GI DPR Flashcards
What is the SOAP note format used for taking a history?
S: Subjective
O: Objective
A: Assessment/Differential Diagnosis
P: Plan
What components are included in the History of Present Illness (HPI)?
- Onset
- Palliation/Provocation/Progression
- Quality/Quality of life
- Radiation/Region
- Severity/Setting or Situation
- Timing
- Associated symptoms
What are the possible causes of right upper quadrant abdominal pain?
- Cholecystitis
- Biliary colic
- Congestive hepatomegaly
- Hepatitis
- Hepatic abscess
- Perforated duodenal ulcer
- Retrocecal appendicitis (rarely)
What does a sudden onset of abdominal pain suggest?
Possible perforated ulcer, renal stone, ruptured ectopic pregnancy, torsion of ovary or testis, ruptured aneurysms
What is the significance of Murphy’s sign during an abdominal exam?
A sharp increase in tenderness with a sudden stop of inspiratory effort suggests acute cholecystitis
True or False: Acute pancreatitis can cause diffuse abdominal pain.
True
What is McBurney’s point and its relevance?
Located 1/3 from the ASIS and 2/3 from the umbilicus in the right lower quadrant; pain here suggests acute appendicitis
What are the characteristics of renal colic pain?
Waves of waxing and waning flank pain that may radiate
Fill in the blank: The assessment for the presence of ascites includes testing for _______.
[Shifting Dullness]
What does rebound tenderness suggest?
Suggestive of peritonitis; elicited by pressing deeply and quickly releasing the pressure
What associated symptoms precede pain in gastroenteritis?
Vomiting precedes pain and is followed by diarrhea
What is the role of the Costovertebral Angle (CVA) in abdominal exams?
Defines the region to assess for kidney tenderness
What factors increase the risk of abdominal aortic aneurysm (AAA)?
- Older age
- Male sex
- Cigarette smoking
- 1st degree relative with AAA
What is the recommended screening for AAA in men aged 65 to 75 years who have ever smoked?
1 time screen with abdominal duplex ultrasound
What does referred rebound tenderness indicate?
Suggestive of peritonitis; pain felt in another quadrant upon release of pressure
What is the difference between visceral pain patterns of the foregut, midgut, and hindgut?
- Foregut: stomach, duodenum, liver, pancreas
- Midgut: small bowel, proximal colon, appendix
- Hindgut: distal colon, genitourinary tract
What are the symptoms of acute pyelonephritis?
- Persistent high fever
- Chills
- Flank pain
- Dysuria
- Hematuria
- Nocturia
- Urinary frequency and urgency
What is the significance of the Psoas sign?
Increase in abdominal pain when the thigh is raised against resistance suggests appendicitis
What does the term ‘visceral pain’ refer to?
Pain that arises from internal organs, often described as dull or crampy
What are the main parasympathetic nerves associated with abdominal organs?
Vagus for gallbladder, kidney, pancreas; pelvic splanchnics for left colon.
What are the classic symptoms of acute appendicitis?
RLQ pain, gradual, steady; nausea, vomiting, anorexia, fever.
What key signs should be assessed during the examination for acute appendicitis?
- Rebound tenderness
- Referred rebound tenderness
- Rovsing’s sign
- Psoas sign
- Obturator sign
- Cutaneous hyperesthesia
What is the common cause of acute cholecystitis?
Usually related to gallstone disease.
What are the typical symptoms of acute cholecystitis?
RUQ pain, fever, leukocytosis, nausea, vomiting, anorexia.
What examination sign is positive in acute cholecystitis?
Murphy’s sign.
What are the common symptoms of acute diverticulitis?
RLQ or LLQ pain, fever, chills, mildly distended abdomen.
What is a significant risk of inflammation and necrosis in acute diverticulitis?
Bowel perforation.
What are the characteristics of acute pancreatitis?
Rapid onset, severe mid epigastric or upper abdominal pain; commonly associated with alcoholism or gallstones.
What examination findings may suggest acute pancreatitis?
- Voluntary guarding
- Epigastric tenderness
- Diminished bowel sounds
What are the signs of acute salpingitis?
- Rebound tenderness
- Rigidity
- Pain on motion of the cervix or uterus
What is mesenteric ischemia characterized by?
Abrupt onset of pain out of proportion to examination.
What is peritonitis?
Inflammation of the peritoneal cavity, often due to perforation of the GI tract.
What are the examination findings associated with peritonitis?
- Muscular rigidity
- Rebound tenderness
- Voluntary guarding
What key symptom did the 82-year-old male patient report?
Non-radiating crampy abdominal pain occurring intermittently.
What dietary factors provoked the patient’s abdominal pain?
Eating large steak or pork chops.
What significant weight change did the patient report?
Unintended weight loss of 10 lbs in the past 2 months.
What chronic conditions were included in the patient’s medical history?
- Diabetes Mellitus (DM)
- Hypertension (HTN)
- Coronary Artery Disease (CAD)
- Peripheral Vascular Disease (PVD)
- Hyperlipidemia
What are the possible differential diagnoses for the patient’s symptoms?
- Chronic appendicitis
- Chronic cholecystitis
- Chronic diverticulitis
- Chronic mesenteric ischemia
- Chronic pancreatitis
What diagnostic imaging was planned for the patient?
CT angiography.
What lifestyle modifications were suggested for the patient?
Dietary and lifestyle modifications.
What is the recommended follow-up plan for the patient?
Follow-up in 2 weeks; advised to go to ED if symptoms worsen.
True or False: Pain from peritonitis is less severe than visceral pain.
False.
Fill in the blank: The patient’s abdominal pain resolves within _______.
2 hours.
