Concepts in GI Assessment

Question 1

What is dyspepsia?

Answer 1

epigastric pain assoc w/ nausea (look for Chapman point for esophagus & stomach)

Question 2

What should you look for on PE in pt w/ upper GI complaint?

Answer 2

look for signs of anemia (pallor, chelitis, tachycardia, hypotension)

Question 3

What are some complications of GERD?

Answer 3

asthma, hoarseness, dental erosions

Question 4

What are important ROS red flag sxs for upper GI complaint?

Answer 4

syncope, light-headedness, melena or hematochezia, dysphagia, odynophagia

Question 5

When do you refer to EGD?

Answer 5

anemia
+FOB
any red flag symptoms or findings

Question 6

What is a major red flag sx for upper GI?

Answer 6

unexplained wt loss

Question 7

What is the workup for a pt w/ upper GI complaint?

Answer 7

Fecal Occult Blood (FOB)
assess for current H pylori infxn
consider CBC if concern for anemia
Radiography is NOT indicated

Question 8

What is the tx for pt w/ upper GI complaint?

Answer 8

PPI for acid suppression
treat for H pylori
address lifestyle issues

Question 9

How does biliary dz present?

Answer 9

RUQ
colicky pain as stone moves thru common duct
some nausea
radiates to lower ribs & back
\+ Murphy's sign

Question 10

Test of choice for biliary dz?

Answer 10

Transabdominal US

Question 11

How does acute cholecystitis or choledocolithiasis present?

Answer 11

fever, N/V, RUQ pain
+/- colicky, +/i infection
presence of stone obstructing cystic duct (may progress to cholangitis)

Question 12

What is a major PE finding assoc w/ dyspepsia?

Answer 12

SCLERAL ICTERUS (yellowing of sclera b/c deposition of BR)

Question 13

What are causes of conjugated hyperbilirubinemia?

Answer 13

hepatocellular dysfunction

biliary obstruction

Question 14

What are signs & sxs of hepatocellular dysfunction?

Answer 14

Non infectious (pruritis, light colored stools, jaundice)

Infectious (constitutional sxs, low grade fever, RUQ pain, jaundice, enlarged liver)

Question 15

What are signs & sxs of biliary obstruction?

Answer 15

RUQ pain
jaundice
pruritis
dark urine
light colored stools
*unintentional wt loss (red flag)

Question 16

What do you assess in pt w/ hyperBR?

Answer 16

assess for ascites (fluid wave)

Question 17

What are signs & sxs of pancreatitis?

Answer 17

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

Question 18

What are risk factors from pt history for pancreatitis?

Answer 18

comorbidities
alcohol
medications
abdominal trauma
previous episode

Question 19

What are the lab results assoc w/ pancreatitis?

Answer 19

elevated serum amylase & LIPASE
leukocytosis
proteinuria
hyperglycemia & glycosuria
elevated serum BR
elevated BUN, ALT

Question 20

When does ALT indicated biliary pancreatitis?

Answer 20

if ALT>150

Question 21

What imaging is done for pancreatitis?

Answer 21

CT usually obtained, MRI w/ contrast will be more sensitive

Question 22

What is the workup/plan for acute pancreatitis?

Answer 22

NPO
pain management
hydration/fluid resuscitation
identify & correct underlying cause

Question 23

Chapman point for esophagus

Answer 23

btwn rib 2 & 3 parasternally

Question 24

Chapman point for stomach

Answer 24

btwn rib 5-6 & 6-7 @ costochondral junction on LEFT

Question 25

Chapman point for liver

Answer 25

btwn rib 5-6 & 6-7 @ costochondral junction on RIGHT

Question 26

Chapman point for pancreas

Answer 26

btwn rib 6-7 @ costochondral junction on RIGHT

Question 27

Chapman point for small intestines

Answer 27

btwn rib 8-11 bilateral @ costochondral junction

Question 28

What are some signs & sxs of constipation?

Answer 28

less than 3BM/week excessive straining hard or dry stools sense of incomplete evacuation

Question 29

What is most important regarding constipation?

Answer 29

pattern or change in pattern of normal bowel habits

Question 30

What are important aspects of pt history for colitis?

Answer 30

Previous episodes Constitutional sxs ROS (joint pain, rashes, lesions, sores in mouth, wt loss) Bowel habits (color change, texture, frequency, diet)

Question 31

What are PE findings assoc w/ colitis?

Answer 31

sick or not sick VS w/ fever & tachycardia HEENT for apthous ulcers Ab exam for deep palpation, guarding, rebound

Question 32

What is diverticulosis?

Answer 32

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)

Question 33

What is diverticulitis?

Answer 33

inflammation of diverticuli leads to microperoforation & localized paracolic inflammation can rupture & develop into an abscess

Question 34

What is the workup/plan for sigmoid diverticula w/ adjacent inflammatory changes?

Answer 34

NPO or clear liquid diet Fluid maintenance or resuscitation Antibiotics (gram negative & anaerobic coverage)

Question 35

How does diverticulitis present?

Answer 35

``` age>60 abdominal pain tenesmus, CONSTIPATION, diarrhea, hematochezia may have fever may have had previous episode palpable mass on affected side peritonitis ```

Question 36

How does IBD present?

Answer 36

``` age>60 abdominal pain tenesmus, diarrhea, hematochezia (no constipation) CD + fever UC may have insidious onset acute CD may have palpable RLQ mass peritonitis ```

Question 37

What is on the DDX for infectious IBD?

Answer 37

Salmonella, C diff, E coli, Shigella, Yersinea TB, HIV, CMV, HSV fungal & parasitic infections

Question 38

What is on the DDX for non infectious IBD?

Answer 38

``` appendicitis diverticulitis ischemic colitis neoplasm drugs & chemical (NSAIDs, gold, cocaine) ```

Question 39

What should a PE for GI complaint include?

Answer 39

CV system skin, mucous membranes renal neuro

Question 40

What should a history & ROS focus on for GI complaint?

Answer 40

extensive history & ROS required ``` similar episodes? bowel habits (frequency, color shape) ```