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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
Q

What are sxs of acute pancreatitis?

A

acute onset of persistent, severe ab pain (dull)

progression of pain can last for hours/days

90% pts w/ N/V

26
Q

What are sxs of chronic pancreatitis?

A

pt develops triad of ab pain, exocrine pancreatic insufficiency (steatorrhea, wt loss, malnutrition) & DM (over years-decades)

main complaint is ab pain (85%)

27
Q

What are PE & lab findings for pancreatitis?

A

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
Q

What is hepatitis?

A

inflammation of liver parenchyma, either due to infectious or non-infectious etiologies

29
Q

What are the most common causes of acute hepatitis in the US?

A 
biliary tract dz
viral infections (CMV, EBV, Hep A)
alcohol & acetaminophen overdose
30
Q

What are sxs of acute hepatitis?

A 
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
Q

What is colitis?

A

inflammation of colon

due to infectious, autoimmune, ischemic or idiopathic causes

32
Q

What is diverticulitis?

A

acute inflammation of pseudo-diverticulum (usually on L side in sigmoid colon)

33
Q

What causes diverticulitis?

A

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
Q

When do pts become symptomatic with diverticulitis?

A

when a macroscopic inflammation of diverticulum leads to microperforation & localized paracolic inflammation

OR

macroperforation w/ abscess or generalized peritonitis

35
Q

What is the most common cause of hematochezia in pts >60yo?

A

diverticular hemorrhage

36
Q

What are signs & sxs of diverticulitis?

A 
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
Q

What imaging is used for diverticulitis?

A

CT w/ oral & IV contrast

38
Q

What findings on imaging confirms dx of diverticulitis?

A

thickened colonic wall >4mm

inflammation w/ in pericolic fat w/ or w/o collection of contrast material of fluid

sensitivity 94%, specificity 99%

39
Q

What is IBD?

A

inflammatory bowel dz

ab pain, diarrhea, bleeding

40
Q

What are signs & sxs of ulcerative colitis?

A 
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
Q

What are signs & sxs of Crohn dz?

A

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
Q

When is an appendectomy protective?

A

protective w/ ulcerative colitis (risk reduction 13-26%)

NOT protective w/ Crohn dz

43
Q

What may imaging show for Crohn dz?

A

upper GI w/ SBFT shows segmental narrowing, fistula formation & string sign in terminal ileum

44
Q

What is a string sign?

A

narrow band of barium flowing thru inflamed or scarred area

45
Q

What are common PE findings for ulcerative colitis?

A

involves the large intestine

95% w/ rectal involvement

uniform & continuous involvement of affected areas

PE w/ diffuse abdominal pain

46
Q

What are common PE findings for Crohn dz?

A

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
Q

What management is indicated in pts w/ UC or Crohn dz?

A

1.5-2 fold higher risk of colon cancer

requires annual or biennial colonoscopy

48
Q

OSE & Management for Gastritis

A

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
Q

OSE & Management for GERD

A

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
Q

OSE & Management for PUD

A

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
Q

OSE & Management for Biliary Dz

A

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
Q

OSE & Management for Pancreatitis

A

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
Q

OSE & Management of Acute Hepatitis

A

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
Q

OSE & Management for Diverticulitis

A

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
Q

OSE & Management of IBD

A

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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