401 quiz 2

What is in the RUQ

liver, gallbladder, duodenum, head of pancreas, right kidney and adrenal, hepatic flexure of colon, part of ascending and transverse colon

What is in the LUQ

stomach, spleen, L lobe of liver, body of pancreas, L kidney and adrenal, splenic flexure of colon, part of transverse/descending colon

What is in the RLQ

cecum, appendix, r ovary, r ureter, r spermatic cord

what is in the LLQ

descending colon, sigmoid colon, L ovary, L ureter, L spermatic cord

what is Cullens sign

ecchymosis at the umbilicus due to retroperitoneal bleed

What is Grey Turner's sign?

ecchymosis at the flank due to retroperitoneal bleed

Why is auscultation done before percussion and palpation?

because it can create abdominal sounds that were not there before palpation

what to listen for with auscultation of GI

bowel sounds

what are Red Flags for abdominal pain?

vomiting bright red blood or black, fever \>101 w/ab p!, persistent vomiting, unstable vital signs, decreased loss of consciousness

what commonly causes splenomegaly

mono

what are some signs of traumatic spleen injury

splenomegaly, LUQ p!, Kehr's sign, shock, abdominal rigidity

Red Flags for Traumatic Abdominal Pain

MOI for liver or spleen, diffuse abdominal pain/rigidity, pain in the back w/o MOI, unstable vitals, hematuria, excessive N/V

when to refer NVD

if persists for \>36 hours and or accompanied by pain/fever

when to immediately refer vomit

large amounts of bile, blood/coffee grounds, stool-like material

when to refer diarrhea

bloody, maroon in color, mucus-like

look at stool colors and appearance

ok

what is the BRAT diet

bananas, rice, applesauce, toast

What is viral gastroenteritis?

inflammation of stomach and small intestines; self-limiting viral infection

info about viral gastroenteritis

highly contagious, common in close quarters, runs course in 2-3 days, norovirus common

S/s of viral gastroenteritis

NVD quick onset; fever varies; affects children/elderly more than adults; pain, weakness, loss of appetite

management of viral gastroenteritis

OTC/hydration (Imodium), IV fluids

Px of viral gastroenteritis

afebrile, no lingering malaise/weakness

what are some types of food poisoning

e-coli, campylobacter jejune, staphylococcus, shigella sp, bacillus cereus

look at types of bacterial gastroenteritis

ok

S/S of bacterial gastroenteritis

similar to viral, symptoms last longer and more severe, high fever, abdominal cramping

onset of staph bacterial gastro

4-6

onset of ecoli and salmonella

3-10 days

dx of bacterial gastro

stool culture, CBC, BMP

What is a CBC test?

complete blood count

What is a BMP test?

basal metabolic pannel

Tx of bacterial gastro

OTC meds, Hydration, antibiotics

Px of bacterial gastro

when sx resolved

what is the most common cause of parasitic infection and the types

Protozoas: guardia, entamoeba species, other

what is Giardia

waterborne protozoa

where are entamoeba species located

tropical locations

what are some other causes of parasitic infections

tapeworms, roundworms, flukes

s/s of Giardia

significant gas, acute/intermittent explosive diarrhea, dull abdominal cramps, bloating

s/s of entamoeba

chronic/intermittent diarrhea, abdominal pain, WL, fever

what type of referral for parasites

prompt

what is constipation

subjective discomfort from difficulty passing stools

Tx of constipation

increase fiber intake, fluids, laxitive

when to give laxative to constipated pt.

after doctor permission

info about stress induced GI symptoms

dx of exclusion, R/O other causes, psychological intervention, anti-anxiety meds

what is GERD

gastroesophageal reflux disease; "heartburn"

pathological reason for GERD

low tone esophageal sphincter

s/s of GERD

heartburn sensation, chest p!, belching, food/acid regurgitation, chronic cough, hoarse voice, asthma attack, burning sensation, nausea when supine

Dx of GERD

usually based on sx, upper GI series, EGD

what is EGD test

upper GI endoscopy

Tx of GERD

OTC, remove cause, lifestyle management

What is gastritis?

diffuse inflammation of the lining of the stomach

what is peptic ulcer

erosion of the lining of the stomach or duodenum

what are the types of peptic ulcers

gastric, dueodenal

causes of gastritis/peptic ulcers

erosion from NSAIDs/alcohol, stress, helicobacter pylori bacteria

gastric acid secretion with gastric vs duodenal ulcer

gastric-decreased; duodenal-increased between meals, after meals, during night

when is pain with gastric ulcer? duodenal?

20-60 minutes, 2-3 hours after meal

which type of ulcer has pain relieved with food

duodenal

peak age for gastric? duodenal?

50-60, 35-45

wight fluctuation with gastric? Duodenal?

weight loss, weight gain

s/s of gastritis/peptic ulcer

loss of appetite, nausea, melena, hematochezia, hematemesis

Tx of gastritis/peptic ulcer

OTC/Rx acid reducers, antibiotics

what is IBS

spasms contract the bowel

s/s of IBS

diarrhea altering with constipation, urgency, sudden sensation of bowel movement

Dx of IBS

Dx of exclusion

Tx of IBS

stress management, OTC meds, high fibers, antispasmodic (dicyclomine)

what is celiac disease

autoimmune disorder that affects GI tract and triggered by gluten

causes of Celiac disease

chronic inflammation in small intestinal mucosa leads to atrophy small intestinal villa leads to malabsorption

direction s/s of celiac disease

chronic diarrhea, cramping, gas pains, WL

s/s due to malabsorption for Celiac

delayed growth, bone/joint pain, weakness, anemia, migraines

Dx of celiac disease

BMP, CBC, TSH, Vit D3, allergy testing, serologic testing

Tx of celiac

remove gluten

what is inflammatory bowel disease

Ulcerative colitis (UC) and Crohn's disease

what does IBD affect

intestine and colon

sx related to inflammation of GI

persistent diarrhea (bloody), rectal bleeding, urges need to move bowels, ab cramps and p!, sensation of incomplete evacuation, constipation

general symptoms that may be with IBD

fever/night sweats, loss of appetite, wL, fatigue, skin and eye conditions, abnormal menstrual cycle

Main things about Crohns disease

may involve any segment of the GI tract from mouth to anus; prolonged diarrhea w abdominal p!, fatigue, WL; skip lesions; transmural inflammation; anal fistulae, abscesses, fissures, and ulcers

main things about ulcerative colitis

recurring episodes of inflammation limited to the mucosal layer of the colon, bloody diarrhea with mucus, involves rectum and extends proximally

Dx of IBD

colonoscopy

Tx of IBD

immune suppressors, anti-inflammatories, supportive

what is the most common cause of emergency abdominal surgery

appendicitis

what is appendicitis

acute obstruction and inflammation of the appendix

s/s of appendicitis

non-specific periumbilical pain early on, P! at McBurney's point, loss of appetite, N/V, fever, r hip flexion alleviates

tests of appendicitis

McBurney's point, Rovsing's sign, Psoas sign, Obturator sign

what is Rovsing's sign

RLQ pain upon palpation of LLQ

what is psoas sign

passive extension of the hip leading to RLQ pain

what is obturator sign

passive internal rotation of the flexed hip leading to RLQ pain

Dx of appendicitis

ultrasound, CT scan

Differential Dx of appendicitis

hernia, ectopic, PID, ovarian cyst, abdominal pain

what is cholecystitis

gallbladder inflammation

What is cholelithiasis?

gallstones

how do gallstones form

cholesterol and other substances in the bile form crystals that become hard stones in the gallbladder

gallstones cause \___% of cholecystitis cases

90

S/S of cholecystitis

RUQ p!, Boa's sign, N/V, sx increase after fatty foods, indigestion, jaundice, fever, severe pain with long term blockage, Murphy's sign, 5 Fs

what are the 5 fs

Fat, female, forty, fertile, and fair

Tx of Cholecystitis

cholecystectomy

what is the 2nd leading cause of cancer in US

colorectal cancer

Risk factors for Colorectal cancer

family history, hereditary polyposis syndromes, obesity, dietary factors

S/s colorectal cancer

red/maroon stool, anemia, change in bowel habits

Dx of colorectal cancer

colonoscopy with biopsy

Tx of cholorectal cancer

colectomy, chemo and radiation

if diagnosed early, colorectal cancer \_______% can be cured

\>90