Gastroenterology / GI Disorders Flashcards
What are some red flags for immediate medical referral of the patient who presents with certain signs and symptoms of acute gastro-intestinal pathology?
dysphagia, early satiety, sitophobia, hematemesis, coffee ground emesis, melena, hematochezia, jaundice, pruritis, ascites
What is dysphagia? What are possible causes?
Difficulty and/or discomfort with swallowing
achalasia, esophageal stricture, esophageal cancer, GERD, scleroderma, diffuse esophageal spasm
How is dysphagia diagnosed?
Barium X-ray, endoscopy, esophageal manometry, CT scan, MRI
How is hidden blood in the stool identified?
Fecal Occult Blood Test
What is melena? What does it suggest?
black tarry stool
upper GI bleeding
List major signs and symptoms of GI pathology
adbominal/chest/pelvic pain nausea and/or vomiting jaundice blood in stool dysphagia and/or odynophagia pruritus early satiety sitophobia hematemesis fever and other systemic signs/symptoms peritoneal signs
List major risk and triggering factors for GERD
obesity, hiatal hernia, pregnancy, supine position
gastric distention, fatty food, nicotine, alcohol, coffee, CCK and secretin, progesterone and estrogen, anti-hypertensive medicaiton, some anti-depressants
What are the major complications of GERD?
Barrett's esophagus Esophageal stricture otitis media aspiration pneumonia chronic cough
What is Barrett’s esophagus?
A complication of GERD in which the squamous epithelium of the esophagus is replaced by columnar epithelium (metaplasia)
Barrett’s esophagus is strongly correlated with the development of what disease?
esophageal adenocarcinoma
What is achalasia? What is its etiology?
- Disorder in which the lower esophgeal sphincter does not relax when food passes down the esophagus to the stomach
- Etiology is unknown although some connections have been made to autoimmune disorder triggered by viral infection, heredity, neurodegenerative disorder, genetic disorder
How is achalasia diagnosed?
Barium swallow with chest X-ray
What is the major etiology of Peptic Ulcer Disease?
Heliobacter Pylori colonization of the stomach
What is the major pathogenesis of Peptic Ulcer Disease?
Disruption of GI mucosal barrier
What PUD location is the most common in the US population?
What are clinical differences between presentations of gastric vs. duodenal peptic ulcers?
duodenal peptic ulcer
gastric peptic ulcer - pain upon eating
duodenal peptic ulcer - pain when hungry, alleviated by eating
What is portal hypertension? Describe major signs and symptoms
Increase in blood pressure in the portal vein system due to blockage in blood flow to liver
hemorrhoids, esophageal varices, caput medusae, splenomegaly, GI bleeding, vomiting blood, ascites, encephalopathy, confusion, forgetfulness, reduced levels of platelets or decreased white blood cell count
List risk factors for gastric cancer
diet (preservatives, lack of fresh fruits and vegetables), smoking, H. pylori infection, chronic auto-immune gastritis
What are common clinical presentations of advanced gastric cancer?
anorexia, weight loss, abdominal pain, vomiting, anemia, hemorrhage, altered bowel habits
What are common metastases of gastric cancer?
Virchow’s node, ovaries
Describe typical clinical presentation of acute appendicitis
initially poorly localized peri-umbilical pain, later pain localized in lower right quadrant, nausea, vomiting, fever, anorexia, constipation, inability to pass gas, abdominal swelling. Positive peritoneal signs
List peritoneal signs
severe abdominal pain*, abominal wall guarding, vomiting, rebound tenderness, cessation of peristalsis, hard/red abdominal wall
*if there is emesis medulla is already affected
What is the most common cause of intestinal adhesions?
surgery
What is a volvulus?
a torsion of the gut upon itself or upon a narrow mesenteric pedicle
What is intussusception?
a condition in which one part of the intestine tunnels into an adjoining section
What is the difference between diverticulosis and diverticulitis?
What is the cumulative term for both?
Diverticulosis is formation of outpockets in the colonic mucosa and submucosa
Diverticulitis is inflammation within the diverticula
The cumulative term for both is diverticular disease
The two main types of inflammatory bowel disease are _______. How are they similar?
Crohn’s disease
Ulcerative colitis
regional enteritis, chronic inflammatory bowel conditions (auto immune), mostly present in Eastern Europeans, Ashkenazi Jews, more common in females
What are principal differences between Crohn’s disease and Ulcerative colitis?
Crohn’s disease - occurs in any part of GI tract, granulomatous inflammation, affects all layers of GI tube, can lead to fistulas, perforations, strictures
Ulcerative colitis - only occurs in colon, always begins in rectum and spreads up to beginning of colon, diffuse inflammation, only affects mucosa layer, bloody diarrhea
List major risk factors for colon cancer development
family history of colorectal cancer, smoking, saturated fat and low fiber diet, obesity, sedentary lifestyle, adenomatous familial polyps
Describe etiology and pathogenesis of Celiac Disease
Etiology is unknown but most probably auto-immune
Pathogenesis - gluten/gliadin-sensitive atrophy of the small intestinal microvilli and infiltration of submucosa by lymphocytes
Regional enteritis is also know as ____?
Crohn’s disease
Diverticulosis is asymptomatic (T/F)
TRUE
Atrophy of gluten/gliadin sensitive Small Intestine villi leads to the following pathology __________, also known as __________.
Celiac aka non-tropical sprue
Intestinal obstruction due to twisting is known as ____________
Volvulus
Highly symmetrical joint pain and stiffness for more than one hour in the morning indicates __________
RA
Which GI pathology is mostly asymptomatic?
Diverticulosis
Gallstone aka silent stones
Cholelithiasis - asymptomatic until acute
________ refers to a physical exam maneuver that indicates acute cholecystitis.
Murphy’s sign
*it is inflammation of the GB
Which of the following choices does not correspond with a red flag for immediate medical referral
a. dysphagia
b. rebound tenderness
c. inaudible peristalsis
d. acute peristalsis
d. acute peristalsis
Meissner’s plexus is also known as _______ and governs __________
submucosal plexus
secretions of the mucosal layer
A low body fat index is a major risk factor for cholelithiasis (T/F)
False
Virchow’s node is the most common metastasis in _________ cancer
gastric
Auerbach’s plexus is also known as _______ and governs __________
myenteric plexus
motility of GI tract
Psoas and obturator signs are suggestive of _____?
acute appendicitis
- pain upon passive extension of the leg
- pain upon passive internal rotation of the flexed thigh
when inspiration is arrested upon examination of the mid clavicular line, underneath the rib cage, this is a sign of ______?
acute cholecystitis
