Gastrointestinal Flashcards
Acute appendicitis
Classic exam findings: low grade fever, RLQ pain, McBurney’s pain with rebound and guarding. Positive psoas and obturator signs
Rupture- involuntary guarding, rebound, board-like abdomen
Classic case: young adult c/o acute onset of periumbilical pain that is steadily getting worse. 12-24 hours localized pain over McBurney’s point, no appetite.
Acute cholecystitis
Overweight female c/o severe RUQ or epigastric pain that occurs w/in 1 hour after eating a fatty meal. Pain may radiate to right shoulder, nausea, vomiting, anorexia
left untreated: gangrene of gallbladder
acute diverticulitis
Elderly patient with acute onset of high fever, anorexia, nausea, vomiting, LLQ abdominal pain.
Risk factors acute diverticulitis
Increased age, constipation, low dietary fiber intake, obesity, lack of exercise, frequent NSAIDS use
Acute diverticulitis signs and symptoms
Acute abdomen are rebound, positive Rovsing’s sign, board-like abdomen
CBC-leukocytosis with neutrophilia and shift to the left
presence of band forms signals severe bacterial infection (bands are immature neutrophils)
Acute diverticulitis complications
abscess, sepsis, ileum, small bowel obstruction, hemorrhage, perforation, fistula, phlegmon stricture.
life-threatening
Acute pancreatitis s & sxs
acute onset of fever, nausea, vomiting associated with rapid onset of abdominal pain that radiates to mid back located in the epigastric region
Acute pancreatitis is caused from____
drugs, biliary factors, alcohol abuse
Acute pancreatitis objective signs
abd exam reveals guarding, tenderness over the epigastric region or the upper abdomen
positive Cullen’s sign (blue discoloration around umbilicus)
grey-turner’s sign (Blue discoloration on the flanks)
ileum may be present
s/s of shock
Clostridium difficile colitis s/s
severe watery diarrhea from 10 to 15 stools a day accompanied by lower abd pain with cramping and fever
sxs appear within 5-10 days after initiation of abxs
abxs: clindamycin (cleocin), fluoroquinolone, cephalosporins, penicillins are the cause
colon cancer
gradual with vague GI sxs, tumor bleed intermittently, may have iron-deficiency anemia, changes in bowel habits, stool, or bloody stool
heme-positive stool, dark tarry stool, mass on abd palpation
usually affect older patient >50yrs
colon cancer risk factors
multiple polyps, inflammatory bowel disease (Crohn’s & Ulcerative colitis)
Crohn’s disease
inflammatory bowel disease that affect any parts of GI tract from mouth (canker sores), small-large intestine, rectum, and anus
ileum involvement=watery diarrhea without blood or mucus
colon involvement=blood diarrhea with mucus
fistula formation and anal disease only occur with CD
palpable abdominal mass sometimes
Crohn’s disease relapse
fever, anorexia, weight loss, dehydration, fatigue with per umbilical to RLQ abdominal pain occur
Crohn’s disease risk factors
higher risk of toxic megacolon and colon cancer, increased risk of lymphoma, especially for patients treated with azathioprine, more common in Ashkenazi jews.
Ulcerative Colitis
inflammatory bowel disease that affects the colon/rectum.
blood diarrhea with mucus (hematochezia) more common with UC than with CD
severe squeezing cramping pain located on the left side of the abd with bloating and gas that is exacerbated by food
UC relapses
fever, anorexia, weight loss, and fatigue accompanied by arthralgia and arthritis that affect large joints, sacrum, and ankylosing spondylitis
may have iron deficiency anemia/anemia of chronic disease
increased risk of colon cancer
RUQ abdominal contents
liver, gallbladder, ascending colon, kidney, pancreas (small portion), right kidney is lower than left b/c of displacement of the liver
LUQ abd contents
stomach, pancreas, descending colon, kidney (left)
RLQ abd contents
appendix, ileum, cecum, right ovary
LLQ abd contents
sigmoid colon, left ovary
Barrett’s esophagus
precancerous to esophageal cancer, diagnosed by upper endoscopy with biopsy
lifestyle factors=no mints, avoid caffeine
Cullen’s sign
edema and bruising of the subq tissue around the umbilicus
Grey-Turner’s sign
bruising/bluish discoloration of the flank area that may indicate retroperitoneal hemorrhage
Classic pain associated with acute pancreatitis
severe midepigastric pain that radiates to mid back
Rovsing’s sign
Supine position
deep palpation of the left lower quadrant of the abd results in referred pain to RLQ, which is positive
McBurney’s point
area located between the superior iliac crest and umbilicus in the RLQ. Tenderness or pain is a sign of possible acute appendicitis
Obturator sign
Supine
positive if inward rotation of the hip causes RLQ abd pain, rotate right hip through full range of motion. Positive sign is pain with the movement or flexion of the hip
rebound tenderness
patient complains of worsening abd pain when hand is released after palpation of abdomen compared to the pain felt during deep palpation
Psoas and obtrutrator signs are positive are indicative of__
acute appendicitis
Psoas
RLQ abd pain occurs during maneuver. Indicates irritation to the ilipsoas group of hip flexors in the abd. A positive finding suggest peritoneal irritation.
patient in supine position, have patient raise right leg against the pressure of the professional’s hand resistance
patient on left side, extend the right leg from the hip
GERD
1st line treatment for mild/intermittent= lifestyle changes
Avoid large/or high-fat meals, especially 3-4 hours before bedtime; lose weight, avoid mints, chocolate, and alcohol (relaxes gastric sphincter), avoid ASA, NSAIDs, caffeine, carbonated beverages, cease smoking.
