Gastrointestinal Disorders: Diagnosis and Management, Exams of Nursing

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NURS 623 EXAM 3 LATEST EXAM | ALL

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MARYVILLE UNIVERSITY

Describe the clinical presentation for Gastroesophageal Reflux Disease (GERD)? ------CORRECT ANSWER---------------heartburn, regurgitation, water brash (reflex salivation), sour taste in morning, belching, coughing, and hoarseness. Objective: only sign may be occult blood in stool. How is GERD diagnosed (when to refer to GI)? ------CORRECT ANSWER-- -------------With symptoms, sometimes with upper endo; refer if failed treatment of step 2- after 6 weeks of treatment Discuss the patient education regarding lifestyle changes for management of GERD. ------CORRECT ANSWER---------------lifestyle changes including diet weight loss, raising the head of their bed 6-8 inches, avoid nicotine products avoid recumbency or sleeping for 3 to 4 hours after a meal, avoid bedtime snacks, avoid fatty and late meals, foods such as chocolate, alcohol, peppermint, caffeine, onions, garlic, citrus, and tomatoes, wearing loose comfortable clothing, and starting a routine exercise and weight loss program Describe medical management of GERD? ------CORRECT ANSWER-------- -------step-up: LIFESTYLE changes, PRN OTC H2ra and antacid; PPI; referral

Step-down: starts with PPI then step down until Sx under control 46 year old male complains of dysphasia hoarseness and cough he states he wakes up with a sour taste in his mouth. What is the most likely cause of the patient symptoms? ------CORRECT ANSWER---------------GERD Managment of peptic/gastric ulcer ------CORRECT ANSWER--------------- *relieve pain, heal the ulcer, and prevent complications/reoccurrence *PHARMACOLOGICAL therapy is the foundation of management (H2Ra, PPI, antacids, antibx w/H-pylori) Describe the diagnosis criteria IBS ------CORRECT ANSWER--------------- 3 Criteria:

1. pain relieved by defacation or change in BMs for 3 months
2. BM with patterns of constipation/diarrhea 25% of the time
3. 2 features of either: altered frequency, form, sensory act of defecation or varied bloating and pain What are the risk factors are associated with Cholelithiasis? ------ CORRECT ANSWER---------------female gender obesity pregnancy increased age drug induced (oral contraceptives, clofibrates) cystic fibrosis rapid weight loss, spinal cord injury ileal disease with extensive resection diabetes mellitus sickle cell anemia

Cirrhosis Biliary issues What is the clinical presentation of cholecystitis? ------CORRECT ANSWER---------------colicky type pain Indigestion N/V (after high-fat meals) Pain localized to RUQ referred pain to back & RT shoulder What laboratory findings would you expect to see with acute cholecystitis? - -----CORRECT ANSWER---------------Elevated Alkaline Phosphatase & Bilirubin 45 year old obese woman with severe pain in tenderness in the right upper quadrant accompanied by nausea and vomiting and fever there is a positive Murphy sign what is the most likely diagnosis? ------CORRECT ANSWER---------------Cholecystitis What elevated laboratory test is considered the gold standard for diagnosis of non-alcoholic pancreatitis? ------CORRECT ANSWER---------------Serum amylase, concurrent with Lipase What is the clinical presentation of chronic pancreatitis? ------CORRECT ANSWER---------------LUQ can radiate to lumbar area weight loss diarrhea N/V dyspepsia

PE findings with pancreatitis? ------CORRECT ANSWER--------------- epigastric tenderness with no rebounding tenderness, may feel pseudeocyst/mass mild jaundice. What are the recommendations/guidelines for colon cancer screenings for average risk? ------CORRECT ANSWER---------------Average Risk: 50-75 or African American 45+ fecal occult blood every 1 yr flex sig every 5 yrs Colonoscopy every 10 years What are the recommendations/guidelines for colon cancer screenings for high risk? ------CORRECT ANSWER---------------fecal occult blood every 1 yr At 40 y/o Barium enema or colonoscopy every 3-5 yrs What is the clinical presentation of diverticular disease? ------CORRECT ANSWER---------------*LLQ pain (worse after eating) relieved with passing stool or gas *colonic distention *W/itis: anorexia, vomiting, chills, tachycardic more common in elderly How would you manage a patient with an incidental finding of uncomplicated diverticular disease? ------CORRECT ANSWER--------------- Requires no further intervention and can be managed with a high-fiber diet or a daily fiber supplementation with psyllium

If antibx are needed with diverticulitis what would be used? ------CORRECT ANSWER---------------Flagyl & Cipro or Bactrim Which of the following best describes the dietary recommendations to reduce the incidence of diverticular disease? ------CORRECT ANSWER----- ----------Increase the amount of fiber in the diet True/False A patient experiencing exacerbation of symptoms of ulcerative colitis should be encouraged to eat high fiber foods such as raw fruits and vegetables ------ CORRECT ANSWER---------------FALSE; True/False A patient with Crohn's disease should be encouraged to eat high fiber foods such as whole grain bread, pumpkin seeds, and nuts. ------ CORRECT ANSWER---------------TRUE True/False A person with Irritable Bowel Syndrome (IBS) should slowly increase their fiber intake to 20 - 30 gm/day. ------CORRECT ANSWER---------------TRUE What type of hernia has The tissue herniates through the internal inguinal ring, which in men extends the length of the spermatic cord. ------CORRECT ANSWER---------- -----Indirect Inguinal

s/s of an ingunal hernia ------CORRECT ANSWER---------------LLQ or RLQ pain and bulging, especially when straining, coughing, or bending over; burning or aching sensation at the bulge S/S of EPIDIDYMITIS ------CORRECT ANSWER-----------------Pain in lower abdomen Swollen, red, warm scrotum.

• Testicle pain and tenderness, usually only on one side that comes on gradually s/s of prostatitis ------CORRECT ANSWER---------------Painful or difficult/frequency of urination
• Fever/chills
• Blood in urine S/S of endometriosis ------CORRECT ANSWER----------------Abdominal and/or pelvic pain
• Painful periods
• Pain with intercourse
• Pain with BM or urination S/S of colon cancer ------CORRECT ANSWER----------------Hypogastrum or LLQ pain
• Blood in stool
• Pencil-thin stools
• Feeling of incomplete BM What type of hernia has The transversus abdominis and internal oblique muscles are attached, forming

a high arch on the inferior border that results in a faulty shutter mechanism ------CORRECT ANSWER---------------Direct inguinal What type of hernia occurs at the fossa ovalis where the femoral artery exits from the abdomen ------CORRECT ANSWER---------------Femoral When you put someone on antidepressant what do you worry about? ------ CORRECT ANSWER---------------Developing suicidal ideations The DMS V criteria for major depressive disorder requires? ------CORRECT ANSWER---------------Five or more symptoms including at least one depressed mood or loss of interest present in the same two weeks an present nearly every day Physical examination of a patient diagnosed with anorexia nervosa includes ------CORRECT ANSWER---------------Emaciation/cachexia What is viseral pain ------CORRECT ANSWER---------------viscera (organs) - pain that is caused by distention or spasm of a hollow viscus How would you describe parietal pain and what abdominal disorder often causes it? ------CORRECT ANSWER---------------sharp well localized pain caused by irritation of the peritoneum ; often associated with appendicitis abdominal pain that is described as colicky (comes and goes) may result from? ------CORRECT ANSWER---------------gallstones or renal stones

What is most most common cause of constipation in the US? What is recommended to help? ------CORRECT ANSWER---------------lack of dietary fiber; recommended amount is 30 grams daily How would you treat constipation nonpharmaologically? ------CORRECT ANSWER---------------*slowly increases fiber 25-35 grams with 12-15 grams in the morning; exercise after meals; uninterrupted toilet time; adequate hydration 64 ounces daily Celiac disease is described as a malabsorption syndrome related to? ------ CORRECT ANSWER---------------an immune reaction to gluten in the diet; more common in women ages 40- 50 Gluten is found in food products that contain..... ------CORRECT ANSWER- --------------wheat barley and rye What a patient with celiac disease have a history of? ------CORRECT ANSWER---------------chronic diarrhea, foul smelling stools, abdominal bloating, weakness and fatigue What confirms the diagnosis of celiac disease? ------CORRECT ANSWER-- -------------distal duodenal biopsy

How do you treat celiac disease? ------CORRECT ANSWER--------------- gluten free diet, and treatment of nutritional deficiencies such as iron, folate and vitamin B Epigastric discomfort, postprandial fullness, early satiety, anorexia, belching, nausea, heartburn, vomiting, bloating, borborygmi, dysphagia, and abdominal burning are symptoms of ..... ------CORRECT ANSWER------ ---------dyspepsia GERD is the backward flow of stomach contents into the ------CORRECT ANSWER---------------esophagus without associated retching or vomiting What are some lifestyle modifications for GERD? ------CORRECT ANSWER---------------smoking cessation, avoid tight clothing, diet, exercise, dont eat 4 hours before bedtime, sleep with HOB elevated The primary cause of GERD is the inappropriate, spontaneous ------ CORRECT ANSWER---------------transient relaxation of the lower espophageal sphincter(LES) to an unknown stimulus Lifestyle modification are the first line treatment for GERD, name some?? -- ----CORRECT ANSWER---------------elevating HOB, avoid large, high fat meals, avoid chocolate, alcohol, peppermint, caffeine, onions garlic, citrus and tomatoes; avoid lying down 3-4 hours after meal, avoid bedtime snacks, weightloss What is the most common psychiatric disorder in the U.S? ------CORRECT ANSWER---------------Anxiety

What are the DSM-5 symptom criteria for a diagnosis of general anxiety disorder? ------CORRECT ANSWER---------------excessive anxiety and worry of variety of things for at least 6 months What are the DSM-5 symptom criteria for a major depressive disorder? -----

• CORRECT ANSWER---------------Five or more symptoms including at least one depressed mood or loss of interest present in the same two weeks and present nearly every day differential diagnoses that would mimic the symptoms of depression? ------ CORRECT ANSWER---------------*Anxiety *PTSD Substance Abuse What are the risk factors for major depression? ------CORRECT ANSWER-- -------------Age *Gender *Personal Hx (migrains, PUD, chronic pain) *Fx Hx (depression, suicide, alcholism, substance abuse) What are the common presenting symptoms of depression in the geriatric patient? ------CORRECT ANSWER---------------Somatic (general pain) Psychology (feeling of guilt/worry, suicidal, memory) Psychomotor (anxiety/agitation) Vegetative (poor appitite/sleep)

What are the NON-pharmacologic treatments for management for major depressive disorder? ------CORRECT ANSWER---------------Interpersonal and cognitive behavior therapy What are the pharmacologic treatments for management for major depressive disorder? ------CORRECT ANSWER---------------SSRI, SNRI, TCA, MAO Names of common SSRIs ------CORRECT ANSWER---------------Fluoxetine (Prozac) Sertraline (Zoloft) Paroxetine (paxil) Citalopram (celexa) Escitalopram (Lexapro) Names of common SNRIs ------CORRECT ANSWER---------------Duloxetine (Cymbalta) Venlafaxine (Effexor) Desvenlafaxine (Pristiq) What are concerns in elderly taking medication for major depression? ------ CORRECT ANSWER---------------a slower metabolism requires lower dosing; greater risk of falls, osteoporosis, fractures What are the pharmacologic versus nonpharmacologic treatment for management for general anxiety disorder? ------CORRECT ANSWER-------- -------non-pharmacological interventions of cognitive behavioral therapy has proven equal results to SSRI pharmacologic therapy

DIGFAST for bipolar because your digging yourself into hole ------ CORRECT ANSWER---------------Distractibility Indiscretion/Insomnia Grandiosity Flight of ideas Activities ↑ Sleep Deficit Talkativeness What is the symptom criteria for BD I? ------CORRECT ANSWER------------- --identification of at least one-lifetime mania episode must have occurred What is the symptom criteria for BD II? ------CORRECT ANSWER------------ ---identification of at least one hypomania episode and one major depressive episode must have occurred What is the symptom criteria for diagnosing unipolar (depression) ------ CORRECT ANSWER---------------persistently depressed mood or loss of interest in activities, causing significant impairment in daily life (no mania/hypomania) How do you assess suicide risk (consider mnemonic SAD PERSONS) ------ CORRECT ANSWER---------------S-ex A-ge D-epression P-revious attempt E-thanol abuse R-ational thinking loss S-ocial support loss O-rganized plan N-o spouse

S-ickness How would you identify intimate partner violence? ------CORRECT ANSWER---------------*reluctant to speak in front of partner *gives evasive answers *Overly protective or controlling partner What are the stages of grieving? (DABDA) ------CORRECT ANSWER-------- -------Denial Anger Bargaining Depression Acceptance What are the phases of grief? (Aca) ------CORRECT ANSWER--------------- Avoid Confront Accomadate Acknowledge the loss Reacting to the separation Recollecting and Re-experiencing the Relationship w/deceased How would you identify intimate partner violence? ------CORRECT ANSWER---------------1) a patient who is reluctant to speak in front of her partner and gives evasive answers

2. Overly protective or controlling partner

What is the clinical presentation of post-traumatic stress disorder (PTSD)? - -----CORRECT ANSWER---------------A: INTRUSIVE thoughts, nightmares or flashbacks B: AVOIDANCE any situation of activity that brings memories C: HYPERAROUSAL: Hypersensitive or on edge, unprovoked anger, jumpiness, and on guard What are the DSM-5 criteria for a diagnosis of PTSD? ------CORRECT ANSWER---------------1 SYMPTOM of intrusive, avoidance, or hyper-arousal MUST HAVE PERSISTED FOR MORE THAN 1 MONTH What is the management for PTSD? ------CORRECT ANSWER--------------- PHARMACOLOGY: SSRI's paroxetine (paxil) or sertaline (Zoloft), anxiolytic buspirone (BuSpar) NON-PHARMACOLOGICAL: cognitive behavioral therapies, brief eclectic psychotherapy, narrative exposure therapy potential complications of over-prescription of opiate pain meds ------ CORRECT ANSWER---------------Constipation Sedation Resp Depression Dizziness N/V Medications that can cause Constipation? ------CORRECT ANSWER--------- ------Antacids, anticholinergics, Anti convulsive, Antidepressants (TCAs), Antihypertensives, NSAIDs, Opioids What are the warning signs that the patient has Anorexia? ------CORRECT ANSWER---------------Substantial weight loss

S/S of depression or mood swings cardio problems preoccupation with weight, calories, and food, wear baggy clothes history of excessive exercise What do labs look like in anorexia? ------CORRECT ANSWER--------------- leukopenia elevated BUN anemic hypomagnesmia elevated TSH sinus bradycardia. What are the warning signs that the patient has Bulemia? ------CORRECT ANSWER---------------Significant weight gain tooth erosion calluses on back of hands esophageal erosion negative body image eats rapidly until uncomfortably full swollen salivary (parotid) glands irregular menses eat large amounts of food in isolation signs or symptoms of depression What do labs look like in bulemia? ------CORRECT ANSWER--------------- Hyponatremia, hypochloremia, elevated amylase Discuss sleep hygiene strategies for a patient complaining of insomnia ------ CORRECT ANSWER---------------Maintain a regular sleep and wake schedule Eat regular meals every day

Develop a relaxing bedtime routine Limit amount of liquid consumed in evening Limit amount of caffeine consumed later in day Avoid tobacco and alcohol later in the day Avoid daytime naps Exercise regularly Limit exposure to bright lights or television in evening Bed should be used for sleeping and sex only Turn any clocks facing the bed away If not asleep after 20 mins get out of bed and engage in quiet activity before reattempting to fall asleep. What is the The most common long term effect of sexual assault ------ CORRECT ANSWER---------------PTSD In an attempt to promote behavioral changes in a patient, what is the best approach to take as the provider? ------CORRECT ANSWER--------------- Educate the patient on all of the options available to them and allow them to choose their plan what are the risk factors for substance abuse disorder ------CORRECT ANSWER---------------*Underlying mental health/emotional problems *low socioeconomic status *access to medications and substances patterns commonly seen in domestic violence among victims? ------ CORRECT ANSWER----------------Feels afraid of their partner

• Avoids certain topics out of fear of angering partner
• Feels they deserve to be hurt or mistreated
• Feels emotionally numb or helpless

patterns commonly seen in domestic violence among perpetrator? ------ CORRECT ANSWER----------------Humiliates/Criticizes partner

• Blames the victim for their abusive behavior
• Acts jealous and possessive
• Limits partners access to money, phone, car What are different types of abuse? ------CORRECT ANSWER--------------- *Physical *verbal *psychological *sexual populations that domestic violence typically affects? ------CORRECT ANSWER----------------Can occur in ANY population higher prevalence in ethnic minorities & women Risk factors of suicide in the elderly? ------CORRECT ANSWER--------------- *male gender *being single, divorced, or separated and without children *personal or family history of a suicide attempt *drug or alcohol abuse *severe anxiety or stress *physical illness *a specific suicide plan with access to firearms In a female patient who presents with abdominal pain, what is the first diagnostic test you would order? ------CORRECT ANSWER--------------- HCG

risk factors for development of a peptic ulcer/PUD ------CORRECT ANSWER---------------*H. Pylori infection *prolonged NSAID/ ASA use smoking Differentiate among diverticulosis and diverticulitis ------CORRECT ANSWER---------------Diverticula are pockets that form in the lining of the colon. They can be present and simply an incidental finding (diverticulosis) or they can become infected or inflamed (diverticulitis) What are the risk factors of diverticulitis? ------CORRECT ANSWER---------- -----Having diverticulosis in conjunction with untreated constipation *Smoking *lack of exercise *obesity *NSAID and Opioid use How would you differentiate between a diagnosis of gastroenteritis and irritable bowel syndrome? ------CORRECT ANSWER---------------IBS: is chronic LLQ pain diarrhea, constipation, passing mucous and occurs 1 or more times a week over 3 months. Gastroenteritis: (stomach bug) is caused by a bacteria, (no constipation) diarrhea, N/V symptom limited to several days How do you treat travelers diarrhea? ------CORRECT ANSWER--------------- azithromycin 1000mg 1 one dose; or 500mg x 3 d Cipro 750 mg one dose Levofloxacin 500 mg 1-3 days

differential diagnosis, for a patient presents with diarrhea ------CORRECT ANSWER---------------Acute: Gastritis, medication induced, lactose intolerant Chronic: CRhons, IBS, IBD, mode of transmission for Hepatitis A ------CORRECT ANSWER--------------- fecal-oral mode of transmission for Hepatitis B ------CORRECT ANSWER--------------- direct contact with infected blood or blood products or by sexual contact mode of transmission for Hepatitis C ------CORRECT ANSWER--------------- blood, semen, maternal-neonate Describe the clinical presentation of appendicitis? (Subjective and objective findings) ------CORRECT ANSWER---------------Vague symptoms first 24 hours, worse when walking or jumping, N/V, low grade temp, +Rovsings, Psoas, obturator, mcburneys Describe the various maneuvers for diagnosing appendicitis? ------ CORRECT ANSWER---------------ROVSING'S: Deep Papation LLQ do sudden unexpected release; Positive if causes Tenderness to RLQ. PSOAS: Pt on back and raise RT leg against pressure or on left side extend RT leg at hip; Positive if increased pain OBTURATOR: Pt on back with the right hip and knee flexed the examiner slowly rotates the right leg internally; Positive if pain over RLQ

McBURNEY'S: pressure applied to McBurney's point (halfway between the umbilicus and the anterior spine of the ilium); Positive if pain with pressure applied If lifestyle modifications dont work in the treatment of GERD what is the first "step up" treatment with non erosive reflux? ------CORRECT ANSWER------ ---------"tidine" :cimetidine, ranitidine, famotidine, nizatidine; if no improvement then PPIs are used What is the initial therapy for patients with GERD who have erosive esophagitis or barretts esophagus ------CORRECT ANSWER--------------- PPI's (razole) such as omeprazole once a day 30 minutes before breakfast (8 week course) For a patient with GERD and complications such as erosive esophagitis or barretts esophagus who is unresponsive to treatments what would your plan of action be? ------CORRECT ANSWER---------------surgical intervention: nissen fundoplication GERD is a lifelong disease and patients should be evaluated on a regular basis , patients with mild to moderate symptoms should be instructed to treat how? ------CORRECT ANSWER---------------lifestyle modifications and antacids or OTC H 2 - RAs (famotidine) for 4 weeks; What are the lifestyle modifications for GERD? ------CORRECT ANSWER-- -------------elevate HOB, no eating 3-4 hour before bed and no snacks, weight reducation, smoking cessation, avoid large meals, tight clothing , avoid bending or straining, advise to eat small frequent meals

What are the most common causes of gasteroenteritis? ------CORRECT ANSWER---------------bacterial, viral and parasitic A stool culture should be done on any patient who has what symptoms? ---- --CORRECT ANSWER---------------severe diarrhea, fever >101.3, bloody stools, leukocytes, lactoferrin or occult blood bc there are indications of a bacterial pathogen Any patient who develops diarrhea after initiation or completion of antibiotics therapy should have a ....... ------CORRECT ANSWER--------------

• tissue culture assay or an ELISA test for possible C-Diff Viral gastroenteritis should be suspected in any patient with ____ as their major symptoms ------CORRECT ANSWER---------------vomiting; and in cases of possible food or water contamination All patients who present with diarrhea should be treated with ------ CORRECT ANSWER---------------fluid and electrolyte management; patients who can take oral replacement should be instructed to drink fluids with a sodium content 45-75 meq (pedialyte or gatorade) Patients with diarrhea require a diet that includes calories that come from -- ----CORRECT ANSWER---------------boiled starches and cereals (potatoes, rice, pasta wheat and oats), with the addition of salt

Patients with febrile dysentery should not receive anti- motility medications, why? ------CORRECT ANSWER---------------because slowing the intraluminal time may prolong the duration of the disease How would you treat travelers diarrhea? ------CORRECT ANSWER----------- ----with trimethoprim-sulfamethoxazole (bactrim DS); one double strength tablet twice a day for 3 days what is the drug of choice for afebrile nondysenteric cases of acute diarrhea? ------CORRECT ANSWER---------------loperamide (Imodium) What would a break in the surface mucosa of the stomach or duodenum, which results when there is a disruption of the normal mucosal defenses and the tissue is exposed to the damaging effects of acid by pepsin> ------ CORRECT ANSWER---------------peptic ulcer disease (gastric and duodenal ulcers) What are the 3 major causes of PUD? ------CORRECT ANSWER--------------

• infection with H-pylori, chronic ingestion of ASA or other NSAID, acid hyper-secretion such as Zollinger-Ellison syndrome Caffeine, alcohol, and spicy food are no longer considered to be a risk for what disease? ------CORRECT ANSWER---------------no longer considered ulcerogenic, PUD Cigarette smoking, ASA, NSAIDs, and the bacteria Hpylori have been linked to? ------CORRECT ANSWER---------------PUD

The hallmark of PUD is? ------CORRECT ANSWER---------------complaint of burning or gnawing hunger sensation or pain (dyspepsia) in the epigastrium which is often relieved by foods or antacids A patient comes in complaining of epigastric pain that clusters and last for minutes with episodes separated by periods of no symptoms, what would you suspect? ------CORRECT ANSWER---------------PUD The diagnostic standard for PUD is what? ------CORRECT ANSWER--------- ------upper endoscopy Zollinger-Ellison syndrome should be suspected in patients whos fasting serum gastrin level is above ___ and who have a basal acid output of more than ___? ------CORRECT ANSWER---------------serum gastrin level 600, basal acid output 15 What is the drug of choice for treating PUD? ------CORRECT ANSWER----- ----------PPI (prazole) omeprazole When treating a patient with PUD if the patient has mild symptoms and no indications of complications or a more serious disease, empiric therapy with an ..... ------CORRECT ANSWER---------------H2-RA should be instituted for 2 weeks

When treating PUD with H2 receptor antagonist how would you administer? ------CORRECT ANSWER---------------once a day at bedtime or 1/2 the dose twice a day for 8 weeks Antacids that contain ____ should not be used in patients with PUD; it can causes rebound acid secretion. ------CORRECT ANSWER--------------- calcium What should you warn patients about when taking Bismuth for the treatment of PUD ------CORRECT ANSWER---------------Bismuth causes feces to darken or turn black; it can also cause hypoglycemia with antidiabetic medications What drug promotes ulcer health by stimulating mucosal bicarbonate and prostaglandin production? ------CORRECT ANSWER---------------Bismuth preparations If a patient is taking sucralfate in conjuction with an antacid , PPI, or H2-RA what should you teach them? ------CORRECT ANSWER--------------- sucralfate cannot be taken at the same time as the other medications or at the same time as digoxin, cipro, or phenytoin What therapy has shown to be effective in the eradication of H-pylori? ------ CORRECT ANSWER---------------triple drug therapy, 2 antibiotics (clarithromycin and either amoxicillin or metronidazole) and a PPI

Cholecystitis is an acute inflammation of the? ------CORRECT ANSWER---- -----------gallbladder wall, which is usually the result of an impacted calculus within the cystic duct causing inflammation proximal to the obstruction A patient comes in with severe pain and tenderness in the epigastrium or RUQ area, this pain is accompanied by nausea, vomiting, fever and leukocytosis, what would you suspect ??? ------CORRECT ANSWER-------- -------cholecystitis What are the signs and symptoms of cholecystitis? ------CORRECT ANSWER---------------severe pain and tenderness in the epigastrium or RUQ area, accompanied by nausea, vomiting, fever and leukocytosis What is the most common form of stone that occurs from cholecystitis?? --- ---CORRECT ANSWER---------------cholesterol stones What is cholelithiasis? ------CORRECT ANSWER---------------gall stones A patient complains of acute colicky type pain what would you suspect? --- ---CORRECT ANSWER---------------acute cholecystitis Where would you expect to assess for pain with the diagnosis of acute cholecystitis? ------CORRECT ANSWER---------------RUQ