GI/Abdomen Flashcards
1
Q
Acute abdominal pain defined
A
sudden onset of acute pain, localized or diffuse, within or referred to the abdomen
2
Q
categories of abdominal pain
A
medical (gastroenterittis
surgical (appy)
3
Q
Characters of abdominal pain
A
Visceral
Parietal
4
Q
Visceral pain
A
dull "ache" diffuse pain fibers in muscular wall of hollow viscera stimulated by tension and stretching poorly localized
5
Q
Parietal Pain
A
sharp
localized
stimulated by inflammation in the parietal peritoneum
lateralization of pain
6
Q
Locations of abdominal pain
A
Suprapubic
Epigastric
Periumbilical
7
Q
Suprapubic pain indicates
A
distal intestine
urinary tract
pelvic organ
8
Q
Epigastric pain indicates
A
liver pancreas biliary tree stomach upper part of small bowel
9
Q
Periumbilical pain indicates
A
distal end of small intestine
cecum
appendix
ascending colon
10
Q
Referred pain
A
sharp, localized pain felt in remote areas innervated by the same nerves as the affected organ
example: gallbladder pain felt in right shoulder
11
Q
Gastrointestinal causes of abdominal pain in children
A
appendicitis mesenteric lympadenitis constipation trauma obstruction peritonitis food poisoning peptic ulcer Meckel's diverticulum Inflammatory bowel disease lactose intolerance
12
Q
Liver, spleen and bilary tract disorders in children
A
hepatitis cholecystitis cholelithiasis splenic infarction spleen rupture
13
Q
Genitourinary disorders in children with abdominal pain
A
UTI calculi dysmenorrhea mittelschmerz pelvic inflammatory disease ectopic endometriosis
14
Q
What is a key factor in abdominal pain differential dx
A
age
15
Q
Common causes of acute abd pain in toddler
A
gastroenteritis constipation appendicitis UTI pneumonia intussusception hernia pharyngitis trauma
16
Q
Common causes of acute abd pain in school age
A
gastroenteritis mesenteric adenitis infection appendicitis trauma HUS HSP IBD
17
Q
Acute abdominal pain mimickers in children
A
Strep pharyngitis lower lobe pneumonia sickle cell crisis DKA hepatitis
18
Q
Physical abdominal exam in children
A
rectal exam
psoas and obturator signs
rebound tenderness
decreased bowel sounds
19
Q
Lab for pediatric abd pain
A
CBC CMP Sed rate UA preg test Gc/chlamydial pap
20
Q
Radiology for abdominal pain
A
KUB
chest x-ray
Abdominal and pelvic ultrasound
CT
21
Q
AAP guidelines for pediatric pain
A
all children <5 refer to surgeon
infants/children with perf appendic have surgeon
anomalies and major issues should be in care of pediatric medical and surgical specialists
22
Q
Patho of appendicitis
A
obstructed lumen
distention results in periumbilical pain
perforation result in RLQ pain
23
Q
Appendicitis in children
A
difficult to dx
high index of suspicion required
rarely presents in textbook fashion
24
Q
Classic finding in appendicitis
A
anorexia vomiting periumbilical pain elevated temp (< 103) RLQ pain
25
Physical exam findings with appendicitis
```
rebound tenderness
guarding
regidity
pain with cough
tenderness with percussion
can't jump off the exam table
pos heel drip jaring test
```
26
Rovsing's sign
refereed pain in RLQ with palpation of LLQ
27
Psoas sign
pain with hip flexion against resistance
28
Obturator sign
passive internal rotation of the flexed right thigh
29
Lab results with appendicitis
left shift in CBC
WBCs present in UA
fecalith in radiology if there is a rupture
30
Diagnostic radiology in children
ultrasonography especially female
| CT can be helpful if uncertian
31
Admission or surgical referral if
2 of the following present:
classic history
exam suspicious
abnormal lab
32
Mantrels system
scoring system for appendicitis and diagnosis
| the cut off and diagnosis is made at 7
33
5 findings consistent with appendicitis in children
```
nausea
RLQ pain
difficulty walking
rebound tenderness
neutrophil count greater than 6,750
```
34
Hernia in children
male: scrotal, inguinal swelling including abdominal contents
female: swelling in abdomen and labia majora
35
Prevalence of hernia
more common in male
common in infancy, esp premature
common on right side
hydroceles can occur with
36
Signs and symptoms of inguinal hernia
palpable mass in inguinal area
mass in scrotum
may appear and disappear
37
Hydroceles lasting more than 1 year
should be approached like inguinal hernias
38
Diagnosing hernia with history
```
have parents record if it comes and goes
find inguinal swelling
silk sign
scrotal bowel sounds
transillumination when the bowl is filled with fluid
may come and go with crying or straining
```
39
Incarcerated hernias
surgical emergency
40
Umbilical hernias in children
considered benign and usually resolves by 3-5 years
| defects as large as 3-5cm can occur and resolve
41
Contraindicated in umbilical hernias
strapping and binding
42
Other conditions present with umbilical hernias
hypothyroidism
Downs
Preterm
43
Intussuseption
prolapse of a intestine into the distal bowel and becomes invaginated at ileo-cecal point
venous return is obstructed and eventually arterial return will become obstructed
44
common age for intussusception
3-33 months
| most common 3-12 months
45
Symptoms of intussusception
sudden onset colicky abd pain
very painful with peristalsis
between episodes the abd is soft
46
Clinical triad of intussusception
vomiting without diarrhea
intermittent abdominal pain
guiac pos stools
47
Physical exam for intussusception
RUQ sausage shaped mass with absence of RLQ bowel (Dance's sign)
hematest pos stools
passage of current jelly (late sign 24 hours after)
48
Dx of intussusception
ultrasound/doppler has >90% accuracy
| Barium enema
49
Tx for intussusception
can use barium enema to tx as well
if can't reduce with barium the surgical manipulation
you want hydrostatic pressure between 60-100
50
Post op intussusception
admit for observation bc reoccurance can happen within 24 hours
51
Pyloric stenosis
a narrowing of the outlet from the stomach to the small intestine (pyloris) and occurs in infants
52
Idiopathic hypertrophic pyloric stenosis
more common in first born males
familial pattern
most common surgical cause of vomiting
been reports with erythromycin in those
53
age range for pyloric stenosis
2-8 weeks
| more common among whites
54
4 P's of pyloric stenosis
Progressive vomiting for hours or days
Projectile vomiting
Palpable olive
Peristaltic wave that can be palpated
55
Additional s/s in pyloric stenosis
does not appear ill
hungry immediately after emesis
dehydration and mild jaundice
56
lab for pyloric stenosis
ultrasound can verify with a channel >16mm and thickness >4mm
Use Upper GI if ultrasound not avail
57
Sign of pyloric stenosis
string sign
58
must do prior to surgical repair
rehydration
59
Surgery for pyloric stenosis
Ramstedt pyloromyotomy
60
Post op pyloromyotomy
NPO 12 hours
36 hours resume normal diet
no bathing for 5 days
ridge where tape at is normal
61
Diarrhea defined
an increase in stool frequency
| a decrease in stool consistency
62
Acute diarrhea
```
usually infectious; (viral) Rotavirus
Iatrogenic; abx induced, lactose deficiency
hyperosmotic; juices, foods
anatomic; intussusception
parenteral; UTI, AOM, pneumonia
```
63
Chronic diarrhea
could be infectious but suggests malabsorption
64
Rotavirus
```
leading cause of diarrhea (gastroenteritis)
has 2 day incubation period
diarrhea for 3-8 days
common 4-24 months
watery sweet smelling stools x10-20/day
```
65
Rotavirus season
November-May
66
Rota-Teq
rotavirus vaccination
give 3 liquid doses starting 6-12 weeks then 4-10 week intervals
do not give after 32 weeks
will make much more mild
may experience mild vomiting and diarrhea
67
Rotarix
rotavirus vaccination
| 2-4 months
68
Bacterial causes of diarrhea
```
salmonella
shigella
compylobacter
yersinea
e. coli
```
69
Salmonella
fever
blood/pea green diarrhea
usually self limited so abx only in high risk
70
Shigella
```
high fever
seizures
toxicity
mucosy, water, bloody stools
usually self limited
```
71
Compylobacter
mild temlp
watery stools with blood
get from well water and shopping carts
72
Yersinea
occasional blood, vomiting
| more common north
73
E. Coli types
```
Shiga toxin-productin e. coli (0157:H7)
Enteropathogenic E coli
Enterotoxigenic E coli
Enteroinvasive E coli
Enteroaggregative E coli
```
74
Tx E. Coli
no antimotility agents with bloody diarrhea
TMP-Sulfa (Bactrum)
Azithromycin
75
Hemolytic Uremic Syndrome (HUS)
can occur with E coli 0157:H7
develops 2 weeks after onset of diarrhea
common ages 6months - 4 years
higher socioeconomic class
76
Triad of finding with HUS
acute renal failure- dialysis
thrombocytopenia
hemolytic anemia
77
Prevent HUS
cook beef
good hand washing
pasturize milk and cider
78
Clostridium difficle in children
restrict testing to those older than 1 year with two days of diarrhea with GI symptoms
don't tx with vanco
79
Protozoa cause of diarrhea
Giardia
| Cryptosporidium
80
Giardia
watery diarrhea no blood
flatulence
distention
suspect if > 7 days diarrhea
81
Cryptosporidium
```
diarrhea
vomiting
fatigue
summer and fall
recreational water/daycare
```
82
Recreational Water Illnesses
```
Cryptosporidium
Giardia
Sheigella
E coli 0157:H7
Norovirus
```
83
Abx induced diarrhea
occurs with 20-40% of abx use
| Co administer with probiotic lactobaccilus to decrease
84
Probiotics in children
recommend not to use
85
Tx Shigella
TMP-sulf/Azithrom
86
Tx Campylobacter
Erythromycin/Azithro
87
Tx Yersinea
TMP-sulfa/Tetracycline
88
Tx Giardia
Nitazoxanide/Metronidazole
89
Tx Cryptosporidium
Nitazoxanide
90
C. Diff
d/c abx
metronidazole
avoid vanco
91
Oral replacement therapy principles
use for rehydration over 3-4 hours
follow rehydration with normal diet
nurse the breastfed infant
92
2 phases of ORT
Rehydration- fluids given to replace those lost
| Mainenance- ongoing replacement
93
what is most indicative of hydration
weight
94
mild dehydration by weight
<3%
95
moderate dehydration by weight
3-9%
96
severe dehydration by weight
>9% need iv rehydration
97
ORT for mild dehydration
50ml/kg over 4 hours
98
Hospitalization for gastroenteritis
age less than 6 weeks
lethargy
when follow-up can't be guaranteed
need close observation
99
Exclusion for ORT
less than 1 month
shock
unconscious
illeus
100
Recommended foods in children
```
complex carbs (rice,wheat, potatoes, bread)
avoid fatty
avoid juices and soft drinks
```
101
Oral zofran and rehydration
ODT 8-15kg = 2mg
if they vomit within 15 minutes give another dose
wait 15 minutes and then start oral rehydration
102
Differential dx RUQ pain adults
```
Biliary: cholecystitis, choleylithiasis
Colonic: cholitis, diverticulitis
Hepatic: hepatic absess
Pulmonary: pneumo, embolus
Renal: pyelo, nephrothyasis
```
103
Differential dx epigastric pain adults
Biliary
Cardiac: MI, pericarditis
Gastric: esophagitis, gastritis, peptic ulcer
Pancreatic: mass, pancreatitis
Vascular: aortic disection, mesontaric ichemia
104
Differential dx LUQ pain adults
```
cardiac: angina
gastric
pancreatic
renal
vascular
```
105
Differential dx periumbilical abd pain
colonic: early appendicitis
gastric: peptic ulcer, esophagitis
vascular
106
Differential dx RLQ pain adults
Colonic: appy, IBS, diverticulitis
Gynecologic: ectopic, fibroids, PID, ovarian mass, torsion
Renal: pyelo
107
Differential dx Suprapubic pain adults
Colonic
gyn
renal
108
Differential dx LLQ pain adults
cholitis
gyn
renal: pyelo, nephro
109
Sudden and severe pain in adults
rupture
performation
ectopic
110
Rapid progression of abd pain in adults
appy
| pancreatitis
111
Gradual progression of abd pain in adults
neoplasm
112
Burning pain
GERD
113
Pressure pain
cardiac
114
gnawing pain
peptic ulcer
115
Abdominal pain red flags
```
projectile vomiting
no po intake
GI blood loss
syncope
pregnancy
recent surgery
fever
foreign body
```
116
Test of choice for adult abdominal pain
Supine and upright abdominal plain films
117
Imaging for RUQ
ultrasonography
118
Imaging for LUQ
CT
119
Imaging for RLQ
CT with iv contrast
120
imaging for LLQ
CT with iv and oral contrast
121
Imaging for suprapubic
Ultrasoonography
122
Functional non-ulcerative dyspepsia
postprandial fullness
early satiation
epigastric pain
burning in the absence of structural disease
123
Causes of dyspepsia
PUD
| GERD
124
Indication for endoscopy for dyspepsia
unintended weight loss
persistent vomiting
GI bleed
family history of cancer
125
H2 blockers and PPIs in dyspepsia
can reduce symptoms
126
4 causes of peptic ulcers
H. pylori
NSAIDS
acid hypersecretory
idiopathic ulcers
127
Initial management of dyspepsia
a trial acid suppressants
test and treat for H. Pylori
early endoscopy
128
Tx H.Pylori
tx for 14 days
PPI + clarithromycin+ amox
or
PPI + Bismuth + metronidazole + tetracycline
129
Hepatopancreatobiliary complications
biliary colic
cholecystitis
acute pancreatitis
130
Biliary colic (choelithiasis
gallstones occlude cystic duct
epigastric RUQ visceral pain
pain builds over 15 to 60 mintues and slowly dissipates
131
Test of choice with cholecystitis
ultrasonography
usually see stone
get surgical consult
132
Causes of pancreatitis
gallstones
| alcohol
133
S/S pancreatitis
focal epigastric tenderness
guarding
possible pos gray turner, cullen and fox sign but very rare
134
Gray Turner's sign
flank ecchymosis with pancreatitis
135
Cullen's sign
periumbilical ecchymosis with pancreatitis
136
Fox's sign
unguinal ecchymosis with pancreatitis
137
Lab/Imaging for pancreatitis
amylase
lipase
3x normal indicate
CT scan to confirm
138
Tx for pancreatitis
IV volume resuscitation
139
Diverticulitis incidence
1/3 of those over 50
| 2/3 of those over 80
140
Diverticulitis described
diverticulum in the lining of the colon bulges through a weak spot and becomes inflammed
141
Test of choice for diverticulitis diagnosis
CT with oral contrast
| thick with arrowhead sign
142
Tx diverticulitis
liquids and antibiotics
metronidazole + quinelone
Amoc-clur x7-10 days
143
Causes of bowel obstruction
peritoneal bands post surgical
| hernias
144
S/S bowel obstruction
colicky diffuse pain that waxes and wanes over 5 min intervals
N/V
fecal emesis
145
Bowel obstruction Tx
NPO
NG tube
IV fluids
Surgical
146
What could be dx in older adult with abd pain
UTI
perforated viscus
ischemic bowel disease
