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Flashcards in Abdo pain and diarrhea high yield Deck (35)
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1
Q

____ is the principal signal in the ENS

A

Mechanical stretch

2
Q

C fibers are ____ and mainly responsible for; A delta fibers are ____ and responsible for

A

unmyelinated; transmission of visceral sensation;

small and myelinated, parietal pain transmission

3
Q

Descending fibers modulating pain are

A

predominantly inhibitory; can project on dorsal horn and modify or control the afferent input from the gut

4
Q

Referred pain:

A

visceral afferent neurons and somatic afferent neurons converge on second order neurons in spinal cord (central convergence)

5
Q

Hyperalgesia and allodynia come about from; hyperalgesia often accompanied by

A

sensitization of secondary neurons from chronic visceral impulses;
spasm

6
Q

Kehr’s sign:

A

subdiaphragmatic irritation-ipsilateral shoulder or supraclavicular pain

7
Q

Carnett Test:

A

Ask patient to raise head and tense the abdo musculature; if greater tenderness on repeat palpation, test is positive and suggests abdo wall pathology

8
Q

Hypoactive/absent bowel sounds are;

Hyperactive is

A

peritonitis;

enteritis, colitis, early part of obstruction

9
Q

Peptic ulcer:

A
  1. epigastric, can radiate to BACK
  2. gnawing, burning
  3. gastric: food can aggravate it
  4. duodenal: nocturnal, relieved by eating
10
Q

Pancreatitis:

A
  1. epigastric, can radiate to back
  2. deep boring, severe, longer lasting than peptic ulcer
  3. meals aggravate
  4. relived by sitting UPRIGHT
  5. N/V usually positive
11
Q

Obstruction of hollow viscera described as

A

colicky pain (small bowel obstruction either supra or periumbilical; chronic obstruction infraumbilical with lumbar rad)

12
Q

Intestinal angia:

A
  1. post prandial (not enough blood flow to meet mesenteric visceral demands)
  2. sitophobia (aversion to food)
  3. tenesmus
  4. frequent and often painful inclination to evacuate bowels with feeling of incomplete evacuation
13
Q

Biliary pain:

A

referred pain in right infrascapular region; (Boa’s sign with hyperesthesia in right infrascapular region) with ongoing inflamm, becomes more localized in RUQ;
acute cholecystitis with pos Murphy’s sign

14
Q

Hepatic pain can be caused by; splenic pain can be caused by

A

stretching of Glisson capsule;

stretching of capsule or splenic infarct (sickle cell)

15
Q

Appendicitis:

A

symptoms are pain, anorexia, nausea, tenderness (PANT); initially periumbilical and then becomes more localized in RLQ

16
Q

In young female with acute abdo pain;

with upper abdo pain,

A

rule out ectopic pregnancy;

keep cardiac and respiratory differentials in mind

17
Q

Median arcuate ligament syndrome (MALS)/Celiac artery compression syndrome

A

Here, ligament is anterior, leading to compression and irritation of celiac ganglion;
bruit in epigastric region and can have pain after eating

18
Q

IBS:

A

recurrent abdo pain or discomfort greater than 3 days/mo in last 3 mos with 2 or more of improvement with defecation, onset associated with change in frequency/form of stool

19
Q

Thera approach for abdo pain:

A

opiates, NSAIDs, topical like lidocaine patch or injections;

TCA’s, anticonvulsants, baclofen

20
Q

Secretion occurs primarily in; absorption in

A

crypts;

apical epi cells

21
Q

Two key components in colon ion transport mechs:

A

electroneutral NaCl absorption, and electrogenic Na absorption

22
Q

Short chain fatty acids absorbed in colon by

A

diffusion or anion exchange; BUTYRATE the preferred energy source for colonocytes

23
Q

Some NT’s released by enteric neurons:

A

VIP and ACh (both can stim epi cells to secrete Cl)

24
Q

Acute diarrhea is; chronic diarrhea is

A

less than 4 wks; greater than 4 weeks (if chronic, unlikely infectious)

25
Q

Osmotic diarrhea:

A

Increased osmotic load, no component of increased secretion; think maldigestion and malabsorption syndromes with no nocturnal episodes

26
Q

What two numbers can tell you secretory vs. osmotic diarrhea?

A

Sec: stool osmolar gap less than 50, stool Na over 90; could see nocturnal episodes
Osmotic: over 125, less than 60

27
Q

Two examples of osmotic diarrhea; also includes:

A
  1. Cholestasis
  2. Pancreatic insufficiency;
    celiac disease, lactose intolerance, infections;
    lactulose, miralax, acarbose, colchicine, PEG
28
Q

Intestinal secretory mechs:

A

Electroneutral: Cl/bicarb exchanger at apical membrane;
electrogenic mech: through CFTR channels;
bicarb secretion most prominent at prox duodenum

29
Q

Bile salt diarrhea induces

A

secretory diarrhea, or fat malabsorption and steatorrhea (former with normal serum bile acids and high fecal bile acids; latter with low serum bile acids and low fecal bile acids, with stool having fat)

30
Q

What can cause secretory diarrhea?

A

Lubiprostone (activates Cl channel), linaclotide (cGMP mediated activation of CFTR channels)

31
Q

Inflamm diarrhea:

A

secretion/reabsorption balance affected (toxin-mediated with cytotoxins with abdo pain and can be watery with occasionally bloody diarrhea, enteroadherent, invasive)

32
Q

V cholera with

A

cAMP mediated toxin action (increases Cl channel secretion)

33
Q

Enterohemorrhagic E coli: what is contraindicated?

A

Antibiotics

34
Q

Spurious diarrhea

A

most common cause of diarrhea in practice

35
Q

For treatment of diarrhea, think

A

rehydration as the priority (oral as good as IV);
maybe antimotility agents like loperamide (opiate with high first pass effect);
adsorbents like bismuth that can bind enterotoxins;
antibiotics shouldn’t be used with EHEC