3] GI, Hepatic And Biliary System

Question 1

GI disease can also appear to be

Answer 1

MSK disease

Question 2

What is GI disease?

Answer 2

Ulceration of mucosal lining of GI tract

Question 3

Primary GI pain pattern

Answer 3

Epigastric
Periumbilical
Lower abdomen (hypogastric)

Question 4

What’s th epigastric region

Answer 4

Midsternum to xiphoid process

Question 5

Where does pain in epigastric regions adiare

Answer 5

Around ribs or straight through chest

Question 6

Structures in the epigastric region

Answer 6

Stomach
Esophagus
Duodenum
Pancreas

Question 7

Innervation of epigastric region

Answer 7

T3-T5 sympathetic

Question 8

DDx of epigastric region

Answer 8

HEart
Liver
Gallbladder

Question 9

Structures in periumbilical region

Answer 9

Small intestine
Pancreas
Appendix
Proximal colon

Question 10

Innervation of periumbilical region

Answer 10

T9 - T 11 sympathetic

Question 11

Lower ab region structures

Answer 11

Large intestine

Colon

Question 12

Innervation of Lower ab

Answer 12

T10 - L 2 sympathetic

Question 13

DDx for lower ab region

Answer 13

Bladder

Uterus

Question 14

Dermatomes associated with nerve roots innervating organs

Answer 14

Referred GI pain

Question 15

Associated signs and sx for GI

Answer 15

Melena
Dysphagia
Etc

Question 16

NMS signs and Sx

Answer 16

Paresthesias in UE, B&B signs, etc

Question 17

Primary pain pattern for GI

Answer 17

Epigastric
Periumbilical
Lower ab
Chest

Question 18

Referred pain pattern

Answer 18

Dermatomes of nerve roots associated with levels innervating diseased organs OR those having pressure/tension applied to them

Question 19

Mid back, low back, shoulder, peri-scapular

Answer 19

Referred pain pattern for GI disease

Question 20

With the GI system there is referred pain to…

Answer 20

MS system at the same level

Question 21

Quality of visceral pain

Answer 21

Deep ache
Boring
Burning
Cramping
Gnawing

Question 22

Associated signs and symptoms with GI

Answer 22

Dysphagia
Odynophagia
Bleeding (melena)

Question 23

What is the Kehrs sign

Answer 23

Referred pain when you place pressure on upper abdomen

Question 24

3 special tests for appendicitis

Answer 24

Rebound tenderness
Rovsings sign
Pinch an inch test

Question 25

Rebound tenderness

Answer 25

Pain happens after you let go. | RLQ

Question 26

Rovsings sign

Answer 26

+ is palpation of the LLQ of abs increases the pain felt in the RLQ

Question 27

Pinch an inch test

Answer 27

McBurney’s point | + pain with release

Question 28

What is McBurney’s point

Answer 28

1/3 from ASIS to umbilical (where appendix is)

Question 29

Possible extension of infection into peritoneum, kidneys, lumbar IVD or vertebra

Answer 29

Iliopsoas abscess

Question 30

4 tests for Iliopsoas abscess

Answer 30

Heel tap Hop test Iliopsoas uscle test- active SLR Palpation at appendix

Question 31

3rd most common CA

Answer 31

Colorectal cancer

Question 32

Colorectal cancer is more common in?

Answer 32

Males | Older age

Question 33

Action of NSAIDs

Answer 33

Analgesic, anti-inflammatory, antipyretic, antithrombotic

Question 34

Adverse drug reaction of NSAIDs

Answer 34

GI bleed, may lead to death

Question 35

Other adverse rxns of NSAIDs

Answer 35

``` Renal toxicity Increased BP CNS problems Hepatoxicity CV ```

Question 36

Signs and Sx of using NSAIDS

Answer 36

Indigestion Increased BP Tinnitus

Question 37

Risk factors of NSAID induced gastric ulceration

Answer 37

More than 65 years | Corticosteroid, anticoagulant, antidepressant use

Question 38

Hepatic means

Answer 38

Liver

Question 39

Innervation of liver

Answer 39

T5 - T 11 ANS

Question 40

Primary location

Answer 40

Midepigastrium or RUQ

Question 41

Referred pain location of hepatic disease

Answer 41

T7-T10 | R shoulder and upper trap

Question 42

#1 cause of sudden liver failure in the USA

Answer 42

Non-viral drug induced hepatitis

Question 43

Innervation of gall bladder for biliary disease

Answer 43

T5-T11 ANS

Question 44

Location of bile duct/gallbladder

Answer 44

RUQ

Question 45

Referred pain of biliary disease or gallbladder

Answer 45

``` R shoulder, upper trap R interscapular (T4-T8) and R subscap ```

Question 46

Cholelithiasis

Answer 46

Presence or formation of gall stones

Question 47

Blockage or cystic duct by gallstones

Answer 47

Cholecystitis

Question 48

Additional Sx of hepatic and biliary disease

Answer 48

Rhabdomyolysis Joint aches NM Sx

Question 49

Liver flap

Answer 49

Asterixis

Question 50

How do you do asterixis?

Answer 50

Pt raises arm to 90 flex, elbows ext and forearms pronated —> add wrist ext with finger ext and ABD and observe for any large amplitude tremors at the wrist (flapping)

Question 51

Signs of hepatic and biliary disease

Answer 51

Skin and nail changes, asterixis, referred shoulder pain, ascites, cholecystitis test

Question 52

Gallbladder special test

Answer 52

Murphys sign

Question 53

What does Murphy’s sign indicate

Answer 53

Cholecystitis

Question 54

How do you perform Murphy’s sign?

Answer 54

Hook fingers under lower R costal border. Ask pt to take a deep breath in, palpate liver and ask about pain while watching the face

Question 55

Risk factors for ADRs

Answer 55

``` More than 65 years old Polypharmacy Hyperpharmacotherapy Alcohol Small Women ```