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GIGU & Men’s Health > Gastric & Small Intestine Conditions > Flashcards

Gastric & Small Intestine Conditions Flashcards

1
Q

Symptoms of dyspepsia

A

-Epigastric pain/discomfort
-Bloating
-Feeling of fullness after meal
-Loss of appetite
-Anorexia
-Nausea/vomitting
-Pyrosis
-Regurgitation
-Belching

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2
Q

Sensation of pain or discomfort of fullness. May be accompanied by other symptoms.

A

Dyspepsia

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3
Q

Heartburn

A

Pyrosis

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4
Q

Backflow of food particles

A

Regurgitation

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5
Q

Sense of fullness. For gastric, may be located in epigastric area.

A

Bloating

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6
Q

Belching

A

Eructation

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7
Q

Vomiting of red blood. Suggests active bleeding

A

Hematmesis

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8
Q

Vomiting dark granular material. Suggest slowed or stopped bleeding

A

Coffee ground hematemesis

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9
Q

Black, tarry stool. Suggest upper GI bleeding

A

Melena

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10
Q

Gastric Conditions: Red Flags

A

• Chest pain
• Weight loss
• Abrupt, acute onset
• Severe pain
• Signs of shock
• Signs of peritonitis

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11
Q

Gastric Conditions: Complications

A

• Bleeding
• Malnutrition, dehydration
• IDA or B12 anemia
• Obstructive issues: gastric outlet syndrome
• Overuse of medication: Milk Alkali
• Life threatening: gastric cancer
• Emergency: perforation & peritonitis

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12
Q

Gastric Conditions: Exams

A

• Often do not provide evidence
• Possible procedures:
o Inspection: may see bloating? o Palpation: pain

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13
Q

Gastric Conditions: Diagnostic Procedures

A

• Endoscopy
• Barium swallow (esophagus, gastric, small intestine)
• Test for H pylori (breath, stool, blood tests)
• Tests for concomitant sx (IDA, B12, calcium, vitamin D)
• DP for complications (ex: heart, kidney)

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14
Q

• Hole or tear of the stomach, intestines or abdominal organs

A

Perforation

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15
Q

Causes of perforation

A

– Gastric conditions: gastritis, peptic ulcer

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16
Q

Symptoms of Perforation develop:

A

Suddenly; Severe pain followed by signs of shock (requires emergency care)

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17
Q

Peritoneal inflammation secondary to from any abdominal condition w/ an acute onset of severe abdominal pain
(Life threatening!)

A

Peritonitis

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18
Q

Defined as sensation of pain or discomfort in the upper
abdomen

A

Dyspepsia

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19
Q

Symptoms of Dyspepsia

A

Indigestion, gassiness, early satiety, postprandial fullness, gnawing, or burning

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20
Q

Red flags of nausea/vomiting

A

– Signs of hypovolemia
– Headache, stiff neck, or mental status change
– Peritoneal signs
– Distended, tympanic abdomen

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21
Q

Rectal bleeding

A

– Hematemesis: active bleeding
– Coffee ground: bleeding slowed/stopped
– Melena: tarry stool

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22
Q

Rumination Syndrome

A

• Unintentional spitting up or undigested or partially digested food
– After 15-30 min after eating
– After rechewed and swallowed
– Commonly observed in infants
– May be seen in children, adolescents, adults

(Considered a functional condition-may be part of eating disorder)

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23
Q

Rumination Syndrome: Symptoms

A

-Regurgitation
-Other sx: Halitosis, Nausea?
-No pain
-Usually diagnosed through observation

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24
Q

Rumination Syndrome: Diagnosis/Treatment

A

-Clinically diagnosed
-Treatment: Breathing techniques

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25
Q

H Pylori

A

• Bacterial infection causing gastric and duodenal inflammation
• Very common: 30-40% in US (CDC)
• Can acquire in childhood (unusual in developed countries such as US)
– increases with age

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26
Q

H Pylori is most common in:

A

– Elderly (50%)
– African Americans, Asians, Hispanics

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27
Q

H Pylori is believed to be:

A

“Silent in body” (mostly asymptomatic)

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28
Q

H Pylori: Possible Transmission

A

-Fecal/oral or oral/oral
-Infected food/water, kissing

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29
Q

H Pylori: Risk Factors

A

– Elderly
– Living with someone who has it
– Living in crowded conditions

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30
Q

H Pylori: Common Causes

A

• Gastritis (acute/ chronic)
• Peptic ulcers
• Stomach cancer (3-6x more likely to develop)
• Functional dyspepsia

• May be cause of unexplained iron deficiency anemia

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31
Q

H pylori: Exam

A

Exam: not helpful
• Possible epigastric tenderness

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32
Q

H Pylori: Diagnostic Procedures

A

• Breath test (urea test)
• Stool test
• Blood test
• Endoscopy

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33
Q

H Pylori: Medical Treatment

A

-Medication: triple or quadruple therapy (2 antibiotics, PPI/H2 blocker)
-If treated: 10% reoccur but if NOT then 50+% reoccur

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34
Q

Inflammation, irritation or erosion of stomach

A

Gastritis

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35
Q

How is Gastritis classified

A

– “Timing”: acute vs. chronic
– Severity of injury: erosive v. non-erosive
– Location: cardia, body, antrum

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36
Q

Erosive Gastritis

A

-Damage, injury or erosion to the mucosa-shallow or deep
-Typically acute
-Common causes: NSAIDs & alcohol
-Less common causes: Trauma, radiation, vascular injury, viral infection

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37
Q

Non-erosive gastritis

A

Inflammation in lining (NO erosion)
-Can be chronic (lead to atrophy)
-Common cause: H Pylori
-Frequently Asymptomatic

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38
Q

Gastritis: Risk Factors

A

-Older
-Factors damaging mucosa: NSAIDs, alcohol, H pylori
-Autoimmunities: Crohns, Hashimotos
-Associated with: Infections, reaction to surgery/trauma, bile reflux

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39
Q

Gastritis: Complications

A

-Ulcerations (can bleed/cause IDA)
-Chronic inflammation can lead to atrophy (pernicious anemia)
-Increased risk of gastric cancer

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40
Q

Gastritis: Common symptoms

A

-Epigastric pain or discomfort
-Bloating or sense of fullness
-Anorexia
-Nausea
-Foul breath
-Eating may or may not aggravate

-Mild: Vague or asymptomatic
-Severe: hematemesis or melena

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41
Q

Gastritis: DDx

A

GERD, Peptic ulcer, gastric carcinoma
-May have contaminant symptoms related to: IDA, B12 deficiency

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42
Q

Gastritis: Exam

A

• May have increased epigastric tenderness

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43
Q

Gastritis: Diagnostic procedures

A

-Endoscopy
-Possible barium swallow

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44
Q

Gastritis: Treatment

A

Address Gastritis (medication: triple therapy)
-Address cause/risk factors (eliminate alcohol, NSAIDs)
-Address complications

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45
Q

Gastritis: Lifestyle Factors

A

-Avoid irritating foods/drink
-Eat smaller meals,
-Drink 6-8 glasses of water
-Manage stress
-Exercise

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46
Q

Mucosa is injured or eroded

A

Peptic Ulcer

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47
Q

Peptic ulcer: Types/Locations

A

– Gastric ulcer (stomach)
– Duodenal ulcer (duodenum)

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48
Q

Peptic Ulcer: Common Causes

A

– H.pylori
– NSAIDS

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49
Q

Although peptic ulcers can occur at any age, they are more prevalent in:

A

Middle age adults

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50
Q

Peptic ulcers: Risk factors

A

-Age (increases over 60)
-Female
-NSAIDs
-Smoke
-Alcohol
-Personal and/or family history of ulcer disease

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51
Q

Peptic ulcer: Complication

A

-Bleeding
-Perforation & peritonitis
-Scar tissue leading to gastric outlet syndrome
-Increased risk of gastric cancer

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52
Q

Peptic ulcers: General signs/symptoms

A

• Some have few or no sx
• Burning, gnawing epigastric pain most common
• Sometimes relieved by food or antacids
• Usually chronic & recurrent
• Symptoms can differentiate location of ulcer

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53
Q

Peptic Ulcers: Gastric vs. Duodenal

A

Gastric:
• Pain not consistent
• Pain immediately after eating -may worsen pain rather than relieve it

Duodenal:
• More consistent pain
• Relieved by food
• Pain occurs 2-3 hours after eating or wakens pt at night

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54
Q

Peptic Ulcers: Diagnosing

A

• Diagnostics:
– Endoscopy can confirm
– Test for H pylori

• Often a clinical diagnosis based on history
• Treat before endoscopy

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55
Q

Peptic Ulcers: Treatment

A

• Antibiotics (for H pylori)
• Stop smoking & alcohol
• Proton pump inhibitors
• Histamine 2 blockers
• Antacids

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56
Q

Ingestion of large amounts of calcium and absorbable alkali results in hypercalcemia

A

Milk Alkali Syndrome (Burnett’s Syndrome)

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57
Q

Milk alkali syndrome has increased due to:

A

– Use of antacids to treat dyspepsia
• Antacids have calcium carbonate

– Use of calcium and vitamin D supplements
to prevent / treat osteoporosis

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58
Q

Stages of Milk Alkali Syndrome

A

• Acute: irritability, vertigo, apathy, headaches, weakness, muscle aches, and/or vomiting

• Intermediate (Cope Syndrome): includes conjunctivitis

• Chronic (Burnett syndrome): includes soft tissue calcification

• Other symptoms: Constipation, urinary frequency, cardiac issues

59
Q

Other names for Milk Alkali Syndrome

A

– Calcium alkali
– Cope syndrome
– Burnett syndrome

60
Q

Milk Alkali Syndrome: Labs

A

• Serum calcium (elevated)
• Vitamin D (possible elevation)

61
Q

Any disease or issue that mechanically impedes gastric emptying

A

Gastric Outlet Obstruction

62
Q

GOO causes obstruction in:

A

Pyloric area between gastric and duodenum

63
Q

GOO initial cardinal symptoms

A

– Vomiting and nausea (Usually intermittent)

64
Q

GOO: Lateral symptoms

A

– Significant weight loss, malnutrition, dehydration

65
Q

GOO: Diagnosis/Treatment

A

• Diagnosis: endoscopy
• Tx: surgery

66
Q

GOO: Benign Causes

A

Intrinsic to area
• Scarring due to peptic ulcers
• Gastric polyps
• Pyloric stenosis (children)
• Drugs

67
Q

GOO: Malignant Causes

A

Intrinsic tumors
• Gastric
• Duodenum

Extrinsic tumors
• Gall bladder
• Pancreas (mc)

68
Q

Gastric cancer: MCC

A

H. pylori (gastritis/ulcer can increase risk)

69
Q

Gastric Cancer: Initial Symptoms/Later stages

A

– Epigastric discomfort, fullness or early satiety
– Heartburn or dysphagia

Later Stages: Weight loss

70
Q

Which two gastric conditions can lead to milk alkali syndrome

A

Gastritis and Peptic Ulcer

71
Q

How to differentiate between GERD, gastritis and peptic ulcer

A

-GERD: would more likely have heartburn, acid reflux
-Gastritis: Epigastric pain (less severe), acute, may be related to an increase use of NSAIDs
-Peptic ulcer: More severe (burning/gnawing pain)

72
Q

Pyloric value hypertrophied/ thickened

A

Pyloric Stenodid

73
Q

When does Pyloric Stenosis typically occur

A

Infancy

74
Q

Pyloric Stenosis: Signs/Symptoms

A

• Intermittent vomiting: Increasing frequency & severity
• Epigastric distention
• Initial hungry
• Later weakness
• Can quickly become dehydrated

75
Q

Gastric vs. Duodenal Ulcer

A

Gastric ulcer: Food makes it worse
Duodenal ulcer: Food makes it better

76
Q

Small intestine: Primary Function

A

Absorption
– Any disorder, inflammation, infection or injury can disrupt absorption

77
Q

Small Intestine: Referral pain location

A

• periumbilical / epigastric

78
Q

Congenital sacculation of distal ileum within 100 cm of
ileocecal valve

A

Meckel’s Diverticulum

79
Q

Meckel’s Diverticulum: Because it’s proximity to the appendix, it is a differential consideration for

A

Appendicitis and RLQ px

80
Q

Meckel’s Diverticulum: Sx

A

– rectal bleeding
– cramping in epigastric/ umbilical area
– nausea, vomiting
– possible bowel obstruction

81
Q

MC Structural/Mechanical cause of Obstruction in small bowel

A

Surgical adhesions or scar tissue
(MC-60-75%)

82
Q

Obstruction in Small Bowel: Other Structural/Mechanical Causes

A

• Hernias
• Tumors
• Crohn’s
• Volvulus
• Intussusception

83
Q

Mimics structural / mechanical blockage, but no actual blockage seen

A

Pseudo Obstruction

84
Q

Causes of pseudo obstruction

A

– Post surgery
– Trauma
– Infections

85
Q

Protrusion of intestinal contents

A

Hernia

86
Q

Protrusion of intestinal contents

A

Hernia

87
Q

Hernia: Diagnosis

A

Clinical (observation)

88
Q

Hernia: Complications

A

– Strangulation, gangrene, infarction, perforation, peritonitis

89
Q

Types of Hernias

A

Umbilical:
• protrusions through the umbilical ring
• mostly congenital
• some acquired: obesity, pregnancy, etc.

Incisional
• occur through an incision from previous abdominal surgery

90
Q

Twisting of intestine around itself

A

Volvulus

91
Q

Part of intestine telescopes into another section

A

Intussusception

92
Q

Intussusception tends to occur between, which ages?

A

6 months and 3 years

(Most common cause of intestinal obstruction in this age group)

93
Q

Temporary arrest of intestinal peristalsis

A

Ileus

94
Q

Ileus commonly occurs after:

A

Abdominal surgery, particularly when the intestines have been manipulated.

95
Q

Ileus: Symptoms

A

Abdominal distention/discomfort, nausea, vomiting

96
Q

Other conditions of small intestine

A

• Duodenal ulcers (covered in gastric)
• Small intestine diverticula (acquired)
• Crohns disease (cover in large intestine)
• Irritable Bowel Syndrome (cover in large intestine)

97
Q

Risk factors of Small Intestine Cancer

A

Crohns & Celiac Sprue

98
Q

Non-GI conditions affecting small intestine

A

– Diabetes
– Thyroid
– Parkinson’s
– MS
– Scleroderma
– Medication side effects
– Radiation therapy

99
Q

Infectious/Gastroenteritis: Causes

A

• Bacterial: salmonella, staph, e coli
• Viral
• Parasitic / worm

100
Q

Infectious/Gastroenteritis: MC symptom:

A

• sudden onset diarrhea

101
Q

Inadequate assimilation of dietary substances due to defects in digestion, absorption or transportation

A

Malabsorption

102
Q

Conditions Causing Malabsorption: Intestine

A

Celiac, Crohn, IBS

103
Q

Conditions Causing Malabsorption: Infections

A

Whipples, Tropical sprue, parasites

104
Q

Conditions Causing Malabsorption: Other

A

Lactose intolerance, bacterial overgrowth, Zollinger-Ellison syndrome, Alcohol

105
Q

Conditions Causing Malabsorption: Structural

A

Bariatric, surgery/short bowel, strictures, fistulas, diverticula

106
Q

Conditions Causing Malabsorption: Liver/GB/Pancreas

A

cirrhosis, chronic pancreatitis, pancreatic cancer, pancreas, biliary obstruction, cholestasis

107
Q

Conditions Causing Malabsorption: Systemic

A

Thyroid, DM, Addision’s

108
Q

Conditions Causing Malabsorption: Medication

A

Gastric (PPI), cholesterol, tetracyclines, laxative

109
Q

Malabsorption: IDA

A

• Iron

110
Q

Malabsorption: Overview of History

A

• Stools: Loose watery or pale, foul smelling bulky suggesting steatorrhea
• Fatigue
• Tingling
• Muscle weakness/ cramps
• Bleeding or Bruise easily
• Anxiety/ depression
• Often involves GI sx:Bloating, Gas, Abdominal pain/discomfort

111
Q

Malabsorption: General Exam

A

– Orthostatic hypotension
– Muscle wasting
– Cheilosis, glossitis, ulcers of mouth
– Peripheral edema

112
Q

Malabsorption: Neurological

A

– Motor weakness
– Peripheral neuropathy
– Ataxia

113
Q

Malabsorption: Abdominal Exam

A

– Pale skin (anemia)
– Distended abdomen
– Hyperactive bowel
-Possible ascites

114
Q

Malabsoption Syndrome: Screening Tests

A

• CBC, RBC indices
• Ferritin, hemoglobin
• Vitamin B12, folate

115
Q

Excess bacteria in stomach/ small intestine

A

Bacterial overgrowth syndrome

116
Q

Bacterial overgrowth syndrome: Sx/Si

A

Often asymptomatic.
-May only have weight loss or nutritional deficiencies.

117
Q

Disaccharide deficiency (usually of lactase)

A

Carbohydrate Intolerance

118
Q

Carbohydrate Intolerance: Sx

A

Diarrhea, abdominal distention, gas,nausea, borborygmi, and abdominal cramps after ingesting lactose

119
Q

Hereditary disorder caused by sensitivity to gluten, rye, barley

A

Celiac disease

120
Q

Celiac Disease: Symptoms

A

-Children: Failure to thrive, abdominal distention, muscle wasting, stool changes
-Adults: Mild intermittent diarrhea, Steorrhea, Sx of nutritional deficiencies

121
Q

Celiac Disease: Diagnostics

A

• Endoscopy, Biopsy confirms
• Labs to detect malabsorption issues

122
Q

Celiac Disease: Treatment

A

– Gluten free diet
– Supplement for deficiencies
• Support groups

123
Q

Bariatric Surgery: Indications

A

BMI > 40
– or >35 if there is diabetes, hypertension, obstructive sleep apnea, high-risk lipid profile

124
Q

Bariatric Surgery: Nutritional Deficiencies

A

Iron, B12, fat soluble, thiamine, folate

125
Q

Bariatric Surgery: Neuro issues

A

Unsteadiness and numbness or tingling of the hands or feet

126
Q

Peripheral neuropathy

A

Vitamin B1, B6, B12

127
Q

Peripheral neuropathy

A

Vitamin B1, B6, B12

128
Q

Pain in limbs, bones, fractures

A

Mg, Ca, Vitamin D, potassium

129
Q

Spasms

A

Ca, Mg, possibly potassium

130
Q

Spasms

A

Ca, Mg, possibly potassium

131
Q

Generalized motor weakenss

A

Vitamin B5, Vitamin D

132
Q

Generalized motor weakenss

A

Vitamin B5, Vitamin D

133
Q

Loss of vibration and position

A

Vitamin B12

134
Q

Latent Tetany

A

Calcium

135
Q

Seizures

A

Biotin

136
Q

Malabsorption: Gas/ distention

A

Carbohydrate/Lactose Malabsorption

137
Q

Malabsorption: Edema

A

Protein Malabsorption

138
Q

Malabsorption: Glossitis & Cheilosis

A

Vitamin B2, B12, folate, niacin, iron

139
Q

Malabsorption: Peripheral Neuropathy

A

Vitamin B1, B6, B12

140
Q

Malabsorption: B12 Deficiency

A

B12, Folate

141
Q

Malabsorption: Night Blindness

A

Vitamin A

142
Q

Malabsorption: Increased Bleeding, Bruising, Petechiae

A

Vitamin C and K

143
Q

Malabsorption: Osteoporosis

A

Calcium & Vitamin D

144
Q

Malabsorption: Muscle Spasms

A

Magnesium

GIGU & Men’s Health (7 decks)

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