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Flashcards in Adult - GI II Deck (41):
1

inflammation or localized perforation of diverticula with abcess formation

diverticulitis

2

diverticulitis - more common in men or women

women

3

Typical location of pain of diverticulitis?

LLQ

4

Signs and symptoms of diverticulitis? (3)

LLQ pain
low grade fever
nausea, vomiting
constipation or loose stools

5

What is a potentially significant complication of diverticulitis?

bowel perforation --> peritonitis --> acute abdomen

6

What test rules out perforation of the bowel?

plain abdominal films

+ for perforation if free air under diapragm

7

What might lab work show in diverticulitis?

leukocytosis
elevated ESR

8

Management of diverticulitis (2)

patient may be NPO
may refer to GI

9

What is the cause of irritable bowel syndrome?

etiology is unknown but there is a stress theory

10

Irritable bowel syndrome - more common in men or women

women

11

What are the signs and symptoms of irritable bowel syndrome? (4)

abdominal cramping relieved by defecation
preoccupation with symptoms
fatigue
anxiety or depression

12

Management of irritable bowel syndrome (3)

emotional support
high fiber diet
SSRIs

13

What can be used in severe cases of irritable bowel syndrome? (2)

anticholinergics
antidiarrheals

14

what often precipitates cholecystitis?

a large or fatty meal

15

What is the typical pain of cholecystitis?

steady, severe pain in RUQ

16

What is classic *SIGN* for cholecystitis?

Murphy's sign - pain on INspiration when fingers placed under the R rib cage

17

What is the gold standard for cholecystitis evaluation?

ultrasound

18

What is the management for cholecystitis? (6)

Refer for:
pain management
NG tube for gastric decompression
IV crystalloids
broad spectrum ABT
GI and surgical consult

19

Possible causes of bowel obstruction (6)

tumor
hernia
fecal impaction
adhesions
volvulus - in children - twisting/malrotation of bowel
ileus (functional obstruction)

20

Vomiting with minutes of pain indicates what about the location of the obstruction?

proximal location

21

More marked distention indicates what about the location of the obstruction?

distal location

22

Bowel sounds of obstruction?

high-pitched tinkling...going around the obstruction

23

Bowel sounds of perforation?

quiet....ominous

24

Patient with obstruction will tell you what about their stool or gas?

"unable to even pass gas"

25

What will plain abdominal films show in obstruction?

dilated loops of bowel
and
air-fluid levels

26

What does management include in obstruction? (5)

Refer for:
NG tube
broad spectrum ABT
fluid resuscitation
GI - surgical consult

27

What is hallmark symptom of ulcerative colitis?

bloody diarrhea

28

What test establishes the diagnosis of ulcerative colitis?

sigmoidoscopy

29

What factors are associated with increased risk of colon cancer?

family history of colon cancer or other adenocarcinomas
inflammatory bowel disease
polyps
high fat diet
refined carb diet

30

What are common early symptoms of colon cancer?

None - often asymptomatic in early stage

31

What are late symptoms of colon cancer?

changes in bowel habits
thin stools
weight loss

32

What is the marker for colon cancer?

CEA - carcinoembryonic antigen
nonsmokers < 2.5 ng/mL
smoker < 5 ng/mL

33

Who presents most commonly with appendicitis?

men 18 - 30 years old

34

What are possible triggers for appendicitis?

fecalith - food bits like diverticulitis
neoplasm (rarely)

35

Early pain of appendicitis?

vague, colicky umbilical pain

36

Late pain of appendicitis?

RLQ

37

Psoas sign

pain with R thigh extension

+ appendicitis

38

Obturator sign

pain with R thigh internal rotation


+ appendicitis

39

Rovsing's sign

RLQ pain when LLQ is pressed

+ appendicitis

40

Is frequent vomiting associated with appendicitis?

no - more than one or two episodes suggests a different diagnosis

41

What imaging studies are diagnostic of appendicitis?

CT or ultrasound