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Urgent Care Guide > GI 2 > Flashcards

GI 2 Flashcards

1
Q

diverticulitis

A

inflammation +/- infection of diverticulum or diverticula causing apin, anorexia, fever

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2
Q

diverticulitis - severe cases may result in
4

A
  1. intestinal abscess
  2. fistula formation
  3. obstruction
  4. perforation/bleeding
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3
Q

diverticulitis - where in pain most common
2

A

LLQ - overall
RLQ - most common in Asians

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4
Q

diverticulitis - pain may be
3

A
  1. intermittent or constant
  2. crampy
  3. associated w/ change in bowel habits - diarrhea, constipation
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5
Q

diverticulitis - clinical pres
5

A
  1. abd pain
  2. anorexia
  3. nausea
  4. vomiting
  5. dysuria and urinary frequency - bladder irritation
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6
Q

diverticulitis - PE findings can include
7

A
  1. fever
  2. hypotension
  3. shock
  4. localized LLQ pain +/- rebound and guarding
  5. +/- RLQ tenderness
  6. decreased bowel sounds
  7. tenderness or mass on rectal exam
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7
Q

diverticulitis - img/testing
2

A
  1. plain films - perf or obstruction, little role in dx diverticulitis
  2. pregnancy test
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8
Q

diverticulitis - DD
4

A
  1. malignancy
  2. PID
  3. irritable bowel syndrome
  4. ischemic colitis
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9
Q

diverticulitis - tx if pt has prior dx, localized pain w/o s/sx of localized peritonitis and w/o evidence of systemic illness
2

A
  1. amoxicllin/clavulanate 875 mg PO BID 7-10 days
  2. metronidazole 500 mg PO q8H 7-10 days +
    cipro 500 mg PO BID or levofloxacin 750 mg PO daily
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10
Q

diverticulitis - diet

A

NPO initially w/ slow advancement to diet

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11
Q

diverticulitis - when to refer to ER
5

A
  1. diverticulitis suspected, w/ no prior dx
  2. unable to tolerate PO
  3. peritonitis
  4. persistent fever
  5. increased pain or failure to improve w/ OP therapy
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12
Q

appendicitis classic presentation

A

“colicky” periumbilical pain followed by vomiting, progressive pain, localizing to RLQ in approximately 24-48 hours

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13
Q

appendicitis pain is exacerbated w/

A

movement

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14
Q

appendicitis - fever?

A

+/-

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15
Q

obturator sign

A

flex knee at 90 degrees and internally rotate - pain in lower quadrant is positive sign

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16
Q

mcburney’s point

A

1/3 of the way in from umbilicus - pain w/ palpation bc this is appendix area

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17
Q

psoas sign

A

lay flat, have them lift their leg while you resist then above the knee - positive then consider appendicitis

18
Q

rovsing’s sign

A

push in on LLQ and quick release, if they feel pain in RLQ then + sign

19
Q

appendicitis - what tests can you do during physical exam
4

A
  1. McBurney’s point tenderness
  2. obturator
  3. psoas
  4. rovsing’s
20
Q

appendicitis - img/testing
3

A
  1. pregnancy test
  2. POC urine
  3. consider CBC (leukocytosis w/ CBC), BMP/LFT/lipase
21
Q

appendicitis - gyno
4

A
  1. tubo ovarian abscess
  2. ectopic pregnancy
  3. ovarian torsion
  4. ruptured ovarian cyst
22
Q

appendicitis - Uro DD
3

A
  1. renal colic
  2. pyelonephritis
  3. UTI
23
Q

appendicitis - surgical DD
8

A
  1. mesenteric adenitis
  2. mesenteric ischemia
  3. bowel obstruction
  4. intussusception
  5. Meckel’s diverticulum
  6. diverticulitis
  7. pancreatitis
  8. cholecystitis
24
Q

appendicitis - tx and disposition
4

A
  1. NPO
  2. consider analgesia
  3. antiemetics
  4. Ed referral
25
Q

appendicitis - when to refer to ER
3

A
  1. when advanced img is indicated
  2. unexplained pain
  3. worsening RLQ pain/tenderness, intractable vomiting, pyrexia (fever)
26
Q

GERD - patient may c/o
7

A
  1. retrosternal burning
  2. dyspepsia
  3. CP
  4. cough
  5. bitter taste in mouth
  6. belching
  7. hoarseness
27
Q

GERD - in hx taking, ask about
2

A
  1. relief with antacids
  2. type of food and timing after intake (30-60 mins)
28
Q

GERD - risk factors include
5

A
  1. pregnancy
  2. obesity
  3. cigarette smoking
  4. elderly
  5. stress
29
Q

GERD - hx may include
5

A
  1. Sjorgren’s syndrome
  2. radiation
  3. hiatal hernia
  4. gastroparesis
  5. gastric outlet obstruction
30
Q

PUD - pt may c/o
7

A
  1. gnawing burning epigastric pain
  2. belching/bloating
  3. food intolerance
  4. Nausea
  5. vomiting
  6. hematemesis
  7. hematochezia
31
Q

PUD - classic presentation but varies
Gastric vs Duodenal

A

gastric - pain during/shortly after meals
duodenal - pain 2-3 hours after meal, at night

32
Q

PUD - ask about what med use
3

A
  1. NSAIDs
  2. steroids
  3. anticogas
33
Q

PUD - sharp and severe abx pain may be concerning for

A

perforation

34
Q

GERD/PUD - vitals
2

A

usually normal
hypotension/tachycardia - think perforation or anemia

35
Q

GERD/PUD - PE include
3

A
  1. peritoneal signs w/ perforation
  2. signs of anemia w/ blood loss
  3. rectal exam for fecal blood testing
36
Q

GERD/PUD - img/testing

A
  1. none usually req
  2. consider cxr to r/o free air (perforation)
37
Q

GERD/PUD - foods to avoid
9

A
  1. fats
  2. chocolate
  3. caffeine
  4. mints
  5. alcohol
  6. citrus
  7. oils
  8. spicy
  9. acidic
38
Q

GERD/PUD - lifestyle mods
4

A
  1. smaller meals (GERD)
  2. avoid laying down for three hours after eating (GERD)
  3. weight loss (GERD)
  4. smoking cessation
39
Q

PUD - avoid what meds
2

A

NSAIDs
steroids

40
Q

persistent GERD, suspected PUD
Rx and f/u
2

A
  1. PPI 4-8 weeks
  2. f/u with GI

Urgent Care Guide (38 decks)

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