GI Assessment

Question 1

Red flag symptoms of GI complaint

Answer 1

syncope, light-headedness, melena, hematochezia, dysphagia, odynophagia, unexplained weight loss

Question 2

Diagnostic data tx for GI complaint

Answer 2

FOB, H. pylori assessment, CBC, PPI; address lifestyle issues, treat for H. pylori, consider EGD

Question 3

When to refer to EGD

Answer 3

anemia, FOB, any red flag sxs or findings

Question 4

PE biliary disease

Answer 4

RUQ colicky pain, associated with nausea radiating to lower ribs and back, positive murphy’s sign

Question 5

Test of choice for biliary disease

Answer 5

transabdominal US

Question 6

PE acute cholecystitis/choledocolithiasis

Answer 6

fever, N/V, RUQ pain, may or not be colicky or associated with infection

Question 7

HIDA scan steps

Answer 7

1. radionucleotide injected that collects in the liver and moves to gall bladder
2. administer CCK to activate GB to eject bile
3. CCK will reproduce sxs
4. Sequential imaging to track isotope movement
5. failure to visualize GB is positive for obstruction

Question 8

Scleral icterus

Answer 8

yellowing of sclera due to bilirubin binding to elastin

Question 9

PE pancreatitis

Answer 9

severe epigastric or periumbilical, N/V, fever, tachycardia, hypotension, epigastric rigid abdomen, ileus

Question 10

Lab data for pancreatitis

Answer 10

elevated serum amylase and lipase, leukocytosis, proteinuria with granular casts, glycosuria, hyperglycemia, elevated serum bilirubin and BUN

Question 11

Acute pancreatitis treatment

Answer 11

NPO, pain management, hydration/fluid resuscitation, ID underlying cause

Question 12

Esophagus chapman point

Answer 12

between rib 2 & 3 parasternally

Question 13

Stomach chapman point

Answer 13

Left between rib 5-6 and 6-7 at costochondral junction

Question 14

Pancreas chapman point

Answer 14

Right between ribs 6-7 at costochondral junction

Question 15

Liver chapman point

Answer 15

right between 5-6 and 6-7 at costochondral junction

Question 16

Small intestines chapman point

Answer 16

ribs 8-11 b/l at costochondral junction

Question 17

Gallbladder chapman point

Answer 17

R rib 6-7 at costochondral junction

Question 18

Constipation definition

Answer 18

less than 3 BM/week OR excessive straining OR hard or dry stools OR sense of incomplete evacuation

Question 19

Dyspepsia

Answer 19

pain or discomfort center in upper abdomen associated with fullness, early satiety, bloating or nausea

Question 20

Behavioral model change for gastritis

Answer 20

stop intake of causative agent

Question 21

Metabolic/energetic model change for gastritis

Answer 21

urea breath test and triple therapy for H. pylori, acid suppression

Question 22

Respiratory/circulatory model change for gastritis

Answer 22

FOB, eval and treat lymphatic changes

Question 23

Neurologic model change for gastritis

Answer 23

treat chapman points, eval and treat viscerosomatic findings

Question 24

Biomechanical model change for gastritis

Answer 24

eval and tx somatic dysfunction

Question 25

Behavioral model change for GERD

Answer 25

lifestyle modification--elevating head of bed, avoiding cigarettes, alcohol, coffee, peppermint, chocolate, high carbs, large meals

Question 26

Metabolic/energetic model change for GERD

Answer 26

suppression of gastric acid production, promotility therapy

Question 27

Respiratory/circulatory model change for GERD

Answer 27

assess for reflux complications such as asthma, hoarseness, and dental erosions

Question 28

Biomechanical model change for GERD

Answer 28

MSK findings and chapman point tx

Question 29

Neurologic model for GERD

Answer 29

address PSI and SI to esophagus and stomach, address chapman points

Question 30

Preferred imaging for diverticulitis

Answer 30

CT with oral and IV contrast

Question 31

Bowel sounds associated with obstruction

Answer 31

high pitched

Question 32

Bowel sounds associated with ileus

Answer 32

decreased/absent

Question 33

Percussion of abdomen

Answer 33

tympany over air-filled viscera, dullness over solid organs and fluid or feces

Question 34

Expected liver span

Answer 34

6-12 cm at mid-clavicular line on R

Question 35

Expected spleen span

Answer 35

ribs 6-10 at mid-axillary line on L

Question 36

Rebound tenderness indicates...

Answer 36

peritoneal inflammation

Question 37

Percussion sounds of ascites

Answer 37

shifting dullness

Question 38

Quality of visceral pain

Answer 38

gnawing, burning, aching, cramping