GI Flashcards
appendicitis s/s
vague, cramp-like, moves to RLQ
biliary colic s/s
severe, steady aching pain in RUQ or epigastrium lasting 1-4hrs, associated with meals, occurs at night
acute cholecystitis s/s
persistent pain with fever, pain referred to R scapula
Pancreatitis s/s
epigastric/periumbilical steady, boring pain radiating to back, relieved when sitting, recent alcohol engestion
bowel ischemia s/s
sudden, severe onset
if you have afib and bowel ischemia what are you at risk for
arterial embolism
bowel obstruction s/s
crampy, midabdominal pain, no BMs
Nephrolithiasis s/s
begins gradually and escalates to severe in 20-60mins with flank pain to groin
Jaundiced occurs with what?
Hepatitis, doesn’t occur in cholecytitis or biliary colic unless bile duct obstruction
Diminished peripheral pulses occur with what?
bowel ischemia or AAA
absent bowel sounds occur in which problems?
pancreatitis, bowel ischemia
bowel sounds are high pitched in which problem?
bowel obstruction
rebound tenderness occurs with?
peritoneal irritation—IMMEDIATE REFERRAL
point tenderness occurs with which problems?
appendicitis, diverticulitis, cholecystitis
McBurney’s point occurs with which problem?
appendicitis
Murphy’s sign occurs which which problem?
associated with cholecystitis
severe abdominal pain but a normal physical exam would indicate which problems?
ischemic bowel, pancreatitis, acute intermittent porphyria
on ultrasound fluid filled will look?
dark
on ultrasound solid masses will look?
white
which scan is good for pancreatitis and diverticulitis?
CT
an increased anion gap=acids are added. This is associated with which problems?
bowel infarcts, DKA, severe pancreatitis
a normal anion gap=loss of base but chloride is preserved. This is associated with which problems?
diarrhea, illial loop problems
what happens to K with bowel infarcts?
it increases
which test is mandatory to do if woman is not 2 years post metapause to r/o preg related conditions?
Serum HcG
what happens to serum amylase levels in pancreatitis?
markedly increases
what happens to serum amylase levels in biliary disease, bowel obstruction, DKA, bowel ischemia
moderately increases
which problem has an elevated alkaline phoshate?
cholecystitis
mild pyuria is found with which problems?
diverticulitis and appendicitis
hematuria is key in which problem?
nephrolithiasis
Watson-Schwartz test
used in acute porphyria to differentiate porphobilinogen from urobilinogen
porphobilinogen
intermediate product of heme synthesis
where is porhobilinogen found? and what happens to it?
in urine, normal when fresh but then turns wine or black when heated and diluted HCL
intermittent porphyria
rare metabolic disorder
porphyria
disorders of heme synthesis
which vascular problems should be considered in the elderly?
bowel ischemia or AAA
abdominal plains are good for which tests?
obstruction or perforation
DKA s/s
abdominal pain, vomiting, ketonuria, anion gap acidosis
Hematemesis
frank blood in vomit
Hematochezia
bright blood in stool, bleeding from lower bowel
Melena
black tarry stool, bleeding from upper bowel (ileocecal valve)
which lab values will melena produce?
increased BUN d/t absorption of nitrogenous and products from digestion of blood
positive occult testing is d/t which problems?
gastritis, peptic ulcer or lesions of the small intestine
which cranial nerves help with swallowing?
V, IX, X, XII
dysphagia
difficulty in swallowing
Odynophagia
painful swallowing
Achalasia
lower esophageal sphincter fails to relax and food stays in the lower esophagus
esophageal diverticulum
outpouching of esophageal wall leading to retention of food
s/s esophageal diverticulum
gurgling, belching, coughing, foul-smelling breath
Mallory-Weiss Syndrome and whats it associated with?
tears in esophagus, associated with severe alcoholism, vomiting
what can Mallory-Weiss Syndrome lead to?
inflammatory ulcers or mediastinitis
mediastinitis
infection of the mediastinum
which test should be done to evaluate Gastroesophageal reflux?
EGD; esophagogastroduodenoscopy
What does Aspirin or NSAIDS prevent the stomach from making?
prostaglandin E
what does prostaglandin E do?
helps protect lining of the stomach so hydrochloric acid cant attack it, NSAIDS stop this from happening
H.Pylori
disrupts the mucosal barrier that protects the stomach from harmful effects of its digestive enzymes
acute gastritis
transient inflammation of the gastric mucosa, associated with endotoxins, alcohol and asa
chronic gastritis
characterized by the absence of grossly visible erosions and the presence of chronic inflammatory changes
what does chronic gastritis lead to?
atrophy of the glandular epithelium of the stomach
C. urea breath test, stool antigen, endoscopic biopsy and titer blood tests are used to test for which infection?
H. pylori infection
Duodenal ulcers have low or high gastric acid?
high gastric acid
gastric ulcers have low or high gastric acid?
normal or reduced gastric acid
why is there a reduced amount of gastric acid with gastric ulcers?
because the cells atrophy (decrease in size)
risk factors for ulcers
male, first degree relatives with duodenal ulcers, stress, smoking, ASA, NSAID use
s/s of duodenal ulcers
food and antacids provide relief, awaken in middle of night but NOT before bkfst, melena
when does pain occur with duodenal ulcers?
2-3 hours after meal
why does food provide relief of duodenal ulcers?
because it coats the stomach
does food help with gastric ulcer pain?
no, it aggravates it
gold standard for peptic ulcer disease
culture
what else causes PUD
pancreatitis, GERD, MI, cholecystitis, non-ulcer dyspepsia
location of gastric ulcers
stomach
location of duodenal ulcers
duodenum
when does pain occur with gastric ulcers?
1-2 hours after eating
Zollinger-Ellison Syndrome
gastrin-secreting tumor (gastrinoma)
treatment for Zollinger-Ellison Syndrome?
surgical removal of gastrinoma
s/s Zollinger-Ellison Syndrome?
diarrhea, impaired fat digestion, elevated serum gastrin, decreased intestinal pH
Gastric Cancer s/s
weight loss, palpable mass, ascites
what results from a deficiency of intrinsic factor which is necessary for intestinal absorption of vit B12?
pernicious anemia
important vit B12 deficiency symptom?
paresthesias of the hands and feet
dumping syndrome
rapid emptying of the gastric contents into the small intestine
when does dumping syndrome occur?
about 30 mins after eating
s/s of dumping syndrome
abdominal cramping, diarrhea, tachycardia, perspiration, weakness and dizziness, Borborygmi
Borborygmi
gurgling, splashing sound normally heard over the large intestine
Gastroenteritis
inflammation of the stomach and intestinal tract, usually s/t infectious agent from eating, traveling
whats the most common cause of gastroenteritis
ingestion of contaminated food or drink (x48 hrs)
Gastroenteritis s/s
abdominal pain fever, dehydration, orthostatic hypotension, dry mucosal membranes, decreased skin turgor
Gold standard test for Gastroenteritis
culture
Crohn disease
granulomatous inflammation, affects any area of the bowel, leads to thickening and scarring
ulcerative colitis
uniform, affects the colon, limited to mucosa
alarm symptoms of IBS that need to be investigated
weight loss, anemia, fever, persistent diarrhea causing dehydration, severe constipation, family hx colon ca, onset of symtomps >50
if <50 with alarm symptoms of IBS what test do you do?
labs and flexible sigmoidoscopy
if >50 with alarm symptoms of IBS what test do you do?
colonoscopy and obtain biopsy
transmural of bowel
affects entire bowel
tenesmus
painful urgency to move bowels
Crohns disease s/s
palpable mass, rectal fistulas, perirectal abscess, cramp-like pain, weight loss, fever
what can acute ileitis mimic?
appendicitis
Irritable Bowel Disease includes which problems?
Crohns disease and ulcerative colitis
Lower GI bleed problems
Diverticulosis, colon ca or polyps, A-V malformation, Hemorrhoids
with IBD will serum albumin be low or high?
low
crohns disease appearance
cobblestone
ulcerative colitis appearance
psuedopolyps
ulcerative colitis main s/s
bloody diarrhea
who gets Chronic Mesenteric Ischemia?
patients with vascular disease
mesenteric ischemia
ischemia in either the superior or inferior mesenteric arteries to the large or small intestine
who gets acute mesenteric ischemia?
patients who are at risk for systemic embolization (recent MI, afib)
what tests do you need to do for an acute or chronic mesenteric ischemia? and what is gold standard?
doppler ultrasound, CT but ANGIOGRAPHY is gold standard!
Ischemic colitis s/s
rectal bleeding, mild to moderate left-sided aabdominl pain
Ischemic colitis is secondary to what?
inadequate blood supply to watershed areas of the colon
preferred test for ischemic colitis
colonoscopy
Diverticulosis and where is it found
outpouching of the intestinal mucosa, most common in sigmoid colon
Diverticulitis and s/s
inflammation of one or more of diverticuli, LLQ pain, diarrhea, fever
external hemorrhoids location
lie below anal sphincter and can be see on inspection
internal hemorrhoids location
lie above anal sphincter, cant be seen on inspection
which scan is most effective for appendicitis if patient is NOT pregnant
CT
Peritonitis and s/s
inflammation of the peritoneum, fever, chills, right guarding of abdomen, pallor, abdominal distention
perforated peptic ulcer, ruptured appendix, PID, gangrenous bowel, abdominal trauma are all causes of which problem?peritonitis
peritonitis
Celiac Disease
immune-mediated disorder triggered by ingestion of gluten
what happens to the immune response with patients who have celiac disease?
inappropriate T-cell response in genetically predisposed pts, may impair absorption
how does the metabolic disorder, intermittent porphyria occur?
excessive use of sulfonamides and barbiturates, they become sensitive to light
