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Adult Health > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

RUQ Organs

A
  1. Liver
  2. Gallbladder
  3. Hepatic flexure
  4. Kidney
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2
Q

RLQ Organs

A
  1. Appendix
  2. Ureter
  3. Ovary
  4. Fallopian tube
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3
Q

LUQ Organs

A
  1. Spleen
  2. Stomach fundus
  3. Kidney
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4
Q

LLQ Organs

A
  1. Left colon
  2. Ureter
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5
Q

Lower Abdominal Segment Organs

A
  1. Uterus
  2. Bladder
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6
Q

Epigastrium Organs

A
  1. Heart
  2. Lung
  3. Esophagus
  4. Pancreas
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7
Q

Acute Gastroenteritis: What is it?

A

Acute infection or irritation of the digestive tract, particularly the stomach and intestine, that results in vomiting, diarrhea, and abdominal cramps.
** Some patients also experience fever

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8
Q

Acute Gastroenteritis: Etiology

A
  1. Fecal-oral route (usually by food or water contamination) or person-to-person contact
  2. Viruses
  3. Bacterial
  4. Parasites
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9
Q

Acute Gastroenteritis: Viral Causes

A
  • Most infections in healthy U.S. hosts are viral
    1. Rotavirus (more common in children less than 1 yo)
    2. Norovirus
    3. Enteric adenovirus
    4. Astrovirus
    ** Most commonly transmitted in winter and spring
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10
Q

Acute Gastroenteritis: Bacterial Causes

A
  • Less common than viral, but is more severe
    1. Campylobacter jejuni (most common in children)
    2. Salmonella (most common foodborne illness in US)
    3. Staph aureus
    4. Shigella
    5. E. coli
    6. C. diff
    7. Clostridium perfringens
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11
Q

Acute Gastroenteritis: Parasitic Causes

A
  1. Giardia lamblia
  2. Cryptosporidium
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12
Q

Acute Gastroenteritis: Risk Factors

A
  1. Improper handwashing and food preparation
  2. Daycare attendance
  3. Recent use of antibiotics
  4. Recent hospitalization
  5. Poor sanitation
  6. Immunocompromised status
  7. Recent travel to developing countries
    ** Pregnancy and age over 65 can have more severe complications
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13
Q

Acute Gastroenteritis: Assessment Findings

A
  1. Hyperactive bowel sounds
  2. Acute diarrhea (3 or more loose stools within 24 hours; lasts no longer than 2 weeks)
  3. Blood in stool (RED flag)
  4. Abd pain upon palpation; guarding
  5. WBC in stool
  6. N/V precede diarrhea
  7. Anorexia
  8. Weight loss (RED flag)
  9. Fever
  10. Fecal incontinence
  11. Dehydration
  12. Lethargy
  13. Pale skin color
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14
Q

Acute Gastroenteritis: Signs of Dehydration

A
  1. Poor skin turgor
  2. Dry mucous membranes
  3. Flattened or sunken fontanels
  4. Tachycardia, tachypnea
  5. Hypotension
  6. AMS
  7. HA
  8. Oliguria
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15
Q

Acute Gastroenteritis: Diagnostic Studies

A
  1. Usually none unless symptoms are severe and last longer than 48 hours
  2. Stool for WBC
  3. Stool cultures
  4. Stool for ova and parasites
  5. Occult stool
  6. UA
  7. Dehydration: BUN, specific gravity, electrolytes
  8. More severe cases may require blood cultures to ensure absence of systemic infection
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16
Q

Acute Gastroenteritis: Nonpharmacologic Treatment

A
  1. Correct dehydration, orally if possible
  2. Rehydrating with soft drinks, gelatin, or apple juice not advised due to high carbohydrate, low electrolyte composition
  3. Age-appropriate diet as soon as possible
  4. Reintroduce solid foods within 24 hours of diarrhea onset
  5. BRAT diet no longer recommended (inadequate protein, fat, and calories)
  6. Monitor oral intake, urine output, and bowel movements; count wet diapers
  7. Use of sitz baths, hydrocortisone cream, zinc oxide cream, and/or witch hazel hemorrhoidal pads can provide pain relief from perineal irritation
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17
Q

Acute Gastroenteritis: Pharmacologic Treatment Staph aureus

A

Antibiotics not recommended

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18
Q

Acute Gastroenteritis: Pharmacologic Treatment Salmonella

A
  • Antibiotics not recommended
    ** Cipro or Bactrim for patients with valvular heart disease or immunocompromise
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19
Q

Acute Gastroenteritis: Pharmacologic Treatment Shigella or E. coli

A

Bactrim BID x 3-5 days
** If shigella acquired outside of U.S., use cipro x 10 days

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20
Q

Acute Gastroenteritis: Pharmacologic Treatment Campylobacter

A
  1. Erythromycin QID x 5 days
    OR
  2. Cipro BID x 7 days
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21
Q

Acute Gastroenteritis: Pharmacologic Treatment Giardia

A

Metronidazole 250 mg TID x 5-7 days

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22
Q

Acute Gastroenteritis: Pharmacologic Treatment C. diff

A
  1. Metronidazole 500 mg TID or 250 mg QID x 10-14 days
    OR
  2. Vancomycin 125 mg QID
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23
Q

Acute Gastroenteritis: General Pharmacologic Treatments

A
  1. Antiemetics
  2. Probiotics
    ** Antidiarrheals can worsen symptoms
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24
Q

Acute Gastroenteritis: When to refer?

A
  1. Patients with red flags may need hospitalization
  2. Parenteral rehydration for intractable symtpoms
  3. Neurologic symptoms
  4. Severe abdominal pain
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25
Q

Appendicitis: What is it?

A

Inflammation of the vermiform appendix, a projection from the apex of the cecum. Appendicitis is a medical emergency; the organ must be removed before it ruptures.

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26
Q

Appendicitis: Etiology

A

Obstruction of the appendix secondary to stool, inflammation, stricture, foreign body, or neoplasm. The obstructed lumen prevents drainage. The resultant increased pressure decreases mucosal blood flow, and the appendix becomes hypoxic.

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27
Q

Appendicitis: Risk Factors

A
  1. Family history
  2. Abdominal neoplasm
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28
Q

Appendicitis: Assessment Findings

A
  1. Abd pain, usually severe; initially presents throughout abdomen or periumbilical area and later becomes localized to the RLQ
  2. Most common symptoms: anorexia, abd pain, N/V (typically present in this order)
  3. Constipation and diarrhea occur after the pain
  4. Maximum abd tenderness and rigidity occurs over the right rectus muscle (McBurney’s point)
  5. Psoas sign: pain with right thigh extension
  6. Obturator sign: pain with internal rotation of flexed right thigh
  7. Fever
  8. Decreased bowel sounds
  9. Older adults may present with weakness, anorexia, tachycardia, and abd distention
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29
Q

Appendicitis: Assessment Considerations

A
  • A rectal exam is no longer best practice
  • A pelvic exam should be performed on all women with lower abd pain to rule out pelvic inflammatory disease, adnexal mass, ectopic pregnancy, or uterine pathology.
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30
Q

Appendicitis: Diagnostic Studies

A
  1. UA: may be positive for RBCs and leukocytes
  2. CBC: higher leukocytosis associated with bowel perforation
  3. Urine pregnancy test: negative
  4. KUB xray: may show gas-filled appendix
  5. Abd and pelvic CT with and without contrast
  6. Ultrasound: imaging study of choice in children and pregnancy
  7. Pediatric appendicitis score for children
  8. Alvarado score for acute appendicitis
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31
Q

Appendicitis: Non-Pharmacologic Management

A
  1. Keep NPO
  2. Instruct to refrain from laxatives, enemas, or heat application to the abdomen
  3. Prompt surgery is treatment of choice
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32
Q

Appendicitis: Pharmacologic Management

A
  • Preoperative antibiotics may be prescribed by surgeon
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33
Q

Appendicitis: Follow-Up

A
  1. Routine postoperative assessment at 2 weeks and 6 weeks
  2. May require postoperative antibiotics if perforation has occurred.
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34
Q

Appendicitis: Expected Course

A
  • Quick recovery usually follows surgical removal of intact appendix
  • Activity should be restricted for 2-6 weeks
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35
Q

Cholecystitis: What is it?

A

Inflammation of the gallbladder usually associated with gallstone disease; can be acute or chronic.

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36
Q

Cholecystitis: Etiology

A
  1. Gallstone obstructs the gallbladder-cystic duct junction, resulting in inflammation (90-95% of cases) and acute pain
  2. In small number of cases, gallbladder inflammation occurs without stone formation
  3. Obstruction of common bile duct can cause jaundice, light-colored stools, and biliary colic
  4. Obstruction of pancreatic duct can produce pancreatitis; pain over upper abdomen; nausea and vomiting
  5. Gallbladder sludge
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37
Q

Cholecystitis: Risk Factors

A
  1. Pregnancy
  2. Rapid weight loss (ex: bariatric surgery)
  3. Obesity
  4. Gallstones or bile duct blockage
  5. Infection
  6. Tumor
  7. Surgery or trauma
  8. Sickle cell anemia
  9. Age greater than 40
  10. Female sex
  11. Sedentary lifestyle
  12. Use of OCP
  13. Family history of gallstones
  14. Crohn’s disease
  15. Medications such as clofibrate, ceftriaxone, and octreotide
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38
Q

Cholecystitis: Assessment Findings

A
  1. Patients are usually ill-appearing, febrile, and tachycardic
  2. Murphy’s sign
  3. RUQ pain: may be unremitting with or without rebound pain; may radiate to right shoulder or right subscapular area
  4. Nausea and vomiting/anorexia
  5. Attack follows meal (especially high in fat) by 1-6 hours
  6. Low grade fever
  7. Palpable RUQ mass
    ** A patient with acute cholecystitis usually avoids movement because peritoneal inflammation is present and discomfort worsens with movement
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39
Q

What is Murphy’s Sign?

A
  • Occurs with cholecystitis
  • Inspiratory arrest with deep palpation of the RUQ
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40
Q

Cholecystitis: Lab Results for Classic Presentation

A

CBC - mild leukocytosis
Bilirubin - normal or mild elevation
Amylase - normal
ALT/AST - slightly elevated
ALP - Normal
GGT - Normal

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41
Q

Cholecystitis: Lab Results for Cholecystitis with Bile Duct Obstruction

A

CBC - Leukocytosis
Bilirubin - Elevated
Amylase - Usually elevated
ALT/AST - Normal
ALP - Elevated
GGT - Elevated

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42
Q

Cholecystitis: Lab Results for Cholecystitis with Pancreatitis

A

CBC - Leukocytosis
Bilirubin - Elevated
Amylase - Elevated
ALT/AST - Elevated
ALP - Normal
GGT - Normal

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43
Q

Cholecystitis: Non-Pharmacologic Management

A
  1. Severe attacks: NPO
  2. Mild attacks: avoid fatty meals
  3. NG tube for persistent nausea or abd distention
  4. Lap chole or open chole within 72 hours of diagnosis
  5. Reduce fatty meals in diet
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44
Q

Cholecystitis: Pharmacologic Management

A
  1. Ursodeoxycholic acid - treatment of gallstones
  2. Antiemetics - promethazine; ondansetron
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45
Q

Constipation: What is it?

A

GI syndrome presenting as unsatisfactory defecation with infrequent stools, difficult stool passage, or both.
- Patients describe hard stools, and feeling of incomplete evacuation, abd discomfort, bloating, and distention

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46
Q

Constipation: Etiology

A
  1. Primary - most patients have constipation that cannot be attributed to any structural abnormalities or systemic disease. These patients may be further categorized as having normal colonic transit time, slow transit, or defectatory disorders (with or without colonic transit)
  2. Secondary - may be caused by secondary disorders, medications, or obstructing colonic lesions
47
Q

Constipation: Risk Factors

A
  1. Advanced age
  2. Inadequate intake of dietary fiber
  3. Inadequate fluid intake
  4. Sedentary lifestyle
  5. Ignoring the urge to defecate
  6. Change in daily routine
  7. Medications
  8. IBS
  9. Laxative abuse
  10. Neurologic, endocrine, and metabolic disorders
  11. Diverticulosis
  12. Hirschsprung’s disease
  13. Intestinal obstruction
48
Q

Constipation: Medication Causes

A
  1. Antacids containing aluminum
  2. Antidepressants
  3. Anticholinergics
  4. Anticonvulsants
  5. Antihypertensives
  6. Antihistamines
  7. Calcium supplements
  8. Cough suppressants containing codeine
  9. Diuretics
  10. Iron supplements
  11. Narcotics
49
Q

Constipation: Assessment Findings

A
  1. Decrease in number of BMs compared to patient’s “usual” frequency
  2. Hard, dry stools
  3. Pain and difficulty with defecation
  4. Abd distention
  5. Associated symptoms including abd pain/cramps, fever, rectal bleeding, mucus in stool, anorexia, HA, depression, anxiety
  6. Rectal fissures
  7. Inflammation of rectal area
50
Q

Constipation: Prevention

A
  1. Fiber supplements once or twice per day
  2. Establish regular toileting routine; respond to urge to have BMs
  3. High fiber diet (20-35g/day); beans, whole grains, bran, fruit, veggies
  4. Adequate intake of water and juice (1.5 - 2 liters/day) and elimination of caffeine (dehydrating effects)
  5. Adequate exercise
  6. Avoidance of medications that contribute to constipation
  7. Limit use of laxatives, enemas, and stool softeners
51
Q

Constipation: Pharmacologic Treatment

A
  1. Bulk Producing Agents
  2. Stool Softeners
  3. Hyperosmotic Agents
  4. Stimulants/Irritants
  5. Lubricant/Emollient
  6. Saline Laxatives
  7. IBS Medications
52
Q

Bulk Producing Agents

A
  • Psyllium
  • Methylcellulose
  • Polycarbophil
53
Q

Hyperosmotic Agents

A
  • Lactulose
  • Polyethylene glycol
54
Q

Stimulants/Irritants

A
  • Bisacodyl
  • Senna
55
Q

Lubricant/Emollient

A
  • Mineral Oil
56
Q

Saline Laxatives

A

Magnesium sulfate

57
Q

IBS Medications

A
  • Linaclotide (Linzess)
  • Lubiprostone (Amitiza)
58
Q

Encopresis: What is it?

A

The repeated passage of stool in inappropriate places, such as on clothing or the floor. May be involuntary or voluntary. Considered abnormal after toilet training has been achieved, generally around age 4 years.
- Also known as fecal incontinence

59
Q

Encopresis: Etiology

A
  1. Functional constipation
  2. Functional fecal incontinence
    - Retentive
    - Nonretentive
60
Q

Encopresis: Etiology Functional Constipation

A

Defined by criteria that include:
- Stool frequency
- Hardness
- Size
- Fecal incontinence
- Painful defecation
- Volitional stool retention
- With or without abdominal pain

61
Q

Encopresis: Etiology Retentive Fecal Incontinence

A

It’s retentive if:
- If associated with functional constipation
- Most constipation in children has a functional cause, meaning that the symptoms are real, but there is no sign of injury or infection, blood, or anatomic abnormality
- About 80% of children with fecal incontinence have underlying constipation
- Only a small percentage of cases in children is caused by disease

62
Q

Encopresis: Etiology Nonretentive Fecal Incontinence

A

It’s nonretentive if:
- Absence of symptoms and signs of functional constipation
- One-month history in a child greater than 4 years old
- Defecation into places inappropriate to the social context
- No evidence of fecal retention
- Fecal incontinence cannot be explained by another medical condition after medical evaluation
- Physical exam normal
- No excessive stool on exam

63
Q

Encopresis: Risk Factors

A
  • Chronic constipation in infancy
  • Dehydration
  • Inappropriate use of laxatives
  • Major life or family stress
  • Positive family history
  • Inappropriate toilet training or irregular toileting patterns
  • Painful bowel movements
  • Changes in diet
  • Physical or sexual abuse
64
Q

Encopresis: Assessment Findings

A

-Hx of constipation: often large volumes of stool with painful defecation
- Hx of soiling (rarely during sleep)
- Large amounts of stool noted on abd and rectal exams, with intermittent passage of extremely large BMs
- May note stool smeared around anus, anal fissures, or lax sphincter
- Fecal/foul odor surrounds child
- Rectum enlarged and filled with soft stool
- Negative occult stool
- Normal neuro findings
- Normal anal wink, normal sensation, normal reflexes
- Reports of hiding during play, fear of toilet, low self-esteem, social difficulties, risk for bullying
- Decreased quality of life

65
Q

Encopresis: Non-pharmacologic Treatment-Retentive

A
  • High fiber diet
  • Age-appropriate fluid intake
  • Physical activity
  • Prebiotics
  • Probiotics
  • Limit milk intake in child older than 1 year
  • Encourage child to take responsibility for toileting; development of bowel routine
  • Initially, scheduled toilet sitting recommended (ex. 10 minutes 2-3 times per day)
  • Reinforce cooperation with treatment plan with age-appropriate awards
66
Q

Encopresis: Non-pharmacologic Treatment-Nonretentive

A
  • Assist with development of appropriate bowel routine: child should be instructed to use the bathroom at specific times
  • Give responsibility to child
  • Put footstool near toilet
  • Reinforce appropriate bowel habits with rewards
  • Diet adequate in fluid and fiber
67
Q

Encopresis: Pharmacologic Treatment - Retentive

A
  • If impacted, disimpaction can be achieved with oral cathartics, enemas, or combination
  • After initial bowel evacuation (or if not impacted), initiate therapy with laxatives/stool softeners to achieve one or two soft stools a day
  • Wean from medications when goal of regular, soft stools achieved
68
Q

Encopresis: Pharmacologic Treatment - Nonretentive

A

No recommendations for pharmacologic management

69
Q

GERD: What is it?

A

Is the movement of GI contents into the esophagus or beyond, facilitated by decreased lower esophageal sphincter (LES) tone. Some reflux is physiologic. GERD is present when gastric contents flow upward into the esophagus or oropharynx, producing symptoms

70
Q

GERD: Incidence

A
  • Affects 1/3rd of Americans
  • Affects 81% of patients 60 years and older
  • Affects 50-60% of women during pregnancy
  • Little is known about prevalence in children and adolescents
  • Small number of infants develop GERD, but recurrent vomiting common: but resolves spontaneously in nearly all infants
71
Q

GERD: Risk Factors

A
  1. Factors that reduce LES tone
  2. Aging
  3. DM, diabetic gastroparesis
  4. Delay in gastric emptying
  5. Increased gastric acid secretion
  6. Medications that irritate esophageal mucosa
  7. Zenker’s diverticulum
  8. Zollinger-Ellison syndrome
  9. Childhood GERD
72
Q

GERD: Factors that reduce LES

A
  1. Alcohol ingestion
  2. Anticholinergic medications, beta blockers, diazepam, theophylline
  3. Calcium channel blockers
  4. Caffeine
  5. Chocolate, peppermint
  6. Fatty, spicy, citrus foods
  7. Hormones: estrogen, progesterone, glucagon, secretin
  8. Meperidine
  9. Nicotine
  10. Overweight
  11. Pregnancy
73
Q

GERD: Medications that cause irritation of esophageal mucosa

A
  1. NSAIDs
  2. Tetracycline
  3. Quinidine
  4. Caffeine
  5. Alendronate
  6. Bupropion
  7. Citalopram
  8. Paroxetine
  9. Hydrocodone
  10. Dulaglutide
  11. Exenatide
  12. Liraglutide
74
Q

GERD: Assessment Findings

A
  • Chest pain (requires cardiac workup)
  • Chronic sore throat, hoarseness
  • Dysphagia
  • Erosion of teeth by acid
  • Esophageal pain referred by neck, midback, upper abdomen
  • Extraesophageal presentation: asthma, chronic cough, laryngitis
  • Postnasal drip, throat clearing
  • Pyrosis (heartburn) is cardinal symptom: burning beneath sternum, typically postprandial and nocturnal
  • Regurgitation
  • Sensation of lump in throat
  • Ulceration: hematemesis, fatigue, anemia
75
Q

GERD: Prevention

A
  1. Lifestyle modifications
  2. Maintain a healthy weight
  3. Eat smaller meals
  4. Avoid trigger foods
  5. Do not lie down for 2-3 hours after eating meals
  6. Elevate head of bed 6-8 inches
  7. Quit smoking
  8. Limit alcohol consumption
76
Q

GERD: Pharmacologic Management

A
  1. 8 week course of PPI therapy is treatment of choice
  2. PPI therapy should be dosed once a day and before first meal of the day
  3. If partial response to daily PPI, increased BID dosing
  4. If symptoms persist after 8 weeks of PPI therapy, refer to GI specialist
77
Q

Antacids

A

Calcium carbonate

78
Q

H2 Antagonists

A
  1. Cimetidine
  2. Antacid and alginic acid
  3. Famotidine
  4. Nizatidine
79
Q

Proton Pump Inhibitors

A
  1. Dexlansoprazole
  2. Esomeprazole
  3. Lansoprazole
  4. Omeprazole
  5. Pantoprazole
  6. Rabeprazole
80
Q

Inguinal Hernia: What is it?

A

The protrusion of viscera or adipose tissue through the inguinal or femoral canal

81
Q

Inguinal Hernia: Three Types

A
  1. Indirect
  2. Direct
  3. Femoral
82
Q

Inguinal Hernia: Indirect

A

Abdominal tissue passes through an abdominal wall defect into the internal inguinal ring and inguinal canal

83
Q

Inguinal Hernia: Direct

A

Abdominal tissue protrudes through the posterior wall of the inguinal canal

84
Q

Inguinal Hernia: Femoral

A

Hernia located inferior to the inguinal ligament and protruding through the femoral ring.
- 40% are incarcerated or strangulated (EMERGENCY)

85
Q

Incarcerated Hernias

A

Contents cannot be replaced into the abdomen

86
Q

Strangulated Hernias

A

Blood supply to the entrapped bowel is diminished; a surgical emergency. Pain is out of proportion to exam. Erythema, hyperesthesia, or wound drainage may be present

87
Q

Reducible Hernias

A

Hernia easily replaced into the abdomen using gentle pressure or may occur spontaneously

88
Q

Inguinal Hernia: Etiology

A
  1. Congenital or acquired defect
  2. Familial or hereditary predisposition
  3. Connective tissue disorder
  4. Decreased collagen levels
89
Q

Inguinal Hernia: Risk Factors

A
  1. 8-10 times more common in men
  2. Age of 60 years
  3. Cigarette smoking: can damage connective tissue
  4. Inheritance: first degree relatives, especially in women
  5. Connective tissue disorder
  6. Prostatectomy history
  7. Previous contralateral hernia
  8. Low BMI
90
Q

Inguinal Hernia: Assessment Findings

A
  1. A heavy or dragging sensation in the groin or hernia
  2. Painful or painless swelling or lump in groin or into scrotum; may increase with standing or sitting
  3. Bulge may be intermittent and palpable during episodes of increased abd pressure (defecation, micturation, coughing, exercise, sexual activity). Symptoms worse at the end of day and relieved by laying down or manually reducing hernia
  4. In women, bulge may be seen in the labia majora
  5. Strangulated hernia: colicky abd pain, N/V, abc distention
91
Q

Inguinal Hernia: Non-Pharmacologic Treatment

A
  • Educate about s/sx of strangulation and advise to seet immediate medical help if these occur
  • Do not attempt to reduce a strangulated hernia
  • Surgical correction (herniorrhaphy) is required if hernia does not resolve spontaneously
92
Q

Nausea and Vomiting: What is it?

A

May occur together or separately. Nausea often precedes or accompanies vomiting. N/V may be a component of arganic and functional disorders, a defense mechanism to expel ingested toxins, or related to neurological trauma. Other causes are damage to or abnormality of the chemoreceptor trigger zone, intestinal obstruction, or chronic GI mucosal disease

93
Q

Nausea and Vomiting: Etiology

A
  • Numerous (depending on etiology)
  • May be acute or chronic
94
Q

Nausea and Vomiting: Assessment Findings

A
  • Causes unrelated to GI tract should be ruled out, with attention to the CNS
  • Abdominal examination to assess for presence of distention, characteristics of bowel sounds, and presence of tenderness, guarding or rebound
  • Rectal examination to assess for fecal impaction
  • Examine vomitus if possible, to determine feculent vs. undigested food vs. bilious in nature
  • Oral cavity examination to assess for dental involvement or chronic situation (bulimia)
95
Q

Antiemetics

A
  1. Prochlorperazine
  2. Promethazine
96
Q

Dopamine Antagonist

A

** For N/V
1. Metoclopramide (Reglan)

97
Q

Phenothiazine

A

** For N/V
1. Chlorpromazine

98
Q

Anticholinergic

A

** For N/V
1. Scopolamine

99
Q

Selective 5-HT3 Receptor Antagonist

A

** For N/V
1. Ondansetron
2. Dolasetron mesylate

100
Q

Nausea and Vomiting: Expected Course

A
  1. Dehydration
  2. Orthostatic hypotension
  3. Arrhythmias
  4. Electrolyte abnormalities
  5. Acute renal failure
101
Q

Pinworm Infection: What is it?

A

An intestinal worm infection caused by Enterobius vermicularis, a helminth parasite.
- Transmission is through the fecal-oral route
- Adult female pinworm 8-13 mm
- Adult male pinworm 2-5 mm

102
Q

Pinworm Infection: Etiology

A
  • Eggs are deposited around the anus by the worm and may be transferred to vectors such as hands, fingernails, toilet seats, clothing, bedding, and toys
  • Eggs are commonly ingested and less commonly inhaled: possible due to the very small size of the eggs
  • Eggs hatch in the duodenum and the larvae grow rapidly and migrate through the small intestine toward the colon as they become adults
  • The male and female pinworms mate in the ileum. Males die after mating and are passed in stool. Gravid females slowly transmit through the digestive tract, emerging from the anus approximately 5 weeks after initial ingestion to lay eggs
  • Each female produces 11,000 to 16,000 eggs
  • Eggs can survive 2-3 weeks in an indoor environment
103
Q

Pinworm Infection: Risk Factors

A
  • Family contacts of infected children
  • Primary caregivers of infected children
  • Day care center attendance, institutional residence
  • Children 4-11 years at highest risk
  • Common in parents aged 30-39 due to transmission from their children
  • Finger sucking and nail biting
  • Poor hygiene and improper handwashing
  • Crowded living conditions
  • Sexual contact with infected person
104
Q

Pinworm Infection: Assessment Findings

A
  • 30-40% of people are asymptomatic
  • Perianal and/or vaginal itching; worse at night
  • Vulvovaginitis in girls and women
  • UTIs in young girls
  • Childhood enuresis
  • Perianal trauma, anal dermatitis, and/or perianal folliculitis
  • Abd pain
  • Irritability, restlessness, insomnia
  • Anorexia
  • Weight loss
  • N/V
105
Q

Pinworm Infection: Diagnostic Studies

A
  1. Directly visualize female worm at night 2-3 hours after asleep (or early morning) by shining a flashlight on the perianal area
  2. Glass slide microscopic analysis: egg and larva
  3. Transparent adhesive tape test: identification of ova on low-power microscope after touching tape to perianal area in the mornings before voiding or bathing
  4. Paddle test: clear, plastic paddle with adhesive surface is pressed against perianal area; paddle inspected under a microscope for worms
  5. All microscopy methods should be performed on three separate occasions, which increases sensitivity from 50% to 90%
  6. Stool and serology are not diagnostic
106
Q

Pinworm Infection: Pharmacologic Treatment

A
  • Successful eradication requires at least 2 doses of medication separated by 2 weeks
  • Total elimination of the parasite in a household may require repeated doses for up to a year or more
  • All family members or classmates who are infected must be treated simultaneously
107
Q

Antihelminthics

A

** For pinworm infections
1. Pyrantel
2. Mebendazole
3. Albendazole

108
Q

Recurrent Abdominal Pain: What is it?

A

Recurrent abd pain no associated with meals, change in bowel habits, or menstruation, persisting for 6 months or more. Is a chronic debilitating condition associated with loss of daily function.
** Also known as functional abdominal pain syndrome (FAPS)
- Coexisting anxiety, depression, or somatization often occurs
- Many patients have poor coping mechanisms and social support

109
Q

Recurrent Abdominal Pain: Etiology

A
  • Unknown
  • Sometimes confused with common GI disorders such as IBS or dyspepsia
  • Chronic pain has sensory, emotional, and cognitive components
110
Q

Recurrent Abdominal Pain: Risk Factors

A
  1. Prior abd surgeries
  2. Chronic pain syndrome
  3. IBS, IBD
  4. Fibromyalgia
  5. Depression, anxiety
  6. Recent alcohol consumption/binge
  7. Prior ileus/bowel obstructions
  8. High stress levels
111
Q

Recurrent Abdominal Pain: Diagnostic Studies

A
  1. CBC with diff: normal
  2. Liver panel: exclude elevation
  3. Amylase/lipase: exclude
  4. UA: normal
  5. Urine pregnancy test: negative
  6. Flat and erect Xray of abd: negative
    * No further workup needed if physical exam is negative and no alarming symptoms are present (unexplained weight loss, anorexia, or bloody bowel movements)
112
Q

Recurrent Abdominal Pain: Non-Pharmacologic Management

A
  • Introduce the possibility that the pain is functional (inorganic)
  • Discuss relationship between stress and pain
  • Increase dietary fiber and ensure adequate hydration if constipation is present
  • Dietary/lifestyle modification for healthy diet and exercise pattern
  • Stress management
113
Q

Recurrent Abdominal Pain: Pharmacologic Management

A
  • Pain medications generally not helpful
  • Identify etiology to determine which pharmacologic agent would work best (SSRIs, SNRIs, TCAs, and/or anticonvulsants)

Adult Health (20 decks)

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