Week 10-GI Flashcards
When voiding is inconvenient, brain can inhibit what?
Detrusor muscle
Odynophagia is:
Painful swallowing
Type of pain that is gnawing, burning, cramping, or aching:
Visceral pain
This occurs when hollow organs contract forcefully or are distended or stretched, or when the capsules of solid organs are stretched; can also happen with ischemia
Visceral pain
This type of pain is a steady, aching, more severe than visceral type of pain that occurs from inflammation of the parietal peritoneum (peritonitis); it is aggravated by coughing or moving, patients prefer to lie still
Parietal pain
This type of pain that is felt at more distant sites which are innervated at approximately the same spinal levels as the disordered structures.
Referred pain
Visceral pain in the RUQ suggests:
Liver distention against its capsule (hepatitis)
Visceral periumbilical pain suggests ____ then becomes ______ in the RLQ from inflammation of the parietal peritoneum
Early appendicitis from distention of the Inflamed appendix
Parietal pain
Referred pain to the ___ from pancreatic or duodenal origin.
Back
Referred pain from the Biliary tree to the :
Right scapular region or the right posterior thorax
Referred pain from pleurisy or inferior wall myocardial infarction to the ____.
Epigastric area
Sensitivity of pain increases or decreases in older adults?
Decreased
Colicky acute upper abdominal pain:
Renal stone
Sudden knife-like epigastric pain:
Pancreatitis
Epigastric pain:
GERD, pancreatitis, and perforated ulcers
RUQ/upper abdominal pain:
Cholecystitis and cholangitis
Pain precipitated by exertion consider:
CAD
Chronic, recurrent upper abdominal pain:
Dyspepsia
Negative feeling that is not painful:
Discomfort
3 month history of nonspecific upper abdominal discomfort or nausea not attributable to structural abnormalities or PUD.
Functional (non-ulcer) dyspepsia
Dysphagia, odynophagia, recurrent vomiting, evidence of GI bleed, early satiety, weight loss, anemia, rial factors for GI cancer, palpable mass, painless jaundice are all
Alarm symptoms in chronic upper abdominal discomfort/pain
Postprandial fullness, early satiety, epigastric pain/burning are symptoms of:
Dyspepsia
RLQ pain that migrates from periumbilical area plus abdominal wall rigidity is suspicious for:
Appendicitis
RLQ pain in women consider:
PID, ruptured ovarian cysts, ectopic pregnancy
LLQ pain plus palpable mass:
Diverticulitis
Diffuse abdominal pain, distention, hyperactive high-pitched bowel sounds and tenderness on palpation:
Small or large bowel obstruction
Pain, absent bowel sounds, rigidity, percussion tenderness, and guarding:
Peritonitis
Change in bowel habits with mass:
Colon cancer
Pain for 12 weeks in preceding 12 months, relief with defecation, change in frequency of bowel movements, change in form of stool:
IBS
Nocturnal diarrhea is usually:
Pathologic
Grey or light colored stools are called __ and are caused by ___?
Acholic stools
Obstructive jaundice
Acholic Stools with itchy skin consider:
Hepatitis A, B, C, alcoholic, toxic liver damage from meds/toxins, gallbladder disease or surgery
Melena is___
Black, tarry stool less than 100 ml blood from upper GI bleed
Red or maroon colored stool greater than 100 ml of blood with lower GI bleed:
Hematochezia
Feeling as if one cannot evacuate all the stool present:
Tenesmus
Suprapubic pain indicates:
Bladder disorder
Dysuria in women presents as:
Internal urethral discomfort or external across inflamed urethra
Dysuria in men presents as:
Proximal to glans penis, prostatic pain- in the Perineum and across the rectum
Increase in urine volume in 24 hour period (>3L)
Polyuria
Polyuria causes:
Psychogenic polydipsia, poorly controlled diabetes, decreased secretion of ADH of central DI
Increased abdominal pressure causes bladder pressure to exceed urethral resistance (usually poor sphincter tone or poor support of bladder).
Stress incontinence
Urgency is followed by involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance.
Urge incontinence
Neurological disorder or anatomic obstruction from pelvic organs or the prostrate limit bladder emptying until the bladder becomes over distended.
Overflow incontinence
Combined incontinence is:
Stress and urge
Functional incontinence is caused by:
Impaired cognition, MSK problems, immobility
Screen all patients for alcohol abuse T/F?
True
HAV is spread by:
Fecal/ oral transmission prevented with hand washing and bleach
HAV does or does not become chronic?
Does not
HBV is transmitted:
Sexual, percutaneous, mucosal transmission
HBV can or cannot become chronic?
Can
HCV transmission:
Percutaneous, blood or organ transplant before 1992, clotting factors before 1987, hemodialysis, healthcare workers with needle stick injury, birth to HSV positive mother.
Chronic Illness occurs in what present of those infected with HCV?
75%
Risk factors for colorectal cancer:
Increasing age, personal history, polyps, long-standing IBD, family hx. Weak- male, AA, tobacco use, excessive alcohol use, red meat consumption, obesity
When to start screening for colorectal cancer?
Adults 50-75
How to screen for colorectal cancer?
- ) high sensitivity FOBT annually
- ) sigmoidoscopy every 5 years with FOBT q3yrs
- ) screening colonoscopy every 10 years
Normal bowel sounds:
Clicks and gurgles, 5-34 per minute
Rumbling bowel sounds:
Borborygmi
These bowel sounds suggest vascular occlusive diagnosis:
Bruits
If patient has HTN where should one auscultate in the abdominal?
Epigastrum and CVAs for renal artery stenosis
Aorta, iliac arteries and femoral arteries
These bowel sounds are found over the liver and spleen and are present in hepatoma, gonococcal infection around the liver, splenic infarction, and pancreatic carcinoma.
Friction rubs
These bowel sounds are a soft humming with both systolic and diastolic component and indicate collateral circulation between the portal and systemic venous systems (hepatic cirrhosis)
Venous hums
Tympanic areas with percussion in the abdomen indicate:
Air/gas
Dull areas with percussion of the abdomen indicate:
Mass or enlarged organ
On inspiration, liver is palpable about __ below the right costal margin.
3cm
If dullness is present over spleen this indicates:
Splenomegaly in 80% of patients
This is when you percuss the lowest interspace- should be tympanic and should remain tympanic even with deep breath.
Splenic percussion sign
Left hand behind and press forward, right hand below costal margin, press toward spleen:
Palapation for splenic edge
CVA tenderness indicates:
Pyelonephritis/MSK
Enlarged kidney caused by:
Hydronephrosis, cysts, tumors, polycystic kidney dz(bilateral)
Aortic span should not be over:
3cm in adults of 50
Ultrasound of the aorta is recommended for:
Men over 65 who have ever smoked
Protuberant abdomen with bulging flanks:
Ascites, happens commonly with cirrhosis
How to test for shifting dullness in abdomen?
Supine and then on side, without ascites border should stay the same
How to test for a fluid wave in the abdomen?
Have someone push midline, tap on one flank sharply and feel opposite flank for an impulse
Tests for appendicitis:
Mcburney point Rovsing sign Psoas sign Obturator sign Rectal exam and pelvic in women
When you press deeply into LLQ and assess for withdrawal pain?
Rovsing sign
When you raise thigh against resistance or turn to left side and extend the right leg at the hip?
Psoas sign
When you flex right thigh at hip and internally rotate hip?
Obturator
When the patient exhales and the examiner places hand below costal margin on the right side at the mid-clavicular line and then the patient inspires. If the patient stops breathing in and winces with a catch in breath this is a:
Positive Murphy’s sign
A positive Murphy’s sign indicates:
Acute cholecystitis due to an inflamed gallbladder being palpated as it descends on inspiration
Ventral hernia:
Diastasis recti: 2-3 cm gap in rectus muscles
These are detectable by a few weeks of age and disappear by 1 year, nearly all by 5:
Umbilical hernias
A midline ridge that resolves during early childhood:
Diastasis recti
These are generally easily palpated in newborns/infants?
Spleen and liver
In peds a silent, tympanic, distended and tender abdomen suggests:
Peritonitis
Abnormal palpation findings in peds:
Hydronephrosis (enlarged kidney)
Deep palpation in RUQ olive size firm pyloric mass (May have visible peristaltic waves followed by projectile vomiting)- pyloric stenosis
Patient with peritonitis May present with:
Guarding, rigidity, rebound tenderness
This is voluntary contraction of the abdominal wall often with grimace:
Guarding
Involuntary reflex contraction of the ab wall from peritoneal inflammation:
Rigidity
Kidney pain is an example of what type of pain?
Visceral
Appendicitis typically presents with pain in what area?
Periumbilical migrating to RLQ
