GI/Abdomen Flashcards
Organs in the RUQ
ascending and transverse colon duodenum gallbladder liver pylorus right adrenal gland right kidney right ureter
Organs in the RLQ
appendix ascending colon and cecum right kidney right ovary and tube right ureter right spermatic cord
Organs in the LUQ
right adrenal gland left kidney left ureter pancreas spleen stomach transverse descending colon
Organs in the LLQ
left kidney left ovary and tube left ureter left spermatic cord descending and sigmoid colon
At what age (on average) have most people lost 50% of their taste buds?
60
diseases associated with abnormal vasculature on inspection of abdomen
malnutrition liver disease portal hypertension venous fluids building up pregnancy
outie
protuberant
innie
recessed
blue striae
Cushing’s or steroid use
how long should you listen for 1 bowel sound
5-15 seconds, then for 5 minutes to say there are no bowel sounds
Tests for ascites
shifting dullness/ fluid wave test- use percussion to find tympany when pt lies on their side… fluid will go to the dependent area
Test for cholecystitis
Murphy’s sign- pt breathes in with pressure on the right side, breath catches with pain and wincing
Rebound tenderness
test for appendicitis-pain upon release of deep pressure
Roving’s sign
also called referred rebound tenderness- LLQ is palpated deeply and pain is felt in the RLQ upon release
Psoas sign
extension of the R leg with light pressure causes pain
Obturator sign
pain on internal rotation of the right thigh
visceral pain
poorly defined and localized, intermittent
parietal pain
severe and steady; generally localized and almost always some form of peritonitis
referred pain
pain felt somewhere where there’s no pathology
F’s of abdominal distention
Fecal fat feces fibroids flatus (gas in or around intestines) fluid fatal tumor
diastasis recti
bowel protruding through a tear in the rectus abdominus muscles
incisional hernea
bowel protruding through a tear in the incision
umbilical hernia
bowel protruding through a ring around the umbilicus
enlarged liver
anything over 12 cm
enlarged nodular liver
cancer, cirrhosis, syphilis
liver higher than normal
a mass or ascites
enlarged spleen
greater than 7 cm
enlarged kidney
cysts, tumor, inflammation
dysphagia
difficulty swallowing; could be anything from a dry mouth to disease
achalasia
difficulty with speech
esophageal diverticulum and the problem with it
“out-pouching”; hernia
problem is that the esophagus is not expandable or flexible so outpouching causes breaks and bleeding– it is an emergency
GERD
the persistent reflux of gastric contents into the espophagus; lower esophageal sphincter is weak/ incompetent
reflux disorder
a temporary situation of acid coming into esophagus and going away
treatments for acid reflux and GERD
antacids, PPIs, H2-receptor antagonists
Barrett esophagus
damage to the lower esophagus; can lead to adenocarcinoma
acute gastritis
abdominal pain and diarrhea;
most often caused by h. pylori and NSAIDS
chronic gastritis
insidious, slow onset, chronic;
most common reason is autoimmune disease;
can get chronic from not treating acute
Peptic ulcer disease
erosion of the stomach ining
Zollinger-Ellison syndrome
tumors in the pancrease and somethinges upper edge of duodenum; tumors increase the acid in the stomach which creates multiple gastric ulcers
hallmark sign of a stress ulcer besides abdominal pain
pain before or after eating and blood mixing with food (coffee-ground emesis), and melena (dark, sticky, black stool)
Who gets stress ulcers?
people who are stressed and burn patients (bc their body is constantly in fight or flight)
survival rate of stomach cancer
25%
IBS
recurring abdominal pain, diarrhea, flatulence; often from gluten intolerance or lactose intolerance
hallmark sign of IBS
abdominal pain that is relieved with bowel movements; pts are more well than sick
Crohn’s disease
inflammation that can occur anywhere and everywhere in the GI tract, from lips to anus; some classify as autoimmune, others don’t;causes permament changes in the lining of the gut and development of “skip lesions”: ulcer, strip of well tissue, ulcer, well, etc…
ulcerative colitis
inflammation in the rectum and colon; similar to symptoms of Crohn’s but without the skip lesions; high rate of cancer development
infections entercolitis
viral: rotovirus
bacterial: c.diff, e.coli
diverticular diseases
outpouching in the intestines
diverticulosis
the state of having outpouching in the diverticula, but it doesn’t bother you; well-developed countries have it the most
diverticulitis
when one of the outpouches becomes an abscess and is spilling into the peritoneum; acute lower-quadrant pain and fever
entercolitis
water is pulled into the bowel and it causes osmotic diarrhea and vomiting
diarrhea causes loss of which electrolyte
salt (Na+)
noninflammatory diarrhea
large volume; rarely have blood; from e.coli, staph, etc, and the toxins from these bugs cause the diarrhea
inflammatory diarrhea
small volume, fever, and blood in stools; caused by shigella, salmonella, etc.. actual organism is invading the tissues (not just toxins from the organism)
secretory diarrhea
if the bile doesn’t get absorbed, it causes loss of electrolytes; pt could stop eating and they’ll still have diarrhea no matter what
-cholera
osmotic diarrhea
explosive
constipation
decreased water in stool or a neuro issue
slow-transit constipation
infrequent bowel movements bc of innervation of the gut;
hershbrung’s disease- child with big belly- congenital absence of ganglion in the gut, so they can’t sense expansion in the gut
disorders of defecation
spinal chord injury parkinsons MS hypothyroidism anything obstructive drugs
mechanical obstruction
severe, colicky pain
borborygmus heard before obstruction
audible, high-pitched peristalsis
awareness of intestinal movements
paralytic obstruction
continuous pain (dif from colicky) silent abdomen
compartment syndrome
result of obstruction; causes ischemia and necrosis- part of that organ system gets cut off from the blood supply;
any pressure from inflammation can cause compartment syndrome
peritonitis symptoms and signs
muscles of the abdominal wall tighten to protect inflammed bowel;
board-like abdomen
guarding reflex
peritonitis patho
pain and SNS cause the bowel to freezy in position
diaphragm and accessory breathing muscle movements decrease–> shallow breathing and vomiting
malabsorbtion syndrome
diarrhea and weightloss despite eating a lot of food
statarhea (fat in the stool bc its not being digested
bleeding bc of vitamin K deficiency
celiac disease
tcell immune reaction to gluten
causes intense inflammation of the intestine and loss of villi, which does not allow for absorption
Affected share the MHCII allele
colorectal adenomas: tubular, villous, tubulovillus
tubular- peduncated, not too bad
villous- caulifower-like, very bad
tubulovillus- mix between both
how often should someone over 50 get screened for colon cancer?
every ten years unless they’re at risk
what stage are you in if you’re already bleeding when you come in for colon cancer screeding
2 or 3
occult blood test
Guaiac
frank hematemesis
hemorrhage that is above the stomach;
can see the blood bright red in the emesis
what type of hemorrhage is seen with coffee ground vomitus
its into the stomach with partial digestion; vomit is blood mixed with food
what type of hemorrage is seen with melena
it is into the intestines with large volumes of blood; stools are dark and tarry
hemorrage seen with red blood coating the stools
in the rectum
bright red bleeding in stools
hepatitis A
self-limited
fever, malaise, abdominal pain
Hepatitis B
very bad
oral and sexual contact
highly contagious and often results in cirrhosis and liver failure
Hepatitis B- Associated Delta Virus (hepatitis D)
causes the same symptoms as hepatitis A but worse bc they have 2 viruses
Hepatitis C
bad, “criminal”
very unstable so we can’t get a vaccine
IV drug abuse, needle sticks
usually leads to cirrhosis, cancer, or liver failure
Hepatitis E
fecal-oral transmission
sympt similar to A if you’re not pregnant; if pregnant, it could be fatal
Fatty liver
alcoholic liver disease;
liver cells contain fat deposits; the liver is enlarged
alcoholic hepatitis
rapid onset of liver inflammation and liver failure
rapid onset of jaundice
50% mortality
Cirrhosis
long-term effects of any type of liver problem;
liver border would feel lumpy;
scar tissue block blood flow through liver, the blood back up into the organs before the liver causing portal hypertension
portal hypertension
veins from the stomach, intestines, spleen, pancrease merge into the portal vein
caput medusa
spider veins around the umbilicus
biggest toxin that causes encephalopathy
ammonia
how much function do you have to lose to establish liver failure
80%
treatment of liver failure
transplant
what hormones cause endocrine disorders like fluid retention, hypokalemia, and disordered sexual functions
decreased aldosterone, which helps us get rid of water; if we don’t have it we get water and salt retention
oliguria
less than 500 ml urine in 24hrs or less than 30 an hour
should be 0.5 ml/kg/hr
hepatorenal syndrome
azotemia- increased BUN
increased plasma creatinine
oliguria
hepatic encephalopathy
- asterixis- when asked to hyperextend wrist and you push on it, hand at wrist will flap
- confusion, coma, convulsions
cholelithiasis
gallstones
choledocholithiasis
stones in the common bile duct
cholangitis
inflammation of the common bie duct
surgical emergency
ERCP- endoscopic procedure with an XRay
autodigestion of the pancreas
- activated enzymes begin to digest the pancreas cells- start eating itself
- starts with trypsin
- severe pain in the LUQ that radiates to the back and down the flanks
- can see cullen’s sign
- pancreatic enzymes increased x3
- hypocalcemia
- distention
- flank swelling
cullen’s sign
superficial edema and bruising around umbilicus
chronic pancreatitis and pancreatic cancer
- digestive problems bc of inability to deliver enzymes to the duodenum
- glucose control probs
- signs of biliary obstruction
- 4% 5-year survival rate
