Exam 2 Flashcards
(85 cards)
1
Q
Patients with visceral pain will have difficulty doing what?
A
finding a comfortable position
- deep aching, boring, gnawing, vague burning, or deep grinding
2
Q
Patients with inflammatory pain will often do what?
A
see a quiet position w/o movement
- sitting/lying with knees bent or in a curled up/fetal position
3
Q
What type of pain is steady, has a sudden onset, and is extremely intense? What causes it?
A
Ischemic pain
- secondary to vascular disease or from an obstruction causing strangulation of bowel tissue
4
Q
pain from the _______ can be referred to the midback, and visa versa
A
esophagus
5
Q
What may be altered in referred pain distribution
A
sensation
6
Q
hyperesthesia
A
excessive sensibility to sensory stimuli of skin
7
Q
hyperalgesia
A
excessive sensibility to painful stimuli of muscle
8
Q
What organs refer to the shoulder?
A
- liver
- respiratory diaphragm
- pericardium
9
Q
What organs refer to the midback and scapular region?
A
- gallbladder
- stomach
- pancreas
- small intestine
10
Q
What refers to the pelvis, flank, low back, or sacrum?
A
- colon
- sigmoid colon
- appendix
- rectum
- ureters
- testes
11
Q
Dysfunction of the stomach, gallbladder, liver, pylorus, or respiratory diaphragm can cause what?
A
contraction, guarding, and splinting of the rectus abdominis and muscles superior to umbilicus
12
Q
Dysfunction of the ileum, jejunum, appendix, cecum, colon, and rectum can cause what?
A
muscle spasm of the rectus abdominis inferior to the umbilicus
13
Q
What are causes of dysphagia?
A
difficulty swallowing
- non-GI conditions (neuro diseases)
- achalasia - obstruction of muscles for peristalsis
- peptic esophagitis
- GERD
- Neoplasm
- certain antidepressants, antipsychotics, antihypertensive, and asthma drugs
14
Q
What is odynophagia? What are potential causes?
A
pain during swallowing
- esophagitis
- esophageal spasm
15
Q
GI bleeding manifest as ___________ pain with radiation to the RUQ
A
mid-thoracic back pain
16
Q
signs of GI bleeding
A
- coffee-ground emesis
- bloody diarrhea
- bright red blood
- melena (blood in stool)
- reddish colored stools
17
Q
GI cancer pain S&S
A
more intense, boring, constant, unable to be relieved
18
Q
Duodenal ulcer S&S
A
pain that could be relieved by eating
19
Q
accompanying symptoms of arthralgia in GI disorders
A
- fever
- skin rash
- nails separate from nail bed
- conjuctivities
20
Q
pancreatic cancer involving tail of pancreas refers to where?
A
Left shoulder
21
Q
Kehr’s sign
A
L shoulder pain with pressure placed on the upper abdomen
22
Q
Danforth sign
A
shoulder pain with inspiration
23
Q
pancreatic cancer involving head of pancreas refers where?
A
Right shoulder
24
Q
What GI issues refer to the right shoulder?
A
- perforated duodenal or gastric ulcers that irritate diaphragm
- pancreatic cancer involving head of pancreas
- liver trauma
25
What GI issues refer to both shoulders?
- ruptured ectopic pregnancy w/ retroperitoneal bleeding
- accumulation of blood from a slow bleed
26
S&S of obturator or psoas abscess
- hectic fever
- night sweats
- abdominal pain
- back, pelvic, abdominal, hip, and/or knee pain
- antalgic gait
- palpable, tender mass
27
what does a + heel tap indicate?
obturator or psoas abscess
28
What is a red flag of a peptic ulcer?
new onset of shoulder/back pain for someone with a hx of peptic ulcers
29
S&S of peptic ulcer
- heartburn
- night pain
- radiating back pain
- R shoulder pain/lateral border of R scapula
- blood stools
- black, tarry stools
30
Gastric ulcer is ________ by food
aggravated
31
Duodenal ulcers is _______ by food
relieved
32
Diverticulosis vs Diverticulitis. Where is the pain for deverticulitis?
Diverticulosis - colon balloons out through weakened areas in the wall
Diverticulitis - infection and inflammation that accompany a microperforation of 1 of the diverticula
- left lower abdominal or pelvic pain/tenderness
33
Diverticulitis S&S
- abdominal pain often with loss of appetite, nausea, abdominal bloating
- Lower left quadrant pain ~70% of patients
- lower right quadrant pain - asians
- decreased or absent bowel sounds
- bloody stools
34
Pinch-an-inch test + test
pain upon release of the skin fold
- indicates appendicitis
35
What is the most common cause of acute pancreatitis?
gall stones
Other causes:
- chronic alcoholism
- High triglyceride blood levels
- toxicity from some other agent
36
What is the most common cause of chronic pancreatitis?
alcohol use and smoking
37
acute pancreatitis S&S
- epigastric pain radiating to the back
- abdominal distention
- fever and sweating
- bluish discoloration of abdomen or flanks
- jaundice
- Colon's sign - bruise formed on the abdomen around umbilicus
38
chronic pancreatitis S&S
- epigastric pain radiating to the back
- upper left lumbar region pain
- clay-colored or pale stools
39
Who is most likely to have pancreatic cancer?
men in their 7th decade (60s)
40
S&S of pancreatic cancer
- epigastric pain radiating to the back
- back pain may be the only symptom
- jaundice
- light-colored stool
41
Aggravating and relieving factors of pancreatic pain
Aggravating
- walking and lying supine
- alcohol, large meals
- digestive activities
Relieving
- sitting and leaning forward
42
Pain from head of pancreas refers to ______ shoulder
right
43
Pain from tail of pancreas refers to the _____ shoulder
left
44
ulcerative colitis affects _______
the colon
45
Crohn's disease affects _________
any portion of the intestine from the mouth to the anus
46
Who is most likely to develop Crohn's disease?
- between 20-29 y/o
- parental/sibling Hx of IBD
- smokers
47
Who is more likely to develop colorectal cancer, Crohn's disease or ulcerative colitis?
ulcerative colitis
48
Crohn's disease and ulcerative colitis S&S
- fever
- abdominal pain
- rectal bleeding
- night sweats
- decreased appetite
- skin lesions
- uveitis - eye redness and swelling in whites of the eye
- migratory arthralgias
49
What is uveitis?
eye redness and swelling in whites of the eye
- sign of Crohn's disease and ulcerative colitis
50
IBS typically affects who
females > males
51
risk factors for IBS
- family hx of IBS
- emotional stress, tension or anxiety
- food intolerance
- Hx of physical or sexual abuse
- severe digestive tract infection
52
Who is at an increased risk for colorectal cancer?
- non-hispanic AA
- native americans and native Alaskans
- family Hx of colorectal cancer
- prior Hx IBD
53
S&S of early stage colorectal cancer
- rectal bleeding, hemorrhoids
- abdominal, pelvic, back, or sacral pain
- back pain that radiates down the leg
- changes in bowel patterns
54
S&S of advanced stages of colorectal cancer
- constipation progressing to obstipation
- diarrhea with copious amounts of mucus
- N&V
- abdominal distention
- weight loss
- fatigue
55
What skin changes occur with liver disorders?
- jaundice
- pruritus - itchy skin
- bruising
- spider angiomas - red branched dilations of the superficial capillaries
- palmar/plantar erythema
- White nails of Terry - white hue of nails with darker redness on the distal end of nails
56
What is Leukonychia and Koilonychia?
Leukonychia - white discoloration of the nails
Koilonychia - soft nails that look scooped out
57
What nailbed changes occur with liver disorders?
- Leukonychia - white discoloration of the nails
- clubbed nails
- Koilonychia - soft nails that look scooped out
58
What are the primary pain patterns for hepatic/bilary disorders?
- mid-epigastrium or RUQ of the abdomen
59
liver disease referred pain patterns
- thoracic spine
- right upper trapezius and shoulder
60
gallbladder referred pain patterns
- right upper trapezius and shoulder
- right interscapular area
- right subscapular area
61
Neuro symptoms of liver disease
- confusion
- hyperractive reflexes
- asterixis - liver flap in hands
- peripheral nerve dysfunction
62
What color will stool and urine be with liver disease?
- light-colored (almost white) stools
- during the color of tea or cola
63
What is white nails of Terry? What does it indicate?
- white hue of nails with darker redness on the distal ends of nails
- indicates liver disease
64
red flag of hepatitis
- joint or muscle pain that is disproportionate to the physical findings
- the presence of palmar tendinitis in someone with RA
- positive risk factors for hepatitis
65
risk factors for hepatitis
- IV drug use
- acupuncture
- tattos/piercings
- recent operation
- liver transplant recipient
- health care worker
- unprotected sex
- severe alcoholism
66
S&S of hepatitis
- extreme fatigue
- fever
- right upper abdominal pain
- clay-colored stools
- dark urine
- jaundice
- alteration in senses of taste and smell
- low-grade fever
67
S&S of HBV
- jaundice
- arthralgia
- rash
- fever
68
What is considered chronic hepatitis?
Illness associated with prolonged (>6 months) inflammation of the liver
69
S&S of chronic hepatitis
- fatigue
- jaundice
- abdominal pain
- anorexia
- arthralgia
- fever
- ascites
70
What is Wilson's disease? What are symptoms that a patient may have?
- biliary excretion of copper is impaired
- may have mild to severe neurologic involvement
71
What is hematochromatosis? What does it cause?
- autosomal recessive defect of iron absorption
- causes liver failure
72
What joints are typically involved in hematochromatosis?
- 2nd and 3rd (point and middle finger) MCP joints commonly involved first, then knees/hips/shoulders/low back
73
What is the most common hepatotoxic agent?
acetaminophen
74
S&S of drug-induced hepatitis
- jaundice
- dark urine
- clay-colored stools
- fever, rash, arthralgias, epigastric or RUQ pain
75
S&S of cirrhosis
- mild RUQ pain
- GI symptoms
- weight loss
- ease of fatigue (w/ mild exertion)
- fever
76
integument S&S of cirrhosis
- poor tissue turger
- spider angiomas
- palmar erythema
77
S&S of portal HTN
- ascitis
- esophageal varices
- hemorrhoids
- splenomegaly
78
S&S of hemorrhage associated w/ esophageal varices
- pallor
- tachycardia
- cooling of the skin
- hypotension
79
What is kernicterus?
A type of brain damage from toxic levels of bilirubin in the blood
80
What is the most common cause of a liver abscess?
biliary tract disease
81
S&S of liver abscess
- right abdominal pain
- right shoulder pain
- fever, chills, malaise
- diaphoresis
- anemia
- tender liver
- jaundice
82
cholelithiasis risk factors
- increased age
- women > men before 60 y/o
- elevated estrogen levels
- obesity
- DM
- liver disease
- rapid weight loss or fasting
- statins
- genetics/family hx
83
symptom of biliary colic cholelithiasis
right upper abdominal pain that comes and goes in waves
84
S&S of cholelithiasis
- chills, low grade fever
- jaundice
- tenderness over the gallbladder
- tenderness over 10th rib
- RUQ and epigastrium severe pain
- right shoulder and between the scapulae
chronic = pain may radiate to midback between the scapulae
85
Primary Biliary Cirrhosis S&S
- pruritus - itchy skin
- dry eyes and mouth
- jaundice
- ascites
- RUQ pain
- osteoporosis
- burning, pins and needles, prickling of the eyes
