Gastrointestinal

Question 1

Acute appendicitis

Answer 1

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.

Question 2

Acute cholecystitis

Answer 2

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

Question 3

acute diverticulitis

Answer 3

Elderly patient with acute onset of high fever, anorexia, nausea, vomiting, LLQ abdominal pain.

Question 4

Risk factors acute diverticulitis

Answer 4

Increased age, constipation, low dietary fiber intake, obesity, lack of exercise, frequent NSAIDS use

Question 5

Acute diverticulitis signs and symptoms

Answer 5

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)

Question 6

Acute diverticulitis complications

Answer 6

abscess, sepsis, ileum, small bowel obstruction, hemorrhage, perforation, fistula, phlegmon stricture.

life-threatening

Question 7

Acute pancreatitis s & sxs

Answer 7

acute onset of fever, nausea, vomiting associated with rapid onset of abdominal pain that radiates to mid back located in the epigastric region

Question 8

Acute pancreatitis is caused from____

Answer 8

drugs, biliary factors, alcohol abuse

Question 9

Acute pancreatitis objective signs

Answer 9

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

Question 10

Clostridium difficile colitis s/s

Answer 10

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

Question 11

colon cancer

Answer 11

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

Question 12

colon cancer risk factors

Answer 12

multiple polyps, inflammatory bowel disease (Crohn’s & Ulcerative colitis)

Question 13

Crohn’s disease

Answer 13

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

Question 14

Crohn’s disease relapse

Answer 14

fever, anorexia, weight loss, dehydration, fatigue with per umbilical to RLQ abdominal pain occur

Question 15

Crohn’s disease risk factors

Answer 15

higher risk of toxic megacolon and colon cancer, increased risk of lymphoma, especially for patients treated with azathioprine, more common in Ashkenazi jews.

Question 16

Ulcerative Colitis

Answer 16

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

Question 17

UC relapses

Answer 17

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

Question 18

RUQ abdominal contents

Answer 18

liver, gallbladder, ascending colon, kidney, pancreas (small portion), right kidney is lower than left b/c of displacement of the liver

Question 19

LUQ abd contents

Answer 19

stomach, pancreas, descending colon, kidney (left)

Question 20

RLQ abd contents

Answer 20

appendix, ileum, cecum, right ovary

Question 21

LLQ abd contents

Answer 21

sigmoid colon, left ovary

Question 22

Barrett’s esophagus

Answer 22

precancerous to esophageal cancer, diagnosed by upper endoscopy with biopsy

lifestyle factors=no mints, avoid caffeine

Question 23

Cullen’s sign

Answer 23

edema and bruising of the subq tissue around the umbilicus

Question 24

Grey-Turner’s sign

Answer 24

bruising/bluish discoloration of the flank area that may indicate retroperitoneal hemorrhage

Question 25

Classic pain associated with acute pancreatitis

Answer 25

severe midepigastric pain that radiates to mid back

Question 26

Rovsing’s sign

Answer 26

Supine position

deep palpation of the left lower quadrant of the abd results in referred pain to RLQ, which is positive

Question 27

McBurney’s point

Answer 27

area located between the superior iliac crest and umbilicus in the RLQ. Tenderness or pain is a sign of possible acute appendicitis

Question 28

Obturator sign

Answer 28

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

Question 29

rebound tenderness

Answer 29

patient complains of worsening abd pain when hand is released after palpation of abdomen compared to the pain felt during deep palpation

Question 30

Psoas and obtrutrator signs are positive are indicative of__

Answer 30

acute appendicitis

Question 31

Psoas

Answer 31

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

Question 32

GERD

Answer 32

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.