Gastro-Intestinal Flashcards
Acute Appendicitis
Patient who is a young adult complains of acute onset of periumbilical pain
-steadily getting worse over 12 to 24 hours
-pain starts to localize at McBurney’s point.
Classic exam findings:
-low-grade fever
-right lower quadrant (RLQ) pain (McBurney’s point)
-rebound and guarding.
-psoas and obturator signs are positive.
When the appendix ruptures, clinical signs of acute abdomen occur, such as involuntary guarding, rebound, and a boardlike abdomen. Refer to ED.
Rovsing sign
Rovsing/Reverse/Right
Palpate L lower quadrant and it hurts on Reverse/Right side
+ = Appendicitis
Markle sign
“Heel Jar”
Pain in R lower quadrant when pt hops on one foot
+ = Appendicitis
“megan dug her heel into Harry’s foot. he hopped up and down in pain”
Blumburg Sign
Rebound Tenderness
+ = Appendicitis
[ think”BLUMB!” is. the sound when doing the rebound ]
Mcburney’s Point
2/3 distance from navel to R axis.
Tenderness = Maximal
+ = Appendicitis
Psoas Sign
Oberator Sign
Psoas Sign
-raising leg against resistance = abdominal pain
“SO AS i was saying–> while keeping kids leg down”
Oberator Sign
-rotation of R hip 90’. Pain in lower quad
“sounds like “rotator”
+ = Appendicitis
Murphy’s Sign
if + then what?
why do imaging in this order?
“bear down to let out a MURPH…. offended them so bad he had to come to the US to HIDA”
Take deep breath and hold-
+ pain w/palpation R subcostal area
+ = Cholecystitis
if + then what?
-#1: we order an US (to see if its Gallstones)
then
-#2: HIDA scan
why do imaging in this order?
HIDA scan wont work if there are Gall Stones
-do US to check for gallstones first.
GERD
PPI or H2 Blocker?
PPI complications:
when to Refer?
what blood pressure med to avoid?
PPI or H2 Blocker?
H2 good for:
(“-tidines”)
—>mild symptoms
-no insurance
-B12 anemia
-osteoporosis
leo in the titanic; “He 2, would like Ti’DINE with us” who? this 12 year old? i feel it in my bones that he is not worthy”
PPI good for:
( “-prazole”)
—->more severe symptoms
-H2 doesn’t work
-these are more effective & more expensive
-take right before first meal of the day
-prescribed 4-8 wks
“PPI “prepare to be PRAZOLED”
PPI complications:
COB
-C-Diff
-Osteoporosis
-B12 Deficiency
when to Refer?
-when symptoms don’t resolve
what blood pressure med to avoid?
-CCB
Acute Cholecystitis
where is the pain?
-Overweight female patient complains of severe right upper quadrant (RUQ) or epigastric pain
-occurs within 1 hour (or more) after eating a fatty meal.
-Pain may radiate to the right shoulder.
-Accompanied by nausea/vomiting and anorexia. If left untreated, may develop gangrene of the gallbladder (20%). May require hospitalization
“when doing the murphy- i felt it in like my shoulder! stop holding your breath so much, your going to get gangrene”
Acute Diverticulitis
where is the pain?
signs of acute attack?
CBC will show?
tx?
Elderly patient with acute onset of high fever, anorexia, nausea/vomiting, and left lower quadrant (LLQ) abdominal pain.
Risk factors for acute diverticulitis include increased age, constipation, low dietary fiber intake, obesity, lack of exercise, and frequent nonsteroidal anti-inflammatory drug (NSAID) use.
Signs of acute abdomen are rebound, positive Rovsing’s sign, and a boardlike abdomen.
-Complete blood count (CBC) will show leukocytosis with neutrophilia and shift to the left.
-The presence of band forms signals severe bacterial infection (bands are immature neutrophils).
-Complications include abscess, sepsis, ileus, small-bowel obstruction, hemorrhage, perforation, fistula, and phlegmon stricture. May be life-threatening.
TX:
augmentin or Ciprofloxacin
Acute Pancreatitis
where is the pain?
Symptoms include:
Signs?
Labs used to assess the pancreas:
Causes:
Tx: What two things must you do?
Symptoms include:
-acute onset of fever, nausea, and vomiting
-pain in L UPPER QUADRANT
-rapid onset of abdominal pain that RADIATES TO the MIDBACK (“boring”) located in the epigastric region.
-guarding/tenderness
-positive CULLEN’s sign (blue discoloration around umbilicus)
-positive GREY TURNER’s sign (blue discoloration on the flanks).
The patient may have an ileus and show signs and symptoms of shock. Refer to ED
Labs used to assess the pancreas:
-Amylase
-Lipase
Causes:
-drugs (approximately 90% of cases of acute pancreatitis)
-Gall stone blockage
-increased Ca levels
-increased Triglycerides
-alcohol abuse.
Tx: What two things must you do?
Figure out cause
-stop drinking/ get Ca down/ etc
Manage symptoms:
-NPO (pancreas will stop producing digestive enzymes)
-pain control
-stay hydrated
-antibiotics
-decrease fat in diet
Clostridium Difficile Colitis
s/s
causes
Tx
-Severe watery diarrhea from 10 to 15 stools a day
-lower abdominal pain with cramping and fever.
-Symptoms usually appear within 5 to 10 days after initiation of antibiotics.
-Cause: long term antibiotic use:
Clindamycin & Fluroquinolones
Tx:
-DC whatever antibiotic we were using
-Start vancomycin
Colon Cancer
-Very gradual (years) with vague gastrointestinal (GI) symptoms.
-Tumor may bleed intermittently, and patient may have iron-deficiency anemia.
-***ribbon shaped or thin pencil stools
-Heme-positive stool, dark tarry stool, and mass on abdominal palpation.
-The U.S. Preventive Services Task Force (USPSTF) recommends screening for colon cancer between ages of 50 and 75 years (Grade A recommendation).
Where do most polyps occur? – Descending colon
Crohn’s Disease
CD is an IBD that may affect any/ALL part(s) of the GI tract, from mouth (canker sores), small or large intestine, rectum, and anus.
- periumbilical to RLQ abdominal pain occur.
-***Fistula formation and anal disease occur only with CD (not UC).
-May palpate tender abdominal mass. Remissions and relapses are common.
-Higher risk of toxic megacolon and colon cancer.
-Risk of development of lymphoma is also increased, especially for patients treated with azathioprine.
-More common in Ashkenazi Jews.
Colitis
________(hematochezia) more common with UC than with CD.
Severe “___ ______” located on the ________ side of the body
exacerbated by ________
IBD that affects the colon/rectum.
-***Bloody diarrhea with mucus (hematochezia) more common with UC than with CD.
-Severe “squeezing” cramping pain located on the left side of the abdomen with bloating and gas that is exacerbated by food.
-Accompanied by arthralgias and arthritis (15%–40%) that affect large joints, sacrum, and ankylosing spondylitis.
-May have iron-deficiency anemia or anemia of chronic disease.
-Higher risk of toxic megacolon and colon cancer.
Zollinger–Ellison Syndrome
A gastrinoma located on the pancreas or the stomach; secretes gastrin, which stimulates high levels of acid production in the stomach.
-The end result is the development of multiple and severe ulcers in the stomach and duodenum.
-Complaints of epigastric to midabdominal pain.
-Stools may be a tarry color.
-Screening by serum fasting gastrin level.
-Refer to gastroenterologist.
The nurse practitioner reviews the results of a serum fasting gastrin level and finds there is no inhibition of gastrin levels. Which diagnosis is most likely?
— Zollinger–Ellison syndrome is a neuroendocrine tumor that leads to gastrin hypersecretion and multiple peptic ulcer formation. These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes the stomach to produce too
“feeling ILL due to all the acid!”
Carnett’s Test
An abdominal maneuver that is used to determine if abdominal pain is from inside the abdomen or if it is located on the abdominal wall.
-Patient is supine with arms crossed over their chest. Instruct patient to lift up shoulders from the table so that the abdominal muscles (rectus abdominus) tighten.
-If source of pain is the abdominal wall, it will increase the pain; if the source is inside the abdomen, the pain will improve.
“in CARNage doing these crunches”
