What is C. diff?
infectious bacteria that can result in life-threatening diarrhea
symptoms of C. diff
watery diarrhea, fever, loss of appetite, nausea and belly pain and tenderness
precautions for C. diff
contact (hand-washing, gown, gloves)
Obstipation
intractable constipation w/ resulting fecal impaction or inability to pas gas and retention of hard, dry, stools in the rectum and colon
Where can constipation refer pain to?
abdomen, anterior hip, groin or thigh
anorexia
loss of appetite w/ an inability to eat
anorexia nervosa
prolonged loss of appetite and inability to eat
concerns: nutritional and electrolyte imbalance causing cardiac arrhythmia and neuropathy
dysphagia
difficulty in swallowing
achalasia
lower esophageal sphincter fails to relax and food is trapped in the esophagus
vomit that looks like coffee grounds
consistent w/ gastric ulcer, gastritis or esophageal cancer
bright red blood in stool
lower colon/rectum disorders
tarry or dark stool
upper digestive tract disorders
referred pain pattern: esophagus
midback, midthoracic spine pain
referred pain pattern: liver, diaphragm, pericardium
shoulder
referred pain pattern: gallbladder, stomach, pancreas or small intestine
midback and scapula
referred pain pattern: colon, appendix or pelvic viscera
pelvis, low back or sacrum
Characteristics of hepatitis
inflammation of the liver
viral or bacterial infection, chemical agents, autoimmune or biliary cirrhosis and metabolic disorders
hepatitis A transmission
fecal-oral route
contaminated food or water or person-to-person contact
hepatitis B transmission
blood, body fluids or body tissues
hepatitis A severity
acure = mild to severe
hepatitis B severity
mild (acute) to severe
hepatitis C transmission
same as HBV (blood, body fluids or body tissue)
hepatitis D
dependent upon having hep B
Hepatitis D prognosis
poot, often present w/ liver failure
Initial signs of Hepatitis
preicteric phase
low-grade fever anorexia nausea vomitting diarrhea fatigue malaise headache abdominal tenderness myalgia and arthralgia
Jaundice phase of Hepatitis
icteric phase
fever jaundice enlarged liver w/ tenderness abatement of earlier symptoms amber-colored or dark urine
elevated lab values w/ Hepatitis
hepatic transaminases and bilirubin
Cirrhosis
irreversible chronic injury of the hepatic parenchyma as a result of chronic hepatitis
clinical presentation of Cirrhosis
jaundice peripheral edema Dupuytren's contracture palmar erythmea angiomas hepatomegaly splenomegaly ascites
hepatic encephalopathy
neuropsychiatric abnormalities w/ personality changes. etc
asterisks (liver flap)
Lactulose
cholelithiasis
(gallstones)
biliary colic
if gallstones block the common bile duct
pain in RUQ w/ radiation to R scapula
cholecystitis
partial or complete obstruction of the common bile duct resulting in inflammation of the gallbladder
signs and symptoms of cholecystitis
severe RUQ pain radiating to R scapular
nausea, vomiting, low grade fever possible
(+) Murphy’s sign
Murphy’s sign
palpate near R subcostal margin as pt takes deep breath
pain= (+)
acute pancreatitis cause
gallstones, alcoholism, substance abuse
characteristics of acute pancreatitis
“band-like” pain that radiates to the back and is worse in supine
hypotension, tachycardia, nausea, vomiting
characteristics of chronic pancreatitis
epigastric and LUQ pain
anorexia, nausea, vomiting, constipation, flatulence, weight loss and steatorrhea (greasy stools)
What is GERD caused by?
reflux or backward movement of gastric contents of the stomach into the esophagus, producing heartburn
what does GERD result from?
failure of the lower esophageal sphincter to regular flow of food from the esophagus into the stomach
increased gastric pressure
What contributes to anti reflux function?
lower esophagus, diaphragm and oblique muscles
respiratory symptoms with GERD
wheezing and chronic cough, hoarseness
complications from GERD
strictures (narrowing) and Barret’s esophagus (a precancerous state)
which positions should you avoid with GERD?
full supine or exercises (jogging, jumping) that exacerbate symptoms
hiatal hernia
protrusion of the stomach upward through the diaphragm or displacement of both the stomach and the gaastroesophageal junction upward into the thorax
symptoms of hiatal hernia
heartburn from GERD
gastritis
inflammation of the stomach mucosa
What is acute gastritis caused by?
severe burns, aspirin or NSADs, corticosteroids, food allergies or viral or bacterial infections
hemorrhagic bleeding can occur
symptoms of gastritis
anorexia
nausea
vomiting
pain
When does chronic gastritis occur?
peptic ulcer, bacterial infection from H.pylori, stomach cancer, pernicious anemia ro autoimmune disease (thyroid disease, Addison’s disease)
peptic ulcer disease
ulcerative lesions that occur in the upper GI tract in areas exposed to acid-pepsin secretions
what is peptic ulcer disease caused by?
bacterial infection (H.pylori), aspirin (acetylsalicylic aspirin) and NSAID, excessive secretion of gastric acids, stress and heredity
symptoms of peptic ulcer disease
epigastric pain described as gnawing, burning or crap-like
pain aggravated by position change and absence of food in stomach
relieved by foods and antacids
complications of peptic ulcer disease
hemorrhage
symptoms of hemorrhage
weakness, dizziness and signs of circulatory shock
Location of pain from peptic ulcers on post wall of stomach
radiating back pain
radiates to R shoulder
Malabsorption Syndrom
problems in intestinal absorption of nutrients
what can Malabsorption Syndrome be caused by?
gastric or small bowel resection (short-gut syndrome)
CF, celiac, Chron’s chronic pancreatitis and pernicious anemia, NSAIDs
symptoms of Malabsorption Syndrome
anorexia weight loss abdominal bloating pain and cramps indigestion steatorrhea diarrhea
What can Malabsorption syndrome produce?
iron-deficiency anemia and easy bruising and bleeding due to lack of Vitamin K
muscle weakness and fatigue due to lack of nutrients
bone loss, pain and predisposition to develop fx
neuropathy and other neuro signs
muscle spasms
peripheral edema
Inflammatory bowel disease
refers ro Chron’s and ulcerative colitis
symptoms of Inflammatory bowel disease
abdominal pain
frequency attacks of diarrhea
fecal urgency
weight loss
red flags w/ Inflammatory bowel disease
jt pain and skin rashes can occur- pain referred to low back
intentional obstruction and corticosteroid toxicity
intestinal absorption is dirstupted
Chronic IBD can lead to anxiety and depression
Chron’s disease
granulomatous inflammation that occurs in GI tract
skip lesions (area of adjacent normal tissue) are present
Ulcerative colitis
ulcerative and exudative inflammation of large intestine and rectum
bloody diarrhea, mucus and pus
no skip lesions
Irritable bowel syndrome
abnormally increased motility of small and large intestines
symptoms of IBS
persistent or recurrent abdominal pain that is relieved with defecation
constipation or diarrhea bloating abdominal cramps flatulence nausea anorexia
diverticular disease
pouch-like herniations of the mucosal layer of the colon
diverticulosis
pouch-like herniations of the colon (sigmoid)
symptoms of diverticulosis
minimal
can include rectal bleeding
diverticulitis
inflammation of one or more diverticulitis
symptoms of diverticulitis
pain and cramping the the LLQ, nausea, vomiting, slight fever, and elevated WBC
may complain of back pain
appendicitis
inflammation of the vermiform appendix
Blumberg’s sign
rebound tenderness
symptoms of appendicitis
abrupt pain localized to epigastric of periumbilical area
rebound tenderness (Blumberg’s sign
Point tenderness at McBurney’s pt
Rovsing;s sign pain in RLQ
Obtrutator sign
Markle’s sign
(+) psoas test
Rovsing’s sign
when pressure is put on LLQ, pain in RLQ occurs
Obturator sign
RLQ pain w/ ER and flex to 90 of R hip w/ 90 deg of knee flexion
indicative of inflammation of the sheath of the obturator nerve
Markle’s sign
pain elicited in the RLQ when a pt drops from standing on toes to the heels with a jarring landing
elevations in WBC greater than _____ is indicative of ____
> 20,000/mm3 = perforation
peritonitis
inflammation of the peritoneum
what does peritonitis result from?
bacterial invasion and infection of the peritoneum
E.coli, bactericides, fusobacterium and streptococci
symptoms of peritonitis
abdominal distension, severe abdominal pain, rigidity from reflex, guarding, rebound tenderness, decreased of absent bowel sounds, cause and vomiting, tachycardia
elevated WBC, fever, electrolyte imbalance and hypotension common
Psoas sign
pain in RLQ w/ hip extension from inflammation of the peritoneum overlying the poses muscle
rectal fissure
tear or ulceration of the lining of the anal canal
contributing factors to rectal fissures
constipation nd large, hard stools
hemorrhoids
varicosities in the lower rectum or anus caused by congestion of the veins in the hemorrhoidal plexus
symptoms of heorrhoids
local irritation, pain, rectal itching