GI 4

Question 1

hernia

Answer 1

protrusion of internal organs through muscle wall

Question 2

hernia - pt may c/o

Answer 2

noticeable lump or bulge that may or may not be painful

Question 3

hernia - ask about prior
2

Answer 3

surgeries
injury/trauma

Question 4

hernia - perform what while standing

Answer 4

have them perform valsalva maneuver while standing

Question 5

hernia - PE findings
2

Answer 5

1. +/- pain
2. +/- bulge

Question 6

hernia - reducible

Answer 6

soft and easy to palpate in abd cavity

Question 7

hernia - incarcerated
3

Answer 7

firm, painful, non reducible

Question 8

hernia - strangulated

Answer 8

incarcerated hernia that has impaired blood flow - emergency

Question 9

strangulated hernia presentation

Answer 9

often severely pain, sx of obstruction, possibly overlying skin changes (erythema/ecchymosis)

Question 10

hernia - img/testing

Answer 10

none usually in UC

Question 11

reducible hernia tx
3

Answer 11

1. analgesia
2. refer to surgery
3. limit activity, no heavy lifting

Question 12

hernia - when to refer to ER

Answer 12

concern for incarceration or strangulation

Question 13

internal hemorrhoids - patient may c/o
2

Answer 13

1. painless, bright red bleeding
2. streaks of blood on surface of stool

Question 14

external hemorrhoids - pt may c/o
3

Answer 14

1. typically localized pain
2. bright red bleeding ( no abd pain)
3. associated pruritis

Question 15

external hemorrhoids - thrombosed sx

Answer 15

acute increase in pain

Question 16

hemorrhoids - PE should include

Answer 16

digital rectal exam

Question 17

internal hemorrhoids on PE
1

Answer 17

not visualized on external inspection unless prolapsed

Question 18

external hemorrhoids on PE
2

Answer 18

1. appear on external inspection as dilated blood vessels
2. thrombosed - dark blue to purple, firm

Question 19

hemorrhoids - img/testing
2

Answer 19

1. none usually req
2. anoscopy is available

Question 20

hemorrhoids - tx
5

Answer 20

1. increase fiber and water intake
2. warm water sitz bath
3. stool softener i.e. docusate
4. donut seat
5. topical analgesia

Question 21

thrombosed hemorrhoids tx

Answer 21

consider thrombectomy or refer to surgery w/in 48-72 hours of presentation

Question 22

pancreatitis

Answer 22

inflammation of the pancreas that may involve surrounding tissues and/or remote organ system dysfunction

Question 23

pancreatitis mechanical obstruction causes
3

Answer 23

1. gallstones
2. sludge
3. malignancy

Question 24

pancreatitis toxic causes
2

Answer 24

1. ETOH
2. drugs (thiazides, furosemide, corticosteroids, sulfonamides, tetracycline)

Question 25

pancreatitis metabolic causes
2

Answer 25

1. hyperlipidemia
2. hypercalcemia

Question 26

pancreatitis other causes
5

Answer 26

1. trauma
2. congenital
3. vascular
4. pregnancy
5. post ercp

Question 27

pancreatitis patient may c/o
2

Answer 27

1. acute mod-severe epigastric or upper abd pain that may radiate to back
2. NV

Question 28

pancreatitis - patient may have hx of
2

Answer 28

gallstones
ETOH abuse

Question 29

pancreatitis - PE findings may include
6

Answer 29

1. +/- acute distress
2. +/- jaundice
3. acute abd pain
4. +/- rebound and guarding
5. +/- Cullen’s sign (umbilical discoloration)
6. +/- grey turners sx (flank discoloration)

Question 30

pancreatitis - img/testing
3

Answer 30

1. none usually
2. consider pregnancy test
3. POC urine

Question 31

pancreatitis - DD
5

Answer 31

1. CAD
2. AAA
3. gallbladder dx
4. gastritis
5. PUD

Question 32

pancreatitis - tx
3

Answer 32

npo
consider antiemetics
consider IV fluids/analgesia

Question 33

pancreatitis - when to refer to ER

Answer 33

all suspected cases

Question 34

docusate/Colace vs senna

Answer 34

docusate/Colace is a stool softener and works by drawing in water and fat into your stool in the colon to help it pass easier

senna is a laxative that stimulates bowel movement