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Gastrointestinal problems Flashcards

1
Q

Abdominal pain

A

visceral=in organs, dull and pain poorly localized

Parietal pain-sharp and well localized

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2
Q

RUQ

A 
chest cavity
liver
gallbladder
stomach
bowel
right kidney
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3
Q

LUQ

A

pancreas
left kidney
spleen
heart and chest cavity

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4
Q

RLQ

A 
Appendix
bowel
right ureter
perlvis
ovary
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5
Q

LLQ

A

bowel-diverticulitis
ureter
pelvis

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6
Q

Appendicitis

A

Good oral history/OLDCARTS

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7
Q

Get consult when:BWAD

A

blood in stool
weight loss
anemia
dysphagia

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8
Q

Appeddicitis

A

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

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9
Q

Appedicitis-S/S

A

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

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10
Q

appendicitis-after 24 hours

A

if perforates may have sudden cessation of pain, abdominal rigidity, high fever, vominting, dehydration, decreased bowel sounds, shock

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11
Q

appendicitis- physicla findings before perforation

A

fever
abdominal rigidity, point and rebound tenderness in RLQ, decreased bowel sounds, +psoas and obturator signs
rectal exam-tenderness in right perirectal area

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12
Q

Psoas-

A

pain when lifting right leg against pressure

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13
Q

Obturator sign

A

positive when hip and knee is flexed and rotate right leg into the inside

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14
Q

Appendicitis labs

A

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

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15
Q

Appedicitis

A

Mayy reveal mass when doing rectal exam and it will be tender, refer to surgeon

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16
Q

Nausea and Vomiting

A

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

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17
Q

N/V

A

No solids for 4 hours, clear liquids gradually increase

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18
Q

N/V-medications

A 
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
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19
Q

N/V during pregnancy

A

Reglan- Class B
zofran-Class B
Complimentary-ginger, B6
Consult if persists over 24 hours

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20
Q

Constipation

A

Medications that cause constipation are anticholinergics, calcium channel blockers, diuretics, antacids

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21
Q

Constipation

A

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,

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22
Q

Constipation

A

caused by hypothyroidism, DM, slow transit, pelvic floor dysfuntion

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23
Q

Constipation lab studies

A 
urnialysis
stool occult for blood
TSH
CBC and differential
Chemistry profile
stool culture
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24
Q

Constipation

A 
lifestyle changes
bulk forming laxatives
stool softners
osmotic laxatives
stimulant laxatives
chloride channel activators
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25
IBS
Functional disturbance of intestinal motility diarrhea or constipation influenced by emotional factors
26
IBS- relieved abdominal discomfort by pasage of stool or associated with diarrhe, constipation, or mucus in stool
young adulthood, no blood in stool
27
IBS
3x per month for 3 months begining 6 mos prior to dx dx of exclusion abdomen - mild abdominal tenderness
28
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. ```
29
Constipation or Diarrhea will affect the education
Abdominal pain must be present
30
IBS
Usually unremarkable exam . mild abdominal tenderness, normal or mild hyperactive bowel sounds
31
IBS labs
``` CBC, sed rate, blood chemistry, TSG Stool occult Fecal leukocytes Pts > 50 colonoscopy Pts <50 sigmoidoscopy Rule out lactose intolerance ```
32
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
33
IBS-constipation Tx
High fiber diet bulking agents drug therapy for sever symptoms-1/3rd
34
IBS-diarrhea
Antispasmodics-Bentyl or Hyoscomine Immodium Anti-depressants SSRIs Behavioral therapy, etc
35
IBS constipation
Miralax, therapy, SSRIs, etc.
36
IBS education
Sit on toilet after breakfast every morning for 20 minutes Meds and lifestyle Watch for blood, fever, unintentional weight loss and then refer
37
Regular Diarrhea
No labs if under 48 hours and no s/s Stop all soldis for 12-24 hours, rehydrate kaopectate of pepto bismol for symtomatic relief, Donnatol for cracmping
38
Infectious diarrhea
Most is viral Antibiotics if fecal leukocytes, occult blood, fever with watery diarrhea or symptoms > a week (salmonella, campy, shigella) Give Cipro 500 mg every 12 hours orally 1-3 days in adults.
39
No antimotility drugs if fecal leukocytes or blood in stools
none
40
C-difficile
Metronidazole 500 mg 3x/day for 10-14 days or vancomycin
41
Travelers Diarrhea
Antibiotics if fecal leukocytes, occult blood, fever with watery diarrhea or symptoms great than 1 week (usually salmonella, shigella, campylobactor Cipro
42
No antimotility drugs if fecal leukocytes or blood in stools
Slows the bug from excreting form the body.
43
Diarrhea over 2 weeks consider giardia
Tx with flagyl
44
Dyspepsia and heartburn
disturbed digestion GERD
45
GERD
Daily presence of heartburn, 10% in normal adults, is a defect in esophageal motility
46
GERD
retrosternal aching or burning occurring 30-60 minutes after eating and associated with large meals and aggravated by lying down-can mimic angina with heavy chest and pressure daiating down to the neck or jaw or shoulders-regurgitation of food particles, nonturnal aspiration can cause pneumonia or bronchospasm
47
GERD-physical findings
epigastric tenderness, stool for occult blood have them do at home. Dysphagia with weight loss, loss of dental enamal from acid
48
GERD labs
Usually dx by history Endoscopy indicated if >50 with sudden onset does not respond to therapy alarm symptoms (bleeding, anemia, dysphagia, odynophagia long standing symptoms at risk for barretts esophagus
49
GERD Management
lifestyle modification PPI x 8 weeks and if no response then endoscopy Follow up 2-4 weeks Treat with antacids first then PPI's
50
GERD differentials
Angina PUD gastritis heart attack
51
GERD
``` Decrease meal size smoking cessation reduce alcohol consumption reduce carbonated drinks redeuce fat weight loss ```
52
GERD labs
if indicated CBC and stool occult. Usually only after meds dont work
53
Barretts esophagus can lead to caner
If PPI's don't work refer
54
Causes of negative blood in melena
iron, pepto, licorice
55
Jaundice
elevated aspartate aminotransferase (AST) and alamine aminotransferase (ALT) are indicate hepatocyte damage
56
jaundice
ALT is usually higher in viral hepatitis | In alcoholic hepatitis the AST may be higher
57
AST ratio with ALT over 2
indicates cirrohsis and alcohol problem
58
Alkaline phosphatase is found in the liver (alp-1 and the bone alp-2)
Elevated in a teen means bone growth. Could be fetal bone growth
59
elevated alkaline phosphatase
cirrohsis or cholecstasis, obstructive liver disease
60
gamma glutamyl transferase (GTT)
May determine the cause of elevated ALP
61
ALP and GTT are elevated in disease of the bile ducts
and in some liver diseases
62
Only ALP will be elevated in bone disease
If GTT is normal and a high ALP it is most likely bone disease
63
ALP is up in bone disease
Got that !!
64
Peptic Ulcer Disease
ulceration of the GI mucosa | bathesd by acid pepsi, stomach, and esophagus
65
PUD
H. pylori | NSAID usage
66
PUD aggravating factors
severe trauma, burns. shock alcohol and nicotine use presence of cirrohsis, chronic pancratitis famiy hx
67
PUD
80% are duodenal
68
PUD s/s
intermittent epigastric pain begins 1-3 hours after eating, awakens a person at night pain relieved by food They eat then feel better
69
If its a gastric ulcer
people get skinny and don't like to eat.
70
PUD dx
pain-food-relief pattern
71
PUD Dx
limited to epi tenderness include rectal exam and testing for occult blood CBC with diff-could be anemia H. pylori testing
72
H. Pylori testing
serum culture breath test fecal antigen test serum culture will not tell if previous or now Next two test can only be done if not PPI's for a week previous
73
PUD
Endoscopy in pt over 50. Do if two week PPI shows no improvement to locate bleeding site in those with dx or suspected blood loss
74
Management of PUD
``` relieve symptoms stop smoking avoid nsaids reduce stress reduce alcohol and caffeine ```
75
PUD medication
1st line PPIs most potent, but expensive | H2RA's 4-6 weeks then nightly pm x 1yr
76
H. Pylori
PPI twice daily 10-14 days Clarithromycin 500 mg/twice a day Amoxicillin 1000mg/twice/day
77
PUD education
no evidence for bland diet encourage avoidance of known gastric acid stimulants, coffe, soda stress reduction report lack of response, rectal bleeding, weight loss, increased weakness or dizziness
78
PUD f/u
1-2 weeks to check on response to meds, GI bleeding, toxic side effects of meds
79
Diverticulitis
``` Inflammation of the diverticuli occurs in 25% of population Increases after 45 MOre in women and low fiber diets mostly in sigmoid colon 15% will develop complications ```
80
Diverticulitis
``` acute lower left quadrant pain-steady and severe or crampy and lasts for days constipation more usual than diarrhea pain increased with defecation flatulence N/v low grade fever ```
81
Diverticulitis findings
``` mild fever, tachycardia guarding rebound tenderness rigidity over LLQ tender palable mass if abcess has formed ```
82
Diverticulitis Dx labs
``` CBC with slight leukocytes urinalysis-wbc Stool for occult blood plain abdominal films if no response to tx CT scan colonoscopy after acute phase ```
83
Diverticulitis Tx
clear liquids for 2-3 days Metronidazole 500 bid AND Cipro 500 mg BID 7-14 days of Bactrim or Augmentin If moderate or severe will require hospitilization
84
Diverticulitis
Should be better in 1-2 days or refer
85
Diverticulitis
After acute phase, gradually increase fiber, avoid laxatives, use bulk forming agents F/U in 24-48 hrs and again after antx therapy
86
Acute pancreatitis
Severe abdominal pain, poorly localized, frequently radiates to the back rebound tenderness
87
Pancreatitis
Cullens and Grey turners can be seen in sever cases. rare but loooks like bluing in the flank area
88
Pancreatitis- labs
``` Serum amylase is the most common test Rises 6-12 hours after onset and then normal in 3-5 days. A three fold serum lipase elevation is more diagnostic and is elevated in both alcoholic and non alcoholic pancreatitis Chem 7, bun creatinine tryipsynogin C-reactive protein TSH ```
89
pancreatitis
abnormal CT scan is useful | Refer to gastroenterologist

Dermatology (9 decks)

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