Gastroenterology: Notes

Question 1

Where does visceral pain originate

Answer 1

Walls of hallow organs like gallbladder, appendix, or in the capsules of solid organs. Described as vague or cramp like pain.

Question 2

What mechanisms can cause visceral pain?

Answer 2

Inflammation, distension, ischemia.

Question 3

What causes somatic pain?

Answer 3

Bacterial and chemical irritations.
Usually chemicals come from perforated ulcer, or inflamed pancreas. Resultant peritonitis can lead to sepsis and even death.

Question 4

What kind of pain does appendicitis present with?

Answer 4

Periumbilical pain

Question 5

What often causes upper gastrointestinal bleeding?

Answer 5

Often caused by ulcerated lesions

Question 6

What are the six major identifiable causes of upper GI hemorrhage?

Answer 6

Peptic ulcer disease
Gastritis
Variceal Rupture
Mallord-Weiss Tear
Esophagitis
Duodenitis

Question 7

What are primary treatments for upper GI bleeding?

Answer 7

Oxygen
2 large bore IV’s (one for blood, one for fluid replacement)
IV fluids at 20cc/kg

Question 8

Esophageal Varix

Answer 8

Swollen vein of the esophagus. Often these rupture and hemorrhage.

Question 9

What causes Esophageal Varix?

Answer 9

Increase in portal pressure, which is usually a result of damage to the liver. This blood backs up into the left gastric veins causing bulges (varices). Two thirds of these cases are a result of Alcoholic liver cirrhosis.

Question 10

What are signs and symptoms of esophageal varix?

Answer 10

Painless bleeding 
Hematemesis with bright red blood
Dysphagia (difficulty swallowing)
Burning or tearing sensation
Increased pulse
Increased respirations
Signs of Shock

Question 11

Acute Gastroenteritis

Answer 11

Caused by damaged vili in the intestine (which absorb water). Damage done by chemical agents or commonly, aspirin. Alcohol and tobacco users at higher risk.
Signs and symptoms:
Diarrhea
Hypovolemia secondary to dehydration
Tachycardia
Melena
Hematochezia
Fever
N/V
Malaise
Widespread pain, not focused on one region
Treatment:
O2 if needed
Oral rehydration
IV fluid
Antiemetic- phenergan (promethazine)

Question 12

Peptic Ulcers

Answer 12

Commonly caused by NSAIDS, acid-stimulating products like alcohol and nicotine, or Helicobacter Pylori (found in 80% of gastric and duodenal ulcers)
Signs and Symptoms if Hemorrhaging:
Acute, sever pain
Ecchymosis and distension
Hematemesis
Melena-colored stool
Signs of Shock
Treatment:
Oxygen
IV fluid resuscitation

Question 13

Lower GI Bleed

Answer 13

Common Causes: 
Aging
Colon Lesions
Rectal Lesions
Ulcerative colitis
Crohn's Disease
Signs and Symptoms:
Cramping 
nausea/vomiting
Melena (if slow bleeding)
Treatment:
O2 if needed
CPAP if needed
Fluid resuscitation if needed

Question 14

Ulcerative Colitis

Answer 14

Inflammatory bowel disorder: 2 types
Type One: Pancolitis- spans entire colon
Type Two: Proctitis- Limited to rectum
Signs and symptoms:
Bloody Diarrhea or stool with mucus
Nausea/Vomiting
Fever
Weight Loss
Signs of Shock 
Treatment:
Oxygen
IV access and fluid replacement
Antiemetics

Question 15

Crohn’s Disease

Answer 15

Can occur anywhere from mouth to rectum.
Significant GI bleed in this disease is rare.
Can cause fistulas between intestinal linings.
Signs and symptoms:
GI bleeding
Weight Loss
Abdominal Cramping/pain
Nausea
Vomiting
Diarrhea
Fever
Pain can't be localized
Tenderness
Treatment:
Managed airway
Antiemetics

Question 16

Diverticulitis

Answer 16

Small outpouchings of mucosal and submucosal tissue that push through the outermost layer of the intestine.- Balloons out of the intestines 
Signs and Symptoms:
Lower left sided pain
Signs of hemorrhage if present
Fever
N/V
Bright red and blood feces
Treatment:
Supportive/ Treat for hemorrhage if signs of shock present

Question 17

Hemorrhoids

Answer 17

Small masses of swollen veins that occur in the anus or rectum.
Signs and Symptoms:
Bright red bleeding and pain on deviations
Treatment:
Usually emotional reassurance

Question 18

Bowel Obstructions

Answer 18

Blockages- usually in small intestines
Signs and Symptoms:
Decreased appetite
Fever
Malaise
N/V- vomit looks and smells like feces
Weight Loss
Visceral pain
Ecchymosis if significant hemorrhage occurs 
Treatment:
Supportive unless shock present, then treat shock

Question 19

Appendicitis

Answer 19

Inflammation of vermiform appendix at the junction of the large and small intestines.
Signs and Symptoms:
Diffuse colicky pain
N/V
Fever
Loss of appetite
Pain in umbilical region or at McBurney’s Point which in 1-2 inches above the anterior iliac crest in direct line from iliac crest to umbilicus.

Question 20

Cholecystitis

Answer 20

Inflammation of the gallbladder
Caused when bile is supersaturated with calculi (stones) that lodge in common filed duct, obstructing the flow of bile causing gallbladder inflammation.
Signs and Symptoms:
Acute attack of upper right quadrant abdominal pain- with referred pain to right shoulder- often after eating fatty meal.
Signs and Symptoms:
Right upper quadrant pain referred to right shoulder
Paled cool clammy skin with sympathetic stimulation, or warm skin if inflamed peritoneum.
N/V
Treatment:
ABCs
oxygen
Managed Pain

Question 21

Pancreatitis

Answer 21

Inflammation of the pancreas. 80% due to alcohol intake.
Signs and Symptoms:
Intense abdominal pain- upper left quadrant radiating to epigastric region.
N/B
Ecchymosis and swelling of the left upper quadrant with diaphoresis, tachycardia, and hypotension if hemorrhaging.
Treatment:
ABC’s
Oxygen
IV fluid resuscitation

Question 22

Hepatitis

Answer 22

Transmitted oral-fecal route- damaged liver cells.
Signs and Symptoms:
Upper right quadrant abdominal tenderness
Anorexia, Losing weight, Clay colored stools, Jaundice, nausea and vomiting, malaise, photophobia, Pharyngitis, cough.
Treatment:
ABC’s
IV line
Antiemetic