GI Flashcards
Danger Signals
Acute A_____
Acute Ch_______
Acute D________
Acute P_______
(1) Colitis
Colon _____
C____ Disease
U______ Colitis
(1) Syndrome
Acute Appendicitis
Acute Cholecystitis
Acute Diverticulitis
Acute Pancreatitis
Clostridium Difficile Colitis
Colon Cancer
Crohn’s Disease
Ulcerative Colitis
Zollinger-Ellison Syndrome
Acute Appendicitis
Patient who is a young adult complains of ____ onset of peri______ pain that is steadily getting worse. Over a period of 12 to 24 hours, the pain starts to localize at _____ point. The patient has no ______ (anorexia). Classic exam findings include low-grade ____ and right lower quadrant (RLQ) pain (McBurney’s point) with re_____ and g______. The p____ and o_____ signs are positive. When the appendix ruptures, clinical signs of acute _______ occur, such as involuntary guarding, rebound, and a b____like abdomen. Refer to ___.
Patient who is a young adult complains of acute onset of periumbilical pain that is steadily getting worse. Over a period of 12 to 24 hours, the pain starts to localize at McBurney’s point. The patient has no appetite (anorexia). Classic exam findings include low-grade fever and right lower quadrant (RLQ) pain (McBurney’s point) with rebound and guarding. The psoas and obturator signs are positive. When the appendix ruptures, clinical signs of acute abdomen occur, such as involuntary guarding, rebound, and a boardlike abdomen. Refer to ED.
Acute Cholecystitis
Overw_____ gender (1) patient complains of severe (1) quadrant or epigastric pain that occurs within 1 hour (or more) after eating a _____ meal. Pain may radiate to the right ______. Accompanied by nausea/vomiting and anorexia. If left untreated, may develop ______ of the gallbladder (20%). May require hospitalization.
Overweight female patient complains of severe right upper quadrant (RUQ) or epigastric pain that occurs within 1 hour (or more) after eating a fatty meal. Pain may radiate to the right shoulder. Accompanied by nausea/vomiting and anorexia. If left untreated, may develop gangrene of the gallbladder (20%). May require hospitalization.
Acute Diverticulitis
(1) Age patient with acute onset of high fever, anorexia, nausea/vomiting, and (1) quandrant abdominal pain. Risk factors for acute diverticulitis include increased a__, con_____, low dietary ____ intake, obesity, lack of exercise, and frequent (1)Rx use.
Signs of acute abdomen are rebound, positive ______ sign, and a _____like abdomen. Complete blood count (CBC) will show leuko_____ with neutro____ and shift to the _____. The presence of band forms signals severe bacterial _____ (bands are immature neutrophils). Complications include abscess, s____, il____, small-bowel _____, hemorrhage, per_____, fis____, and phlegmon stricture. May be life-threatening.
Elderly patient with acute onset of high fever, anorexia, nausea/vomiting, and left lower quadrant (LLQ) abdominal pain. Risk factors for acute diverticulitis include increased age, constipation, low dietary fiber intake, obesity, lack of exercise, and frequent nonsteroidal anti-inflammatory drug (NSAID) use.
Signs of acute abdomen are rebound, positive Rovsing’s sign, and a boardlike abdomen. Complete blood count (CBC) will show leukocytosis with neutrophilia and shift to the left. The presence of band forms signals severe bacterial infection (bands are immature neutrophils). Complications include abscess, sepsis, ileus, small-bowel obstruction, hemorrhage, perforation, fistula, and phlegmon stricture. May be life-threatening.
Rovsing’s sign is the finding of right lower quadrant pain during palpation of the left side of the abdomen or when left-sided rebound tenderness is elicited
Acute Pancreatitis
Adult patient complains of acute onset of fever, nausea, and vomiting that is associated with rapid onset of abdominal pain that radiates to the _____ (“b____”) located in the _____ region.
Frequent causes include _____ (approximately 90% of cases of acute pancreatitis), biliary factors, and al____ abuse. Abdominal exam reveals guarding and tenderness over the _____ area or the upper abdomen, as well as positive ______ sign (blue discoloration around umbilicus) and (1) sign (blue discoloration on the flanks). The patient may have an ileus and show signs and symptoms of sh_____. Refer to ED
Adult patient complains of acute onset of fever, nausea, and vomiting that is associated with rapid onset of abdominal pain that radiates to the midback (“boring”) located in the epigastric region.
Frequent causes include drugs (approximately 90% of cases of acute pancreatitis), biliary factors, and alcohol abuse. Abdominal exam reveals guarding and tenderness over the epigastric area or the upper abdomen, as well as positive Cullen’s sign (blue discoloration around umbilicus) and Grey Turner’s sign (blue discoloration on the flanks). The patient may have an ileus and show signs and symptoms of shock. Refer to ED
Clostridium Difficile Colitis
Severe w_____ diarrhea from __ to __ stools a day that is accompanied by lower abdominal pain with cr______ and f____. Symptoms usually appear within 5 to 10 days after initiation of _____ (such as _____ (Cleocin), fl______, ceph_____, and p______) have been implicated as the most likely cause of C. difficile infection. Most cases occur in patients in h_____ as well as those residing in n_____ facilities
Severe watery diarrhea from 10 to 15 stools a day that is accompanied by lower abdominal pain with cramping and fever. Symptoms usually appear within 5 to 10 days after initiation of antibiotics. (clindamycin (Cleocin), fluoroquinolones, cephalosporins, and penicillins) have been implicated as the most likely cause of C. difficile infection. Most cases occur in patients in hospitals as well as those residing in nursing facilities
Colon Cancer
Very gradual (years) with v____ gastrointestinal (GI) symptoms.
Tumor may bleed intermittently, and patient may have (1). Changes in _____ habits, stool, or bl____ stool. H____-positive stool, dark ____ stool, and mass on abdominal palpation.
(1) gender, older patients (>___ years of age), patients with history of multiple p_____ or inflammatory bowel disease (IBD) such as (2), and post_____l women with (1) should be referred to GI specialist for colonoscopy and endoscopy.
(1) race have the highest incidence of colon cancer in the United States. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colon cancer between ages of __ and __ years (Grade A recommendation).
Very gradual (years) with vague gastrointestinal (GI) symptoms.
Tumor may bleed intermittently, and patient may have iron-deficiency anemia. Changes in bowel habits, stool, or bloody stool. Heme-positive stool, dark tarry stool, and mass on abdominal palpation.
Males, older patients (>50 years of age), patients with history of multiple polyps or inflammatory bowel disease (IBD) such as Crohn’s disease (CD) or ulcerative colitis (UC), and postmenopausal women with iron-deficiency anemia should be referred to GI specialist for colonoscopy and endoscopy.
African Americans have the highest incidence of colon cancer in the United States. The U.S. Preventive Services Task Force (USPSTF) recommends screening for colon cancer between ages of 50 and 75 years (Grade A recommendation).
Crohn’s Disease
CD is an IBD that may affect what part of the GI tract?
If ____ is involved, there is watery diarrhea without blood or mucus. If ____ is involved, there is bloody diarrhea with mucus.
During relapses, fever, anorexia, weight loss, dehydration, and fatigue with periumbilical to (1) quandrant abdominal pain occur. ____ formation and ___ disease occur only with CD (not UC). May palpate tender abdominal mass. R____ and r_____ are common. Higher risk of (2) colon. Risk of development of _____ is also increased, especially for patients treated with azathioprine. More common in (1) ethnicity.
CD is an IBD that may affect any part(s) of the GI tract, from mouth (canker sores), small or large intestine, rectum, and anus.
If ileum is involved, there is watery diarrhea without blood or mucus. If colon is involved, there is bloody diarrhea with mucus.
During relapses, fever, anorexia, weight loss, dehydration, and fatigue with periumbilical to RLQ abdominal pain occur. Fistula formation and anal disease occur only with CD (not UC). May palpate tender abdominal mass. Remissions and relapses are common. Higher risk of toxic megacolon and colon cancer. Risk of development of lymphoma is also increased, especially for patients treated with azathioprine. More common in Ashkenazi Jews.
Ulcerative Colitis
IBD that affects what part?
_____ diarrhea with mucus (hematochezia) more common with UC than with CD. Severe “_____” cramping pain located on the ____ side of the abdomen with bl____ and gas that is exacerbated by food.
Relapses characterized by fever, anorexia, weight loss, and fatigue. Accompanied by (1)gia/ritis (15%–40%) that affect large joints, sacrum, and ankylosing spondylitis. May have ___-deficiency anemia or anemia of _____ disease. Disease has remissions and relapses. Increased risk of (2) colon.
IBD that affects the colon/rectum.
Bloody diarrhea with mucus (hematochezia) more common with UC than with CD. Severe “squeezing” cramping pain located on the left side of the abdomen with bloating and gas that is exacerbated by food.
Relapses characterized by fever, anorexia, weight loss, and fatigue. Accompanied by arthralgias and arthritis (15%–40%) that affect large joints, sacrum, and ankylosing spondylitis. May have iron-deficiency anemia or anemia of chronic disease. Disease has remissions and relapses. Increased risk of colon cancer. Risk of toxic megacolon.
(1)
A gastrinoma located on the pancreas or the stomach; secretes gastrin, which stimulates high levels of acid production in the stomach. The end result is the development of multiple and severe ulcers in the stomach and duodenum. Complaints of epigastric to midabdominal pain. Stools may be a tarry color. Screening by serum fasting gastrin level. Refer to gastroenterologist.
Zollinger–Ellison Syndrome
Route of Food or Drink from the Mouth
=
Esophagus → stomach (hydrochloric acid, intrinsic factor) → duodenum (bile, amylase, lipase) → jejunum → ileum → cecum → ascending colon → transverse colon → descending colon → sigmoid colon → rectum → anus
Abdominal Contents
Which quadrants/areas of the abdomen are these organs located?
(1): Liver, gallbladder, ascending colon, kidney (right), pancreas (small portion); right kidney is lower than the left because of displacement by the liver
(1): Stomach, pancreas, descending colon, kidney (left)
(1): Appendix, ileum, cecum, ovary (right)
(1): Sigmoid colon, ovary (left)
(1) area: Bladder, uterus, rectum
- RUQ:* Liver, gallbladder, ascending colon, kidney (right), pancreas (small portion); right kidney is lower than the left because of displacement by the liver
- Left upper quadrant (LUQ):* Stomach, pancreas, descending colon, kidney (left)
- RLQ:* Appendix, ileum, cecum, ovary (right)
- LLQ:* Sigmoid colon, ovary (left)
- Suprapubic area:* Bladder, uterus, rectum
Abdominal Maneuvers Indicating Acute Abdomen or Peritonitis
Psoas
Obturator
Rosving’s
Mcburney’s
Involuntary Guarding
Rebound Tenderness
Murphy’s
Carnett’s Test
Psoas/Iliopsoas Sign
How to perform the maneuver?
+ Sign
What does a + sign indicate?
With patient in supine position, have patient raise right leg against the pressure of the professional’s hand resistance.
RLQ pain = + sign
Indicates irritation of iliopsoas group of hip flexors suggesting acute appendicitis, peritoneal irritation
Obturator Sign
How to perform the maneuver?
+ Sign =
What does a + sign indicate?
Bend knee and rotate inward at hip joint
+ Sign = RLQ Pain with movement or flexion of hip
Acute Appendicitis, Acute abdomen or peritonitis
Rosving’s Sign
How to perform the maneuver?
+ Sign =
What does a positive sign indicate?
Deep palpation of LLQ
+ Sign = Deep palpation of LLQ results in referred pain to the RLQ
Sign of peritonitis/acute abdomen
McBurney’s Point
=
Palpation of RLQ illicits pain/tenderness - sign of possible acute appendicitis
(Area located between superior iliac crest and umbilicus in RLQ)
Markle Test (Heel Jar)
=
The Markle Sign, Markle Test or Heel Drop Jarring Test is elicited in patients with intraperitoneal inflammation by having a patient stand on his or her toes and suddenly dropping down onto the heels with an audible thump, or jumping in place If abdominal pain is localized as the heels strike the ground or patient refuses to perform bc of pain - Markle Sign is positive
Involuntary Guarding
=
With abdominal palpation, the abdominal muscles reflexively become tense or boardlike. Suspect acute or surgical abdomen. Refer to ED.
Rebound Tenderness
=
Patient complains of worsening abdominal pain when hand is released after palpation of abdomen compared with the pain felt during deep palpation. Suspect acute or surgical abdomen. Refer to ED
Murphy’s Maneuver
How to perform manuever?
+ Sign =
What does a + sign indicate?
Press deeply on the RUQ under the costal border during inspiration
Midinspiratory arrest is a positive finding (Murphy’s sign).
Positive with cholecystitis or gallbladder disease.
Carnett’s Test
How to perform maneuver?
What is it used to test?
Results of test?
Patient is supine with arms crossed over their chest. Instruct patient to lift up shoulders from the table so that the abdominal muscles (rectus abdominus) tighten.
An abdominal maneuver that is used to determine if abdominal pain is from inside the abdomen or if it is located on the abdominal wall.
If source of pain is the abdominal wall, it will increase the pain; if the source is inside the abdomen, the pain will improve.
Gastroesophageal Reflux Disease
=
- ___ percent of U.S. adults have gastroesophageal reflux disease (GERD).
- Diagnosis is based on h____ and clinical s______.
- Chronic GERD does what to the esophagus? (2)
Acidic gastric contents regurgitate from the stomach into the esophagus due to inappropriate relaxation of the lower esophageal sphincter.
- Forty percent of U.S. adults have gastroesophageal reflux disease (GERD).
- Diagnosis is based on history and clinical symptoms.
- Chronic GERD causes damage to squamous epithelium of the lower esophagus, and in about 10% of GERD patients may result in Barrett’s esophagus (a precancer), which increases risk of squamous cell cancer (cancer of the esophagus).
Classic Case of GERD
Middle-aged to older adult complains of chronic heart____ of many years’ duration.
Symptoms associated with l___ and/or f__ meals that worsen when in what position?
Long-term history of self-medication with over-the-counter (OTC) ant____ or __-antagonists
Risk factors may include the chronic use of N____, as____, or al____.
Middle-aged to older adult complains of chronic heartburn of many years’ duration.
Symptoms associated with large and/or fatty meals that worsen when supine.
Long-term history of self-medication with over-the-counter (OTC) antacids and H2 antagonists.
Risk factors may include the chronic use of NSAIDs, aspirin, or alcohol.
Objective Findings in GERD
Acidic or s____ odor to breath
Reflux of sour acidic stomach contents, especially with overeating
______ tooth enamel (rear molars) due to increased hydrochloric acid
Chronic ____-red throat (not associated with a cold)
Chronic c________
Acidic or sour odor to breath
Reflux of sour acidic stomach contents, especially with overeating
Thinning tooth enamel (rear molars) due to increased hydrochloric acid
Chronic sore red throat (not associated with a cold)
Chronic coughing
GERD 1st Line Treatment
First line treatment for mild/intermittent GERD =
- Avoid ___ and/or high-___meals, especially 3 to 4 hours before ___time.
- Avoid foods or medications that ____ the lower esophageal sphincter or foods or medications that irritate the esophagus
- Weight ______ if overweight (body mass index [BMI] >___) or obese.
- Cease s_____. Smoking increases stomach ___ and lowers esophageal sphincter ____.
If poor response, next step is to (1) and continue with lifestyle modifications.
Lifestyle changes for mild/intermittent GERD
- Avoid large and/or high-fat meals, especially 3 to 4 hours before bedtime.
- Avoid foods or medications that relax the lower esophageal sphincter or foods or medications that irritate the esophagus (Box 1).
- Weight reduction if overweight (body mass index [BMI] >25) or obese.
- Cease smoking. Smoking increases stomach acid and lowers esophageal sphincter pressure.
If poor response, next step is to prescribe medications and continue with lifestyle modifications.
Foods that Worsen GERD Symptoms
(1)-flavored gum or candy
Ch_____
C______
A_____ drinks
Ca______ beverages
T_____ sauce
Citrus drinks (e.g., ____ juice)
F____ foods
Peppermint- or mint-flavored gum or candy
Chocolate
Caffeine
Alcoholic drinks
Carbonated beverages
Tomato sauce
Citrus drinks (e.g., orange juice)
Fatty foods
Medications that Worsen GERD Symptoms
_____ channel blockers
N_____
Ni_____
____-adrenergic receptor agonists
Antich_____
I____ supplements
Bis_________
Quinidine
Theophylline
Calcium channel blockers
NSAIDs
Nitrates
Alpha-adrenergic receptor agonists
Anticholinergics
Iron supplements
Bisphosphonates
Quinidine
Theophylline
H2 Antagonists
(3)
First-line treatment for what type of symptoms/GERD?
When should you take this medication?
Ranitidine (Zantac) 300 mg
Nizatidine (Axid) 300 mg
Famotidine 40 mg at bedtime (Pepcid)
First-line treatment for mild-to-moderate symptoms or mild esophagitis.
Should be taken at bedtime.
Proton-pump inhibitors (PPIs)
(4)
Indicated for what type of GERD?
When should you take this medication?
Do not discontinue abruptly, why?
Omeprazole (Prilosec) 20 mg once daily
Esomeprazole (Nexium) 40 mg once daily
Lansoprazole (Prevacid) 30 mg once daily
pantoprazole (Protonix) 40 mg once daily.
For erosive esophagitis. Refer to gastroenterologist.
Take 30 to 60 minutes before meals.
Do not discontinue PPIs abruptly because can cause rebound symptoms/worsen symptoms- taper dose to wean
Proton Pump Inhibitors (PPIs) Complications of Long Term Use
(1) in postmenopausal women (interferes with calcium homeostasis)
Acute interstitial _____
hypo______
(1) infection
Reduced absorption of _____
Osteoporosis and bone/hip fractures in postmenopausal women (interferes with calcium homeostasis)
acute interstitial nephritis
hypomagnesemia
C. difficile infection
Reduced absorption of iron.
Antacids for GERD
(1) (Mylanta, Maalox)
(1) (Tums, Caltrate)
(1) (Gaviscon)
Minerals can bind with certain medications such as t_____ and lev_______
Aluminum–magnesium–simethicone (Mylanta, Maalox)
Calcium carbonate (Tums, Caltrate)
Aluminum–magnesium (Gaviscon)
Minerals can bind with certain medications such as tetracycline and levothyroxine (Synthroid).
GERD Treatment
What should you do if patient has? Gold standard procedure =
no relief after __-__ weeks of therapy
high risk for _____ esophagus (long term GERD, white male >50yo)
Experiencing worrisome symptoms
Refer to GI specialist for upper endoscopy/biopsy (GOLD STANDARD)
no relief after 4-8 weeks of therapy
high risk for Barrett’s esophagus (long term GERD, white male >50yo)
Experiencing worrisome symptoms
Complications of GERD
(3)
Barrett’s esophagus (a precancer for esophageal cancer)
Esophageal cancer
Esophageal stricture/scarring
Worrisome Symptoms of GERD
Refer to Gastroenterologist
- Odynophagia =
- Dysphagia =
- Early _____
- Weight ____
- (1) anemia
- gender (1) over (1) years old
- Odynophagia = pain with swallowing
- Dysphagia = difficulty swallowing
- Early Satiety
- Weight Loss
- Iron deficiency anemia (weight loss)
- Male >50 yo
Clinical Pearls for GERD
Any patient with at least a _____ or more history of chronic heartburn should be referred to a ______ for an ______ to rule out (1)
Patients with Barrett’s esophagus have up to ___ times higher risk of _____ of the esophagus (______ type).
Any patient with at least a decade or more history of chronic heartburn should be referred to a gastroenterologist for an endoscopy to rule out Barrett’s esophagus.
Patients with Barrett’s esophagus have up to 30 times higher risk of cancer of the esophagus (adenocarcinoma type).
Exam Tips
Barrett’s Esophagus =
How do you diagnose Barrett’s Esophagus?
Know lifestyle factors to teach patient with GERD (e.g., no m____, avoid c______).
(1) sign = edema and bruising of the subcutaneous tissue around the umbilicus indicates → (1)
(1) sign = bruising/bluish discoloration of the flank area that may indicates → (1)
Barrett’s esophagus is a precancer (esophageal cancer).
Diagnosed by upper endoscopy with biopsy.
Know lifestyle factors to teach patient (e.g., no mints, avoid caffeine).
Cullen’s sign = edema and bruising of the subcutaneous tissue around the umbilicus → haemorrhagic pancreatitis
Grey Turner’s sign = bruising/bluish discoloration of the flank area that may indicate → retroperitoneal hemorrhage/necrotizing pancreatitis
Exam Tips
Classic pain of acute pancreatitis =
How do you perform Rosving’s maneuver?
How do you perform Markle’s maneuver?
Positive Rosvings and Markle’s Maneuver tests indicate what?
How do you perform Psoas maneuver?
How do you perform Obturator sign?
Positive Psoas and Obturator signs indicate what?
Acute pancreatitis pain = severe midepigastric pain that radiates to midback (boring pain)
Rosving’s maneuver = pain in RLQ when palpating LLQ
Markle’s maneuver = having patient stand on toes and suddenly drop onto heels with an audible thump
Positive Rosving’s and Markles = acute abdomen
Psoas maneuver = having the patient lie on his or her left side while the right thigh is flexed backward
Obturator sign = internal rotation of right hip (ankle moves outward) with hip and knee flexed
Positive Psoas and Obturator signs = acute appendicitis
Exam Tips
Worrisome symptoms for esophageal cancer ____ on swallowing, early _____, and ____ loss
If patient needs treatment for GERD, start with Rx (1); if poor relief or erosive esophagitis, step up to Rx (1)
Worrisome symptoms for esophageal cancer include pain on swallowing, early satiety, and weight loss.
If patient needs treatment for GERD, start with H2 antagonists; if poor relief or erosive esophagitis, step up to PPIs.
Acute Gastroenteritis
Most common pathogens (1) (50-70%), (1) (15-20%), (1) (10-15%)
Main symptom =
Acute diarrhea =
Persistent diarrhea =
Chronic diarrhea =
Most common pathogens viruses (50-70%), bacteria (15-20%), protozoans (10-15%)
Main symptom = Loose, watery diarrhea 3x or more per day
Acute diarrhea = 1-2 days
Persistent diarrhea = 2-4 weeks
Chronic diarrhea = _>_4 weeks
(1)
Acute onset of nausea and vomiting accompanied by watery diarrhea that is not bloody. It is self-limited and of short duration, typically lasting 1 to 3 days.
Most common pathogens (2)
One of these pathogens (1) can cause outbreaks in crowded areas such as (2)
Viral Gastroenteritis
Acute onset of nausea and vomiting accompanied by watery diarrhea that is not bloody. It is self-limited and of short duration, typically lasting 1 to 3 days.
Rotavirus, Norovirus
Norovirus can cause outbreaks in crowded areas such as nursing homes, cruise ships
(1)
Acute onset of high fever, bloody diarrhea, severe abdominal pain with at least six stools in a 24-hour period.
Incubation period ranges from 1 to 6 hours if (1)
Incubation period 1 to 3 days if (1)
Bacterial Gastroenteritis
Acute onset of high fever, bloody diarrhea, severe abdominal pain with at least six stools in a 24-hour period.
Incubation period ranges from 1 to 6 hours if due to contaminated food (enterotoxin)
Incubation period 1 to 3 days if bacterial infection
Bacterial Gastroenteritis
Bacterial pathogens include E____ ____ Sa_____, Sh____, Ca_____, C. ______ (antibiotic use, recent hospitalization), and L_____ (pregnant women 12-fold risk).
Symptoms usually resolve in __ to __ days.
(1) can prolong the length and/or severity of the disease(pregnant women 12-fold risk).
Bacterial pathogens include Escherichia coli, Salmonella, Shigella, Campylobacter, C. difficile (antibiotic use, recent hospitalization), and Listeria (pregnant women 12-fold risk).
Symptoms usually resolve in 1 to 7 days.
Antibiotics can prolong the length and/or severity of the disease
(1)
Symptoms develop within 7 days of exposure and typically last ≥7 days. It is usually watery diarrhea. Travelers’ diarrhea starts within 3 to 7 days after exposure and usually resolves in 5 days. It is usually self-limited.
Pathogens (3)
Protozoal Gastroenteritis
Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
Protozoal Gastroenteritis
Risk Factors
- Travel to (1)
- Recent _____ use
- _________ state
- ____ care or resides in a _____ setting (e.g., nursing homes, institutions)
- Travel to developing countries
- Recent antibiotic use
- Immunocompromised state
- Day care or resides in a crowded setting (e.g., nursing homes, institutions)
Protozoal Gastroenteritis
Preventive Measures
- Drink (1), avoid (1)
- Food and water precautions when traveling in ____-world countries
- _____ hands frequently
- Careful food _____, such as washing v____ and f____
- ______ vaccine (infants)
- Drink bottled water during foreign travel; avoid ice cubes
- Food and water precautions when traveling in third-world countries
- Wash hands frequently
- Careful food preparation, such as washing vegetables and fruits
- Rotavirus vaccine (infants)
(1)
A chronic functional disorder of the colon (normal colonic tissue) marked by exacerbations and remissions (spontaneous). Commonly exacerbated by excess stress. It may be classified as diarrhea-predominant or constipation-predominant. In some cases, it may alternate between the two
Irritable Bowel Syndrome
Classic Case of IBS
Young adult to middle-aged ____ complains of in______ episodes of moderate-to-severe cr_____ pain in the lower abdomen, especially in the (1) quadrant. Bl_____ with fl______. Relief obtained after _______. Stools range from _____ to ______ or both types with __creased frequency of bowel movements.
Young adult to middle-aged female complains of intermittent episodes of moderate-to-severe cramping pain in the lower abdomen, especially in the LLQ. Bloating with flatulence. Relief obtained after defecation. Stools range from diarrhea to constipation or both types with increased frequency of bowel movements.
