GI test 2: Approach to pt with lower GI condition-diagnostics

Question 1

Special test for peritonitis?

Answer 1

blumberg sign

Question 2

Special tests for appendicitis?

Answer 2

McBurney’s point, Rovsing’s sign, rebound tenderness, psoas sign, obturator sign

Question 3

Ascites tests?

Answer 3

fluid wave & shifting dullness

Question 4

Cholecystitis test?

Answer 4

Murphy’s sign

Question 5

Kidney inflammation test?

Answer 5

CVA tenderness

Question 6

Other exams for lower GI sxs?

Answer 6

DRE, gynecological exam, male genitalia exam

Question 7

2 things that can cause RUQ pain?

Answer 7

hepatitis, cholecystitis/cholelithiasis, cholangitis, biliary colic, Budd Chiari syndrome, pancreatitis, pneumonia/pleuris

Question 8

2 things that can cause epigastric pain?

Answer 8

GERD, gastritis, PUD, pancreatitis, myocardial ischemia, pericarditis, ruptured aortic aneurysm

Question 9

2 things that can cause LUQ pain?

Answer 9

spleen infarct, splenic rupture, gastritis, gastric ulcer, pancreatitis, hiatal hernia

Question 10

2 things that can cause R flank pain?

Answer 10

kidney inflam, pyelonephritis

Question 11

2 things that can cause periumbilical pain?

Answer 11

early appendicitis, gastroenteritis, bowel obstruction, peritonitis

Question 12

2 things that can cause L flank pain?

Answer 12

kidney inflam, pyelonephritis

Question 13

2 things that can cause RLQ pain?

Answer 13

appendicitis, IBD, cecal diverticulitis, inguinal hernia, nephrolithtiasis, female: ovarian cyst, salpingitis, endometriosis, ectopic pregnancy; male: testicular or epididymal inflam

Question 14

2 things that can cause suprapubic pain?

Answer 14

cystitis, acute urinary retention, female: uterine cramps, cervicitis, endometriosis, PID; male: acute prostatitis

Question 15

2 things that can cause LLQ pain?

Answer 15

diverticulitis, IBD, IBS, nephrolithiasis, same female & male conditions as RLQ

Question 16

Things that can cause diffuse abd pain

Answer 16

early appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS, abd wall hematoma, infections, metabolic d/o’s, thoracic d/o’s, toxic events

Question 17

Clinical definition of diarrhea

Answer 17

> 200 g/day of stool weight or >3 BM a day

Question 18

4 types of diarrhea

Answer 18

1. osmotic= too much water into bowels
2. secretory= increase in active secretion or inhibition of absorption
3. exudative= mucous, blood, protein from inflam
4. motility= increase or decrease contact b/w GI contents & mucosal surface

Question 19

Causes of osmotic diarrhea?

Answer 19

maldigestion= pancreatic dz, celiac dz
osmotic laxatives
ions

Question 20

Causes of secretory diarrhea?

Answer 20

enterotoxins
hormones
gastric hypersecretion
laxatives
bile salts
fatty acids

Question 21

Causes of exudative diarrhea?

Answer 21

idiopathic (Crohn's, UC)
infectious
ischemic
vasculitis
radiation injury

Question 22

Causes of motility diarrhea?

Answer 22

increased motility= hyperthyroidism, postgastrectomy

decreased motility= DM, hypothyroid, scleroderma

Question 23

RED FLAGS WITH DIARRHEA & COMPLICATIONS

Answer 23

RED FLAGS: blood, pus in stool, fever, signs of dehydration, chronicity, unintended wt loss, failure to thrive in kids
COMPLICATIONS: dehydration, electrolyte imbalance

Question 24

What is constipation?

Answer 24

difficulty passing, infrequent stool, hardness of stool, incomplete feeling afterwards

Question 25

Two main categories of constipation?

Answer 25

acute (organic) | chronic (functional or organic)

Question 26

RED FLAGS WITH CONSTIPATION

Answer 26

abd distention, vomiting, blood in stool, wt loss, severe or worsening sxs

Question 27

What causes gas?

Answer 27

colonic bac fermenting nutrient, swallowed air

Question 28

What are the 3 types of gas?

Answer 28

belching bloating/distention flatus

Question 29

RED FLAGS WITH GAS

Answer 29

wt loss, blood in stool

Question 30

What are the two forms a GI bleed can present as?

Answer 30

gross or occult blood

Question 31

What is hematochezia?

Answer 31

gross blood suggesting lower GI bleed

Question 32

What are some causes of small bowel bleeding?

Answer 32

angioma, AV malformation, tumors, meckel's diverticulum

Question 33

What are some causes of colon, anal bleeding?

Answer 33

anal fissure, colitis, carcinoma & polyps, diverticular dz, IBD, hemorrhoids

Question 34

What is dyschezia? What is happening to cause it?

Answer 34

difficulty stooling- feel urge but can't go, often from incoordination of rectal muscles & sphincter

Question 35

Why do an O&P x 3?

Answer 35

to find protozoa, worms, worm eggs & other parasites commonly detect parasites like giardia, cryptosporidium & worms like roundworms, hookworms, tapeworms, flukes & flatworms

Question 36

Why do a stool culture?

Answer 36

immunocompromised pt, severe inflam diarrhea, in those w/IBD to distinguish b/w a flare & infxn

Question 37

What will a fecal occult blood analysis tell you about?

Answer 37

detect upper GI bleed

Question 38

What will a fecal leukocyte analysis tell you?

Answer 38

help confirm or deny bac cause of diarrhea

Question 39

What is the point of a fecal lactoferrin test?

Answer 39

marker for fecal WBCs, help distinguish b/w inflam diarrhea (bac infxn, IBD) & non-inflam (viral, IBS)

Question 40

What is a fecal lysozyme test used for?

Answer 40

measure success of tx for IBD, N= absence of colonic inflam, suggests irritation only

Question 41

What is a comprehensive digestive stool analysis include?

Answer 41

markers for digestion, absorption, metabolism plus micro

Question 42

When is a salival secretory IgA test low? High?

Answer 42

``` low= celiac, IBD, chronic infxn, chronic stress high= acute GI infxn ```