Gastrointestinal problems Flashcards
Abdominal pain
visceral=in organs, dull and pain poorly localized
Parietal pain-sharp and well localized
RUQ
chest cavity liver gallbladder stomach bowel right kidney
LUQ
pancreas
left kidney
spleen
heart and chest cavity
RLQ
Appendix bowel right ureter perlvis ovary
LLQ
bowel-diverticulitis
ureter
pelvis
Appendicitis
Good oral history/OLDCARTS
Get consult when:BWAD
blood in stool
weight loss
anemia
dysphagia
Appeddicitis
obstruction of appendix with feces, inflammation, or stricture
occurs in all age groups-more common in males 10-30
higher mortality in complications of children and those over 55
leading cause of surgery in abdomen
Appedicitis-S/S
Acute onset of periumbilcal or epi-gastric pain
Anorexia, n/v
Shifting of pain to right lower quadrant
McBurneys point after several hours
aggravated by coughing/walking
pain may be in testicles, spasm, contipation more so than diarrhea
appendicitis-after 24 hours
if perforates may have sudden cessation of pain, abdominal rigidity, high fever, vominting, dehydration, decreased bowel sounds, shock
appendicitis- physicla findings before perforation
fever
abdominal rigidity, point and rebound tenderness in RLQ, decreased bowel sounds, +psoas and obturator signs
rectal exam-tenderness in right perirectal area
Psoas-
pain when lifting right leg against pressure
Obturator sign
positive when hip and knee is flexed and rotate right leg into the inside
Appendicitis labs
CBC with diff-leukocytosis with increased band cells (shift to the left)
C-reactive protein (normal after 24 hours would mean NO appendicitis)
Urinalysis
HCG-ectopic
abdominal ultrasound- if uncertain
Appedicitis
Mayy reveal mass when doing rectal exam and it will be tender, refer to surgeon
Nausea and Vomiting
Caused by: GI, PUD, CNS (motion sickness)
systemic-pregnancy, food poisoning
Iatrogenic-meds, bulemia
NO lab if no systemic S/S and duration is <24 hrs
N/V
No solids for 4 hours, clear liquids gradually increase
N/V-medications
Phergen-generalized n/v bismuth subsalicylate-pepto bismal-n/v Transdermal scope-motion sickness Benzamides-due to reflux, diabetes phenothiazines-sever nausea & vomiting Chemo-5-HT (serotonin rec antagonists dopamine, cannabinoids,benzodiazepines, and antihistaines and anticholinergic agents for motion sickness and migraines
N/V during pregnancy
Reglan- Class B
zofran-Class B
Complimentary-ginger, B6
Consult if persists over 24 hours
Constipation
Medications that cause constipation are anticholinergics, calcium channel blockers, diuretics, antacids
Constipation
2 of the following for 3 months and 6 months previous to that
fewer than 3 movements per week, hard lumpy stools, sensation of straining, feeling of incomplete evacuation, obstruction,
Constipation
caused by hypothyroidism, DM, slow transit, pelvic floor dysfuntion
Constipation lab studies
urnialysis stool occult for blood TSH CBC and differential Chemistry profile stool culture
Constipation
lifestyle changes bulk forming laxatives stool softners osmotic laxatives stimulant laxatives chloride channel activators
IBS
Functional disturbance of intestinal motility
diarrhea or constipation
influenced by emotional factors
IBS- relieved abdominal discomfort by pasage of stool or associated with diarrhe, constipation, or mucus in stool
young adulthood, no blood in stool
IBS
3x per month for 3 months begining 6 mos prior to dx
dx of exclusion
abdomen - mild abdominal tenderness
ROME III Diagnositc criteria
must have two or more of the following: improvement with defecation, onset associated with change in frequency (less than 3 BMs per week or more than 3 per day) onset associated with change in appearance (lumpy hard or loose and watery) One or more on 25% of the time Abnormal stool abnormal passage stool form bloating or distention mucous in stool loose stools Must be present for 6 mos prior to dx at least e days per mo for 3 mos.
Constipation or Diarrhea will affect the education
Abdominal pain must be present
IBS
Usually unremarkable exam . mild abdominal tenderness, normal or mild hyperactive bowel sounds
IBS labs
CBC, sed rate, blood chemistry, TSG Stool occult Fecal leukocytes Pts > 50 colonoscopy Pts <50 sigmoidoscopy Rule out lactose intolerance
How to rule out lactose intolerance
Intolerance with a two week lactose free dite OR drink a quart ofmilk and check for symptoms/hydrogen breath testing
IBS-constipation Tx
High fiber diet
bulking agents
drug therapy for sever symptoms-1/3rd
IBS-diarrhea
Antispasmodics-Bentyl or Hyoscomine
Immodium
Anti-depressants SSRIs
Behavioral therapy, etc
IBS constipation
Miralax, therapy, SSRIs, etc.