoms Bowel Obstruction:
| 2. Vomiting within hours of pain (_____)
distal
122
Physical Findings Bowel Obstruction:
| 1. Minimal abdominal distention (_____)
proximal
123
Physical Findings Bowel Obstruction:
| 2. Pronounced abdominal distention (_____)
distal
124
Physical Findings Bowel Obstruction:
| 3. Mild tenderness but no ______ findings
peritoneal
125
Physical Findings Bowel Obstruction:
| 4. High pitched, _____ bowel sounds
tinkling
126
Physical Findings Bowel Obstruction:
| 5. _____ to pass stool/gas
Unable
127
Laboratory/Diagnostics/ Bowel Obstruction
1. Later in the diagnosis, we may see _____ WBCs and values consistent with dehydration
2. Plain films show dilated loops of bowel and air-fluid levels
a. A horizontal pattern in SBO
b. Frame pattern in LBO
elevated
128
Laboratory/Diagnostics/ Bowel Obstruction
2. Plain films show dilated loops of bowel and air-fluid levels
a. A ______ pattern in SBO
horizontal
129
Laboratory/Diagnostics/ Bowel Obstruction
2. Plain films show dilated loops of bowel and air-fluid levels
b. _____ pattern in LBO
Frame
130
Management/ Bowel Obstruction
1. Refer for:
a. Fluid resuscitation and ____ suction
b. Broad-spectrum antibiotics
c. GI/surgical consultation; partial obstructions may be
treated medically
NGT
131
_____ ____ is an idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon. Unlike Crohn's disease (upper bowel malabsorption syndrome), it involves the rectum and may extend upward involving the whole colon.
Ulcerative Colitis
132
Signs/Symptoms/ Ulcerative Colitis
| 1. _____ diarrhea is the hallmark symptom
Bloody
133
Signs/Symptoms/ Ulcerative Colitis
| 2. Rectal ______
tenesmus
134
Laboratory/Diagnostics/ Ulcerative Colitis
| 1. Stool studies are _______
negative
135
Laboratory/Diagnostics/ Ulcerative Colitis
| 2. ________ establishes diagnosis
Sigmoidoscopy
136
Management/ Ulcerative Colitis
| 1. _______ (Canasa) suppositories or enemas for three to 12 weeks
Mesalamine
137
Management/ Ulcerative Colitis
| 2. _______ suppositories and enemas
Hydrocortisone
138
Causes/General Comments/ Colon Cancer
| 1. _______ cause
Unknown
139
Causes/General Comments/ Colon Cancer
2. Increased incidence among patients with a family history of colon cancer or other adenocarcinomas (e.g., ovarian, endometrial), ____ fat or refined carbohydrate diets, polyps, or inflammatory bowel disease
high
140
Signs/Symptoms/ Colon Cancer
| 1. Often _____ until complications occur (e.g., bowel obstruction)
asymptomatic
141
Signs/Symptoms/ Colon Cancer
| 2. Changes in bowel _____
habits
142
Signs/Symptoms/ Colon Cancer
3. _____ stools; "ribbon stools"=descending colon cancer
4. Weight loss
Thin
143
Signs/Symptoms/ Colon Cancer
| 4. _____ loss
Weight
144
Diagnostics/ Colon Cancer
1. The stool may be guaiac _____
2. Colonoscopy
3. CBC
positive
145
Diagnostics/ Colon Cancer
4. Carcinoembryonic antigen (CEA) elevated; normal:
a. Non-smokers: < ____ ng/mL
b. Smokers: < 5 ng/mL
2.5
146
Diagnostics/ Colon Cancer
4. Carcinoembryonic antigen (CEA) elevated; normal:
a. Non-smokers: < ____ ng/mL
b. Smokers: < ____ ng/mL
5
147
Management/ Colon Cancer
1. Surgical consult with subsequent _____ consult
2. Supportive care with patient/family education, support groups, etc.
oncology
148
__________
| Inflammation of the appendix; if untreated gangrene and perforation may develop within 36 hours
Appendicitis
149
Appendicitis
| 1. The most common presentation is among ____ 18 to 30 years of age
men
150
Appendicitis
| 2. Affects approximately ___% of the population
10
151
Fecal stone is called?
Fecalith
152
Signs/Symptoms /Appendicitis
| 1. Begins with vague, colicky _____ pain
umbilical
153
Signs/Symptoms /Appendicitis
| 2. After several hours, pain shifts to ____ lower quadrant
right
154
Signs/Symptoms /Appendicitis
3. Nausea with ___ to ___ episodes of vomiting (more vomiting suggests another diagnosis)
4. The pain worsened and localized with coughing
1 to 2
155
Physical Findings /Appendicitis
| 1. _____ lower quadrant guarding with rebound tenderness
Right
156
Physical Findings /Appendicitis
| 2. ____ sign: pain with right thigh extension
Psoa's
157
Physical Findings /Appendicitis
| 3. _____ sign: pain with internal rotation of the flexed right thigh
Obturator
158
Physical Findings /Appendicitis
| 4. Positive ______ sign: right lower quadrant pain when pressure is applied to the left lower quadrant
Rovsing's
159
Physical Findings /Appendicitis
| 5. ___-grade fever (high fever suggests perforation or another diagnosis)
Low
160
Laboratory/Diagnostics /Appendicitis
| 1. WBCs ______/uL
10,000-20,000
161
Laboratory/Diagnostics /Appendicitis
| 2. ____ or ultrasound is diagnostic
CT
162
Management /Appendicitis
| 1. Refer to ____ treatment and pain management
surgical
163
Management /Appendicitis
| 1. Refer to ____ treatment and pain management
surgical
164
Gerontology Considerations
a. Decreased strength of ____ muscles for chewing
jaw
165
Gerontology Considerations
b. Decreased thirst and ____ perception
taste
166
Gerontology Considerations
c. Decreased ____ motility with delayed emptying
gastric
167
Gerontology Considerations
d. ______ intestinal transit time
Increased
168
Gerontology Considerations
e. Impaired ______ signal
defecation
169
Gerontology Considerations
f. Decreased liver _____
size
170
Gerontology Considerations
g. Decreased liver blood _____
flow
171
Gerontology Considerations
Possible findings and/or results
a. Risk of:
1. _____ nutrition
Poor
172
Gerontology Considerations
Possible findings and/or results
a. Risk of:
2. Altered drug ________
absorption
173
Gerontology Considerations
Possible findings and/or results
a. Risk of:
3. Decreased or impaired ______ of drugs
metabolism
174
Gerontology Considerations
Possible findings and/or results
a. Risk of:
4. ________ (difficulty swallowing) (e.g., GERD?)
Dysphagia
175
Gerontology Considerations
Possible findings and/or results
a. Risk of:
5. NSAID-induced _____
ulcers
176
Gerontology Considerations
Possible findings and/or results
a. Risk of:
6. ______ (though no_..La normal finding); most
common causes include lack of fiber, decreased
exercise, poor dentition, history of laxative abuse,
and impaired mental stares.
Constipation
177
Gerontology Considerations
Possible findings and/or results
a. Risk of:
6. ______ (though no_..La normal finding); most
common causes include lack of fiber, decreased
exercise, poor dentition, history of laxative abuse,
and impaired mental stares.
Constipation
