question

the lining of the digestive tract from the esophagus through the large intestine is lined with cells that contain?

answer

neuropeptides and their receptors these substances, produced by nerve cells, are a key to the mind-body connection that contributes to the physical manifestation of emotions

question

more than two thirds of all immune activity occurs in the?

answer

gut

question

there are more T cells where than in all other body tissues combined?

answer

intestinal epithelium

question

what type of T cells form the forefront of the immune defense mechanism?

answer

gamma delta T cells they act as an early warning system in the cells lining the intestines, which are heavily exposed to microorganisms and toxins

question

GI disorders can refer pain to the?

answer

- sternal region - shoulder and neck - scapular region - mid-back - lower back - hip - pelvis - sacrum

question

the most common intraabdominal diseases that refer pain to the musculoskeletal system are those that involve?

answer

ulceration or infection of the mucosal lining

question

drug-induced GI symptoms can occur with delayed reactions as much as how many weeks after exposure to the medication?

answer

6 or 8 weeks

question

what are the most common drug-induced GI symptoms?

answer

- antibiotic colitis - nausea, vomiting, and anorexia from digitalis toxicity - NSAID-induced ulcers

question

any disruption of the digestive system can create symptoms such as?

answer

nausea, vomiting, pain, diarrhea, and constipation

question

GI effects of chemotherapy include?

answer

nausea and vomiting, anorexia, taste alteration, weight loss, oral mucositis, diarrhea, and constipation

question

the small intestine (viscera) is innervated by what sympathetic nerve distribution?

answer

T9 - T11

question

the small intestine (viscera) refers (somatic) pain to what anatomic location?

answer

L3 - L4 (anatomic) lumbar spine

question

GI visceral pain (internal organs) occurs in what anatomic location?

answer

midline because the digestive organs arise embryologically in the midline and receive sensory afferents from both sides of the spinal cord. the site of pain generally corresponds to dermatomes from which the visceral organs receive their innervation

question

GI visceral pain is not well localized because innervation of the viscera is multisegmental over up to how many segments of the spinal cord with fewer nerve endings than other sensitive organs?

answer

eight segments

question

reasons for abdominal pain fall into what three broad categories?

answer

- inflammation - organ distention (tension pain) - necrosis (ischemic pain)

question

pain in the epigastric region occurs anywhere from the midsternum to the xiphoid process from the heart, esophagus, stomach, duodenum, gallbladder, liver, and other mediastinal organs corresponding to what sympathetic nerve distribution?

answer

T3 - T5 the client may report the pain radiates around the ribs or straight through the chest to the thoracic spine at the T3 to T6 or T7 anatomic levels

question

pain in the periumbilical region occurs anywhere from the pancreas, small intestine, appendix, or proximal colon and corresponds to what sympathetic nerve distribution?

answer

T9 - T11 primary pain in the periumbilical region usually sends the client to a physician

question

pain around the umbilicus may be accompanied by pain in what anatomic location?

answer

low back

question

the umbilicus is level with the disk located anatomically between what vertebral bodies?

answer

L3 and L4

question

pain in the lower abdominal region (hypogastrium) from the large intestine and/or colon may be mistaken for bladder or uterine pain (and vice versa) by its suprapubic location. referred pain at the same anatomic level posteriorly corresponds to the sacrum. the large intestine and colon are innervated by what sympathetic nerve distribution?

answer

T10 - T12, depending on the location (e.g., ascending, transverse, descending colon)

question

visceral pain fibers are sensitive only to?

answer

stretching or tension in the wall of the gut from neoplasm, distention, or forceful muscular contractions secondary to bowel obstruction or spasm

question

what type of pain can occur as a result of bowel obstruction; constipation; and pus, fluid, or blood accumulation from infection or other causes?

answer

tension pain

question

rapid, peristalsis forces of the bowel trying to eliminate irritating substances can cause tension pain described as?

answer

"colicky" pain

question

individuals with what type of pain have trouble finding a comfortable position?

answer

tension pain

question

visceral organs of the GI tract (particularly hollow organs such as the intestines) respond to what as pain?

answer

stretching and distention, more so than typical tissue injury caused by cutting or crushing

question

one difference between visceral organ pain and pain from the parietal peritoneum is?

answer

parietal peritoneum is innervated by nerves that travel with the somatic nerves, providing a more precise location of pain

question

acute appendicitis, when early, vague pain is replaced by more localized pain at what location once the inflammation involves the parietal peritoneum?

answer

McBurney's point

question

inflammatory pain arising from the visceral or parietal peritoneum (e.g., acute appendicitis) is described as?

answer

steady, deep, and boring it can be poorly localized as when the visceral peritoneum is involved or more localized with parietal peritoneum involvement

question

individuals with what type of pain seek a quiet position (often with the knees bent or in a curled up/fetal position) without movement?

answer

inflammatory pain

question

ischemia (deficiency of blood) may produce visceral pain by increasing the concentration of what in the region of the sensory nerve?

answer

tissue metabolites

question

pain associated with ischemia is described as?

answer

steady pain, whether this ischemia is secondary to vascular disease or due to obstruction causing strangulation of bowel tissue

question

visceral pain produced by what is sudden in onset and extremely intense?

answer

ischemia. it progress in severity and is not relieved by analgesics

question

visceral pain produced by what is not relieved by analgesics?

answer

ischemia

question

it is possible to have extensive disease without pain until the disease progresses enough to involve the?

answer

parietal peritoneum

question

visceral pain is usually described as?

answer

deep aching, boring, gnawing, vague burning, or deep grinding as opposed to the sharp, pricking, and knifelike qualities of cutaneous pain

question

referred GI pain sites lie within the dermatomes of?

answer

the dorsal nerve roots serving the painful viscera

question

referred pain or visceral pain is often more intense and localized?

answer

referred pain

question

afferent nerve impulses transmit pain from the esophagus to the spinal cord by what sympathetic nerves?

answer

T5 - T10

question

integration of the autonomic and somatic systems occurs through what nerves?

answer

vagus and phrenic nerves

question

there can be referred pain from the esophagus to what anatomic location?

answer

mid-back and vice versa

question

visceral afferent nerves from the liver, respiratory diaphragm, and pericardium are derived from what sympathetic nerves?

answer

C3 to C5

question

visceral afferent nerves from the liver, respiratory diaphragm, and pericardium are derived from C3 to C5 sympathetics and reach the CNS via what nerve?

answer

phrenic nerve the visceral pain associated with these structures is referred to the corresponding somatic area (i.e., the shoulder)

question

afferent nerves from the gallbladder, stomach, pancreas, and small intestine travel through the celiac plexus and the greater splanchnic nerves and enter the spinal cord from what spinal segments?

answer

T6 to T9 referred visceral pain from the visceral structures may be perceived in the mid-back and scapular regions

question

afferent stimuli from the colon, appendix, and pelvic viscera enter the 10th and 11th thoracic segments through what plexus and what nerves?

answer

mesenteric plexus and lesser splanchnic nerves

question

the sigmoid colon, rectum, ureters, and testes are innervated by fibers that reach T11 to L1 segments through what nerves?

answer

lower splanchnic nerve and pelvic splanchnic nerves from S2 to S4 referred pain may be perceived in the pelvis, flank, low back, or sacrum

question

any structure touching the respiratory diaphragm can refer pain to?

answer

ipsilateral shoulder

question

what is the sensation of food catching or sticking in the esophagus?

answer

dysphagia (difficulty swallowing)

question

a process by which the circular and longitudinal muscular fibers of the lower esophageal sphincter fail to relax, producing an esophageal obstruction is called?

answer

achalasia

question

achalasia may cause?

answer

dysphagia

question

what are possible GI causes of dysphagia?

answer

- achalasia - peptic esophagitis (inflammation of the esophagus) with stricture (narrowing) - gastroesophageal reflux disease (GERD) - neoplasm

question

what drugs can make swallowing difficult?

answer

- antidepressants - anti-HTN - asthma drugs

question

odynophagia (pain during swallowing), can be caused by?

answer

esophagitis or esophageal spasm esophagitis may occur to GERD, herpes simplex virus, or fungus caused by the prolonged use of strong antibiotics

question

pain after eating may occur with esophagitis or may be associated with?

answer

coronary ischemia

question

how is esophagitis differentiated from coronary ischemia?

answer

upright positioning relieves esophagitis pain, whereas cardiac pain is relieved by nitroglycerin or by supine positioning

question

upright positioning relieves esophagitis pain or cardiac pain (i.e., coronary ischemia)?

answer

esophagitis pain

question

supine positioning or nitroglycerin relieves esophagitis pain or cardiac pain (i.e., coronary ischemia)?

answer

cardiac pain

question

what type of GI bleeding can appear as mid-thoracic back pain with radiation to the right upper quadrant?

answer

occult (hidden) GI bleeding

question

what tests are needed to detect occult GI bleeding?

answer

serial Hemoccult tests and laboratory tests (checking for anemia and iron deficiency)

question

coffee ground emesis (vomit) may indicate?

answer

perforated peptic or duodenal ulcer

question

what type of GI bleeding may accompany other signs of ulcerative colitis?

answer

bloody diarrhea

question

what color of blood usually represents pathology close to the rectum or anus and may be an indication of rectal fissures (e.g., history of anal intercourse) or hemorrhoids but can also occur as a result of colorectal cancer?

answer

bright red blood

question

what color of stool occurs as a result of large quantities of blood in the stool?

answer

melena, or black, tarry stool black color arises as the digestive acids in the bowel oxidize red blood cells

question

what color of stool has an unusual, noxious odor?

answer

melena, or black, tarry stool odor is caused by the presence of blood

question

what type of stool is very sticky and does not clean well?

answer

melena, or black, tarry stool

question

esophageal varices are dilated blood vessels, usually secondary to?

answer

alcoholic cirrhosis of the liver ruptured esophageal varices are an emergent, life-threatening condition

question

vascular abnormalities of the stomach causing bleeding may include?

answer

ulcers

question

melenic stool is from what part of the GI tract?

answer

upper GI tract; ask about a history of NSAID use

question

bright red stool is from what part of the GI tract?

answer

lower GI tract (distal colon or rectum) large intestine is called the colon

question

what colored stool can occur from eating certain foods, such as beets, or significant amounts of red food coloring but can also represent bleeding in the lower GI/colon?

answer

reddish or mahogany-colored stools

question

medications that contain what can cause darkened or black stools and the client's tongue may also appear black?

answer

bismuth (e.g., kaopectate, pepto-bismol, bismatrol, pink bismuth)

question

clients who have received pelvic radiation for gynecologic, rectal, or prostate cancers have an increased risk for?

answer

radiation proctitis

question

epigastric pain perceived as intense or sharp pain behind the breastbone with radiation to the back may occur secondary to?

answer

long-standing ulcers

question

anyone with epigastric pain accompanied by a burning sensation that begins at the xiphoid process and radiates up toward the neck and throat may be experiencing?

answer

heartburn heartburn is often associated with GERD

question

bitter or sour taste in the back of the throat, abdominal bloating, gas, and general abdominal discomfort are common symptoms of?

answer

heartburn

question

pain associated with what type of ulcer may begin within 30 to 90 minutes after eating?

answer

gastric ulcer (located more proximally in the GI tract)

question

pain associated with what type of ulcer may occur 2 to 4 hours after meals (i.e., between meals)?

answer

duodenal or pyloric ulcer (located distally beyond the stomach)

question

food is likely to relieve the pain of what type of ulcer?

answer

duodenal ulcer food is NOT likely to relieve the pain of a gastric ulcer

question

what type of ulcer is located more proximally in the GI tract?

answer

gastric ulcer

question

what type of ulcer is located distally beyond the stomach?

answer

duodenal or pyloric ulcer

question

the client with what type of ulcer or cancer-related pain may report pain during the night between midnight and 3:00 AM?

answer

duodenal ulcer

question

ulcer pain may be differentiated from the nocturnal pain associated with cancer by its?

answer

intensity (7 or higher on a scale from 0 to 10) and duration (constant)

question

ulcer pain is described as?

answer

gnawing pain pain associated with duodenal ulcer may be relieved by eating

question

pain associated with cancer is described as?

answer

intense, boring pain pain associated with cancer is not relieved by any measures

question

what occurs when the client feels hungry, takes one or two bites of food, and feels full?

answer

early satiety this can be a symptom of obstruction, stomach cancer, gastroparesis (slowing down of stomach emptying), peptic ulcer disease, and other tumors. vertebral compression fractures can occur from a variety of disorders including osteoporosis and can result in severe spinal deformity. this deformity, along with severe back pain, can cause early satiety resulting in malnutrition

question

what is defined clinically as being a condition of prolonged retention of fecal content in the GI tract resulting from decreased motility of the colon or difficulty in expelling stool?

answer

constipation

question

constipated clients with trigger points in what muscle may report anterior hip, groin, or thigh pain when the fecal bolus presses against the TrPs?

answer

psoas

question

intractable constipation is called?

answer

obstipation

question

what condition can result in a fecal impaction that must be removed?

answer

obstipation back pain may be the overriding symptom of obstipation

question

the individual who has low back pain with constipation could also be manifesting symptoms of?

answer

pelvic floor muscle overactivity or spasm

question

diets that are high in refined sugars and low in fiber discourage what activity?

answer

bowel activity

question

transit time of the alimentary bolus from the mouth to the anus is influenced main by?

answer

dietary fiber transit time is decreased with increased fiber intake

question

constipation associated with severe depression can be improved by?

answer

exercise

question

pressure on sacral nerves from stored fecal content may cause what kind of discomfort in the sacrum, buttocks, or thighs?

answer

aching discomfort

question

true or false: it is NOT considered a red flag symptom when clients with unexplained constipation have sudden and unaccountable changes in bowel habits or blood in the stools

answer

false; it is considered a red flag symptom

question

what condition is an abnormal increase in stool frequency and liquidity?

answer

diarrhea this may be accompanied by urgency, perianal discomfort, and fecal incontinence

question

acute or chronic diarrhea can accompany invasive enteric infection?

answer

acute diarrhea especially when associated with fever, cramps, and blood or pus in the stool

question

acute or chronic diarrhea associated with weight loss is more likely to indicate neoplastic or inflammatory bowel disease?

answer

chronic diarrhea

question

extraintestinal manifestations such as arthritis or skin or eye lesions are often present in what condition?

answer

inflammatory bowel disease

question

drug-induced diarrhea is associated most commonly with?

answer

antibiotics symptoms may develop 6 to 8 weeks after first ingestion of an antibiotic

question

a more serious, less frequent antibiotic-induced colitis with severe diarrhea is caused by?

answer

clostridium difficile

question

what clients are at higher risk for acquisition of C. difficile and associated severe diarrhea?

answer

clients receiving enteral (tube) feedings

question

what is the major cause of diarrhea in patients hospitalized for more than 3 days?

answer

C. difficile it is spread in an oral-fecal manner and is readily transmitted from patient to patient by hospital personnel

question

athletes using what supplement may experience minor GI symptoms?

answer

creatine the use of creatine for individuals under the age of 18 is not recommended

question

laxative abuse contributes to the production of diarrhea and begins a vicious cycle as chronic laxative users experience excessive secretion of?

answer

aldosterone and resultant edema when they attempt to stop using laxatives

question

what condition may be described as an inability to control evacuation of stool and is associated with a sense of urgency, diarrhea, and abdominal cramping?

answer

fecal incontinence causes include partial obstruction of the rectum (cancer), colitis, and radiation therapy, especially in the case of women treated for cervical or uterine cancer. radiation may cause trauma to the rectum that results in incontinence and diarrhea

question

inflammatory bowel disease (ulcerative colitis and Crohn's disease) is often accompanied by?

answer

rheumatic manifestations peripheral joint arthritis and spondylitis with sacroiliitis are the most common of these manifestations

question

sacroiliac (SI) disease without inflammation has been documented as a primary cause of?

answer

lower abdominal or inguinal pain

question

joint arthralgia associated with GI infection is usually asymmetric, migratory, and oligoarticular (affecting only one or two joints). this type of joint involvement is termed?

answer

reactive arthritis

question

what type of joint involvement is triggered by microbial infection such as C. difficile from the GI tract?

answer

reactive arthritis

question

what condition may present as low back pain and morning stiffness that improves with activity and restriction of chest and spinal movement?

answer

spondylitis with sacroiliitis

question

"bamboo" spine results from what condition?

answer

spondylitis with sacroiliitis

question

inflammation involving the sites of bony insertion of tendons and ligaments is termed as?

answer

enthesitis

question

enthesitis is a classic sign of what condition?

answer

reactive arthritis

question

left shoulder pain with pressure placed on the upper abdomen is what sign?

answer

Kehr's sign

question

shoulder pain with inspiration is what sign?

answer

Danforth sign

question

perforated duodenal or gastric ulcers can leak gastric juices on the posterior wall of the stomach that irritate the diaphragm referring pain to the shoulder; although the stomach is on the left side of the body, the referral pattern is to what shoulder?

answer

right shoulder

question

when the head of the pancreas is involved, the client could have left or right shoulder pain?

answer

right shoulder pain but more often it manifests as mid-back or mid-thoracic pain sometimes lateralized from the spine on either side

question

when the tail of the pancreas is diseased, pain can be referred to the left or right shoulder?

answer

left shoulder

question

accumulation of blood from a slow bleed of the spleen, liver, or stomach can produce pain in the left or right shoulder?

answer

bilateral shoulder pain

question

abscess of what muscles is a possible cause of lower abdominal pain?

answer

obturator or psoas the abscess is usually confined to the psoas fascia but can spread to the hip, upper thigh, or buttock

question

what is the most common cause of psoas abscess secondary to vertebral osteomyelitis?

answer

staphylococcus aureus (staph infection) peritonitis as a result of any infectious or inflammatory process can result in psoas abscess

question

what side is affected most often when psoas or iliacus abscess is associated with appendicitis?

answer

right side

question

what syndrome may be mistaken for appendicitis?

answer

psoas minor syndrome; be sure to assess for TrPs

question

what tests are performed when acute abdominal pain is a possible cause of hip or thigh pain?

answer

iliopsoas muscle test, obturator muscle test

question

when an abscess forms on the iliopsoas muscle from an inflamed or perforated appendix or inflamed peritoneum, the iliopsoas muscle test causes pain felt in what quadrant?

answer

right lower abdominal quadrant

question

a perforated appendix or inflamed peritoneum can irritate the obturator muscle, producing pain in what quadrant during the obturator test?

answer

right lower quadrant abdominal pain

question

although uncommon, psoas abscess still can be confused with what condition?

answer

hernia

question

how is psoas abscess differentiated from a hernia?

answer

psoas abscess is often softer than a femoral hernia and has ill-defined borders, in contrast to the more sharply defined margins of the hernia

question

what is the major differentiating feature of psoas abscess vs. hernia?

answer

psoas abscess lies lateral to the femoral artery, whereas the femoral hernia is located medial to the femoral artery

question

psoas abscess is located medial or lateral to the femoral artery?

answer

lateral

question

hernia is located lateral or medial to the femoral artery?

answer

medial

question

- fever - night sweats - lower abdominal, pelvic, or back pain - referred pain to the hip, medial thigh or groin (femoral triangle area), or knee - antalgic gait (secondary to reflex spasm) - loss of appetite or other GI upset - palpable, tender mass clinical manifestations of what condition?

answer

psoas or iliacus abscess

question

what are screening tests for psoas abscess (4)?

answer

- heel tap - hop test - iliopsoas muscle test - palpate iliopsoas muscle

question

reproducing or causing lower quadrant, pelvic, or abdominal pain is considered a positive sign for what condition?

answer

iliopsoas abscess

question

"hectic" up and down fever pattern is a clinical manifestation of what condition?

answer

psoas abscess

question

numbness and weakness of the lower extremities have been reported as a result of what deficiencies?

answer

vitamin B12 deficiency (aging adult) or thiamine deficiency (after gastric bypass)

question

symmetric paresthesias and ataxia associated with loss of vibration and position sense in the lower extremities may occur with what deficiency?

answer

vitamin B12 deficiency

question

thiamine deficiency after gastric bypass may present how long after the procedure?

answer

as early as 2 months or as late as 10 years

question

what condition is an array of problems related to the backward movement of stomach acids and other stomach contents, such as pepsin and bile, into the esophagus, a phenomenon called acid reflux?

answer

gastroesophageal reflux disease (GERD)

question

backward movement of stomach acids and other stomach contents, such as pepsin and bile, into the esophagus, is a phenomenon called?

answer

acid reflux

question

what condition is usually caused by intermittent relaxation of the lower esophageal sphincter (LES)?

answer

GERD

question

- heartburn - chest pain - dysphagia - sense of a lump in the throat clinical manifestations of what condition?

answer

GERD symptoms are sometimes mistaken for a heart attack

question

heartburn, regurgitation with bitter taste in mouth, and belching are typical symptoms of what condition?

answer

GERD

question

sensation of a lump in the throat is an atypical symptom of what condition?

answer

GERD

question

Barrett's esophagus (precancerous condition) can be a serious consequence of what condition?

answer

GERD

question

most adults with asthma also have what condition?

answer

GERD

question

frequent, forceful spitting up or vomiting, accompanied by irritability is an alarm symptom for what condition in infants?

answer

GERD

question

what clients are at increased risk for reflux with aspiration?

answer

neurologically impaired children and adults

question

chronic GERD is a major risk factor for?

answer

adenocarcinoma, an increasingly common cancer in white males in the US

question

drug treatment for what condition includes antacids, H2-receptor blockers, and proton pump inhibitors (PPIs)?

answer

GERD

question

what condition is a loss of tissue lining the lower esophagus, stomach, and duodenum?

answer

peptic ulcer (gastric and duodenal ulcers)

question

peptic ulcer: acute lesions that do not extend through the mucosa are called?

answer

erosions

question

many of the gastric and duodenal ulcers are caused by infection with what bacterium?

answer

Helicobacter pylori; a corkscrew-shaped bacterium that bores through the layer of mucus that protects the stomach cavity from stomach acid

question

ten percent of ulcers are induced by chronic use of what drugs?

answer

NSAIDs

question

H. pylori ulcers are primarily located in the lining of the?

answer

duodenum (upper portion of the small intestine that connects to the stomach)

question

NSAID-induced ulcers occur primarily in the lining of the?

answer

stomach, most frequently on the posterior wall, which can account for right shoulder pain or back pain as an associated symptom

question

the cardinal symptom of what condition is epigastric pain that may be described as "heartburn" or as burning, gnawing, cramping, or aching located over a small area near the midline in the epigastrium near the xiphoid?

answer

peptic ulcer

question

what type of ulcers are found along the distribution of the eighth thoracic nerve which causes pain in the upper epigastrium about one to two inches to the right of a spot halfway between the xiphoid and the umbilicus?

answer

gastric ulcers

question

what type of ulcer pain tends to present more in the right epigastrium, specifically a localized spot one to two inches above and to the right of the umbilicus because of its innervation by the tenth thoracic nerve?

answer

duodenal ulcers

question

pain with what type of ulcer is prominent when the stomach is empty such as between meals and in the early morning?

answer

duodenal uclers the pain may last from minutes to hours and may be relieved by antacids

question

what type of ulcers are more likely to cause pain associated with the presence of food?

answer

gastric ulcers symptoms often appear for 3 or 4 days or weeks and then subside; reappearing weeks or months later

question

steady pain near the midline of the back between T6 and T10 with radiation to the right upper quadrant may indicate perforation of the posterior duodenal wall in what type of ulcer?

answer

duodenal ulcers

question

ulcer symptoms associated with what bacterium include halitosis (bad breath) and a form of facial acne called rosacea?

answer

H. pylori

question

the most obvious clinical effect of NSAIDs is on what part of the GI tract?

answer

gastroduodenal mucosa

question

what NSAIDs are gastroprotective?

answer

COX-2 inhibitors (group of enzymes that facilitate the production of prostaglandins)

question

infection with what bacteria increases the risk of ulcer disease threefold or more in people taking standard NSAIDs or low-dose aspirin?

answer

H. pylori

question

low-dose aspirin is defined as?

answer

325 mg taken every other day or one "baby aspirin" containing 81 mg used for cardioprotection by people with or at risk for heart disease

question

for those who are symptomatic, the most common side effects of NSAIDs are?

answer

stomach upset and pain, possibly leading to ulceration

question

NSAIDs are potent renal vasoconstrictors, so look for?

answer

increased BP and ankle/foot edema

question

the manufacturer's highest recommended NSAID dose on the package insert is given a value of?

answer

1.00

question

what is a benign condition in which the mucosa (lining) of the colon balloons out through weakened areas in the wall?

answer

diverticulosis typically asymptomatic; the diverticula are diagnosed when screening for colon cancer or other problems

question

what condition describes the infection and inflammation that accompany a microperforation of one of the diverticula?

answer

diverticulitis

question

the most common cause of major lower intestinal tract bleeding is?

answer

diverticulosis

question

perforation and subsequent infection causes symptoms of what quadrant in diverticulitis?

answer

left lower abdominal or pelvic pain and tenderness

question

the diagnosis of what condition is confirmed by accompanying fever, bloody stools, elevated white blood cell count, and imaging studies?

answer

diverticulitis

question

left lower abdominal/pelvic (cramping) pain and tenderness; possible positive pinch-an-inch test clinical manifestation of what condition?

answer

diverticulitis

question

what condition is an inflammation of the vermiform appendix that occurs most commonly in adolescents and young adults?

answer

appendicitis

question

right lower lobe pneumonia sometimes is associated with prominent pain in what quadrant?

answer

right lower quadrant

question

pain preceding nausea and vomiting and low-grade fever in adults are the classic symptoms of what condition?

answer

appendicitis children tend to have higher fevers

question

coated tongue and bad breath are symptoms of what condition?

answer

appendicitis

question

pain may be referred to the thigh or right testicle in what condition?

answer

retrocecal appendicitis groin and/or testicular pain may be the only symptoms of appendicitis, especially in young, healthy, male athletes

question

the pain usually begins in the umbilical region and eventually localizes in the right lower quadrant of the abdomen over the site of the organ in what condition?

answer

appendicitis

question

what condition can result in a "boardlike" abdomen due to the spasm of the rectus abdominis muscles?

answer

generalized peritonitis, whether caused by appendicitis or some other abdominal or pelvic inflammatory condition

question

parietal pain caused by inflammation of the peritoneum in acute appendicitis or peritonitis (from appendicitis or other inflammatory/infectious causes) may be located at what anatomic landmark?

answer

McBurney's point

question

the vermiform appendix receives its sympathetic supply from what spinal segment?

answer

T11 in some people, a branch of the 11th thoracic nerve pierces the rectus abdominis muscle and innervates the skin over McBurney's point. this may explain the hyperalgesia seen at this point in appendicitis

question

the vermiform appendix and colon can refer pain to the area of sensory distribution for what spinal nerve?

answer

T11

question

where is McBurney's point located?

answer

halfway between the ASIS and the umbilicus, usually on the right side

question

how does the position used to locate iliopsoas muscle differ from the position used to palpate McBurney's point?

answer

the position used to locate the iliopsoas muscle is the client in a supine position, with hips and knees flexed in a 90-degree position, whereas McBurney's point is palpated with the client in the fully supine position

question

where is the palpation point for the iliopsoas muscle?

answer

one-third the distance between the ASIS and the umbilicus

question

since the appendix develops during the descent of the colon, its final position can be posterior to the cecum or colon. these positions of the appendix are called?

answer

retrocecal or retrocolic the appendix is retrocecal or retrocolic in about 50% of cases

question

both McBurney's point and the iliopsoas muscle are palpated for reproduction of symptoms to rule out?

answer

appendicitis or iliopsoas abscess associated with appendicitis or peritonitis

question

a positive pinch-an-inch test is a classic sign of what condition?

answer

peritonitis and represents aggravation by stretching or moving the parietal layer of the peritoneum a positive pinch-an-inch test, or alternatively, rebound tenderness, may occur with any disease or condition affecting the peritoneum (including appendicitis when it has progressed to include peritonitis)

question

if the pinch-an-inch test is negative, then proceed with what tests/palpations?

answer

rebound tenderness test and/or palpation of McBurney's point

question

what test is a new technique for detecting peritonitis/appendicitis that is more comfortable and statistically equivalent to the traditional rebound tenderness technique?

answer

pinch-an-inch test if the individual has increased pain when the skin fold strikes the peritoneum (upon release of the skin), the test is positive for possible peritonitis

question

negative tests for appendicitis using McBurney's point may occur when?

answer

the appendix is located somewhere other than at the end of the cecum

question

what condition is an inflammation of the pancreas that may result in autodigestion of the pancreas by its own enzymes?

answer

pancreatitis

question

what organ is both an exocrine gland and an endocrine gland?

answer

pancreas

question

the pancreas function in digestion is primarily an exocrine or endocrine activity?

answer

exocrine activity

question

what is the etiology of acute pancreatitis?

answer

unknown chronic alcoholism or toxicity from some other agent, such as glucocorticoids, thiazide diuretics, or acetaminophen, can bring on an acute attack of pancreatitis viral infections (e.g., mumps, herpesviruses, hepatitis) also may cause an acute inflammation of the pancreas

question

what is the cause of chronic pancreatitis in more than 90% of adult cases?

answer

long-standing alcohol abuse

question

what condition is characterized by the progressive destruction of the pancreas with accompanying irregular fibrosis and chronic inflammation?

answer

chronic pancreatitis a mechanical obstruction of the biliary tract may be present, usually because of gallstones in the bile ducts

question

abdominal pain associated with pancreatitis begins abruptly in what region?

answer

midepigastrium pain increases in intensity for several hours, and can last from days to more than a week

question

pain is made worse by walking and lying supine and is relieved by sitting and leaning forward in what condition?

answer

pancreatitis

question

what sign is a bluish discoloration of the periumbilical area?

answer

Cullen sign

question

what is a physical manifestation of acute pancreatitis?

answer

Cullen sign this occurs in cases of severe hemorrhagic pancreatitis jaundice is also a clinical manifestation of acute pancreatitis

question

what sign is a reddish-brown discoloration of the flanks?

answer

Turner's sign

question

Turner's sign is a physical manifestation of what condition?

answer

hemorrhagic pancreatitis

question

Cullen sign (bluish discoloration of the periumbilical area) and Turner's sign (reddish-brown discoloration of the flanks) are physical manifestations of what condition?

answer

hemorrhagic pancreatitis

question

symptoms associated with what condition include persistent or recurrent episodes of epigastric and left upper quadrant pain with referral to the upper left lumbar region?

answer

chronic pancreatitis

question

pathology of what part of the pancreas is more likely to cause epigastric and mid-thoracic pain from T5 to T9?

answer

head of the pancreas

question

press your fingers gently but deeply over the right lower quadrant for 15-30 seconds to assess for appendicitis or generalized peritonitis what test?

answer

rebound tenderness or Blumberg's sign

question

since abdominal pain is increased uncomfortably with this test, save it for last when assessing abdominal pain during the physical examination

answer

rebound tenderness or Blumberg's sign

question

in clients with alcohol-associated pancreatitis, the pain often begins how many hours after an episode of inebriation?

answer

12 to 48 hours

question

when do clients with gallstone-associated pancreatitis typically experience pain?

answer

after a large meal

question

the majority of pancreatic cancers (70%) arise in what part of the pancreas?

answer

head of the gland only 20% to 30% occur in the body and tail

question

- anorexia - weight loss - epigastric/upper abdominal pain with radiation to the back - jaundice secondary to obstruction of the bile duct most common symptoms of what condition?

answer

pancreatic cancer

question

what condition is characterized by fatigue and yellowing of the skin and sclera of the eye?

answer

jaundice

question

the urine may become dark like the color of a cola soft drink in what condition?

answer

jaundice (pancreatic cancer)

question

radiation of pain into the lumbar region is common and sometimes the only symptom of what condition?

answer

pancreatic cancer

question

light-colored stools and jaundice are clinical manifestations of what condition?

answer

pancreatic cancer

question

inflammatory bowel disease (IBD) refers to what two inflammatory conditions?

answer

- ulcerative colitis - Crohn's disease (also referred to as regional enteritis or ileitis)

question

what IBD condition affects the large intestine (colon)?

answer

ulcerative colitis (UC)

question

what IBD condition can affect any portion of the intestine from the mouth to the anus?

answer

Crohn's disease (CD)

question

manifestations of what condition involves the joint most commonly?

answer

inflammatory bowel disease (IBD)

question

skin lesions may occur as either erythema nodosum (red bumps/purple knots over the ankles and shins) or pyoderma (deep ulcers or canker sores) of the shins, ankles, and calves in what condition?

answer

IBD

question

what condition may cause red and painful eyes that are sensitive to light, but does not affect the person's vision?

answer

uveitis

question

uveitis is a clinical manifestation of what condition?

answer

IBD

question

what are the most common complications of IBD?

answer

nutritional deficiencies

question

what condition is an inflammatory disease that most commonly attacks the terminal end (or distal portion) of the small intestine (ileum) and the colon?

answer

Crohn's disease (CD)

question

when may the client with CD experience relief of discomfort?

answer

after passing stool or flatus for this reason, it is important to ask whether low back pain is relieved after passing stool or gas

question

what condition is an inflammation and ulceration of the inner lining of the large intestine (colon) and rectum?

answer

ulcerative colitis (UC)

question

UC: when inflammation is confined to the rectum only, the condition is known as?

answer

ulcerative proctitis

question

cancer of the colon is more common among clients with what condition than among the general population?

answer

UC

question

what is the predominant symptom of UC?

answer

rectal bleeding mainly the left colon is involved; the small intestine is never involved

question

clients with what condition often experience diarrhea, possibly 20 or more stools per day?

answer

UC

question

ankylosing spondylitis, anemia, and clubbing of the fingers are occasional finding of what condition?

answer

UC clubbing develops quickly within 7 to 10 days

question

what condition has been called the "common cold of the stomach"?

answer

irritable bowel syndrome (IBS) it is a functional disorder of motility in the small and large intestines diagnosed according to specific bowel symptom clusters

question

what condition is classified as a "functional" disorder because the abnormal muscle contraction identified cannot be attributed to any identifiable abnormality of the bowel?

answer

IBS

question

- painful abdominal cramps - flatulence - foul breath clinical manifestations of what condition?

answer

IBS

question

what is the most common GI disorder in Western society and accounts for 50% of subspecialty referrals?

answer

IBS

question

what condition is most common in women in early adulthood, and there is a well-documented association with dysmenorrhea?

answer

IBS

question

the client may report white mucus in the stools in what condition?

answer

IBS

question

dull deep discomfort with sharp cramps in the morning or after eating are clinical manifestations of what condition?

answer

IBS

question

abdominal pain or discomfort is relieved by defecation in what condition?

answer

IBS

question

when do symptoms of IBS tend to disappear?

answer

at night when the client is asleep nocturnal diarrhea, awakening the client from a sound sleep, is more often a result of organic disease of the bowel and is less likely to occur in IBS

question

what is the third leading cause of cancer deaths in the US and the leading cause of cancer deaths among nonsmokers?

answer

colorectal cancer - higher in men than women - more african-american than caucasian men

question

colorectal cancer mortality can be significantly reduced by population screening by means of what test?

answer

simple fecal occult blood test (FOBT)

question

fatigue and shortness of breath may occur secondary to the iron deficiency anemia that develops with chronic blood loss in what condition?

answer

colorectal cancer

question

what colored-stools may be present in colorectal cancer?

answer

mahogany-colored stools

question

bleeding with what color blood is more common with a carcinoma of the left side of the colon?

answer

bright red blood

question

pencil-thin stool may be described with what type of cancer?

answer

cancer of the rectum

question

back pain that radiates down the legs is a clinical manifestation of what condition?

answer

colorectal cancer

question

what condition is a massive dilation of the cecum and proximal colon in the absence of actual mechanical causes such as colonic obstruction?

answer

acute colonic pseudo-obstruction (Ogilvie's syndrome)

question

what condition is most commonly detected in surgical patients after trauma, burns, and GI tract surgery or in medical patients who have severe metabolic, respiratory, and electrolyte disturbances?

answer

acute colonic pseudo-obstruction (Ogilvie's syndrome) this complication has also been seen after hip arthroplasty

question

what drugs most commonly induce GI symptoms?

answer

antibiotics and NSAIDs

question

what occurs as a result of free air or blood in the abdominal cavity causing distention (e.g., trauma, ruptured spleen, laparoscopy, ectopic pregnancy)?

answer

Kehr's sign (left shoulder pain)

question

what can be a primary symptom of peptic ulcer, pancreatitis, or pancreatic carcinoma?

answer

epigastric pain radiating to the upper back or upper back pain alone

question

appendicitis and diseases of the intestines, such as Crohn's disease and ulcerative colitis can cause abscess of what muscle?

answer

iliopsoas; resulting in hip, thigh, or groin pain

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