CLIN GIT Systems Review - Week 4 Flashcards
GIT Systems Review Qs
- Abdominal pain
o Do you ever suffer from stomach/abdominal/tummy pain? Acute or chronic? Onset? Frequency? Radiation ? Character ? Aggravating and reliving factors? - Nausea
o Do you ever feel nauseated? - Vomiting
o Do you ever vomit? Timing ? Contents ? - Haematemesis
o Do you ever vomit up blood? - GORD/Heartburn
o Do you ever feel like there is acid at the back of your chest, throat or neck? Is it worse on laying down or after eating particular foods? Waterbrush ? Does smoking, alcohol, chocolate, Ca2+ channel blockers, coffee make it worse? - Post-prandial fullness /Early satiation
o Do you feel fuller than normal after meals? Do you feel fuller sooner when eating? - Dysphagia/Odynophagia
o Do you ever have difficulty swallowing? Do you ever experience pain when swallowing? - Bowel habits
o Have you noticed any changes in your bowel habits? Diarrhoea – acute/chronic, confirm what is meant by the term ‘diarrhoea,’ character (appearance & smell), volume? Constipation – acute/chronic, confirm what is meant by the term ‘constipation,’ medications, past history, excessive straining, associated pain/discomfort? - Blood in stools
o Have you ever noticed blood in your stools? Is it fresh, mixed in or dark ? - Mucous in stools
o Have you noticed any mucous in your stools? - Flatus
o Are you passing wind? - Bloating/distension
o Have you noticed any bloating? Ankle oedema? Swelling ? - Liver
o Have you noticed any change in the colour of your skin, eyes, urine and/or bowel movements? Jaundice? Icterus ? Have you had an itch ? Any associated abdominal pain? - Systemic symptoms
o Have you had any fevers recently? Lethargy ? Appetite? Change of weight? Travel? Iron-deficiency anaemia?
Abdo pain that radiates to the back may indicate
Pancreatic disease, peptic ulcer
Abdo pain that radiates to the shoulder may indicate
Diaphragmatic irritation
Abdo pain that radiates to the throat may indicate
Oesophageal reflux or spasm.
Dull or burning abdo pain, often relieved by food or antacids may indicate
Peptic ulcer disease.
Steady epigastric pain that is relieved by sitting up and leaning forward w radiation to the back may indicate
Pathology of the pancreas.
Severe, unpredictable, constant pain which can last for hours may indicate
Biliary colic/Cholelithiasis. Shift to RUQ may indicate cholecystitis.
Colicky pain (coming and going in waves) is related to ____ movements and may indicate
Bowel obstruction, ureter obstruction.
Frequent waves suggest and less frequent waves
Small bowel obstruction (every 2-3 mins). Large bowel obstruction (every 10-15 mins).
Vomiting may indicate
GIT infections, pregnancy, drug reactions, peptic ulcer disease, motor disorders, acute hepatobiliary disease, alcoholism, psychogenic vomiting, eating disorders, increased intracranial pressure, gastric outlet obstruction, gastroparesis.
Vomiting >1hr post meal may indicate
Gastric outlet obstruction, gastroparesis.
Early morning vomiting before eating may indicate
Pregnancy, alcoholism, raised intracranial pressure.
Vomiting bile may indicate
Open connection btw duodenum & stomach.
Vomiting old food may indicate
Gastric outlet obstruction.
Vomiting white blood may indicate
Ulceration.
Define waterbrush
Excessive secretion of saliva into the mouth.
Waterbrush may indicate
Peptic ulcer disease or esophagitis.
Post-prandial fullness may indicate
Functional dyspepsia.
Early satiation may indicate
Gastric cancer, peptic ulcer/s
3 causes of watery & high volume stools
Secretory diarrhoea - net secretion of the colon small bowel > absorption which persists when the pt fasts, w/out pus/blood, stools are not excessively fatty
Osmotic diarrhoea - large-volume stools related to the ingestion of food due to excessive solute drag which disappears when the pt fasts
Abnormal intestinal motility
Secretory diarrhoea may indicate
Infections, hormonal conditions, villous adenoma.
Osmotic diarrhoea may indicate
Lactose intolerance, magnesium antacids, gastric surgery.
Abnormal intestinal motility may indicate
Thyrotoxicosis, irritable bowel syndrome.
Stool containing blood or mucous may be caused by
Exudative diarrhoea - small-volume stools but frequent which may have blood/mucous
Exudative diarrhoea may indicate
Inflammatory bowel disease, colon cancer.
Fatty stools may indicate
Malabsorption - fatty, pale-coloured, smelly, float, difficult to flush
Fatty stools may indicate
Severe pancreatic disease.
Constipation may refer to
Both the infrequent passage of stools (<3/wk), hard stools or stools that are difficult to evacuate.
Causes of constipation
Habitual neglect of the impulse to defecate, medications, hypothyroidism, hypercalcaemia, diabetes mellitus, phaechromocytoma, porphyria, hypokalaemia, aganglionosis, Hirschsprung’s disease, autonomic neuropathy, spinal cord injury, MS, partial colonic obstruction due to carcinoma, slow-transit constipation, late stages of pregnancy, irritable bowel syndrome.
Mucous in stools may indicate
Solitary rectal ulcer, fistula, villous adenoma, irritable bowel syndrome.
Abdominal distension/swelling may indicate
Ascitic fluid accumulation.
What is pruritis?
Itching.
Pruritis may indicate
Cholestatic liver disease.
Fatigue (in GIT cases) may indicate
Acute or chronic liver disease, anaemia due to gastrointestinal or chronic inflammatory disease.
PMHx hepatits may predispose to
Cirrhosis, liver failure, cancer.
PMHx gallstones may predispose to
Potential complications
PMHx diabetes may predispose to
Fatty liver disease
FHx gastrointestinal disease may predispose to
IBD, coelic disease, gallstones, colon cancer
MHx of prolonged NSAID use may predispose to
Peptic ulcer disease
MHX statins may predipose to
Liver disease
MHx recreational drug use may predipose to
Blood-borne viruses.
MHx anabolic steroids, contraceptive pill may predispose to
Dose-related cholectasis, peliosis.
MHx alcohol, tetracycline, valproic acid, amiodarone may predispose to
Fatty liver.
MHx acetominophen overdose may predispose to
Acute liver cell necrosis.
PMHx of general anaesthetic may predispose to
Jaundice, hypoxaemia of liver cells, direct damage to the bile duct during abdominal surgery
PMHx of relapsing & remitting epigastric pain for pt presenting w severe epigastric pain may predispose to
Peptic ulcer perforation.
RUQ pain and fever may indicate
Acute cholecystitis.
Jaundice, pain in the RUQ & fever may indicate
Acute cholangitis.
RUQ pain & jaundice may indicate
Choledocholithiasis.
Sudden attack of abdominal pain epigastric pain, w tachycardia and sweating may indicate
Large AAA or ruptured AAA.
Haematemesis may be caused by
Peptic ulcer, ruptured oesophageal variocele, Mallory-Weiss tear.
Name for fresh blood in stools =
Haemochezia.
Name for dark blood in stools =
Melaena.
