CA-lecture facts Flashcards Preview

Module 9: Mali: GI > CA-lecture facts > Flashcards

Flashcards in CA-lecture facts Deck (139):
1

what are GI complaints difficult to evaluate? 3

1. frequently benign

2. often nonspecific

3. occasionally serious

2

what are the majority of visits to the ED for?

stomach and abdominal pain, cramps, or spasms

3

what is often required to make a specific diagnosis for abdominal complaints?

imaging

4

what drives the evaluation of pain?

location

5

what do the pain receptors in the abdomen respond to?

4

2

1. mechanical stimuli-stretch, distention, traction, compression torsion

 

2. chemical stimuli-inflammation or ischemia

6

what are the 3 types of pain?

1. visceral

2. parietal

3. referred

7

visceral pain

dull, aching, can be colicky, poorly localized and arises from distention of hollow organs

 

ex: bowel obstruction

8

parietal pain

sharp, very well localized

 

arises from paritoneal irritation

 

Ex: appendicitis

9

refferred pain

aching, perceived to be near body surface

 

EX: cholecystitis referred to right scapula

10

what is the key to formulating the dif Diagosis list?

location of the pain is KEY!!!!

 

so have them point to the area that hurts

11

what are the 5 organs in RUQ?

1. liver/gallbladder

2. pylorus/duodenum

3. head of pancreus

4. ascending/transverse colon

5. right kidney/adrenal

12

what are 5 organs in the right lower quadrant?

1. right kidney/ureter

2. cencum/appendix

3. ovary/fallopian tube

4. spermatic cord

5. uterus/bladder

13

what are 6 organs in the upper left quadrant?

1. liver (left lobe)

2. spleen

3. stomach

4. body of pancreus

5. descending/transverse colon

6. left kidney/adrenal

14

what are the 5 organs in the LLQ?

1. left kidney and ureter

2. sigmoid/descending colon

3. ovary/fallopian tube

4. spermatic cord

5. uterus/bladder (if enlarged)

15

what are 2 key things that can be reasons for pain in the left upper quadrant?

 

1. myocardial infarction

2. splenic rupture

16

what is 1 key thing that can appear in the RLQ?

1. ectopic pregnancy

2. appendicitis (starts periumbilically)

17

what is 1 important thing that can appeare in the left lower quadrant?

1. ectropic pregnancy

2. diveriticularis can be midline too

18

what are 4 things tht can appeare as epigastric pain?

1. myocardial infarction

2. reptured aortic aneurysm

3. esophagitis

4. PUD

19

what is 1 imporant thing you can see in the periumbilical area?

1. ruptured aortic aneurysm

20

what is 1 important thing that can be in the suprapubic area?

1. ectopic pregnancy

21

what are 2 important things that can cause diffuse pain?

1. mesenteric ischemia

2. peritonitis

22

what are 2 things that are key patterns for pain in RUQ?

1. cholecystitis

2. hepatitis

23

pain radiating to the back suggests...

pancreatitis

24

pain radiating to the R shoulder indicates....

cholecystitis

25

pain radiating to the groin suggests...

renal colic

26

steady, rapid increase in pain suggests...

pancreatitis

27

several days pf pain prior to presentations suggestsion

diverticulitis

28

sudden, abrupt onset, severe pain suggests...

appendix rupture

aortic dissection

29

buring or gnawing pain suggests....2

GERD

PUD

30

colicky may suggest....3

1. gastroenteritis

2. bowel obstruction

3. nephrolithiasis

31

high intensity pain could suggest....

biliary or renal colic

mesenteric infarcation

32

lower intensity pain coud suggest

gastroenteritis

33

pain with empy stomache

AND

pain relieved with eating could suggest

PUD

34

pain with any movement

AND

COUGH PAIN

AND

relief with lying on back and not moving could suggest.

peritonitis

35

pain worse with eating any fatty food could suggest...

cholecystitis

36

pain relieved with sitting up and leaning forward could suggest

pancreatitis

37

what do you need to exclude in all women of childbearing age presenting with abdominal pain?

PREGANCY!!

38

what are 3 vital signs that are important to note in abdominal complaints?

1. temp (infection)

2. HR

3. orthostatic BP (GI blood loss or dehydration)

39

what are 3 things that can cause increased 3rd spacing of fluid and intravascular volume depletion or overt shock?

1. bowel obstruction

2. peritonitis

3. bowel infarction

40

what do you want to look at the eyes for? 

scleral icterus

 

A image thumb
41

what do you look at the skin for? seen in?

jaundice

-hepatitis

-cholgangitis

42

how often do normal bowel sounds occur?

what do they sound like?

5-10 seconds

clicks and gurgles

43

 

how long should you listen for bowel sounds?

2 minutes!! must listen for this long to say that they have NO BOWEL SOUNDS

44

if high pitched bowel sounds...suspect

small bowel obstruction

45

what are 4 things that can cause decreased bowel sounds?

1. peritonitis

2. ileus

3. mesenteric

4. narcotic use

46

what are 2 things that can cause friction rub?

1. splenic infarction

2. hepatitic metastasis

47

what are 4 places you listen for bruits?

A image thumb
48

what are 6 organs that are usually not palpable?

1. stomach

2. spleen

3. gallbladder

4. duodenum

5. pancreas

6. kidneys

49

what are two things you should suspect if the pt has rebound tenderness "guarding"?

1. peritonitis

2. appendicitis

50

Q image thumb

spleen palpation

51

Q image thumb

kidney palpation

52

what are 4 tests you do for appendicitis?

1. McBurneys point

2. Rovsings sign

3. psoas sign

4. obturator sign

53

what is the test you do for gallbladder disease?

 murphys sigh

54

what are two tests you do for ascites?

Q image thumb

1. shifting dullness

2. fluid wave

55

Q image thumb

McBurneys point

for appendicitis

 

 

56

Q image thumb

rovsing's sign

appendicitis

 

if you deep press in RLQ and then lift up they haverebound pain as you lift up

57

Q image thumb

psoas sign

appendicitis

pain with pushing down

58

Q image thumb

obturator sign

appendicitis

pain with this motion

59

Q image thumb

murphys sign

gallbladder/cholecystitis

slide hand under right rib while breathing out and causes pain

60

Q image thumb

shifting dullness

ascites

A image thumb
61

Q image thumb

fluid wave

acities

push on one side and see if you feel wave on other side

62

what is this? 

caused by?

Q image thumb

caput medusa

varicose veins of the liver

63

spider angiomata

little telangestasis that is indicative of liver disease

64

what are 2 signs that are can be indicative of liver disease?

1. spider angiomata

2. caput medusa

65

***what do you need to consider in any patient over 50 years old with pain out of proportion to PE findings**

mesenteric ischemia

66

what are 5 conditions that are more common in elderly?

1. cholecystitis

2. diverticulitis

3. mesenteric ischemia

4. small bowel obstruction

5. ruptured aortic aneurysm

67

if woman has adnexal pathology, what should you think of?

1. ovarian cyst

2. torsion

3. neoplasm

68

when presentation would you consider for ectopic pregnancy?

vaginal bleeding 6-8 weeks after LMP

69

what are two things you need to do in all women of childbearing age who present with abdominal pain?

1. HCG

if postitive

2. transvaginal US

70

what is the HCG level know as the discriminatory zone that allows you to see gestational sac of the IUP on US?

1,500

71

what are 4 sxs other than pain that children can present with?

1. vomiting

2. fever

3. irritibaility

4. lethargy

72

what does stillness in a child indicate?

irritation of the peritoneum like appendicitis

73

what does writhing for a comfortable positions suggest in a child?

obstruction or renal colic

74

what are 2 symptomatic reliefs for abdominal pain?

1. opoid analgesia

2. antiemetics (zofran)

75

amylase

pacreatitis if lipase not avaliable

76

lipase 

pancreatitis

77

coagulation studies

GI bleeding

end stage liver dxs

coagulopathy

78

electrolytes

dehydration

metabolic disorder

79

glucose

diabetic ketoacidosis

pacreatitis

80

plain radiograph

3 indications

Q image thumb

flat and upright views

screening for obstruction "dilated looks of 

sigmoid volvus perforation (free air)

severe constapation

81

US

2 preferences

preferred for:

1. biliary tract-cholecystitis

2. GYN-ectopic pregnancy

82

CT

pros?

cons?

pros: sensitive and specific

cons: delay in surgery, radiation, cost and must check creatine with contrast

83

patients with unclear diagnosis at end of the visit shoud...

reevalation within 12 hours

and return if sxs change with increased pain, fever, vomiting, syncope, bleeding etc

84

what should you make sure to document?

pertinent negatives

85

what should you make sure to do for the radiologist?

provide clinical information

86

what are the majority of  abdominal plain view films?

AP view

87

on a xray, how dose gas appeare?

black

88

on a xray, how does fat appeare?

dark grey

89

on a xray, how dose soft tissue or fluid appeare?

light grey

90

on a xray how does bone/calcification appeare?

white

91

on a xray how does metal appear?

intense white

92

pelvic phelboliths is.....

calcificaiton within the mesentary

 

this is normal finding

93

what is wrong with this?

Q image thumb

the marking of L isn't right.....it was marked on the wrong side by looking at the anatomy (look at the heart and the somach)

94

how large is the diametere of the SI?

2.5-3 cm

95

how large is the diameter of the LI?

3-5 cm

96

what are 6 things you should look at when examining the bone?

Cortical Outline

Joint and Disc Space

Trabecular Pattern

General Bone Density

Lysis, Fracture, Sclerosis

Epiphyseal Lines

 

97

conventional CT scan

 

how are the scans taken?

what must patient do?

scan taken slice by slice

 

after each scan it stops and move to the next place

 

requires the pt to hold still without movement 

 

ON THE WAY OUT AS A MEHTOD FOR CT

98

spiral/helical CT

 

HOW ARE THE IMAGES TAKEN?

CONTINUOUS SCAN taken in spiral fashion

DUH, hence the name

 

MUCH FASTER PROCESS AND IMAGES ARE CONTINUOUS

 

REPLACING THE CONVENTIONAL CT SCANNERS

 

IT ROTATES AROUND THE PATIENT AND PRODUCES A BLOCK IMAGE IN ONLY A SECOND

99

housefield units

 

what are they?

scale?

allows radiologist to differntiate between different types of tissues on CT, measure of density

 

air-1000 units (minimum)

water=0

bone +1000

 

the numerical number allows the radiologist to determine the type of tissue/fluid it is

100

explain the difference between clotting blood and free running blood on a hemmorage using housefield units?

clotting: 45-70 HU

 

free: 20-45 HU

101

what are two rxns you worry about when giving contrast for CT? 

what is the new type less likely to do this?

anaphylaxsis-bronchospasm/laryngeal edema

renal failure

**injections can make patient feel warm, or even severe pain**

 

non-ionic options are less likely to cause severe allergic rxns but $$$

102

what is the insoluble powerd that is suspecnded in water that is used as a common radiocontrast for the gastrointestinal tract during CT? 

alternative?

barium sulfate

 

alternative: water soluble iodine

103

what can prevent the risk associated with giving contrast dye?

good hydration

104

what do you withhold before a CT scan?

metformin

 

**want to insure if person does get renal failure they don't have this in their system because it can cause a toxic accumlation if their kidneys can't filter it out**

LACTIC ACIDOSIS

105

when reading CT how should it be done?

head to toe

superficial to deep

106

Shifting dullness test to assess for ascites

 

After percussing border of tympany and dullness w/ patient supine, ask patient to turn onto one side then percuss and mark borders again  

 

In ascites, dullness shifts to the more dependent side, whereas tympany shifts to the top

107

Fluid wave test to assess for ascites  

Ask patient or assistant to press edges of both hands firmly down the midline of abdomen. While you tap one flank sharply w/ your fingertips, feel on the opposite flank for a “wave” transmitted through the fluid

 

An easily palpable “wave” suggests ascites

108

McBurney’s point

tenderness to assess for appendicitis

Find point (lies 2” from ASIS on an imaginary line drawn to umbilicus)

 

 

Positive if tender w/ guarding, rigidity and rebound tenderness

109

Rovsing’s sign

to assess for appendicitis

Press deeply and evenly in LLQ then quickly withdraw your fingers

 

Positive if pain in RLQ during left-sided pressure

110

Psoas sign

to assess for appendicitis

Place hand just above patient’s right knee and ask patient to raise thigh against your hand

 

Positive if pain increases

111

Obturator sign

to assess for appendicitis

Flex patient’s right thigh at hip, w/ knee bent, and rotate leg internally at hip (swing lower leg laterally)

 

Positive if right-sided pain

112

Murphy’s sign

to assess for acute cholecystitis

Hook your left thumb or fingers of your right hand under costal margin of RUQ and ask patient to take deep breath

 

Positive if sharp increase in pain w/ sudden stop in inspiratory effort or wincing. Less pronounced pain may indicate liver inflammation

113

Ventral hernia assessment

(umbilical or incisional)

Ask patient to raise the head and shoulders off the table

 

Bulge of hernia will usually appear

114

Mass in abdominal wall assessment

Ask patient either to raise the head and shoulders off the table or bear down

 

Mass in abdominal wall remains palpable

 

115

what are the four liver enzymes you check for liver function?

Q image thumb

1. aspartate aminotransferase (AST)

2. alanine aminotransferase (ALT)

3. gamma-glutamyl transpeptidase (GGT)

4. alkaline phosphatase

A image thumb
116

what are the 3 things you check for liver function?

Q image thumb

1. albumin

2. bilirubin, total and direct

3. prothrombin time

A image thumb
117

what would you expect to see for LFTs with hepatocellular damage? 2 examples?

increased ALT/AST

increased alkaline phosphate

118

what would you expect to see on LFTs with cholestasis?

increases ALT/AST, increase alkphos

119

what would you expect to see for labs with jaundice?

increased total bilirubin...but can't differentiate wb etween hepatocellular damage or cholestasis

120

what does low albumin suggest?

chronic procress

121

what does a prolonged PT/INR suggest?

significant hepatocellular damage

122

what should these values of AST to ALT ratios make you think of?

AST:ALT

2:1 ...

4x greater

25x normal

50x normal

 

2:1  alcohol liver disease, cirrohosis

 

x4 greater nonalchoholic fatty liver disease

 

25x greater hepatitis, toxin related

 

50x greater ischemic hepatopathy

123

unconjugated indirect Bilirubin

 

how is this produced?

2 things cause increase?

3 sxs?

a product of RBC break down when the cell dies, naturally or not naturally

 

if increased:

1. hemolytic anemia

2. imparied bilirubin uptake and storage

 

S&S:

1. mild jaundice

2. stool and urine abnormal

3. splenomegaly (in hemolysis)

A image thumb
124

conjugated direct bilirubin

 

where is this made?

what do increased levels come from?

3 S&S?

 

becomes conjugated in the liver

 

if this accumulates i nthe blood it means tha:

1. liver isn't functioning

2. billiary obsruction causing it to backup into blood

 

S&S

1. jaundice, pruritis

2. dark urine, light colored stool

3. RUQ pain (hepatomegaly)

125

inclass activity:

bowel obstruction

 

2 key word findings

imaging 1st and second

Q image thumb

dilated loops of bowel on xray standing and supine

**air fluid levels on xray**

 

if need surgery, do ct

A image thumb
126

mesenteric ischemia

 

 

when does pain occur?

3 KEY FINDINGS

TEST 

1. worst 10-30 mins after eating with pain out of proportion to exam

 

TEST: CT ANGIOGRAM

**focal and segmental bowel wall thickening with gas infiltration into the liver**

A image thumb
127

cholecystitis 

IN CLASS

 

3 tests to check/order

Tests:

1. CBC

2. MURPHYS SIGN with guarding

 

 

test- color flow US

stones (doppler)

A image thumb
128

acute cholangitis

 

 

4 tests to check?

how to tx?

Tests:

1. CBC

2. LFT hyperbilirubin

3. increase alkaline phosphatase

4.2 blood cultures

 

 

ECRP for DX and TX

A image thumb
129

what is the earliest indicator of acute infection for hepatits B?

hepatitis B surface antigen

130

when does hepatitis A IgM antibody typically develop?

2-3 weeks after being infected

131

when is a unique time hepatitis B IgM core antibody can occur, outside of initial infection

in hepatitis flares in people with chronic hep B

132

what is important to keep in mind regarding the hepatitis C antibody?

you can't distinguish between active or previous infection

133

hepatitis

 

test you want to check? 1 finding?

2 sxs?

hepatitis panel

 

LFTs in 1,000s

jaudice

itchy

 

check glucose

134

PUD

 

how to describe the pain?

3 tests, which absolute?

urease breath test

fecal stool antigen

endoscopy NEEDED

 

BURNING OR GNAWING

A image thumb
135

how do you test for H. pylori if there is no acute bleed?

1. upper endoscopy with bx

 

others;

urease breth test

fecal stool antigen

136

how do you test for H. pylori if presence of acute upper GI bleed?

urea breath test

137

pancreatitis

where does pain go?

2 tests?

2 findings?

epigastic pain that radiates to back

 

1.amylase/lipase

2. abdominal CT

"heterogenous with multiple colors or FAT STRANDING"

A image thumb
138

appendicitis

 

pain location

3 positive findings

test and tx?

periumbilical FOLLOWED BY RLQ

 

postiive:

ROVSINGS

PSOAS
MCBURNEYS

 

CT AND REMOVE

A image thumb
139

diverticularis

 

type of pain?

3 tests?

LLQ with progressive pain

 

CBC

GUIAC TEST

CT

A image thumb