Common manifestations of GI disorders

Question 1

How to categorise abdominal pain for physical assessment?

Answer 1

upper GI
Lower GI
Non- GI that can cause pain

Question 2

common diagnosis for Upper GI

Answer 2

GERD ( gastroesophageal reflux disease)
Gastritis
gastric/ duodenal ulcers, biliary colic ( gall bladder stones) , pancreatitis,
maglinancy

Question 3

What organs are in upper GI?

Answer 3

liver, oesophagus, stomach, gall bladder, pancreas, bile duct

Question 4

what are the common diagnosis for lower GI?

Answer 4

functional bowel disorders
Inflammatory bowel diasease
diverticulosis
mechnical obstruction
maglinancy
appendicitis

Question 5

what are the organs in lower GI?

Answer 5

large intestine, small intestine, rectum, appendix

Question 6

What are the common diagnosis that are non GI related but presents with abdominal pain?

Answer 6

Genitourinary ( stones/ UTI, pyelonephritis)
Reproductive ( endometriosis, ovarian cysts, uterine fibroids)
Maglinancy

rare case: chest structures may promote pain in the upper abdomen which might radiate to umbilicus- belly button.

MI and pneumonia/emphyema can present this way too.

Question 7

how many types of abdominal pain are there?

Answer 7

3
- visceral pain
-parietal pain
- referred pain

Question 8

WHat is visceral pain?

Answer 8

• dull or achy pain
• originate in hollow organs (stomach, intestines, gallbladder, bladder, and rectum.) and capsules of solid organs
• corresponds to embryonic development

Question 9

what is parietal pain?

Answer 9

due to stretching or irritation of parietal peritoneum
- pain is usually sharper.

Question 10

what is referred pain?

Answer 10

• felt at a site far from diseased organ
• gallbladder pain felt from right shoulder. cholecystitis too.

Question 11

what is the common condition that causes pain to radiate to the back?

Answer 11

pancreatitis

Question 12

what is dysphagia?

Answer 12

difficulty swallowing

Question 13

what is odynophagia

Answer 13

pain with swallowing

Question 14

what are the types of oesophageal dysphagia?

Answer 14

dysphagia to solid- mechanical obstruction
dysphagia to liquids/ both liquid and solid = motility disorder or complete obstruction

Question 15

how to diagnose dysphagia?

Answer 15

• barium swallow
• upper endoscopy
• oesophageal manometry ( monitor pressure in oesphagus as pt swallows)
• pH monitoring ( insert pH monitor)

Question 16

what is associated with bird’s beak on barrium swallow?

Answer 16

achalasia

Question 17

which electrolytes to worry about when u have diarrhea?

Answer 17

bicarbs and potassium. then metabolic acidosis

Question 18

what are the mechanisms of diarrhea?

Answer 18

• osmotic ( water, lactose intolerant )
• secretory ( tumour secrete fluid into lumen of intestine)
• altered motility ( fat malabsorption, increase in colonic secretion)
• exudative diarrhea ( damage to mucosa- blood )
• anorectal dysfunction result in involuntary loss of stool, incontinence.

Question 19

what causes osmotic diarrhea and describe it?

Answer 19

• carbohydrate maldigestion ( lactase - disaccharidase deficiency), non absorbed solutes - mannitol.
• large stool volume, osmolar gap > 100
  stops with fasting.
  pH<6

Question 20

what causes secretory diarrhea and describe it?

Answer 20

• bacterial toxins ( E.coli)
• hormonal peptide eg. serotonin ( carcinoid tumour)
• excessive gastric acid’
• laxative abuse - senna
• bile salt malabsorption
• large stool volume, persistent diarrhea with fasting. osmolar gap > 50

Question 21

what causes abnormal motility?

Answer 21

dumping syndrome
increased motility,
hyperthyroid carcinoma.

decreased motility can cause bacterial overgrowth which in turn cause diarrhea,

Question 22

what causes exudative diarrhea?

Answer 22

inflammatory bowel disease such as ulcerative colitis, infection, diverticulitis,

ulcer and stool inside then got blood.

Question 23

what does the presence of 5HIAA in the urine means

Answer 23

detection of carcinoid tumour

Question 24

causes of primary constipation

Answer 24

• slow transit: prolonged stool transit through colon
• dyssynergic defecation: difficulty with expelling stool from anorectum
  -irritable bowel syndrome - altered bowel habits with abdominal pain.

Question 25

causes of secondary constipation

Answer 25

meds- opiods, endocrine disorders, neurologic disorders