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Differential Dx > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is dysphagia?

A

The sensation of food catching or sticking in the esophagus

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2
Q

What are the causes of dysphagia?

A

Motor –> loss of coordinated local muscle activity

Mechanical –> mechanical obstructive disorder

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3
Q

What are s/s of dysphagia originating from a motor cause?

A

Gradual onset with slow progression

Equal difficulty to swallow solids and liquids

Swallowing is worse with cold substances

Bolus passage is facilitated by swallowing, valsalva, or throwing the head and shoulders backward

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4
Q

What are s/s of dysphagia originating from a mechanical cause?

A

Fast onset with fast progression

Swallowing is more difficult with solids

No change in swallowing difficulty when having different temperatures of food

Bolus can possibly regurgitated

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5
Q

What is odynophagia?

A

Pain with swallowing

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6
Q

What are the causes of odynophagia?

A

Esophagitis (GERD or coronary ischemia)

Esophageal spasm

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7
Q

What position relieves esophagitis pain?

A

sitting upright

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8
Q

What is dyspepsia?

A

Indigestion/heartburn

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9
Q

What are the causes of dyspepsia?

A

Organic, functional, medication

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10
Q

What are the s/s of dyspepsia?

A

Retrosternal pain
Epigastric pain

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11
Q

What is the treatment for dyspepsia?

A

Antacids

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12
Q

What is the physical cause of GERD?

A

ineffective lower esophageal sphincter

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13
Q

GERD commonly affects those who are >____ y/o.

A

> 40 y/o

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14
Q

What are s/s of GERD?

A

Heartburn, Belching, Dysphagia

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15
Q

What are treatments for GERD?

A

Medication (zantac, prolisec, prevacid, nexium)

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16
Q

GERD has a relationship with ____.

A

asthma

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17
Q

What causes a peptic ulcer?

A

Digestive acids irritate/erode the lining of the digestive tract

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18
Q

What pain pattern is caused by a peptic ulcer? Where can it manifest and possibly radiate?

A

a. Coursing in waves and lasts for several minutes

b. Epigastric pain (heartburn); back pain @ t8-t10 region

c. radiates to inferior costal margins in the back

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19
Q

What are causes of peptic ulcers?

A

H-pylori

NSAID use

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20
Q

What are the risk factors for NSAID induced gastropathy?

A

> 65 y/o with the use of medications (prozac, zoloft, celexia, paxil)

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21
Q

Gastric ulcers are associated with increased ____ use especially in the elderly, causing pain with eating.

A

NSAID use

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22
Q

(true/false) Gastric ulcers are always benign

A

FALSE (they can be malignant)

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23
Q

What is the appearance of stool in a patient with an esophageal ulcer?

A

Black/tar/coffee-ground

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24
Q

What is duodenal ulcers associated with?

A

H-pylori

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25
Q

What are s/s of duodenal ulcers?

A

Dull/gnawing/burning pain… empty stomach

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26
Q

Where is pain found if caused by a duodenal ulcer?

A

epigastric
midthoracic (T6-T10)
Supraclavicular area

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27
Q

Pain 30-90 minutes after eating food is caused by a _____ origin.

A

gastric

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28
Q

Pain 2-4 hours after eating food is caused by a _____ origin.

A

duodenal

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29
Q

(true/false) Foods can produce or alleviate symptoms

A

true

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30
Q

Any substance that is a ____ can decrease symptoms of an ulcer/GERD

A

base (ex: milk)

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31
Q

If a person has midthoracic pain/R scapular pain after indigestion of fatty foods, it can be an indication of a possible ____ disorder.

A

gallbladder disorder

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32
Q

What is black/tar stool an indication for?

A

Large upper GI bleed

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33
Q

Bright/bloody red colored stool is indicative of what?

A

lower GI bleed

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34
Q

Reddish/non-bloody stool is caused by what?

A

foods (ex: beets)

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35
Q

Light grey/pale stool is associated with what?

A

Obstructive jaundice and/or an increase in fat contact

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36
Q

Stool that floats is indicative of what?

A

cystic fibrosis/increased fat content

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37
Q

What are possible s/s of lower GI bleeds?

A

Red bloody stool
difficulty initiating bowel movements
lightheadedness
Fatigue

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38
Q

What are s/s of constipation and fecal impaction?

A

Abdominal fullness
bloating
fever
agitation
mental status change

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39
Q

What should you do when fecal impaction is suspected?

A

call MD

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40
Q

What are possible causes of diarrhea?

A

Infectious agents
Laxative abuse
Colon cancer
Irritable bowel syndrome
Crohn’s disease
Ulcerative colitis
Diabetic enteropathy

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41
Q

What are the manifestations of dehydration?

A

Thirst and dry mouth
Postural hypotension
Rapid breathing
Rapid pulse (> 100 bpm)
Confusion irritability, lethargy
HA

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42
Q

Difficulty initiating bowel movements can cause what?

A

Constipation (mistaken for acute LBP)

43
Q

Difficulty initiating bowel movements can be an indication of what?

A

Inflammation OR cancer at the anorectal region

44
Q

What dermatome(s) is epigastric pain found in?

A

T3-T5

45
Q

What sympathetic nerve distribution is periumbilical pain found in?

A

T10

46
Q

What sympathetic nerve distribution is lower abdominal pain found in?

A

T10-L2 with referred pain to the sacrum

47
Q

Lower abdominal pain (T10-L2 sympathetic nerve distribution) can refer to where?

A

the sacrum

48
Q

What dermatome(s) is esophageal pain in?

A

T6-T10

49
Q

What dermatome(s) is gallbladder pain in?

A

T6-T9

50
Q

What dermatome(s) is colon/appendix pain in?

A

T10, T11

51
Q

What dermatome(s) is sigmoid colon/genital pain found in?

A

T11-S4

52
Q

What are early stages of abdominal pain?

A

Changes in the skin within the affected dermatome

53
Q

What is arthralgia? What is it commonly associated with?

A

pain within a joint commonly associated with a gut problem OR followed by a gut problem

54
Q

What is the general presentation of arthralgia?

A

General presentation: asymmetric, migratory pain found in 1-2 joints

Specific presentation:
- nails separate from nail beds and are thin and discolored
- skin has rashes and lesions
- conjunctivitis

55
Q

What can shoulder pain be caused by if there is GI involvement?

A
  • Free air/blood in the abdominal cavity caused by ruptured spleen (Kehr’s sign), trauma, ruptured ectopic pregnancy, Liver trauma
  • Enlarged organ (Splenomegaly)
  • Pancreatic disease
56
Q

What are patient interview red flags indicating possible appendicitis?

A
  • pain may initially be epigastric/periumbilical but the moves to the RLQ
  • flank pain or pain in thigh and testicles (depending on position)
  • nausea and anorexia AFTER pain onset
57
Q

What are physical exam red flags indicating possible appendicitis?

A
  • abdominal rigidity w/ rebound tenderness
  • (+) mcBurney’s point
  • (+) psoas and obturator sign
58
Q

What are tests used to rule out appendicitis?

A

Mcburney’s point
Iliopsoas muscle palpation

59
Q

What is the psoas sign?

A

Pain at the psoas during passive EXT of the RIGHT thigh

–> pain in the R lateral buttock

60
Q

What is the obturator sign?

A

Pain during passive IR of the flexed thigh

–> pain on lateral side of knee

61
Q

What is diverticulosis?

A

a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon.

62
Q

What is diverticulitis?

A

inflammation or infection within the colon wall

63
Q

What are s/s of diverticulitis?

A
  • over intestinal bleeding
  • L lower adominal pain
  • L pelvic pain
  • Bloody stool
  • increased WBC
64
Q

Where is palpation done for diverticular diseases?

A

suprapubic area

65
Q

How is diverticular disease diagnosed?

A

CT

66
Q

Diverticular disease may look like ___.

A

appendicitis

67
Q

What is pancreatitis?

A

Inflammation of the pancreas resulting in auto digestion

68
Q

Approx 70% of predisposing risk factors for pancreatitis are what?

A

Gallstones and alcoholism

69
Q

What GI diagnosis is the most common to lead to admission to a hospital?

A

Pancreatitis (other than gallbladder)

70
Q

Where is pain found for pancreatitis?

A

Upper shoulder (epigastric)

71
Q

What are s/s of pancreatitis?

A
  • N/V (MOST COMMON)
  • upper shoulder pain (epigastric)
  • constant pain
  • increased temperature
  • tachycardia
72
Q

Pancreatic cancer is found in what population?

A

African American men < 45 y/o

73
Q

(true/false) Pancreatic cancer is common.

A

FALSE (it is rare)

74
Q

Pancreatic cancer can be associated with what?

A

DM

75
Q

What are s/s of pancreatic cancer?

A
  • jaundice
  • back pain (indication of advanced disease)
  • low/dull R abdominal pain
76
Q

How is pancreatic cancer diagnosed?

A

US and CT

77
Q

What are risk factors for pancreatic cancer?

A

smoking and high fat diet

78
Q

What is considered as the “common cold of the stomach?”

A

IBS

79
Q

What is IBS?

A

A functional disorder of motility in the small and large intestines with no identifiable abnormality of the bowel.

80
Q

What is the most common GI disorder in the west?

A

IBS

81
Q

What are s/s of IBS?

A
  • pain abdominal cramps
  • flatulence
  • anorexia
  • belching
  • abdominal distention
  • bowel changes
82
Q

What are examples of INFLAMMATORY bowel disease?

A
  • ulcerative colitis
  • crohn’s disease (regional enteritis / ileitis)
83
Q

About 15% of patients w/ inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have ______. clinically

A

sacroiliitis

84
Q

What are s/s of crohn’s disease?

A
  • purple or red skin rash (LEs most commonly affected)
  • joint pain/arthritic component
  • intermittent fever
  • sweats, malaise, anemia
85
Q

What is ulcerative colitis?

A

Inflammation and ulceration of the inner lining of the large intestine (colon) & rectum

86
Q

What is more common to form with ulcerative colitis?

A

colon cancer

87
Q

What are s/s of ulcerative colitis?

A
  • rectal bleeding
  • nocturnal diarrhea
  • fever
  • N/V
  • weight loss
88
Q

Ulcerative colitis that is associated with colon cancer commonly develops at what age?

A

< 16 y/o

UC is commonly present for > 30 yrs

89
Q

What is crohn’s disease?

A

Chronic inflammation of all layers of the bowel wall

90
Q

What population is crohn’s disease commonly found in?

A

15-30 y/o

91
Q

What are the 5 subtypes of Crohn’s disease?

A

Gastroduodenal
Jejunoileitis
Ileitis = ileum (lowest/last part of small intestine)
Ileocolitis = most common
Colitis

92
Q

What are patient interview red flags for colon cancer?

A
  • bowel disturbance (rectal bleeding and red stool)
  • weight loss
  • Family PMH of colon cancer
  • pain not altered by positioning or movement
93
Q

(true/false) colon cancer is in the 3rd most common cancer.

A

true

94
Q

What are physical exam red flags for colon cancer?

A
  • TTP of adomen
  • ascites (fluid in the abdomen)
95
Q

What can be the first signs for colon cancer?

A

Metastases to liver, lung, bone, or brain

96
Q

What is the most common MET site of colon cancer?

A

T-spine and ribcage

97
Q

What are precursors to cancerous lesions for colon cancer?

A

polyps

98
Q

Colon cancer and colorectal cancer are commonly found in what population?

A

> 50 y/o

99
Q

Colorectal cancer is commonly misdiagnosed as ______ due to similar presentation.

A

Diverticular disease

100
Q

(true/false) colorectal cancer can be asymptomatic until it is fully progressed

A

true

101
Q

What are s/s associated with a better prognosis with colorectal disease?

A

rectal bleeding

102
Q

What are s/s associated with a worse prognosis for colorectal cancer?

A

Constipation

103
Q

What are s/s for colorectal cancer when symptomatic?

A
  • rectal bleeding
  • constipation
  • colicky pain
  • sacral pain and LBP (usually in advanced stage)

Differential Dx (13 decks)

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