DDx, conditions, etc. Flashcards
(31 cards)
Prolonged exposure of esophagus to gastric acid due to impaired esophageal motility or lower esophageal sphincter.
GERD
Describe the location and quality of GERD pain.
Burning chest/epigastric pain
Describe the provocative/palliative factors affecting GERD.
physical activity, lying down, alcohol, fatty meals, chocolate make worse BUT antacids and avoiding Ca Channel blockers make better.
Associated symptoms of GERD
chronic cough, SOB, hoarseness, halitosis, sore throat
Describe the location and quality of pain associated with a peptic ulcer.
gnawing, burning, boring, aching or hunger like epigastric pain/discomfort that may radiate to the back
Patient complains of pain that wakes her at night and is intermittent over a few weeks.. even disappears for months
Duodenal ulcer should be considered.
Describe the location and quality of pain associated with acute appendicitis.
Initially mild, poorly localized periumbilical pain that becomes more steady, severe and moves to RLQ
Associated symptoms for acute appendicitis
anorexia, nausea/vomiting, low fever
Gallbladder inflammation due to cystic or common bile duct obstruction (gallstone)
acute cholecystitis
Pt. complains of steady, aching RUQ pain than radiates to the rt. scapular area.
Acute cholecystitis
A steady epigastric pain that radiates to the back… it seems to get better when leaning forward with trunk flexed.. Which organ will you focus on?
Pancreas.. Acute/chronic pancreatitis? cancer?
Pt. complains of steatorrhea and DM… Part of Ddx should include:
chronic pancreatitis
A cramping LLQ pain comes on gradually, but becomes steady… Pt. has fever, constipation, and brief initial diarrhea. What you think?
Acute diverticulitis
Cramping, paroxysmal pain… Obstipation and possible vomiting… What you think?
Bowel obstruction… location of pain and composition of vomit may help decide between SBO and colon..
Three reasons for a bowel lumen obstruction?
adhesions, hernias, cancer, diverticulitis
When might you consider mesenteric ischemia as part of your Ddx?
abrupt periumbilical cramping pain at first that becomes diffuse and persistent.. older pt. possibly prone to thrombi or emboli
What causes oropharyngeal dysphagia?
motor disorders affecting the pharyngeal muscles (stroke, bulbar palsy, neuromuscular conditions)
AS with oropharyngeal dysphagia:
aspiration, regurgitation into nose with attempts to swallow
Various reasons for esophageal dysphagia:
mucosal rings, esophageal stricture, or cancer causing a mechanical narrowing
P/P factors associated with esophageal dysphagia
Solid foods provocate… regurgitation of the bolus relieves
Uncoordinated spasms of esophagus that fail to propel food to stomach… shows a characteristic corkscrew barium swallow x-ray… What is condition and possible triggers?
DES (diffuse esophageal spasm). Uncontrolled gastroesophageal reflux, really hot/cold beverages
Provide 3 life activities/habits that suggest constipation
ignoring defecation reflex, false expectations, low-fiber diet
Functional change in frequency/form of BM w/o known pathology…possible change in intestinal bacteria.. What’s the problem?
Irritable Bowel Syndrome
3 reasons for a mechanical obstruction resulting in constipation
narrowed lumen from adenocarcinoma, fecal impaction, diverticulitis, volvulus, intussusception, hernia..
