-
Retrosternal from xiphoid to neck is symptom of?
Esophagus
-
Difficulty swallowing
Dysphagia
-
Painful swalling
Odonophagia
-
Dysphagia to both solids and liquids at same time?
Esophageal motility problem
(Growing mass usually first has dysphagia for solids which progresses to include liquids)
-
LES persistent contraction
Increased risk of esophageal cancer
Achalasia
-
Diagnose achalasia with (2)
- Barium swallo
- Confrimation w/ manometry
-
Water brash?
Burping up stuff
-
GERD
Gastroesophageal esophageal reflux disease
-
Heartburn, water brash, epigastric pain (obese patient lying flat w/ water brash and substernal burning after meals)
GERD
-
Increased risk of
1) Achalasia
2) GERD
- 1) Esophageal cancer
- 2)Barrett's cancer
-
-
In GERD, where is the Z line located?
Located above the Gastroesophageal junction
-
Odynophagia in an HIV pt. w/ fever
Esophageal candidiasis
-
2 things indicated with esophageal candidiasis
- AIDS-defining illness (CD4<200)
- Can alsso occur w/ hematologic malignancies
-
Esophageal candidiasis tx?
Fluconazole
-
Dysphagia w/ solids progressing to liquids w/ 20 lb weight loss
Adenocarcinoma of esophagus
-
Name 3 risk factors for adenocarcinoma
- Nitrates (Asia)
- Smoking
- EtOH
-
Dysphagia w/ solids and Iron Deficiency Anemia
- Plummer Vinson Syndrome
- (Hypopharyngeal web= dysphagia)
-
Where is the web located in Plummer Vinson Syndrome?
Upper esophagus
-
Intensive vomitting w/ sudden retrosternal pain radiation to the back
- Mallory-Weiss Syndrome (longitudinal mucosal lacerations in the distal esophagus and proximal stomach)
- Etiology: Forceful wretching
-
Boerhave's
- Etiology: Forceful wretching
- Associated w/ massive hematemesis
-
Mallory-Weiss Syndrome
Longitudinal mucosal lacerations in teh distal esophagus and proximal stock due to forceful wretching
-
Alcoholic with intermittent hematemesis; no coffee grounds
Esophageal varices
-
2 things associated w/ Esophageal Varices
- Increased portal HTN
- Most common etiology ETOH/cirrhosis
-
4 techniques of Abdominal Exam
- Observation
- AUSCULTATION
- Palpation
- Percussion
-
Cupid's bow demonstrates
Adynamic ileus
-
How long should you listen to the abdomen?
At least 30 seconds
-
Where do you start palpations?
Start in quadrant furthest from symptoms
-
Guarding tells us?
There is peritoneal inflammation present
-
Percussion tells us (3 things)
- Organ size
- Organ location
- Abnormal masses
-
Stomach pain occurs in the
epigastrum
-
History of NSAIDs, smoker w/ coffee ground emesis
PUD/Gastritis
PUD= Peptic Ulcer Disease
-
3 things that can cause PUD/Gastritis?
-
Poorly controlled diabetic w/ nausea, vomitting, abdominal pain, and bloating
Gastroparesis: Abnormal emptying of gastrin of stomach
-
Gastroparesis is associated with 3 things
- Diabetes Mellitus
- Scleroderma/connective tissue diseases
- Drugs (Narcotics, CCB's, dopamine agonists)
-
Diabetes mellitus is associated with?
Gastroparesis
-
Diagnose Gastroparesis
Gastric emptying study
-
Periumbilical symptoms with radiation is a sign of a disorder with the?
Small intestine
-
Child w/ painless hematochezia
Meckel's Diverticulum
-
Incomplete obliteration of hte omphalomesenteric duct
Meckel's Diverticulum
-
Meckel's Diverticulum: Rules of 2
- 2% of population
- Within 2 ft. of ileocecal valve
- 2 in. long
-
Child w/ painful hematochezia; currant jelly stool
Intussuiception
-
Previous abdominal surgery w/ nausea, bilious vomitting, and abdominal pain
SBO (Small Bowel Obstruction)
-
Physical exam of small bowel obstruction
tympany, high pitched sounds, rebound tenderness
-
4 causes of Large Bowel Obstruction (LBO)
- Diverticulitis- large sausage in left upper/lower quadrant
- Volvolus
- Hischsprung's Disease
- Colon Ca
-
Pt. w/ atherosclerosis, anorexia, wt. loss, and posprandial abdominal pain
- Ischemic Colitis
- (Atherosclerotic Disease)
-
Atherosclerotic disease
Microscopic hematochezia
Bloody diarrhea
Post-prandial abdominal cramping in LUQ/LLQ
Ischemic colitis
-
6 F's of Abdominal Distention
- Fat
- Food
- Feces
- Fetus
- Fluid
- Fatus
-
Epigastric pain w/ radiation to back, frequently w/ peritoneal signs (guarding)
Pancreas
-
Risk Factors of Pancreatitis
- Drugs (HIV), thiazides
- ETOH
- Duplication
- Trauma
- Gallstones
-
Pancreatitis tx?
- Bowel rest- Pt. should be NPO
- Pain reflief
- Aggressive fluid management and electrolyte replacement
-
Which criteria diagnose the severity of pancreatitis?
Ranson's Disease
-
Islet cell destruction (Type I DM)
Fat vitamin malabsorption (no lipase)
These are complications of
Pancreatitis
-
3 Signs of Pancreatitis
- Cullens
- Grey-Turner
- Sentinel Loop- air-filled small intestine in LUQ
-
What is Cullen/Turner's sign
- Cullens Periumbilical hemorrhage
- Turner's Flank hemorrhage
These are signs of hemorrhagic pancreatitis
-
Steatorrhea, wt loss in pt. with CF
Exocrine pancreas deficiency
-
Kehr Sign
Pain radiation to left shoulder, indicative of spleen problem
-
Where is spleen pain
- LUQ/flank distribution
- can radiatie to L shoulder (Kehr sign)
-
Should you feel a spleen on abdominal palpation?
No
-
RUQ paiin w/ radiation to right should
Biliary tract
-
Murphy Sign
Tenderness to palpation, mid-clavicular line at right costal margin
-
Tenderness to palpation, mid-clavicular line at right costal margin
Murph's Sign
-
Painless mass in RUQ w/ jaundice
- Biliary tract carcinoma or carcinoma in head of pancreas
- Cousovier's sign- enlarged palpable gallbladder w/ jaundice
-
Enlarged palpable gallbladder w/ jaundice
Courvosier's Sign
-
RUQ pain after fatty meal w/ radiation to right should
Cholecystitis
-
4 F's for Cholecystitis
Fat, Female, Fertile, Forty
-
Cholangitis: Chargot triad
- Biliary pain
- Fever
- Jaundice
-
Biliary pain
Fever
Jaundice
Cholangitis: Chargot's Triad
-
Raynold's Pentad
- Charcot triad (biliary pain, fever, jaundice)
- Mental confusion
- Refractory sepsis (hypotension)
-
Liver pain?
RUQ, can be refferred and diffuse
-
Woman with pruritus, asymptomatic cholestasis
Primary biliary cirrhosis
-
What kind of antibodies are present in primary biliary cirrhosis?
Antimitochondiral Ab's
-
Progressive neurologic impairment, cirrhosis, and eye findings
Wilson's Disease (Kaiser-Fleischer rings)
-
Progresive multifocal arthritis, dark skin, and new-onset DM
Hemachromatosis (Iron overload)
-
Recurrent duodenal ulcers and family history of pancreatic, parathyroid, and pituitary tumors (3 P's)
- Zollinger-Ellison Syndrome
- Gastrinomas
-
Jaundice, ETOH abuse, asterixis, and fetor hepaticus
- Cirrhosis
- ETOH, viral
- Asterixis
- Fetor hepaticus
- Caput medusa
- Spider hemangiomata
-
Collateral Venous Drainage:
1) Toward lower abd-
2) Toward upper abd-
3) Bidirectional flow-
- 1) Superior vena cava obs
- 2) Inf. vena cava obs
- 3) Portal obstruction
-
Patient w/ early emphasematous lung changes and cirrhosis
Alpha I-antitrypsin deficiency
-
PE:
Abdominal fluid wave
- Have pt. turn to side, intestines float, fluid goes to bottom
- Results in shifting dullness
-
Most common malignancy of liver
Metastatic
-
Hyperbilirubinemia
- Gilbert's
- Dubin-Johnson
- Rotor Syndrome
- Criglar-Najar
-
Mild elevation inbili w/ illness
Gilbert's (10%)
-
Jaundice w/ stress
- Dubin-Johnson
- Black pigment in hepatocytes
- Rotor-no pigment in hepatocytes
-
Severe Jaundice in an infant w/ early death
- Crigler-Najjar Type I- abscence of glucuronosyltransferase
- Type 2- deficiency, milder course
-
-
Chron's and UC are both examples of
IBD
-
Skip lesions, rectal sparing, mouth to anus
Chron's Disease (IBD)
-
IBD: Colonic involvement, Sclerosing cholangitis
UC
-
Hiker in Colorado w/ watery diarrhea
Giardiasis
-
Flatulence, bloating, diarrhea, FE def anemia, low albumin
Celiac sprue (gluten sensitivity)
-
Celiac sprue has decreased (2 C's_
-
Pt. w/ arthralgias, weight loss, diarrhea, and neuro disease
- Whipple's Disease
- Treat with: Ceftriaxone, bactrim
-
Diarrhea, wt loss, low albumin; previous missionary to tropics
Tropical sprue (long lag time to onset)
-
30 y/o w/ colon CA and dark spots on lips
- Peutz-Jegher's
- Hamartomas in small bowel
-
32 y/o w/ colon CA; several relatives w/ early colon CA
- Gardner's Syndrome
- Familial adenomatous polyposis syndrome
-
Sausage mass in LLQ w/ pain, fecal occult blood, and fever
Diverticulitis
Comparison: Diverticulosis (Noinfections, no fever, no mass)
-
Courvosier
Painless, palpable GB
-
Dance
Absence of bowel sounds in RLQ
-
Mcburney's point
RLQ point tenderness; appendix
-
Iliopsoas, Obturator
Retro signs
-
-
-
-
Sister Mary Joseph nodule (node)
Colon CA
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