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NM703 Primary Care of the Woman > Module 6 - GI > Flashcards

Module 6 - GI Flashcards

1
Q

Appendicitis: Three most predictive sx

A
  1. Periumbilical or epigastric pain
  2. Migration of pain to RLQ
  3. Abdominal rigidity
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2
Q

Physical Exam for ____________:

1) Abdominal tenderness will be elicited with cough.
2) Painful spot can often be specified with one finger; Usually in RLQ between umbilicus and anterosuperior iliac spine
3) Signs of peritoneal irritation: guarding, rebound tenderness, positive obturator and psoas signs
4) Rectal exam may reveal tenderness or mass
5) Pelvic exam should be done in females

A

Suspected appendicitis

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3
Q

Describe obturator sign

A

Elicited by passive rotation of R leg with pt supine and R hip and knee flexed.

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4
Q

Describe psoas sign

A

Elicited by asking the supine patient to raise the straightened R leg against resistance by the practitioner.

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5
Q

Labs for suspected appendicitis:

A

CBC with diff for elevated WBC/neutrophils; serum beta Hcg to help rule out ectopic; C reactive protein- if normal after 24 hours of abdominal pain, suggests NOT appendicitis; Imaging if presentation is atypical - CT scan has high sensitivity & specificity

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6
Q

What do you do in the event appedicitis is suspected?

A

Immediately refer for surgical consult or send to ED.

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7
Q 
Abdominal pain by region:
Chest cavity
Liver
Gallbladder
Stomach
Bowel
Right kidney
A

RUQ

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8
Q 
Abdominal pain by region:
Pancreas
Left kidney
Spleen
Heart or chest cavity
A

LUQ

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9
Q 
Abdominal pain by region:
Appendix
Bowel
Right ureter
pelvis
A

RLQ

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10
Q

Abdominal pain by region:
Bowel (diverticulitis)
Ureter
pelvis

A

LLQ

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11
Q

Obtain consult or refer GI disorders that present with BWAD. What is BWAD?

A

B - blood in stool
W- weight loss
A- Anemia
D- Dysphagia

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12
Q

Primary causes of constipation

A

Disordered colonic transport and pelvic floor or anorectal dysfunction

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13
Q

True/False
Secondary causes of constipation are related to medical and psychogenic conditions, medications, structural abnormalities, and lifestyle.

A

True

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14
Q

Hx for constipation should include :

A
  1. when the change in BM occurred
  2. # of stools per day & week
  3. last BM
  4. Need to strain?
  5. sensation of incomplete evacuation
  6. any episodes of fecal incontinence, diarrhea, abdominal pain, or blood, or pain with defacation
  7. systemic, neurologic or other related sx
  8. hx of assoc illnesses
  9. 24hr diet/fluid review
  10. complete medication review
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15
Q

What common meds can cause constipation?

A

anticholinergics, calcium channel blockers, diuretics, antacids

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16
Q

Diagnostic tests for constipation with abd. discomfort, nausea or vomiting? Why?

A

Abdominal x-ray or CT scan and CBC w/diff; to exclude obstruction, ileus, megacolon or volvulus

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17
Q

When is a colonoscopy or barium enema indicated with constipation?

A

With a recent change in bowels or the presence of abd. pain or rectal bleeding to evaluate for obstructive neoplasm.

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18
Q

What diagnostics for chronic constipation?

A

Stool sample for occult blood, TSH, CBC, CMP

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19
Q

True/False

Volvulus and obstruction require immediate surgical eval.

A

True

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20
Q

True/False

Ileus and pseudo-obstruction require immediate surgical eval.

A

False - can be medicallyy managed with NG suction and IV fluid

21
Q

IBS presents with diarrhea, constipation or an alternating pattern of the two with ___________.

A

abdominal pain

22
Q

How can IBS be differentiated from lactose intolerance?

A

2 week lactose free diet or hydrogen breath test to exclude lactose intolerance.

23
Q

Rome criteria for IBS:
Abd. pain or discomfort with at least two of the following: (3)
Also must have one or more of the following on at seat 25% of occ.

A
  1. improvement with defacation
  2. onset assoc with change in freq of stool (< 3 bm/wk or > 3 bm/day)
  3. onset assoc with change in appearnace of stool (lumpy/hard, loose/watery)
  4. Abn frequency
  5. abn passage (straining)
  6. abn form (lumpy)
  7. bloating
  8. mucus in stool
  9. freq loose stools

At least 3 days/month for last 3 months with onset 6mos prior.

24
Q

Tx for IBS

A

Education, reassurance, lifestyle and diet modifications. synthetic fiber

25
Q

Triggers for IBS

A

dairy products, gas forming foods, artificial sweeteners, carbonated beverages, caffeine, and alcohol.

26
Q

Pharmacotherapy for IBS:

A

Antispasmodics; antidiarrheal (immodium); anticonstipation (sythetic fiber); psychotropic (avoid tricyclics with constipation)

27
Q

Tx for c diff diarrhea

A

flagyl tid for 10-14 days

28
Q

Meaning of elevated AST and ALT ?

A

Hepatocellular necrosis or inflammation

29
Q

A ratio of AST to ALT greater than 2 indicates _________ _______ ________

A

Alcoholic liver injury

30
Q

Elevated alk phos indicates (3):

A

cholestasis, primary biliary cirrhosis, or infiltrative liver disease

31
Q

What can an elevated alk phos mean in an adolescent?

A

growth spurt

32
Q

What does elevated GGT indicate?

A

hepatobilliary disease

33
Q

Diagnostics for GERD

A

Stool for occult blood x3; CBC with diff and EGD if indicated.

34
Q

Tx for GERD

A

PPI x8wk followed by maintenance H2RA

35
Q

Tx for travelers diarrhea?

A

Fluroquinolones cipro bid for 3-5days; e coli most likely

36
Q

Tx for salmonella

A

usually deferred; if over 50 or infant; immunocompromised, sickle cell - then fluroquinolones and ceftriaxone

37
Q

Tx for camplyobacter?

A

Macrolides

38
Q

tx for shigella

A

cipro 500 q12 for 1-3 d

39
Q

Risk factors for PUD?

A

H. pylori infection; NSAID use

40
Q

Diagnostics for PUD

A

CBC; serum culture for H, pylori; urea breath test and fecal antigen test more accurate

41
Q

Use of PPI can affect what test results?

A

urea breath test and fecal antigen test

42
Q

Tx for PUD

A

2 wk trial of anti ulcer therapy. D/C Nsaid or cox2 inhibitors; if H. pylori - PPI with clarithromycin and amoxicillin or metronidazole for 10-14 days

43
Q

What is Murphy’s sign? When is it seen?

A

Inability to take deep breath during palpation beneath the R costal margin; seen in cholecystitis

44
Q

Gold standard test for pancreatitis?

A

helical contrast enhanced CT; serum amylase and lipase

45
Q

Hep A: Route and Incubation

A

fecal/oral; 2-6wks

46
Q

Hep A IgG

A

Past infection

47
Q

Hep A IgM

A

Acute infection

48
Q

Hep B route / incubation

A

blood/sex; 2-6months

NM703 Primary Care of the Woman (5 decks)

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