Concepts in GI Assessment Flashcards
What is dyspepsia?
epigastric pain assoc w/ nausea (look for Chapman point for esophagus & stomach)
What should you look for on PE in pt w/ upper GI complaint?
look for signs of anemia (pallor, chelitis, tachycardia, hypotension)
What are some complications of GERD?
asthma, hoarseness, dental erosions
What are important ROS red flag sxs for upper GI complaint?
syncope, light-headedness, melena or hematochezia, dysphagia, odynophagia
When do you refer to EGD?
anemia
+FOB
any red flag symptoms or findings
What is a major red flag sx for upper GI?
unexplained wt loss
What is the workup for a pt w/ upper GI complaint?
Fecal Occult Blood (FOB)
assess for current H pylori infxn
consider CBC if concern for anemia
Radiography is NOT indicated
What is the tx for pt w/ upper GI complaint?
PPI for acid suppression
treat for H pylori
address lifestyle issues
How does biliary dz present?
RUQ colicky pain as stone moves thru common duct some nausea radiates to lower ribs & back \+ Murphy's sign
Test of choice for biliary dz?
Transabdominal US
How does acute cholecystitis or choledocolithiasis present?
fever, N/V, RUQ pain
+/- colicky, +/i infection
presence of stone obstructing cystic duct (may progress to cholangitis)
What is a major PE finding assoc w/ dyspepsia?
SCLERAL ICTERUS (yellowing of sclera b/c deposition of BR)
What are causes of conjugated hyperbilirubinemia?
hepatocellular dysfunction
biliary obstruction
What are signs & sxs of hepatocellular dysfunction?
Non infectious (pruritis, light colored stools, jaundice)
Infectious (constitutional sxs, low grade fever, RUQ pain, jaundice, enlarged liver)
What are signs & sxs of biliary obstruction?
RUQ pain jaundice pruritis dark urine light colored stools *unintentional wt loss (red flag)
What do you assess in pt w/ hyperBR?
assess for ascites (fluid wave)
What are signs & sxs of pancreatitis?
severe epigastric or periumbilical pain
N/V
fever, tachycardia, hypotension
epigastric rigid abdomen w/ percussion or light palpation OR guarding OR rebound pain (peritonitis)
hypoactive bowel sounds
What are risk factors from pt history for pancreatitis?
comorbidities alcohol medications abdominal trauma previous episode
What are the lab results assoc w/ pancreatitis?
elevated serum amylase & LIPASE leukocytosis proteinuria hyperglycemia & glycosuria elevated serum BR elevated BUN, ALT
When does ALT indicated biliary pancreatitis?
if ALT>150
What imaging is done for pancreatitis?
CT usually obtained, MRI w/ contrast will be more sensitive
What is the workup/plan for acute pancreatitis?
NPO
pain management
hydration/fluid resuscitation
identify & correct underlying cause
Chapman point for esophagus
btwn rib 2 & 3 parasternally
Chapman point for stomach
btwn rib 5-6 & 6-7 @ costochondral junction on LEFT
Chapman point for liver
btwn rib 5-6 & 6-7 @ costochondral junction on RIGHT
Chapman point for pancreas
btwn rib 6-7 @ costochondral junction on RIGHT
Chapman point for small intestines
btwn rib 8-11 bilateral @ costochondral junction
What are some signs & sxs of constipation?
less than 3BM/week
excessive straining
hard or dry stools
sense of incomplete evacuation
What is most important regarding constipation?
pattern or change in pattern of normal bowel habits
What are important aspects of pt history for colitis?
Previous episodes
Constitutional sxs
ROS (joint pain, rashes, lesions, sores in mouth, wt loss)
Bowel habits (color change, texture, frequency, diet)
What are PE findings assoc w/ colitis?
sick or not sick
VS w/ fever & tachycardia
HEENT for apthous ulcers
Ab exam for deep palpation, guarding, rebound
What is diverticulosis?
incidental finding on CT or colonoscopy
can occur anywhere in large bowel (usually left side/sigmoid colon)
assoc w/ low fiber/high fat diet b/c slows transit & increases pressure (leads to pseudodiverticuli)
What is diverticulitis?
inflammation of diverticuli leads to microperoforation & localized paracolic inflammation
can rupture & develop into an abscess
What is the workup/plan for sigmoid diverticula w/ adjacent inflammatory changes?
NPO or clear liquid diet
Fluid maintenance or resuscitation
Antibiotics (gram negative & anaerobic coverage)
How does diverticulitis present?
age>60 abdominal pain tenesmus, CONSTIPATION, diarrhea, hematochezia may have fever may have had previous episode palpable mass on affected side peritonitis
How does IBD present?
age>60 abdominal pain tenesmus, diarrhea, hematochezia (no constipation) CD + fever UC may have insidious onset acute CD may have palpable RLQ mass peritonitis
What is on the DDX for infectious IBD?
Salmonella, C diff, E coli, Shigella, Yersinea
TB, HIV, CMV, HSV
fungal & parasitic infections
What is on the DDX for non infectious IBD?
appendicitis diverticulitis ischemic colitis neoplasm drugs & chemical (NSAIDs, gold, cocaine)
What should a PE for GI complaint include?
CV system
skin, mucous membranes
renal
neuro
What should a history & ROS focus on for GI complaint?
extensive history & ROS required
similar episodes? bowel habits (frequency, color shape)
