Ch. 306 - Major Signs and Symptoms of Digestive Tract Disorders Flashcards Preview

Nelson - The Digestive System > Ch. 306 - Major Signs and Symptoms of Digestive Tract Disorders > Flashcards

Flashcards in Ch. 306 - Major Signs and Symptoms of Digestive Tract Disorders Deck (110):
1

The sensation of something stuck in the throat without a clear etiology

Globus

2

Swallowing is a complex process that starts where

In the mouth with mastication

3

Occurs when transfer of food bolus from mouth to esophagus is imapired

Oropharyngeal dysphagia

4

Oropharyngeal dysphagia is aka

Transfer dysphagia

5

Structures affected in oropharyngeal dysphagia

Striated muscles of the mouth, pharynx, and UES

6

Most serious complication of oropharyngeal dysphagia

Life-threatening aspiration

7

Occurs when there is difficulty in transporting food bolus down the esophagus

Esophageal dysphagia

8

Causes of esophageal dysphagia

1) Neuromuscular disorders 2) Mechanical obstruction

9

T/F Primary motility disorders causing impaired peristaltic function and dysphagia is common in children

F, rare

10

Cause a fixed impediment to the passage of food bolus because of a narrowing within the esophagus, as in a stricture, web, or tumor

Intrinsic structural defects

11

Caused by compression from vascular rings, mediastinal lesions, or vertebral abnormalities

Extrinsic obstruction

12

T/F Structural defect cause more problems in swallowing solids than liquids

T

13

A thin ring of mucosal tissue near the lower esophageal sphincter that is a mechanical cause of recurrent dysphagia

Schatzki ring

14

Esophageal symptoms are usually referred to what anatomic landmark

Suprasternal notch

15

The effortless movement of stomach contents into the esophagus and mouth

Regurgitation

16

T/F Infants with regurgitation are often hungry immediately after an episode

T

17

A result of GER through an incompetent or immature LES

Regurgitation

18

T/F Regurgitation or "spitting" resolves with maturity

T

19

Prolonged lack of appetite

Anorexia

20

Satiety is stimulated by

Distention of the stomach or upper small bowel

21

A highly coordinated reflex process that may be preceded by increased salivation and begins with involuntary retching

Vomiting

22

Vomiting, as a reflex process is coordinated in the

Medullary vomiting center

23

2 causes of bile-stained vomitus

1) Obstruction below 2nd part of duodenum 2) Repeated vomiting in the absence of obstruction when duodenal contents are refluxed into stomach

24

A syndrome with numerous episodes of vomiting interspersed with well intervals

Cyclic vomiting

25

2 criteria that must be present for cyclic vomiting in children as defined by Rome III criteria

1) 2 or more periods of intense nausea and unremitting vomiting 2) Retching lasting hours to days and return to usual state of health lasting weeks to months

26

Onset of cyclic vomiting is usually

Between 2 and 5 years of age

27

Average frequency of vomiting episodes in cyclic vomiting

12 episodes per year, each episode lasting 2-3 days and 4 or more emesis episode per hour

28

Episodes of vomiting in cyclic vomiting usually comes during what time of the day

Early hours or upon wakening

29

Precipitants of cyclic vomiting

1) Infection 2) Physical stress 3) Psychologic stress

30

T/F More than 80% of children with cyclic vomiting have a 1st-degree relative with migraines

T

31

T/F Many patients with cyclic vomiting develop migraines later in life

T

32

Diarrhea is best defined as

Excessive loss of fluid and electrolyte in the stool

33

Acute diarrhea is defined as a sudden onset of excessively loose stools of ___mL/kg/day in infants and ____g/24 hrs in older children

>10, >200

34

By definition, acute diarrhea lasts for how long

Less than 14 days

35

Chronic or persistent diarrhea lasts for how long

>14 days

36

Normally, a young infant has approximately ___ /day stool output

5mL/kg

37

The greatest volume of intestinal water is absorbed in which part of the GIT

Small intestine

38

T/F The colon concentrates intestinal contents against a high osmotic gradient

T

39

T/F Disorders that interfere with absorption in the small bowel tend to produce voluminous diarrhea, whereas disorders compromising colonic absorption produce lower-volume diarrhea

T

40

Small-volume, frequent bloody stools with mucus, tenesmus, and urgency

Dysentery

41

The predominant symptom of colitis

Dysentery

42

Basis of all diarrhea

Disturbed intestinal solute transport and water absorption

43

Secretory vs osmotic diarrhea: Cholera

Secretory

44

Secretory vs osmotic diarrhea: Large volume

Secretory

45

Secretory vs osmotic diarrhea: Stops with fasting

Osmotic

46

Secretory vs osmotic diarrhea: Occurs after ingestion of a poorly absorbed solute

Osmotic

47

Secretory vs osmotic diarrhea: Stool osmolality predominantly indicated by electrolytes

Secretory

48

Secretory vs osmotic diarrhea: Lactulose

Osmotic

49

Secretory vs osmotic diarrhea: Ion gap of 100 mOsm/kg or less

Secretory

50

Secretory vs osmotic diarrhea: Sorbitol

Osmotic

51

Secretory vs osmotic diarrhea: Lactase deficiency

Osmotic

52

Secretory vs osmotic diarrhea: Rotavirus diarrhea

Osmotic

53

Secretory vs osmotic diarrhea: Anion gap will not be explained by electrolyte content

Osmotic

54

Secretory vs osmotic diarrhea: Anion gap is >100 mOsm

Osmotic

55

Secretory vs osmotic diarrhea: No stool leukocytes

Both

56

Secretory vs osmotic diarrhea: Bile salt malabsoprtion

Secretory

57

Secretory vs osmotic diarrhea: Toxigenix E. coli

Secretory

58

Secretory vs osmotic diarrhea: Neuroblastoma

Secretory

59

Secretory vs osmotic diarrhea: C. difficile

Secretory

60

Secretory vs osmotic diarrhea: Cryptosporidiosis in AIDS

Secretory

61

Formula for ion gap of stool

Stool osm - [(Stool Na + stool K) x2]

62

Secretory vs osmotic diarrhea: Increased breath hydrogen with carbohydrate malabsorption

Osmotic

63

T/F A hard stool passed with difficulty every 3rd day should be treated as constipation

T

64

T/F A soft stool only every 2nd or 3rd day without difficulty should be treated as constipation

F

65

True constipation during the neonatal period is most likely secondary to what 3 entities

1) Hirschprung disease 2) Intestinal pseudo obstruction 3) Hypothyroidism

66

Watery content from the proximal colon might percolate around hard retained stool and pass per rectum unperceived by the child. This is called

Involuntary encopresis

67

T/F A child with functional abdomi-
nal pain (no identifiable organic cause) may be as uncomfortable as one with an organic cause.

T

68

Reassuring PE findings in a child who is suspected of having functional abdominal pain

1) Normal growth and PE 2) Absence of anemia or hematochezia

69

Types of nerve fibers that transmit painful stimuli in the abdomen

1) A fibers: Sharp, localized, skin and muscle 2) C fibers: Dull, poorly localized, viscera, peritoneum, and muscle

70

In the gut, the usual stimulus provoking pain is

Tension or stretching

71

Pain that suggests a potentially serious organic etiology is associated with (14)

1) Younger than 5 y/o 2) Weight loss 3) Fever 4) Bile or blood-stained emesis 5) Jaundice 6) Hepatosplenomegaly 7) Back or flank pain or pain in a location other than the umbilicus 8) Awakening from sleep in pain 9) Referred pain to shoulder, groin, or back 10) Elevated ESR, WBC, or CRP 11) Anemia 12) Edema 13) Hematochezia 14) Strong family history of IBD or celiac disease

72

Pain that tends to be dull and aching and is experienced in the dermatome from which the affected organ receives innervation

Visceral pain

73

Referred pain: Liver

Epigastrium

74

Referred pain: Pancreas

Epigastrium

75

Referred pain: Distal small bowel

Umbilicus

76

Referred pain: Distal large bowel

Suprapubic

77

Referred pain: Appendix

Umbilicus

78

Referred pain: Biliary tree

Epigastrium

79

Referred pain: Stomach

Epigastrium

80

Referred pain: Upper bowel

Epigastrium

81

Referred pain: Cecum

Umbilicus

82

Referred pain: Urinary tract

Suprapubic

83

Referred pain: Proximal colon

Umbilicus

84

Pain from the cecum, ascending colon, and descending colon sometimes is felt at the site of the lesion because

Short mesocecum and corresponding mesocolon

85

Pain from the transverse cool is usually felt in the

Suprapubic region

86

Pain that is intense and is usually well localized

Somatic pain

87

Pain from extraintestinal locations, from shared central projections with the sensory pathway from the abdominal wall, can give rise to abdominal pain, as in pneumonia when the parietal pleural pain is referred to the abdomen

Referred pain

88

Hematemesis is bleeding that originates from

Esophagus, stomach, or duodenum

89

Hematochezia signifies bleeding from as far as

Distal ileum

90

Melena signifies

Mild to moderate bleeding from sites above the distal ileum

91

Black tarry stool is aka

Melena

92

MCC of GI bleeding

Erosive damage to the mucosa of the GIT

93

T/F Vascular malformations are a common cause of GI bleeding in children

F

94

Capsule endoscopy facilitates evaluation of bleeding from

Small intestines

95

Useful means of locating the site of bleeding if it is brisk and intestinal in origin

Tagged RBC scan

96

Guaiac test is very sensitive but can miss ___

Chronic blood loss

97

T/F GI hemorrhage can produce hypotension and tachycardia but rarely causes GI symptoms

T

98

Ascitic fluid is usually: Transudate vs exudate

Transudate

99

Ascitic fluid is usually: High in protein vs low in protein

Low

100

Ascitic fluid results from (2)

1) Reduced plasma colloid osmotic pressure from hypoalbuminemia 2) Raised portal venous pressure

101

What happens to serum Na excretion in the urine as the ascitic fluid accumulates

Decreases

102

When ascitic fluid is high in protein, it is usually secondary to

1) Inflammation 2) Neoplastic lesion

103

Nonspecific pain, often periumbilical

Functional ab pain

104

Intermittent cramps, diarrhea, and constipation

IBS

105

Peptic ulcer–like symptoms without abnormalities on evaluation of the upper GI tract

Nonulcer dyspepsia

106

Bloating, gas, cramps, and diarrhea, not associated with lactose intake

Parasite infection, especially Giardia

107

Burning or gnawing epigastric pain; worse on awakening or before meals; relieved with antacids

PUD

108

Epigastric pain with substernal burning

Esophagitis

109

Periumbilical or lower abdominal pain; may have blood in stool (usually painless)

Meckel diverticulum

110

RUQ pain, might worsen with meals

Cholelithiasis