Seven years into my nurse practitioner career, I still recite many of the mnemonics from my nurse practitioner school days. “Female, fat, fertile and forty…”, yep, this patient fits the bill for an acute cholecystitis diagnosis… A few simple memorization tricks can make life as an NP student much more manageable. So, next time you’re studying for an anatomy final or preparing to be grilled on your next clinical rotation, have a few mnemonics up your sleeve.
Here are a few of my favorite mnemonics relating to assessment, diagnosis and treatment of gastrointestinal system disorders that just might help nurse practitioners to-be.
Abdominal Assessment: Physical Exam
What is the physical exam telling you? Simply remember DR. GERM.
Distension (Liver problems, bowel obstruction)
Rigidity (Board like, caused by internal bleeding)
Guarding
Ecchymosis (Blunt abdominal trauma, ruptured ectopic, acute pancreatitis, ruptured aortic aneurysm, spontaneous bleeding related to anticoagulopathy)
Rebound tenderness (Infection)
Masses (Neoplasm)
Abdominal Assessment: Signs of Chronic Liver Disease
It’s as simple as ABCDEFGHIJ.
Ascites, Atrophy of testicles, Ankle edema, Asterixis
Bruising
Clubbing, Color change of nails
Dupuytren’s Contracture
Encephalopathy, Erythema of palms
Foetor hepaticus
Gynecomastia
Hepatomegaly
Increased parotid size
Jaundice
Differential Diagnoses: Causes of Acute Abdominal Pain
What’s going on with your patient’s BAD GUT PAINS?
Bowel Obstruction
Appendicitis, Adenitis (mesenteric)
Diverticulitis, Diabetic Ketoacidosis, Diarrhea, Drug withdrawal
Gastroenteritis, Gallbladder disease
Urinary tract obstruction (stone), Urinary tract infection
Testicular torsion, toxin (lead)
Pneumonia, Pleurisy, Pancreatitis, Perforated bowel
Abdominal aneurysm
INfarcted bowel, Infarcted myocardium, Incarcerated hernia, Inflammatory bowel disease
Splenic rupture/infection, Sickle cell crisis
Differential Diagnoses: Causes of Abdominal Swelling
Swollen? Bloated? Distended? The 9 F’s may be the key to your diagnosis.
Fat (Time to hit the gym…)
Feces (Constipation, bowel obstruction)
Fluid (Ascites)
Flatus (Diet, dysphagia)
Fetus (Hey, preggo…)
Full-sized tumors
Full bladder (Urinary retention)
Fibroids
False pregnancy
Differential Diagnoses: Causes of Hepatomegaly
Keep the 3 common and 3 rarer C’s in mind when looking for the cause of an enlarged liver.
3 Common C’s
Cirrhosis
Carcinoma
Cardiac Failure
3 Rarer C’s:
Cholestasis
Cysts
Cellular Infiltration
Differential Diagnoses: Vomiting
Vomiting may not be an indication of an abdoninal diagnosis. Don’t overlook extra GI causes!
Vestibular disturbance or Vagal causes
Opiates
Migraine or Metabolic causes (DKA, gastroparesis, hypercalcemia)
Infections
Toxcicity (cytotoxic, digitalis toxicity)
Increased ICP, Ingested alcohol
Neurogenic, psychogenic
Gestation
Differential Diagnoses: Right Lower Quadrant Abdominal Pain
Appendicitis is not always to blame. But, the word can aid in identifying other possibilities.
Appendicitis
Pelvic Inflammatory Disease, Period (menstrual)
Pancreatitis
Endometriosis, Ectopic Pregnancy
Neoplasia
Diverticulitis
Intussusception
Cyst
Inflammatory Bowel Disease
Torsion (ovarian)
Irritable Bowel Syndrome
Stones
Treatment: H. Pylori Regimen
‘Please Make Tummy Better’ is a common request of patients with H. pylori. Here’s how to make it happen.
Proton Pump Inhibitor
Metronidazole
Tetracycline
Bismuth
Which mnemonics help you as a nurse practitioner student?
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