GI/GU

Question 1

Name organs & conditions found in the RUQ

Answer 1

Liver ---> Cirrhosis, Hepatitis
Gallbladder --> Cholecystitis
Pylorus
Duodenum --> Ulcers
Hepatic flex colon
Head of the pancreas
R Kidney --> Renal colic

Question 2

What organs are found in the LUQ?

Answer 2

Spleen --> Splenomegaly
Splenic fx of colon
Stomach --> Ulcers
Body and tail of pancreas --> Pancreatitis
L Kidney --> Renal colic

Question 3

Name organs found in the RLQ

Answer 3

Cecum
Appendix --> appendicitis
Ascending colon
Terminal ileum
R ovary --> ectopic pregnancy
Iliac artery

Question 4

Name organs found in the LLQ

Answer 4

Sigmoid colon
Descending colon –> common Diverticulitis site
L ovary –> ectopic pregnancy
Iliac artery

Question 5

Describe esophogeal varicies, signs/symptoms and risk factors.

Answer 5

• Often due to hypertension in the portal vein (normally 5-10 mmHg), usually due to liver damage
• High mortality of 10 -20% due to blood loss
• Most common sign is frank hematemisis, jaundice, spider veins on the belly and RUQ pain
• Highest risk factors are hypertension and alcoholism

Question 6

Describe signs and symptoms of esophagitis

Answer 6

Causes prolonged retrosternal chest pain and almost always odynophagia (difficulty swallowing).
May be inflammatory or infectious, often caused by GERD, ulcers, etc.

Question 7

Describe bowel obstruction, signs and symptoms and risk factors.

Answer 7

• May be due to mechanical obstruction (narcotics, hernia, tumor, post-op adhesions), or from paralytic ileus. Can be duodenal, small bowel or colon.
• Palpation - of the 9 quadrants - causes diffuse, tender moderate pain, abdomen may be distended, pt “looks sick”, possibly vomiting bile. c/o constipation.
• Constipation greater than 4 days is an emergency, 70% mortality with septic bowels.
• Risks include, female greater than 70, opioid use, history of surgery or previous bowel obstructions.

Question 8

Describe peptic ulcer disease

Answer 8

• Often caused by decreased mucus production or increase in H+ acids, which create perfect environment for helibactor pylori bacteria (present to some degree in 50% of the world’s population (#randomfact) to flourish and erode lining of mucosal layer.
• 5x more likely to be gastric vs. duodenal
• Over 50% of pt’s are asymptomatic until life threatening complication occurs. s/s include: “hangover-like” pain in epigastrum, worse on waking, changed by food intake, reduced appetite, nausea and weight loss, coffee ground emesis.
• Risk factors include age over 65, NSAID use usually within the first 1-3mos (need COX-2 inhibitors), history of ulcers or h.pylori infection

Question 9

Describe GERD, signs and symptoms and risk factors

Answer 9

• Caused by relaxation of esophogeal sphincter, allowing acidic stomach contents into esophogus, worsened by reduced gastric motility or h.pylori infection.
• Certain foods such as chocolate, alcohol, tobacco and peppermint contribute to relaxation of sphincter.
• s/s retrosternal “burning” c/p worse at night or after meals, worse when lying down, hypersalivation, regurgitation, dysphagia, cough/asthma. Rarely worse on palpation.

Question 10

Describe cholecystitis, signs and symptoms and risk factors

Answer 10

• Gallstones (made from cholesterol, bile salts and fats) become stuck in cystic ducts
• s/s include pain in epigastrum or RUQ that can radiate to the back, especially during the night or when lying down. A positive Murphy’s sign: pain on deep inspiration when palpating RUQ, may be clay-like stools. Fever and tachycardia in severe cases.
• Risk factors include demographic of female, overweight, 40+ yet still ovulating. Fatty food intolerance may be a factor, but is not a reliable predictor.

Question 11

Describe Pancreatitis, signs and symtoms and risk factors

Answer 11

• Trypsin os overactivated, and the pancreas essentially digests itself
• s/s signifigant LUQ pain worse when supine, fever, tachycardia, Cullen’s (umbilical) and Grey-Turner’s (flank) bruising signs are not specific, but do indicate a 37% higher mortality.
• Risk factors: in men usually ETOH abuse, in women biliary colic/gallstones, diabetes, obesity as well as alcoholism.

Question 12

Describe appendicitis, signs and symptoms and risk factors

Answer 12

RANDOM FACTS

• Develops due to obstruction with mucus accumulation, swelling, ischemia, necrosis and perforation: poop gets stuck!
• s/s: abdominal pain initially diffuse, then localizing to RLQ as severe pain (pain going over speedbumps), guarding, fever, anorexia, nausea, vomiting, bloating. Pain on McBurney’s point (2/3 between umbilicus and iliac crest), and positive Rosvings (pain in RLQ when LLQ is palpated), and Psoas sign (pain in RLQ when R hip is flexed).
• Risk factors: most commonly appears between 10 - 19 years of age, pt otherwise generally heathy. MUST be differentiated from ectopic pregnancy in ovulating females.

• Occurs in 7% of population, risk of rupture increases with age, 10% if pt under 40, 50% if they are over 75
• Rebound tenderness and guarding are the MOST specific signs after RLQ pain, but absence of these symptoms cannot rule out appendicitis
• 40% of pt’s are febrile, only 50-60% report nausea or vomiting

Question 13

Describe renal colic, signs and symptoms and risk factors

Answer 13

• Calcium “stones” move through the ureter, sometimes causing obstruction leading to hydronephrosis and renal failure
• s/s include: squirming, colicky pain, which may be intermittent, located in flank and radiating to groin. Pain with urination, discoloration of urine, malodorous urine or reduction of urine output. Pain on percussion of costovertebral angle (CV angle), which is at the 12th rib where it meets the spine.
• Risk factors: obesity, low urine output, high meat or sodium intake, gout and insulin resistance

Question 14

What is Kehr’s sign?

Answer 14

Acute pain in the tip of the shoulder when a person is lying down and the legs are elevated, due to presence of blood in the peritoneal cavity. Kehr’s sign in the L shoulder is a classic symptom of a ruptured spleen.