[DSA Week 1] N/V Epigastric abdominal pain, Dyspepsia, Heartburn, Hematemesis (McGowan) Flashcards
Define:
Retching
Regurgitation
Rumination
Retching = Labored rhythmic respiratory activity that precedes emesis
Regurgitation = Gentle expulsion of gastric contents in the absence of nausea and abdominal diaphragmatic muscular contraction
Rumination = Regurgitation, rechewing and reswallowing of food from the stomach
What is gastroparesis?
Slowing of the gastric emptying
What are the symptoms associated with gastroparesis?
Intermittent waxing and waning
Early satiety
Define:
Paralytic ileus
Obstruction of the intestine due to paralysis of the intestinal muscles
What are the common findings on physical exam and in the hx of an acute paralytic ileus pt?
N/V, distention
Decreased or absent bowel sounds
Commonly seen in hospitalized pts
Define:
Dyspepsia
Indigestion
“A condition characterized by upper abdominal symptoms that may include pain/discomfort, bloating, feeling of fullness w/ very little food, heartburn, loss of appetite”
Define:
Pyrosis
Heartburn
What are the two primary causes of gastritis?
H. pylori
Autoimmune
State where H. pylori vs Autoimmune gastritis are located
H. pylori = Antrum
Autoimmune = Body
Antral type chronic gastritis is HIGHLY associated with?
MALT lymphoma
State which type of ulcer is:
Relieved by food
and
Food averse
Relieved by food = Duodenal ulcer
Food averse = Gastric ulcer
Which type of ulcer is worse 1-3 hours AFTER meals?
Duodenal ulcer
Which type of ulcer is worse by food within 30 min of eating?
Gastric ulcer
When can perforated viscus occur?
When any hallow organ (esophagus, stomach, intestine, uterus, bladder) perforates
What are the terms for air trapped:
Below the diaphragm
Above the diaphragm
Below the diaphragm = Pneumoperitoneum
Above the diaphragm = Pneumomediastinum
What is a curling ulcer?
Peptic ulcer in a patient with extensive burns
What is a cushing ulcer?
Peptic ulcer occuring from severe head (brain) inury or with other lesions of the CNS
H. pylori is
Gram (+)/(-)?
Gram negative
Following a completion of H.Pylori eradication thearpy, what do you need to do?
Need to confirm successful eradication
Urea breath test
Fecal antigen test
Endoscopy w/ biopsy
What is the unique histology associated w/ gastric adenocarcinoma?
Signet-ring cells
What are the two forms of cholelithiasis? (gallstones)
Cholesterol = Cholesterol monohydrate
Pigment stones = Calcium bilirubinate
What is the best diagnostic test for cholelithiasis?
Ultrasound
Where are stones typically impacted with calculous acute cholecystitis?
Cystic duct
What is the etiology of acute pancreatitis?
Biliary tract gallstones greater than 5mm
Heavy alcohol use
What are two major PE findings that are indicative of pancreatitis?
Cullen
or
Grey turner sign
What are the criteria used to assess the severity of pancreatitis?
Ranson criteria
APACHE II
What is key to the management of acute pancreatitis?
LOTS of fluid resuscitation
Define:
Hematemesis
Melena
Hematochezia
Hematemesis = vomit bright red blood or “coffee grounds”
Melena = develops after little as 50-100mL blood loss in most cases
Hematochezia = bright red blood per rectum
What is your initial step when managing an acute upper gastrointestinal bleed?
Assessment of the hemodynamic status
How do you stabilize an acute upper gastrointestinal bleed?
Two large bore “18-gauge or larger” IV lines
1 unit of PRBC’s raises the HBG by ????
1 unit of PRBC’s raises the HBG by 1g/dl
What is the treatment for esophageal varices?
Emergent upper endoscopy w/ variceal banding
Describe the hematemesis of hemorrhagic gastropathy/gastritis
Coffee ground emesis
Where is zollinger ellison syndrome frequently found?
Duodenum
What is the confirmatory test for ZE?
Serum (fasting) gastrin
>1000ng/L
What is the treatment for ZE?
PPI
What is menetrier disease characterized by?
Giant thickened gastric folds involving predominantly the body of the stomach
Chronic protein loss
What is the etiology of mallory weiss tear?
Superficial/non-transmural tear
