Imported: Gi_Test 2: Gotfried_Gi Pain

Front 1

Positive McBurney’s sign

Back 1

between umbilicus and right ASIS

shows appendicitis

Front 2

Rovsing’s sign

Back 2

press on lower left quadrant

pain goes to lower right quadrant

shows appendicitis

Front 3

Psoas sign

Back 3

stretch the psoas w/ pt on their side

pt will have pain

shows appendicitis

Front 4

T10-L1 rotated right can be associated with what GI problem

Back 4

appendicitis

Front 5

Abdominal pain from any cause is mediated by either the...

Back 5

visceral or somatoparietal afferent system

Front 6

visceral afferents arise from what spinal levels?

Back 6

T5-11

Front 7

Visceral vs Somatoparietal pain

diffuse not localized, midline

****in red

Back 7

Visceral

Distention or stretch of the visceral peritoneum produces visceral pain

Front 8

Visceral vs Somatoparietal pain

nonradiating, precisely localized

****in red

Back 8

Somatoparietal pain

Front 9

Visceral vs Somatoparietal pain

more intense or “sharp”

****in red

Back 9

Somatoparietal pain

Front 10

source of visceral pain for pain that is perceived as

epigastric

periumbilical

suprapubic

Back 10

Foregut-perceived as epigastric

Midgut-periumbilical

Hindgut-suprapubic

Somatoparietal pain - nonradiating

Front 11

an important defense mechanism that pts have to wall off problems is lost in these 2 populations...leading to a more diffuse peritonitis

Back 11

Children

Old people

Front 12

bacteria that generally cause appendicitis?

Back 12

Bacteria are
E. Coli 80%,
Bacteroides Fragilis 70%, Pseudomonas 40%

Anaerobes exceed aerobes by 3:1

Front 13

how does referred pain occur?

Back 13

One explanation is that visceral afferent nerve fibers enter the spinal cord close to inputs from somatic receptors, and both types of inputs activate the same spinothalamic pathways

Front 14

what is the order for examination of the abdomen?

***RED BOLD

Back 14

INSPECTION
AUSCULTATION
PERCUSSION
PALPATION

Front 15

is your pt RESTLESS or STILL?

what do these indicated?

***RED

Back 15

Restless: kidney stone (ureters are retroperitoneal)

Still: something in the peritoneum

Front 16

4 Steps for progression of symptoms in acute appendicitis

****one step was in red

Back 16

1. Vague periumbilical pain, followed by....

2. “Tormeanor” (anorexia, nausea, vomiting, malaise), followed by....

3. Migration of pain into LRQ (***IN RED) , followed by....

4. Temperature elevation (~101f.)

note: the whole sequence takes 24-48 hours

Front 17

if a female pt has generalized GI pain, what test should you make sure to do?

Back 17

HCG (preggo)

Front 18

What is the definitive tx for appendicitis?

Back 18

Appendectomy

no significant difference in laparoscopic and open

Front 19

in a woman who is pregnant, what is the most reliable symptom of appendicitis?

Back 19

is periumbilical or diffuse abdominal pain that later localizes to the right lower quadrant.

so pretty much the same thing

Front 20

60% of jaundice cases are a result of?

** in red

Back 20

ACUTE CHOLANGITIS
USUALLY SECONDARY TO CBD STONE

Front 21

pt is sitting up and leaning forward in pain when you walk into the room..the pt has lancinating (spearing) pain that radiated directly through to the back... what do they have?

***red

Back 21

Acute pancreatitis

Front 22

most common cause of mechanical small bowel obstruction is?

Followed by?

****RED

Back 22

Adhesions

Hernia

Front 23

The most common cause of Large Bowel Obstruction is....

***RED BOLD

Back 23

NEOPLASM

Front 24

- Found in 50-70% of patients with cholangitis. URQ pain in 70%, fever with chills in 90%, jaundice in 60%
(All as a result of acute cholangitis), usually secondary to CBD stone.

May progress to pus in the biliary tree and the patient may develop hypotension, mental confusion, and death (Reynolds pentad).

Back 24

Charcot's Triad

Front 25

- Males (30-40). Pain is sudden in onset, severe and located first in epigastrium. Shoulder pain is common.

-Patient lies still, afraid to move “board like abdomen”. There is diffuse rebound tenderness and hypoactive bowel sounds. WBC 12,000-20,000.

There will be air beneath the diaphragm (pneumoperitoneum)

Back 25

Perforated Peptic Ulcer

Front 26

What is Murphy's Sign? What does it indicate?

Back 26

Tenderness to palpation on inspiration

indicates cholecystitis/gall bladder dz

Front 27

- Women (30-60), with URQ constant, dull pain, n/v, possible palpable mass, hypoactive bowel sounds, tenderness to palpation on inspiration (Murphy’s sign),

-WBC 10,000-13,000 and bilirubin may be elevated.

-Dx with ultrasound

Back 27

Acute Cholecystitis

Front 28

- Sudden, colicky pain-periumbilical. Relief of symptoms between colic. Nausea/vomiting.

- Color of emesis (yellow, green, brown – feculent), hyperactive bowel sounds with an increased pitch, HCT elevated (dehydration), step ladder or stack of coins pattern on abdominal x-ray.

Back 28

Small Bowel Obstruction

M/C caused by ADHESIONS, then, hernias

Front 29

- Age over 40. Gradual in onset with constipation and abdominal distention (tympanic), carcinoma or stricture from chronic diverticulitis or volvulus. X-ray markedly dilated colon +/- small bowel.

- Volvulus (sigmoid>cecum), usually sudden in onset. Contrast BE xray to diagnose.

Ogilvies syndrome is when there is a pseudo-obstruction.

Back 29

Large Bowel Obstruction

M/C cause: NEOPLASM

Front 30

General appearance – position in bed restless or still.

-They will have signs of dehydration, unwillingness to change position, hip flexion with knees drawn up suggests peritoneal irritation.

-Shallow breathing, use of accessory muscles suggests peritoneal irritation (won’t want/hurts to cough).

Back 30

Acute Appendicitis

Front 31

Which is better for diagnosing acute apendicitis:

CT scan or Clinical Assesment?

Back 31

Clinical assessment yielded a 90% accuracy for the diagnosis of acute appendicitis, compared to 92% for CT.

-The greater sensitivity of clinical assessment makes it the ideal screening modality. The greater specificity of CT makes CT a useful diagnostic tool when clinical assessment is inadequate.

Front 32

What is the most reliable symptom of appendicitis during pregnancy?

Back 32

Periumbilical or diffuse pain that later localizes to RLQ

Front 33

What is the definitive tx for appendicitis?

Back 33

appendectomy

Front 34

Name the problem:

- Males are affected more commonly than females (4:1) in the 6-7th decade of life.

-75% are asymptomatic. Presents as a vague abdominal pain radiating to the low back, flank groin, testicles, buttocks and legs (expansion).

- There will be palpable, pulsatile, immobile periumbilical mass (above or below) with a bruit.

-Tenderness and flank pain suggest rupture.

Back 34

Abdominal Aortic Aneurysm