Flashcards in GI Deck (34)
How is visceral pain described?
Deep, dull, crampy, poorly localized
How is parietal pain described?
What does rebound tenderness suggest?
What does vascular pain look like?
Severe, ripping, radiating to back
Lead poisoning pain?
Poorly localized, wandering pain, rigid abdomen
What are some causes of referred pain to abdomen?
MI, pneumonia, ovarian problems, urinary tract problems
What medication can worsen GERD?
CCB, progestin, estrogens
Red flags for Gerd?
Dysphagia, odynophagia, globus, asthma, GI bleeding, weight loss, anemia, gastric cancer, palpable mass, jaundice
What's an important differential diagnoisis for GERD?
Step therapy for GERD?
1. Lifestyle modifications, tums, malox, mylanta, cimetidine, rinatidine
2. Prescription medications
3. Increase PPI for 8-12 weeks, possible referral
4. Refferal and possible surgical intervention
What's an important complication of GERD?
Barret's esophagus, 40x increased risk for esophageal cancer, EGD every 3-5 years to look for cancer
Factors for PUD?
NSAIDS, alcohol, tobacco, glucocorticoids, anticoagulants, H. Pylori
Differential for PUD from gastric to duodenal?
1. Duodenal is woken up at night, relieved by food.
2. Gastric is worsened by food
When do you do endoscopy for PUD?
for alarm signs, including hx of gastric cancer, weight loss, bleeding, anemia, abdominal mass, hematemesis, early saiety
Treatments for PUD?
PPIs, H2 blockers, antacids, cytotec, COX-2 inhibitors, Carafate, H.Pylori eradication
What is triple and quad therapy for H. Pylori
Triple- Ciprofloxacin, amoxicillin or flagyl, PPI
Quad- Bismuth, PPI, Flagyl + tetracycline
What is a side effect of Bismuth?
Hypoglycemia and turning stools black
When should you refer for PUD?
> 2 weeks, suspect gastric ulcer, treatment failure, endoscopy
Risk factors for gallstones
6. fat intolerant
Rapid weight loss
Assessment sign for gallstones and cholecystitis?
Labs suggestive of cholecystitis?
Increase alkaline phosphatase and billiruben, U/S, WBC up to 15K
Symptoms of IBS/ Rome Criteria?
1. painless diarrhea
2. Abdominal pain with altered bowel habits
3. Abdominal pain with relief with dedication, mucus in stool
Physical exam of IBS?
may have tender sigmoid colon and discomfort on rectal exam
Treatment of IBS?
Fiber, antispasmodics (bentyl), antidiarrhea, reglan, antidepressants, probiotics
When do you refer IBS?
Patient's >50y.o. organic disease, treatment failures
Important risk factors for colon cancer?
Advanced age, family history, etcetera
Main symptom for colon cancer?
Change in BM
Systemic signs of Ulcerative Colitis and Crohn Disease?
1. Central Arthropothies- ankylosing spondylitis and sacroiliitis
2. Peripheral arthritis
4. Erythema nudism
5. Pyoderma gangrenosum
6. Aphthous ulcers
9Gallstones/Primary Sclerosing cholangitis
Describe diverticular disease
Greater than 40 y.o., LLQ pain, possible firm mass, CT with oral contrast is best test