Kulkarni Gi I

Front 1

Nociceptors are located within _____ and ____

Back 1

mucosa/muscularis of hollow viscera

serosal surface of peritoneum and mesentary

Front 2

Nociception is mediated by ____ fibers and _____ fibers

Back 2

A-delta fibers

C-fibers

Front 3

A-delta fibers are located in skin and muscle and are ____ conducting fibers associated with _____ types of pain

Back 3

rapidly-conducting

sharp, sudden and well-localized

Front 4

C-fibers are located in muscle, periosteum, mesentary, peritoneum, and viscera and are ____ conducting fibers associated with ____ types of pain

Back 4

slow-conducting

dull, burning and poorly localized pain with slower onset and longer duration

Front 5

_____ is the primary type of nociception for the abdominal viscera

Back 5

C-fiber

Front 6

Afferent neurons in the GI tract discharge in response to _______

Back 6

luminal chemicals

mechanical deformation of terminal fields
cytokines/inflammatory mediators
endocrine cells
mast cells

Front 7

Efferent neurons in the GI tract have what function?

Back 7

influence secretion, motility, and possibly supply blood vessels directly

Front 8

First-order neurons innvervating the viscera carry information to the ______ and synapse at the _____

Back 8

thoracolumbar SNS
dorsal horn of the spinal cord

Front 9

Second-order neurons _______ and ascend the ______ to synapse at the _____ before proceeding to the ______

Back 9

cross

spinothalamic / spinoreticular tracts

thalamus

limbic / somatosensory areas

Front 10

Name the 3 types of abdominal pain

Back 10

Visceral
Somatic
Referred

Front 11

Visceral pain is ______ in quality as a result of ______

Back 11

dull and poorly-localized to the midline

bilateral spinal cord transmission of sensory afferents by the organs

Front 12

A patient will describe VISCERAL adbominal pain as ______ in quality; secondary autonomic effects of visceral pain include

Back 12

cramping, burning, or gnawing

sweating, restlessness, nausea, vomiting

Front 13

SOMATIC pain is described as ______ and due to

Back 13

more intense and more precisely localized than visceral

irritation of the parietal peritoneum

Front 14

An excellent example of somatic pain is

Back 14

the early vague periumbilica visceral pain of appendicitis eventually localizes to McBurney's point with increased peritoneal irritation

Front 15

SOMATIC pain is generally worsened by

Back 15

movement / coughing

Front 16

REFERRED abdominal pain is due to

Back 16

convergence of visceral afferent neurons with somatic afferent neurons from different anatomical regions on second-order neurons in the same spinal cord segment

Front 17

Two stimuli of VISCERAL pain include

Back 17

mechanical
chemical

Front 18

The primary stimulus in MECHANICAL-caused induction of visceral pain is _____, NOT _____!

Back 18

stretching

cutting, tearing or crushing

Front 19

Examples of mechanically-induced visceral pain include

Back 19

Stretching things

rapid distention (obstruction)
forceful muscular contractions (biliary or renal colic)
mesenteric torsion (cecal volvulus)
traction on mesentary or vessels

Front 20

Chemical stimuli in VISCERAL pain include

Back 20

local mechanical, inflammatory, ischemic, noxious thermal or radiation that releases certain subtances (H, K, histamine, substance P, etc)

Front 21

Chemical-induced visceral pain is basically due to

Back 21

Accumulation of nocireactive substances which decrease the pain threshold by alterting the microenvironment of the injured tissue

Front 22

Changes in location during the H/P of abdominal pain may indicate

Back 22

progression from visceral to somatic pain (ie appendicitis)

Front 23

Aggravating/alleviating factors related to the following:

peritonitis
renal colic
biliary colic
duodenal ulcer
gastric ulcer

Back 23

pt lies motionless
pt listless and writhes
triggered by fatty-food ingestion
pain alleviated by meals
exacerbated with eating

Front 24

Pts who are writhing and listless most likely have _____ pain

Back 24

visceral pain

Front 25

Pts lying still and reluctant to move in obvious distress most likely have ____

Back 25

peritonitis

Front 26

Hyperactive bowel sounds indicate ______, while hypoactive indicate ____

Back 26

obstruction

ileus

Front 27

Normal liver span is _____

Back 27

10-12cm at MCL

Front 28

When doing an abdominal exam, always begin _______

Back 28

at the point of LEAST TENDERNESS

Front 29

Serologic eval in abdominal pain should include

Back 29

CBC w/ diff, UA, BMP

Front 30

The imaging study of choice for hepatobiliary, kidneys, and pelvic organs is ____

Back 30

US

Front 31

Mechanisms of dysphagia include

Back 31

Dysmotility
Mechanical
GERD

Front 32

Mechanical causes of dysphagia include

Back 32

Narrowing of esophageal lumen with dysphagia severity relating to the degree of obstruction, associated esophagitis, and type of food

Front 33

Defects in oral preparation leading to oropharyngeal dysphagia include

Back 33

disruption in the coordination of jaw, facial and buccal muscles, lips, saliva, teeth, etc. that impede the break down of food and mixing with saliva

Front 34

Defects in oral transfer leading to oropharyngeal dysphagia include

Back 34

inhibition of the tongue moving upwards and backwards to propel bolus into esophagus

Front 35

In oropharyngeal dysphagia, the pt is often aware that

Back 35

bolus has not left the oropharynx and will localize discomfort to the cervical esophagus

Front 36

Complications of oropharyngeal dysphagia include

Back 36

aspiration or nasal regurgitation (coughing during meal)

hoarseness (d/t recurrent laryngeal nerve dysfunction or instrinsic muscle disease leading to vocal cord impairment)

dysarthria, nasal speech, pharyngonasal regurgitation d/t weakness of soft palate or pharyngeal mm

Front 37

Localization in esophageal dysphagia is

Back 37

substernal

Front 38

3 crucial questoins to ask in the eval of esophageal dysphagia include

Back 38

Type of food causes the sxs?
Is the dysphagia intermittent or progressive?
Does the pt have heartburn?

Front 39

Dysphagia to both solids AND liquids indicates a(n) ...

Back 39

esophageal dysmotility disorder

Front 40

Dysmotility disorders are often relieved by ...

Back 40

repeated swallowing
raising arms over head
valsalva maneuver

Front 41

Achalasia is

Back 41

painless regurgitation of undigested foods, usually at night, with wt loss

Front 42

Spastic motility disorders are characterized by

Back 42

chest pain with hot or cold sensitivities

Front 43

Scleroderma is characterized by

Back 43

accompanied by severe GERD and dysphagia; generally related to peptic strictures

Front 44

Dysphagia to SOLIDS only indicates ...

Back 44

mechanical obstruction

Front 45

Episodic and nonprogressive dysphagia is usually _____ and epitomized by

Back 45

benign

"steakhouse syndrome" (hastily eating a meal with or without EtOH)

Front 46

Progressive dysphagia may indicate

Back 46

mechanical stricture (severity worsens with worsening obstruction); pt may regurgitate to relieve food impaction

Front 47

Benign (peptic) strictures are characterized by

Back 47

Long-standing hx of GERD
No wt loss

Front 48

Malignant strictures clinically look how?

Back 48

Old pts with rapidly-progressive dysphagia without reflux

anorexia leading to profound wt loss beyond severity of sxs

Front 49

Odynophagia is ...

Back 49

pain with swallowing due to severe inflammatory process involving the esophageal mucosa

Front 50

Globus sensation is

Back 50

feeling a lump or tightness in throat unrelated to swallowing

most common in middle-aged women

psych factors likely involved

Front 51

A key important HX in diagnosing noncardiac chest pain

Back 51

triggered by hot or cold foods