Concepts in GI Assessment Flashcards

1
Q

What is dyspepsia?

A

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

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2
Q

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

A

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

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3
Q

What are some complications of GERD?

A

asthma, hoarseness, dental erosions

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4
Q

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

A

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

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5
Q

When do you refer to EGD?

A

anemia
+FOB
any red flag symptoms or findings

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6
Q

What is a major red flag sx for upper GI?

A

unexplained wt loss

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7
Q

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

A

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

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8
Q

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

A

PPI for acid suppression
treat for H pylori
address lifestyle issues

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9
Q

How does biliary dz present?

A
RUQ
colicky pain as stone moves thru common duct
some nausea
radiates to lower ribs & back
\+ Murphy's sign
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10
Q

Test of choice for biliary dz?

A

Transabdominal US

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11
Q

How does acute cholecystitis or choledocolithiasis present?

A

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

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12
Q

What is a major PE finding assoc w/ dyspepsia?

A

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

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13
Q

What are causes of conjugated hyperbilirubinemia?

A

hepatocellular dysfunction

biliary obstruction

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14
Q

What are signs & sxs of hepatocellular dysfunction?

A

Non infectious (pruritis, light colored stools, jaundice)

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

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15
Q

What are signs & sxs of biliary obstruction?

A
RUQ pain
jaundice
pruritis
dark urine
light colored stools
*unintentional wt loss (red flag)
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16
Q

What do you assess in pt w/ hyperBR?

A

assess for ascites (fluid wave)

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17
Q

What are signs & sxs of pancreatitis?

A

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

18
Q

What are risk factors from pt history for pancreatitis?

A
comorbidities
alcohol
medications
abdominal trauma
previous episode
19
Q

What are the lab results assoc w/ pancreatitis?

A
elevated serum amylase & LIPASE
leukocytosis
proteinuria
hyperglycemia & glycosuria
elevated serum BR
elevated BUN, ALT
20
Q

When does ALT indicated biliary pancreatitis?

A

if ALT>150

21
Q

What imaging is done for pancreatitis?

A

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

22
Q

What is the workup/plan for acute pancreatitis?

A

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

23
Q

Chapman point for esophagus

A

btwn rib 2 & 3 parasternally

24
Q

Chapman point for stomach

A

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

25
Q

Chapman point for liver

A

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

26
Q

Chapman point for pancreas

A

btwn rib 6-7 @ costochondral junction on RIGHT

27
Q

Chapman point for small intestines

A

btwn rib 8-11 bilateral @ costochondral junction

28
Q

What are some signs & sxs of constipation?

A

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

29
Q

What is most important regarding constipation?

A

pattern or change in pattern of normal bowel habits

30
Q

What are important aspects of pt history for colitis?

A

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

31
Q

What are PE findings assoc w/ colitis?

A

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

32
Q

What is diverticulosis?

A

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)

33
Q

What is diverticulitis?

A

inflammation of diverticuli leads to microperoforation & localized paracolic inflammation

can rupture & develop into an abscess

34
Q

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

A

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

35
Q

How does diverticulitis present?

A
age>60
abdominal pain
tenesmus, CONSTIPATION, diarrhea, hematochezia
may have fever
may have had previous episode
palpable mass on affected side
peritonitis
36
Q

How does IBD present?

A
age>60
abdominal pain
tenesmus, diarrhea, hematochezia (no constipation)
CD + fever
UC may have insidious onset
acute CD may have palpable RLQ mass
peritonitis
37
Q

What is on the DDX for infectious IBD?

A

Salmonella, C diff, E coli, Shigella, Yersinea

TB, HIV, CMV, HSV

fungal & parasitic infections

38
Q

What is on the DDX for non infectious IBD?

A
appendicitis
diverticulitis
ischemic colitis
neoplasm
drugs & chemical (NSAIDs, gold, cocaine)
39
Q

What should a PE for GI complaint include?

A

CV system
skin, mucous membranes
renal
neuro

40
Q

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

A

extensive history & ROS required

similar episodes?
bowel habits (frequency, color shape)