Clinical Manifestations of GI Dysfunction

Question 1

1) Constipation

Answer 1

Infrequent or difficulty defecation

Normal: Two or three per day to one per week

Question 2

Normal transit (functional) constipation- pathophysiology

Answer 2

Normal rate of stool passage, but difficulty with stool evacuation from low-residue, low-fluid diet

Question 3

Slow transit constipation- pathophysiology

Answer 3

Impaired colonic motor activity with infrequent bowel movements and straining

Question 4

Pelvic floor dysfunction

Answer 4

(pelvic floor dyssynergia or anismus): Failure of the pelvic floor muscles or anal sphincter to relax with defecation
*Secondary: From an actual disease process or condition

Question 5

Constipation: clinical manifestations

Answer 5

(Two of the following for at least 3 months)

• Straining with defecation at least 25% of the time
• Lumpy or hard stools at least 25% of the time
• Sensation of incomplete emptying at least 25% of the time
• Manual maneuvers to facilitate stool evacuation for at least 25% of defecations
• Fewer than three bowel movements per week
• Fecal impaction: Hard, dry stool retained in rectum

Question 6

Constipation: treatment

Answer 6

• bowel retraining
• exercise
• increase fluid & fibre intake
• enemas
• stool softeners and laxatives

Question 7

2) Diarrhea

Answer 7

Increased frequency of bowel movements
Three or more per day
Increased volume, fluidity, weight of feces

Question 8

Diarrhea: Treatment

Answer 8

• Restore fluid and electrolyte balance
• Medications: Antimotility (loperamide [an opiate] or atropine [Lomotil]) and/or water absorbent (attapulgite and polycarbophil)
• Mild diarrhea: Natural bran and psyllium
• Clostridium difficile–associated diarrhea: Probiotics
• Fecal transplantation

Question 9

Systemic Manifestations of diarrhea

Answer 9

*Manifestations of acute bacterial or viral infection
- Fever, with or without cramping pain
*Manifestations of inflammatory bowel disease
Fever, cramping pain, bloody stools
*Manifestations of malabsorption syndromes
Steatorrhea (fat in the stools) and diarrhea

Question 10

3) Abdominal pain

Answer 10

From stretching, inflammation, or ischemia
Parietal (somatic) pain: In the peritoneum
Visceral pain: In the organs themselves
Referred pain: Felt in another area, usually the back

Question 11

Biochemical mediators of the inflammatory response

Answer 11

(histamine, bradykinin, and serotonin) stimulate pain nerve endings, producing abdominal pain.

Question 12

4) GI bleeding (upper & lower) + treatment

Answer 12

Upper GI bleeding: From the esophagus, stomach, or duodenum. Frank, bright red bleeding in emesis or digested blood (“coffee grounds”) in stool
Lower GI bleeding: From the jejunum, ileum, colon, or rectum
*Treatment: Blood products

Question 13

GI Bleeding: Hematemesis

Answer 13

bloody vomit

Question 14

GI Bleeding: Hematochezia

Answer 14

Bloody stools

Question 15

GI Bleeding: Melena

Answer 15

Black, tarry stools

Question 16

Occult Bleeding

Answer 16

not visible GI bleeding