NR511 iMidterm iStudy iGuide iWorksheet
Disease Risk Subjective iFinding Objective iFindings Diagnostics Treatment
GI DISORDERS
i
Appendicitis Risk: iage i10-30; imen Subjective: iacute Objective: ilooks iill; idiffuse Tests: iCBC i- imild ito 1st iline: iIV iantibiotics, icorrecting
itwice ias ilikely ias ionset iof imild ito itenderness iwith ipalpation imoderate ileukocytosis; ifluid iand ielectrolyte iimbalances,
iwomen; idiet ilow iin isevere icolicky, iof iabdomen i– itenderness iurinalysis i– imicroscopic ibedrest, iNPO, iNG itube iif iindicated
ifiber, ihigh iin ifat iand iepigastric, ior iover iRLQ ihematuria ior ipyuria; ix-
ihigh iin irefined isugars iperiumbilical ipain; iray i– ifecalith, igas-filled 2nd iline: isurgery
iand iother icarbs inausea/vomiting; iappendix, ismall ibowel
ifever iileus, ideviation iin ibowel
igas ipattern, ior iloss iof
iright iiliopsoas ishadow;
US i– ito ivisualize
iinflamed iappendix
Celiac idisease Risk: ifamily ihistory, Subjective: imost iare Objective: iexam imay ibe Tests: iserological itesting 1st iline: istrict igluten-free idiet
iDown’s isyndrome, iasymptomatic; imay inormal; isigns iof ifor ianti-tTG iIgA
iHLA-DQ2 ior iHLA-DQ8, icomplain iof idiarrhea, imalabsorption isuch ias iantibodies; itotal iIgA; 2nd iline: iimmunomodulating
Turner’s isyndrome, ior iweight iloss, imuscle iwasting, ipallor inutritional ideficiencies i– iagents
iother igenetic ibased idyspepsia, iand i(anemia), ireduced ihemoglobin, iiron, ifolate,
iautoimmune idisease iflatulence isubcutaneous ifat, iataxia, ivitamin iB12, icalcium,
isuch ias iType i1 iDM iand iand iperipheral iand ivitamin iD
ithyroiditis ineuropathy i(Vitamin iB12
ideficiency)
Cholelithiasis i- igallstones Risk: i> i25 iy/o; imost Subjective: isymptoms Objective: iif ipain iis isevere Tests: igold istandard iis 1st iline ifor iasymptomatic ipatients:
iprevalent iin iAmerican ivary, igeneralized iGI ipatient imay ihave iabdominal iultrasound iavoid ifoods ihigh iin ifat
iIndian iwomen; icomplaints ito iinvoluntary iguarding iover
iintractable ipain; ithe iRUQ; ipositive During iacute iphase i– 2nd iline:
Cholesterol istones: iindigestion, inausea, iMurphy’s isign iw/ imild iWBC ielevation ito Treatment iof ichoice ifor iacute
ifemale, iobesity, iand ivomiting i– ipalpation iover ithe iRUQ; i15,000/mL; iserum icholecystitis:
pregnancy, iincreased especially iafter ia low igrade ifever; imay ihave transaminases ielevated
, NR511 iMidterm iStudy iGuide iWorksheet
age, idrug-induced meal ihigh iin ifat; ias diminished ibowel isounds 4x inormal; iaspartate hospitalization ifor irehydration iw/
i(oral icontraceptives, ithe iinflammation iaminotransferase iand iIV ifluids, iantibiotics, ianalgesics, iGI
iclofibrates), icystic iprogresses, ithe ipain ialanine irest, iNG iplacement ifor ipersistent
nd
ifibrosis, irapid iweight ilocalizes iover ithe iaminotransferaseican ibe iemesis; i2 ior i2rd igeneration
iloss, ispinal icord iinjury, iRUQ ior iepigastrum; ielevated ito i300 iU/L; icephalosporin iis istarted
iileal idisease iwith ipain imay irefer ito ialkaline iphosphatase iis
iextensive iresection, imiddle iof iback, ielevated ito i2-4x inormal Once istable ithe ipatient iwill
iDM, isickle icell ianemia iinfrascapular iarea, ior ilevels; ibilirubin ias ihigh iundergo isurgery ifor ia
iR ishoulder ias i4 img/dL icholecystectomy
Pigmented istones:
ihemolytic idiseases, If iconsidered ia ipoor isurgical irisk
iincreasing iage, ipatients ican ibe itreated iw/ ioral
ihyperalimentation, iingestion iof iursodeoxycholic
icirrhosis, ibiliary istasis, i(ursodoil) ior idirect idissoluction iby
ichronic ibiliary ipercutaneous iinstillation iof
iinfections imethyl-tertiary-butyl iether;
ilithotriopsy
Six iF’s: ifat, ifemale,
iforty, iflatulent, ifertile,
iand ifat-intolerant
Crohn’s idisease Risk: igenetic Subjective: iabd Objective: Tests: icolonoscopy i- 1st iline: inutrition icounseling i–
ipredispositio icramping iand 1. Inflammation, iRLQ ireveals iulcers ithat iare iavoid icaffeine, iraw ifruits,
n itenderness, ifever, ipain, iand itendnerness ieither iminor ierosions ior ivegetables, iseeds, iand inuts, iand
ianorexia, iweight iloss, – ipresenting ilike ideep ilongitudinal ifoods ihigh iin ifiber i(whole igrain
ispasm, iflatulence iand iappendicitis ifissures, icobblestone ibread iand icereal); ibland idiet ithat
iRLQ ipain ior imass; 2. Obstruction, ifibrosis, iappearance iis ihigh iin icalories iand iprotein iyet
iincrease iin isymptoms iand istenotic ichanges ilow iin ifat
iduring istress ior iwithin ithe ibowel 1st iline imedication: ioral
iemotional iupset ior icausing iobstruction iprednisone
iafter imeals iconsisting iassociated iw/ isevere
of ifatty, ispicy ifoods, colic, iabdominal 2nd iline: imesalamine i(Asacol) iand
, NR511 iMidterm iStudy iGuide iWorksheet
or imilk; istools iare distension, sulfasalazine i(Azulfidine)
isoft ior isemi-liquid; iconstipation iand
iblood iin istools; ivomiting
isteatorrhea; iperiods 3. Diffuse ijejunoileitis
iof iacute iexacerbation iinvolving ithe ijejunum
ialternating iwith iand iileum iand
icomplete iremission icharacterized iby iboth
iinflammation iand
iobstruction
4. Abdominal ifistulas
iand iabscesses icausing
ifever, igeneralized
iwasting, iand
abdominal imasses
Diverticulitis Risk: ilow-fiber iand Subjective: iLLQ ipain; Objective: itenderness iin Tests: iabdominal ix-rays i– 1st iline: ihigh ifiber idiet ior idaily ifiber
ihigh ifat idiet; ichronic ipain imay ibe iworse ithe iLLQ; ifirm-fixed imass ireveal ifree iair, iileus, ior isupplementation iwith ipsyllium
iconstipation iand iafter ieating, ipain iis imay ibe iidentified iin ithe iobstruction; ia ibarium iMild isymptoms: irest iclear iliquid
istraining; iirregular isometimes irelived iarea iof ithe idiverticula; ienema i– ioutlines ithe idiet
ibowel icontractions; iwith iBM ior ipassing ihypoactive ibowel isounds ilumen iof ithe ibowel
iweakness iof ibowel iflatus; ialternating iinitially, ibut ihyperactive iif iclearly idefining 2nd iline: ihospitalization ifor iIV
imuscle ibrought ion iby ibowel ipatterns ian iobstructive iprocess ihas idiverticula iantibiotics iand ihydration,
iaging ibetween iconstipation ideveloped ianalgesia, ibowel irest, iand ipossible
iand idiarrhea iNG itube
GERD Risk: ioverweight, iBMI Subjective: imild ito Objective: iexam iin Tests: 1st iline ifor imild isymptoms: ilifestyle
iover i25; iincreases iw/ isevere iheartburn, inormal; ipossible istool Diagnosis iis imade iby imodifications i– iweight iloss,
iage ithen idecreases iregurgitation, iwater ipositive ifor ioccult iblood ihistory ialone ielevating iHOB ito i6-8 iinches, iavoid
iafter ithe iage iof i69; ibrash, idysphagia, idue ito imicrohemorrhages ieating imeals i2-3 ihours ibefore
iingestion iof isour itaste iin ithe iin ithe iirritated iesophageal If iunclear idiagnosis: iEGD ibedtime, iavoid icertain ifoods isuch
ifoods/pharmacologica imouth iin ithe iepithelium ias ichocolate, ialcohol, icaffeine,
l morning, ibelching, acidic ior ispicy ifoods; ismoking
agents ithat ilower ithe
, NR511 iMidterm iStudy iGuide iWorksheet
lower iesophageal coughing, cessation
isphincter ipressure ihoarseness, ichest
ipain 2nd iline ifor imild ito imoderate
isymptoms: i4-8 iweek icourse iof iPPI
ionce idaily i30 iminutes ibefore
ibreakfast
-Omeprazole, iLansoprazole,
iPantoprazole
Giardia ilamblia i– ia Risk: ihypogamma- Subjective: irange Objective: iexamination iof Tests: 1st iline:
iprotozoan ithat iattaches ito iglobulinemia ifrom inonspecific istool iimmunofluorescent quinacrine ihydrochloride
ithe imucosa iof ithe ismall icomplaints iof iantibody itests iand i(Atabrine) i100 img ithree itimes
ibowel Transmitted ivia ioral- ibloating, iflatulence, idiagnostic ienzyme-linked idaily iafter imeals ifor i5-7 idays
ianal iintercourse iand iis inausea, iand iwatery iimmunsorbent iassay iOR
ia icommon icause iof inoninflammatory i(ELISA) itests metronidazole i(Flagyl) i250 img
itraveler’s idiarrhea iand idiarrhea ito ichronic ithree itimes idaily ifor i5-7 idays
idiarrhea iin ichildren idiarrhea iwith iweight Duodenaliaspirate ior
iwho iattend iday-care iloss, ianorexia, iand ismall ibowel ibiopsy
icetners imalabsorption
Stool iexam iis ipositive ifor
itrophozoites iin iabout
i50% iof icases
H. iPylori iInfection Risk: iincreases iwith Subjective: iburning ior Objective: iPE iis inot iuseful Tests: 1st iline: iPPI i+ iclarithromycin i+
iage i>60, ignawing i(hunger) Fecal iantigen iassay iamoxicillin i(or imetroniadozle iif
isensation ior ipain iin iUrea i breath i test ipenicillin iallergy) itwice ia iday ifor
ithe iepigastrium iBiopsy iwith ihistological i14 idays
iexamination
iSerological iantibody 2nd iline: iPPI i+ ibismuth
isubsalicylate i+ itetracycline i+
metronidazole
Irritable ibowel isyndrome Risk: iwomen iare Subjective: Objective: iPE iis iusually Tests: inone, idiagnosed 1st iline: ielimination iof icertain
iaffected imore ithan iabdominal ipain iand inormal, imay ihave ibased ioff iof ihistory ifoods ifrom idiet i(caffeine, ilegumes,
men; ilate iadolescents altered ibowel ihabits tenderness iin iLLQ iand artificial isweeteners); iincrease
Disease Risk Subjective iFinding Objective iFindings Diagnostics Treatment
GI DISORDERS
i
Appendicitis Risk: iage i10-30; imen Subjective: iacute Objective: ilooks iill; idiffuse Tests: iCBC i- imild ito 1st iline: iIV iantibiotics, icorrecting
itwice ias ilikely ias ionset iof imild ito itenderness iwith ipalpation imoderate ileukocytosis; ifluid iand ielectrolyte iimbalances,
iwomen; idiet ilow iin isevere icolicky, iof iabdomen i– itenderness iurinalysis i– imicroscopic ibedrest, iNPO, iNG itube iif iindicated
ifiber, ihigh iin ifat iand iepigastric, ior iover iRLQ ihematuria ior ipyuria; ix-
ihigh iin irefined isugars iperiumbilical ipain; iray i– ifecalith, igas-filled 2nd iline: isurgery
iand iother icarbs inausea/vomiting; iappendix, ismall ibowel
ifever iileus, ideviation iin ibowel
igas ipattern, ior iloss iof
iright iiliopsoas ishadow;
US i– ito ivisualize
iinflamed iappendix
Celiac idisease Risk: ifamily ihistory, Subjective: imost iare Objective: iexam imay ibe Tests: iserological itesting 1st iline: istrict igluten-free idiet
iDown’s isyndrome, iasymptomatic; imay inormal; isigns iof ifor ianti-tTG iIgA
iHLA-DQ2 ior iHLA-DQ8, icomplain iof idiarrhea, imalabsorption isuch ias iantibodies; itotal iIgA; 2nd iline: iimmunomodulating
Turner’s isyndrome, ior iweight iloss, imuscle iwasting, ipallor inutritional ideficiencies i– iagents
iother igenetic ibased idyspepsia, iand i(anemia), ireduced ihemoglobin, iiron, ifolate,
iautoimmune idisease iflatulence isubcutaneous ifat, iataxia, ivitamin iB12, icalcium,
isuch ias iType i1 iDM iand iand iperipheral iand ivitamin iD
ithyroiditis ineuropathy i(Vitamin iB12
ideficiency)
Cholelithiasis i- igallstones Risk: i> i25 iy/o; imost Subjective: isymptoms Objective: iif ipain iis isevere Tests: igold istandard iis 1st iline ifor iasymptomatic ipatients:
iprevalent iin iAmerican ivary, igeneralized iGI ipatient imay ihave iabdominal iultrasound iavoid ifoods ihigh iin ifat
iIndian iwomen; icomplaints ito iinvoluntary iguarding iover
iintractable ipain; ithe iRUQ; ipositive During iacute iphase i– 2nd iline:
Cholesterol istones: iindigestion, inausea, iMurphy’s isign iw/ imild iWBC ielevation ito Treatment iof ichoice ifor iacute
ifemale, iobesity, iand ivomiting i– ipalpation iover ithe iRUQ; i15,000/mL; iserum icholecystitis:
pregnancy, iincreased especially iafter ia low igrade ifever; imay ihave transaminases ielevated
, NR511 iMidterm iStudy iGuide iWorksheet
age, idrug-induced meal ihigh iin ifat; ias diminished ibowel isounds 4x inormal; iaspartate hospitalization ifor irehydration iw/
i(oral icontraceptives, ithe iinflammation iaminotransferase iand iIV ifluids, iantibiotics, ianalgesics, iGI
iclofibrates), icystic iprogresses, ithe ipain ialanine irest, iNG iplacement ifor ipersistent
nd
ifibrosis, irapid iweight ilocalizes iover ithe iaminotransferaseican ibe iemesis; i2 ior i2rd igeneration
iloss, ispinal icord iinjury, iRUQ ior iepigastrum; ielevated ito i300 iU/L; icephalosporin iis istarted
iileal idisease iwith ipain imay irefer ito ialkaline iphosphatase iis
iextensive iresection, imiddle iof iback, ielevated ito i2-4x inormal Once istable ithe ipatient iwill
iDM, isickle icell ianemia iinfrascapular iarea, ior ilevels; ibilirubin ias ihigh iundergo isurgery ifor ia
iR ishoulder ias i4 img/dL icholecystectomy
Pigmented istones:
ihemolytic idiseases, If iconsidered ia ipoor isurgical irisk
iincreasing iage, ipatients ican ibe itreated iw/ ioral
ihyperalimentation, iingestion iof iursodeoxycholic
icirrhosis, ibiliary istasis, i(ursodoil) ior idirect idissoluction iby
ichronic ibiliary ipercutaneous iinstillation iof
iinfections imethyl-tertiary-butyl iether;
ilithotriopsy
Six iF’s: ifat, ifemale,
iforty, iflatulent, ifertile,
iand ifat-intolerant
Crohn’s idisease Risk: igenetic Subjective: iabd Objective: Tests: icolonoscopy i- 1st iline: inutrition icounseling i–
ipredispositio icramping iand 1. Inflammation, iRLQ ireveals iulcers ithat iare iavoid icaffeine, iraw ifruits,
n itenderness, ifever, ipain, iand itendnerness ieither iminor ierosions ior ivegetables, iseeds, iand inuts, iand
ianorexia, iweight iloss, – ipresenting ilike ideep ilongitudinal ifoods ihigh iin ifiber i(whole igrain
ispasm, iflatulence iand iappendicitis ifissures, icobblestone ibread iand icereal); ibland idiet ithat
iRLQ ipain ior imass; 2. Obstruction, ifibrosis, iappearance iis ihigh iin icalories iand iprotein iyet
iincrease iin isymptoms iand istenotic ichanges ilow iin ifat
iduring istress ior iwithin ithe ibowel 1st iline imedication: ioral
iemotional iupset ior icausing iobstruction iprednisone
iafter imeals iconsisting iassociated iw/ isevere
of ifatty, ispicy ifoods, colic, iabdominal 2nd iline: imesalamine i(Asacol) iand
, NR511 iMidterm iStudy iGuide iWorksheet
or imilk; istools iare distension, sulfasalazine i(Azulfidine)
isoft ior isemi-liquid; iconstipation iand
iblood iin istools; ivomiting
isteatorrhea; iperiods 3. Diffuse ijejunoileitis
iof iacute iexacerbation iinvolving ithe ijejunum
ialternating iwith iand iileum iand
icomplete iremission icharacterized iby iboth
iinflammation iand
iobstruction
4. Abdominal ifistulas
iand iabscesses icausing
ifever, igeneralized
iwasting, iand
abdominal imasses
Diverticulitis Risk: ilow-fiber iand Subjective: iLLQ ipain; Objective: itenderness iin Tests: iabdominal ix-rays i– 1st iline: ihigh ifiber idiet ior idaily ifiber
ihigh ifat idiet; ichronic ipain imay ibe iworse ithe iLLQ; ifirm-fixed imass ireveal ifree iair, iileus, ior isupplementation iwith ipsyllium
iconstipation iand iafter ieating, ipain iis imay ibe iidentified iin ithe iobstruction; ia ibarium iMild isymptoms: irest iclear iliquid
istraining; iirregular isometimes irelived iarea iof ithe idiverticula; ienema i– ioutlines ithe idiet
ibowel icontractions; iwith iBM ior ipassing ihypoactive ibowel isounds ilumen iof ithe ibowel
iweakness iof ibowel iflatus; ialternating iinitially, ibut ihyperactive iif iclearly idefining 2nd iline: ihospitalization ifor iIV
imuscle ibrought ion iby ibowel ipatterns ian iobstructive iprocess ihas idiverticula iantibiotics iand ihydration,
iaging ibetween iconstipation ideveloped ianalgesia, ibowel irest, iand ipossible
iand idiarrhea iNG itube
GERD Risk: ioverweight, iBMI Subjective: imild ito Objective: iexam iin Tests: 1st iline ifor imild isymptoms: ilifestyle
iover i25; iincreases iw/ isevere iheartburn, inormal; ipossible istool Diagnosis iis imade iby imodifications i– iweight iloss,
iage ithen idecreases iregurgitation, iwater ipositive ifor ioccult iblood ihistory ialone ielevating iHOB ito i6-8 iinches, iavoid
iafter ithe iage iof i69; ibrash, idysphagia, idue ito imicrohemorrhages ieating imeals i2-3 ihours ibefore
iingestion iof isour itaste iin ithe iin ithe iirritated iesophageal If iunclear idiagnosis: iEGD ibedtime, iavoid icertain ifoods isuch
ifoods/pharmacologica imouth iin ithe iepithelium ias ichocolate, ialcohol, icaffeine,
l morning, ibelching, acidic ior ispicy ifoods; ismoking
agents ithat ilower ithe
, NR511 iMidterm iStudy iGuide iWorksheet
lower iesophageal coughing, cessation
isphincter ipressure ihoarseness, ichest
ipain 2nd iline ifor imild ito imoderate
isymptoms: i4-8 iweek icourse iof iPPI
ionce idaily i30 iminutes ibefore
ibreakfast
-Omeprazole, iLansoprazole,
iPantoprazole
Giardia ilamblia i– ia Risk: ihypogamma- Subjective: irange Objective: iexamination iof Tests: 1st iline:
iprotozoan ithat iattaches ito iglobulinemia ifrom inonspecific istool iimmunofluorescent quinacrine ihydrochloride
ithe imucosa iof ithe ismall icomplaints iof iantibody itests iand i(Atabrine) i100 img ithree itimes
ibowel Transmitted ivia ioral- ibloating, iflatulence, idiagnostic ienzyme-linked idaily iafter imeals ifor i5-7 idays
ianal iintercourse iand iis inausea, iand iwatery iimmunsorbent iassay iOR
ia icommon icause iof inoninflammatory i(ELISA) itests metronidazole i(Flagyl) i250 img
itraveler’s idiarrhea iand idiarrhea ito ichronic ithree itimes idaily ifor i5-7 idays
idiarrhea iin ichildren idiarrhea iwith iweight Duodenaliaspirate ior
iwho iattend iday-care iloss, ianorexia, iand ismall ibowel ibiopsy
icetners imalabsorption
Stool iexam iis ipositive ifor
itrophozoites iin iabout
i50% iof icases
H. iPylori iInfection Risk: iincreases iwith Subjective: iburning ior Objective: iPE iis inot iuseful Tests: 1st iline: iPPI i+ iclarithromycin i+
iage i>60, ignawing i(hunger) Fecal iantigen iassay iamoxicillin i(or imetroniadozle iif
isensation ior ipain iin iUrea i breath i test ipenicillin iallergy) itwice ia iday ifor
ithe iepigastrium iBiopsy iwith ihistological i14 idays
iexamination
iSerological iantibody 2nd iline: iPPI i+ ibismuth
isubsalicylate i+ itetracycline i+
metronidazole
Irritable ibowel isyndrome Risk: iwomen iare Subjective: Objective: iPE iis iusually Tests: inone, idiagnosed 1st iline: ielimination iof icertain
iaffected imore ithan iabdominal ipain iand inormal, imay ihave ibased ioff iof ihistory ifoods ifrom idiet i(caffeine, ilegumes,
men; ilate iadolescents altered ibowel ihabits tenderness iin iLLQ iand artificial isweeteners); iincrease
