3] GI, Hepatic And Biliary System Flashcards
GI disease can also appear to be
MSK disease
What is GI disease?
Ulceration of mucosal lining of GI tract
Primary GI pain pattern
Epigastric
Periumbilical
Lower abdomen (hypogastric)
What’s th epigastric region
Midsternum to xiphoid process
Where does pain in epigastric regions adiare
Around ribs or straight through chest
Structures in the epigastric region
Stomach
Esophagus
Duodenum
Pancreas
Innervation of epigastric region
T3-T5 sympathetic
DDx of epigastric region
HEart
Liver
Gallbladder
Structures in periumbilical region
Small intestine
Pancreas
Appendix
Proximal colon
Innervation of periumbilical region
T9 - T 11 sympathetic
Lower ab region structures
Large intestine
Colon
Innervation of Lower ab
T10 - L 2 sympathetic
DDx for lower ab region
Bladder
Uterus
Dermatomes associated with nerve roots innervating organs
Referred GI pain
Associated signs and sx for GI
Melena
Dysphagia
Etc
NMS signs and Sx
Paresthesias in UE, B&B signs, etc
Primary pain pattern for GI
Epigastric
Periumbilical
Lower ab
Chest
Referred pain pattern
Dermatomes of nerve roots associated with levels innervating diseased organs OR those having pressure/tension applied to them
Mid back, low back, shoulder, peri-scapular
Referred pain pattern for GI disease
With the GI system there is referred pain to…
MS system at the same level
Quality of visceral pain
Deep ache Boring Burning Cramping Gnawing
Associated signs and symptoms with GI
Dysphagia
Odynophagia
Bleeding (melena)
What is the Kehrs sign
Referred pain when you place pressure on upper abdomen
3 special tests for appendicitis
Rebound tenderness
Rovsings sign
Pinch an inch test
Rebound tenderness
Pain happens after you let go.
RLQ
Rovsings sign
+ is palpation of the LLQ of abs increases the pain felt in the RLQ
Pinch an inch test
McBurney’s point
+ pain with release
What is McBurney’s point
1/3 from ASIS to umbilical (where appendix is)
Possible extension of infection into peritoneum, kidneys, lumbar IVD or vertebra
Iliopsoas abscess
4 tests for Iliopsoas abscess
Heel tap
Hop test
Iliopsoas uscle test- active SLR
Palpation at appendix
3rd most common CA
Colorectal cancer
Colorectal cancer is more common in?
Males
Older age
Action of NSAIDs
Analgesic, anti-inflammatory, antipyretic, antithrombotic
Adverse drug reaction of NSAIDs
GI bleed, may lead to death
Other adverse rxns of NSAIDs
Renal toxicity Increased BP CNS problems Hepatoxicity CV
Signs and Sx of using NSAIDS
Indigestion
Increased BP
Tinnitus
Risk factors of NSAID induced gastric ulceration
More than 65 years
Corticosteroid, anticoagulant, antidepressant use
Hepatic means
Liver
Innervation of liver
T5 - T 11 ANS
Primary location
Midepigastrium or RUQ
Referred pain location of hepatic disease
T7-T10
R shoulder and upper trap
1 cause of sudden liver failure in the USA
Non-viral drug induced hepatitis
Innervation of gall bladder for biliary disease
T5-T11 ANS
Location of bile duct/gallbladder
RUQ
Referred pain of biliary disease or gallbladder
R shoulder, upper trap R interscapular (T4-T8) and R subscap
Cholelithiasis
Presence or formation of gall stones
Blockage or cystic duct by gallstones
Cholecystitis
Additional Sx of hepatic and biliary disease
Rhabdomyolysis
Joint aches
NM Sx
Liver flap
Asterixis
How do you do asterixis?
Pt raises arm to 90 flex, elbows ext and forearms pronated —> add wrist ext with finger ext and ABD and observe for any large amplitude tremors at the wrist (flapping)
Signs of hepatic and biliary disease
Skin and nail changes, asterixis, referred shoulder pain, ascites, cholecystitis test
Gallbladder special test
Murphys sign
What does Murphy’s sign indicate
Cholecystitis
How do you perform Murphy’s sign?
Hook fingers under lower R costal border. Ask pt to take a deep breath in, palpate liver and ask about pain while watching the face
Risk factors for ADRs
More than 65 years old Polypharmacy Hyperpharmacotherapy Alcohol Small Women
