Gastrointestinal Flashcards
(76 cards)
A 15 year old presents with umbilical pain that is worsening over the past 12 hours, now localized in the RLQ. He admits to loss of appetite and nausea. What tests should be performed as part of the physical exam?
Rosving’s, Psoas, Bloomberg, Markle and Obturator
In the 15 year old with peri-umbilical and RLQ abdominal pain, what exam findings would be suggestive for acute appendicitis? (Describe tests performed and findings)
Pain at McBurney’s point (between umbillicus and RLQ)
+ Bloomberg (rebound tenderness)
+ Rovsing’s Sign (palpation LLQ produces pain in RLQ)
+ Psoas sign (pain with resisted extension of RLE)
+ Obturator sing (pain in RLQ with inward rotation R. Hip)
Abdominal pain localized in the LLQ, described as cramping and fullness with associated anorexia and nausea/vomiting is suggestive of what condition?
Diverticulitis
When examining someone you suspect to have diverticulitis, would you expect a positive or negative Rovsing’s sign?
Positive, although negative does not exclude diverticulitis
Sudden onset of severe epigastric abdominal pain that radiates into the back that is often accompanied by tachypnea, tachycardia, fever, nausea and vomiting is suspicious for what disorder?
Acute pancreatitis
What sign may be found with acute pancreatitis?
+ Cullen sign (peri-umbilical ecchymosis)
+ Grey Turner’s sign (flank ecchymosis)
A sudden or gradual change in bowel habits in patient over the age of 55, presence of occult or visible blood in stool, vague abdominal pressure or discomfort without acute findings is suspicious for what disorder?
Colon cancer
What are the recommendation ages for colon cancer screenings?
Males and females between the ages of 50-70 years, 40-45 for those with first degree relatives w/ hx of colon cancer
What patients are at higher risk for colon cancer?
First degree relatives w/ hx of colon cancer Hx of crown’s disease Smokers Heavy red meat eaters Diets low in fiber
T/F Crohn’s disease may affect any part of the GI?
True
Patient with history of Crohn’s disease presents with abdominal pain and watery non-bloody diarrhea, what part of the GI tract do you suspect is involved?
Ileum
Patient with history of Crohn’s disease, colonic involvement would be suspected if the stools appear as?
Bloody diarrhea w/ mucous
Unlike ulcerative colitis, what complication can occur with Crohn’s disease?
Fistula and anal diseases
What associated findings are common with Crohn’s relapse?
Fever, anorexia, weight loss, dehydration, fatigue and peri-umbilical to RLQ abdominal pain.
Hematochezia is what?
Bloody diarrhea w/ mucous
Younger patient who experiences recurring episodes LLQ abdominal pain that described as of squeezing or cramping, which is accompanied by bloody/mucous diarrhea, as well as bloating and gas which is exacerbated by eating is suspicious for what chronic disorder?
Ulcerative colitis
Toxic megacolon is a concerning risk for patients with which disorders?
UC and Crohn’s
What causes Zollinger-Ellison Syndrome and how is it manifested?
A gastinoma in the pancreas or stomach that stimulates gastric producing excessive acids in the stomach which causes multiple and severe ulcers to form.
What lab test screens for Zollinger-Ellison syndrome?
Serum fasting gastrin
A Carnett’s test performed who and indicates what?
While supine, have pt lift shoulders off the exam table. If positive, the pain is worse when pt lifts shoulders. If negative, pain is reduced indicating source within the abdominal cavity.
What is a long-term GI complication of untreated GERD?
Barrett’s esophagus, esophageal cancer and stricture
What is Barrett’s esophagus?
Precancerous condition found on UGI biopsy
What are some signs of esophageal cancer?
Significant early satiety, odynophagia (painful swallowing), dysphasia, and weight loss.
When should someone be referred to gastroenterologist for GERD?
Any red flags, advanced age, after failure of PPI, or anyone with 10 or greater hx of GERD.
