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25 Cards in this Set
- Front
- Back
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abdominal pain Hx
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nature: colicky (obstruction of a viscus) or steady
intensity: location: if localized (peritoneal) or diffuse (visceral), radiation (to back: pancreas, aorta, penetrating peptic ulcer), shoulder (diaphragm), neck (oesophageal reflux) epigastric (stomach or cystic duct obstruction) -RUQ cholecystitits -renal angle pain radiating to groin (renal colic pain) -vomit, pain and distention (obstruction) duration: chronic or acute, if chronic daily pattern aggravating and releiving: defecation may relieve colonic pain temporarily, moving helps colicky pain while lying still better for peritoneal pain features: vomiting for pancreatitis - |
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appetite and weight change
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-anorexia and weight loss (malignancy or other diseases)
-increased appetite and weight loss (malabsorption, hypermetabolism) -when did weight loss occur -how much and over how much time -loss of taste: acute hepatitis may stop smoking) |
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early satiation and postprandial fullness
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-carcinoma
-peptic ulcer -gastritis -fxnal GIT disease |
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nausea and vomit
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-timing of vomiting (more than 1hr after meal--> gastroparesis, gastric outlet obstruction ie PUD, early morning vomit--> raised intracranial pressure, alcoholism, pregnancy),
-contents of vomitus (bile --> open connection b/w SI and stomach, old food--> gastric outlet obstruction, blood--> ulcer or bleeding varices) obstuction (ie PUD) motor dysfxn (ie DM, post surgery) drugs (dopamine agonist, chemo drugs, opiates, digoxin infection (ie staph aureus food poisoning) |
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heartburn and acid regurg
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-occurs after meals
-bending lying supine or stooping -assoc with acid regur--> acid taste in mouth -drugs that aggravate (theophylline, caffeine, alcohol, CCB, anticholinergics |
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dysphagia
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difficulty swallowing
-is it painful (odynophagia)--> inflammation of esophagus ie infection, peptic ulcer,caustic damage, perforation -course of dysphagia: present only on first few swallows or intermittently (lower esophageal ring or esophageal spasm), progressive difficulty swallowing (stricture, carcinoma, achalasia) -food sticking (mechanical obstruction) -difficulty initiating swallowing, food regur into nose, or choking on trying to swallow (pharyngeal dysphagia--> motor neurone disease, CVA CN X, IX palsy) -both food and liquids (motor disorder more likely--> achalasia or diffuse oesophageal spasm, scleroderma) 1. mechanical obstruction (internal and external) 2. neuromuscular motility disorders 3. pharyngeal disphagia |
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diarrhoea
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larger number of stools (>3/day)
more watery and loose -if just increase freq but lower volume and same consistency (rectal pathology, or desire to defecate increased) -chronic or acute (more likely infection) ->1L/day (secretory) no pus or blood , not excessively fatty--> infection (E coli, staph,vibrio) hormones (VIP tumor, carcinoid syndrome) villous adenoma. -osmotic: dissappearance with fasting, large volume stools related to ingestion of food (dissacharidase def, Mg antacids, gastric surgery) -abnormal motility: (thyrotoxicosis, IBS) -exudative (inflammation of colon (small vol but freq, may have blood or mucus (IBD, colon cancer) -malabsorption (steatorrhea--> stools pale coloured and smelly >7g of fat in 24hrs) |
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constipation
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usually <3/wk stools
-neglect to defecate -drugs (Ca, aluminum antacids, antidepressants, codeine) -metabolic/endocrine (hypothyr, hypercalcemia, DM, phaeochromo, porphyria, hypokalemia) -neuro (Hirschsprung's, autonomic neuropathy, spinal cord injury, MS) -carcinoma obstructing (recent onset) -slow colonic transit (young women) -difficult evacuation --> anorectal disease, pelvic floor injury, feel need to strain and anal blockage -alternating const and diarrhoea, abdo pain relieved by defecation, pass mucous PR, unfinished feeling in rectum, abdo distention. (IBS) |
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mucous passage
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-villous adenoma
-fistula -rectal ulcer -IBS |
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bleeding
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-hematemesis (proximal to or at duodenum--> is it tooth socket or nose? ask about Sx of PUD (acute--> no pain or chronic--> pain), mallory weiss tear (repeated vomit)
-malaena (jet black stools) upper GI or small lesions in right colon or SI -haematochezia (bright red stool PR)--> hemorrhoids and anorectal disease--> small amounts not mixed, substantial (angiodysplasia, diverticular disease more common in right colon), IBD, colon ca/polyp, ischaemic colitits -occult blood (right colon ca) |
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jaundice
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yellow sclera--> ask about colour of stool and urine (dark urine and pale stool) --> obstructive or cholestatic jaundice
ask about abdo pain--> gallstones |
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pruritus
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itchy extremities-> cholestatic liver disease
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abdo bloating
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-gas
-hypersensitivity (ie IBS) -ascities (gradual worsening, ankle edema (non-pitting) |
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lethargy
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easily tired/fatigued--> acute or chronic liver disease, anemia due to GI or chronic inflammatory disease.
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treatments
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-NSAIDs (bleeding)
-halothane, phenytoin, chlorothiazide (acute hepatitis) -chlorpromazine, phenothiazines, sulphonamides, sulphonylureas, phenylbutazone, rifampicin or nitrofurantoin (cholestasis) oral contraceptive pill, anabolic steroid (dose related cholestasis or peliosis hepatitis) -alcohol, amiodarone, tetracycline, valproic acid--> fatty liver) -OD of paracetamol (liver cell necrosis) |
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PMHx
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-surgical procedures ie anaesthetics causing cholestasis, hypoxemia of liver cells causing surgical or post-op hypotension, direct damage to common bile duct,
-Hx of remitting epigastric pain with acute severe pain (perforated peptic ulcer) -Hx of IBD |
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Social Hx
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occupation exposure to infective hepatitis
-toxin exposure in chronic liver disease (carbon tetrachloride, vinyl chloride) -ask about travel with recent liver disease -alcohol Hx -contact with anyone jaundiced -sexual Hx -IV drugs, plasma transfusions, dental tx or tattoo,--> hep B,C |
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FHx
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IBD, PUD, bowel Ca, jaundice, anemia, splenectomy, cholecystectomy, -->hemolytic anemia or congenital or familial hyperbilirubinemia
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gall stone risk factors
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-DM, obesity, hyperlipidemia
-native american, older age -ileal resection or Crohn's -cirrhosis of liver -multiple pregnancies, estrogen, -CF -haemolytic (hereditary spherocytosis, thalassemia, sickle cell anemia, artificial heart valve), alcoholic cirrhosis |
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causes of acute pancreatitis
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-gall stones and alcohol most common
-drugs (sulphonomides, frusemide, thiazide, HIV drugs) -hypercalcemia -hyperlipidemia -infection viral (cocksackie B or mumps) -uraemia -scorpion bite -pancreatic divisium -ERCP -abdominal surgery recently -trauma -pancreatic cancer |
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upper epigastric pain
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1. pancreatitis:
-alcohol use and gallstones are most common -viral infections (cocksackie B, mumps) -drugs (sulphonamides, diuretics, estrogens, HIV meds) -ERCP recently or surgery -hypercalcemia -hyperlipidemia -scorpion bites, -pancreatic cancer -uraemia -trauma in kids |
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right upper quadrant pain
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-gall stones causing cholecystitis (inflammation of GB) or biliary cholic (stone blocking cystic duct)
causes of gall stones: -hyperlipidemia, DM, obesity -multiple pregnancy or OCP -cirrhosis of liver -ileum resection or Crohn's disease -CF -advanced age or native american black stones: haemolysis (hereditary spherocytosis, thalassemia, sickle cell anemia, artificial heart valve), alcohol cirrhosis |
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complications of acute pancreatitis
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-aseptic necrosis of the pancreas
-septic necrosis -hypocalcemia - |
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what are the apache II score variables when evaluating a patient with acute pancreatitis, what tests would you order to evaluate such a patient?
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-temperature
-RR -HR -MAP -A-a gradient or PaO2 -pH or HCO3 -K -Na -Cr -Ht -WBC count -age -GCS -chronic Dx -upper abdo US and CT (w/ and wo contrast) -FBC, U+E, arterial blood gas, amylase and lipase, LFTs |
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what are the complications of acute pancreatitis? how would you Ix?
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-ARDS, hypoxemia
-pseudocyst--> rupture, infection, gastric outlet obstruction, fistula, hemorrhage into cyst, pancreatic ascites, impinge on adjacent organs (duodenum, stomach, transverse colon, CBD) -non infective necrosis -infective necrosis -hemorrhagic pancreatitis (cullen's grey turner's or Fox's signs) -pancreatic abscess (rare) -pancreatic ascites/pleural effusion (inflammation of pleural surfaces) -ascending cholangitis (gall stone in ampulla and infection) CT with contrast for hemorrhage suspicion CT guided percutaneous aspiration (for necrotic tissue to do MCS) ABG and SPO2 abdominal US CXR FBC LFTs |
