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What are examples of things that can cause visceral pain? Intestine, biliary tree, liver disease What are examples of things that can cause parietal pain? Appendicitis, peritonitis What are examples of things that can cause referred pain? Cholecystitis What are examples of things that can cause colicky pain? Renal stones What is the order in which you should perform an abdominal physical exam?
- inspection
- auscultation
- percussion
- palpation What diagnosis would you consider for a 30 year old with heart burn, early satiety, burping and generalized abdominal pain? Dyspepsia related to gastritis What diagnosis would you consider for a 50 YEAR OLD SMOKER with heart burn and abdominal pain? Colon cancer How high is the bilirubin level when the patient is starting to develop physical jaundice? 2.5 or higher ______________ bilirubin is unconjugated, which means that it has not been metabolized by the liver or made into a water soluble form of bilirubin Indirect bilirubin ________________ is processed bilirubin that is water soluble Direct bilirubin
What does a history of fever, chills and RUQ pain indicate? Acute cholangitis What does RUQ pain with a history of anorexia, malaise and myalgias indicate? Viral hepatitis What is the terminology for when the gallbladder is so distended that you can palpate it? Courvoiser Sign What is the terminology for inspiratory arrest that occurs when you are putting pressure on the RUQ due to inflammed gallbladder? Murphey's Sign Which liver enzyme is specific for hepatocytes? ALT Which liver enzyme is more specific to alcohol, statins and tylenol use? AST
If the ratio of AST to ALT is 2 to 1, what does this indicate? Liver damage due to alcohol, statins or tylenol If the ratio of ALT is twice as high as AST, what does this indicate? Viral hepatitis What is the normal range for ALT and AST? 30 - 40 What does an elevated ALT, AST and Alk Phos indicate? Gallbladder obstruction What are the signs and symptoms in a patient that has MILD melena? Resting tachycardia What are the signs and symptoms in a patient that has melena with a blood volume loss of at least 15%? Orthostatic hypotension
What is the gold standard diagnostic test for dysphagia? Video fluoroscopic swallow study IF a patient over the age of 50 comes in with dysphagia, what would you assume? Esophegeal cancer If a patient comes in with SUDDEN dysphagia, what would you assume? Patient had a stroke What is the term used to describe the chronic immunological disease that manifests in intestinal inflammation? Inflammatory Bowel Disease What is the term used to describe a clinical syndrome of uncertain etiology characterized by lower abdominal pain and alternating diarrhea and/or constipation Irritable Bowel Syndrome What is the term used to describe the disease process in which the MUCOSAL surface of the colon and rectum erodes resulting in bloody diarrhea? Ulcerative Colitis
What is the term used to describe the disease process in which ALL layers of the bowel wall have tissue damage characterized by skip (cobblestone) lesions in both the small and large intestine? Chron's Disease What are the signs and symptoms of Ulcerative colitis?
- Diarrhea
- 4 - 10 bowel movements a day
- small and large amounts of blood and mucus in the stool
- abdominal pain and tenderness
- impaired nutrition, anemia and hypovolemia What are the signs and symptoms of Crohn's disease?
- insidious gradual onset
- diarrhea
- bloody stool intermittently
- steatorrhea
- abdominal cramping
- FEVER
- weight loss, anorexia Which type of anemia can occur in patients with ulcerative colitis?
What are the medications that can be used to treat Ulcerative Colitis? 1st line is ASA THERAPY- Mesalamine (oral or rectal) Topical or systetmic steroids Immunomodulating Drugs
- Azathioprine
- Methotrexate
- Infliximab
- Adalimumab When would you hospitalize a patient with Ulcerative Colitis? 10 + bloody stools a day Fever Tachycardia Using the Crohn's Disease activity index calculator, what does a score less than 150 indicate? Remission
Using the Crohn's Disease activity index calculator, what does a score between 150 - 220 indicate? MILD Disease Using the Crohn's Disease activity index calculator, what does a score of 220- 450 indicate? MODERATE-SEVERE disease Using the Crohn's Disease activity index calculator, what does a score greater than 450 indicate? Severe fulminant disease What are the treatment options for a patient with Mild Crohn's disease?
- Budenoside
- Sulfasalazine (mild colitis)
- Mesalamine (mild ileitis)
- Oral prednisone for 1-2 weeks and taper What are the treatment options for a patient with Moderate- Severe Crohn's disease?
- Steroids to achieve remisison
- Azathioprine
- Cyclosporine
- an altered sensory act of defecation
- passage of mucus
- varying degrees of bloating and abdominal distention How can you manage IBS? Antidiarrheal medications during periods of diarrhea High fiber diet Anticholinergics Antispasmodics Antidepressants What are the symptoms of IBS? Bloating Cramping Diarrhea Nausea Constipation Abdominal pain Gas
Incomplete bowel movements Fatigue What are the signs and symptoms of bowel obstructions? Sudden onset of colicky abdominal pain Nausea/vomiting Diarrhea early/ constipation late Signs of dehydration Abdominal distention Bowel sounds may be high pitched/ hyperactive or totally absent Mass may be palpable What are the diagnostic tests that can be performed to identify a bowel obstruction? Abdominal xray films will reveal air-fluid levels in the bowel What is the treatment plan for a patient with a bowel obstruction?
Pruritis External hemorrhoids: not visible at rest but will portrude when standing or with the valsalva maneuver Internal hemorrhoids most often present with rectal bleeding What are the treatment options for hemorrhoids?
- oral analgesics
- sitz baths
- bulk- forming laxative
- increase fiber intake slowly from 25- 35
- topical hydrocortisone cream (anusol and proctofoam)
- surgical excision What are the symptoms of colorectal cancer? Usually asymptomatic however the patient may report a change in bowel habit, stool caliber or blood streaks in stools
Late symptoms include weight loss and anorexia What is the management of colorectal cancer? Surgical resection Chemotherapy based on staging Radiation What are the screening recommendations for the average risk person for colorectal cancer? Beginning at age 50 through 75 For African Americans begin screening at 45 years Perform colonoscopy every 10 years What are the screening recommendations for high risk people with a family history of colorectal cancer before age 60? Colonoscopy every 5 years starting at age 40 or 10 years younger at age of diagnosis of youngest affected relative
Scalp ringworm What is tinea corporis? Ringworm on any part of the body What is tinea cruris? jock itch fungal infection of the groin What is tinea pedis? athlete's foot What is tinea manuum? fungal infection of the hands What is tinea versicolor? Yeast infection of the skin that inhibits melanin production resulting in patches of discoloration What is tinea unguium? ringworm of the nails (onchymycosis)
What are the 3 main fungal species that cause dermatophytosis?
- Trichophyton
- Microsporum
- Epidermophyton Which two types of fungal skin infections require systemic medication? Tinea capitus and tinea unguimus What is the treatment for tinea versicolor? Selenium sulfide What is the diagnostic study that is performed to identify a dermatophytosis and yields rapid results? KOH preparation What is the diagnostic study that is performed to identify a dermatophytosis that takes several weeks to result? fungal culture
