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117 Cards in this Set
- Front
- Back
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Constipation affects which groups the most?
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women, children and elderly
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Causes of constipation in older adults?
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medications, decreased activity, consequenses of illnesses
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What medicaions are associated with constipation?
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amantidine, amitripyline, antacids, anticholinergisc, antihistamines, CA channel blockers, CA suppliments, diuretisc, FEso4, narcotics,NSAIDS
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What diseases can be associated with constipation?
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diabetes, hypothyroid, hypoparathyroid, Hirschsprungs disease, MS, parkinsons,
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What questions to ask patient about constipation?
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Change in bowel pattern, # stools per week, last BM, need to strain during defecation, sensation of incomplete defecation any episodes of fecal incontenence, blood, abd pain
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What is important when diagnosing chronic constipation?
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underlying pathologic conditions or metabolic distrubances
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Management of Chroinic constipation
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increase fluids, increase activity, bowel training -allow to time to go and go at same time everyday - 30 min after a meal, increase fiber (can use psyllium - fiberall or polycarbophil - fibercon
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When is diarrhea most worrisome?
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When accompanied by fever, abdominal pain, dehydration or bloody stool
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When are abdominal viruses seen most?
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winter months
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When are abdominal bacerial infections seen most?
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summer & early fall
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Describe ulceration pain
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gnawing or burning
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Describe pain with hollow tube obstruction
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intermittent colicky or wavelike quality
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Describe pain with peritoneal irritation
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stedy adn increases with coughin, palpation or movement
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Describe pain with metabolic disturbances or bowel motility
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crampy, localized or generalized in women
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Describe vascular pain
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localized crampy discomfort usually midabdominal related to meals
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Describe pain r/t encapsualted organ (kidney, liver, spleen, ovary)
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constant and aching
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What can be source of RUQ pain?
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chest cavity, liver, gallbladder, stomach, bowel or right kidney or ureter. Usually cholecystitis or leakign duodenal ulcer
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What can be source of LUQ pain?
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heart or chest, spleen, stomach, pancreas
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What can be source or RLQ pain?
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appendicitis, bowel, right ureter or pelvis
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What is sequence of events for appendicitis?
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Pain starts in epigastrum or periumbilical, then localizes to RLQ. initial pain colicky not severe, but will reach this w/i 4 hours the will subside again, N/V, anorexia, constipation
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Exam for appendicitis
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tender abd when cough, low grade fever, localized tenderness, RLQ pain
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What are common causes of bowel obstruction
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adhesions, hernias and tumors
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Physical exam of bowel obstruction
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distended typanic abdomen. Peristatltic rushe snd high pitched tinkling sounds or absent bowel sounds, abd pain
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Tests for Bowel obstuction
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abdomen and chest x-ray, sitting and lying down, CBC with diff, electrolytes, BUN creatinine,
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Hepatitis A
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Infectious - spread by oral fecal route, can be spread by shellfish, incubation 2-7 weeks, malaise, anorexia, nausea, fever. RUQ pain, will go away
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Hepatitis A tests
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ast & alt, Anti-IGM - indicates acute infection
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What are s/s of hemorrhoids?
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bleeding, pruritus, protrusion & pain
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Are internal hemmorrhiods painful?
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usually no - external are painful. Internal usually seen bleeding after defecation
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Name degrees of internal hemorrhoids
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1st: bulge, but do not prolapse 2nd: prolapse through anal orifice, but reduce spontaneiously 3rd: prolapse with defication and needs manual reinsertion 4th: protrude permainently
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Is an internal hemorrhiod palpable?,
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no - best seen with anoscpe
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How to treat hemorroids
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high fiber diet and increased fluids, topical steriod creams, sitz baths and OTC pain meds
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How will a thrombosed hemrrhoid feel?
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hard, tender and dark blue if internal
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What age are anal fissures seen?
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young and middle age
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Treatment of anal fissures
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increased fiber, sitz baths, stool softners, topical anesthetic before stool
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What is pruritus Ani and who gets it most?
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itiching of hte anus seen mostly in children
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Which foods can cause pruritus ani?
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coffee, tea, soda, alcohol, tomatoes, citrus fruits adn chocolate
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What can cause pruritis ani which is seen mostly at night?
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pinworms,
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What disease is oftne associated with Chrons disease
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anal fistulas
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What ethnic group is highly susceptible to gallstones?
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native americans, scandinavians
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What is incidence of gallstones?
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30-80 years old, women more likely
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What is seen with biliary obstruction?
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jaundice, diarrhea, n/v, pain
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What are risk factors for gallstones?
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obesity or rapid weight loss, pregnancy, sterioids, estrogens, maternl hx of gallstones, tpn or fasting, crohns disease or alcohol
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What are s/s of cholelithiasis
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manifests with biliary colic, RUQ pain radiating to right shoulder 1 hour after eating - lasting 1-6 hrs, can be constant or intermittent,n/v
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What are s/s of cholecystitis
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recurrent mild or mod RUQ pain with n/v,
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How is cholecystitis or cholelithiasis diagnosed?
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mostly by good history, and gallbladder US, can have fever, guarding and tenderness with cholecystitis
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What can cause diarrhea?
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virus, bacterial, parasites, medications
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What are causes of diverticulosis?
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low fiber diet of refined diet of white flour, sugar and meat - mostly seeni n western hemi
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What are s/s of diverticulitis?
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80-85% asympotmatic. irregular defecation, intermitant abd pain, bloating incr. flatus, change in stool - ribbon like or pellet like
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What is GERD?
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Gastric juices that enter the esophagus - most people get this, but when mucosal damage occurs then GERD pain present
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What populations is GERD normally seen in?
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more males than females, more causcasions than black
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What are 3 types of GERD?
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1) Non erosive or endoscopic Neg GERD 2) Eroseive Gerd 30 Barretss espohagus (premalignant condition)
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What are causes of GERD?
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1) transient esophageal spincter relaxation - reflux 2) low resting pressure of sphincter 3) poor esophageal clearance 4) defects in esophagagastirc motitilty
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What are s.s of GERD
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heartburn, bitter belching, acid regurgitation, sour stomach, burning pain retrosternal,
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How to relieve pain of GERD
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antacids, milk, baking soda (short lived)
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When see GERD?
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within 1 hour of eating large fatty meal, eating citrus, tomatos, spicy foods
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What exacerbates GERD?
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bending over, exercise, lying down after eating, smoking drinking alcohol, pills,
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What s/s of GERD can be alarming of advance disease?
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dysphagia - impairment of swallowing - food gets stuck Odynophagia: painful swallowing
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HOw to treat GERD?
Lifestyle modifications |
stop smoking, decrease alcohol, reduce dietary fat, decrease meal size, elevate head of bed
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How to treat GERD -
medications |
Acid supression with PPI treatment of choice - can use h2 antagonists for mild gerd
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How is HAV spread>
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oral fecal route, contaminated food or water, person to person contact
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What fluids is HAV virus found
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bile, blood, stool
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What is incubation period of HAV
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2-6 weeks -infectious 2-3 weeks before s/s and 1 week after clinical jaundice, mostly infectious before clinical symptoms
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Which type of hepatitis can progress into chronic or CA?
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HBV
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Where is HBV endemic?
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Asia -seen mostly in newborns and young children and spread from mother to child, and alaskan natives
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What body fluids is HBV found?
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blood, tears, cerbrospinal fluid, breast milk, saliva, vaginal secretionsand seminal fluid
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How is HBV spread?
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IV, sexually, perinatally
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Which hepatis is hte #1 reason for liver transplants?
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HCV
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How is HCV spread?
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IV drug use or sexully - can be chronic - maybe worried about tattoo needles, body piercings,
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What other disease is often seen with HCV
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HIV, hemodialysis and prisioners
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What is cirrhosis?
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scaring of hepatocytes and fiborsis, necrosis and cellular edema and death
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What is a complicaiton of cirrhosis?
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liver cancer
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What are s/s of HBV
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clay colored stools, fever, dark urine,arthralgias and rash, jaundice comes next with liver nad spleen enlarged
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Lab values with hepatitis
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increase ALT and AST (SGPT & SGOT), total bilirubin, abnormal platelets and albumin
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What areas is HAV seen?
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after ingestion of contaminated foods or shellfish, after natural disasters, institutionalized adults or children, travelers from endemic countries, daycare
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What is leading cause of death with Hepatitis?
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cirrhosis of liver, other complications liver failure and cancer
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How is IBS diagnosed?
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Abdominal pain present at least 25% time releived with defication, and associated with change in stool frequency or change stool consistency
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When IBS seen?
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more women, onset late adolescents peaking 30-40's
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What is thought to exacerbate IBS
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stress, anxiety, anger, druge, intestinal infection adn small bowel overgrowth of bacteria
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Where is IBS pain seen
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non radiating intermittant, crampy pain in lower abd mostly LLQ - usually in same spot - worse 1-2 hours after eating, can be relieved by BM, does not interrupt sleep
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What is leading cause of death with Hepatitis?
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cirrhosis of liver, other complications liver failure and cancer
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How is IBS diagnosed?
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Abdominal pain present at least 25% time releived with defication, and associated with change in stool frequency or change stool consistency
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When IBS seen?
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more women, onset late adolescents peaking 30-40's
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What is thought to exacerbate IBS
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stress, anxiety, anger, druge, intestinal infection adn small bowel overgrowth of bacteria
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Where is IBS pain seen
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non radiating intermittant, crampy pain in lower abd mostly LLQ - usually in same spot - worse 1-2 hours after eating, can be relieved by BM, does not interrupt sleep
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What s/s woudl exclude IBS
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night pain, arthralagias, bloody stools, weight loss, fatigue, myalgias
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How to treat IBS
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treat symptoms - dietary, modifications, meds, education and reassurance
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What foods cause increased gas?
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dairy, beans, brocolli, brussel sprouts, cabbage, carbonated beverages, cauliflower, coffee, grapes, plums, raisins, raw onions, red wine
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What should be excluded when thinking about IBS intoleranc?
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lactose intolerance
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How to test for lactose intolerance?
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drink 1/2 gallon of milk and see if abd pain, hydrogen breath tesst or 2-3 week trial of lactose free diet
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What s/s woudl exclude IBS
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night pain, arthralagias, bloody stools, weight loss, fatigue, myalgias
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How to treat IBS
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treat symptoms - dietary, modifications, meds, education and reassurance
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What foods cause increased gas?
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dairy, beans, brocolli, brussel sprouts, cabbage, carbonated beverages, cauliflower, coffee, grapes, plums, raisins, raw onions, red wine
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What should be excluded when thinking about IBS intoleranc?
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lactose intolerance
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How to test for lactose intolerance?
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drink 1/2 gallon of milk and see if abd pain, hydrogen breath tesst or 2-3 week trial of lactose free diet
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What categories of meds are used with IBS
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antispasmodics, antidiarrheal, anticonstipation, psychotripic
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What are some alternative treatments for IBS
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accupuncture, hypnosis, relaxation techniques, stress management
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What categories of meds are used with IBS
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antispasmodics, antidiarrheal, anticonstipation, psychotripic
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What are some alternative treatments for IBS
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accupuncture, hypnosis, relaxation techniques, stress management
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Name the 3 types of jaundice
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1) unconjugated hyperbilirubinemia 2) obstructive jaundice 3) conjugated jaundice
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When would you see increase in unconjucated bilirubin?
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increase destruction of RBC
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When would you see increase in conjugated bilirubin?
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liver dysfunction and obstruction
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Conjucated bilirubin is water soluble and is excreted in the urine. T or F
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true - urine turns orange
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Where to observe jaundice in african american?
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mandibular frenulum
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What other symptoms are seen with obstructive jaundice?
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pruritis - d/t nerve injurty in skin caused by bile pigments
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What are s/s of cirrohis?
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spider angiomas, palmar erythema, ascites, malaise, anorexia and rUQ discomfort
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s/s of obstructive jaundice
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colicky RUQ pain, light-colored stools, weight loss
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Occult blood in stools along with jaundice suggests what?
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cancer as cause of jaundice
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What questions should be asked when acute jaundice is seen
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any recent travel, transfusions, tattoos, IV drug use, alcohol intake, medications, food, toxins, animal or infected person exposure, unsafe sex, or s/s biliary tract disease
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What would suspect with Chronic jaundice?
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viral hepatitis, biliary tract disease, pancreatitis or chronic alcohol intake
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What other organ can be affected with liver problesm?
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spleenomegaly - suggests portal hypertension, can also seen gynecomastia nad testicular atroophy
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What drugs can cause toxic hepatitis?
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acetominophen, allopurinol, ontraceptive sterioids, chlorpromaine, aspirin, androgenic steroids, contraceptive steroids, chlorpromazine, eryc, glucocorticoids, methotrexate, NSAIDS, sulfa
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what other s/s can be seen with n/v?
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pain, HA, dizziness, tinnitus, diarrhea, fever, mental status change, anxiety,
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What should be assessed when presented with n/v patient?
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abdominal and rectal exam to check for distention, peristatsis, tenderness, rigidity, rebound, masses, fecal impaction and bleeding
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What is the most common cause of pancreatitis>
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gallstones, then toxins, then alcohol
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What happens in pancreatitis>
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pancreas secrets enzymnes and digests itself - digestive enzymes are activated in pancreas instead of intestine
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What ares/s of pancreatitis?
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sudden knife like poorly localized abd pain which can radiate to back in 50 % of pts, pain worse in supine position,
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Labs changes with pancreatitis>
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serum amyulase increases and serum lipase
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