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Medical Emergencies > GI/GU emergencies > Flashcards

GI/GU emergencies Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the Cullen sign?

A

bruising in the periunbilical space

periumbilical ecchymosis

  • pancreatitis can cause pleural effusion (fluid in pleural space)
  • bleeding in the peritoneal.
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2
Q

with GI complaints, what is the first thing we need to consider?

A
  • life threats first.
  • MI (good to get 12-lead for all GI complaints)
  • Abdominal Aneurysm (bilateral pedal pulses)
  • Diabetic Ketoacidosis (check sugar)
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3
Q

what are the three sections of the GI system?

A

(superior to superior)
Duodenum
Jejunum
Ileum

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4
Q

what is visceral pain?

A

vague, not localized

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5
Q

Somatic/Parietal Pain

A

Localized

Pancreas (leading localized pain)

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6
Q

Referred Pain

A

where the pain is referred to

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7
Q

Mallory-weiss syndrome

A

tear on the gastric side of the Gastroesophageal junction which may extend to the distal esophagus

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8
Q

Boerhaaves syndrome

A

transmural

hammers sign crunching sound upon auscultation of the heart due to pneumomediastinum

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9
Q

Esophagus spasm

A

present exactly like angina and is relieved by nitro

If pain gets worse when pt swallows its a spasm

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10
Q

what is the treatment for esophagus spasms?

A

glucagon (0.5-1 units IM)

Nitro

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11
Q

esophageal Varices

A

Portal hypertension from chronic alcoholism and liver dysfunction.

Pretty mucha carices vein.

you get varicose veins in your legs, esophagus, anus (hemorrhoids)

Hepatitis can cause this

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12
Q

what dont we give to varices?

A

No supraglottic airways- big contraindication

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13
Q

Gastritis

A

irritation of the gastric lining.

Norovirus most common cause.

helicobacteria pylori (H pylori) - comes from fecal contamination

ASA

NSAIDS

  • can be chronic or acute.
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14
Q

when do we see more ulcers most?

A

in the morning, after pt has been laying down.

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15
Q

what can cause diverticulosis?

A

red meat
painless hematochezia
60% by age of 60
holes in the weak spot of the colon, they fill with feces

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16
Q

diverticulitis

A

inflammation of the diverticuli

can get a bowl obstruction.

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17
Q

what are adhesions?

A

bands of fibrous tissue that forms between tissues and organs

Things stick together

obstructers can occur.

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18
Q

Volvulus

A

twisting of the bowl

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19
Q

Cholecystitis

A 
Fair
Fat
Female
Fertile
Forty

blocking the bile duct. bile helps with digestion.

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20
Q

what is visceral pain?

A

organ pain (non specific pain)

  • from the inflammation or the stretching of the organs in the abdominal cavity
  • tends to come and go.
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21
Q

what is Somatic Pain?

A

pain that is produced from a bacterial or chemical irritation of the nerve fibers in the peritoneum (peritonitis).

usually a constant or a localized pain.

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22
Q

what is our main concern with Solid Organs and when they are injured?

A

Bleeding

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23
Q

How does the liver gets its main O2 supply?

A

veins, it can bleed profusely

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24
Q

What does the pancreas produce?

A

Bile (Enzymes that help with break down of food)

Insulin- to help the glucose get into the cells

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25
Q

What is the difference between exocrine and endocrine?

A

exocrine - secrete substances into ducts to then get released

endocrine- secrete substances directly into the blood stream.

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26
Q

how does the pancreas use both endocrine and exocrine functions?

A

the exocrine function is it releases enzymes and bile into ducts or digestion

endocrine- releases insulin into blood stream for glucose use.

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27
Q

what is the number one cause of pancreatitis?

A

chronic alcoholism

production of gallstones

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28
Q

what is the name for enlarged spleen?

A

splenomegaly

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29
Q

what are some ways that you can get splenomegaly?

A

Epstein Barr Virus (herpes virus that is spread though saliva, like cough or sneezing or sharing a drink)

Mono (mononucleosis) - this can come from Epstein Barr Virus. (the kissing disease)

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30
Q

How does splenomegaly work?

A

it most often is from leukocytes clogging the spleen.

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31
Q

what is our biggest concern with hallow organs if they were to be damaged?

A

what is in them, if they were to rupture.

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32
Q

Inflammation of the gall bladder is called?

A

cholecystitis

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33
Q

what is the Alimentary canal?

A

it is the entire route that food takes from mouth to anus.

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34
Q

if there is a blockage in the alimentary canal, what can it cause?

A

a back up, and there can be fecal emesis.

this does not cause abdominal distention

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35
Q

what causes the abdominal to become rigid?

A

it is the GI fluids and flora leaking into the peritoneal space.

Also a collection of blood pooling

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36
Q

What is a good thing to gather with a person that is having an ABD complaint?

A

what are your Ins and outs like…

Normal? - this can lead you to think an organ issue, not alimentary canal issue.

If abnormal then you can think that it can involve the alimentary canal.

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37
Q

what is referred pain?

A

referred pain is because the brain is interpreting a discomfort on an afferent nerve (nerve that sends signals back to the brain), the nerve however is not involved in the effected area.

the brain can not specifically tell the difference.

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38
Q

what is the kehrs sign?

A

shoulder pain can be referred pain from upper abdomen.

If L. Shoulder- spleen
If R. Shoulder- Liver

39
Q

Will there be pain in the referred location if it was palpated?

A

no, this can be a sign that it is coming from somewhere else.

40
Q

what can an esophagus obstruction or spasm present like?

A

MI - get a good assessment and history

41
Q

what drug can we give to relax the esophagus in the event of obstruction?

A

Glucagon (but can’t give if it is an MI, so good assessment)

42
Q

what is involved with Boerhaave Syndrome?

A

Extremely life threatening.

Full tear of the esophagus

Stomach contents are being dumped into the pleural space

43
Q

what is mallory-weiss syndrome?

A

forcefully vomiting tear, but it is not a complete tear, and is usually involved closer to the stomach.

44
Q

what is a small test that can maybe lead you to an esophageal spasm vs angina?

A

swallowing, if the pain increases with a spasm it can be a spasm.

45
Q

what are varices?

A

they are pretty much a varicose vein. these can rupture and bleed (usually painless)

46
Q

what is contraindicated if you have a varices pt who is bleeding and having trouble breathing?

A

a supraglottic airway

47
Q

what is esophageal atresia?

A

seen primarily in children, its when the esophagus is not fully attached. it can be attached to the trachea.

SS: drooling, difficulty feeding, coughing, choking.

48
Q

what is gastritis?

A

inflammation of the gastric mucosa.

49
Q

what can H Pylori-Bacteria cause?

A

ulcer (#1 cause)

Its a bacteria in the stomach that can cause a lot of issues.

50
Q

what are some medications that can cause gastritis?

A

ASA, NSAIDS, narcotic pain medications, acetaminophen

51
Q

what are some other major causes of gastritis?

A

Chronic Alcoholism

Excesive Caffeine

52
Q

will gastritis have distention?

A

No, if there is distention then you should think that there is a leak going into the peritoneal space or supporting organ is leaking.

53
Q

can stress cause an ulcer?

A

no

54
Q

why is it more painful when you eat and you have an ulcer?

A

the open wound in the stomach is sensitive to your stomach acids, when you eat then you are secreting and stimulating the stomach acids.

55
Q

what is IBS?

A

a sudden and overwhelming need to defecate.

Common in middle aged women.

56
Q

what is diverticulosis?

A

little pockets or pouches in the wall of your large intestine. (thinning walls of the intestine cause this.)

57
Q

what is diverticulitis?

A

when those pouches get filled with fecal matter and become infected.

this can be a life threat (infection)

seeds can also get stuck.

58
Q

what is hematochezia?

A

bright red blood in stool

59
Q

what is Melena?

A

dark bloody poop

60
Q

There are 4 types of bowel obstruction…

A

Adhesions- tissue grows around the bowel (pinching it off)

volvulus- twisting of the bowel (previous surgeries can cause this twist.)

intussusception- the intestine folds back inside of itself (causes it to create a pocket)

Hernia- the protrusion of the intestine through an abdominal opening in the muscle.

61
Q

what are some concerns with ischemia of the intestinal track?

A

1) sepsis
2) it can rupture and spill out the toxins
3) the flora (what helps move and break down the food) gets damaged from the ischemia.

62
Q

what is ulcerative Colitis?

A

A chronic, inflammatory bowel disease that causes inflammation in the digestive tract (the colon)

major abdominal pain, diarrhea, constipation, bloody stool.

Lead to electrolyte imbalance (so get a 12-lead to look for any of the changes)

63
Q

What is Crohns Disease

A

listed as an auto immune disorder

chronic inflammation, younger (under 30s), immune system attacks GI tract.

64
Q

What is a hemorrhoid?

A

blood filled pouch either internal or external sphincter.

Presents with bright red blood per rectum

65
Q

What is hepatitis?

A

inflammation of the liver

66
Q

what is Hep A

A

presents like the flu.

transmitted through ingestion of contaminated food and water or through direct contact with an infectious person

67
Q

what is Hep B?

A

you get an immunization for Hep B.

spread when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected

68
Q

what is Hep C?

A

Passed by blood, fecal; patients get treated with interferon or get a new liver.

most people become infected with the hepatitis C virus by sharing needles or other equipment used to prepare and inject drugs.

69
Q

what will chronic alcoholism give you in regards to your liver?

A

Cirrhosis

70
Q

what is cirrhosis?

A

Scaring of your liver…

caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time your liver is injured — whether by disease, excessive alcohol consumption or another cause — it tries to repair itself.

71
Q

what are some signs that a person could be in liver failure?

A

they will have a yellowing skin (jaundice)

72
Q

what causes acute pancreatitis?

A

Gallstones, it blocks the pancreatic ducts.

Alcoholism can do this.

The pancreas is then damaged by its own enzymes.

73
Q

what can cause chronic pancreatitis?

A

alcoholism

74
Q

what is menarche?

A

first ovulation

75
Q

what is menopause?

A

woman runs out of eggs, so they stop ovulated. around 50-60 yo

76
Q

how often is menstruation?

A

about every 28 days.

77
Q

what is the first thing we must assume with any woman with abd pain, until we are proven otherwise?

A

pregnant

78
Q

what is abortion?

A

termination of a pregnancy

79
Q

what is the only solid answer for a woman not being pregnant?

A

abstinence

80
Q

what is pelvic inflammatory disease (PID)?

A

usually caused by bacteria that effect the inflammation of the mucosal layer that surrounds the uterus and other female reproductive organs.

Can cause infertility if they continue to get the infection.

81
Q

what can be causes of PID?

A

Sex (and the transfer of sexually transmitted diseases.)

82
Q

S/S of PID?

A

Vaginal Odor

horrible abdominal pain, and often pain with intercourse

They have the PID shuffle (shuffle the feet to avoid motion in the pelvic region.

WILL NOT have dysuria (they will not have painful urination.)

83
Q

what is the worry of a ovarian cyst?

A

if they were to rupture. They can have severe internal hemorrhage.

84
Q

SS of ovarian cyst?

A

unilateral pinpoint pain

painful during menstruation

85
Q

what is cystitis?

A

bacterial infection of the inner lining of the bladder, associated with UTI>

86
Q

what is the difference with endometritis and PID?

A

Endometritis is the inflammation of the endometrium (uterus) and is often occurs in relation to pregnancy (after child birth there is retained placenta, or abortion related.)

PID is inflammation of the uterine lining, but not pregnancy related, bacterial related.

87
Q

what is endometriosis?

A

tissue growth outside the uterus. can be very painful.

Usually no fever.

88
Q

what is an ectopic pregnancy?

A

ectopic meaning out of place. (outside the uterus in this case)

when an egg is fertilized where ever there is vascular tissue. This results in destroying the surrounding tissue.

This usually will happen in the Fallopian tubes.

89
Q

Is an ectopic pregnancy considered an emergency?

A

YES,

will have horrible abd pain, can have vaginal bleeding, and then if pain goes away it could have ruptured.

90
Q

what are some concerns of vaginal bleeding that are not menstruation related?

A

spontaneous abortion (prior to 20 weeks)

disorders of the placenta

hormonal imbalances (menopause)

lesions

PID

onset of labor

morning after pill

91
Q

what is the sphincter called that separates the esophagus and the stomach?

A

cardiac sphincter

92
Q

where does food go after the stomach? what is that section called and what is the sphincter called?

A

pyloric sphincter and into the duodenum

93
Q

what separates the duodenum and the jejunum?

A

ligament of Treitz

Medical Emergencies (12 decks)

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