Gastric & Small Intestine Conditions Flashcards
Symptoms of dyspepsia
-Epigastric pain/discomfort
-Bloating
-Feeling of fullness after meal
-Loss of appetite
-Anorexia
-Nausea/vomitting
-Pyrosis
-Regurgitation
-Belching
Sensation of pain or discomfort of fullness. May be accompanied by other symptoms.
Dyspepsia
Heartburn
Pyrosis
Backflow of food particles
Regurgitation
Sense of fullness. For gastric, may be located in epigastric area.
Bloating
Belching
Eructation
Vomiting of red blood. Suggests active bleeding
Hematmesis
Vomiting dark granular material. Suggest slowed or stopped bleeding
Coffee ground hematemesis
Black, tarry stool. Suggest upper GI bleeding
Melena
Gastric Conditions: Red Flags
• Chest pain
• Weight loss
• Abrupt, acute onset
• Severe pain
• Signs of shock
• Signs of peritonitis
Gastric Conditions: Complications
• Bleeding
• Malnutrition, dehydration
• IDA or B12 anemia
• Obstructive issues: gastric outlet syndrome
• Overuse of medication: Milk Alkali
• Life threatening: gastric cancer
• Emergency: perforation & peritonitis
Gastric Conditions: Exams
• Often do not provide evidence
• Possible procedures:
o Inspection: may see bloating? o Palpation: pain
Gastric Conditions: Diagnostic Procedures
• 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)
• Hole or tear of the stomach, intestines or abdominal organs
Perforation
Causes of perforation
– Gastric conditions: gastritis, peptic ulcer
Symptoms of Perforation develop:
Suddenly; Severe pain followed by signs of shock (requires emergency care)
Peritoneal inflammation secondary to from any abdominal condition w/ an acute onset of severe abdominal pain
(Life threatening!)
Peritonitis
Defined as sensation of pain or discomfort in the upper
abdomen
Dyspepsia
Symptoms of Dyspepsia
Indigestion, gassiness, early satiety, postprandial fullness, gnawing, or burning
Red flags of nausea/vomiting
– Signs of hypovolemia
– Headache, stiff neck, or mental status change
– Peritoneal signs
– Distended, tympanic abdomen
Rectal bleeding
– Hematemesis: active bleeding
– Coffee ground: bleeding slowed/stopped
– Melena: tarry stool
Rumination Syndrome
• 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)
Rumination Syndrome: Symptoms
-Regurgitation
-Other sx: Halitosis, Nausea?
-No pain
-Usually diagnosed through observation
Rumination Syndrome: Diagnosis/Treatment
-Clinically diagnosed
-Treatment: Breathing techniques
H Pylori
• 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
H Pylori is most common in:
– Elderly (50%)
– African Americans, Asians, Hispanics
H Pylori is believed to be:
“Silent in body” (mostly asymptomatic)
H Pylori: Possible Transmission
-Fecal/oral or oral/oral
-Infected food/water, kissing
H Pylori: Risk Factors
– Elderly
– Living with someone who has it
– Living in crowded conditions
H Pylori: Common Causes
• Gastritis (acute/ chronic)
• Peptic ulcers
• Stomach cancer (3-6x more likely to develop)
• Functional dyspepsia
• May be cause of unexplained iron deficiency anemia
H pylori: Exam
Exam: not helpful
• Possible epigastric tenderness
H Pylori: Diagnostic Procedures
• Breath test (urea test)
• Stool test
• Blood test
• Endoscopy
H Pylori: Medical Treatment
-Medication: triple or quadruple therapy (2 antibiotics, PPI/H2 blocker)
-If treated: 10% reoccur but if NOT then 50+% reoccur
Inflammation, irritation or erosion of stomach
Gastritis
How is Gastritis classified
– “Timing”: acute vs. chronic
– Severity of injury: erosive v. non-erosive
– Location: cardia, body, antrum
Erosive Gastritis
-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
Non-erosive gastritis
Inflammation in lining (NO erosion)
-Can be chronic (lead to atrophy)
-Common cause: H Pylori
-Frequently Asymptomatic
Gastritis: Risk Factors
-Older
-Factors damaging mucosa: NSAIDs, alcohol, H pylori
-Autoimmunities: Crohns, Hashimotos
-Associated with: Infections, reaction to surgery/trauma, bile reflux
Gastritis: Complications
-Ulcerations (can bleed/cause IDA)
-Chronic inflammation can lead to atrophy (pernicious anemia)
-Increased risk of gastric cancer
Gastritis: Common symptoms
-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
Gastritis: DDx
GERD, Peptic ulcer, gastric carcinoma
-May have contaminant symptoms related to: IDA, B12 deficiency
Gastritis: Exam
• May have increased epigastric tenderness
Gastritis: Diagnostic procedures
-Endoscopy
-Possible barium swallow
Gastritis: Treatment
Address Gastritis (medication: triple therapy)
-Address cause/risk factors (eliminate alcohol, NSAIDs)
-Address complications
Gastritis: Lifestyle Factors
-Avoid irritating foods/drink
-Eat smaller meals,
-Drink 6-8 glasses of water
-Manage stress
-Exercise
Mucosa is injured or eroded
Peptic Ulcer
Peptic ulcer: Types/Locations
– Gastric ulcer (stomach)
– Duodenal ulcer (duodenum)
Peptic Ulcer: Common Causes
– H.pylori
– NSAIDS
Although peptic ulcers can occur at any age, they are more prevalent in:
Middle age adults
Peptic ulcers: Risk factors
-Age (increases over 60)
-Female
-NSAIDs
-Smoke
-Alcohol
-Personal and/or family history of ulcer disease
Peptic ulcer: Complication
-Bleeding
-Perforation & peritonitis
-Scar tissue leading to gastric outlet syndrome
-Increased risk of gastric cancer
Peptic ulcers: General signs/symptoms
• 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
Peptic Ulcers: Gastric vs. Duodenal
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
Peptic Ulcers: Diagnosing
• Diagnostics:
– Endoscopy can confirm
– Test for H pylori
• Often a clinical diagnosis based on history
• Treat before endoscopy
Peptic Ulcers: Treatment
• Antibiotics (for H pylori)
• Stop smoking & alcohol
• Proton pump inhibitors
• Histamine 2 blockers
• Antacids
Ingestion of large amounts of calcium and absorbable alkali results in hypercalcemia
Milk Alkali Syndrome (Burnett’s Syndrome)
Milk alkali syndrome has increased due to:
– Use of antacids to treat dyspepsia
• Antacids have calcium carbonate
– Use of calcium and vitamin D supplements
to prevent / treat osteoporosis
Stages of Milk Alkali Syndrome
• 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
Other names for Milk Alkali Syndrome
– Calcium alkali
– Cope syndrome
– Burnett syndrome
Milk Alkali Syndrome: Labs
• Serum calcium (elevated)
• Vitamin D (possible elevation)
Any disease or issue that mechanically impedes gastric emptying
Gastric Outlet Obstruction
GOO causes obstruction in:
Pyloric area between gastric and duodenum
GOO initial cardinal symptoms
– Vomiting and nausea (Usually intermittent)
GOO: Lateral symptoms
– Significant weight loss, malnutrition, dehydration
GOO: Diagnosis/Treatment
• Diagnosis: endoscopy
• Tx: surgery
GOO: Benign Causes
Intrinsic to area
• Scarring due to peptic ulcers
• Gastric polyps
• Pyloric stenosis (children)
• Drugs
GOO: Malignant Causes
Intrinsic tumors
• Gastric
• Duodenum
Extrinsic tumors
• Gall bladder
• Pancreas (mc)
Gastric cancer: MCC
H. pylori (gastritis/ulcer can increase risk)
Gastric Cancer: Initial Symptoms/Later stages
– Epigastric discomfort, fullness or early satiety
– Heartburn or dysphagia
Later Stages: Weight loss
Which two gastric conditions can lead to milk alkali syndrome
Gastritis and Peptic Ulcer
How to differentiate between GERD, gastritis and peptic ulcer
-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)
Pyloric value hypertrophied/ thickened
Pyloric Stenodid
When does Pyloric Stenosis typically occur
Infancy
Pyloric Stenosis: Signs/Symptoms
• Intermittent vomiting: Increasing frequency & severity
• Epigastric distention
• Initial hungry
• Later weakness
• Can quickly become dehydrated
Gastric vs. Duodenal Ulcer
Gastric ulcer: Food makes it worse
Duodenal ulcer: Food makes it better
Small intestine: Primary Function
Absorption
– Any disorder, inflammation, infection or injury can disrupt absorption
Small Intestine: Referral pain location
• periumbilical / epigastric
Congenital sacculation of distal ileum within 100 cm of
ileocecal valve
Meckel’s Diverticulum
Meckel’s Diverticulum: Because it’s proximity to the appendix, it is a differential consideration for
Appendicitis and RLQ px
Meckel’s Diverticulum: Sx
– rectal bleeding
– cramping in epigastric/ umbilical area
– nausea, vomiting
– possible bowel obstruction
MC Structural/Mechanical cause of Obstruction in small bowel
Surgical adhesions or scar tissue
(MC-60-75%)
Obstruction in Small Bowel: Other Structural/Mechanical Causes
• Hernias
• Tumors
• Crohn’s
• Volvulus
• Intussusception
Mimics structural / mechanical blockage, but no actual blockage seen
Pseudo Obstruction
Causes of pseudo obstruction
– Post surgery
– Trauma
– Infections
Protrusion of intestinal contents
Hernia
Protrusion of intestinal contents
Hernia
Hernia: Diagnosis
Clinical (observation)
Hernia: Complications
– Strangulation, gangrene, infarction, perforation, peritonitis
Types of Hernias
Umbilical:
• protrusions through the umbilical ring
• mostly congenital
• some acquired: obesity, pregnancy, etc.
Incisional
• occur through an incision from previous abdominal surgery
Twisting of intestine around itself
Volvulus
Part of intestine telescopes into another section
Intussusception
Intussusception tends to occur between, which ages?
6 months and 3 years
(Most common cause of intestinal obstruction in this age group)
Temporary arrest of intestinal peristalsis
Ileus
Ileus commonly occurs after:
Abdominal surgery, particularly when the intestines have been manipulated.
Ileus: Symptoms
Abdominal distention/discomfort, nausea, vomiting
Other conditions of small intestine
• Duodenal ulcers (covered in gastric)
• Small intestine diverticula (acquired)
• Crohns disease (cover in large intestine)
• Irritable Bowel Syndrome (cover in large intestine)
Risk factors of Small Intestine Cancer
Crohns & Celiac Sprue
Non-GI conditions affecting small intestine
– Diabetes
– Thyroid
– Parkinson’s
– MS
– Scleroderma
– Medication side effects
– Radiation therapy
Infectious/Gastroenteritis: Causes
• Bacterial: salmonella, staph, e coli
• Viral
• Parasitic / worm
Infectious/Gastroenteritis: MC symptom:
• sudden onset diarrhea
Inadequate assimilation of dietary substances due to defects in digestion, absorption or transportation
Malabsorption
Conditions Causing Malabsorption: Intestine
Celiac, Crohn, IBS
Conditions Causing Malabsorption: Infections
Whipples, Tropical sprue, parasites
Conditions Causing Malabsorption: Other
Lactose intolerance, bacterial overgrowth, Zollinger-Ellison syndrome, Alcohol
Conditions Causing Malabsorption: Structural
Bariatric, surgery/short bowel, strictures, fistulas, diverticula
Conditions Causing Malabsorption: Liver/GB/Pancreas
cirrhosis, chronic pancreatitis, pancreatic cancer, pancreas, biliary obstruction, cholestasis
Conditions Causing Malabsorption: Systemic
Thyroid, DM, Addision’s
Conditions Causing Malabsorption: Medication
Gastric (PPI), cholesterol, tetracyclines, laxative
Malabsorption: IDA
• Iron
Malabsorption: Overview of History
• 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
Malabsorption: General Exam
– Orthostatic hypotension
– Muscle wasting
– Cheilosis, glossitis, ulcers of mouth
– Peripheral edema
Malabsorption: Neurological
– Motor weakness
– Peripheral neuropathy
– Ataxia
Malabsorption: Abdominal Exam
– Pale skin (anemia)
– Distended abdomen
– Hyperactive bowel
-Possible ascites
Malabsoption Syndrome: Screening Tests
• CBC, RBC indices
• Ferritin, hemoglobin
• Vitamin B12, folate
Excess bacteria in stomach/ small intestine
Bacterial overgrowth syndrome
Bacterial overgrowth syndrome: Sx/Si
Often asymptomatic.
-May only have weight loss or nutritional deficiencies.
Disaccharide deficiency (usually of lactase)
Carbohydrate Intolerance
Carbohydrate Intolerance: Sx
Diarrhea, abdominal distention, gas,nausea, borborygmi, and abdominal cramps after ingesting lactose
Hereditary disorder caused by sensitivity to gluten, rye, barley
Celiac disease
Celiac Disease: Symptoms
-Children: Failure to thrive, abdominal distention, muscle wasting, stool changes
-Adults: Mild intermittent diarrhea, Steorrhea, Sx of nutritional deficiencies
Celiac Disease: Diagnostics
• Endoscopy, Biopsy confirms
• Labs to detect malabsorption issues
Celiac Disease: Treatment
– Gluten free diet
– Supplement for deficiencies
• Support groups
Bariatric Surgery: Indications
BMI > 40
– or >35 if there is diabetes, hypertension, obstructive sleep apnea, high-risk lipid profile
Bariatric Surgery: Nutritional Deficiencies
Iron, B12, fat soluble, thiamine, folate
Bariatric Surgery: Neuro issues
Unsteadiness and numbness or tingling of the hands or feet
Peripheral neuropathy
Vitamin B1, B6, B12
Peripheral neuropathy
Vitamin B1, B6, B12
Pain in limbs, bones, fractures
Mg, Ca, Vitamin D, potassium
Spasms
Ca, Mg, possibly potassium
Spasms
Ca, Mg, possibly potassium
Generalized motor weakenss
Vitamin B5, Vitamin D
Generalized motor weakenss
Vitamin B5, Vitamin D
Loss of vibration and position
Vitamin B12
Latent Tetany
Calcium
Seizures
Biotin
Malabsorption: Gas/ distention
Carbohydrate/Lactose Malabsorption
Malabsorption: Edema
Protein Malabsorption
Malabsorption: Glossitis & Cheilosis
Vitamin B2, B12, folate, niacin, iron
Malabsorption: Peripheral Neuropathy
Vitamin B1, B6, B12
Malabsorption: B12 Deficiency
B12, Folate
Malabsorption: Night Blindness
Vitamin A
Malabsorption: Increased Bleeding, Bruising, Petechiae
Vitamin C and K
Malabsorption: Osteoporosis
Calcium & Vitamin D
Malabsorption: Muscle Spasms
Magnesium
