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88 Cards in this Set
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Classic - diarrhea w/ bulky and foul smelling stool, steatorrhea, flatulence
Children = failure to thrive Dermatitis Herpataformis |
Celiac Disease
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Anemia and Abnormal Digestive function
Diarrhea, loss of appetite, weight loss, sore tongue, weakness, HA, palpitations, irritability |
Folate Deficiency (Folic Acid, Vit. B9)
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Diarrhea, abdominal discomfort, cramping, bloating, flatulence after ingesting dairy
Child may have vomiting and frothy stool |
Lactose intolerance
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Early: anorexia, weakness, mouth sores, glossitis, stomatitis
Late: Pellegra Triad = Dermatitis, Dementia, Diarrhea |
Niacin Deficiency (Vit B3)
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Insidious onset
HALLMARK = intellectual disability "mousy" odor to body and urine abnormal gait, stance, and sitting posture |
Phenylketonuria (PKU)
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Oral mucosa: Angular stomatitis/cheilosis, glossitis
Seborrheic dermatitis Normocyctic anemia |
Riboflavin Deficiency (vit b2)
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Irritability, Muscle Cramp, Anorexia, Paresthesias
Wet Beriberi = Cardiovascular symptoms w/ extreme exertion Dry beriberi = PNS and CNS symptoms |
Thiamine Deficiency (Vit. B1)
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nystagmus, ophthalmoplegia, truncal ataxia, confusion
(seen w/ Thiamine deficiency) |
Wernicke's encephalopathy
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Thiamine deficiency with amnesia, impaired learning and short-term memory, hallucinations, confabulation
(seen w/ Thiamine deficiency) |
Korsakoff syndrome
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Looks like alcohol abuse, mental confusion, memory loss, nystagmus, and ataxia
(seen w/ Thiamine deficiency) |
Wernicke-Korsakoff syndrom
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Early: 1st sign = night blindness
xerosis, Ritot's spots, poor wood healing Late: keratomalacia, endophthalmitis, blindness children: growth deficiency, anemia |
Vitamin A deficiency (retinol)
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Tired/decreased mental work capacity, irritability, depression, memory loss, confusion/disorientation, anorexia, diarrhea, glossitis = "beefy red tongue"
Neurological symptoms = paresthesias, disturbed coordination, difficulty w/ balance, dementia, ataxia |
Vitamin B12 deficiency
(Cobalamin, cyanocobalamin) |
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Early: nonspecific
Late: perifollicular hemorrhages, petechiae, purpura, splinter hemorrhages, bleeding gums Terminal symptoms: edema, oliguria, neuropathy, intracranial hemorrhage |
Vitamin C (ascorbic acid)
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Mild: poor appetite, insomnia, vision problems, burning sensation in mouth and throat
Severe: periodontal disease, rickets, osteomalacia (bony bumps on ribs = "rachitic rosary", bowed legs/arms, Knock knee, osteomalacia) |
Vitamin D Deficiency
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Excessive hemorrhage
Infants (Hemolytic disease of newborn) Symptoms w/in 5-14 days of birth Bleeding from circumcision cite, GI tract, skin, nose Intracranial Hemorrhage |
Vitamin K deficiency (phylloquinone)
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Heartburn
Dysphagia Odynophagia Anemia HX of caustic digestion |
Esophagitis
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Hx of allergies
Adults: hx of dysphagia for solids, episodes of impaction, heartburn Child: abdominal pain, vomiting, chest pain, failure to thrive |
Eosinophilic Esophagitis
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Sudden onset of retrosternal pain (mild or severe)
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Pill induced esophagitis
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Hematemesis following vomiting, straining or coughing
Bright red blood (generally mild/self limiting) May have chest pain |
Mallory-Weiss Tear
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Insidious development over years
Dysphagia Regurgitation Halitosis |
Zenker Diverticulum
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> 90% have solid food dysphagia
Weight loss common Sometimes odynophagia |
Esophageal Neoplasm
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Asymptomatic until rupture
Rupture = painless, massive hematemesis of dark brown blood, pallor, tachycardia, orthostasis Physical signs of cirrhosis of liver |
Varices
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- Disordered peristalsis (Diffuse)
- Motility disorder w/ increased pressure during peristalsis (Nutcracker) - Increased Lower Esophageal Sphincter pressure (Hypertensive) Achalasia |
Esophageal Spasm (motility disorder)
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HALLMARK = Heartburn
Regurgitation Dysphagia Atypical findings: asthma symptoms, chronic cough, chronic laryngitis, sore throat, non-cardia chest pain |
GERD - Gastroesophageal Reflux Disease
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Most are asymptomatic
MC = intermittent dysphagia to solid foods, reflux with rings |
Esophageal Webs and Rings
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Erosive: Upper GI bleed, Hematemesis (coffee grounds) usually asymptomatic, possible anorexia, epigastric pain, N/V
non-erosive = nonspecific |
Gastritis
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Usually silent until late
Nonspecific symptoms: dyspepsia, vague epigastric pain, anorexia, early satiety, weight loss Ulcerated lesions may bleed leading to hematemesis and or melena |
Gastric Neoplasms
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HALLMARK = Dyspepsia
Nonspecific epigastric pain (gnawing, dull, aching, "hunger like" Nausea and Anorexia |
Peptic Ulcer Disease
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Progressive, non bilous projectile vomiting --> children remain hungry
weight loss, dehydration, olive-shaped mass felt to the right of the umbilicus (esp. shortly after vomit) |
Pyloric stenosis
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90% of pts develop peptic ulcer
Mimic peptic ulcer disease GERD is common 1/3 have diarrhea RED FLAGS: Ulcers refractory to tx, multiple giant ulcers, ulcers w/ hypercalcemia, H. pylori negative |
Zollinger-Ellison Syndrome
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Mild fever to severe (septic shock)
Hepatomegaly Charcots triad: RUQ pain, Fever (chills), Jaundice Reynold's Pentad: Charcot's triad, Altered mental status, Hypotension |
Cholangitis
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Hx of biliary colic (gallstones)
Radiating paint to the neck or back N/V, Fever, TTP/pain in RUQ (+) murphy sign, (+) rebound, guarding peritoneal signs |
Cholecystitis
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Frequently asymptomatic
Dull pain RUQ lasts 1-4 hrs Worse pain after fatty meal N/V Pruritus/excoriations, jaundice, light colored stool, Tea colored urine Restless pain, low blood pressure |
Cholelithiasis
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Frequently recurring attacks of severe RUQ pain that lasts several hours
Chills, Fever, Jaundice associated w/ pain Charcot's triad, Reynolds Triad, Hepatomegaly |
Choledocholithiasis
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Classic: epigastric tenderness and abdominal distention
Decreased or absent bowel sounds Tachycardia, pallor, hypotension, shock Cullen's sign = blush discoloration of the skin around the umbilicus Grey Turner's sign = ecchymotic discoloration of the flanks |
Acute pancreatitis
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Classic Triad: pancreatic calcification, steatorrhea, DM
During attack = tenderness of pancreas, mild muscle guarding, ileus Chronic epigastric pain radiating to the back, anorexia, n/v, constipation, flatulence, weight loss, steatorrhea |
Chronic Pancreatitis
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Abdominal pain - diffuse in LUQ, radiation is common, Sister Mary Joseph nodule = hard periumbilical nodule that is palpable
Jaundice - courvoisier's sign (jaundice and palpable gallbladder) Diarrhea = early symptom Weight loss = late symptom |
Pancreatic Cancer
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Abdominal distension, cramping, vomiting,
Later = obstipation SBO = acute symptoms, pain around umbilicus/epigastrium LBO = milder symptoms that develop gradually, constipation, pain in hypogastic region Volvulus = abrupt onset, continuous pain, superimposed waves of colicky pain |
Acute intestinal obstruction
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Early periumbilical pain
w/in 12 hrs pain shift to RUQ Steady ache worsened by coughing or walking Nausea w/ 1-2 episodes of vomiting, Feeling of constipation, low grade fever Local tenderness w/ guarding over LRQ, percussion elicits pain Rupture = temporary pain relief and peritoneal signs |
Appendicitis
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Change in bowel habits/stool consistency
Patterns of rectal bleeding Pain/straining Hard pellet stools = slow transit Straining and feeling incomplete evacuation = Cardinal signs of pelvic floor dysfunction |
Constipation
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Chance in consistency, frequency, quantity, color, odor, melanic(bloody/black) of stool
Watery = Small bowel Blood and mucus = colon Fever, HA, anorexia, vomiting, altered mental status, abdominal pain/distention, malaise, myalgia |
Acute Diarrhea
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Chance in consistency, frequency, quantity, color, odor, melanic(bloody/black) of stool BUT lasts OVER 4 weeks
Tenesmus, Flatus, steatorrhea |
Chronic Diarrhea
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MC = low grade fever, malaise, weight loss, decreased energy
NON-bloody diarrhea Postprandial bloating, cramping, and borborygmi RLQ focal tenderness Fistula and sinus tracts |
Crohn's disease
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HALLMARK = Blood diarrhea
Invariably involves the rectum, but DOES NOT spread Characterized by periods of symptomatic flare-ups and remission Mild, Moderate, and Severe cases |
Ulcerative Colitis
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Symptoms persist for at least 3 months, usually intermittent
Lower abdominal crampy pain Mucus is common in stool DOES NOT interrupt sleep Onset associated w/ change in form and/or frequency |
Irritable Bowel Disease
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Impairment of blood supply and necrosis of bowel segment
Episodic colicky pain and vomiting Sausage shaped mass in hepatic flexure Fever/Dehydration signs "CURRANT JELLY" stools |
Intussuseption
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Acute mesenteric Ischemia: sudden onset of severe abdominal pain out of proportion to exam findings
Chronic mesenteric Ischemia: abdominal angina occurring 10-30 minutes after eating that is relieved by squatting or lying down LLQ pain/tenderness |
Ischemic Bowel Disease
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Very ill appearing, "toxic vitals"
Fever, abdominal pain/distension, diarrhea Dehydration/ electrolyte imbalance Rapid progression of symptoms over 1-2 weeks |
Toxic Megacolon (Hirschsprungs Disease)
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*Occult Blood* (elderly)
Crampy LLQ abdominal pain Worse w/ movement, cough, strain Palpable mass Low grade fever, N/V Abdominal distension Chronic constipation w/ episodes of diarrhea |
Diverticulitis
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Type 3 is most common (Ileum)
Abdominal distension Vomiting in first 24-48 hrs after birth Jaundice |
Intestinal Atresia
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Ampullary = jaundice due to bile duct obstruction or bleeding
Non-ampullary = peak incidence in 6th decade, symptoms of obstruction, acute or chronic bleeding, weight loss, majority have metastasized |
Adenocarcinoma
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Abdominal pain, weight loss, N/V, distension, anemia, occult blood in stool
MC in Distal Small Bowel |
Lymphoma
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90% w/ syndrome have hepatic metastases, facial flushing, edema of the head and neck, abdominal cramps and diarrhea, bronchospasm, cardiac lesions
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Carcinoid Tumors
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Lesions may be present anywhere in the intestinal tract
Visceral involvement usually associated w/ cutaneous disease Most lesions are silent Large lesions may be symptomatic |
Small intestine Sarcoma
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Fever, malaise, N/V
Dark urine Jaundice Normal to low WBC Elevated aminotransferases (AST/ALT) |
Hepatitis A
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MOST PT are asymptomatic
Average time from exposure 4-12 weeks Fatigue, abdominal pain, anorexia, jaundice Slow progression, 75-80% become carriers |
Hepatitis C
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50% of adults are asymptomatic
Pre-icteric (prodromal): 1-3 wks; malaise anorexia, N/V, RUQ pain fever HA dark urine Icteric phase: 1-3 wks; jaundice, acholic stools, hepatic tenderness, hepatomegaly Convalescence: sx resolve |
Hepatitis B
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Hep B titre:
1st evidence of infection, and persists throughout the clinical illness. If it persists more than 6months the disease is chronic |
HBsAg
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Hep B titre:
Antibody to HBsAg appears after clearance of HBsAg. Appears in successful RECOVERY of infection and immunization |
Anti-HBs
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Hep B titre:
Antibody indicates acute HEP B infection |
Anti-HBc
IgM |
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Hep B titre:
Appears during acute HEP B infection, but persists indefinitely whether the pt recovers or is chronic |
Anti-HBc
IgG |
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Hep B titre:
Indicates viral replication and infectivity |
HBeAg
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Hep B titre:
Detected with PCR-generally parallels the presence of HBeAg |
HBV DNA
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Portal HTN: variceal bleeding, edema, ascites, hemorrhoids
Weak, Fatigue, disturbed sleep, wt loss, muscle cramp Skin: spider angioma, palmar erythrema, dupuytren contracture, jaundice 3 stages |
Cirrhosis
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Yellow discoloration in ocular conjuctivae, and oral mucosa
Plasma elevation of unconjugated and/or conjugated bilrubin Pruritis, Dark urine, Light stool |
Jaundice
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Abdominal distension
Bulging flanks Shifting Dullness **MC complication of Cirrhosis** |
Ascites
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Fever, Abdominal Pain, Abdominal tenderness, Altered Mental Status
Some PT are Asymptomatic w/ abnormal labs Common isolates = E.coli and pneumococci |
Peritonitis
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MC cause of GI bleeding due to portal HTN
Acute GI hemorrhage Hypovolemia |
Esophageal Varices
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Disturbed Diurnal Sleep
Asterixis Hyperactive tendon reflex Stages: mild confusion, drowsiness, stupor, coma |
Hepatic Encephalopathy
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Fatigue, Pruritis, Hepatosplenomegaly
Xanthomatous lesion on skin and eyes Advanced: Jaundice, steatorrhea, portal HTN Orthostatic hypotension, cognitive impairment |
Primary Biliary Cirrhosis
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MC from Cirrhosis and Hep C
Cachexia (wasting syndrome) Bloody ascites Hepatomegaly Bruit over tumor or friction rub |
Hepatocellular Carcinoma
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Most pts are asymptomatic
Mild RUQ pain hepatomegaly (common from metabolic syndromes) |
Nonalcoholic fatty liver disease
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Severe tearing pain during defecation
Thobbing discomfort Hematochezia |
Anal Fissure
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Anal:
Throbbing continuous pain Erythema Fluctuance Swelling |
Anorectal Abcess
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Anal:
Purulent discharge Itching Pain and tenderness |
Anorectal Fistula
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Decreased Appetite, N/V
Abdominal pain and distention Paradoxical diarrhea due to stool leaking around the impaction |
Fecal Impaction
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Internal: Bleeding, Prolapse, Mucoid discharge
Pain uncommon until late stage |
Hemorrhoid
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Cyst, Abscess, or one or more sinus tracts in the upper part of the natal cleft
MC in Men 3rd decade (Not in PT over 45) |
Pilonidal Disease
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Non Familial: usually asymptomatic, may have occult bleeding that leads to anemia
Familial: early development of 100-1000 adenomatous polyps |
Polyps
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Right colon: blood loss, iron deficiency anemia fatigue, weakness
Left colon: obstructive sx, abd pain, change in bowel habits, "apple-core" lesion on radiograph Rectosigmoid: hematochezia, tenesmus, narrowing of the caliber of stool |
Colorectal Cancer
Third most common cancer Second leading cause of death due to malignancy |
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Bulge in groin onto anterior thigh below the inguinal ligament
Very susceptible to incarceration and strangulation Can be mistaken for lymph nodes or lipomas MC = Female |
Femoral hernia
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GERD, Tightness, pain related to position, dysphagia, chronic lung infection due to aspiration, hoarse voice
100xMC |
Hiatal hernia (type 1)
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Type 2: No GERD, incarceration or strangulation of fundus may occur
Type 3: Signs of increased intrabdominal pressure, lump in chest |
Hiatal Hernia
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Bulge, pain, discomort at site, bowel obstruction
(MC from a deep wound infection) |
Incisional Hernia
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Bulge in groin
MC right side Male < 20 yro due to increased pressure MC type of hernia |
Indirect Inguinal Hernia
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Bulge in groin
MC in elderly men |
Direct inguinal hernia
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Generally asymptomatic
Soft protuberance at the umbilicus |
Umbilical Hernia
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MC = PT over 30
Progressive dysphagia to solid AND liquid Regurgitation of undigested food Nocturnal cough (due to aspiration) Chest pain/Heartburn Barium swallow = "Bird Beak" narrowing |
Achalasia
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