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GIHEP > 17. Gastroenterology Symptoms Based Approach > Flashcards

17. Gastroenterology Symptoms Based Approach Flashcards

1
Q

What are symptoms of GI disease?

8

A
  1. Oral disease
  2. Oesophageal disease
  3. Abdominal pain
  4. Hematemesis / meleana
  5. Rectal bleeding
  6. Diarrhoea
  7. Weight loss
  8. Bloating / abdominal distension
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2
Q

What are symptoms of oesophageal disease?

7

A
  1. Heartburn
  2. Regurgitation
  3. Chest pain
  4. Dysphasia
  5. Odynophagia
  6. Globus sensation
  7. Water brash
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3
Q

What is dysphasia?

What are the clinical presentation of achalasia?

What S+S present if it is a pharyngeal cause?

What are mechanical causes of dysphasia?
(4)

What are the neuromuscular causes of dysphasia?
(2)

A

Progressive, food > liquids, bolus obstruction, suggests luminal cause, cancer, or peptic stricture

Achalasia: long history, regurgitation, chest pain

Pharyngeal cause: coughing, aspiration, gurgling

MECHANICAL

  1. Oesophageal cancer
  2. Peptic stricture
  3. Achalasia
  4. Inflammatory (esophagitis)

NEUROMUSCULAR

  1. Diffuse oesophageal spasm
  2. Central causes (CVA, bulbar palsy)
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4
Q

What is a globus pharyngeus?

What investigations do you perform?
3

A

Sensation of constant lump in throat without any difficulty swallowing
- Seen in patients with emotional disorders (women)

INVESTIGATIONS

  1. Endoscopy
  2. Barium studies
  3. Manometry
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5
Q

What are webs?

What is a Schataski Ring?

A

Webs: congenital or inflammatory
- Patients may be asymptomatic or experience intermittent dysphasia to solids

Schatski Ring: thin web like constriction located at squamocolumnar mucosal junction or near border of LES
- CP: dysphagia to solids

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6
Q

What questions do you ask when taking a history for abdominal pain?
(7)

A
  1. Quality: what is the pain like?
  2. Location: where is the pain?
  3. Radiation: does it radiate?
  4. Timing: did it start suddenly or gradually?
  5. Connection (reference to eating): any connection with eating?
  6. What aggravates or relieves the pain?
  7. What symptoms are associated with the pain?
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7
Q

What is hematemesis?

What is meleana?

What is hematochezia?

What is occult GI bleeding:

A

Hematemesis: vomitus of red blood

Melaena: black, tarry, foul-smelling stool

Hematochezia: passage of red / maroon blood from rectum

Occult GI bleeding: clinically silent GI bleeding usually presenting with signs of anaemia (pallor, dyspnoea, angina)

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8
Q

What are causes of Upper GI bleed?

6

A
  1. Mallory Weiss (5%)
  2. Oesophagitis (6%)
  3. Erosions / dudoenitits (12%)
  4. Varies (13%)
  5. Gastric ulcer (20%)
  6. Duodenal ulcer (24%)
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9
Q

What are the rare causes of Upper GI Bleed?

6

A
  1. AVM / gastric ectasia
  2. Dielafoy’s lesion
  3. Haemobilia
  4. Aorto-enteric fistula
  5. Neoplasms
  6. Oesophageal ulcers
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10
Q

What are causes of lower GI bleeding?

7

A
  1. Ishcaemia (6%)
  2. IBD / colitis (6%)
  3. Neoplasia (7%)
  4. Other (11%)
  5. Anorectal (12%)
  6. Unknown (23%)
  7. Diverticulosis (35%)
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11
Q

What do you ask / look for when taking a history of GI bleeding?
(8)

A
  1. Confirm GI bleed (not a nosebleed or haemotypsis)
  2. Bright red / melaena / coffee ground
    3 Dyspepsia / heartburn / weight loss
  3. Retching
  4. Past history: previous PUD, bleed
  5. Alcohol
  6. Drug: NSAIDs, Aspirin, Warfarin
  7. Occupation
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12
Q

What do you ask / look for when taking a history of lower GI bleeding?
(6)

A
  1. Colour (bright red / dark red)
  2. Volume
  3. Mixed or separate to stool
  4. Stool consistency (diarrhoea, constipation)
  5. Abdominal pain
  6. Associated features (weight loss, ischaemic heart disease, abdominal mass)
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13
Q

What is diarrhoea?

How is characterized?
(6)

What is the difference between small bowel (5) and large bowel diarrhoea (4)?

A

Diarrhoea: increased frequency and liquidity of faecal evacuation

CHARACTERISTICS

  1. Increased stool frequency (>3/day)
  2. Poorly formed / runny / watery stools
  3. Increased stool weight (>250gr/day)
  4. Acute: <7 days
  5. Persistent: 14-21d
  6. Chronic: > 1 month

SMALL BOWEL DIARRHOEA

  1. Watery
  2. Large volume
  3. Cramping, bloating, gas
  4. Weight loss
  5. No blood, rarely fever

LARGE BOWEL DIARRHOEA

  1. Frequent
  2. Small volume
  3. Blood, mucus
  4. Fever
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14
Q

How do you assess for diarrhoea?
(2)

What history will present with diarrhoea?
(8)

What is the clinical presentation of diarrhoea?
(7)

What is functional vs. Pathological diarrhoea?
(6)

What are clinical features of stool?
(4)

A

ASSESSMENT

  1. Duration: acute, persistent, chronic
  2. Severity:
    - profuse watery diarrhoea with dehydration
    - blood and mucus
    - fever > 38.5
    - >6 stools/ 24h
    - severe abdominal pain
    - diarrhoea in elderly or immunocompromised

HISTORY

  1. Onset: congenital, abrupt, gradual
  2. Pattern: continuous, intermittent
  3. Epidemiology: travel, contacts, contaminated food
  4. Fam hx
  5. Systemic: pain, weight loss
  6. Aggravating: stress, diet, alcohol
  7. Iatrogenic: drugs, surgery, radiation
  8. Incontinence

EXAMINATION

  1. Dehydration
  2. Malnutrition
  3. Mouth ulcers
  4. Rashes
  5. Hepatomegaly / abdominal mass
  6. Arthritis
  7. Anorectal disease

FUNCTIONAL vs. PATHOLOGICAL

  1. General well being
  2. Stool pattern: meal related, morning diarrhoea
  3. Nocturnal symptoms
  4. Blood
  5. Systemic feature: weight loss, fever
  6. Incontinence

STOOL

  1. Watery
  2. Fatty
  3. Bloody
  4. Pebble / pencil
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15
Q

What is constipation?

What causes slow transit constipation?
(3)

What causes obstructive defeaction?
(1)

A

Persistent infrequent passage of hard (pellet link) stool
Rarely indicative of serious or underlying pathology

SLOW TRANSIT CONSTIPATION

  1. Hypothyroidism
  2. Hypercalcium
  3. Idiopathic / dietary

OBSTRUCTIVE DEFEACTION
1. Pelvic floor dysfunction

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16
Q

What causes abdominal distension?

5

A

5Fs:

  1. Fluid
  2. Faeces
  3. Flatus
  4. Foetus
  5. Fat
  • Usually functional
  • Coeilac disease, lactase deficiency
  • Consumption of legumes or fibre
  • Inhibition of gas evacuation (mechanical or paralytic ileus)
  • Decreased absorption of gases across bowel wall (congestive heart failure, portal congestion in cirrhosis patients)

GIHEP (3 decks)

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