Clin Med Iii-Cox Ch 6-Abdomen

Front 1

__ is a term to describe a collection of symptoms including epigastric pain, heartburn, nausea, upper abd. bloating, and belching.

-dysphagia
-reflus
-dyspepsia

Back 1

dyspepsia

Front 2

__ ulcers are a common cause of dyspepsia.

gastric ulcers
duodenal ulcers
peptic ulcers

Back 2

peptic ulcers

Front 3

You should always be alert to __ conditions that can masquerade as dyspepsia.

Back 3

malignant

Front 4

T/F

The distinction is usually made between ulcer dyspepsia and non-ulcer dyspepsia.

Back 4

true

Front 5

__ means difficulty in swallowing.

dyspepsia
achalasia
dysphagia

Back 5

dysphagia

Front 6

You must ask questions regarding a pt's dysphagia so that you can exclude other causes of dysphagia, what are they?

Back 6

-local factors within the mouth
-pain on swallowing (odynophagia)
-globus hystericus

Front 7

What are some common factors within the mouth that may cause a pt. to reduce or quit eating?

Back 7

aphthous ulcers, herpes simplex, candida-all may cause pain when chewing, tonsillitis, pharyngitis. A lack of dentures or ill fitting dentures can also hinder chewing and possible swallowing.

Front 8

__ is a condition that affects anxious people who complain that they have a lump in their throat usually at the level of the larynx.

-dysphagia
-globus hystericus
-hematemesis

Back 8

globus hystericus

Front 9

Stricture, carcinoma, Brown-Kelly/Plummer Vinson syndrome are __ causes of dysphagia.

neurological
mechanical

Back 9

mechanical

Front 10

t/f

with all the previous local causes of dysphagia, the normal function of the esophagus is maintained.

Back 10

true

Front 11

Name some common neurological causes of dysphagia.

Back 11

CVA
motor neuron disease
MS
Parkinson's disease
Achalasia of the esophagus

Front 12

T/F

Dysphagia symptoms are usually abrupt in onset resulting in difficulty swallowing even liquids or saliva.

Back 12

False: usually worsens in a progressive fashion, starting with difficulties with large boluses of food, then smaller pieces, until even liquids and pt's own saliva cannot be swallowed in extreme cases.

Front 13

With neurological causes of dysphagia the normally coordinated contractions of the __ are impaired.

pharyngeus muscles
esophagus
stomach

Back 13

esophagus

Front 14

T/F

Pt's with neurological esophageal dysfunction/dysphagia typically have a greater difficulty swallowing liquids than solids.

Back 14

false; these pt's have a greater difficulty swallowing liquids.

Front 15

T/F

Neurological causes of dysphagia are caused by lower motor neuron disease.

Back 15

False: the swallowing problem is just part of a bulbar or pseudobulbar palse (a lower or upper motor lesion of the IX, X, and XII cranial nerves)

Front 16

Pt's with dysphagia may also experience dysarthria or dysphonia...what is dysarthria and dysphonia?

Back 16

dysarthria-diff. in the articulation of speech
dysphonia-diff. in the power of their speech.

Front 17

T/F

In all cases of dysphagia, it is not possible for regurgitation of food to occur.

Back 17

false; in all cases it is possible for the regurg of food. Take note this regurg is with the absence of wretching and usually undigested food is brought back up. Of real concern is that this regurg. can occur while the pt is asleep and lead to aspiration of the contents.

Front 18

A 65 yr old man is admitted with his 3rd bout of pneumonia in the past 6 months. He has a 2 year hx of parkinson's disease, and an ex-smoker of 40 years. He has never had this type of respiratory problems in the past, what is happening with him?

Back 18

Due to his long hx of smoking, lung CA must be ruled out. But due to his PD, he could be experiencing unrealized nocturnal aspiration pneumonia. A speech therapy evaluation is key in this situation.

Front 19

Dysphagia may be due to __ obstruction or __ diseases.

Back 19

mechanical obstruction or neurological diseases

Front 20

When evaluating a pt with c/o vomiting, your questions can be divided into what 2 categories?

Back 20

-about the vomiting itself
-potential causes of the vomiting

Front 21

Which is the most important aspect to focus your history when evaluating a pt with c/o vomiting?

-the vomiting itself
-potential causes of the vomiting

Back 21

potential causes of the vomiting

Front 22

There are 5 important features of vomiting that you should investigate during the history taking, what are they.

Back 22

-acute v. chronic
-is it preceded by nausea or retching
-volume of vomitus
-what is in the vomit
-does it contain blood

Front 23

Why is it important to know if vomiting is preceded by nausea or retching?

Back 23

effortless vomiting may in fact be regurgitation and suggest esophageal pathology

Front 24

Why is it important to know the volume of vomit?

Back 24

a rough estimate, may help you identify or suspect acid/base imbalances or dehydration

Front 25

Why is it important to understand what the vomit contains?

Back 25

undigested food my indicated pharyngeal pouching. digested food (large quantities vomited in a projectile like fashion may be pyloric stenosis). was it dark and did it smell feculant-could indicated bowel obstruction

Front 26

Why is it important to ask if a pt's vomit contained blood?

Back 26

possible GI bleed

Front 27

When asking about potential causes of vomiting, why is it important to ask about precipitating factors, and can the pt. pinpoint the start of vomiting to eating any suspect food?

Back 27

Usually occurs at social gatherings or restaurants where food improperly prepared or stored.

The time that vomiting began r/t time of consumption can help you determine the type of bacteria you are dealing with, such as:

-bacillus cereus-vomiting begins in as little as 6 hours
-salmonella-12 to 24 hours

Front 28

Colicky abdominal pain with feculant vomiting could indicated intestinal __.

-stangulation
-bleeding
-intrasusception
-obstruction

Back 28

obstruction

Front 29

Name 3 drugs that have a narrow therapeutic serum window, and if too much is given the toxic s/e can cause vomiting.

Back 29

digoxin
aminophylline
phenytoin

Front 30

If you absolutely cannot find any physical reason for the pt's vomiting-what else should you evaluate?

Back 30

any emotional stressors.

Front 31

__ is the vomiting of blood.

melena
hematochezia
hematemesis

Back 31

hematemesis-vomiting of blood
hematochezia-passing of blood in stools
melena-the discharge of black, tarry, bloody stools; following a bleed from the upper GI tract.

Front 32

Dark, tarry stols can occur because of bleeding anywhere from the esophagus down to the ____.

-right side of the colon
-ileocecal junction
-jejunum
-hepatic flexure

Back 32

right side of colon

Front 33

Repeated retching or vomiting before blood appears suggest a __.

-barrett's esophagitis
-esophageal varices
-mallory-weiss tear

Back 33

mallory-weiss tear

Front 34

What 2 medications cause stools to appear as melena?

Back 34

bismuth and iron

Front 35

melena is due to bleeding in the __ GI tract.

-upper
-lower
-liver

Back 35

upper

Front 36

For both melena and hemtaemesis, when is a pt. considered hemodynamically stable?

P < 100
P < 120
SBP > 150
SBP > 100

Back 36

If P < 100, and SBP > 100

Front 37

When a pt. is bleeding anywhere within the GI tract what 2 medications must you be sure to ask if the pt takes?

-warfarin
-tylenol
-heparin
-NSAID's

Back 37

warfarin and NSAIDS

Front 38

What social habit must you ask about when evaluating a pt with a GI bleed?

-smoking
-illicit drug use
-alcohol intake
-exercise habits

Back 38

alcohol consumption

Front 39

There are 2 types of bleeding per rectum, what are they?

Back 39

melena
frank

Front 40

Where is the most common source of bright red bleeding?

-sigmoid colon
-anorectal region
-descending colon
-transverse colon

Back 40

anorectal region

although sources in the sigmoid and descending colon can also be responsible

Front 41

The further __ you go in the bowel the longer the blood takes to work its way to the anus and the darker it will look.

-distally
-proximally

Back 41

proximally

Front 42

All of the following except one are causes of bleeding from the anus/rectum.

-hemorrhoids
-anal fissure
-crohn's disease
-carcinoma of the rectum

Back 42

crohn's disease causes bleeding from the colon

Front 43

Ulcerative colitis, Crohn's disease, ischemic colitis, colon CA, polyps, angiodysplasia are all potential causes of bleeding from the __.

-upper GI tract
-colon
-anus/rectum

Back 43

All are sources of bleeding from the colon

Front 44

T/F

Torrential bleeding from the upper GI tract will pass thru the rectum as black tarry stools.

Back 44

false; a torrential upper GI bleed may pass thru as frank red blood

Front 45

If a pt is taking bismuth, their stools will look like __.

-black
-tarry
-black and tarry

Back 45

black but not usually tarry

Front 46

When a pt presents with bleeding per rectum, what is the first assessment you must do?

Back 46

is the pt hemodynamically stable, are they hypovolemic?

Front 47

What are the signs/symptoms you will observe in an unstable pt experiencing bleeding per rectum?

Back 47

tachycardia
hypotension (most like orthostatic)
diaphoretic
c/o dizziness
pale skin

Front 48

When taking the history of a pt with bleeding PR you ask if the blood is
dark or bright red. The more proximal the bleeding lesion is in the bowel, the __ it will be.

-darker
-lighter

Back 48

darker

Front 49

If a pt claims that blood dripped into the toilet after a BM and that when they wiped blood was on the toilet paper, you are most likely dealing with __ or __.

-hemorrhoids
-anal fissure
-ano-rectal are bleeding
-torrential upper GI bleed

Back 49

hemorrhoids are most common, and occasionally an anal fissue

Front 50

If a pt shows a P > 100 and SBP <100 you have a true emergency and you need to __ and investigate your pt urgently.

-call for an urgent GI consult
-infuse 2-4 units of whole blood
-resuscitate
-take to OR for an emergent laparoscopy

Back 50

resuscitate

Front 51

T/F

If a pt with rectal bleeding denies pain with BM your diagnosis is most likely __.

-rectal CA
-anal fissure
-hemorrhoids
-ulcerative colitis

Back 51

hemorrhoids

Front 52

If a pt experiences pain with BM and bleeding per rectum, they are most likely suffering from __.

-rectal CA
-anal fissure
-hemorrhoids
-ulcerative colitis

Back 52

anal fissure

Front 53

Profuse diarrhea may suggest an __ bowel disease.

obstructive
infectious
inflammatory

Back 53

inflammatory

Front 54

Bleeding PR can be in the form of bright red blood, _ _ _, or melena.

Back 54

dark red blood

Front 55

What is the first thing you had better be thinking about when first evaluating a pt with bleeding PR?

Back 55

are they hemodynamically stable

Front 56

Mucus passed in stool is an indication of ___?

inflammatory bowel disorder
infectious bowl disorder
intestinal obstruction

Back 56

inflammatory bowel disorder

Front 57

Shigella, amebic dysentary, and schistomsomiasis are infections that you must think about when your pt states they have recently ___.

Back 57

travelled over seas

Front 58

Abdominal pain of ulcerative colitis that is colicky or cramp like is relieved by?

-defication
-enema
-narcotics

Back 58

pooping