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(OMS2) PCM III Midterm > HYHO Concepts in GI Assessment > Flashcards

HYHO Concepts in GI Assessment Flashcards

1
Q

What is dyspepsia?

A

pain or discomfort centered in the upper abdomen

can be assoc w/ fullness, early satiety, bloating, nausea

intermittent, continuous, related to meals

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2
Q

What is the most common cause of gastritis worldwide?

A

H pylori

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3
Q

What are sxs of acute gastritis?

A

sudden onset of epigastric pain, N/V, bloated or early satiety

possible history of smoking, alcohol or NSAID, steroid intake or radiation therapy

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4
Q

What are sxs of chronic gastritis?

A

sxs consistent w/ Fe def anemia, neuro sxs related to B12 def (paresthesia of hands & feet), may have epigastric pain

FH may be +

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5
Q

What makes more suspicious for chronic gastritis?

A

pt w/ known autoimmune disorder (Hashimoto thyroiditis, Addison dz, myasthenia gravia, DM, lichen planus)

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6
Q

What are PE findings & labs for acute/chronic gastritis?

A

PE benign, some epigastric tenderness to palpation

test for H pylori w/ urea breath test or stool antigen test

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7
Q

What are sxs & signs of GERD?

A

post-prandial epigastric pain that radiates upward

burning sensation (heart burn)

worse w/ large meals, supine posture, bending over

alleviated by foods or antacids

regurgitation of food/fluid @ night, dysphagia & odynophagia, esophageal erosions or ulcers

dental erosions, reflux induced asthma, chronic cough, laryngitis

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8
Q

What are red flag features of PE for GERD?

A

dysphagia
wt loss
anemia
+FOB

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9
Q

What is peptic ulcer dz (PUD)?

A

break in the mucosal surface (>5mm)

incidence increasees w/ age, assoc w/ smoking & heavy alcohol use

NOT assoc w/ diet or stress

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10
Q

Sxs specific for gastric ulcer

A

pain is dull, aching, gnawing, hunger like
peak btwn 55-70yo
assoc w/ NSAIDs use
pain that awakens pt from sleep (1/3 pts)

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11
Q

Sxs specific for duodenal ulcer

A

pain is dull, aching, gnawing, hunger like
peak btwn 30-55yo
pain that awakens pt from sleep (2/3 pts)

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12
Q

What should the initial eval for gastric & duodenal ulcers include?

A

should perform both H pylori & FOB tests

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13
Q

When is endoscopy incidated?

A

if pt sxs persist or red flag features

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14
Q

What is acute calculous cholecystitis?

A

stone becomes lodged in cystic duct causing biliary colic due to GB distension & inflammation

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15
Q

What is chronic cholecystitis?

A

recurrent pain caused by GB constriction against stone of transient obstruction of cystic duct

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16
Q

What is choledocholiathiasis?

A

stone exits GB into common bile duct, leads to biliary obstruction w/ infection (cholangitis)

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17
Q

What is GB pancreatitis?

A

caused by obstruction of pancreatic duct by gallstone

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18
Q

What is GB dyskinesia?

A

acalculous dysfxn of GB but presents similar to acute cholecystitis

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19
Q

What is biliary sludge?

A

micro-precipitate of components of gallstones (bile, cholesterol crystals, calcium bilirubminate)

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20
Q

Highest prevalence for gallstones?

A

in middle-aged, obese women

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21
Q

Major risk factors for gallstone formation?

A

obesity & caloric excess

rapid wt loss, starvation diets, gastric bypass

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22
Q

What are the sxs of biliary dz?

A

most pts w/ gallstones are asymptomatic

biliary colic presents w/ steady, localized pain in RUQ or epigastrum, radiates to back or R scapula

duration from 2-4 hours

assoc w/ fatty food intolerance, belching, bloating

JAUNDICE (elevated liver enzymes & increased BR)

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23
Q

What test is used for biliary dz?

A

transabdominal ultrasound of RUQ 6 hours post fasting (85%-95% sensitive, 99% specific)

look for stones & biliary sludge, thickness of GB wall

24
Q

What is the sonographic Murphy sign?

A

pain over GB from ultrasound probe

sensitivity & specificity for GB dz is >95%

25
What are sxs of acute pancreatitis?
acute onset of persistent, severe ab pain (dull) progression of pain can last for hours/days 90% pts w/ N/V
26
What are sxs of chronic pancreatitis?
pt develops triad of ab pain, exocrine pancreatic insufficiency (steatorrhea, wt loss, malnutrition) & DM (over years-decades) main complaint is ab pain (85%)
27
What are PE & lab findings for pancreatitis?
ab w/ tenderness to palpation over epigastrum scleral icterus if obstructive jaundice, fever or tachypnea, hypoxemia, hypotension look for hepatomegaly, xanthelasmas, parotid swelling look @ CMP, serum amylase & lipase
28
What is hepatitis?
inflammation of liver parenchyma, either due to infectious or non-infectious etiologies
29
What are the most common causes of acute hepatitis in the US?
``` biliary tract dz viral infections (CMV, EBV, Hep A) alcohol & acetaminophen overdose ```
30
What are sxs of acute hepatitis?
``` fatigue/malaise anorexia N/V ab pain (RUQ) jaundice dark colored urine pruritis abdominal distension (ascites w/ + fluid wave) encephalopathy (acute liver failure) elevated LFTs (AST:ALT >2) elevated BR ```
31
What is colitis?
inflammation of colon due to infectious, autoimmune, ischemic or idiopathic causes
32
What is diverticulitis?
acute inflammation of pseudo-diverticulum (usually on L side in sigmoid colon)
33
What causes diverticulitis?
low fiber, high fat diet increased pressure that breaks integrity of colonic wall where vasa recti penetrate thru muscularis propria chronic low grade inflammation & gut dysmotility
34
When do pts become symptomatic with diverticulitis?
when a macroscopic inflammation of diverticulum leads to microperforation & localized paracolic inflammation OR macroperforation w/ abscess or generalized peritonitis
35
What is the most common cause of hematochezia in pts >60yo?
diverticular hemorrhage
36
What are signs & sxs of diverticulitis?
``` fever anorexia ab pain (hypogastric or LLQ) change in bowel baits (constipation in 50% of pts) palpable tender mass in LLQ guarding/rebound tenderness partial obstruction seconday to luminal narrow mild leukocytosis & elevated CRP ```
37
What imaging is used for diverticulitis?
CT w/ oral & IV contrast
38
What findings on imaging confirms dx of diverticulitis?
thickened colonic wall >4mm inflammation w/ in pericolic fat w/ or w/o collection of contrast material of fluid sensitivity 94%, specificity 99%
39
What is IBD?
inflammatory bowel dz ab pain, diarrhea, bleeding
40
What are signs & sxs of ulcerative colitis?
``` insidious onset pt age 15-30yo or 60-79yo bloody diarrhea, abdominal pain tenesmus erythema nodosum (10%) pyoderma gangrenosum uveitis migratory pauciarticular arthritis (large joints) ```
41
What are signs & sxs of Crohn dz?
FEVER, WT LOSS ``` recurrent RLQ pain w/ diarrhea pt age 15-30yo or 60-79yo bloody diarrhea, ab pain w/ cramping tenesmus erythema nodosum (15%) pyoderma gangrenosum (not common) RLQ pain that mimics appendicitis ulcer of oral cavity uveitis migratory pacuiarticular arthritis (large joints) ```
42
When is an appendectomy protective?
protective w/ ulcerative colitis (risk reduction 13-26%) NOT protective w/ Crohn dz
43
What may imaging show for Crohn dz?
upper GI w/ SBFT shows segmental narrowing, fistula formation & string sign in terminal ileum
44
What is a string sign?
narrow band of barium flowing thru inflamed or scarred area
45
What are common PE findings for ulcerative colitis?
involves the large intestine 95% w/ rectal involvement uniform & continuous involvement of affected areas PE w/ diffuse abdominal pain
46
What are common PE findings for Crohn dz?
may involve any part of GI tract dz involves entire bowel wall (transmural) & may be separated by healthy bowel (skip lesions) PE w/ diffuse ab pain & fullness or palpable masses (adherent loops of bowel)
47
What management is indicated in pts w/ UC or Crohn dz?
1.5-2 fold higher risk of colon cancer requires annual or biennial colonoscopy
48
OSE & Management for Gastritis
Behavioral: stop intake of causative agent, stop smoking Metab: urea breath test or H pylori stool antigen, acid suppression w/ PPI, vitamins Resp/circ: FOB, evaluate & tx lymphatic changes Neuro: tx Chapman points, eval & tx viscerosomatic findings (sympathetic T5-T10, parasymp OA/AA) Biomech: eval & tx SD (MFR, MET, HVLA, etc)
49
OSE & Management for GERD
Behavioral: lifestyle mod to elevate bed, avoid smoking & alcohol & coffee, avoid large meals @ night, wt loss Metab: suppress gastric acid production (PPI or H2 antagonist), promotility therapy, endoscopy if severe or red flag sxs Resp/circ: assess for complications of reflux (asthma, hoarseness, dental erosions) Neuro: address PSI & SI to esoph & stomach, Chapman points Biomech: address any MSK findings OA/AA, T5-T10
50
OSE & Management for PUD
Behavioral: balanced meals @ regular intervals, stop smoking to help healing & reduce recurrence Metab: urea breath test, if + eradicate H pylori w/ antibiotics, acid suppression w/ PPI, EGD if pt w/ + FOB or red flag sxs Resp/circ: FOB & CBC, eval & tx lymphatic changes Neuro: tx Chapman points, eval & tx viscerosomatic findings Biomech: eval & tx SD (MFR, MET, HVLA, CS)
51
OSE & Management for Biliary Dz
Biomech: Laprascopic cholecystectomy is tx of choice if recurrent or symptomatic GB dz, post op eval of SD in upper gut Behavioral: wt loss, exercise, diet w/ fruits & veggies Metab: tx pts who are not surgical candidates w/ bile acid therapy, follow liver enzymes & BR levels for all pts, NPO status for surgical pts Resp/circ: eval & tx lymphatic regions assoc w/ upper GI system, IV fluids for surgery prep Neuro: eval & tx SI & PI to upper gut, ID & tx Chapman point for GB
52
OSE & Management for Pancreatitis
Behavioral: stop intake of alcohol, lower cholesterol Metab: parental rehydration w/ normal saline or Ringer's lactate solution (if no hyper Ca2+) & pain control w/ opioids Resp/circ: watch for signs of complications (splanchnic venous thrombosis w/ increased as pain & rare pseudoaneurysm w/ unexplained GI bleed) Neuro: watch for signs of alcohol withdrawal if heavy drinker, eval & tx Chapman's points, eval viscerosomatic findings Biomech: eval & tx SD (MFR, MET, CS)
53
OSE & Management of Acute Hepatitis
Behavioral: alcohol cessation, address acetaminophen use Metab: Lab tests (AST, ALT, total BR, glucose, viral serology); US of RUQ to assess for biliary obstruction & liver size; nutritional support Resp/circ: O2 & supportive measures, DVT prophylaxis w/ SCD, address lymphatic system once pt is stabilized Neuro: assess for viscerosomatic findings, Chapman reflexes, need to ensure pt safety in ICU if present w/ encephalopathy Biomech: assess SD & tx once pt is stabilized
54
OSE & Management for Diverticulitis
Behavioral: pt education regarding fiber sources in diet or fiber supplementation Metab: liquid diet if have acute episodes, obtain CBC & CRP, administer antibiotics for anaerobes & gram negative rods, fever & pain control, CT scan w/ oral & IV contrast Resp/circ: IV fluid support, DVT prophylaxis w/ SCD, address lymphatic system once stabilized Neuro: tx Chapman points or viscerosomatic lesions assoc w/ colon-PSN sacrum Biomech: allow use bathrrom, find SD & tx pt once stabilized to restore health
55
OSE & Management of IBD
Behavioral: smoking cessation, pt education regarding long-term management (counseling or support groups), address pregnancy & fertility concerns Metab: meds for long term dz management, nutritional support for healing, monitor for anemia, eval & tx lymphatic system Resp/circ: CT scan for thickened bowel wall, use colonoscopy to visualize & biopsy GI tract, annual colonoscopy to screen for colon cancer Neuro: Asses SN regions & PSN, Chapman points Biomech: assess for SD & tx once pt is stabilized to restore pt health

(OMS2) PCM III Midterm (7 decks)

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