Nur 732 Abdominal Conditions Beginning

Front 1

Mechanisms of abdominal pain include?

Back 1

1-obstruction
2-peritoneal irritation
3-vascular insufficiency
4-mucosal alteration
5-altered motility of bowel
6-capsular distention
7-metabolic disorders
8-nerve injuries
9-abdominal wall injuries
10-or pain referred from extra-abdominal sites

Front 2

Evaluator needs to identify?

Back 2

emergent from non-emergent causes in an expedient and cost-effective manner.

Front 3

Evaluation begins with?

Back 3

a thorough history

Front 4

PE of abdomen includes?

Back 4

inspection, auscultation of BS, vascular sounds, percussion, palpation for masses and/or tenderness.

Front 5

What other examination should be done for the abdomen?

Back 5

for groin abnormalities

Front 6

DRE

Back 6

check peripheral pulses and other sources of referred pain (i.e.lungs, CV system, head and neck, musculoskeletal, R/O lymphadenopathy)

Front 7

Work-up includes for abdomen?

Back 7

-CBC -UA, C & S

Front 8

-CXR, EKG, prn-further testing usually includes abdominal U/S, CT with contrast

Back 8

KUB, prn

Front 9

WBC > 12 usually indicates?

Back 9

inflammation or infectious condition. When WBCs are well over 12, usually, see increase in bands and segs with left shift (increase in immature forms)

Front 10

Obstruction?

Back 10

distention and increased bowel wall tension induce a response by pain receptors in the bowel, biliary tree, and uterus

Front 11

Small bowel obstruction induces?

Back 11

severe pain with a jejunal obstruction

Front 12

Proximal obstruction often induces?

Back 12

vomiting

Front 13

Initally, with proximal bowel obstruction, stool passed may range from?

Back 13

small volume to diarrhea, then with complete obstruction, stool passage ceases.

Front 14

Distal obstruction leads to?

Back 14

distention

Front 15

Large bowel obstruction is often preceded by?

Back 15

constipation or a change in bowel habit

Front 16

With large bowel obstruciton, what diagnostic test is usually helpful?

Back 16

KUB is helpful to demonstrate loops of distended bowel (“slinkys”).

Front 17

Biliary colic?

Back 17

= cystic duct obstruction by a stone

Front 18

What are common S/S with common duct obstruction?

Back 18

jaundice, vomiting, increased alk phos and bilirubin.

Front 19

Urinary tract obstruction?

Back 19

may be due to a stone blockage of a ureter. Occurs with sudden onset crampy flank pain with radiation to the groin and lower abdomen. With bladder obstruction, lower abdominal distention and suprapubic pain are usual.

Front 20

Peritoneal irritation produces?

Back 20

severe pain: sharp, burning, aching. Pt is still rather than restless

Front 21

Familial Mediterranean fever causes recurrent?

Back 21

acute abdominal pain with peritoneal irritation, pleuritis and synovitis, abdominal distention, Increased ESR. Usually treated with colchicine.

Front 22

Vascular disease?

Back 22

acute arterial insufficiency secondary to thrombus or atherosclerosis

Front 23

Aortic dissection produces what kind of pain?

Back 23

very severe pain that radiates to the back or genitalia.

Front 24

Mucosal injury, PUD induces what kind of pain?

Back 24

“gnawing” pain, burning.

Front 25

Inflammation due to IBS, acute gastroenteritis usually causes what kind of pain?

Back 25

diffuse pain.

Front 26

Altered motility, includes that caused by irritable bowel syndrome, is characterized by?

Back 26

crampy, lower abdominal pain

Front 27

Tenesmus?

Back 27

term used to describe feeling or urge to defecate but without needing to pass stool.

Front 28

Functional dyspepsia?

Back 28

“irritable gut syndrome” characterized by early satiety, bloating and nausea.

Front 29

Acute ileus secondary to?

Back 29

trauma, infection, peritonitis, abdominal surgery, narcotics or anticholinergics

Front 30

Capsular distention, is secondary to?

Back 30

edema of liver or spleen.

Front 31

Splenic distention is noted for what kind of pain?

Back 31

pain that radiates to the ipsalateral shoulder

Front 32

Metabolic disorders?

Back 32

ketoacidosis

Front 33

porphyria?

Back 33

fever, increased white cells, soft abdomen

Front 34

Nerve injury?

Back 34

from zoster, or secondary to pancreatic CA.

Front 35

Abdominal wall pathology secondary to?

Back 35

muscular injury to the abdominal wall.

Front 36

Referred pain?

Back 36

especially from lower lobe pneumonia, pulmonary infarct. Acute inferior wall MI may present with upper abdominal pain, nausea and vomiting.

Front 37

Most emergent causes of referred pain include problems resulting in?

Back 37

obstruction, peritoneal insufficiency or vascular insufficiency.

Front 38

For irritable bowel syndrome, the Manning criteria are often helpful in diagnosis

Back 38

in presence of all 6 criteria, the predictive value is 88-90%

Front 39

Manning criteria are?

Back 39

1 -visible abdominal distention
2-pain relief with defecation
3-with onset pain, increased number of stools
4-with onset pain, looser stools
5-rectal mucus passage
6-feeling of incomplete evacuation

Front 40

The Rome criteria, which are refined Manning criteria, require?

Back 40

that symptoms continue for at least 3 months, on a continuous or recurrent basis.

Front 41

For the Rome criteria, there needs to be evidence of abdominal pain or discomfort associated with any or all of the following?

Back 41

1-relief with defecation
2-change in stool consistency
3-change in stool frequency
+ PLUS, two or more of the following....

Front 42

For the Rome criteria, there needs to be evidence of abdominal pain or discomfort associated with any or all of the following? + PLUS, two or more of the following?

Back 42

1-altered stool frequency (> 3 BM qD or < 3 per week)
2-altered stool form (lumpy, hard, or loose/watery)
3-altered stool passage (urgency, incomplete evacuation, straining)
4-mucus passage
5-bloating or feeling of abdominal distention

Front 43

Rome criteria for functional dyspepsia?

Back 43

“ulcerlike variant” of predominantly abdominal pain

Front 44

Constipation tx is often?

Back 44

is self-treated, is also a frequent reason for an office visit.

Front 45

Definition of constipation?

Back 45

diverse interpretation usually involves les frequent passage of stool than normal, or passage of hard stool

Front 46

Constipation is a common disorder secondary to?

Back 46

low fiber diet consumed by most Americans.

Front 47

Results from either difficulty?

Back 47

filling rectum by colonic transport or with reflex stool defecation.

Front 48

Aids to prevent constipation are?

Back 48

1-increase decaf. Fluid intake
2- increase fiber, increase exercise to promote bowel motility

Front 49

Incidence of constipaton increases with?

Back 49

co-existing hypokalemia (may occur secondary to laxative abuse or increased diuretic use)

Front 50

Constipation occurs in >50% of pts with colon CA secondary to?

Back 50

1-obstruction from tumor
2-common presentation of Crohn’s disease or irritable bowel
3-with drug use, especially opiates (including codeine)
4-calcium carbonate

Front 51

Work-up for constipation includes?

Back 51

A careful H & P
1 include wt
2 skin
3 abdomen
4 rectal with guiac testing
5 neuro exam

Front 52

For constipation, try ?

Back 52

Therapeutic measures (first, D/C all OTC meds)
1-bowel training
2-increase decaf fluids
3-increase exercise increase fiber in diet (bran, fruits, green veggies, whole grain breads and cereals) to 15 gm per day.
Increasing fiber may also increase flatulence or bloating for up to one month after increase, then fades.

Front 53

Nondigestible fiber sources include?

Back 53

psyllium (Metamucil), methylcellulose (Citrucel): these must be used with increased fluids

Front 54

Laxatives are NOT preferred?

Back 54

as first line therapy.

Front 55

For the elderly client who doesn’t respond to the above measure: consider use of?

Back 55

lactulose, sorbitol for long term use.

Front 56

Avoid stimulant or irritant laxatives, like?

Back 56

e.g. Pericolace, senna, cascara, or protokinetic agents, e.g. cisapride, since they may induce ventricular arrhythmias (including TdP, v fib, v tach, QT prolongation). Enemas are okay, only for fecal impaction.

Front 57

Work up labs for constipation?

Back 57

1 potassium
2 calcium
3 TSH
4 glucose
5 HgA1C
&amp; Colonoscopy

Front 58

Appendicitis' general presentation?

Back 58

classically pain occurs first, then nausea, vomiting, anorexia. Onset periumbilical pain, gradually migrates over hours to RLQ

Front 59

For appenicitis, on PE, check?

Back 59

VS

Front 60

Cholecystitis?

Back 60

stones may block duct inducing acute biliary colic, or be chronic

Front 61

RF for cholecystitis?

Back 61

women are affected more often than men (female, forty, fat, fertile), increases with increased age.

Front 62

Presentation of cholecystitis?

Back 62

Abrupt onset, severe 10/10 pain, epigastric, RUQ with radiation around to back, straight through to back or to right shoulder. Accompanied by nausea, often with vomiting, often awakens pt 1-3 AM, lasts several hours (8-12), unrelated to food intake.

Front 63

How to relieve pain of cholecystitis can be relieved by?

Back 63

Narcotics relieve pain, if not: surgical consult., or if pt presents with fever and increased WBCs.

Front 64

Versus cardiac pain, what is different with pt who has cholecystitis?

Back 64

Pt is usually restless in an attempt to relieve pain (vs. cardiac pt is quiet)

Front 65

With PE & labs, Appendicitis may present?

Back 65

+ Murphy’s.

Front 66

Tx for cholecystitis?

Back 66

IV meperidine for pain, NPO.

Front 67

If pt refuses surgery, drug therapy with?

Back 67

ursodiol (Actigal) may be tried for cholesterol stone dissolution (not indicated for bile stones). Dose is 8-10 mg/kg/day in BID, TID dosing: available as 300 mg capsules.

Front 68

Actigal's contraindicated for which kind of stones?

Back 68

calcified stones.

Front 69

Indications for Actigal, are for?

Back 69

pt who refuse surgery and for those in whom prevention on gallstone development during rapid weight loss is problematic.

Front 70

Safety over 24 months of use not established

Back 70

many interactions have been noted, especially with OCPs, aluminum based antacids, cholestyramine, estrogen.

Front 71

Recurrence is common: 50% of pts + within ?

Back 71

5 years.

Front 72

SE of Ursodiol?

Back 72

GI side effects with ursodiol.

Front 73

Diverticula?

Back 73

are out-pouchings from the large intestine

Front 74

Diverticula occurs most commonly in which part of the intestines?

Back 74

the sigmoid colon

Front 75

Diverticual presents usually ?

Back 75

LLQ pain, sometimes affects the RLQ or suprapubic area Pain is severe and steady, often associated with urinary frequency Pain increases with ambulation, coughing, or moving.

Front 76

On PE, diverticulosis presents?

Back 76

normal BS, extreme LLQ tenderness with +/- palpable LLQ mass.

Front 77

What do you do for pt's with diverticulosis that look toxic?

Back 77

Hospitalize the toxic for IV antibiotics (the febrile)

Front 78

What tests are contraindicated to do for diverticulitis? Why?

Front 79

Recommendation for pta with diverticulitis?

Back 79

High fiber, low fat diet is recommended, gradually increasing amount fiber over time to avoid distention or flatulence..

Front 80

How is fiber administered to pts with diverticulitis?

Back 80

in form of dietary sources or hydrophillic colloids (Metamucil, one tablespoon qD or BID).

Front 81

Acute pancreatitis: high association with?

Back 81

chronic alcoholism or gallstones (80%)

Front 82

Pancreatitis also occurs as?

Back 82

idipathic, or secondary to perforated peptic ulcer disease, trauma, neoplasm, hypercalcemia, hyperlipidemia, drug use, viral infections.

Front 83

Some 75-85% of pts with mild disease resolve. Mortality in mild disease <1%, but mortality in severe disease approaches ?

Back 83

30%.

Front 84

The pancreas is a unique structure since it is the only?

Back 84

endocrine and exocrine gland in the body

Front 85

Insulin and glucagon are released secondary to which function of the pancreas?

Back 85

endocrine function

Front 86

Enzymes of the pancreas?

Back 86

These enzymes are lipase, amylase, and trypsin.

Front 87

Trypsin?

Back 87

digests proteins

Front 88

Amylase and lipase digest?

Back 88

carbs and fats.

Front 89

The pancreas is composed primarily of?

Back 89

protein.

Front 90

The manufactured enzymes are stored as?

Back 90

an inactive form so the pancreas doesn’t digest itself.

Front 91

Pancreatitis occurs when?

Back 91

trypsin is activated. The mechanism is uncertain.

Front 92

Pancreatitis usually affects?

Back 92

those between 40-60 years of age