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CMN 586 > exam 4: GI > Flashcards

exam 4: GI Flashcards

1
Q 
Diffuse pain could mean
1
2
3
4
5
6
A
  1. Inflammatory bowel disease (IBD),
  2. Irritable bowel syndrome (IBS)
  3. gastroenteritis
  4. AAA
  5. bowel obstruction
  6. ischemic bowel
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2
Q 
Epigastric pain could mean
1
2
3
4
A
  1. MI
  2. peptic ulcer disease (PUD), 3. biliary disease
  3. pancreatitis
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3
Q 
Right upper quadrant
pain could mean
1
2
3
A
  1. hepatitis

2. gallbladder (biliary) disease, 3. renal disease (pyleo or renal stone)

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4
Q

Left upper quadrant pain could mean
1
2

A

1 - spleen

2- renal disease

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5
Q

Periumbilical pain could mean
1
2

A
  1. early appendicitis

2. small bowel disease

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6
Q 
Left lower quadrant: pain could mean
1
2
3
4
A

1 diverticulitis (can be diffuse)
2 PID
3 ovarian cyst
4 ectopic pregnancy

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7
Q 
Right lower quadrant pain could mean
1
2
3
4
A

1 appendicitis
2 PID
3 ovarian cyst
4 ectopic pregnancy

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8
Q

___ sign: RUQ pain on deep inspiration: seen with inflamed gallbladder. May also be elicited by palpating the RUQ as they take a deep breath.

A

Murphey’s sign

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9
Q

__ sign: Palpation of the left lower quadrant causes pain in the right lower quadrant. Seen with appendicitis

A

Rovsing sign

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10
Q

___ test: Pain felt in the right lower quadrant on internal rotation of the right hip. Seen with appendicitis.

A

Cope Obturator Test

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11
Q

___ sign: Extension of the right hip causes pain in the right lower quadrant. Seen with appendicitis.

A

Iliopsoas sign

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12
Q

Signs of peritoneal irritation
1.
2.

A

Guarding:

   voluntary: usually symmetric, muscles more tense on inspiration, usually doesn’t hurt to rise from supine to sitting position (using abdominal muscles), lessens with distraction.
  involuntary: aysmmetrical, rigidity present on inspiration and expiration, rising to sitting position greatly increases pain, doesn’t change with distraction

Rebound tenderness: slowly compress abdomen, then quickly release pressure, pain increases.

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13
Q

Imaging:
___: may detect renal stones, look for stool in colon, free air in perforation, dilated loops of bowel in obstruction

A

KUB

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14
Q

_____look for gallstones, ovarian cysts or ectopic pregnancy, hydronephrosis due to renal stone, high specificity for appendicitis but not as sensitive as CT.

A

Abdominal Ultrasound

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15
Q

___ most sensitive test for diagnosing acute abdominal pain. Useful for appendicitis, abscesses, AAA, diverticulitis, bowel obstruction, tumors. Renal CT for renal stones

A

CT

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16
Q

___Anorexia, periumbilical pain that later migrates to RLQ, anorexia, nausea &vomiting usually after onset of pain, prefers to remain still
WBC may be normal or slightly elevated

A

Appendicitis

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17
Q

___Pain is colicky, located in the epigastrium or RUQ with radiation to the flanks & occasionally the R shoulder.
Classic pain occurs within 1 hour after eating a large meal, lasts for several hours, & is followed by a residual aching that can last for days.
May have anorexia, nausea, vomiting & fever

A

CHOLELITHIASIS/ Cholecystitis

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18
Q

___Abrupt onset of severe epigastric pain that may radiate to the back.
Nausea, vomiting, sweating & anxiety.
Pain is ↑ with movement or lying supine and patient prefers to sit up and lean forward.

A

Pancreatitis

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19
Q

Gastroenteritis:

  1. ___ cause: large volume, watery stool, no blood, Lasts 1-2 days, associated N/V, crampy abd pain, fever, malaise, dehydration in young children
A

viral

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20
Q

Gastroenteritis:

  1. ___ : variable from mild symptoms to severe, may have bloody diarrhea. C. difficile may occur up to 8 weeks after exposure to antibiotics, esp. Clindamycin or fluoroquinolines, with watery diarrhea and cramps
  2. ____ watery diarrhea which may be prolonged, cramps
A
  1. Bacterial

2. Parasitic

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21
Q

___
-Mild to moderate aching abd pain, usually in LLQ, constipation or loose stools, N&V may occur, usually symptoms are mild and pts do not seek medical attention until several days after onset.

-Low-grade fever, LLQ tenderness, palpable mass, stool for occult blood +, mild-moderate ↑ WBC

A

Diverticulitis

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22
Q

GERD work-up Patients < ___y/o without alarm symptoms may be treated empirically without further testing.
Patients with alarm symptoms or poor response to empiric therapy should be referred for upper GI endoscopy

A

under 55

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23
Q

___Heartburn is the typical symptom. Usually occurs 30-60min after meals and with reclining. Burning chest pain and regurgitation are common. Pain may be relieved by antacids.
Most have no structural defects
Non-GI symptoms include asthma, chronic cough, laryngitis, sore throat or non-cardiac chest pain and sleep disturbance.

A

GERD

24
Q

___Dyspepsia: described as gnawing, hunger-like, burning pain in epigastric area. Pain may awaken patient. Symptoms wax and wane. May have relief with food intake or antacids and return of pain 2-4 hr later. Up to 60% NSAID-induced PUD have no symptoms.

A

Peptic Ulcer Disease

25
Q

A ___ infant is defined as one who is healthy and well fed but cries for more than 3 hrs. a day, for more than 3 days a week, and for more than 3 weeks.
Characterized by severe & paroxysmal crying that occurs mainly in the late afternoon.
Infant’s knees are drawn up & its fists are clenched.
A behavioral sign that begins in the first few weeks and peaks at age 2-3 months. In 30-40% of cases, it continues into the 4th and 5th months.

A

colicky

26
Q

___ Most common cause of intestinal obstruction in the first 2 yrs of life.
Presents as a thriving infant aged 3-12 months with paroxysmal, colicky pain, draws up knees and screams.
Vomiting & diarrhea occur soon afterward in 90% of cases and bloody BMs with mucus appear within the next 12 hrs. (currant jelly stools). Prostration and fever supervene. Abd is tender and becomes distended. A sausage-shaped mass may be palpated in the upper mid abdomen.
Barium or air enema is diagnostic and therapeutic. Prognosis relates to the duration before reduction.

A

Intussusception

27
Q

___Hernias – affects full-term African American children more often; most close spontaneously within 1st yr of life and majority close by the 5th year; Large defects and those persisting after age 4 are repaired surgically; in adults umbilical hernias need repair because of the high risk of incarceration and strangulation.

A

Umbilical

28
Q

___hernias – account for 75% of abdominal hernias. In children these hernias are congenital, but can be acquired from obesity, chronic cough, ascites, chronic constipation with straining, and lifting heavy objects.

A

Inguinal

29
Q

___healthy infant suddenly refuses to eat, vomits bile, and becomes inconsolable, and develops abdominal distention. This usually occurs during the first 3 weeks of life.
Diagnosis: UGI shows the malrotation and it can be further confirmed with a BE.
Treatment: Surgery

A

Malrotation

30
Q

___Vomiting begins 2-4 wks of age and rapidly becomes projectile after every feeding. It starts at birth in 10% of infants and onset may be delayed in premature infants.
Vomitus may be blood streaked.
Infant appears hungry, eats frequently, & eventually has constipation, dehydration, wt loss, & is fretful.
After feeding, upper abdomen may be distended
Prominent gastric peristaltic waves may be seen
In some infants, an olive-sized mass can be felt on deep palpation in the right upper abdomen.

A

Pyloric Stenosis

31
Q

___Symptoms usually begin around 4-6 yrs of age.
Symptoms include intestinal dilatation, bloating, increased flatulence, pain and eventually diarrhea.
Symptoms appear 2 hrs. after ingestion of milk or products, sometimes as long as 12 hrs. after.
Often confused with cow’s milk intolerance, which occurs in infancy and has symptoms of blood in the stools and often manifestations of allergies such as eczema, hives and asthma.

A

Lactose Intolerance

32
Q

___Acute onset of unilateral lower quadrant pain which usually is continuous and crampy with some degree of vaginal bleeding and a low-grade fever.
Positive pregnancy test
Ultrasound fails to reveal intrauterine pregnancy
Emergent referral to OB

A

Ruptured Ectopic Pregnancy

33
Q

___Mid-cycle pain caused by irritation of the peritoneum due to spillage of fluid from the ruptured follicular cyst at time of ovulation.
Sudden onset of localized unilateral lower quadrant pain, which persists for a few minutes to as long as 8 hrs.
Rarely mimics the abdominal findings of appendicitis, torsion or rupture of ovarian cyst, or ectopic pregnancy.
Anovulatory cycles can lead to a normal follicular cyst growing large over several cycles and causing considerable pain on rupture.

A

Mittelschmerz

34
Q 
MISCELLANEOUS Causes of Abdominal Pain
1
2
3
4
A

Dissecting aortic aneurysm
Acute pyelonephritis
Splenic infarction or rupture
Acute mesenteric vascular occlusion and related conditions

35
Q

NONSURGICAL CONDITIONS SIMULATING ACUTE ABD PAIN

A 
Metabolic conditions:
Diabetes mellitus (ketoacidosis)
Hyperthyroidism
Hypercalcemia/Hyperkalemia
Familial mediterranean fever
Pneumonias
Sickle Cell Crisis
Papillary necrosis of the kidney
Herpes zoster
Hemolytic uremic syndrome
Henoch-Schonlein purpura
36
Q

___Anorexia, periumbilical pain that later migrates to RLQ, anorexia, nausea &vomiting usually after onset of pain, prefers to remain still
WBC may be normal or slightly elevated

A

Appendicitis

37
Q

___Pain is colicky, located in the epigastrium or RUQ with radiation to the flanks & occasionally the R shoulder.
Classic pain occurs within 1 hour after eating a large meal, lasts for several hours, & is followed by a residual aching that can last for days.
May have anorexia, nausea, vomiting & fever

A

CHOLELITHIASIS/ Cholecystitis

38
Q

___Abrupt onset of severe epigastric pain that may radiate to the back.
Nausea, vomiting, sweating & anxiety.
Pain is ↑ with movement or lying supine and patient prefers to sit up and lean forward.

A

Pancreatitis

39
Q

Gastroenteritis:

  1. ___ cause: large volume, watery stool, no blood, Lasts 1-2 days, associated N/V, crampy abd pain, fever, malaise, dehydration in young children
A

viral

40
Q

Gastroenteritis:

  1. ___ : variable from mild symptoms to severe, may have bloody diarrhea. C. difficile may occur up to 8 weeks after exposure to antibiotics, esp. Clindamycin or fluoroquinolines, with watery diarrhea and cramps
  2. ____ watery diarrhea which may be prolonged, cramps
A
  1. Bacterial

2. Parasitic

41
Q

___
-Mild to moderate aching abd pain, usually in LLQ, constipation or loose stools, N&V may occur, usually symptoms are mild and pts do not seek medical attention until several days after onset.

-Low-grade fever, LLQ tenderness, palpable mass, stool for occult blood +, mild-moderate ↑ WBC

A

Diverticulitis

42
Q

GERD work-up Patients < ___y/o without alarm symptoms may be treated empirically without further testing.
Patients with alarm symptoms or poor response to empiric therapy should be referred for upper GI endoscopy

A

under 55

43
Q

___Heartburn is the typical symptom. Usually occurs 30-60min after meals and with reclining. Burning chest pain and regurgitation are common. Pain may be relieved by antacids.
Most have no structural defects
Non-GI symptoms include asthma, chronic cough, laryngitis, sore throat or non-cardiac chest pain and sleep disturbance.

A

GERD

44
Q

___Dyspepsia: described as gnawing, hunger-like, burning pain in epigastric area. Pain may awaken patient. Symptoms wax and wane. May have relief with food intake or antacids and return of pain 2-4 hr later. Up to 60% NSAID-induced PUD have no symptoms.

A

Peptic Ulcer Disease

45
Q

A ___ infant is defined as one who is healthy and well fed but cries for more than 3 hrs. a day, for more than 3 days a week, and for more than 3 weeks.
Characterized by severe & paroxysmal crying that occurs mainly in the late afternoon.
Infant’s knees are drawn up & its fists are clenched.
A behavioral sign that begins in the first few weeks and peaks at age 2-3 months. In 30-40% of cases, it continues into the 4th and 5th months.

A

colicky

46
Q

___ Most common cause of intestinal obstruction in the first 2 yrs of life.
Presents as a thriving infant aged 3-12 months with paroxysmal, colicky pain, draws up knees and screams.
Vomiting & diarrhea occur soon afterward in 90% of cases and bloody BMs with mucus appear within the next 12 hrs. (currant jelly stools). Prostration and fever supervene. Abd is tender and becomes distended. A sausage-shaped mass may be palpated in the upper mid abdomen.
Barium or air enema is diagnostic and therapeutic. Prognosis relates to the duration before reduction.

A

Intussusception

47
Q

___Hernias – affects full-term African American children more often; most close spontaneously within 1st yr of life and majority close by the 5th year; Large defects and those persisting after age 4 are repaired surgically; in adults umbilical hernias need repair because of the high risk of incarceration and strangulation.

A

Umbilical

48
Q

___hernias – account for 75% of abdominal hernias. In children these hernias are congenital, but can be acquired from obesity, chronic cough, ascites, chronic constipation with straining, and lifting heavy objects.

A

Inguinal

49
Q

___healthy infant suddenly refuses to eat, vomits bile, and becomes inconsolable, and develops abdominal distention. This usually occurs during the first 3 weeks of life.
Diagnosis: UGI shows the malrotation and it can be further confirmed with a BE.
Treatment: Surgery

A

Malrotation

50
Q

___Vomiting begins 2-4 wks of age and rapidly becomes projectile after every feeding. It starts at birth in 10% of infants and onset may be delayed in premature infants.
Vomitus may be blood streaked.
Infant appears hungry, eats frequently, & eventually has constipation, dehydration, wt loss, & is fretful.
After feeding, upper abdomen may be distended
Prominent gastric peristaltic waves may be seen
In some infants, an olive-sized mass can be felt on deep palpation in the right upper abdomen.

A

Pyloric Stenosis

51
Q

___Symptoms usually begin around 4-6 yrs of age.
Symptoms include intestinal dilatation, bloating, increased flatulence, pain and eventually diarrhea.
Symptoms appear 2 hrs. after ingestion of milk or products, sometimes as long as 12 hrs. after.
Often confused with cow’s milk intolerance, which occurs in infancy and has symptoms of blood in the stools and often manifestations of allergies such as eczema, hives and asthma.

A

Lactose Intolerance

52
Q

___Acute onset of unilateral lower quadrant pain which usually is continuous and crampy with some degree of vaginal bleeding and a low-grade fever.
Positive pregnancy test
Ultrasound fails to reveal intrauterine pregnancy
Emergent referral to OB

A

Ruptured Ectopic Pregnancy

53
Q

___Mid-cycle pain caused by irritation of the peritoneum due to spillage of fluid from the ruptured follicular cyst at time of ovulation.
Sudden onset of localized unilateral lower quadrant pain, which persists for a few minutes to as long as 8 hrs.
Rarely mimics the abdominal findings of appendicitis, torsion or rupture of ovarian cyst, or ectopic pregnancy.
Anovulatory cycles can lead to a normal follicular cyst growing large over several cycles and causing considerable pain on rupture.

A

Mittelschmerz

54
Q 
MISCELLANEOUS Causes of Abdominal Pain
1
2
3
4
A

Dissecting aortic aneurysm
Acute pyelonephritis
Splenic infarction or rupture
Acute mesenteric vascular occlusion and related conditions

55
Q

NONSURGICAL CONDITIONS SIMULATING ACUTE ABD PAIN

A 
Metabolic conditions:
Diabetes mellitus (ketoacidosis)
Hyperthyroidism
Hypercalcemia/Hyperkalemia
Familial mediterranean fever
Pneumonias
Sickle Cell Crisis
Papillary necrosis of the kidney
Herpes zoster
Hemolytic uremic syndrome
Henoch-Schonlein purpura

CMN 586 (2 decks)

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