Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CMS150 final (wk 9-14) > week 10 > Flashcards

week 10 Flashcards

1
Q

what is typically right upper, right lower and left lower quadrants

A

right upper= liver and gallbladder
right lower= appendix
left lower= diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

must not miss conditions in the presence of abdominal pain

A
  • Appendicitis
  • Bowel obstruction
  • Abdominal malignancy
  • Cardiovascular origins of abdominal pain
  • Gynecological: PID, ectopic pregnancy, ovarian torsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

4 highest LR+ for appendicitis

A
  1. right lower quadrant pain
  2. migrating pain from periumbilical area to right lower quadrant
  3. fever
  4. psoas sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

appendicitis imagining

A

abdominal CT scan or ultrasound if pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what to do If have appendicitis

A

need antibiotics of surgery

may progress to ischemia, necrosis, perforation of bowel and sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is more common bowel obstruction of large or small bowel

A

small (76%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ethology of large vs small bowel obstruction

A

large
* Cancer (53%)
* Sigmoid or cecal volvulus (17%)
* Diverticular disease (12%)
* Extrinsic compression from metastatic cancer (6%)
* Other (12%)

small
* Postsurgical adhesions, 70%
* Malignant (usually metastatic) tumor, 10–20%
* Hernia (ventral, inguinal, or internal), 10%
* IBD (with stricture), 5%
* Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

signs of bowel obstruction

A

absent bowel sounds and flatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

large bowel obstruction LR+

A
  1. constripation; LR+ = 8.8
  2. abdominal distention; LR+ = 5.7
  3. pain decreasing after vomiting LR+ - 4.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

small and large bowel obstruction LR+

A
  1. increased bowel sounds with history of prior surgery, LR+ =11
  2. distention associated with increased bowel sounds, vomiting, constipation or prior surgery, LR+= 10
  3. increased bowel sounds after vomiting, LR+ = 8
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

testing for large bowel obstruction

A

CT scan, barium enema for large bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

testing for small bowel obstruction

A

radiograph (x-ray), ultrasound, CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

complete vs partial small bowel obstruction

A

complete could progress to bowel strangulation and infarction
-clinical signs DO NOT allow for identification of strangulation prior to infarction
-surgery

partial
-rarely progressed to strangulation of infarction
-can still pass stool or flatus
-resolves spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

abdominal malignancy

A
  • Colorectal cancer
  • Gynecological cancers
  • Pancreatic cancer
  • Gall bladder/bile duct cancer
  • Gastric cancer
  • Liver cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

systemic symptoms of cancer

A
  • Unintentional weight loss (up to 36% of cancer diagnoses)
  • Loss of appetite
  • Significant night sweats
  • Symptoms waking patient from sleep (diarrhea e.g.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cardiovascular origins of abdominal pain

A
  • Abdominal Aortic Aneurysm (AAA)
  • Myocardial infarction (see Cardiovascular lecture)
  • Pericarditis (see Cardiovascular lecture)
  • Aortic dissection (see Cardiovascular lecture)
  • Mesenteric ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

abdominal aortic aneurysm symptoms

A
  • Pulsatile abdominal mass with ruptured AAA (LR+, 8.0; LR–, 0.6)
  • Sensitivity severely limited in patients with rupture, large girth
  • In patients without AAA rupture who are symptomatic:
  • Abdominal pain: 83%
  • Flank or back pain: 61–66%
  • Syncope: 26%
  • Abdominal mass on careful exam: 52% (only 18% had abdominal mass noted on routine abdominal exam)
  • Hypotension or orthostasis: 48%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

mesenteric ischemia acute vs chronic signs and symptoms

A

Acute:
* Abdominal pain intensity out of proportion to exam is a classic finding but is absent in 20–25%
* Vomiting (71%)
* Diarrhea (42%)
* Prior history of intestinal angina (50%)

Chronic:
* Recurrent postprandial abdominal pain (often in first hour and diminishing 1–2 hours later)
* food fear, weight loss
* history of tobacco use (75%),
* peripheral vascular disease (55%)
* coronary artery disease (43%)
* hypertension (37%)
* Abdominal pain: 94%
* Typically epigastric or periumbilical pain
* Postprandial pain: 88%
* Weight loss due to food aversion: 78%
* Diarrhea: 36%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

IMAGING for mesenteric ischemia acute vs chronic

A
  • CT angiography for acute
  • Ultrasonography for chronic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

gynecological conditions

A

Ectopic pregnancy
Ovarian torsion
Pelvic Inflammatory Disease (PID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

etopic pregnancy signs and symptoms

A
  • Severe lower quadrant pain occurs in almost every case.
  • Pain sudden onset , stabbing, intermittent, does not radiate
  • At least 2/3 patients have a history of abnormal menstruation
  • Slight vaginal bleeding (spotting)
  • Pelvic adnexal mass may be palpable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

investigations for topic pregnancy

A

serum beta- hCH (pregnancy test) and pelvic ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is ovarian torsion

A

Ischemia or necrosis of the ovary usually due to the presence
of cyst or mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

who is at risk for ovarian torsion

A

pre-menarchal patients (before first period) and in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ovarian torsion signs and symtposm

A

Almost 70% of torsions occur on the right side
* Sudden-onset, severe, unilateral, lower abdominal pain
* Pain may also have gradual onset and be mild or intermittent
* Nausea and vomiting present in 70% of cases
* Abdominal tenderness and guarding on palpation
* Presence of latero-uterine mass
* Close to 30% of patients have bilateral adnexal tenderness on bimanual examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which side is ovarian torsion usually on

A

right side (70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

investigation for ovarian torsion

A

transvaginal ultrasound with droppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

prognosis of ovarian torsion

A

Ovary and fallopian tube can be saved depending on duration and extent of ischemia/necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

signs and symptoms of pelvic inflammatory disease

A
  • Lower abdominal pain
  • Chills and fever
  • Menstrual disturbances
  • Purulent cervical discharge
  • Cervical and adnexal tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

prognosis of pelvic inflammatory disease

A
  • About 20% of women with PID become infertile, 40% develop chronic pain, and 1% of women who conceive have an ectopic pregnancy
  • Can resolve spontaneously
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

investigations for pelvic inflammatory disease

A
  • C-reactive Protein (CRP)
  • Erythrocyte Sedimentation Rate (ESR)
  • Endocervical culture
  • Neisseria gonorrhoeae or Chlamydia trachomatis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

other causes of abdominal pain

A
  • Peptic Ulcer Disease
  • Cholecystitis
  • Cholelithiasis
  • Nephrolithiasis
  • Acute & Chronic Pancreatitis
  • Diverticular disease
  • Autoimmune conditions
  • Infectious gastroenteritis
  • Functional disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

where do you get ulcer in peptic ulcer disease

A

gastric or duodenal lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

2 most common causes of peptic ulcer disease

A
  1. NSAID use
  2. H pylori infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what increases risk or peptic ulcer disease

A

age

36
Q

symptoms of peptic ulcer disease

A

could be asymptomatic
weight lossi
1st sign might be lift threatening complication like hemorrhage or perforation or bleeding

37
Q

test for h pylori

A
  • Urea breath test
  • Stool antigen test
  • Blood test (antibodies): cannot distinguish between past and current H. pylori infection
38
Q

imaging for peptic ulcer disaese

A
  • Esophagogastroduodenoscopy (EGD) (endoscopy) only recommended for >60 years old or if alarm features present
39
Q

cholecystitis

A

Inflammation of the gall bladder and or bile ducts, secondary to cystic duct obstruction

40
Q

high LR for cholecytitis

A

Murphys sign, right upper quadrant pain, fever, jaundice

41
Q

investigations for cholecystitis

A
  • Leukocytosis (elevated white blood cell count): (> 10,000/mcL) present in 52–63% of patients.
  • Ultrasound
  • Cholelithiasis is usually present (84–99%)
  • Cholecystitis does not typically cause significant increases in lipase or liver biochemical tests
42
Q

nephrolithiasis is aka

A

kidney stones

43
Q

risk for nephrolithiasis

A

previous occurrence, men, family history

44
Q

signs for nephrolithiasis

A
  • Rapid onset of excruciating back and flank pain, may radiate to the abdomen or groin
  • Pain may be associated with nausea, vomiting, dysuria, or urinary frequency
  • Abdominal tenderness unusual
  • Hematuria (gross or microscopic) (blood in urine) may be present, but absence does not rule out (LR+, 1.4; LR–, 0.49)
45
Q

what investigations for nephrolithiasis

A

non contrast renal CT, urine culture, ph and stone analysis, serum calcium

46
Q

what is the most common type of kidney stone

A

calcium oxalate stones

47
Q

main causes of acute pancreatitis

A

80% is alcohol abuse and choledocholithiasis (obstruction of common bile duct(

20% of cases are idiopathic (undetermined cause), maybe due to microlithiasis or sphincter of oddi dysfunction

48
Q

symptoms of acute pancreatitis

A

Signs & Symptoms
* Low-grade fevers (< 38.3°C) are common (60%).
* Pain may radiate to the back (50%) and may be exacerbated
in the supine position.
* Nausea and vomiting are usually present (75%).
* Rebound is rare on presentation; guarding is common (50%).
* Periumbilical bruising (Cullen sign) is rare.
* Pancreatitis (and other diseases) can lead to retroperitoneal bleeding and flank bruising (Grey Turner sign), which is a rare but valuable clue if present.

49
Q

blood tests and imaging for acute pancreatitis

A

lipase, amylas, ALT or AST

transabdominal ultrasounds

50
Q

chronic pancreatitis

A

recurrent acute pancreatitis from alcohol Abuse 70%

51
Q

signs of chronic pancreatitis

A

Signs & Symptoms
* Chronic, disabling, mid-epigastric postprandial pain (80–100% of patients)
* Pain may radiate to the back and be relieved by sitting forward
* Abdominal bloating (30% of cases)
* Unintentional weight loss and diarrhea (68% of patients)
* Weight loss secondary to anorexia and malabsorption with steatorrhea

52
Q

stetorrhea

A
  • Manifestations include difficult to flush oily stools and weight loss
  • Floating stools are not specific for steatorrhea. Bacterial gas may also cause stools to float.
53
Q

diverticulitis vs diverticulosis

A
  • Acute inflammation of outpouching of large intestine = diverticulitis
  • Presence of outpouching = diverticulosis

itis= inflammation

54
Q

where is pain in diverticular disease

A

left lower quadrant

55
Q

signs of diverticular disease

A
  • Left lower quadrant tenderness: (LR+, 3.4; LR–, 0.41)
  • May present with fever (45% of cases)
56
Q

scan for diverticular disease

A

ct scan

57
Q

Potential complications of diverticulitis:

A

Potential complications of diverticulitis:
* Abscess
* Peritonitis
* Sepsis
* Colonic obstruction
* Fistula formation

58
Q

2 types of infalmmatory bowel disease

A

ulcerative colitis and crohns disease

59
Q

when to evaluate IBD and celiac disease

A

chronic diarrhea and ab pain

60
Q

potential causes of diarrhea

A

Potential causes of diarrhea
* Infectious
* Bacterial, viral, parasitic
* Antibiotic Side Effect
* Autoimmune/inflammatory
* Ulcerative colitis
* Crohn’s disease
* Celiac disease
* Endocrine
* Hyperthyroid
* Bile acid malabsorption
* Dietary
* Food intolerances
* Food sensitivities
* Functional GI conditions

61
Q

functional GI disorder

A
  • Disorders of the Gut-Brain Interaction (DGBI)
  • Limited abnormalities on diagnostic testing
  • Symptom clusters
  • Potential processes involved:
  • Impaired GI motility
  • Altered microbiome
  • Visceral hypersensitivity
  • Mucosal layer alterations
62
Q

what is the difference between functional diarrhea and constripation and IBS

A
  • IBS includes pain/visceral hypersensitivity, whereas FD and FC do not
  • In both cases there is no clear cause that can be reliably tested
63
Q

IBS ROME IV FCRITERIA

A

Recurrent abdominal pain on average at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
1. Related to defecation
2. Associated with a change in frequency of stool
3. Associated with a change in form (appearance) of stool
* Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

64
Q

britstol stool scale

A

1= constipated
4= normal
7= diarrhea

65
Q

IBS-C, IBS-D, IBS-M, IBS-U

A

IBS-C (Constipation dominant)
* >25% of bowel movements with Bristol stool types 1 and 2 and <25% Bristol stool charts type 6 or 7.
IBS-D (Diarrhea dominant)
* >25% of bowel movements with Bristol stool types 6 and 7 and <25% Bristol stool charts type 1 or 2.
IBS-M (Mixed)
* >25% of bowel movements with Bristol stool types 1 and 2 and >25% Bristol stool charts type 6 or 7.
IBS-U (Unclassified)
* Patients who meet IBS criteria but whose bowel habits do not fall into the above categories.

66
Q

testing for IBS-D or functional diarrhea

A

CBC, CRP, celiac disease

fecal calprotectin (to exclude IBD)

colonoscopy if >50 yrs +alarm features

SeHCAT for bile acid diarrhea

67
Q

alarm features in IBS-D

A

Alarm features:
* Unintentional weight loss
* Nocturnal diarrhea
* Tenesmus
* Passing of bright red blood in stool (haematochezia)
* High‐volume diarrhea, or very high number of bowel movements
* Suspicion of malnutrition
* Family history of colorectal cancer

68
Q

SIBO testing in IBS-D or functional diarrhea

A

recommend against SIBO testing unless predisposing conditions (e.g. gastrointestinalmotility diseases, gastrointestinal anatomical abnormalities, hypochlorhydria, various immune deficiency conditions, signs of malabsorption).

also recommend against microbiota (stool tests)

69
Q

chronic constipation epidemiology

A
  • More prevalent in females than males
  • Prevalence increases with age
  • Genetic predisposition
70
Q

chronic/ functional constipation vs IBS- C

A

symptoms with absence of pain/visceral hypersensitivity

71
Q

things to look for in digital rectal exam that can cause constipation

A

detect stool in the rectal vault, anorectal masses, hemorrhoids, anal fissures, rectal prolapse, and rectoceles that may cause constipation

72
Q

rome IV criteria in functional constripation

A
  • Straining with bowel movement
  • Hard stools (Bristol 1‐2)
  • Sensation of incomplete evacuation
  • Sensation of anorectal obstruction
  • Need for manual maneuvers to facilitate evacuation
  • Less than 3 spontaneous bowel movements per week *present in 25% of bowel movements (ESNM 2022) *NB: absence of abdominal pain
73
Q

red flag/ alarms in constipation

A
  • Blood in stool
  • Weight loss
  • Anemia
  • Family history of colon cancer, celiac disease or inflammatory bowel disease
  • Acute onset at age older than 50
  • Significant pain
  • Vomiting, especially if recurrent
  • Fever
74
Q

prognosis of IBS

A
  • Not at increased risk for colorectal cancer
  • Small increased risk of developing celiac and IBD 5 years
    post-diagnosis
  • Quality of life an important factor to consider
75
Q

labs for IBS

A

IgG food sensitiivity
SIBO testing

76
Q

SIBO risk factors

A
  • Dysmotility (impaired motility of small intestine)
  • Proton Pump Inhibitor (PPI) use
  • Surgeries (gastric bypass)
  • Conditions reducing acid secretion (H. pylori e.g.)
  • Connective tissue disorders (Not significant based on Bohm 2020 study)
77
Q

SIBO signs and symptoms

A

diarrhea, ab pain, bloating
maybe asymptomatic

  • Diarrhea and/or constipation
  • Esophageal reflux
  • Dyspepsia
  • Belching and/or flatulence
  • Nausea
  • Fatigue
78
Q

does the lactulose breath test or glucose breath test for SIBO have a higher LR+

A

glucose; LR+ 3.24

79
Q

testing for SIBO

A

-duodenal aspirate via endoscopy (accurate, but lack standardization and expensive)
-lactulose breath test Lr+ 1.43
-glucose breath test LR+ 3.24

80
Q

allergy vs intolerance vs delayed sensitivity

A
  • Allergy
  • IgE mediated (Type I reaction)
  • Short reaction time (minutes to hours) * Sxs: Anaphylaxis, urticaria, vomiting
  • Intolerance
  • Lacking enzyme for digestion (lactose e.g.)
  • Sxs: abdominal bloating, gas, diarrhea, constipation…
  • Delayed sensitivity
  • IgG-mediated?
  • Delayed reaction: up to 72 hours * Symptoms are varied
81
Q

immunoglobulins in allergy vs delayed sensitivity

A

allergy- IgE
sensitivity- IgG

82
Q

intolerance= lack __

A

enzyme

83
Q

Do IgG antibody levels correspond to symptoms?

A

“In the light of current scientific knowledge, the IgG-specific antibody-mediated reactions are a body’s natural and normal defensive reactions to infiltrating food antigens, which are considered as pathogens. On the other hand, specific IgG antibodies against food allergens play a crucial role in the induction and maintaining of immunological tolerance to food antigens”

84
Q

elimination diets based on IgG and IBS

A

see some benefits in IBS, quality of life, headaches,

85
Q

food sensitivity testing

A
  • Lack of published research to suggest a clear association between elevated serum IgG levels and clinical symptoms
  • Mixed data suggests some improvement in IBS (and other) symptoms following an IgG-based elimination diet
  • However:
  • Studies are few and sample sizes are generally small
  • Symptom improvements may be due to elimination of commonly aggravating foods in IBS, such as dairy and wheat (Hunter 2005)
86
Q

pathogenesis of pain, gut brain axis and psychosocial factors

A
  • Chronic Disorders of Gut-Brain Interaction pain is real
  • Pain is perceived from sensory signals that are processed and
    modulated in the brain
  • Peripheral factors can drive increased pain
  • Pain is modifiable
87
Q

patient dialogue around testing and treatment of IBS

A

“Phrase the diagnosis as “You have IBS”. This use of qualified language increases patient acceptance, reduces apprehension, and provides a framework to build upon for treatment recommendations, medication adherence, and a positive patient- provider relationship.

  • Set shared goals and expectations for pain management
  • “Phrase the diagnosis as “You have IBS” instead of “We think
    you have IBS”.
  • This use of qualified language increases patient acceptance, reduces apprehension, and provides a framework to build upon for treatment recommendations, medication adherence, and a positive patient-provider relationship

CMS150 final (wk 9-14) (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions