Acute Illness-GI

Question 1

What is the classification of diarrhea?

Answer 1

Characterized by an abnormally high fluid content in stool due to imbalance in physiology of small and large intestinal processes. Typically has increased frequency in BMs (3 times in a 24 hour period). NORMAL BOWEL PATTERNS =range from 1-3x/day to 2-3x/week

Diarrhea is classified by:

PATTERN: osmotic, secretory, exudative, motile

CAUSE: Infectious, noninfectious; most related to altered fluid and electrolyte transport within intestine-decreased absorption or increased secretion

DURATION: Acute(<14days)-self-limiting, Chronic (lasting >14 or 30 days-sources vary)

Question 2

What are the risk factors for diarrhea?

Answer 2

Foreign travel 
Exposure to contaminated food or water
Exposure to others who are infected 
Day care or institutional living 
Medication effects 
Recent antibiotics 
Lactose intolerance

Question 3

What are the categories of abdominal pain?

Answer 3

Acute pain: pain of less than a few days that has worsened progressively until presentation

Chronic pain: Pain lasting greater than 12 weeks and remaining unchanged over a period of months to years- Recurrent abdominal pain falls here too.

Subacute pain: pain lasting from a few days to several weeks

Emergent pain: pain that lasts 3 hours or longer, accompanied by fever or vomiting

Question 4

What are the causes of abdominal pain based on location on the abdomen?

Answer 4

LEFT UPPER QUADRANT PAIN:

• splenomegaly (pain discomfort in LUQ , left shoulder pain and/or early satiety)
• Splenic infarct (severe LUQ pain)
• Splenic abscess (associated with fever and LUQ tenderness)
• splenic rupture (may c/o LUQ, left chest wall, or left shoulder pain that is worse with inspiration)

EPIGASTRIC PAIN:

• acute MI
• acute pancreatitis
• chronic pancreatitis
• GERD
• gastritis/gastropathy
• functional dyspepsia
• gastroparesis

RIGHT UPPER QUADRANT PAIN:

• Biliary colic
• acute cholecystitis
• acute cholangitis
• sphincter of oddi dysfunction
• acute hepatitis
• liver abscess
• budd chiari syndrome
• portal vein thrombosis

LOWER ABDOMINAL PAIN:

• appendicitis
• diverticulitis
• nephrolythiasis ???
• pyelonephritis
• acute urinary retention
• cystitis
• infectious colitis

Women can have many more reasons for abdominal pain.

Question 5

What are the patterns of referred abdominal pain?

Answer 5

Pain from the viscera often(not always) localized according to the structure’s embryo logic origin, with foregut structures (mouth to proximal half of duodenum) presenting with upper abdominal pain. Midgut structures(distal half of duodenum to middle of transverse colon) presenting with periumbilical pain and hind gut structures (remainder of colon and rectum, pelvic genitournary organs) presenting with lower abdominal pain. Radiation of pain may provide insight into the diagnosis. As examples, pain from pancreatitis may radiate to the back, while pain from gallbladder disease may radiate to the right shoulder or subclavicular region.