Exam 2 Flashcards
Patients with visceral pain will have difficulty doing what?
finding a comfortable position
- deep aching, boring, gnawing, vague burning, or deep grinding
Patients with inflammatory pain will often do what?
see a quiet position w/o movement
- sitting/lying with knees bent or in a curled up/fetal position
What type of pain is steady, has a sudden onset, and is extremely intense? What causes it?
Ischemic pain
- secondary to vascular disease or from an obstruction causing strangulation of bowel tissue
pain from the _______ can be referred to the midback, and visa versa
esophagus
What may be altered in referred pain distribution
sensation
hyperesthesia
excessive sensibility to sensory stimuli of skin
hyperalgesia
excessive sensibility to painful stimuli of muscle
What organs refer to the shoulder?
- liver
- respiratory diaphragm
- pericardium
What organs refer to the midback and scapular region?
- gallbladder
- stomach
- pancreas
- small intestine
What refers to the pelvis, flank, low back, or sacrum?
- colon
- sigmoid colon
- appendix
- rectum
- ureters
- testes
Dysfunction of the stomach, gallbladder, liver, pylorus, or respiratory diaphragm can cause what?
contraction, guarding, and splinting of the rectus abdominis and muscles superior to umbilicus
Dysfunction of the ileum, jejunum, appendix, cecum, colon, and rectum can cause what?
muscle spasm of the rectus abdominis inferior to the umbilicus
What are causes of dysphagia?
difficulty swallowing
- non-GI conditions (neuro diseases)
- achalasia - obstruction of muscles for peristalsis
- peptic esophagitis
- GERD
- Neoplasm
- certain antidepressants, antipsychotics, antihypertensive, and asthma drugs
What is odynophagia? What are potential causes?
pain during swallowing
- esophagitis
- esophageal spasm
GI bleeding manifest as ___________ pain with radiation to the RUQ
mid-thoracic back pain
signs of GI bleeding
- coffee-ground emesis
- bloody diarrhea
- bright red blood
- melena (blood in stool)
- reddish colored stools
GI cancer pain S&S
more intense, boring, constant, unable to be relieved
Duodenal ulcer S&S
pain that could be relieved by eating
accompanying symptoms of arthralgia in GI disorders
- fever
- skin rash
- nails separate from nail bed
- conjuctivities
pancreatic cancer involving tail of pancreas refers to where?
Left shoulder
Kehr’s sign
L shoulder pain with pressure placed on the upper abdomen
Danforth sign
shoulder pain with inspiration
pancreatic cancer involving head of pancreas refers where?
Right shoulder
What GI issues refer to the right shoulder?
- perforated duodenal or gastric ulcers that irritate diaphragm
- pancreatic cancer involving head of pancreas
- liver trauma
What GI issues refer to both shoulders?
- ruptured ectopic pregnancy w/ retroperitoneal bleeding
- accumulation of blood from a slow bleed
S&S of obturator or psoas abscess
- hectic fever
- night sweats
- abdominal pain
- back, pelvic, abdominal, hip, and/or knee pain
- antalgic gait
- palpable, tender mass
what does a + heel tap indicate?
obturator or psoas abscess
What is a red flag of a peptic ulcer?
new onset of shoulder/back pain for someone with a hx of peptic ulcers
S&S of peptic ulcer
- heartburn
- night pain
- radiating back pain
- R shoulder pain/lateral border of R scapula
- blood stools
- black, tarry stools
Gastric ulcer is ________ by food
aggravated
Duodenal ulcers is _______ by food
relieved
Diverticulosis vs Diverticulitis. Where is the pain for deverticulitis?
Diverticulosis - colon balloons out through weakened areas in the wall
Diverticulitis - infection and inflammation that accompany a microperforation of 1 of the diverticula
- left lower abdominal or pelvic pain/tenderness
Diverticulitis S&S
- abdominal pain often with loss of appetite, nausea, abdominal bloating
- Lower left quadrant pain ~70% of patients
- lower right quadrant pain - asians
- decreased or absent bowel sounds
- bloody stools
Pinch-an-inch test + test
pain upon release of the skin fold
- indicates appendicitis
What is the most common cause of acute pancreatitis?
gall stones
Other causes:
- chronic alcoholism
- High triglyceride blood levels
- toxicity from some other agent
What is the most common cause of chronic pancreatitis?
alcohol use and smoking
acute pancreatitis S&S
- epigastric pain radiating to the back
- abdominal distention
- fever and sweating
- bluish discoloration of abdomen or flanks
- jaundice
- Colon’s sign - bruise formed on the abdomen around umbilicus
chronic pancreatitis S&S
- epigastric pain radiating to the back
- upper left lumbar region pain
- clay-colored or pale stools
Who is most likely to have pancreatic cancer?
men in their 7th decade (60s)
S&S of pancreatic cancer
- epigastric pain radiating to the back
- back pain may be the only symptom
- jaundice
- light-colored stool
Aggravating and relieving factors of pancreatic pain
Aggravating
- walking and lying supine
- alcohol, large meals
- digestive activities
Relieving
- sitting and leaning forward
Pain from head of pancreas refers to ______ shoulder
right
Pain from tail of pancreas refers to the _____ shoulder
left
ulcerative colitis affects _______
the colon
Crohn’s disease affects _________
any portion of the intestine from the mouth to the anus
Who is most likely to develop Crohn’s disease?
- between 20-29 y/o
- parental/sibling Hx of IBD
- smokers
Who is more likely to develop colorectal cancer, Crohn’s disease or ulcerative colitis?
ulcerative colitis
Crohn’s disease and ulcerative colitis S&S
- fever
- abdominal pain
- rectal bleeding
- night sweats
- decreased appetite
- skin lesions
- uveitis - eye redness and swelling in whites of the eye
- migratory arthralgias
What is uveitis?
eye redness and swelling in whites of the eye
- sign of Crohn’s disease and ulcerative colitis
IBS typically affects who
females > males
</= 50 y/o
risk factors for IBS
- family hx of IBS
- emotional stress, tension or anxiety
- food intolerance
- Hx of physical or sexual abuse
- severe digestive tract infection
Who is at an increased risk for colorectal cancer?
- non-hispanic AA
- native americans and native Alaskans
- family Hx of colorectal cancer
- prior Hx IBD
S&S of early stage colorectal cancer
- rectal bleeding, hemorrhoids
- abdominal, pelvic, back, or sacral pain
- back pain that radiates down the leg
- changes in bowel patterns
S&S of advanced stages of colorectal cancer
- constipation progressing to obstipation
- diarrhea with copious amounts of mucus
- N&V
- abdominal distention
- weight loss
- fatigue
What skin changes occur with liver disorders?
- jaundice
- pruritus - itchy skin
- bruising
- spider angiomas - red branched dilations of the superficial capillaries
- palmar/plantar erythema
- White nails of Terry - white hue of nails with darker redness on the distal end of nails
What is Leukonychia and Koilonychia?
Leukonychia - white discoloration of the nails
Koilonychia - soft nails that look scooped out
What nailbed changes occur with liver disorders?
- Leukonychia - white discoloration of the nails
- clubbed nails
- Koilonychia - soft nails that look scooped out
What are the primary pain patterns for hepatic/bilary disorders?
- mid-epigastrium or RUQ of the abdomen
liver disease referred pain patterns
- thoracic spine
- right upper trapezius and shoulder
gallbladder referred pain patterns
- right upper trapezius and shoulder
- right interscapular area
- right subscapular area
Neuro symptoms of liver disease
- confusion
- hyperractive reflexes
- asterixis - liver flap in hands
- peripheral nerve dysfunction
What color will stool and urine be with liver disease?
- light-colored (almost white) stools
- during the color of tea or cola
What is white nails of Terry? What does it indicate?
- white hue of nails with darker redness on the distal ends of nails
- indicates liver disease
red flag of hepatitis
- joint or muscle pain that is disproportionate to the physical findings
- the presence of palmar tendinitis in someone with RA
- positive risk factors for hepatitis
risk factors for hepatitis
- IV drug use
- acupuncture
- tattos/piercings
- recent operation
- liver transplant recipient
- health care worker
- unprotected sex
- severe alcoholism
S&S of hepatitis
- extreme fatigue
- fever
- right upper abdominal pain
- clay-colored stools
- dark urine
- jaundice
- alteration in senses of taste and smell
- low-grade fever
S&S of HBV
- jaundice
- arthralgia
- rash
- fever
What is considered chronic hepatitis?
Illness associated with prolonged (>6 months) inflammation of the liver
S&S of chronic hepatitis
- fatigue
- jaundice
- abdominal pain
- anorexia
- arthralgia
- fever
- ascites
What is Wilson’s disease? What are symptoms that a patient may have?
- biliary excretion of copper is impaired
- may have mild to severe neurologic involvement
What is hematochromatosis? What does it cause?
- autosomal recessive defect of iron absorption
- causes liver failure
What joints are typically involved in hematochromatosis?
- 2nd and 3rd (point and middle finger) MCP joints commonly involved first, then knees/hips/shoulders/low back
What is the most common hepatotoxic agent?
acetaminophen
S&S of drug-induced hepatitis
- jaundice
- dark urine
- clay-colored stools
- fever, rash, arthralgias, epigastric or RUQ pain
S&S of cirrhosis
- mild RUQ pain
- GI symptoms
- weight loss
- ease of fatigue (w/ mild exertion)
- fever
integument S&S of cirrhosis
- poor tissue turger
- spider angiomas
- palmar erythema
S&S of portal HTN
- ascitis
- esophageal varices
- hemorrhoids
- splenomegaly
S&S of hemorrhage associated w/ esophageal varices
- pallor
- tachycardia
- cooling of the skin
- hypotension
What is kernicterus?
A type of brain damage from toxic levels of bilirubin in the blood
What is the most common cause of a liver abscess?
biliary tract disease
S&S of liver abscess
- right abdominal pain
- right shoulder pain
- fever, chills, malaise
- diaphoresis
- anemia
- tender liver
- jaundice
cholelithiasis risk factors
- increased age
- women > men before 60 y/o
- elevated estrogen levels
- obesity
- DM
- liver disease
- rapid weight loss or fasting
- statins
- genetics/family hx
symptom of biliary colic cholelithiasis
right upper abdominal pain that comes and goes in waves
S&S of cholelithiasis
- chills, low grade fever
- jaundice
- tenderness over the gallbladder
- tenderness over 10th rib
- RUQ and epigastrium severe pain
- right shoulder and between the scapulae
chronic = pain may radiate to midback between the scapulae
Primary Biliary Cirrhosis S&S
- pruritus - itchy skin
- dry eyes and mouth
- jaundice
- ascites
- RUQ pain
- osteoporosis
- burning, pins and needles, prickling of the eyes
