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6431 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

mechanism of abdominal pain

A

Hollow viscus, capsular distention, peritoneal irritation, mucosal ulceration, vascular insufficiency, altered body motility, nerve injury, abdominal wall injury and pain referred from extra-abdominal site

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2
Q

pain described as: constant achy feeling

A

abdominal wall pain

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3
Q

pain described as: dull, crampy and poorly localized

A

visceral pain, arising form hollow viscus usually result of distention or spasm of a hollow organ

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4
Q

pain described as: sharp well-localized pain

A

parietal pain arising from the parietal peritoneum ie acute appendicitis pain with inflammation spread to peritoneum

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5
Q

pain described as aching and near surface of body

A

Referred pain; experienced away from the disease process, result of shared central pathways

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6
Q

upper right abdominal quadrant pain

A

emanates from the chest cavity, liver, gallbladder, stomach, bowel, right kidney or ureter

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7
Q

left upper quadrant pain associated with

A

heart, chest cavity, spleen, stomach, pancreas, acute pancreatitis, left kidney or ureter.

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8
Q

Left lower quadrant pain associated with

A

bowel, left ureter, pelvis or commonly associated with diverticulitis especially when pain is protracted or severe

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9
Q

right lower quadrant pain associated with

A

appendix, bowel, right ureter, pelvis most common diagnosis appendicitis

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10
Q

pain in epigastrium or periumbilical area with migration to right lower quadrant and abdominal rigidity often short duration of pain

A

appendicitis

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11
Q

Labs r/t appendicitis

A

CBC w diff, BMP, CRP, Serum HCG, sickeldex test, urinalysis,
CT scan, ultrasound

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12
Q

nausea, vomiting, abdominal distention and pain. distended bowel on xray of abdomen

A

small bowel obstruction

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13
Q

labs and imaging for small bowel obstruction

A

CBC w/ diff, CMP, lactate dehydrogenase, hcg,

Abdominal x ray upright and supine, ct scan, MRI, transabdominal ultrasound as indicated.

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14
Q

pain starting in the epigastrium and spread rapidly throughout the abdomen with frequent early radiation of pain. frequent radiation to the scapular area

A

peptic ulcer disease

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15
Q

common cause of peptic ulcer disease

A

repeated use of nsaid drugs and h. pylori

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16
Q

labs for peptic ulcer

A

CBC w/diff, cmp, serum amylase, fobt, h. pylori. hcg (in women)
abdominal x ray upright and left lateral decubitus
endoscopy, urea breath test. `

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17
Q

high fever, chills, acute abdominal pain. diffuse, localized or referred. patients with cirrhosis may not complaint of pain and may run only a low-grade fever
additional complaints: abdominal pain, tenderness, nvd or constipation

A

peritonitis

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18
Q

dx of peptic ulcer suggested by

A

H & P, confirmed by detection of pneumoperitoneum on upright abdominal or chest x-ray h. pylori test and urea breath test.

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19
Q

dx of peritonitis based on

A

fever, abdominal pain, tenderness and leukocytosis. decreasing bowel sounds. increasing tenderness, rebound tenderness chest and abdo x ray cbc w/diff

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20
Q

asymtpomatic before rupture, may have abdominal flank or back pain several days after the rupture.

A

AA rupture.

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21
Q

abdominal exam findings may include abdominal distention, flank or back pain, tenderness. pulsations over the mass

A

AAA

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22
Q

who should be screened for AAA

A

men 65-75 with history of smoking at least 100 cigarettes in a lifetime

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23
Q

Standard evaluation for AAA

A

CT scan

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24
Q

labs for ruptured AA

A

CBC w/diff, cmp, hcg as appropriate, type and cross,

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25
Q

What are hemorrhoids

A

nonpathologic venous cushions in the submucosal layer of the anal canal

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26
Q

these hemorrhoids are more likely to be painful

A

external hemorrhoids

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27
Q

typically present with painless bright red blood per rectum with bowel movements

A

internal hemorrhoids

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28
Q

first-degree hemorrhoids cause:

A

cause bright red painless bleeding, may bulge but do not prolapse

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29
Q

second-degree hemorrhoids:

A

prolapse during defecation but reduce spontaneously, pt. report bleeding and itching from the chronic moisture secreted by the anal canal mucosa

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30
Q

third degree hemorrhoid

A

prolapse with defecation and require manual reduction. Patient has secondary pain related to local ischema and mucoid drainage

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31
Q

fourth-degree hemorrhoid

A

permanently prolapse and not reducible, incarcerated hemorrhoids require urgent surgical intervention

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32
Q

recommended tx of hemorrhoids

A

high-fiber diet and increased fluid intake reduction in constipation and straining

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33
Q

painful linear crack or tears of the lining of the anal canal

A

Anal fissure

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34
Q

definition of chronic vs acute anal fissure

A

less than 6 weeks acute; greater than 6 weeks in chronic

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35
Q

patient experiences severe, sharp rectal pain during and after bowel movements and small amounts of bright red blood on toilet paper

A

Anal fissure

36
Q

differential dx for anal fissure

A

anal carcinoma, perianal abscess, thrombosed external hemorrhoid.

37
Q

patient experiences uncontrollable urge to scratch the anus tend to be worse at night or after a bowel movement may involve the buttocks, vulva, scrotum area

A

pruritus ani

38
Q

Tx of pruritis ani

A

1% hydrocortisone for a period of no more than two weeks to discourage skin atrophy
may require antibiotics if area has become infected

39
Q

infection that occurs from the obstruction of the duct of an anal gland at the level of the denatate line. after formation may spread to adjacent pelvic tissue or the perianal skin

A

anorectal abscess

40
Q

abnormal communication between abscess and perianal skin chronic manifestation of perianal abscess

A

perianal fistula

41
Q

abscess-fistula complex appears to arise from penetrating inflammation in this disease process in up to 35% of patients

A

Crohns disease

42
Q

patient complaint of perianal pain and swelling that increases with movement sitting or bowel movements. malaise and fever , persistent purulent drainage with hx of abscess may also be present. inguinal lymphnodes may be enlarged as well

A

anorectal abscess

43
Q

tx of anorectal abscess

A

incision and drainage, cbc if systemisc symptoms or unclear diagnosis, antibiotics not generally indicated. ciprofloxacin or metronidazole may be used if abx are desired

44
Q

right upper quadrant pain, radiated to right posterior shoulder within an your of eating an type of large meal especially with high fat content. described as mild to severe accompanied by nausea and vomiting

A

cholelithiasis

45
Q

similar to systemic cholelithiasis, but lasts longer than 4 to 6 hours

A

acute cholecystitis

46
Q

recurrent mild to moderate upper quadrant pain and epigastric abdominal pain accompanied by nausea and vomiting pain may radiate to the region of the posterior right shoulder associated with eating fatty foods

A

chronic cholecystitis

47
Q

moderate distress from systemic toxicity, tachycardia and fever. The right upper quadrant abdominal pain is associated with tenderness and muscle guarding or rigidity. gallbladder distention, hypoactive bowel sounds and presence of murphy’s sign

A

acute cholecystitis

48
Q

What is cirrhosis

A

end stage consequence of progressive hepatic fibrosis affecting normal liver function, serious irreversible disease

49
Q

most common cause of cirrhosis in the united states

A

hepatitis B and C virus, alcoholic liver diseases, nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH)

50
Q

medication associated with liver cirrhosis

A

acetaminophen, amiodarone, methotrexate, isoniazid, varied antibiotics, carbon tetrachloride

51
Q

early symptoms include pruritis, weight loss and fatigue additionally- malaidse, dark urine or pale stools, later symptoms nausea and vomiting

A

primary biliary cirrhosis

52
Q

abnormal diagnositis in cirrhosis

A

hypoalbuminemia, elevated serum protein, elevated AST and ALT, alk phos elevation, y glutamyl elevated

53
Q

education for patient with cirrhosis

A

dietary discipline, avoidance of hepatotoxic drugs, and risk reduction.

54
Q

primary causes of constipation

A

irritable bowel syndrome, disordered colonic transit, evacuation disorders, dyssynergic defecation

55
Q

inability of abdominal and pelvic floor muscles to coordinate correctly and empty stool, may affect half of patients with chronic constipation

A

dyssynergic defecation

56
Q

secondary causes of constipation

A

medical and psychogenic condition, medications, structural abnormalities and lifestyle

57
Q

c/o nausea, vloating, straining, cramping, and difficulty passing stools

A

constipation

58
Q

Diagnostics related to constipation

A

abdominal xray, ct scan, CBC w/diff to rule out obstruction, ileus, megacolon and volvulus

59
Q

constipation management

A

lifestyle changes, increase exercise, increase dietary fiber

bulk forming laxatives, stool softeners, osmotic laxatives, stimulant laxatives in this order.

60
Q

what is diarrhea

A

increase in stool frequency of more than three unformed stools per day loose or liquid characterized by urgency and consistent

61
Q

chronic diarrhea characterized as

A

diarrhea for a month without improvement

62
Q

acute diarrhea characterized as

A

diarrhea lasting less than 2 weeks

63
Q

malabsorptive disorders from ingesting solute rich molecules (sugar free gum, alha glucosidase, ampicillin, clindamycin, miralax, methyldopa, qunidines, hydralaien ace inhibitors

A

osmotic diarrhea

64
Q

Most common type of diarrhea, more likely to result in watery stools as absorption in gut is compromised

A

secretory diarrhea

65
Q

steatorrhea

A

known as fatty diarrhea a type of secretory diarrhea i.e. bile acid malabsorption post gallbladder removal

66
Q

brief episodes of acute diarrhea typically caused by :

A

viral or food-borne illness

67
Q

diarrhea diagnostics

A

x-ray KUB, flat and upright if small bowel obstruction or stool impaction with overflow incontinence is suspected

68
Q

outpouching of mucosa through the colon wall

A

Diverticular disease

69
Q

mild to moderate aching abdominal pain present in the left lower quadrant

A

diverticulitis

70
Q

Diagnostics for diverticulitis

A

cbc w/diff, crp, ua, bun, colonoscopy 4-6 weeks later

71
Q

most common cause of lower GI bleeding

A

diverticular bleeding

72
Q

swallowing disorder that involves dysfunction of one or more stages in the sequence of swallowing

A

oropharyngeal dysphagia

73
Q

causes of oropharyngeal dysphagia

A

medication side effects, postsurgical muscular or neurogenic disorder, radiation therapy

causes of Iatrogenic oropharyngeal dysphagia

74
Q

Botulism, diphtheria, lyme disease, syphilis

A

infectious cause of oropharyngeal dysphagia

75
Q

Amyloidosis, Cushing syndrome, Thyrotxicosis, Wilson disease

A

Causes of metabolic oropharyngeal dysphagia

76
Q

Connective tissue disease, myasthenia gravis, myotonic dystrophy, polymyositis, sarcoidosis, paraneoplastic syndromes

A

Myopathic causes of oropharyngeal dysphagia

77
Q

amyotrophic lateral sclerosis, brain-stem tumors, cerebral palsy, dementia, guillain-barre syndrome

A

neurologic causes of oropharyngeal dysphagia

78
Q

chewing (mastication) involves which cranial nerves

A

V ( trigeminal, VII Facial, IX glossopharyngeal and XII hypoglossal

79
Q

diagnostics for oropharyngeal dysphagia

A

modified barium swallow, CT or MRI, fiberoptic endoscopic examination of swallow

80
Q

first factor causing acid reflux

A

TLESR- transient lower esophageal sphincter relaxations

81
Q

second cause of acid reflux

A

hiatal hernia

82
Q

third factor of acid reflux

A

intensity of acid exposure

83
Q

fourth cause of acid reflux

A

pathogenic factor affecting the ability of the esophagus to clear itself of reflux material resulting in longer exposure to gastric contents

84
Q

fifth factor of acid reflux

A

integrity of the protective barrier of the mucosal lining

85
Q

abdominal pain that occurred a minimum of once each week for the previous 3 months in combination with two or more of following
defecation related pain
pain related to change in stool frequency
pain associated with change in appearance of stoll

A

Irritable bowel syndrome IBS

6431 (5 decks)

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