GI exam/procedures

Question 1

Visceral pain

Answer 1

(colic pain): source is usually hollow organ caused by distension or stretching. Comes and goes, crescendo/decrescendo pattern. Cramping- Not well localized.

Question 2

parietal pain

Answer 2

Caused by inflammation of the peritoneum. Steady aching pain that is usually well localized.

Question 3

right shoulder pain?

Answer 3

gallbladder

Question 4

left shoulder pain?

Answer 4

spleen

Question 5

back pain?

Answer 5

pancreas or aorta

Question 6

RUQ pain?

Answer 6

cholecystitis, duodenal ulcer, hepatitis, appendicitis, pneumonia

Question 7

epigastric pain?

Answer 7

inferior wall MI, peptic ulcer, acute cholecystitis, perforated esophagus

Question 8

LUQ pain?

Answer 8

ruptured spleen, gastric ulcer, AA, perforated colon,

Question 9

RLQ pain?

Answer 9

appendicitis, ectopic pregnancy, renal/uerter stone, Meckel’s, CD,

Question 10

LLQ pain?

Answer 10

ectopic pregnancy, intestinal obstruction, acute pancreatitis, AA, diverticulitis, perforated colon, CD, UC

Question 11

melena

Answer 11

Black tarry stools
50-60 ml of blood in the stomach can produce melena
Above the “Ligament of Treitz” (b/w duodenum and jejunum)

Question 12

hematochezia

Answer 12

Blood unchanged by passage through the gut usually at the level of the colon or lower

Blood mixed with stool suggests colon, blood outside the stool suggests the anus

Question 13

acholic feces?

Answer 13

often seen w/ dark urine

malodorous, gray to light colored stools

indicates biliary block

Question 14

obstruction of bile?

Answer 14

see elevated conjucated hyperbilirubinemia

elevated Alk phos!!

Question 15

most common cause of ascites?

Answer 15

cirrhosis!!

malignancy, CHF, TB

Question 16

adequate exposure?

Answer 16

Xiphoid to the pubis

Question 17

normal size of liver?

Answer 17

<10 cm at right MCL

Question 18

normal aorta

Answer 18

2.5-3 cm

Question 19

psoas sign?

Answer 19

turn patient on left side and extend the right leg to check for psoas muscle inflammation.

= appendicitis

Question 20

obturator sign

Answer 20

place the right leg in a “figure 4”. Press on the right knee while holding down the left iliac crest.

= appendicitis

Question 21

acute cholecystitis?

Answer 21

RUQ postprandial pain. Biliary colic pain.
Pain radiating to the right shoulder.
Nausea and vomiting.
Anorexia
Obesity
Fever
The 5 “f’s” – female, fat, fertile, fair, flatulent.

Diagnostic Triad – RUQ pain, fever and leukocytosis.

Question 22

murphy’s sign

Answer 22

RUQ pain and sudden arrest of inspiration during palpation of the liver and gallbladder.

= acute cholecystitis

Question 23

acute pancreatitis?

Answer 23

History:
Acute onset
Nausea/vomiting
Pain radiating to the back
Constant pain 

Physical Examination:

• Low grade fever
• Hypotension
• Decreased or absent bowel sounds
• Epigastric tenderness
• Turner’s sign – discoloration around the flanks (indicates hemorrhagic pancreatitis)
• Cullen’s sign – discoloration around the umbilicus

see elevated amylase and lipase!!!

Question 24

glucose threshold?

Answer 24

diabetes >180 in urine

Question 25

indication of UTI?

Answer 25

leukocyte esterase in urine nitrites in urine pH change and WBCs in urine

Question 26

RBC casts?

Answer 26

glomerulonephritis or severe tubular damage

Question 27

WBC casts

Answer 27

acute pyelonephritis

Question 28

most common bacteria in urine?

Answer 28

E. coli

Question 29

CI's of bladder catheterization?

Answer 29

Known urinary tract obstruction (stricture) Reconstructive surgery of urethra or bladder neck Combative or uncooperative patient Pelvic trauma – suspect urethra injury Acute infection of the prostrate and/or urethra (relative)

Question 30

CI's of suprapubic cath?

Answer 30

Uncooperative patient Blood dyscrasia or anti coagulation treatment Infection or cellulitis of the suprapubic area

Question 31

how to do suprapubic cath?

Answer 31

1 cm lateral incision 5 cm above pubic symphysis inserted inferiorly at 60 degrees

Question 32

cytoscopy

Answer 32

a way to look in the bladder to evaluate pelvic pain/recurrent UTIs

Question 33

IVP

Answer 33

Intravenous Pyelogram(IVP) An x-ray of the kidneys, ureters, and bladder which uses contrast material (usually iodine based) injected into the vein To detect problems in these areas including kidney stones, cancer, enlarged prostate

Question 34

Extracorporeal Lithotripsy

Answer 34

procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body focused to strike the stones

Question 35

Intracorporeal Lithotripsy

Answer 35

Patient undergoes cystoscopy Laser is introduced through the cystoscope into the ureter and stones are broken into small pieces that will pass Procedure works well on stones in the ureter.

Question 36

Levin vs. Salem Sump

Answer 36

NG intubation tubes Levin tube is a one-lumen nasogastric tube. The Levin tube is usually made of PVC with several drainage holes near the gastric end of the tube Salem-Sump tube is a two-lumen tube. It has a drainage lumen and a smaller secondary tube that is open to the atmosphere. The second lumen allows for continuous suction and prevents gastric mucosa from being aspirated into the tube.

Question 37

EGD

Answer 37

Esophagogastroduodenoscopy Other instruments can be passed through the endoscope to perform additional procedures. For example, a biopsy can be done in which a small tissue specimen is obtained for microscopic analysis. A polyp or tumor can be removed using a thin wire snare and electrocautery. CIs: Absolute contraindications Known or suspected perforation Medically unstable patients Obstruction ``` Relative contraindications Anticoagulation Pharyngeal diverticulum Recent head or neck surgery Esophageal stricture ```

Question 38

most common places for gastric cancer?

Answer 38

In western countries, the most common sites of gastric cancer are the proximal lesser curvature, cardia, and GE junction In Asia, distal locations in the stomach are more common

Question 39

sigmoidoscopy

Answer 39

rectum and the lower (sigmoid) colon is examined under direct visualization. colorectal cancer screening ``` CI's: Absolute: contraindications Bowel perforation Acute diverticulitis Active peritonitis Fulminant colitis Cardiopulmonary instability ``` Relative contraindications: Lack of informed consent (except in emergencies) Lack of patient cooperation Lack of good bowel preparation Advantages: - quick, few complications, minimal discomfort, may be able to remove polyps, less extensive cleansing needed than colonoscopy Disadvantages: - only view rectum/lower colon, very small risk of bleeding/perforation

Question 40

colonoscopy

Answer 40

** The advantage of colonoscopy over flexible sigmoidoscopy is the ability to find and remove polyps in the parts of colon that are beyond the reach of the flexible sigmoidoscope patient is mildly sedated endoscope is inserted through the anus and advanced gently around the bends of the colon. If a polyp is encountered, a thin wire snare is used to remove it. Electrocautery (electrical heat) is applied to painlessly control any bleeding. Other tests can be performed during colonoscopy, including biopsy. absolute CI's: Fulminant colitis Known or suspected perforation During early post-colectomy time period Relative contraindications History of radiation therapy for abdominal or pelvic cancer History of abdominal or pelvic malignancy Extensive adhesions from prior abdominal surgery Bleeding dyscrasias Anticoagulant therapy Adv: - allows doctors to view entire colon, can use to remove polyps/biopsy Dis: - may not detect all polyps, need thorough cleansing and sometimes sedation - bleeding, tearing, perforation may occur

Question 41

polyps

Answer 41

sessile = flat - more malignant pedunculated = have a stalk - less malignant

Question 42

UC

Answer 42

Patients generally have more pain, cramping and rectal bleeding Diarrhea and fever are common On colonoscopy, characterized by ulceration, bleeding, continuous involvement and pseudopolyps Mucosa is more friable and bleeds more easily than Crohn’s Risk of colon cancer rises each decade after diagnosis

Question 43

CD

Answer 43

Symptoms can occur at any point along the gastrointestinal tract Symptoms are similar to ulcerative colitis but usually: ***More cramping with diarrhea Less bleeding Symptoms wax and wane On colonoscopy, characterized by inflammation, cobble-stone appearance and “skip” lesions

Question 44

Virtual Colonoscopy/Colonography (VC)

Answer 44

Medical imaging procedure which uses imaging and computers to produce two- and three-dimensional images of the colon from the rectum, all the way to the distal ileum. performed via x-rays, i.e. computed tomography (CT) or magnetic resonance imaging (MRI). Adv: - view entire rectum/colon - non-invasive Dis: - may not detect small polyps, need thorough cleansing

Question 45

Optical Colonoscopy

Answer 45

actual scope

Question 46

occult blood

Answer 46

VERY sensitive, not specific (reacts w/ iron) Should be repeated three to four times prior to drawing any conclusions

Question 47

FOBT- colorectal screening test

Answer 47

advantages: - No cleansing of the colon is necessary. - Samples can be collected at home. - The cost is low compared with other colorectal cancer screening tests. - FOBT does not cause bleeding or tearing/perforation of the lining of the colon Disadvantages - This test fails to detect most polyps and some cancers. - False-positive results are common. - Dietary restrictions and changes, such as avoiding meat, certain vegetables, vitamin C, iron supplements, and aspirin are often recommended for several days before a guaiac FOBT. - Additional procedures, such as colonoscopy, may be necessary if the test indicates an abnormality.

Question 48

Double Contrast Barium Enema (DCBE)

Answer 48

Advantages This test usually allows the doctor to view the rectum and the entire colon. Complications are rare. No sedation is necessary Disadvantages This test may not detect some small polyps and cancers. Thorough cleansing of the colon is necessary before the test. False-positive results are possible. The doctor cannot perform a biopsy or remove polyps during the test. Additional procedures are necessary if the test indicates an abnormality.

Question 49

DRE

Answer 49

Advantages Often part of a routine physical examination. No cleansing of the colon is necessary. The test is usually quick and painless. Disadvantages The test can detect abnormalities only in the lower part of the rectum. Additional procedures are necessary if the test indicates an abnormality.