Gastrointestinal and Nutritional Flashcards
What is biliary colic?
intense, dull comfort located in the RUQ or epigastrium, associated with nausea, vomiting, and diaphoresis
- it generally lasts at least 30 minutes, plateauing within one hour
- benign abdominal examination
What is acute acholecystitis?
prolonged (>4 to 6 hours) RUQ or epigastric pain, fever.
-patients will have abdominal guarding and Murphy’s sign
What is acute cholangitis?
fever, jaundice, RUQ pain
What is sphincter of Oddi dysfunction?
RUQ pain is similar to other biliary pain
What is acute hepatitis?
RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia
-patients may also have jaundice, dark urine, and light-colored stools
What is perihepatitis (Fitz-Hugh-Curtis syndrome)?
RUQ pain with a pleuritic component, pain sometimes referred to the right shoulder
What is a liver abscess?
fever and abdominal pain are the most common symptoms
What is Budd-Chiari syndrome?
symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/or hepatic encephalopathy
What is portal vein thrombosis?
symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/or hepatic encephalopathy
What is portal vein thrombosis?
symptoms include abdominal pain, dyspepsia, or gastrointestinal bleeding
What are the clinical features of acute myocardial infarction?
may be associated with shortness of breath and exterional symptoms
What are the clinical features of acute pancreatitis?
acute-onset, persistent upper abdominal pain radiating to the back
What are the clinical features of chronic pancreatitis?
epigastric pain radiating to the back
What are the clinical features of peptic ulcer disease?
epigastric pain or discomfort is the most prominent symptom
What are the clinical features of gastroesophageal reflux disease?
associated with heartburn, regurgitation, and dysphagis
What are the clinical features of gastritis/gastropathy?
abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis
What are the clinical features of functional dyspepsia?
the presence of one or more of the following: postprandial fullness, early satiation, epigastric pain, or burning
What are the clinical features of gastroparesis?
nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating
What are the clinical features of splenomegaly?
pain or discomfort in LUQ, left shoulder pain, and/or early satiety
What are the clinical features of splenic infarct?
severe LUQ pain
What are the clinical features of splenic abscess?
associated with fever and LUQ tenderness
What are the clinical features of splenic rupture?
may complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration
Where is the localization of appendicitis?
generally right lower quadrant
What are the clinical features of appendicitis?
periumbilical pain initially that radiates to the right lower quadrant
-associated with anorexia, nausea, and vomiting
Where is the localization of diverticulitis?
generally left lower quadrant; right lower quadrant more common in Asian patients
What are the clinical features of diverticulitis?
the pain is usually constant and present for several days prior to presentation
-may have associated nausea and vomiting
Where is the localization of nephrolithiasis?
either
What are the clinical features of nephrolithiasis?
pain most common symptom varies from mild to severe
-generally, flank pain, but may have back or abdominal pain
What are the clinical features of pyelonephritis?
associated with dysuria, frequency, urgency, hematuria, fever, chills, flank pain, and costovertebral angle tenderness
Where is the localization of pyelonephritis?
either
Where is the localization of acute urinary retention?
suprapubic
What are the clinical features of acute urinary retention?
present with lower abdominal pain and discomfort; inability to urinate
Where is the localization of cystitis?
suprapubic
What are the clinical features of cysitis?
associated with dysuria, frequency, urgency, and hematuria
Where is the localization of infectious colitis?
either
What are the clinical features of infectious colitis?
diarrhea is the predominant symptom, but may also have associated abdominal pain, which may be severe
What is an acute appendicitis?
the first symptom is crampy or “colicky” pain around the navel (periumbilical)
- there is usually a marked reduction in or total absence of appetite, often associated with nausea, and occasionally, vomiting and low-grade fever
- as the inflammation increases, the abdominal pain tends to move downward - begins in epigastrium - umbilicus - RLQ
- right lower quadrant = “McBurney’s point”, this “rebound tenderness” suggests inflammation has spread to the peritoneum
What are the signs of acute appendicitis?
- Rovsing - RLQ pain with palpation of LLQ
- Obturator sign - RLQ pain with internal rotation of the hip
- Psoas sign - RLQ pain with hip extension
How is an acute appendicitis dx?
- imaging if atypical presentation - appy ultrasound or abdominal CT scan
- CBC - neutrophilia supports the diagnosis
What is the tx of acute appendicitis?
surgical appendectomy
What is cholelithiasis?
a precursor to cholecystitis
-stones in the gallbladder, pain secondary to contraction of gall against the obstructed cystic duct
What are the characteristics of cholelithiasis?
- asymptomactic (most), symptoms only last few hours
- biliary colic - RUQ pain or epigastric
- pain after eating at night
- Boas sign - referred right subscapular pain
- RUQ ultrasound - high sensitivity and specificity if > 2 mm, CT scan and MRI
What is the tx of cholelithiasis?
asymptomatic - no treatment necessary
-elective cholecystectomy for recurrent bouts
What is cholecystitis?
inflammation of the gallbladder; usually associated with gallstones
What is the presentation of cholecystitis?
- 5 Fs: Female, Fat, Forty, Fertile, Fair
- (+) Murphy’s sign (RUQ pain with GB palpation on inspiration)
- RUQ pain after a high-fat meal
- Low-grade fever, leukocytosis, jaundice
How is cholecystitis dx?
- ultrasound is the preferred initial imaging - gallbladder wall > 3 mm, pericholecystic fluid, gallstones
- HIDA is the best test (gold standard) - when ultrasound is inconclusive
- CT scan - alternative, more sensititve for perforation, abscess, pancreatitis
- labs: increase Alk-P and increase GGT, increase conjugated bilirubin
- porcelain gallbladder = chronic cholecystitis
- choledocholithiasis = stones in common bile duct - diagnosed with ERCP (gold standard)
What is the tx of cholecystitis?
cholecystectomy (first 24-48 hours)
What is acute hepatitis?
an acute (temporary) form of hepatitis, which describes the inflammation of the liver tissue
What are the causes of acute hepatitis?
- viral hepatitides (HAV, HCV, and HBV)
- parasites (toxoplasmosis)
- alcohol
- drug-induced (acetaminophen)
- autoimmune hepatitis
- steatohepatitis
- metabolic disease
What is the presentation of acute hepatitis?
recent travel and sudden jaundice
- initial prodrome of flu-like symptoms (fatigue, nausea, vomiting, headaches) followed by jaundice (1-2 weeks after)
- right upper quadrant (RUQ) pain, jaundice, scleral icterus, hepatomegaly, splenomegaly, fever
How is acute hepatitis dx?
ultrasound is a good initial imaging modality for rule out of other causes of abdominal pain
-hepatomegaly (most sensitive sign) and gallbladder wall thickening
Serum analysis
-(CBC) may demonstrate elevated WBC count with atypical lymphocytosis in viral hepatitis
-hepatic panel
-mixed direct and indirect hyperbilirubinemia
-dramatically elevated aspartate aminotransferase (AST) and alanine aminotranferase (ALT)
-ALT usually higher than AST
-AST: ALT > 2, suspect alcohol hepatitis
-hepatitis viral serologies
-IgM antibodies are present during early infection
-IgG antibodies are present and remain after recovery: if patient is positive for IgG but negative for IgM, the patient is immune via either prior infection or vaccination
What is the serology for acute HBV?
+ Anti-HBc IgM
- Anti-HBc IgG
+ HBsAg
- Anti-HBs
What is the serology for early acute HBV?
- Anti-HBc IgM
- Anti-HBc IgG
+ HBsAg - Anti-HBs
What is the serology for resolved acute HBV?
- Anti-HBc IgM
+ Anti-HBc IgG - HBsAg
+ Anti-HBs
What is the serology for HBV vaccine/immunity?
- Anti-HBc IgM
- Anti-HBc IgG
- HBsAg
+ Anti-HBs
What is the serology for no infection or immunity?
- Anti-HBc IgM
- Anti-HBc IgG
- HBsAg
- Anti-HBs
What is the serology for chronic HBV?
- Anti-HBc IgM
+ Anti-HBc IgG
+ HBsAg - Anti-HBs
What is the serology for acute hepatitis C?
+ HCV RNA
+/- Anti-HCV
What is the serology for resolved hepatitis C?
- HCV RNA
+/- Anti-HCV
What is the serology for chronic hepatitis C?
+ HCV RNA
+ Anti-HCV
What is the serology for acute hepatitis A?
+ IgM HAV Ab
What is the serology for past exposure of hepatitis A?
- IgM HAV Ab
+IgG HAV Ab
What is the lifestyle treatment for acute hepatitis?
- supportive care
- indications
- especially for patients with acute viral hepatitis and alcoholic hepatitis
- modalities
- fluid and electrolyte management
- treatment of any encephalopathy or coagulopathy
- monitor and management for alcohol withdrawal and abstain from alcohol
- nutritional support for acute alcoholic hepatitis
- thiamine/folate
What is the medical treatment for acute hepatitis?
- antiviral therapy
- indications: used for the treatment of severe acute hepatitis B
- modalities: nucleoside analogs (e.g. entecavir)
- pentoxifylline and/or corticosteroids
- indications: used for severe alcoholic hepatitis
What is acute pancreatitis?
inflammation of the pancreas
-it happens when digestive enzymes start digesting the pancreas itself
What are the characteristics of acute pancreatitis?
- pancreatitis may start suddenly and last for days, or it can occur over many years
- symptoms include upper abdominal pain radiating to the back, nausea, and vomiting
- it has many causes, including gallstones and chronic, heavy alcohol use
- the mnemonic GET SMASHED is useful in recalling the most common causes: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia, Hyperlipidemia, ERCP, and drugs
How is acute pancreatitis dx?
clinical + elevated lipase and amylase
- abdominal CT is the diagnostic test of choice - required to differentiate from necrotic pancreatitis
- ERCP is the most sensitive for chronic pancreatitis
What are the signs of acute pancreatitis?
Grey Turner’s sign (flank bruising), Cullen’s sign (bruising near umbilicus)
What is the Ranson’s criteria for poor prognosis for acute pancreatitis?
At admit
- Age > 55
- Leukocyte: >16,000
- Glucose: >200
- LDH: >350
- AST: >250
At 48 hours:
- Arterial PO2: <60
- HCO3: <20
- Calcium: <8.0
- BUN: Increase by 1.8+
- Hematocrit: decrease by >10%
- Fluid sequestration > 6 L
What is the tx of acute pancreatitis?
IV fluids (best), analgesics, bowel rest -complication: pancreatic pseudocyst (a circumscribed collection of fluid rich in pancreatic enzymes, blood and necrotic tissue)
What is an anorectal abscess?
a result of infection, whereas fistula is a chronic complication of an abscess
- produce painful swelling at the anus as well as painful defecation
- examination reveals localized tenderness, erythema, swelling, and fluctuance; fever is uncommon
- deeper abscesses may produce buttock or coccyx pain and rectal fullness; fever is more likely
What is the tx of anorectal abscess?
requires surgical drainage, followed by warm-water cleansing, analgesics, stool softeners, and a high-fiber diet are prescribed for all patients
- many abscesses can be drained as an in-office procedure; deeper abscesses may require drainage in the operating room
- antibiotics are needed for high-risk patients
What is an anorectal fistula?
an open tract between two epithelium-lined areas and is associated with deeper anorectal abscesses
-fistulae will produce anal discharge and pain when the tract becomes occluded
What is the tx for anorectal fistula?
must be treated surgically
What is an anal fissure?
tearing rectal pain and bleeding which occurs with or shortly after defecation, bright red blood on toilet paper
- superficial laceration (paper cut like)
- pain lasts for several hours and subsides until the next bowel movement
What is the tx of an anal fissure?
- sitz baths, increase dietary fiber, and water intake, stool softeners, or laxatives
- usually heals in 6 weeks
- Botulinum toxin A injection (if failed conservative treatment)
What is the classic chronological order of an appendicitis?
- periumbilical pain (intermittent and crampy)
- nausea/vomiting
- anorexia
- pain migrates to RLQ (constant and intense pain), usually in 24 hours
What are the symptoms of gastric ulcers?
epigastric pain, vomiting, anorexia, and nausea
What are the symptoms of duodenal ulcers?
epigastric pain - burning or aching, usually several hours after a meal (food, milk, or antacids initially relieve pain) bleeding back pain nausea, vomiting, and decreased appetite
What are the symptoms of gastric cancer?
“WEAPON”: weight loss, emesis, anorexia, pain/epigastric discomfort, obstruction, nausea
What are the symptoms of lower GI bleed?
hematochezia (bright red blood per rectum [BRBPR]), with or without abdominal pain, melena, anorexia, fatigue, syncope, shortness of breath, shock
What are the symptoms of carcinoma of the gallbladder?
biliary colic, weight loss, anorexia; many patients are asymptomatic until late; may present as acute cholecystitis
What are the symptoms of pancreatic carcinoma?
painless jaundice from obstruction of common bile duct; weight loss; abdominal pain; back pain; weakness; pruritus from bile salts in the skin; anorexia; Courvoisier’s sign; acholic stools; dark urine; diabetes
What are the medications that cause anorexia?
sedatives, digoxin, laxatives, thiazide diuretics, narcotics, antibiotics
What are the causes of constipation/obstipation (severe or complete constipation)?
- colerectal cancer: consider this in all patient over 50 with new-onset constipation
- bowel obstruction: x-ray with air-fluid levels and dilated loops of bowel
- volvulus: an obstruction due to twisting or knotting of the gastrointestinal tract, symptoms include belly pain and bloating, nausea, bloody stools, and constipation, X-ray with colonic distention
- Illeus: hypermobility of the GI tract in the absence of mechanical obstruction, absent bowel sounds
- gastroparesis: (diabetes) vomiting, abdominal pain, fullness after eating small amounts
What are causes of diarrhea?
may be infectious, toxic, dietary (excessive laxative use) or other GI disease, inflammatory diarrhea (bloody diarrhea with fever) indicates an invasive organism or inflammatory bowel disease