Gastrointestinal Flashcards
mechanism of abdominal pain
Hollow viscus, capsular distention, peritoneal irritation, mucosal ulceration, vascular insufficiency, altered body motility, nerve injury, abdominal wall injury and pain referred from extra-abdominal site
pain described as: constant achy feeling
abdominal wall pain
pain described as: dull, crampy and poorly localized
visceral pain, arising form hollow viscus usually result of distention or spasm of a hollow organ
pain described as: sharp well-localized pain
parietal pain arising from the parietal peritoneum ie acute appendicitis pain with inflammation spread to peritoneum
pain described as aching and near surface of body
Referred pain; experienced away from the disease process, result of shared central pathways
upper right abdominal quadrant pain
emanates from the chest cavity, liver, gallbladder, stomach, bowel, right kidney or ureter
left upper quadrant pain associated with
heart, chest cavity, spleen, stomach, pancreas, acute pancreatitis, left kidney or ureter.
Left lower quadrant pain associated with
bowel, left ureter, pelvis or commonly associated with diverticulitis especially when pain is protracted or severe
right lower quadrant pain associated with
appendix, bowel, right ureter, pelvis most common diagnosis appendicitis
pain in epigastrium or periumbilical area with migration to right lower quadrant and abdominal rigidity often short duration of pain
appendicitis
Labs r/t appendicitis
CBC w diff, BMP, CRP, Serum HCG, sickeldex test, urinalysis,
CT scan, ultrasound
nausea, vomiting, abdominal distention and pain. distended bowel on xray of abdomen
small bowel obstruction
labs and imaging for small bowel obstruction
CBC w/ diff, CMP, lactate dehydrogenase, hcg,
Abdominal x ray upright and supine, ct scan, MRI, transabdominal ultrasound as indicated.
pain starting in the epigastrium and spread rapidly throughout the abdomen with frequent early radiation of pain. frequent radiation to the scapular area
peptic ulcer disease
common cause of peptic ulcer disease
repeated use of nsaid drugs and h. pylori
labs for peptic ulcer
CBC w/diff, cmp, serum amylase, fobt, h. pylori. hcg (in women)
abdominal x ray upright and left lateral decubitus
endoscopy, urea breath test. `
high fever, chills, acute abdominal pain. diffuse, localized or referred. patients with cirrhosis may not complaint of pain and may run only a low-grade fever
additional complaints: abdominal pain, tenderness, nvd or constipation
peritonitis
dx of peptic ulcer suggested by
H & P, confirmed by detection of pneumoperitoneum on upright abdominal or chest x-ray h. pylori test and urea breath test.
dx of peritonitis based on
fever, abdominal pain, tenderness and leukocytosis. decreasing bowel sounds. increasing tenderness, rebound tenderness chest and abdo x ray cbc w/diff
asymtpomatic before rupture, may have abdominal flank or back pain several days after the rupture.
AA rupture.
abdominal exam findings may include abdominal distention, flank or back pain, tenderness. pulsations over the mass
AAA
who should be screened for AAA
men 65-75 with history of smoking at least 100 cigarettes in a lifetime
Standard evaluation for AAA
CT scan
labs for ruptured AA
CBC w/diff, cmp, hcg as appropriate, type and cross,
What are hemorrhoids
nonpathologic venous cushions in the submucosal layer of the anal canal
these hemorrhoids are more likely to be painful
external hemorrhoids
typically present with painless bright red blood per rectum with bowel movements
internal hemorrhoids
first-degree hemorrhoids cause:
cause bright red painless bleeding, may bulge but do not prolapse
second-degree hemorrhoids:
prolapse during defecation but reduce spontaneously, pt. report bleeding and itching from the chronic moisture secreted by the anal canal mucosa
third degree hemorrhoid
prolapse with defecation and require manual reduction. Patient has secondary pain related to local ischema and mucoid drainage
fourth-degree hemorrhoid
permanently prolapse and not reducible, incarcerated hemorrhoids require urgent surgical intervention
recommended tx of hemorrhoids
high-fiber diet and increased fluid intake reduction in constipation and straining
painful linear crack or tears of the lining of the anal canal
Anal fissure
definition of chronic vs acute anal fissure
less than 6 weeks acute; greater than 6 weeks in chronic
patient experiences severe, sharp rectal pain during and after bowel movements and small amounts of bright red blood on toilet paper
Anal fissure
differential dx for anal fissure
anal carcinoma, perianal abscess, thrombosed external hemorrhoid.
patient experiences uncontrollable urge to scratch the anus tend to be worse at night or after a bowel movement may involve the buttocks, vulva, scrotum area
pruritus ani
Tx of pruritis ani
1% hydrocortisone for a period of no more than two weeks to discourage skin atrophy
may require antibiotics if area has become infected
infection that occurs from the obstruction of the duct of an anal gland at the level of the denatate line. after formation may spread to adjacent pelvic tissue or the perianal skin
anorectal abscess
abnormal communication between abscess and perianal skin chronic manifestation of perianal abscess
perianal fistula
abscess-fistula complex appears to arise from penetrating inflammation in this disease process in up to 35% of patients
Crohns disease
patient complaint of perianal pain and swelling that increases with movement sitting or bowel movements. malaise and fever , persistent purulent drainage with hx of abscess may also be present. inguinal lymphnodes may be enlarged as well
anorectal abscess
tx of anorectal abscess
incision and drainage, cbc if systemisc symptoms or unclear diagnosis, antibiotics not generally indicated. ciprofloxacin or metronidazole may be used if abx are desired
right upper quadrant pain, radiated to right posterior shoulder within an your of eating an type of large meal especially with high fat content. described as mild to severe accompanied by nausea and vomiting
cholelithiasis
similar to systemic cholelithiasis, but lasts longer than 4 to 6 hours
acute cholecystitis
recurrent mild to moderate upper quadrant pain and epigastric abdominal pain accompanied by nausea and vomiting pain may radiate to the region of the posterior right shoulder associated with eating fatty foods
chronic cholecystitis
moderate distress from systemic toxicity, tachycardia and fever. The right upper quadrant abdominal pain is associated with tenderness and muscle guarding or rigidity. gallbladder distention, hypoactive bowel sounds and presence of murphy’s sign
acute cholecystitis
What is cirrhosis
end stage consequence of progressive hepatic fibrosis affecting normal liver function, serious irreversible disease
most common cause of cirrhosis in the united states
hepatitis B and C virus, alcoholic liver diseases, nonalcoholic fatty liver disease and nonalcoholic steatohepatitis (NASH)
medication associated with liver cirrhosis
acetaminophen, amiodarone, methotrexate, isoniazid, varied antibiotics, carbon tetrachloride
early symptoms include pruritis, weight loss and fatigue additionally- malaidse, dark urine or pale stools, later symptoms nausea and vomiting
primary biliary cirrhosis
abnormal diagnositis in cirrhosis
hypoalbuminemia, elevated serum protein, elevated AST and ALT, alk phos elevation, y glutamyl elevated
education for patient with cirrhosis
dietary discipline, avoidance of hepatotoxic drugs, and risk reduction.
primary causes of constipation
irritable bowel syndrome, disordered colonic transit, evacuation disorders, dyssynergic defecation
inability of abdominal and pelvic floor muscles to coordinate correctly and empty stool, may affect half of patients with chronic constipation
dyssynergic defecation
secondary causes of constipation
medical and psychogenic condition, medications, structural abnormalities and lifestyle
c/o nausea, vloating, straining, cramping, and difficulty passing stools
constipation
Diagnostics related to constipation
abdominal xray, ct scan, CBC w/diff to rule out obstruction, ileus, megacolon and volvulus
constipation management
lifestyle changes, increase exercise, increase dietary fiber
bulk forming laxatives, stool softeners, osmotic laxatives, stimulant laxatives in this order.
what is diarrhea
increase in stool frequency of more than three unformed stools per day loose or liquid characterized by urgency and consistent
chronic diarrhea characterized as
diarrhea for a month without improvement
acute diarrhea characterized as
diarrhea lasting less than 2 weeks
malabsorptive disorders from ingesting solute rich molecules (sugar free gum, alha glucosidase, ampicillin, clindamycin, miralax, methyldopa, qunidines, hydralaien ace inhibitors
osmotic diarrhea
Most common type of diarrhea, more likely to result in watery stools as absorption in gut is compromised
secretory diarrhea
steatorrhea
known as fatty diarrhea a type of secretory diarrhea i.e. bile acid malabsorption post gallbladder removal
brief episodes of acute diarrhea typically caused by :
viral or food-borne illness
diarrhea diagnostics
x-ray KUB, flat and upright if small bowel obstruction or stool impaction with overflow incontinence is suspected
outpouching of mucosa through the colon wall
Diverticular disease
mild to moderate aching abdominal pain present in the left lower quadrant
diverticulitis
Diagnostics for diverticulitis
cbc w/diff, crp, ua, bun, colonoscopy 4-6 weeks later
most common cause of lower GI bleeding
diverticular bleeding
swallowing disorder that involves dysfunction of one or more stages in the sequence of swallowing
oropharyngeal dysphagia
causes of oropharyngeal dysphagia
medication side effects, postsurgical muscular or neurogenic disorder, radiation therapy
causes of Iatrogenic oropharyngeal dysphagia
Botulism, diphtheria, lyme disease, syphilis
infectious cause of oropharyngeal dysphagia
Amyloidosis, Cushing syndrome, Thyrotxicosis, Wilson disease
Causes of metabolic oropharyngeal dysphagia
Connective tissue disease, myasthenia gravis, myotonic dystrophy, polymyositis, sarcoidosis, paraneoplastic syndromes
Myopathic causes of oropharyngeal dysphagia
amyotrophic lateral sclerosis, brain-stem tumors, cerebral palsy, dementia, guillain-barre syndrome
neurologic causes of oropharyngeal dysphagia
chewing (mastication) involves which cranial nerves
V ( trigeminal, VII Facial, IX glossopharyngeal and XII hypoglossal
diagnostics for oropharyngeal dysphagia
modified barium swallow, CT or MRI, fiberoptic endoscopic examination of swallow
first factor causing acid reflux
TLESR- transient lower esophageal sphincter relaxations
second cause of acid reflux
hiatal hernia
third factor of acid reflux
intensity of acid exposure
fourth cause of acid reflux
pathogenic factor affecting the ability of the esophagus to clear itself of reflux material resulting in longer exposure to gastric contents
fifth factor of acid reflux
integrity of the protective barrier of the mucosal lining
abdominal pain that occurred a minimum of once each week for the previous 3 months in combination with two or more of following
defecation related pain
pain related to change in stool frequency
pain associated with change in appearance of stoll
Irritable bowel syndrome IBS
