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Test 2 PC1 > GI/Abdomen > Flashcards

GI/Abdomen Flashcards

1
Q

Acute abdominal pain defined

A

sudden onset of acute pain, localized or diffuse, within or referred to the abdomen

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2
Q

categories of abdominal pain

A

medical (gastroenterittis

surgical (appy)

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3
Q

Characters of abdominal pain

A

Visceral

Parietal

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4
Q

Visceral pain

A 
dull "ache"
diffuse
pain fibers in muscular wall of hollow viscera
stimulated by tension and stretching
poorly localized
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5
Q

Parietal Pain

A

sharp
localized
stimulated by inflammation in the parietal peritoneum
lateralization of pain

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6
Q

Locations of abdominal pain

A

Suprapubic
Epigastric
Periumbilical

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7
Q

Suprapubic pain indicates

A

distal intestine
urinary tract
pelvic organ

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8
Q

Epigastric pain indicates

A 
liver
pancreas
biliary tree
stomach
upper part of small bowel
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9
Q

Periumbilical pain indicates

A

distal end of small intestine
cecum
appendix
ascending colon

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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

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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
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12
Q

Liver, spleen and bilary tract disorders in children

A 
hepatitis
cholecystitis
cholelithiasis
splenic infarction
spleen rupture
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13
Q

Genitourinary disorders in children with abdominal pain

A 
UTI
calculi
dysmenorrhea
mittelschmerz pelvic inflammatory disease
ectopic
endometriosis
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14
Q

What is a key factor in abdominal pain differential dx

A

age

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15
Q

Common causes of acute abd pain in toddler

A 
gastroenteritis
constipation
appendicitis
UTI
pneumonia
intussusception
hernia
pharyngitis
trauma
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16
Q

Common causes of acute abd pain in school age

A 
gastroenteritis
mesenteric adenitis
infection 
appendicitis
trauma
HUS
HSP
IBD
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17
Q

Acute abdominal pain mimickers in children

A 
Strep pharyngitis
lower lobe pneumonia
sickle cell crisis
DKA
hepatitis
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18
Q

Physical abdominal exam in children

A

rectal exam
psoas and obturator signs
rebound tenderness
decreased bowel sounds

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19
Q

Lab for pediatric abd pain

A 
CBC
CMP
Sed rate
UA
preg test
Gc/chlamydial
pap
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20
Q

Radiology for abdominal pain

A

KUB
chest x-ray
Abdominal and pelvic ultrasound
CT

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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

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22
Q

Patho of appendicitis

A

obstructed lumen
distention results in periumbilical pain
perforation result in RLQ pain

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23
Q

Appendicitis in children

A

difficult to dx
high index of suspicion required
rarely presents in textbook fashion

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24
Q

Classic finding in appendicitis

A 
anorexia
vomiting
periumbilical pain
elevated temp (< 103)
RLQ pain
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25
Q

Physical exam findings with appendicitis

A 
rebound tenderness
guarding
regidity
pain with cough
tenderness with percussion
can't jump off the exam table
pos heel drip jaring test
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26
Q

Rovsing’s sign

A

refereed pain in RLQ with palpation of LLQ

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27
Q

Psoas sign

A

pain with hip flexion against resistance

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28
Q

Obturator sign

A

passive internal rotation of the flexed right thigh

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29
Q

Lab results with appendicitis

A

left shift in CBC
WBCs present in UA
fecalith in radiology if there is a rupture

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30
Q

Diagnostic radiology in children

A

ultrasonography especially female

CT can be helpful if uncertian

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31
Q

Admission or surgical referral if

A

2 of the following present:
classic history
exam suspicious
abnormal lab

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32
Q

Mantrels system

A

scoring system for appendicitis and diagnosis

the cut off and diagnosis is made at 7

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33
Q

5 findings consistent with appendicitis in children

A 
nausea
RLQ pain
difficulty walking
rebound tenderness
neutrophil count greater than 6,750
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34
Q

Hernia in children

A

male: scrotal, inguinal swelling including abdominal contents
female: swelling in abdomen and labia majora

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35
Q

Prevalence of hernia

A

more common in male
common in infancy, esp premature
common on right side
hydroceles can occur with

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36
Q

Signs and symptoms of inguinal hernia

A

palpable mass in inguinal area
mass in scrotum
may appear and disappear

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37
Q

Hydroceles lasting more than 1 year

A

should be approached like inguinal hernias

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38
Q

Diagnosing hernia with history

A 
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
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39
Q

Incarcerated hernias

A

surgical emergency

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40
Q

Umbilical hernias in children

A

considered benign and usually resolves by 3-5 years

defects as large as 3-5cm can occur and resolve

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41
Q

Contraindicated in umbilical hernias

A

strapping and binding

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42
Q

Other conditions present with umbilical hernias

A

hypothyroidism
Downs
Preterm

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43
Q

Intussuseption

A

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

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44
Q

common age for intussusception

A

3-33 months

most common 3-12 months

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45
Q

Symptoms of intussusception

A

sudden onset colicky abd pain
very painful with peristalsis
between episodes the abd is soft

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46
Q

Clinical triad of intussusception

A

vomiting without diarrhea
intermittent abdominal pain
guiac pos stools

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47
Q

Physical exam for intussusception

A

RUQ sausage shaped mass with absence of RLQ bowel (Dance’s sign)
hematest pos stools
passage of current jelly (late sign 24 hours after)

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48
Q

Dx of intussusception

A

ultrasound/doppler has >90% accuracy

Barium enema

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49
Q

Tx for intussusception

A

can use barium enema to tx as well
if can’t reduce with barium the surgical manipulation
you want hydrostatic pressure between 60-100

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50
Q

Post op intussusception

A

admit for observation bc reoccurance can happen within 24 hours

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51
Q

Pyloric stenosis

A

a narrowing of the outlet from the stomach to the small intestine (pyloris) and occurs in infants

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52
Q

Idiopathic hypertrophic pyloric stenosis

A

more common in first born males
familial pattern
most common surgical cause of vomiting
been reports with erythromycin in those

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53
Q

age range for pyloric stenosis

A

2-8 weeks

more common among whites

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54
Q

4 P’s of pyloric stenosis

A

Progressive vomiting for hours or days
Projectile vomiting
Palpable olive
Peristaltic wave that can be palpated

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55
Q

Additional s/s in pyloric stenosis

A

does not appear ill
hungry immediately after emesis
dehydration and mild jaundice

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56
Q

lab for pyloric stenosis

A

ultrasound can verify with a channel >16mm and thickness >4mm
Use Upper GI if ultrasound not avail

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57
Q

Sign of pyloric stenosis

A

string sign

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58
Q

must do prior to surgical repair

A

rehydration

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59
Q

Surgery for pyloric stenosis

A

Ramstedt pyloromyotomy

60
Q

Post op pyloromyotomy

A

NPO 12 hours
36 hours resume normal diet
no bathing for 5 days
ridge where tape at is normal

61
Q

Diarrhea defined

A

an increase in stool frequency

a decrease in stool consistency

62
Q

Acute diarrhea

A 
usually infectious; (viral) Rotavirus
Iatrogenic; abx induced, lactose deficiency
hyperosmotic; juices, foods
anatomic; intussusception
parenteral; UTI, AOM, pneumonia
63
Q

Chronic diarrhea

A

could be infectious but suggests malabsorption

64
Q

Rotavirus

A 
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
Q

Rotavirus season

A

November-May

66
Q

Rota-Teq

A

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
Q

Rotarix

A

rotavirus vaccination

2-4 months

68
Q

Bacterial causes of diarrhea

A 
salmonella
shigella
compylobacter
yersinea
e. coli
69
Q

Salmonella

A

fever
blood/pea green diarrhea
usually self limited so abx only in high risk

70
Q

Shigella

A 
high fever
seizures
toxicity
mucosy, water, bloody stools
usually self limited
71
Q

Compylobacter

A

mild temlp
watery stools with blood
get from well water and shopping carts

72
Q

Yersinea

A

occasional blood, vomiting

more common north

73
Q

E. Coli types

A 
Shiga toxin-productin e. coli (0157:H7)
Enteropathogenic E coli
Enterotoxigenic E coli
Enteroinvasive E coli
Enteroaggregative E coli
74
Q

Tx E. Coli

A

no antimotility agents with bloody diarrhea
TMP-Sulfa (Bactrum)
Azithromycin

75
Q

Hemolytic Uremic Syndrome (HUS)

A

can occur with E coli 0157:H7
develops 2 weeks after onset of diarrhea
common ages 6months - 4 years
higher socioeconomic class

76
Q

Triad of finding with HUS

A

acute renal failure- dialysis
thrombocytopenia
hemolytic anemia

77
Q

Prevent HUS

A

cook beef
good hand washing
pasturize milk and cider

78
Q

Clostridium difficle in children

A

restrict testing to those older than 1 year with two days of diarrhea with GI symptoms
don’t tx with vanco

79
Q

Protozoa cause of diarrhea

A

Giardia

Cryptosporidium

80
Q

Giardia

A

watery diarrhea no blood
flatulence
distention
suspect if > 7 days diarrhea

81
Q

Cryptosporidium

A 
diarrhea
vomiting
fatigue
summer and fall
recreational water/daycare
82
Q

Recreational Water Illnesses

A 
Cryptosporidium
Giardia
Sheigella
E coli 0157:H7
Norovirus
83
Q

Abx induced diarrhea

A

occurs with 20-40% of abx use

Co administer with probiotic lactobaccilus to decrease

84
Q

Probiotics in children

A

recommend not to use

85
Q

Tx Shigella

A

TMP-sulf/Azithrom

86
Q

Tx Campylobacter

A

Erythromycin/Azithro

87
Q

Tx Yersinea

A

TMP-sulfa/Tetracycline

88
Q

Tx Giardia

A

Nitazoxanide/Metronidazole

89
Q

Tx Cryptosporidium

A

Nitazoxanide

90
Q

C. Diff

A

d/c abx
metronidazole
avoid vanco

91
Q

Oral replacement therapy principles

A

use for rehydration over 3-4 hours
follow rehydration with normal diet
nurse the breastfed infant

92
Q

2 phases of ORT

A

Rehydration- fluids given to replace those lost

Mainenance- ongoing replacement

93
Q

what is most indicative of hydration

A

weight

94
Q

mild dehydration by weight

A

<3%

95
Q

moderate dehydration by weight

A

3-9%

96
Q

severe dehydration by weight

A

> 9% need iv rehydration

97
Q

ORT for mild dehydration

A

50ml/kg over 4 hours

98
Q

Hospitalization for gastroenteritis

A

age less than 6 weeks
lethargy
when follow-up can’t be guaranteed
need close observation

99
Q

Exclusion for ORT

A

less than 1 month
shock
unconscious
illeus

100
Q

Recommended foods in children

A 
complex carbs (rice,wheat, potatoes, bread)
avoid fatty
avoid juices and soft drinks
101
Q

Oral zofran and rehydration

A

ODT 8-15kg = 2mg
if they vomit within 15 minutes give another dose
wait 15 minutes and then start oral rehydration

102
Q

Differential dx RUQ pain adults

A 
Biliary: cholecystitis, choleylithiasis
Colonic: cholitis, diverticulitis
Hepatic: hepatic absess
Pulmonary: pneumo, embolus
Renal: pyelo, nephrothyasis
103
Q

Differential dx epigastric pain adults

A

Biliary
Cardiac: MI, pericarditis
Gastric: esophagitis, gastritis, peptic ulcer
Pancreatic: mass, pancreatitis
Vascular: aortic disection, mesontaric ichemia

104
Q

Differential dx LUQ pain adults

A 
cardiac: angina
gastric
pancreatic
renal
vascular
105
Q

Differential dx periumbilical abd pain

A

colonic: early appendicitis
gastric: peptic ulcer, esophagitis
vascular

106
Q

Differential dx RLQ pain adults

A

Colonic: appy, IBS, diverticulitis
Gynecologic: ectopic, fibroids, PID, ovarian mass, torsion
Renal: pyelo

107
Q

Differential dx Suprapubic pain adults

A

Colonic
gyn
renal

108
Q

Differential dx LLQ pain adults

A

cholitis
gyn
renal: pyelo, nephro

109
Q

Sudden and severe pain in adults

A

rupture
performation
ectopic

110
Q

Rapid progression of abd pain in adults

A

appy

pancreatitis

111
Q

Gradual progression of abd pain in adults

A

neoplasm

112
Q

Burning pain

A

GERD

113
Q

Pressure pain

A

cardiac

114
Q

gnawing pain

A

peptic ulcer

115
Q

Abdominal pain red flags

A 
projectile vomiting
no po intake
GI blood loss
syncope
pregnancy
recent surgery
fever
foreign body
116
Q

Test of choice for adult abdominal pain

A

Supine and upright abdominal plain films

117
Q

Imaging for RUQ

A

ultrasonography

118
Q

Imaging for LUQ

A

CT

119
Q

Imaging for RLQ

A

CT with iv contrast

120
Q

imaging for LLQ

A

CT with iv and oral contrast

121
Q

Imaging for suprapubic

A

Ultrasoonography

122
Q

Functional non-ulcerative dyspepsia

A

postprandial fullness
early satiation
epigastric pain
burning in the absence of structural disease

123
Q

Causes of dyspepsia

A

PUD

GERD

124
Q

Indication for endoscopy for dyspepsia

A

unintended weight loss
persistent vomiting
GI bleed
family history of cancer

125
Q

H2 blockers and PPIs in dyspepsia

A

can reduce symptoms

126
Q

4 causes of peptic ulcers

A

H. pylori
NSAIDS
acid hypersecretory
idiopathic ulcers

127
Q

Initial management of dyspepsia

A

a trial acid suppressants
test and treat for H. Pylori
early endoscopy

128
Q

Tx H.Pylori

A

tx for 14 days
PPI + clarithromycin+ amox
or
PPI + Bismuth + metronidazole + tetracycline

129
Q

Hepatopancreatobiliary complications

A

biliary colic
cholecystitis
acute pancreatitis

130
Q

Biliary colic (choelithiasis

A

gallstones occlude cystic duct
epigastric RUQ visceral pain
pain builds over 15 to 60 mintues and slowly dissipates

131
Q

Test of choice with cholecystitis

A

ultrasonography
usually see stone
get surgical consult

132
Q

Causes of pancreatitis

A

gallstones

alcohol

133
Q

S/S pancreatitis

A

focal epigastric tenderness
guarding
possible pos gray turner, cullen and fox sign but very rare

134
Q

Gray Turner’s sign

A

flank ecchymosis with pancreatitis

135
Q

Cullen’s sign

A

periumbilical ecchymosis with pancreatitis

136
Q

Fox’s sign

A

unguinal ecchymosis with pancreatitis

137
Q

Lab/Imaging for pancreatitis

A

amylase
lipase
3x normal indicate
CT scan to confirm

138
Q

Tx for pancreatitis

A

IV volume resuscitation

139
Q

Diverticulitis incidence

A

1/3 of those over 50

2/3 of those over 80

140
Q

Diverticulitis described

A

diverticulum in the lining of the colon bulges through a weak spot and becomes inflammed

141
Q

Test of choice for diverticulitis diagnosis

A

CT with oral contrast

thick with arrowhead sign

142
Q

Tx diverticulitis

A

liquids and antibiotics
metronidazole + quinelone
Amoc-clur x7-10 days

143
Q

Causes of bowel obstruction

A

peritoneal bands post surgical

hernias

144
Q

S/S bowel obstruction

A

colicky diffuse pain that waxes and wanes over 5 min intervals
N/V
fecal emesis

145
Q

Bowel obstruction Tx

A

NPO
NG tube
IV fluids
Surgical

146
Q

What could be dx in older adult with abd pain

A

UTI
perforated viscus
ischemic bowel disease

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