Viceral pain (originating in the organs) is caused by distension or spasm of a hollow viscus.
Viceral pain is poorly localized and is described as dull in nature.
Describe parietal pain.
Parietal pain is described as sharp and well localized and caused by irritation of the peritoneum.
Describe abdominal pain that is colicky?
Pain that comes and goes (colicky) maybe from gallstones or renal stones.
Describe burning pain/
Burning pain maybe irritation of the gastric mucosa by gastric contents, is associated with peptic ulcers and esophagitis.
Severe pain and a rigid abdomen...
Emergent situation, refer to physicain.
What is the most common cause of constipation in the united states?
Lack of dietary fiber. Recommended amount is 30 grams a day. The average American gets only 10 grams of fiber a day.
What is simple constipation?
Results from a diet that is low in fiber and high in simple carbohydrates and meat. Some people have difficultly defecating in an environment in other than thier home so they may surpress their urge causing simple constipation.
What is the catagory of constipation suffered by most seniors?
Disordered motility caused by slowed transit time.
Constipation caused by drugs is known as....
What is the treatment for simple constipation?
Increase diatery fiber to 25 to 35 grams a day with 12 to 15 grams at breakfast.
Mild exercise, dedicated toilet time and adequate hydration are also helpful.
What parameters define diarrhea?
If the daily stool is more than 200 grams or the frequency of bowel movements is more than 3 x a day.
What is the resting LES pressure in a normal patient?
10 to 30 mm Hg, patients with sever gerd have an LES pressure of < 10 mm Hg.
How is refluxate cleared and neutralized?
Normally cleared and neutralized by swallowing salivary bicarbonate and esophageal peristalsis. Decreased swalling at night coupled with recumbency, significantly increases exposure of mucosa to acid.
How does Barretts epithelium develop? and what is its significance?
Develops as a response to chronic GERD. Barretts epithelium is more resistent to acid but is a pre-malignant condition that is 40 fold increase risk in the development of esophageal adenocarcinoma.
What are common symptoms of GERD?
Gerd SX: Regurgitation, water brash, dysphagia, sour taste in the mouth in the morning, odynophagia, belching, couging, horseness, or wheezing at night.
Progresssive or persistent dysphagia in association with GERD...
Maybe a sign of stricture or adenocarcinoma
Differentiate between PUD and GERD?
PUD often produces epigastric pain and tenderness on palpation.
The heartburn from PUD is often releived by food!
Outline the four steps in Managing GERD.
1. Trial for 4 wks
Dietary and Lifestyle
Antacids OCT H2RA
2. Trial for 6 wks
Dietary and Lifestyle
H2RA at Prescription doses OR
3. Trial for 8-12 wks
Dieatary and Lifestyle
Increase PPI Dose
Dietary and Lifestyle
What is dysentery?
Frequent small stools containing blood and mucus.
What is the normal pH of the stomach?
2, acts as defense against ingested pathogens.
Infections of the small bowel produce:
Infections of the large bowel produce:
Infections of the small bowel produce: watery, secretroy diarrha.
Infections of the large bowel produce: bloody diarrhea and abdominal pain
Food poisoning occuring after...
6 Hours suggests bacillus cereus.
Greater than 14 incubation suggests viral infection
With Diarrhea, when should a stool culture be sent?
Severe diarrhea, a fever of 101.3 or higher, presence of bloody stools, or stools that test positive for occult blood or leukocytes. These findings are highly suggestive of bacterial infection.
In patients who are vomitting and food or water bourne contamination is suspected....
Typically viral - incubation period > 12 hours.
What are the three major causes of PUD?
1. Infection with H. pylori
2. Chronic ingestion of aspirin and other NSAIDS
3. Acid Hypersecretion as in Zollinger-Ellison Syndrome
How does aspirin decrease mucosal defense?
Decrease mucosal defense by inhibiting prostaglandin synthesis, leaving the area vulnerable to hydrochloric acid and pepsin.
Prostaglandin enhanced mucosal blood flow aids in cell renewel and mucosal protection.
What is the treatment of choice for PUD?
PPI's are more effective and easier to use than H2RAs. Heal 90% of duodenal ulcers in 4 weeks, heal 90% of gastric ulcers in 8 wks.
T/F Use antacids with calcium in PUD.
False. Antacids with calcium can cause REBOUND acid secretion.
Describe the triple drug therapy used to erradicate H. Pylori?
1. Use of clarithromycin
2. Use of Either Amoxicillin (favored) or metronidazole
3. Use of PPI
Differentiate symptoms of duodenal ulcers and gastric ulcers?
Gastric ulcers tend to be MORE painful with eating due to the increase in acid secretions.
What is the diagnostic standard for PUD?
What is the main cause of gastritis (Ulcers) in non - NSAID associated gastritis?
When a patient presents with weight loss and increased gastric pain with eating....
suspect gastric CA
What is the test that demonstrates pain upon palpation of the RUQ?
Positive Murphy's sign
What laboratory values when abnormally high are suggestive of cholecystitis?
Alk phos and bilirubin
What is the gold standard test for cholecysitis?
Differentiate between acute interstitial and necrotizing pancreatitis?
Microcirculation is maintained in acute interstitial pancreatitis.
Name two objective signs on physical exam that may be evident in pancreatitis?
Grey Turners sign - Bluish discoloration of the flanks
Cullens sign - bluish discoloration around the umbilicus
What is the gold standard for DX pancreatitis?
Elevated serum amylase
How can you tell if pancreatitis is caused by billiary disease? (gallstones)
Elvated ALT, AST and alk phos
What narcotic is admin during pancreatits?
Describe the routes of transmission of the various strains of hepatits?
1. Hep A - Fecal oral route - not chronic
2. Hep B - Percutaneous, permucosal, infected body fluids
3. Hep C - Percutaneous
4. Hep D - Percutaneious - must have co-infection with HBV
5. Hep E - Fecal oral - not chronic
What is Budd-Chiari Syndrome?
A disorder resulting from hepatic vein thromosis and outflow obstruction which can occur anywhere from the hepatic veins to the inferior vena cavaor the right atrium.
What is Wilson's disease?
Treatable condition that involves the inabiltiy to metabolize copper. Can lead to cirrosis if not treated.
What is hemochromatosis?
A treatable disease involving the inability to metabolize iron. Can lead to cirrosis if left untreated.
What are some physical manifestations of cirrosis?
Dupuytren's (Palmer) contractions
Parotid gland enlargement
Dialated cutaneous veins called caput Medsae around umbilical area.
Differentiate between a strangulated hernia and an incarcerated hernia?
Strangulated is non-reducable and its blood supply is compromised
Incarcerated hernia has caused a bowel obtruction as a result of its protrusion.