GI Flashcards
Acute appendicitis
S&S: low-grade fever, guarding/rebound tenderness. Pains steadily gets worse, localizes to McBurney’s point (RLQ). Anorexia
Psoas and Obturator signs positive
Refer to ED
Acute cholecystitis
S&S: severe pain in RUQ or epigastric, within 1 hr of eating fatty meal
Anorexia and N/V
Risk factors: female, obese
Acute Diverticulitis
Patho: diverticula are small outpouches in external colon due to lack of fiber in diet. More likely in Western countries. More likely to affect left colon. Outpounches can get infected and burst.
S&S: Acute onset high fever, anorexia, N/V, pain in LLQ. Positive Rovsing sign (pain in RLQ when LLQ palpated) & pos rebound. H/o of bowel changes (50% will have constipation). If ruptured - board-like abdomen.
Diverticulosis: asymptomatic, will only be seen w/ colonoscopy
Risk factors: advanced age, constipation, low fiber, obesity, NSAIDs
Tx: mild cases can be treated outpatient with liquid diet + Augmentin or cipro + flagyl
If no improvement in 48-72h send to ED
Ovoid opiates, will encourage ileus
Acute Pancreatitis
Inflammation of pancreas 2/2 gallstones, alcohol, elevated triglycerides. Causes autodigestion
S&S: Acute onset fever, N/V, pain that radiates from and to mid back. Positive Cullen (blue discoloration around umbilicus) and grey Turner sign (blue discoloration around flank)
Dx: elevated amylase, lipase
Refer to ED
C. Diff colitis
S&S: severe watery stool, 10-15 stools per day. Lower abd pain, cramping, fever. Sx start within 5-10 days of abx initiation (CLindamycin, fluoroquinolones, cephalosporins, penicillins). Oral-fecal transmission
Dx: NAAT & stool assay
Tx: Vanco first line, high rate of reoccurrence
Consider fecal transplant w/ recurrence
inc fluids
Encourage reg diet
Refer to ED
Chrohn’s Dz
IBD
Can occur anywhere in GI tract, fistula and anal involvement only with CD
If ileum involvement - watery diarrhea w/o mucus
If colon - watery diarrhea w/ mucus
W/ flair: fever, anorexia, weight loss, dehydration, fatigue
Risk: ashkenazi jew
Ulcerative colitis
IBD
Affects colon/rectum
More likely to have bloody diarrhea w/ mucus than CD
Severe squeezing, “cramping” pain on L side of abd, w/ bloating and gas, exacerbated by food
May have IDA or anemia of chronic dz
During relapse: fever, anorexia, weight loss, arthralgias
Zollinger–Ellison Syndrome
Gastrinoma on pancreas or stomach that secretes gastrin, causes high levels of acid in stomach
LEads to ulcers in stomach and duodenum
S&S: Pain in epigastric and mid abd, tarry colored stool
Dx: fasting gastrin level
Refer to GI
Abdomen organs by quadrant
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
Psoas/Iliopsoas sign
Positive if elicits RLQ pain
With patient in supine position, have patient raise right leg against the pressure of the professional’s hand resistance. With patient on left side, extend the right leg from the hip.
Obturator Sign
Positive if inward rotation of the hip causes RLQ abdominal pain. Rotate right hip through full range of motion. Positive sign is pain with movement or flexion of the hip.
Rovsing’s Sign
Deep palpation of the LLQ of the abdomen results in referred pain to the RLQ, which is positive. A sign of peritonitis
Markle Test (Heel Jar)
Instruct patient to raise heels and then drop them suddenly. An alternative is to ask the patient to jump in place. Positive if pain is elicited or if patient refuses to perform because of pain.
Murphy’s manuever
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
Used to determine if abdominal pain is from inside the abdomen or if it is located on the abdominal wall.
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. If source of pain is the abdominal wall, it will increase the pain; if the source is inside the abdomen, the pain will improve.
