Abdomen and GI Section (General diagnosis)

What do increased bowel sounds mean?

Early intestinal obstruction

What do absent bowel sounds mean?

Late intestinal obstruction; adynamic (paralytic) ileus

What is the definition hematemesis?

Vomiting up blood

What is the definition hemoptysis?

Coughing up blood

What is the definition hematochesia?

Blood in stool

What is the jaundice?

Yellowing of the skin, sclera, and mucous membranes; can occur with any liver disorder

What are some characteristics of cirrhosis?

Alcoholism is the most common cause; causes portal hypertension, ascites, esophageal varices

What is Mallory Weiss syndrome?

Coughing, tearing esophageal blood vessels and hematemesis with palmar rash due to bile salts

What is Wernicke Korsakoff syndrome?

Thiamin deficiency from alcoholism that leads to dementia

What is Beri Beri?

Thiamin deficiency without alcoholism

What are some characteristics of hepatitis?

Liver may be tender and enlarged but the edge remains soft and smooth

Where do you get hepatitis A from?

From food thought fecal/oral route, self-limiting, not a carrier

Where do you get hepatitis B from?

Dirty needles and sexual contract, carrier for life, most common to become liver cancer

Where do you get hepatitis C from?

Blood transfusions

What is the most common site for metastatic disease?

Liver cancer

What are some characteristics of liver cancer?

Liver will be enlarged, with a hard and irregular border

What is alpha fetoprotein?

Tumor marker specific for hepatocellular carcinoma; liver biopsy is performed for definitive diagnosis

What are characteristics of direct/conjugated bilirubin?

• Water soluble

• Increased with duct obstruction (gallstones), hepatic disease, pancreatic cancer

• Increased amounts in the blood may cause bilirubin in the urine (urobilinogen)

What are characteristics of indirect/unconjugated bilirubin?

• Not water soluble

• Increases with hemolytic disease, drugs, and spleen disorders

• Hemolytic anemia; increase in reticulocyte count (Coomb’s test)

Where is referral pain for the gallbladder?

Right shoulder or tip of right scapula (viscerosomatic)

What are characteristics of cholecysitis?

Most commonly seen in overweight females >40 y.o.a; most common cause is cholelithiasis; severe right upper quadrant pain, nausea, vomiting, and precipitated by eating a large fatty meal; Murphy’s sign; diagnostic ultrasound and oral cholecystogram

What is porcelain and gallbladder?

Calcification that can become malignant due to chronic inflammation

Where is pain felt for pancreatitis?

Epigastric pain going straight through the T10-T12 area like a knife (viscerosomatic)

When do you seen chronic pancreatitis?

Seen with alcoholism

What do you do with acute pancreatitis?

911 emergency

What is grey turner sign?

Bleeding into flank

What is Cullen’s sign?

Periumbilical ecchymosis caused by intraperitoneal hemorrhage or seen with a ruptured ectopic pregnancy

What are characteristics of pancreatic cancer?

Usually at the head of the pancreas; presents with dark urine, clay colored stools and jaundice

What are characteristics of diabetes mellitus?

A condition in which the pancreas does not produce a sufficient amount of insulin to take the sugar out of the blood and transport it to the tissues of the body, these starved tissues force the breakdown of fats in order to obtain energy; polydypsia, polyphagia, and polyuria are seen

What is diabetes type 1?

Insulin dependent; juvenile, under 30, usually thin

What is diabetes type 2?

Non-insulin dependent; adult, over 40, usually obese

What is diabetes insipidus?

Condition of the posterior pituitary gland in which there is insufficient ADH; may have polydypsia, polyuria, but not polyphagia

What is a hiatal hernia?

Protrusion of the stomach above the diaphragm; presents with palpable tenderness in LUQ, reflux esophagitis (acid reflux), dyspepsia (indigestion), made worse after eating large meal or when lying down

What is reflux esophagitis?

Upward reflux of acid contents of the stomach into the esophagus; caused by sliding hiatal hernia; worse when lying down, after big meals, Valslva, or bearing down

What are characteristics of peptic ulcers?

Includes gastric and duodenal ulcers; caused by H.pylori bacteria; burning pinpoint epigastric pain; coffee ground emesis

What is a gastric ulcer?

Has no consistent pain pattern

What is duodenal ulcer?

Most common type of peptic ulcer; pain occurs 2 hours after eating; black/tarry stool; guaiac test (occult blood in the stool)

What is pyloric stenosis?

Projectile vomiting in the newborn

Where is a gastric carcinoma located?

Most common on the lesser curvature

What is Virchow’s node?

Gastric carcinoma with left supraclavicular lymph node invovlement

What is mononucleosis?

Caused by the Epstein barr virus and is seen in young adults (18-25); presents with symptoms similar to the flu such as fever, headache, fatigue, lymphadenopathy in the cervical region, splenomegaly; atypical lymphocytes in blood (Downey cells); monospot, heterophile agglutination; paul bunnell

What is osteopetrosis “marble bone”?

The bone marrow becomes sclerotic, thus the RBC’s are not made properly; the liver and spleen become enlarged

Where is referral pain for the small intestines?

Periumbilical

What is regional illeitis aka crohn’s disease (right side of intestines)

Nonspecific inflammatory disorder that affects distal ileum and colon; presents with RLQ pain, chronic diarrhea, and a cobblestone appearance on sigmoidoscpoy; leads to malabsorption of B12; non-trpoical/celiac spure (gluten allergy) can cause this condition

What is ulcerative colitis (left side of the intestines)?

Most common at the colon and rectum; presents with bloody diarrhea; diagnosed with sigmoidoscopy

What is irritable bowel syndrome aka spastic colon?

Variable degrees of constipation and diarrhea in response to stress; seen more commonly in females; abdominal pain and gas relieved by bowel movements

What is appendicitis?

Dull periumbilical or epigastric pain that radiates to lower right quadrant (McBurney’s point); presents with fever, nausea, vomiting, and anorexia; increased WBC (shilling shift to the left); rebound tenderness, rovsing’s sign, psoas sign, obturator sign; special test is CT scan; refer to ER

What is diverticulitis?

Consequence of inadequate fiber in the diet; chronic constipation which causes small outpouchings within colon that become infected; LLQ pain

What are characteristics of Cushing’s disease?

Increased production of adrenal cortex hormone; hyperadrenalism, hypercortisolism; moon face “pie face”, buffalo hump, pendulous abdomen with purple striae, hirsutism, weakness, and hypertension

What are characteristics of Addison’s disease?

Decreased aldosterone, hypoadrenalism, hypocortisolism; increased ACTH causes melanin deposition (hyperpigmented mouth and face)

What are characteristics of Phenochromocytoma?

Tumor of the adrenal medulla; increased catecholamine production (epinephrine and norepinephrine); may appear similar to hyperthryoidism but this produces extreme hypertension

What are characteristics of nephrolithiasis?

Flank pain described as writhing, Murphy’s test; evaluate by increased BUN, uric acid, creatinine clearance and KUB study; hydronephrosis can cause a staghorn calculi

What are characteristics of acute glomerulonephritis aka nephritic syndrome?

Caused by group A hemolytic strep; RBC casts in urine with small amount of protein

What are characteristics of nephrotic syndrome?

Hypertension, edema, massive proteinuria (HEP); in pregnant women is called pre-eclampsia; waxy or fatty casts in urine

What are characteristics of pyelonephritis?

E-coli from UTI; WBC casts in urine

What are characteristics of polycystic kidney disease?

Inherited disorder characterized by many bilateral renal cysts that increase renal size but reduce functioning renal tissue

What are characteristics of urethritis?

This diagnosis is classified as gonococcal (caused by gonorrhea) or non-gonococcal (caused by chlamydia); caused most commonly by E. Coli in females; nitrites in the urine

What are characteristics of cystitis?

Noninfectious bladder inflammation that causes burning, painful, and frequent urination with incontinence; patient will also have suprapubic and low back pain

What are characteristics of nephroblastoma aka Wilm’s tumor?

Malignant tumor of the kidney; less than 5 years of age, abdominal mass, hematuria

What does urge mean in regards to urinary incontinence?

Often called “overactive bladder”; the urgent need to get to the bathroom

What does stress mean in regards to urinary incontinence?

An increase in abdominal pressure such as exercise, cough, sneeze, laugh; due to weakened pelvic floor muscles

What does overflow mean in regards to urinary incontinence?

Inability to completely empty your bladder when you urinate; as a result, the patient has a constant or frequent dribble of urine

What does functional mean in regards to urinary incontinence?

Most common among older adults with arthritis, Parkinson’s, Alzheimer’s (disorders that involve moving, thinking, or communicating)

What are characteristics of an indirect inguinal hernia?

Most common type; this hernia passes down the inguinal canal and exits at the external inguinal ring and into the scrotum; most common in children and young adults

What are characteristics of a direct inguinal hernia?

Does not pass through the inguinal canal but exits directly through the external inguinal ring instead; it is usually acquired from obesity or heavy lifting; this hernia is felt when the patient cough or bears down; most common in adults over the age of 40

What are characteristics of a femoral hernia?

Not an inguinal hernia; it appears as a bulge lateral and inferior to the external inguinal ring at the site of the femoral pulse