GI FNP TO USE COHEN, LEIK , Brittani

Question 1

Patient who is a young adult complains of acute onset of periumbilical pain that is steadily getting worse. Over a period of 12 to 24 hours, the pain starts to localize at McBurney’s point. The patient has no appetite (anorexia). Classic exam findings include low-grade fever and right lower quadrant (RLQ) pain (McBurney’s point) with rebound and guarding. The psoas and obturator signs are positive. When the appendix ruptures, clinical signs of acute abdomen occur, such as involuntary guarding, rebound, and a boardlike abdomen.

Answer 1

Acute appendicitis

Question 2

Overweight female patient complains of severe right upper quadrant (RUQ) or epigastric pain that occurs within 1 hour (or more) after eating a fatty meal. Pain may radiate to the right shoulder. Accompanied by nausea/vomiting and anorexia. If left untreated, may develop gangrene of the gallbladder (20%). May require hospitalization.

Answer 2

acute. cholecysitis

Question 3

Elderly patient with acute onset of high fever, anorexia, nausea/vomiting, and left lower quadrant (LLQ) abdominal pain.

Answer 3

Acute Diverticulitis

Question 4

what are the risk factors for acute diverticulitis

Answer 4

increased age, constipation, low dietary fiber, obesity, lack of exercise and frequent NSAID use

Question 5

acute diverticulitis will show CBC with

Answer 5

leukocytosis with neutrophila and a shift to the left

Question 6

Adult patient complains of acute onset of fever, nausea, and vomiting that is associated with rapid onset of abdominal pain that radiates to the midback (“boring”) located in the epigastric region.

Answer 6

acute pancreatitis

Question 7

Severe watery diarrhea from 10 to 15 stools a day that is accompanied by lower abdominal pain with cramping and fever. Symptoms usually appear within 5 to 10 days after initiation of antibiotics.

Answer 7

C- diff

Question 8

what causes C-diff

Answer 8

Antibiotics, such as clindamycin (Cleocin), fluoroquinolones, cephalosporins, and penicillins, have been implicated as the most likely cause of C. difficile infection. Most cases occur in patients in hospitals as well as those residing in nursing facilities.

Question 9

THe USPTF recommends screening for Colon cancer between teh ages of

Answer 9

50 - 75

Question 10

BD that may affect any part(s) of the GI tract, from mouth (canker sores), small or large intestine, rectum, and anus. If ileum is involved, there is watery diarrhea without blood or mucus. If colon is involved, there is bloody diarrhea with mucus. During relapses, fever, anorexia, weight loss, dehydration, and fatigue with periumbilical to RLQ abdominal pain occur. Fistula formation and anal disease occur only with CD (not UC). May palpate tender abdominal mass. Remissions and relapses are common. Higher risk of toxic megacolon and colon cancer. Risk of development of lymphoma is also increased, especially for patients treated with azathioprine. More common in Ashkenazi Jews.

Answer 10

Chrons

Question 11

IBD that affects the colon/rectum. Bloody diarrhea with mucus (hematochezia) more common with UC than with CD. Severe “squeezing” cramping pain located on the left side of the abdomen with bloating and gas that is exacerbated by food. Relapses characterized by fever, anorexia, weight loss, and fatigue. Accompanied by arthralgias and arthritis (15%–40%) that affect large joints, sacrum, and ankylosing spondylitis. May have iron-deficiency anemia or anemia of chronic disease. Disease has remissions and relapses. Increased risk of colon cancer. Risk of toxic megacolon.

Answer 11

Ulcerative coliits

Question 12

A gastrinoma located on the pancreas or the stomach; secretes gastrin, which stimulates high levels of acid production in the stomach. The end result is the development of multiple and severe ulcers in the stomach and duodenum. Complaints of epigastric to midabdominal pain. Stools may be a tarry color. Screening by serum fasting gastrin level. Refer to gastroenterologist.

Answer 12

Zollinger - Ellison Syndrome

Question 13

Obturator sign (supine position)

Answer 13

Postive if inward rotation of the hip causes RLQ abdominal pain. positive sign if pain iwth movemnt of flextion of hte hip

Question 14

Rovsigns sign (supine position)

Answer 14

deep palpation of the LLQ ofh te abdomen results in referred pain the RLQ

Question 15

Mcburneys point

Answer 15

area located between the superior iliac crest and umbilicus in teh RLQ, tenderness or pain is a sign of possible acute appendicitis

Question 16

Markle test (heel jar)

Answer 16

patient reaises heels and then drops them suddenly, alternative is to ask patient to jump in place. Postive if pain is illicited or patient refuses to perform becasue of pain

Question 17

Press deeply on the RUQ under the costal border during inspiration (Figure 3). Midinspiratory arrest is a positive finding Positive with cholecystitis or gallbladder disease.

Answer 17

Murphys

Question 18

An abdominal maneuver that is used to determine if abdominal pain is from inside the abdomen or if it is located on the abdominal wall. Patient is supine with arms crossed over their chest. Instruct patient to lift up shoulders from the table so that the abdominal muscles (rectus abdominus) tighten. If source of pain is the abdominal wall, it will increase the pain; if the source is inside the abdomen, the pain will improve.

Answer 18

carnetts test