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83 Cards in this Set

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Tumors and fibrotic strictures that narrow and obliterate the lumen
Intramural
i
When the lumen is compressed and blocked
extramural
e
neutralizes acid and initiates digestion, absorption of iron, calcium and folic acid
deodenum
d
responsible for most of digestion and absorption of water and nutrients
jejunum
j
completes digestion, takes up B12 and recovers bile salts
ileum
i
prevents reflux of colonic contents into small intestine
ileocecal valve
i v
Bacteria also make vitamin K here
large intestine
l
lesions, stones, FB that block the lumen
intraluminal
i
when a segment of the gut is twisted
volvulus
v
when one part of the gut inverts and is pulled into the lumen by peristalsis
intussusception
i
functional obstruction, a segment of the gut losses its propulsive function, gut is “sleeping”
ileus
i
an acute opening where the gut contents spill freely and may lead to peritonitis from bacteria
perforation
p
process invades an adjacent structure
penetration
p
a walled off penetration may lead to this
abscess
a
abnormal tubelike passage from one cavity to another, or from cavity to free surface; can be congenital or acquired
fistula
f
ischemia of deeper muscle layers can cause scarring and this
fibrosis
f
contraction of a scar can cause ____________ with luminal narrowing and obstruction
strictures
s
Can lead to a breach in the mucosa exposing underlying tissue to luminal contents
Typically occurs in peptic ulcer disease
May lead to fibrosis and scarring
chronic inflammation
c i
Injured peritoneum (when apposed to healthy peritoneum) will resurface itself without scarring when inflammation resolves
However, if two injured peritoneal surfaces rub together, they will initially adhere to each other, seal by fibrin, and then scar
Peritoneal scars are called _________ – a common cause of intestinal obstruction years later
adhesions
a
outpouchings of a hollow organ
diverticula
d
_______ diverticulum contain all the layers of the bowel wall
true
t
_______ diverticulum consist of mucosa and submucosa herniated through the muscle layer
false
f
pyrosis
heartburn
h
"coffee ground" emesis(vomiting), BRB
hematemesis
h
coughing up blood
hemoptysis
h
BRB per rectum
hematochezia
h
black, tarry stool
associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.
The most common cause is peptic ulcer disease
melena
m
What else can turns stools black
pepto bismal or iron supplements
fluid in peritoneum
ascites
a
refers to bruising of the flanks.

This sign takes 24-48 hours to appear and predicts a severe attack of acute pancreatitis, with mortality rising from 8-10% to 40%.
Grey-Turner sign
G-T
is blue-black bruising of the area around the umbilicus.
Cullen sign
C
Sharp pain when hand quickly removed from abdomen
rebound tenderness
r
Flexible glass fibers carry image
Light source thru fibers
Channels for insufflation of air, water, suction to remove secretions, instrument passage for biopsy, balloon dilation, injection, cautery
Levers can manipulate tip and steer instrument
endoscopy
e
Allows visual inspection of lumen of GI tract (esophagus, stomach and duodenum)
Used to discover reason for swallowing difficulties, nausea, vomiting, reflux, bleeding, indigestion, abdominal pain, or chest pain
Local anesthetic, conscious sedation
Swallow flexible endoscope
Visualize all lining
Biopsy, cautery
NPO prior 6-8 hours, avoid anticoagulants, aspirin and NSAIDs for 3-5 d before test
upper endoscopy (EGD) esophagogastroduodenoscopy
u e
Allows visual inspection of stomach, duodenum, and ducts in biliary tree and pancreas
Detect problems in the liver, gallbladder, bile ducts and pancreas
Used to determine reason for jaundice, upper abdominal pain, unexplained weight loss
endoscopic retrograde cholangiopancreastography (ERCP)
e r
Local anesthesia, conscious sedation
Swallow flexible endoscope
Localize ducts and opening to duodenum
Pass small tube through scope into ducts, inject a radiopaque contrast material
Visualize pancreatic and common bile duct under fluoroscopy
Biopsy, remove obstruction
NPO prior 6-8 hours, avoid anticoagulants, aspirin and NSAIDs for 3-5 d before test
Endocarditis antibiotic prophylaxis
Dye (iodine) allergy
endoscopic retrograde cholangiopancreastography (ERCP)
e r
Visualize the colon and distal ileum
Used to detect causes of unexplained bowel changes, cancer, abnormal growths, ulcers, bleeding
colonoscopy
c
Conscious sedation
Flexible endoscope inserted into rectum
Biopsy, cautery, inject medication or dyes
Bowel prep prior to procedure
NPO prior 6-8 hours, avoid anticoagulants, aspirin and NSAIDs for 3-5 d before test
colonscopy
c
Visualize distal colon and rectum (65 mm)
Used to detect causes of diarrhea, abdominal pain, constipation, cancer, abnormal growths, ulcers, bleeding
flexible sigmoidoscopy
f s
Can be performed by trained primary providers in office
Flexible tube inserted into rectum and sigmoid colon
Biopsy, cautery
Cleansing enema prior to procedure
flexible sigmoidoscopy
f s
Anoscope for examination of anal canal
Proctoscope for examination of rectum
rigid endoscopes
r e
Wide mediastinum or air-fluid level seen in obstructed esophagus
Pneumothorax or pneumomediastinum in perforated esophagus
Free air under diaphragm in perforated bowel
CXR
C
Abdominal series (3-way)
KUB (kidneys, ureter, bladder)
Air-fluid levels indicate obstruction or ileus
abdominal Xray
a
Detect problems in the esophagus, stomach and small intestine
Used to look for ulcers, scar tissue, abnormal growths, hernias or areas of blockage
Drink barium contrast medium – coats esophagus, stomach and small intestine
Fluoroscope allows visualization of digestive system
Less accurate than endoscopy
NPO for 8 hours prior to procedure
radiography
upper GI series
u
Detect problems in the large intestine (colon and rectum)
Used to look for abnormal growths, polyps and diverticuli
Barium enema: infused via rectum – coats colon and rectum
Bowel prep prior to procedure
radiography/"barium enema"
lower GI series
l
Localizes site of bleeding or occlusion of vessel

Inject contrast dye into the blood vessels that supply the organs of the abdomen
angiography
a
By filling the vessels with dye, they can be identified and abnormalities can be detected.
Diagnose diseases of the blood vessels in the small and large intestines such as a narrowing or tumors.
Identify the site of bleeding in the abdomen and possibly stop the bleeding by injecting a plug or chemical.
Clear liquids 6-8 hours prior to procedure
angiography
a
Good for gallbladder and measuring bile duct size
Less expensive than CT
Liver, gallbladder, pancreas and digestive tract
NPO for 6-8 hours prior to procedure
Stomach, duodenum, small bowel
Increased water intake immediately before test
ultrasound
u
Good for solid organs, not for bowel wall
Better than US for liver and pancreas
CT-guided aspiration and biopsy of lesions
NPO 2-4 hours prior to procedure
Elderly and diabetics need serum creatinine prior to testing with contrast dye
computed tomography
c t
Useful in diagnosis of intra-abdominal masses

Provides detailed pictures of soft tissues
clearly shows lymph nodes and blood vessels, and can evaluate blood flow
may be used in diagnosing abnormal growths
can provide information for the staging of abdominal tumors
NPO 4-6 hours prior to procedure
MRI
m
digital geometry processing is used to generate a three-dimensional image
computed tomography
c
Used to determine if cystic duct is blocked by a stone or inflammation
Isotope is picked up and excreted by the liver
in normal instances, gallbladder will fill with radionuclide
if cystic duct is blocked, gallbladder with not receive any isotope
if common bile duct is not blocked, isotope should pass through duct and end up in GI tract
NPO 6 hours prior to procedure
HIDA scan
h
short-lived, acute painful peristalsis
usually due to acute gastroenteritis
intestinal colic
i c
short-lived, acute painful peristalsis
low in the abdomen, below the umbilicus
relieved by defecation
colon colic
cc
repeated or persistent painful peristalsis
sharp pain that causes patient to double-over
distension, high-pitched “tinkling” bowel sounds, nausea
failure to pass feces or flatus
intestinal obstruction
i o
localized pain over inflamed organ
worse with movement or prodding
peritoneal inflammation
p i
Severe RUQ pain, radiating to the back
Pain comes in waves
Lasts for several hours
Associated with nausea and vomiting
Roam around to find comfortable position
biliary colic
b c
RUQ pain that radiates to the shoulder
Excessive belching
Nausea
inflammed gallbladder
i g
Chronic inflammation with:
Severe pain in the back just below the shoulder blades
Induced by eating or alcohol
Mildly relieved by sitting forward
Pancreatic cancer may be painless but extension retroperitoneally initiates unremitting central back pain
pancreatic pain
p p
Pain that has been present for 6 months or longer
This pain may be an emotional expression
chronic abdominal pain
c a
An urgent situation in which abdominal symptoms onset suddenly and are sufficiently severe to suggest a potentially lethal condition.
Pain is usu the predominant feature.
Steady, severe pain is more ominous than colicky pain
In addition to classic diagnoses consider:
acute MI or angina
aortic disease – dissection or aneurysm
intestinal ischemia
metabolic disorders
severe acute abdominal pain
s a a
Difficulty in starting to swallow
dysphagia
d
Relates to neurological or muscular disease
Assoc with drooling due to difficulty swallowing saliva
Aspiration of saliva with assoc aspiration pneumonia
difficulty with liquids more likely a problem with neurological or muscular control of swallowing
dysphagia
d
Dysphagia of solids more likely a problem with __________ lesion
structural
s
difficulty swallowing solids first then liquids is “BAD”, sign of cancer of esophagus but can be from strictures
progressive dysphagia
p d
this type of dysphagia may suggest a benign structural lesion
non-progressive
n-p
Intermittent sticking affecting solids and liquids suggest ________ disorder
motility
m
“Lump in throat”

Usually in highly anxious people
Increased during stress
Temporary inability to swallow
globus sensation
g s
Highly nonspecific symptom
May be associated with anxiety or depression
If assoc with weight loss may suggest an organic disorder
Initial hunger with rapid feeling of fullness may reflect poorly distensible stomach or motility disorder
loss of appetite
l o a
food returning to mouth from esophagus without reverse peristalsis
regurgitation
r
mouth filled with excess saliva, possibly symptom of peptic ulcers
water brash
w b
Retrosternal, raw, burning sensation – starts at epigastrium and travels up to the throat
Precipitated by large meals, alcohol, stooping, or lying flat in bed
Rapidly relieved by milk/alkali
Persistent heartburn suggests esophagitis and repeated reflux
Dysphagia may result
pyrosis (heartburn)
p
Painful digestion

Often meal-related epigastric discomfort, pain or fullness
Classic symptoms of peptic ulceration:
Pain relieved by food and initiated with hunger
Pain is epigastric and radiates to the back
Antacids relieve symptoms within minutes
Pain awakes patient in early hours
Symptoms come in bouts
dyspepsia
d
Increased serum bilirubin levels with yellow appearance of skin and mucous membranes

Usually noticed first in the sclera
May be preceded by several days of pale stools and dark urine
jaundice
j
Accumulation of serous fluid in the peritoneal cavity
Increased abdominal girth assoc with feeling of distention
nausea and vomiting, SOB
ascites
a
Gas production by bacteria in colon
Normal elimination is approx 1 liter per day (50-500 ml 13.5 times a day)
flatulence
f
(air swallowing)
Belch after a large meal is a physiologic venting of air from the stomach
aerophagia (belching)
a
“distended beyond normal size”
Unknown mechanism - Often assoc with IBS
In hypersensitive gut – abdominal muscles relax to accommodate perceived distention
Intestinal gas production does not cause bloating
bloating
b
feeling of rectal fullness (even if bowel movement was recent), reflects rectal inflammation
tenesmus
t
suggests abscess or thrombosed hemorrhoid
constant anal pain
c a p
Tearing pain on defecation
anal fissure
a f
intense intermittent anal pain attributed to spasm
proctalgia fugax
p f
anal itch, idiopathic or pinworm infection
pruritis ani
p a