Study sets, textbooks, questions
Upgrade to remove ads
FMED - MedU - Epigastric/Abdominal pain
Terms in this set (50)
Potential GI causes of abdominal pain?
Appendicitis, cholecystitis/cholelithiasis, diverticulitis/diverticulosis, dyspepsia, gastroesophageal reflux disease, gastritis, acute or chronic hepatic failure with resultant complications (e.g., ascites), acute hepatitis (e.g., viral, autoimmune, alcoholic, drug-induced), inflammatory bowel disease, intestinal ischemia, intestinal obstruction, irritable bowel syndrome, pancreatitis, peptic ulcer, perforation/peritonitis (e.g., gastric, colonic, intestinal), gastric outlet obstruction, tumor (e.g., gastric, hepatic, pancreatic, intestinal, colonic).
Potential cardiac causes of abdominal pain?
Myocardial infarction, angina pectoris, abdominal aortic aneurysm dissection or rupture.
Psychogenic causes of abdominal pain?
Anxiety, panic disorder, somatiform disorder, post-traumatic stress disorder.
Pulmonary causes of abdominal pain?
Pleurisy, pneumonia, pulmonary infarction, tumor.
Renal causes of abdominal pain?
Nephrolithiasis, pyelonephritis, cystitis, tumor.
Musculoskeletal causes of abdominal pain?
Abdominal wall muscle strain, hernia (e.g., ventral, inguinal, incarcerated), abscess (e.g., psoas, subphrenic), trauma (e.g., contusion, hematoma).
Metabolic causes of abdominal pain?
Drug overdose, ketoacidosis, iron or lead poisoning, uremia.
May present with mild epigastric pain, and
symptoms commonly worsen after meals
, may be worsened by lying down flat, and although the pain is classically described as "burning" and may be located in the substernal rather than epigastric area.
Is melena commonly associated with this?
GERD (more full gastric volume - more likely to reflux through LES causing pain)
Hematemesis in the setting of GERD-like symptoms is unusual and represents an alarm symptom indicative of an upper GI bleed or tumor and warrants prompt GI referral for evaluation and upper endoscopy.
seen in GERD - if present, refer to GI for upper endoscopy.
Epigastric abdominal pain that improves with meals is the hallmark of ____ or ___.
PUD (peptic ulcer disease) or Gastritis would be top in the differential
In some cases however, it may worsen with meals.
What medication should you ask about if they have symptoms of epigastric pain relieved by meals/water?
Is melena or hematochezia commonly associated with this?
use. Obviously also think H. pylori and need for antibiotics along with PPI's/H2 blockers
Hematemesis, if present, suggests more complicated disease including bleeding ulcer and warrants urgent GI referral and endoscopy.
Melena is common with PUD upper GI bleeds. Hematochezia would only be present with very severe bleeds (variceal rupture).
What are two major causes of gastritis?
NSAID use or alcohol
what would you expect to present along with abdominal muscle strain causes of abdominal pain?
Changes in pain upon change in position
Acute left lower quadrant pain +
Change in bowel habits +
Fever = ?
What age group most common?
Diverticulitis - study of choice is abdominal CT scan - EAT FIBER
- >50 years old
Most common cause of non-cardiac chest pain?
Severe abdominal pain
Signs of dehydration - tachycardia
Pain in epigastric area w/ radiation to the back
- common cause?
Excess alcohol use (also cause of chronic pancreatitis)
What are major proven contributors to the development of PUD?
Aspirin and other NSAIDs including Ibuprofen (not Acetominophen).
Moderate to severe physiological stress
Can GERD be distinguished from other GI disorders on the basis of symptoms alone usually?
Which is more associated with relief from pain after eating/drinking but more associated with nausea and vomiting shortly after eating - several hours later?
What is the most common form of GERD (non-erosive = NERD) or erosive GERD?
NERD most common
What is believed to be the primary etiology of GERD?
Transient LES relaxation
Sharp, stabbing, substernal pain worsened by consumption of substances of extreme temperature?
Examples of things that can precipitate GERD?
spicy and fatty foods
alcohol and caffeinated beverages
eating large portions
lying flat in close proximity to a meal
wearing tight clothing around the waist
some medications (calcium channel blockers, beta-agonists, alpha-adrenergic agonists, theophylline, nitrates, and some sedatives)
Potential complications of GERD?
Barrett's Esophagues (squamous epithelium replaced with columnar --> ultimately can lead to adenocarcinoma in 2-5% of cases)
Complications of PUD?
Hemorrhage or perforation into the peritoneal cavity
Ulcer scar healing or inflammation can impair gastric emptying and lead to gastric outlet obstruction syndrome
Dysphagias to solids = ?
Dysphagias to liquids = ?
Solids = development of strictures
Liquids = motility disorder
Quickly advancing dysphagias may indicate an adenocarcinoma
What may be associated with early satiety?
May be associated with gastroparesis or gastric outlet obstruction (stricture or cancer).
Hematemesis indicates what possibly?
Vomiting blood, which suggests bleeding ulcer, mucosal erosions (erosive gastritis/esophagitis), esophageal tear (Mallory-Weiss), or esophageal varices.
Iron deficiency anemia + hematochezia/hematemesis?
The presence of hematemesis, hematochezia, and/or iron deficiency anemia may indicate possible bleeding from a peptic ulcer, mucosal erosions, or cancer.
Physical exam findings of GERD/PUD?
Usually normal. Pay attention to symptoms of other diseases that could cause dyspepsia or look for signs of complications.
What may the following indicate:
- brittle nails/cheilosis (cracks/sores on lips)/pallor of palebral mucosa or nail beds
- Weight loss
- Palpable mass
- Presence of signal lymph nodes (Virchow's nodes)
- Acanthosis nigracans
- Jaundice or positive Murphy's sign (what's that?)
- Constipation/cool pale skin/coarse hair/myxedema (nonpitting), delayed reflexes
- Diarrhea, warm skin, thinning hair, eyelid tags, brisk DTRs, tachycardia?
- hypotension/tachycardia = altered hemodynamic status by significant blood loss
- brittle nails/cheilosis (cracks/sores on lips)/pallor of palebral mucosa or nail beds = Anemia
- Weight loss = Malignancy
- Palpable mass = Malignancy
- Presence of signal lymph nodes (Virchow's nodes) = Malignancy
- Acanthosis nigracans = Malignancy
- Jaundice or positive Murphy's sign (what's that?) = Gallbladder disease (Murphy's - ask patient to exhale and place hand in URQ - ask them to inhale, stopping suddenly is a positive Murphy's sign)
- Constipation/cool pale skin/coarse hair/myxedema (nonpitting), delayed reflexes = Hypothyroidism
- Diarrhea, warm skin, thinning hair, eyelid tags, brisk DTRs, tachycardia = Hyperthyroidism
Thyroid disease is a potential cause of dyspepsia.
Most appropriate initial therapeutic intervention in patients with symptoms of GERD without signs of major complications?
Empiric PPI/H2 antag. therapy is appropriate first line
Short term PPI trail is considered to be a sensitive and specific means of diagnosing GERD
If patient fails initial PPI trial, without any alarm signs or symptoms, is GI referral indicated here?
NO; not yet. Not without alarm signs. Continue to try to manage outpatient.
Appropriate workup for PUD?
- Order H. pylori IgG serology (only indicates past H. pylori infection - cannot be used to confirm erradication)
- Ask about current NSAID and/or aspirin use
- Perform a digital rectal exam + gFOBT
- Obtain a complete blood count
Urease breath test is better for determining active infection - however is more expensive and not indicated first line. H. pylori stool antigen test is also available, but again more expensive than serology would be used as confirmation, not screening.
How much of US pop is infected with H. pylori?
How is H. pylori transmitted?
H. pylori is spread through human saliva and feces and via food and water sources.
What percentage of people with duodenal ulcers are infected with H. pylori?
Tx of H. pylori?
Standard PPI dose (bid) + Amoxicillin (1 g) + Clarithromycin (500 mg) bid for 10-14 days (triple therapy)
Stand dose PPI once or bid + metronidazole (250 mg) + tetracycline (500 mg) + bismuth subsalicylate (525 mg) each qid for 10-14 days (quadruple therapy)
Or if penicillin allergy:
If patient says treatment made his dyspepsia initially resolve, and then it recurred, what would be next step?
Urea breath test
H. pylori fecan antigen test
If fecal antigen is positive, will require re-treatment for resistant infection - should not be given this prior to test for active infection.
If either tests are negative, should be referred to GI specialist for upper EGD
Examples of salvage therapy for H. pylori infection?
Levofloxacin triple therapy for 10 days (eradication rate - 87%)
Standard dose PPI twice daily
Amoxicillin 1 gram twice daily
Levofloxacin 500mg once daily
Quadruple therapy for 14 days (eradication rate - 68%):
PPI standard dose once or twice daily OR ranitidine 150mg twice daily
Tetracycline 500mg three times daily
Metronidazole 250mg four times daily
Bismuth subsalicylate 525mg four times daily
If symptoms persist after salvage therapy, what's next?
Continued epigastric pain despite adequate acid blocking mediation = suspicious for what?
If patient presents with gastric burning pain and has previous tried the PPI trial, next thing to do is?
Probably H. pylori serology screening however, if that's not an option, pick one of the other H. pylori screening options like the urea breath test.
When is documentation of erradicated H. pylori indicated following treatment ?
patients with an H. pylori-associated ulcer, persistent symptoms despite appropriate therapy for H. pylori, patients with H. pylori-associated MALT lymphoma, history of resection for early gastric cancer, and patients planning to resume chronic NSAID therapy.
What are examples of indications of endoscopy?
Patients with alarming symptoms:
- Weight loss (worry about cancer)
- Anemia (think heme positive stool sample)
- Dysphagia/obstructive symptoms
- any evidence of upper GI bleeding
- patients who do not respond to empiric PPI/H2 therapy
- signs of complicated PUD
- Evidence of systemic illness
Is upper GI series (barium contrast) helpful in diagnosis of GERD?
- NO; It is helpful in identifying complications such as strictures/ulcerations
What is gold standard for GERD diagnosis (most sensitive and specific?
24-hour pH study (usually not necessary however) - typically empiric H2 or PPI is indicated first unless more alarming symptoms (then do endoscopy)
When should screening for Barrett's esophagus be done?
When patient has had GERD for at least 5 years and could undergo surgery if positive for cancer
Cytologic findings from aspirate in cases of recurrent pneumonia from aspiration pneumonia?
Lipid laden macrophages (from phagocytosis of fat)
Phases of GERD management:
1 - behavior modification
2 - H2 blocker
3 - switch to PPI
4 - add metoclopramide (Da blocker) as a pro-motility agent or Bethanechol (a cholinergic agnoist)
5 - Combination therapy - H2 + promotility or PPI + promotility
6 - indications for surgery
Tests for pancreatitis
If sludge or gallstones not seen on US, do HIDA scan
Sets with similar terms
GI and GU Pathologies
4.2: PT Screening - GI
Differential Diagnosis Exam 1 Practice Questions (…
Sets found in the same folder
Cancer Screening Guidelines
IM - Step up - Inflammatory Bowel Disease
FMED - Step Up Musculoskeletal
Infant well child checkup
Other sets by this creator
RAD BIO MEMORIZE CARDS
Rad Bio Lectures
Physics -- Dosimetry/IMRT/VMAT/SRS/TBI/W…
Physics - QA
Other Quizlet sets
Chapter 15: Opioid Analgesics
Ch 1 Connect Busin. Comm.
philosophy quiz 2