Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common between -Dx made
... [Show More] clinically, -May have HTN\tachy -Labs are not -Surgical; preoperative -F\U with surgeon
10-30yrs; but can occur based primarily on H&P proportional to diagnostic and care, NPO, correction of -Ambulation after
at any age; rare in exam pain\symptoms nonspecific fluid\electrolyte imbalances surgery
infants and older adults - Classic presentation -When lying flat, may -Women should have -Avoid narcotics -Adv diet when
-men more at risk includes acute onset of flex R knee to relieve urine human chorionic -Atb with 3rd gen bowel sounds return
- Diets low in fiber, high mild to severe colicky, tension in abd muscle gonadotrophin to r\o cephalosporin; Ex: -Return to hosp with
in fat, refined sugars, &
other carbs at increased epigastric, or
periumbilical pain -Pain with palpation in
abd, diffuse in early ectopic pregnancy
- +Rovsing’s Sign- ampicillin, gentamycin,
flagyl s\s of infection
-Avoid heavy lifting
risk. - Pain is vague at first stages. Localized to deep palpation & for at least 2 wks
- Obstruction of appendix then localizes within RLQ later release in LLQ causes
is cause of majority of 24hrs to RLQ -Positive for rebound rebound pain in RLQ
appendicitis - Pain exacerbated by pain; ask pt to cough - +Psoas Sign- lift R
- contributing factors: walking\coughing to localize pain leg against gentle
Intra-abdominal - Men may feel radiated location
pressure causes pain
tumors, positive family pain in testes -Sudden cessation of - +Obturator Sign-
hx - Abd muscle rigidity, pain means perforation flex R hip & knee and
- Recent roundworm N\V, anorexia and is ER slowly rotate internally
infection or viral GI
infection - Mildly elevated temp
99-100F common causes pain
- +McBurney’s Sign-
- If RLQ accompanied pain with pressure
by shaking chills, applied to point
perforation should be between umbilicus &
suspected ilium
- Older adults may - x-ray\CT helpful
present with weakness, when paired with
anorexia, abd positive H&P findings
distention, mild pain
leading to delayed dx
and increased
morbidity.
Celiac disease ** (autoimmune disorder caused by an immunologic response to gluten) Mostly diagnosed in adulthood.
A family member with celiac disease or dermatitis herpetiformis
Type 1 diabetes
Down syndrome or Turner syndrome
Autoimmune thyroid disease
Microscopic colitis (lymphocytic or collagenous colitis)
Addison's disease Many asymptomatic. May complain of diarrhea, gas, dyspepsia, wt. loss. Atypical symptoms: fatigue,
bone or joint pain, arthritis, osteoporosis, or
osteopenia (bone loss) liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, depression or anxiety peripheral neuropathy seizures or migraines missed menstrual periods
infertility or recurrent miscarriage
canker sores inside the mouth Muscle wasting (anemia), reduces subcutaneous fat, ataxia, & peripheral neuropathy (vitamin B12 deficiencies) osteoporosis or osteopenia (bone loss) hypothyroidism
Pts with dermatitis herpetiformis found to have signs of celiac disease on intestinal biopsy. Serologic testing for anti-tTG IgA antibody
Total IgA (2% of pts have IgA deficiency and will falsely test negative)
duodenal biopsies
Test for nutritional deficiencies associated with malabsorption of C.D. (hemoglobin, iron, folate, vit B12, Calcium, and Vitamin D.) lifelong adherence to a strict gluten-free diet.
Referral to a dietician to help.
Some pts may need treatment with immunomodulating agents. teaching related to gluten free diet.
Some people with celiac disease have vitamin or nutrient deficiencies that do not cause them to feel ill, such as anemia due to iron deficiency or bone loss due to vitamin D deficiency. However, these deficiencies can cause problems over the long term. Untreated celiac/developing certain types of gastrointestinal cancer. This risk can be reduced by eating a gluten-free diet.
dermatitis herpetiformis
(itchy skin rash)
Cholelithiasis is the formation of Patient complaint of Right side involuntary Mild elevation of WBC a. Initial management-- Nonsurgical
gallstones and is found indigestion, nausea, guarding of abdominal up to 15, 000 begins with definitive intervention: weight
in 90% of patients with vomiting (after muscles, Positive Abdominal Xray: diagnosis. When loss, avoidance of [Show Less]