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differential dx > GI > Flashcards

GI Flashcards

1
Q

epigastric pain

A

T3-T5 sympathetic nerve distribution
heart, esophagus, stomach, duodenum, gallbladder, liver

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2
Q

periumbilical region

A

T9-11 distribution
small intestine, pancreas, appendix

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3
Q

lower abdominal region

A

large intestine/colon
T10-L2

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4
Q

inflammatory pain

A

steady deep boring
seek quit position - curled up

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5
Q

ischemic pain

A

steady pain sudden onset
not relieved by analgesics

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6
Q

T6-T9 innervates what organs

A

gallbladder, stomach, pancreas, SI

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7
Q

dysphagia

A

difficulty swollowing

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8
Q

odynophagia

A

pain during swallowing
gastritis
medical referral

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9
Q

bleeding w/ stool

A

the higher up the darker the stool the lower down the bleed the redder the stool

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10
Q

epigastric pain w/ radiation

A

chronic ulcers
associated w/ gerd
Heartburn
can be confused w/ MI or angina
requires MD referral

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11
Q

pain affected by food

A

the longer the the period after meal that pain happens than it shows where it could be in the digestive tract
requires MD refferal

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12
Q

GI joint pain

A

usually migratory and asymmetrical

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13
Q

Kehr’s sign

A

pain near shoulder and clavicle w/ pressure on upper abdomen

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14
Q

danforth sign

A

shoulder pain with inspiration

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15
Q

R shoulder GI pain

A

Perforated duodenal or gastric ulcers that irritate diaphragm
pancreatic cancer
liver trauma

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16
Q

Both shoulder pain

A

Ruptured ectopic pregnancy with retroperitoneal bleeding
Accumulation of blood from a slow bleed of the spleen, liver, or stomach

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17
Q

obturator or psoas abscess

A

Infectious disease/ inflammatory processes affecting abdominal and pelvic cavities can seed to the psoas

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18
Q

obturator or psoas abscess s/s

A

Fever (“hectic” fever pattern)
Night sweats
Palpable, tender mass

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19
Q

obturator or psoas abscess PE

A

Antalgic gait (limited hip extension in terminal stance)
Pain with active and passive hip extension motion
Pain with active hip flexion motion
Tender mass in the groin

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20
Q

obturator or psoas abscess special tests

A

Heel Tap: Gently pick up the pt’s involved leg and tap the heel
Positive test: RLQ pain - same side
Hop test: ask the patient to hop on one leg
Positive test: pt clutches that side & is unable to complete the movement
Tenderness to palpation of the iliopsoas
+ Iliopsoas muscle test

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21
Q

GERD typical s/s

A

heartburn
belching
regurgitation

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22
Q

GERD atypical s/s

A

chest pain
asthma
anemia
dysphagia
coughing

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23
Q

GI pain esophageal
location
referral
description
intensity
duration

A

substernal pain
middle back referral
sharp stabby
mild to severe

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23
Q

GI pain esophageal
location
referral
description
intensity
duration

A

substernal pain
middle back referral
sharp stabby
mild to severe
constant/associated w/ meals

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23
Q

GI pain esophageal
location
referral
description
intensity
duration

A

substernal pain
middle back referral
sharp stabby
mild to severe

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24
Q

peptic ulcer?

A

A loss of tissue lining the lower esophagus, stomach, and duodenum
Erosions: acute lesions that don’t extend through the mucosa
Chronic ulcers replace mucosal lining & muscle with scar tissue

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25
Q

red flag peptic ulcer

A

new onset of shoulder back pain w/ hx of peptic ulcer

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26
Q

peptic ulcer s/s

A

night pain - 2400-0300
shoulder pain
lightheadedness
vomiting
bloody stool - black tarry

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27
Q

stomach and duodenal pain
location
referral
description
intensity
duration

A

middle epigastruim, upper abdomen, right umbilicus
referral to back, shoulder
achy burny
mild to severe
comes in waves

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28
Q
  1. diverticulosis vs 2. diverticulitis
A
  1. a benign condition in which the mucosa (lining) of the colon balloons out through weakened areas in the wall” - typically asymptomatic
  2. “the infection and inflammation that accompany a microperforation of one of the diverticula” - lower abdomen pain
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29
Q

diverticular disease s/s

A

fever
constipation/irregular bowel mvmts
flatulence
LLQ pain
RLQ pain if asian
decreased bowl sounds - less than 5 prob

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30
Q

appendicitis?

A

An inflammation of the vermiform appendix

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31
Q

appendicitis age

A

adolescents YA

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32
Q

Diverticulosis age

A

greater than 60

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33
Q

appendicitis s/s

A

can lead to peritonitis
dysuria
low grade fever
coated toungue bad breath
RLQ pain
regidity

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34
Q

appendicitis special tests

A

+ mcburney’s point
+ rebound tenderness - peritonitis
+ hop test
+ rovsing’s sign
+ pinch and inch

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35
Q

peritonitis special tests

A

rebound tenderness
pinch an inch

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36
Q

appendiceal pain
location
referral
description
intensity
duration

A

RLQ
well localized
aching comes in waves
mod to severe
steadily progresses over time

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37
Q

pancreatitis may result in

A

autodigestion of pancreas by its own enzymes

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38
Q

acute pancreatitis
chronic

A

refer out
prob bc of alcohol use and smoking

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39
Q

pancreatitis s/s
acute
chronic

A

acute
fever
tachycardia
malaise
weakness
bluish discoloration of abdomen!!!!!!!
jaundice
chronic
oily fatty stools
clay colored
weight loss

40
Q

pancreatic carcinoma demographics

A

mostly men
most commonly 7th decade

41
Q

pancreatic carcinoma s/s

A

back pain
jaundice
light colored stool
constipation
weakness

42
Q

pancreatic pain
location
referral
description
intensity
duration

A

midline or L of epigastrium
middle back/lower
burning gnawing
severe
constant sudden

43
Q

pancreatic aggravating factors

A

walking/lying supine - pancreatitis
unrelated digestive activities = carcinoma

44
Q

ulcerative colitis

A

affects colon/large intestine rectum
likely to develop cancer

45
Q

crohns disease

A

can affect any portion of the intestine from mouth to anus
most common ileum and colon
20-29

46
Q

crohn’s disease/ UC s/s

A

constipation
fever
rectal bleeding
decreased appetite
migratory arthralgia
hip pain

47
Q

IBS

A

Functional disorder of motility in the small and large intestines diagnosed according to specific bowel symptom clusters
females>males
>50

48
Q

IBS s/s

A

painful abd cramps
constipation/diarrhea
foul breath
flatulence

49
Q

colorectal cancer

A

screening at age 45

50
Q

colorectal cancer s/s

A

rectal bleeding
back pain

advanced stages
constipation prog to obstipation
abdominal distention
weight loss

51
Q

small intestine pain
location
referral
description
intensity
duration

A

midabd pain
pain referred to back
cramping pain
mod to severe
intermittent

52
Q

LI / colon pain
location
referral
description
intensity
duration

A

lower midabd pain
referred to the sacrum
cramping
dull
steady

53
Q

immediate medical attention

A

Anytime appendicitis or iliopsoas/obturator abscess is suspected (positive McBurney’s test, positive iliopsoas/obturator test, positive pinch-an-inch test, positive test for rebound tenderness)
Anytime the therapist suspects retroperitoneal bleeding from an injured, damaged, or ruptured spleen or ectopic pregnancy; or there is a history of trauma; missed menses; positive Kehr’s sign(pain above the clavical)”

54
Q

hepatic biliary MSK s/s

A

greater risk for OA of wrists and ankles
risk of rhabdo
hepatic osteodystrophy = abnorm development of bone

55
Q

hepatic biliary neuro s/s

A

asterixis = w/ elbow and wrist ext wrist flap
peripheral nerve dysfx
hyperreflexia

56
Q

hepatic s/s general

A

ascites
dark urine
oliguria = low urine output

57
Q

gallbladder special tests

A

murphy’s sign

58
Q

liver special tests

A

liver percussion
liver finger percussion
liver palpation

59
Q

hepatitis

A

can be caused by viral(most common), chemical, drug, or alcohol

60
Q

hepatitis red flag

A

joint or muscle pain that is disproportionate to the physical findings, the presence of palmar tendinitis in someone with RA, and positive risk factors for hepatitis

61
Q

hep A
hep B
hep C

A

A = ass - fecal oral
B = body fluid - sexual
C = blood to blood

62
Q

no vaccine or which hep

A

C

63
Q

hepatitis risk factors

A

injection - any needle in the body
unprotected sex
severe alcoholism
raw shell fish

64
Q

hep A s/s

A

commonly in childhood - flu s/s - misdx
extreme fatigue
fever
gen aching
RUQ p!
clay colored stool
dark urine
idigestion

65
Q

HBV s/s

A

potentially asymptomatic
jaundice
dark urine
painful abdominal bloating
fever

66
Q

chronic hepatitis s/s
active
persistent

A

active = jaundice, splenomegaly, hepatomegaly, ascites
persistent = RUQ pain, mild fatigue, malaise

67
Q

chronic active hepatitis can lead to

A

cirrhosis

68
Q

wilsons disease

A

Kayser-fleischer rings = copper ring around eye
mild - severe neuro involv
inc secretion of copper

69
Q

hematochromatosis

A

def of iron absorption
liver failure
arthralgia
2-3 MCP joint commonly involved
pseudo-gout fo knees

70
Q

tox/drug hep

A

anorexia
jaudice
dark urine
clay colored stool

71
Q

cirrhosis?

A

“Chronic hepatic disease characterized by the destruction of liver cells and by the replacement of connective tissue by fibrous bands
inc scarring blood and lymph flow impaired

72
Q

cirrhosis risk

A

stress reduction important
portal vein hypertension
ascites

73
Q

cirrhosis other cause outside of alcohol

A

nonalcoholic fatty liver disease - high cholesterol/triglycerides, obesity, DM2

74
Q

cirrhosis s/s

A

anorexia
indigestion
weight lsos
dull abdominal ache
fever
ease of fatigue

75
Q

clinical manifestations of cirrhosis

A

hypoxia
mental acuity
mild mem loss
hands and feet neuritis - can present as BL carpal tunnel
nose bleeds

76
Q

asterixis

A

full ext elbow and wrist with shake

77
Q

s/s of protal HTN

A

ascites
esophogeal varices
hemorrhoids
splenomegaly

78
Q

s/s of hemorrhage associated w/ esophageal varices

A

restlessness
pallor
tachycardia
cooling of skin
hypotension

79
Q

hepatic encephalopathy

A

Complication of liver disease
A result of the liver’s inability to detoxify ammonia
can result in coma

80
Q

hepatic encephalopathy signs

A

asterixis, paresthesia/anesthesia
short attention span
difficulty concentrating
cog impairment

81
Q

newborn jaundice

A

if left untreated kernicterus
can cause athetoid CP
hearing loss

82
Q

newborn red flag

A

anycolor change in newborns needs immediate referral and testing for abnorm bilirubin

83
Q

kernicterus

A

A type of brain damage from toxic levels of bilirubin in the blood

84
Q

liver abscess?

A

necrotic tissue isolates cavity from rest of liver
fatal if untreated

85
Q

liver abscess s/s

A

R sh pain
diaphoresis
tender hepatomegaly
wieght loss

86
Q

liver CA

A

most likely to be metastatic site
hepatocellular CA most common

87
Q

liver CA s/s

A

jaundice
overall mm weakness
constant ache in the epigastrium or midback
early satiety - full

88
Q

cholelithiasis

A

presence or formation of gallstones
can be asymptomatic

89
Q

what puts you at risk cholelithiasis

A

inc w/ age
women> men before age 60
elevated estrogen
taking statins
ethnicity - native american/mexican

90
Q

cholelithiasis -biliary colic

A

stone lodged in neck of gallbladder
RUQ pain in waves

91
Q

cholecystitis

A

blockage of gallstones in cystic duct
can lead to infection or inflam
NV fever
steady severe pain rapidly inc

92
Q

colangitis

A

can be caused by gallstones lodged further down in the common bile duct

93
Q

cholelithiasis s/s

A

acute
tenderness on the tip of the tenth rib!!!!!! - can affect 11 and 12 on R
severe RUQ pain
pain in R shoulder between scaps

chronic
biliary colic
radiate to mid back
nausea
abdominal fullness
belching

94
Q

primary biliary cirrhosis

A

Chronic, progressive, autoimmune disease of the liver
Primarily involves the intra-hepatic bile ducts

95
Q

primary biliary cirrhosis s/s

A

pruritus
dry eye
ascites
osteoporosis
osteomalacia
pins and needles of the eyes

96
Q

gallbladder CA

A

associated w/ gallstone disease
exposure to radon
chronic gallbladder infection
boring pain constant

97
Q

gallbladder pain description

A

dull aching
deep visceral pain

98
Q

gallbladder pain description

A

Dull aching
Deep visceral pain (gallbladder suddenly distends)

99
Q

gall bladder pain aggravating factors

A

respiratory inspiration
eating
lying down

differential dx (7 decks)

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