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DU PA GI Approach

Duke PA Approach to the Patient with Gastrointestinal Disease

accessory organs to the GI system salivary glands, liver, gall bladder, pancreas
many GI disorders are __, which means there is a lack of laboratory or radiographic abnormalities functional
chronic or recurrent pain or discomfort in the upper abdomen. Incorporates a variety of symptoms including early satiety or fullness. dyspepsia
dyspepsia is a diagnosis of __ exclusion
hematemesis is more commonly associated with __ upper GI bleeds
hematochezia is more commonly associated with __ lower GI bleeds
__ fibers are more associated with visceral pain C
__ fibers are more associated with parietal pain and is more sharp in nature A
__ pain is poorly localized, and is produced by dermatome that innervates the involved tissue visceral
__ pain is initiated by pain receptors in parietal peritoneum, is sharp and well localized somatic
__ is poorly localized, and is felt in areas that may be remote from site of disease referred
__ has a very high predictive rate for appendicitis anorexia
patients with __ pain resist movement peritoneal
if movement (jumping jacks) causes abdominal pain think __ peritoneal
abdominal pain that doesn't interfere with sleep is associated with __ IBS
__ pain gets better after a bowel movement IBS
any inoccent diagnosis is always a diagnosis of __ exclusion
some common causes of chronic abdominal pain GERD, non-ulcer dyspepsia, IBS, IBD, chronic pancreatitis, infectious diarrhea
pain or discomfort is the predominant feature of __, this distinguishes it from GERD Dyspepsia
only patients with __ of dyspepsia require management dyspepsia
in the setting of dyspepsia some warning signs for cancer are bleeding, anemia, weight loss >10% of body weight, progressive dysphagia, odynophagia, persistant vomiting, history of PUD, FH of malignancy, abdominal mass
20th century disease associated with western lifestyle diverticular disease
diverticulosis is most commonly found in what region sigmoid colon
__% of patients with diverticular disease will develop diverticulitis 20
presence of small mucosal herniations in colonic wall diverticulosis
inflammation of diverticula diverticulitis
diverticular pain is most common in the __ region LLQ, suprapubic
can present as left sided appendicitis diverticulitis
associated symptoms of diverticulitis fever, malaise, constipation, diarrhea, nausea, vomiting, dysuria, urinary frequency
lab evaluation with diverticulitis leukocytosis with left shift
Imaging for diverticulitis CT, plain films assess-free air, ileus, obstruction
classic antibiotic treatment for diverticulitis cipro and metronidazole
treatment for diverticulitis clear liquids, 7-10 day course of antibiotics (cipro/metronidazole)
complications of diverticulitis bleeding,intra-abdominal abscesses, fistulas, obstruction
diverticular disease accounts for 50% of episodes of __ lower GI bleed
acute upper GI bleeding is __x more common than lower GI bleeding 3
most common causes of acute upper GI bleed peptic ulcers, esophageal varices
most common causes of lower GI bleed diverticulosis, vascular malformation
most common presentation of lower GI bleed hematochezia
defined as increased frequency or fluidity of stool diarrhea
diarrhea <6 weeks duration acute diarrhea
diarrhea >6 weeks duration chronic diarrhea
most common cause of acute diarrhea infection
majority of acute diarrheas are __ in etiology viral
double digit stools per day C. dif
most common protozoan cause of chronic diarrhea giardia
bulky, frothy stools osmotic diarrhea
If I don't eat I don't get diarhea osmotic diarrhea
greasy, frothy stools, diarrhea, and weight loss fat malabsorption
steatorrhea fat malabsorption
bloating, soft diarrhea carbohydrate malabsorption
edema, muscle wasting protein malabsorption
gold standard test for steatorrhea fecal fat analysis
functional causes of constipation low fiber diets, sedentary activities, slow transit time
new onset constipation in middle age and up should get __ colonoscopy
drugs that cause constipation calcium channel blockers, diuretics, anticholinergics
endocrine/metabolic disorders that cause constipation diabetes, renal failure, hypercalcemia, hypothyroidism, hypokalemia
neurological causes of constipation MS, Parkinson's, spinal cord disorders, Hirschsprung's disease, psychosis
acute causes of N/V appendicitis, cholecystitis, pancreatitis, peritonitis, small or large bowel obstruction
chronic causes of N/V esophageal disorders, PUD, gastric malignancy
difficulty swallowing dysphagia
difficulty swallowing both liquids and solids motility disorders
difficulty swallowing solids mechanical obstruction
painful swallowing odynophagia
pathophysiology of odynophagia inflammation of esophageal mucosa
pyrosis heart burn
classsic symptom of GERD pyrosis
early satiety is worrisome for __ in older patients malignancy
if you think your patient has a GI bleed you need to get __ orthostatics
reason for not doing a rectal exam you don't have a finger and the patient doesn't have a rectum
there should not be stool in the __ rectal vault
if stool is present in the rectal vault do a __ stool guaiac
with acute abdomen the most helpful thing to get is __ CBC
study of choice for acute appendicitis in adults CT
study of choice for acute appendicitis in children ultrasound
the lower 10-15 cm of the colon rectum
divides the squamous epithelium from mucosal or columnar epithelium in the anus dentate line
marks where sensory fibers end in the anus dentate line
pruritis ani anal itching
chronic scratching can result in __ lichenification, fissures, and infection
systemic illnesses that may cause pruritis ani diabetes, malignancies, thyroid disease
ingested irritants that may cause pruritis ani tomatoes, citrus, caffeinated drinks
infections that may cause pruritis ani intertrigo, HPV, HSV, scabies, pinworms
medications that may cause pruritis ani colchicine
sever pain with or immediately after bowel movement (described by patient as a cut) suggests anal fissure
dull, aching pain after bowel movement suggests extensive inflammation of internal hemorrhoids
BRBPR bright red blood per rectum
bright red blood on paper after wiping almost always from an anal rectal lesion (usually hemorrhoids)
most common reason for BRBPR in younger people ulcerative colitis
when anal fissures are lateral suspect __ underlying conditions such as TB, syphilis, occult abscesses or carcinoma
treatment for anal fissures stool softeners, barrier ointments, sitz baths, topical steroids, nitro 2% ointment, botox
abnormal openings between anal canal and perianal skin fistulas
painless bleeding after defecation is most common presentation for internal hemorrhoids
rarely bleed but often exquisitely painful, especially if thrombosed external hemorrhoids
exquisitely tender, bleed easily, usually caused by hard to pass stool anal fissure
treatment for external hemorrhoids sitz baths, topical steroids, stool softeners, early removal of clot if thrombosed, recovery is often prolonged
Created by: bwyche