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Gastro > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the key thing that causes abdominal discomfort?

A

rapid distension of hollow organ smooth muscle

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2
Q

What is the most sensitive structure in the abdomen (pain threshold)?

A

parietal peritoneum

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3
Q

What is the least sensitive structure in the abdomen (pain threshold)?

A

parenchymatous organs

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4
Q

Where is visceral pain often first noticed? (location on abdomen)

A

closer to midline of abdomen

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5
Q

Is visceral pain made worse by palpation?

A

no

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6
Q

Is visceral pain made worse by movement/coughing/breathing deeply?

A

no

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7
Q

Is the underlying musculature tense/painful with visceral pain?

A

NO

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8
Q

Is visceral pain easily localized?

A

No (V for visceral, V for vague)

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9
Q

Three potential sources for localized abdominal pain?

A
  1. peritonitis 2. nerve root/intercostal pain 3. MFTPs
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10
Q

What might a pt have if they complain of pain localized to the abdominal wall, or a diffuse discomfort that mimics visceral pain?

A

MFTPs

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11
Q

Why do pts not realize the area of tenderness is extremely localized and superficial with MFTPs?

A

They are preoccupied with the large area of pain spread

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12
Q

Where does peritoneal pain usually manifest? (location on abdomen)

A

dermatomes T5-L2

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13
Q

Is peritoneal pain easy to localize?

A

Yes

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14
Q

Is peritoneal pain made worse by movement/coughing/deep respiration?

A

Yes

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15
Q

Is peritoneal pain made worse by palpation?

A

yes

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16
Q

What can peritoneal irritation lead to? (muscles)

A

reflexive contraction of segmental msls

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17
Q

If visceral pain changes location and starts becoming parietal pain and you can’t find evidence of an NMS condition or MFTP as the source of pain, what should you start to think about?

A

peritonitis

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18
Q

What is Dunphy’s sign?

A

localized pain that increases with coughing

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19
Q

What is the “jar test”?

A

sudden vibration increases/localizes the pain

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20
Q

What position must the pts knees be in to begin abdominal exam?

A

pt supine, hips and knees flexed

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21
Q

What represents the first physical contact with the pt’s abdomen?

A

auscultation

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22
Q

Do abdominal bruits assist in the Dx of AAA?

A

No

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23
Q

What kind of bruits are more sensitive for renal vascular dz?

A

anterior bruits near the umbilicus

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24
Q

what kind of bruits are more specific for renal vascular dz

A

flank bruits

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25
Q

How deep is superficial palpation?

A

Up to 1 cm

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26
Q

what is the purpose of superficial palpation?

A

compare underlying abdominal msl tone from side to side

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27
Q

what is possible the most important component in assessment of suspected peritonitis?

A

superficial palpation

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28
Q

how deep is deep palpation?

A

> 1 cm

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29
Q

What is the best use of deep palpation?

A

evaluation of abdominal aorta (normal = 2.5-4 cm wide)

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30
Q

palpation of what structure is tender in pts with IBS? (test question!)

A

sigmoid colon (can also cause pain to radiate to rectum and anus)

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31
Q

what does Murphy’s sign assess?

A

gall bladder

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32
Q

what is considered a contraindication to spleen palpation?

A

mononucleosis

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33
Q

what musculoskeletal finding may be associated with SI joint dysfunction?

A

psoas MFTPs

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34
Q

what is used to assess a chronic and unremitting abdominal pain?

A

Carnett’s

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35
Q

when performing Carnetts, what is not included as a component/layer of the abdominal wall?

A

parietal peritoneum

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36
Q

what test is not considered helpful at ruling IN peritonitis?

A

Carnett’s (might be helpful at ruling OUT peritonitis)

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37
Q

what are the abdominal red flags/classic signs of peritonitis?

A

abdominal tenderness, fever >105, vomiting

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38
Q

what are “very bright” red flags of the abdomen?

A

abdominal distension, palpable masses, ecchymosis, hypotension/shock

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39
Q

When interpreting Carnett’s test, with abdominal muscles contracted, what indicates that pain does NOT originate from anterior abdominal wall?

A

pain DECREASES in intensity

40
Q

which ribs are most likely to be hypermobile?

A

“false” ribs

41
Q

what cause of costochondral pain has pain but no swelling?

A

costochondritis

42
Q

what cause of costochondral pain has pain AND swelling?

A

Tietze’s syndrome

43
Q

what is a common cause of acute abdominal pain?

A

food poisoning

44
Q

What are 2 characteristics of acute abdominal pain?

A

<7 day duration of pain/tenderness

45
Q

What is the Acute Abdomen aka?

A

the surgical abdomen (urgent referral)

46
Q

what are entry level red flags for the acute abdoment?

A

abdominal tenderness, fever, vomiting

47
Q

what are the extreme red flags for the acute abdomen?

A

ascites, herniated umbilicus, jaundice, cullens/turners signs, shock

48
Q

what characteristics (of acute abdomen) favor a surgical dx?

A

lasts >6 hrs, sudden onset

49
Q

what is the most valuable single test for the acute abdomen?

A

periodic repetition of physical exam (let them sit) done by the same doctor

50
Q

what are the signs of peritonitis?

A

abdominal tenderness, fever >100.5, vomiting

51
Q

what kind of peritonitis is the most common?

A

infectious

52
Q

what causes inflammatory peritonitis?

A

inflammation of an adjacent structure (no direct infection of the peritoneum)

53
Q

what is the best indicator of peritonitis?

A

rigidity/”true guarding”

54
Q

what is “true guarding”?

A

guarding that doesnt diminish with reassurance and continued palpation

55
Q

What is the unofficial gold standard for peritonitis?

A

Rovsing’s sign

56
Q

What is Rovsings sign aka?

A

contralateral tenderness or indirect rebound tenderness (classically used for acute appendicitis, may be more accurate than direct rebound tenderness)

57
Q

what are the 2 big functional esophageal disorders?

A

functional heartburn, functional chest pain

58
Q

what can gross aspiration lead to?

A

pneumonia

59
Q

what does peppermint leaf/oil do?

A

smooth muscle relaxant

60
Q

what is the side effect of peppermint leaf/oil?

A

heartburn

61
Q

what should you avoid when on statin therapy?

A

peppermint or grapefruit juice (competes for R/C sites)

62
Q

T/F: upper esophageal sphincter is not a true sphincter

A

true

63
Q

T/F: lower esophageal sphincter is not a true sphincter

A

false

64
Q

what are the most common structural abnormalities in the esophagus?

A

rings and webs

65
Q

After the upper esophageal sphincter, what is the last place in the GI tract that has well localized symptoms?

A

anal sphincter

66
Q

what kind of obstruction does trouble swallowing solids indicate?

A

intrinsic

67
Q

what are two examples of intrinsic obstruction?

A

Plummer-Vinson syndrome and Zenker diverticulum

68
Q

What is the classic triad for zenker diverticulum?

A

dysphagia, halitosis, and regurgitation

69
Q

where does a Mallorie-Weiss tear occur?

A

gastroesophageal junction

70
Q

what does the E in CREST syndrome stand for?

A

esophageal dysmotility

71
Q

T/F: when an infant is choking, abdominal thrusts are recommended

A

false

72
Q

what does decreased LES tonus lead to?

A

increased risk of heartburn

73
Q

what is the only thing that has shown to be consistently effective for GERD?

A

weight loss and elevating the head of the bed

74
Q

how often does heartburn refer pain to the spine?

A

40% (left arm/shoulder = 5%)

75
Q

T/F: severeness of heartburn symptoms doesn’t always correlate with degree of damage

A

true

76
Q

what kind of population usually presents with atypical GERD?

A

older

77
Q

what are the heartburn alarm symptoms?

A

angina pectoris mimic, dysphagia, odynophagia, weight loss, blood loss

78
Q

what are oral osteoporosis meds notorious for damaging?

A

esophagus

79
Q

where does H. Pylori tend to colonize?

A

gastric antrum (beneath mucous layer)

80
Q

how do most people with hiatal hernias present?

A

asymptomatic

81
Q

what are the dyspepsia alarm symptoms?

A

anorexia/dysphagia/wt. loss, bleeding/melena/anemia, age/family Hx of gastric cancer, personal Hx of PUD, jaundice/masses

82
Q

which layer of the stomach produces the most bleeding with erosion?

A

submucosa

83
Q

what layer of the stomach produces the least amount of bleeding with erosion?

A

mucosa

84
Q

what does chronic alcohol ingestion decrease the delivery of?

A

mucus glycoproteins

85
Q

what does cigarette smoking significantly reduce?

A

mucus synthesis

86
Q

what is known to dissipate surface active phospholipids?

A

bile acids/some NSAIDs/aspirin

87
Q

what is the possible turnover time of human gastric epithelium?

A

2-4 days

88
Q

what do non-selective OTC NSAIDs inhibit?

A

COX 1 and COX 2

89
Q

what is considered to be the most ulcerogenic OTC NSAID?

A

aspirin

90
Q

what does alcohol stimulate?

A

gastric secretions (and also, bad decisions)

91
Q

what has bile reflux been linked to?

A

long term use of proton pump inhibitors (PPIs)

92
Q

what conditions are H. pylori infection often assoc. with? (4)

A
  1. GERD and dyspepsia 2. PUD 3. chronic antral gastritis 4. increased risk of gastric cancer
93
Q

how do you differentiate the initial clinical presentations of acute gastritis, chronic gastritis, and PUD?

A

they are indistinguishable

94
Q

how often is acute GI hemorrhage due to acute gastritis?

A

30% of cases (most common cause of blood in large quantities in GI tract)

95
Q

what are the physical characteristics of a peptic ulcer?

A

extend through muscularis mucosa and are greater than 5 mm in diameter

Gastro (2 decks)

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