Clinical Approach to GI Disease

Question 1

what are the 14 signs of GI disease?

Answer 1

vomiting regurgitation

diarrhea abdominal pain

tenesmus dyschezia

hematochezia constipation

flatus salivation (ptyalism)

shock weight loss

anemia change in appetite

Question 2

what disorders can vomiting be associated with?

Answer 2

• GI disease
• abdominal disease
• systemic/metabolic/endocrine disease
• neurologic disease

Question 3

what type of vomiting points to delayed gastric emptying?

Answer 3

food vomited more than 10-12 hours after eating (food usually cleared in 12-14 hours)

Question 4

what are the causes of regurgitation

Answer 4

• esophageal inflammatory disease
• extraluminal esophageal compression
• intraluminal esophageal obstruction
• neuromuscular dysfunction

Question 5

how to differentiate between vomiting and regurgitation?

Answer 5

• regurgitation: passive, few pre-episode signs, ptyalism, semiformed material (pH unreliable)
• vomiting: active, abdominal contraction, retching/heaving, ptyalism, swallowing, can be very variable

Question 6

what are the signs of small intestinal diarrhea?

Answer 6

• bulky or fatty stools (maldigestion/malabsorption)
• melena
• only a few diarrhea bowel movements per day

Question 7

what are the signs of acute SI diarrhea?

Answer 7

• <48 hr duration
• seldomly has mucus
• brown/red color
• sense of urgency and increased frequency
• symptomatic therapy is effective

Question 8

what are the signs of chronic SI diarrhea?

Answer 8

• 7-10+ days
• large volume
• no mucus or fresh blood
• steatorrhea
• little urgency
• tenesmus
• frequency 2-3x/day
• weight loss
• must get a specific diagnosis for therapy

Question 9

what are the signs of large intestinal diarrhea?

Answer 9

• sudden urgency
• tenesmus and dyschezia
• excessive mucus
• fresh blood
• small volume
• high frequency (>5x/day)

Question 10

what are the signs of chronic LI diarrhea?

Answer 10

• 7-10 days
• small volume
• lots of mucus (maybe some blood)
• urgency, tenesmus, sometimes dyschezia
• can either do symptomatic therapy or get specific diagnosis

Question 11

what are the signs of acute LI diarrhea?

Answer 11

• uncommon
• <48 hr
• lots of mucus and probably blood
• urgency
• sudden increase in frequency
• give symptomatic therapy, can turn into chronic disease

Question 12

what are the 5 mechanisms of weight loss?

Answer 12

• decreased nutrient intake
• maldigestion/malabsorption
• malassimilation (nutrients are available but not utilized properly, liver or kidney failure)
• excessive utilization
• increased loss of nutrients
• (may also be caused by intestinal parasites)

Question 13

what is the proper approach to diagnosing GI disease?

Answer 13

• take history
• physical findings from thorough exam
• create differentials diagnoses
• diagnostic studies

Question 14

what are the 3 groups of confirmatory diagnostic procedures to eliminate options?

Answer 14

• clinical laboratory studies
  
  • essential (CBC/chem/UA, fecal) vs. confirmatory (amylase, lipase, PLI, TLI, serum folate/cobalamin, FAP)
• radiographs and other imaging (survey, contrast, u/s)
• specific diagnostic procedures (endoscopy, biopsy, abdominal explore)