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ADV DIAG > Exam 3 GI Diagnostics > Flashcards

Exam 3 GI Diagnostics Flashcards

1
Q

RLQ Pain differential dx

A
  1. acute appendicitis
  2. mesenteric adenitis
  3. right renal colic
  4. torsed right testis
  5. chron’s
  6. gynecologic causes?
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2
Q

acute appendicitis clues

A

RLQ pain

shift of pain, anorexia, localized tenderness

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3
Q

mesenteric adenitis pain

A

RLQ pain

fever, inconstant signs

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4
Q

renal colic

A

RLQ pain or LLQ pain

colicky pain, hematuria

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5
Q

torsed testis

A

RLQ pain/LLQ pain

tender swollen testis, usually young age

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6
Q

chron’s disease

A

RLQ pain

recurrent, several day hx

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7
Q

LLQ pain differential dx

A
  1. diverticular disease
  2. acute urinary retention
  3. UTI
  4. inflammatory bowel disease
  5. large bowel obstruction
  6. left renal colic
  7. torsion of testis
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8
Q

diverticular disease clues

A

LLQ pain

elderly pt, recurrent

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9
Q

acute urinary retention pain

A

LLQ pain

palpable bladder, difficulty passing urine

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10
Q

UTI clues

A

LLQ pain

dysuria, frequency

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11
Q

inflammatory bowel disease clues

A

LLQ pain

recurrent attacks, diarrhea (+/- mucus, blood)

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12
Q

large bowel obstruction clues

A

LLQ pain

colicky pain, constipation

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13
Q

differential dx- LUQ and epigastric pain

A
  1. splenic rupture
  2. fractured ribs
  3. pancreatitis
  4. gastritis/ PUD
  5. PNA
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14
Q

splenic rupture clues

A

RUQ/ epigastric pain

hx of trauma or splenic disease

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15
Q

fractured ribs clues

A

LUQ/RUQ

hx of trauma, gross deformity, extreme tenderness on palpation

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16
Q

pancreatitis clues

A

LUQ/epigastric pain

hx of etoh, hx of similar event, elevated labs

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17
Q

gastritis/ PUD clues

A

LUQ/epigastric pain

recurrent, relationship to meals, relationship to posture

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18
Q

pna clues

A

LUQ/epigastric pain

fever, CXR findings, bronchial breathing

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19
Q

differential dx RUQ

A
  1. biliary colic, acute cholecystitis
  2. acute hepatitis
  3. right pyelonephritis
  4. CHF
  5. retrocecal appendicitis
  6. R LLQ PNA
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20
Q

biliary colic, acute cholecystitis clues

A

RUQ pain

recurrent attacks, tender over gallbladder

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21
Q

acute hepatitis clues

A

ruq pain

etoh hx, jaundice, meds

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22
Q

right pyelnophritis

A

RUQ pain

dysuria, fever, CVA tenderness

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23
Q

CHF clues

A

RUQ pain

edema, dyspnea, elevated JVP

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24
Q

retrocecal appendicitis clues

A

RUQ pain

shift of pain, tenderness

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25
Q

right LL pna clues

A

RUQ pain

fever, tachypnea, bronchial breathing

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26
Q

if female is childbearing age and having abd pain, do what

A
  1. ask location of pain
  2. do pregnancy test

never miss dx of ectopic pregnancy

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27
Q

c diff toxin assay

A

gram + spindle shaped anaerobic bacterium

produces toxins- toxins produce bloating, diarrhea, bleeding and necrosis of bowel wall

transmitted from person to person by oral - fecal route

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28
Q

tests for c diff dx

A

stool sample

presence of toxins a and b determined in lab by ELISA (enzyme linked immunoabsorbant assay)

test specific for each toxin- A and B

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29
Q

c diff stool sample should be ordered for any pt with diarrhea/bloating, who:

A
  1. is hospitalized, in nursing home, or recently dc from hospital or SNF
  2. pts on ATBs or who are immunocompromised esp at risk
  3. bloody diarrhea
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30
Q

Is c diff test specific

A

yes

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31
Q

how is c diff spread

A

by spores that are ingested - spores remain dormant on surfaces for a long time - the oral fecal rout accounts for spread of the disease

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32
Q

symptoms of c diff infection

A

bloating, gas, diarrhea, rectal bleeding

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33
Q

what is test for c diff and how is it performed

A

ELISA test done for c diff toxins a and b in stool

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34
Q

what is best way to limit spread of c diff

A

regular hand washing and thorough cleaning of all surfaces with a cleanser containing bleach

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35
Q

esophagogastroduodenoscopy aka EGD aka upper endoscopy

A

Flexible fiber optic tube to directly visualize the esophagus, stomach and the first part of the duodenum

as with cscope, lumen is viewed directly, smaples and bx can be obtained

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36
Q

EGD prep

A

NPO

conscious sedation used, so pt needs someone to drive them home after EGD

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37
Q

recommendations for appropriate EGD

A

older patients (esp those w/ symptoms or unexplained wt loss)
those with positive fecal occult blood tests
history or documented hematemesis or bloody stool
weight loss
trouble swallowing
early satiety

38
Q

not necessary to EGD on all pts with complaints or disorders r/t esophagus or stomach if:

A
  1. under age of 55 (CA less likely)
  2. not anemic from blood loss in GI tract
  3. no s/s of obstruction or perforation of stomach (acute abdomen)

treatment can be initiated based on H&P and if tx fails, pt can be referred***

39
Q

when to refer pt to egd?

A

New symptoms over age 55, bleeding, anemia, unexplained weight loss in an older person especially, patients with emergent sysptoms of possible obstruction or perforation, swallowing difficulties, and when treatment for GERD or dyspepsia fails to alleviate symptoms.

40
Q

what would you tell pt before EGD?

A

explain sedation procedure (check allergies and reactions to sedation in the past), someone must accompany the patient to drive them home after the procedure, NPO after midnight but may take meds if can do so at least 60 min prior to procedure (take with a glass of water)

41
Q

What limits the sensitivity and specificity of the EGD?

A

Skill of the endoscopist, and technical factors making it difficult to visualize the entire mucosa of the esophagus, stomach and duodenum.

42
Q

helicobacter pylori

A

gram - bacterium

associated with duodenal and gastric ulcers
can cause erosive gastritis and esophagitis

ASA and NSAIDs can also cause ulceration and gastritis

43
Q

what re 2 main causes of PUD and gastritis

A

h pylori, asa, nsaids

44
Q

tests for h pylori

A

blood for antibodies, urea breath test, stool for bacterial antigen, biopsy (urease test, microscopic examination and culture)

45
Q

What are the two best tests for H pylori if a biopsy is not obtained? Why?

A

stool for antigen and urea breath test bc less invasive

46
Q

endoscope for h pylori

A

is gold standard but not first lign

47
Q

fresh stool for h pylori

A

tested for presence of h pylori antigen

48
Q

urea breath test for h pylori

A

breath analyzed for co2 content

co2 produced by breakdown of urea by urease secreted by organism

49
Q

blood test for antibodies for h pylori

A

can detect immunoglobins made by hosts immune system to parts of h pylori organism

caution against this bc if pt ever had h pylori antibodies they would be present, false positive

50
Q

pts without alarm symptoms- bleeding, perforation, obstruction

A

may be evaluated and treated as outpatient based on results for h pylori

use urea breath test or stool test

51
Q

h pylori tx

A

triple/quadruple tx- 2 ATB and ppi

52
Q

symptomatic treatment for PUD

A

PPI or H2 blocker

53
Q

if h pylori tests are negative and symptoms recur after tx, do what

A

pt referred for egd

54
Q

protein, blood values

A

6-8.5 g/dl

55
Q

blood proteins have 2 components

A
  1. albumin (60% of blood protein)
    carries meds and hormones throughout body. helps with tissue growth and healing
  2. globulins (40% of blood protein)
    group of proteins. some made by liver. others by immune system. help fight infection and transport nutreints
56
Q

albumin value

A

3.5 - 5 g /dl

57
Q

albumin fx

A

maintains oncotic pressure, keeps excess fluid from seeping into tissues

transports amino acid nutrients to cells

58
Q

when albumin low, what happens

A

oncotic pressure in vascular system is reduced and fluid leaks into surrounding tissues

accounts for edema in pts with low albumin

59
Q

uses for albumin

A 
Measure of nutrition
Post-op patients
Liver disease
Various cancers
Chronic diseases
Renal disease
Burn victims
Pregnancy
60
Q

reduced albumin levels from

A
  1. malnutrition
  2. renal disease
  3. advanced cirrhosis
  4. meds- ie estrogen and po contraceptives, can reduce albumin while total protein may remain WNL
  5. p/o esp GI surgery and recovery prolonged
  6. burns
61
Q

where is albumin made

A

liver

62
Q

where is globulin made

A

reticuloendothelial cells

63
Q

stool tests

A
  1. culture and sensitivity
  2. ova and parasites
  3. WBCs
64
Q

stool tests

A

Toxigenic infectious agents take over the normal flora or inflame the mucosa of the bowel

bacteria, virus, parasitic infections

65
Q

most common cause of gastroenteritis in US

A

viruses

66
Q

bacteria organism causing gastroetneritis

A

e coli, campylobacter, shigella, salmonella

67
Q

stool culture

A

a stool sample is collected in a cup or on a swab to send to the microbiology lab for culture and sensitivity
In the lab, the specimen is placed on various culture media to grow the suspected bacteria.

68
Q

stool sample continued

A

examined under the microscope for ova and parasites - may reveal evidence of a parasitic GI infestation
Stool for ova and parasites should be fresh, i.e. not sit around all night to be brought for testing the next day
Stool for WBCs may be collected with a swab.

69
Q

gi disease caused by virus, bacteria, and parasites causes

A

diarrhea, maybe bloody
bleeding
bloating
n/v

70
Q

recommendations for stool sample

A

Only unusual situations should trigger testing.
Most cases of viral illness are self-limited and require no testing.
When symptoms last longer than 1 - 2 days without stopping or patients are very ill with dehydration stool should be sent for culture and sensitivity.
Low grade symptoms for a week or more or they have traveled to under-developed countries or have drank unfiltered Rocky Mountain stream water send stool for ova and parasites.

71
Q

if stool sample negative the first time and causative agent is strongly suspected, what to do

A

repeat test

72
Q

WBC in stool sample

A

helpful when trying to decide if causative organism is viral or bacterial and stool cx is pending

WBC more plentiful wen pt has symptoms from bacterial disease, will not occur in viral disease

73
Q

positive stool cx is diagnostic for

A

E coli, shigella, salmonella, toxigenic E coli or campylobacter

74
Q

positive stool for ova and parasites requires

A

consideration of appropriate pharmacologic tx

75
Q

When would you order a stool test for bacterial culture and sensitivity?

A

Unexplained lower GI tract symptoms (diarrhea, bloating, gas, bleeding) not abating in 24 to 48 hours

76
Q

When would you order a stool test for ova and parasites?

A

For lower GI symptoms (gas, bloating, loose stools or diarrhea) lasting longer than 1 - 2 weeks especially if there has been travel to countries where parasites are endemic or if the patient has been hiking in the Rocky Mountains (giardia)

77
Q

What is the purpose of ordering a semi-quantative test for stool white blood cells?:

A

To help decide between a viral and a bacterial etiology of lower GI symptoms

78
Q

What is important for patient to know about collecting a stool sample for ova and parasites?

A

stool must be in lab while still warm

79
Q

List the indications for colonoscopy:

A

Screening (disease detection), bleeding, weight loss in older adult especially, unexplained diarrhea, bloating, gas or symptoms not responding to treatment, abdominal pain, change in stool size, constipation (maybe if severe and unresponsive to stool softeners and periodic laxatives).

DX ca with bx

diagnose bleeding in the lower GI tract - diverticuli, ulcerative colitis, Crohn Disease, polyps, fissures, etc

80
Q

What function does blood urea play?

A

Formed in the liver as a breakdown product of proteins, it is transported to the kidney for excretion

81
Q

what causes elevated BUN

A

Blood in the gut, dehydration, renal disease

when there is large amount of protein to digestion

82
Q

under what circumstances might BUN be low

A

chronic liver failure

83
Q

bun normal range

A

7 - 30 mg/dl

84
Q

what happens to bun with inadequate hydration

A

BUN is not excreted as well by kidney, BUN increases (dehydration)

85
Q

usual ratio of BUN to Cr

A

10 to 1

86
Q

the longer the blood in GI tract, what happens to bun/cr ratio

A

it is higher with longer amount of time

87
Q

celiac disease

A

digestive disease that damages small intestine and interferes with absorption of nutrients of food

ppl cannot tolerate gluten, protein in wheat, rye, and barely

gluten found in many foods, meds, vitamins, lip balms

88
Q

when ppl with celiac disease eat foods or used products containing gluten what happens

A

immune system responds by damaging or destroying villi lining in small intestine

89
Q

villi does what

A

normally allows nutreints from food to be absorbed through walls of small intestine into blood stream

w/o healthy villi, person becomes malnourished

90
Q

celiac dx

A

Bloodwork- anti-tissue transglutaminase antibodies plus an IgA antibody (tTG-IgA)
positive in about 98% of patients with celiac disease who are on a gluten-containing diet
Intestinal BX- small intestine; through endocope (EGD)
a biopsy of the small intestine is the only way to diagnose celiac disease

ADV DIAG (23 decks)

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