Differential Diagnosis & Primary Care Practicum (Chamberlain University)
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NR511 Midterm Study Guide Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment
GI DISORDERS
Appendicitis Risk: age 10-30; men Subjective: acute Objective: looks ill; diffuse Tests: CBC - mild to 1st line: IV antibiotics, correcting
twice as likely as onset of mild to tenderness with palpation moderate leukocytosis; fluid and electrolyte imbalances,
women; diet low in severe colicky, of abdomen – tenderness urinalysis – microscopic bedrest, NPO, NG tube if indicated
fiber, high in fat and epigastric, or over RLQ hematuria or pyuria; x-
high in refined sugars periumbilical pain; ray – fecalith, gas-filled 2nd line: surgery
and other carbs nausea/vomiting; appendix, small bowel
fever ileus, deviation in bowel
gas pattern, or loss of
right iliopsoas shadow;
US – to visualize
inflamed appendix
Celiac disease Risk: family history, Subjective: most are Objective: exam may be Tests: serological testing 1st line: strict gluten-free diet
Down’s syndrome, asymptomatic; may normal; signs of for anti-tTG IgA
HLA-DQ2 or HLA-DQ8, complain of diarrhea, malabsorption such as antibodies; total IgA; 2nd line: immunomodulating
Turner’s syndrome, or weight loss, muscle wasting, pallor nutritional deficiencies – agents
other genetic based dyspepsia, and (anemia), reduced hemoglobin, iron, folate,
autoimmune disease flatulence subcutaneous fat, ataxia, vitamin B12, calcium,
such as Type 1 DM and and peripheral and vitamin D
thyroiditis neuropathy (Vitamin B12
deficiency)
Cholelithiasis - gallstones Risk: > 25 y/o; most Subjective: symptoms Objective: if pain is severe Tests: gold standard is 1st line for asymptomatic patients:
prevalent in American vary, generalized GI patient may have abdominal ultrasound avoid foods high in fat
Indian women; complaints to involuntary guarding over
intractable pain; the RUQ; positive During acute phase – 2nd line:
Cholesterol stones: indigestion, nausea, Murphy’s sign w/ mild WBC elevation to Treatment of choice for acute
female, obesity, and vomiting – palpation over the RUQ; 15,000/mL; serum cholecystitis:
pregnancy, increased especially after a low grade fever; may have transaminases elevated
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NR511 Midterm Study Guide Worksheet
age, drug-induced meal high in fat; as diminished bowel sounds 4x normal; aspartate hospitalization for rehydration w/
(oral contraceptives, the inflammation aminotransferase and IV fluids, antibiotics, analgesics, GI
clofibrates), cystic progresses, the pain alanine aminotransferase rest, NG placement for persistent
fibrosis, rapid weight localizes over the can be elevated to 300 emesis; 2nd or 2rd generation
loss, spinal cord injury, RUQ or epigastrum; U/L; alkaline cephalosporin is started
ileal disease with pain may refer to phosphatase is elevated
extensive resection, middle of back, to 2-4x normal levels; Once stable the patient will
DM, sickle cell anemia infrascapular area, or bilirubin as high as 4 undergo surgery for a
R shoulder mg/dL cholecystectomy
Pigmented stones:
hemolytic diseases, If considered a poor surgical risk
increasing age, patients can be treated w/ oral
hyperalimentation, ingestion of ursodeoxycholic
cirrhosis, biliary stasis, (ursodoil) or direct dissoluction by
chronic biliary percutaneous instillation of
infections methyl-tertiary-butyl ether;
lithotriopsy
Six F’s: fat, female,
forty, flatulent, fertile,
and fat-intolerant
Crohn’s disease Risk: genetic Subjective: abd Objective: Tests: colonoscopy - 1st line: nutrition counseling –
predisposition cramping and 1. Inflammation, RLQ reveals ulcers that are avoid caffeine, raw fruits,
tenderness, fever, pain, and tendnerness either minor erosions or vegetables, seeds, and nuts, and
anorexia, weight loss, – presenting like deep longitudinal foods high in fiber (whole grain
spasm, flatulence and appendicitis fissures, cobblestone bread and cereal); bland diet that
RLQ pain or mass; 2. Obstruction, fibrosis, appearance is high in calories and protein yet
increase in symptoms and stenotic changes low in fat
during stress or within the bowel 1st line medication: oral
emotional upset or causing obstruction prednisone
after meals consisting associated w/ severe
of fatty, spicy foods, colic, abdominal 2nd line: mesalamine (Asacol) and
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NR511 Midterm Study Guide Worksheet
or milk; stools are distension, sulfasalazine (Azulfidine)
soft or semi-liquid; constipation and
blood in stools; vomiting
steatorrhea; periods 3. Diffuse jejunoileitis
of acute exacerbation involving the jejunum
alternating with and ileum and
complete remission characterized by both
inflammation and
obstruction
4. Abdominal fistulas
and abscesses causing
fever, generalized
wasting, and
abdominal masses
Diverticulitis Risk: low-fiber and Subjective: LLQ pain; Objective: tenderness in Tests: abdominal x-rays – 1st line: high fiber diet or daily fiber
high fat diet; chronic pain may be worse the LLQ; firm-fixed mass reveal free air, ileus, or supplementation with psyllium
constipation and after eating, pain is may be identified in the obstruction; a barium Mild symptoms: rest clear liquid
straining; irregular sometimes relived area of the diverticula; enema – outlines the diet
bowel contractions; with BM or passing hypoactive bowel sounds lumen of the bowel
weakness of bowel flatus; alternating initially, but hyperactive if clearly defining 2nd line: hospitalization for IV
muscle brought on by bowel patterns an obstructive process has diverticula antibiotics and hydration,
aging between constipation developed analgesia, bowel rest, and possible
and diarrhea NG tube
GERD Risk: overweight, BMI Subjective: mild to Objective: exam in Tests: 1st line for mild symptoms: lifestyle
over 25; increases w/ severe heartburn, normal; possible stool Diagnosis is made by modifications – weight loss,
age then decreases regurgitation, water positive for occult blood history alone elevating HOB to 6-8 inches, avoid
after the age of 69; brash, dysphagia, due to microhemorrhages eating meals 2-3 hours before
ingestion of sour taste in the in the irritated esophageal If unclear diagnosis: EGD bedtime, avoid certain foods such
foods/pharmacological mouth in the epithelium as chocolate, alcohol, caffeine,
agents that lower the morning, belching, acidic or spicy foods; smoking
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