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Differential Diagnosis > Gastrointestinal Disease > Flashcards

Gastrointestinal Disease Flashcards

1
Q

**Epigastric region pain **
- Location
- Nerve distribution
- Referral Organss

A
  • Midsternal to xiphoid process
  • T3-T5 sympathetic nerve distribution
  • Referral from: heart, esophagus, stomach, duodenum, pancreas, gallbladder, liver
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2
Q

Periumbilical Region
- Location
- Nerve distribution
- Referral Organs

A
  • LBP, anterior/posterior trunk
  • T9-T11 nerve distribution
  • Referral area: small intestine, appendix
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3
Q

Lower Abdominal Region
- Nerve distribution
- Referral Organs

A
  • T10-L2
  • Large intestine, colon

*Often taken for uterine or bladder pain

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4
Q

Causes of Visceral Pain

A
  • Stretching/tension
  • Distension
  • Forceful contraction
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5
Q

Common GI Referral Regions

A
  • Sternal Area
  • Shoulder and Neck
  • Scapular area
  • Mid-back
  • Lower back
  • Hip
  • Pelvic
  • Sacrum
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6
Q

Visceral Pain Descriptors

A
  • Colicky pain
  • Deep aching
  • Boring
  • Gnawing
  • Vague burning
  • Deep grinding
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7
Q

Inflammatory pain descriptors

A
  • Steady
  • Deep
  • Boring
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8
Q

What altered sensory patterns may be present with visceral referral patterns?

A
  • Hyperesthesia
  • Hyperalgesia
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9
Q

C3-C5 Dorsal Root Organs and referral area

A
  • liver, diaphragm, pericardium
  • Shoulder
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10
Q

T6-T9 Dorsal Root Organs and referral area

A
  • Gallbladder, stomach, pancreas, small intestine, esophagus
  • Mid-back, scapular area
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11
Q

T10/T11 dorsal root supplies what organs?

A

Colon, appendix, pelvic vicsera

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12
Q

T11-L1 and S2/4 Dorsal roots supply what organs and refer to where?

A
  • Sigmoid colon, rectum, ureters, testes
  • Pelvis, flank, LB, sacrum
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13
Q

Dysfunction of the stomach, gallbladder, liver, pylorus, or diaphragm results in contraction and guarding where?

A

Rectus abdominus superior to umbilicus

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14
Q

Dysfunction of the ileum, jejunum, appendix, cecum, colon, and rectum results in contraction and guarding where?

A

Rectus abdominis inferior to umbilicus

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15
Q

Pain after eating associated with upright positioning is related to:

A

esophagitis

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16
Q

S&S of GI Bleeding

A
  • Coffee-ground emesis
  • Bloody dirrhea
  • Bright red blood
  • Melena
  • Reddish or mahogany-colored stools
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17
Q

How do you differentiate between gastric ulcers and duodenal or pyloric ulcers?

A

Onset to pain after eating:
Gastric: 30-90 min
Duodenal/Pyloric: 2-4 hours (food may relieve symp) and 12-3 am

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18
Q

How do you differentiate between duodenal ulcer and cancer related pain when a patient is waking between 12-3 am every night?

A

Cancer: more intense, boring, constant, unable to be relieved
Duodenal: pain can be relieved by eating

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19
Q

Diagnosis of constipation must include 2 of the following:

A
  • Straining during defecation
  • Hard, lumpy stools
  • Sensation of incomplete evacuation
  • Sensation of anorectal obstruction
  • Manual maneuvers to facilitate defecation
  • Fewer than 3 defecations/wk
  • Loose stools rarely present without laxatives
  • Insufficient criteria for IBS
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20
Q

Kehr’s Sign:

A
  • Left shoulder pain with palpation/pressure place on upper abdomen
  • (+) = retroperitoneal bleeding/ruptured spleen
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21
Q

Danforth Sign

A

Shoulder pain with inspiration

22
Q

I present with…

  • Back, pelvic, abdominal, hip, +/- knee pain
  • Fever (‘hectic’)
  • Night sweats
  • Abdominal pain
  • Loss of appetite/other GI upset
  • Antalgic gait
  • Palpable, tender mass

Who am I?

A

Psoas or Obturator Abcess

23
Q

I present with…

Typical Symptoms
* Heartburn
* Regurgitation with bitter taste in mouth
* Belching

Atypical Symptoms
* Chest pain unrelated to activity
* Sensation of a lump in the throat
* Dysphagia
* Odynophagia
* Wheezing, coughing, hoarseness
* Asthma
* Sore throat, laryngitis
* Weight loss
* Anemia

Who am I?

24
Q

Primary and Referred Esophageal Pain

A

PRIMARY
* substernal
* Upper esophagus anterior neck
* Lower esophagus: xiphoid process radiating around thorax

REFERRED
* Middle of back

25
Esophageal Pain descriptors and intensity
Sharp Sticking Stabbing Burning Mild to severe pain
26
Peptic Ulcer Primary and Referred Pain Pattern
PRIMARY - Epigastric/stomach pain REFERRED - Back, right shoulder
27
Stomach and Duodenal Primary and Referred Pain
PRIMARY - Midline epigastric - Upper abdomen just below xiphoid process - 1-2" above and to right of umbilicus REFERRAL - Back - Right shoulder/upper trap - Lateral border of right scapula
28
Diverticular Disese is primarily seen in what population?
Older Adults >60Y
29
Diverticulistis Primary Pain location
Gen. abdominal pain (LLQ/RLQ) +/- pelvic pain/tenderness
30
Appendicitis Primary Pain
PRIMARY: Periumbilical +/- epigastric REFERRAL: RLQ, flank, right thigh, groin, testicular
31
Pancreatitis Primary and Referred Pain
PRIMARY: Epigastric REFERRED: Back (Also upper left lumbar region w/chronic)
32
Modifiable and Nonmodifiable Risk Factors for Pancreatic Carcinoma
MODIFIABLE - Tobacco use - Overweight - DM - Chronic pancreatitis - Chemical exposure (occupational) NON-MODIFIABLE - Age (>70) - Male - AA - Family Hx
33
Primary and Referred Pain in Pancreatic Carcinoma
PRIMARY: epigastric (midline or to left) REFERRED: - Back pain (mid-low) - Left shoulder (tail of pancreas) - Right shoulder (head of pancreas)
34
Factors Influencing development of Crohn's Disease
- 20-29 YO - Parent/sibling w/Hx IBD - Smoker
35
What portion of the intestines does Crohn's disease most likely affect?
Ileum + colon
36
Where does ulcerative colitis mostly affect?
large intestine + rectum
37
# I present with... - Diarrhea/Constipation - Fever - Abdominal pain - Rectal bleeding - Night sweats - Decreased appetitie/nausea, weight loss - Uveitis - Arthritis/migratory arthralgias - Hip pain | who am I?
Inflammatory Bowel Disease (IBD)
38
# I present with... - Painful abdominal cramps - Constipation/diarrhea - N/V - Anorexia - Flatulence - Foul breath | who am I?
Irritable Bowel Syndrome (IBS)
39
Who is most likely to develop IBS?
40
Risk Factors For Irritable Bowel Syndrome (IBS)
- Family Hx - Emotional Stress, tension, anxiety - Food intolerance - Hx of physical or sexual abuse - Severe digestive tract infection
41
Increased Risk Factors to develop colorectal cancer:
- Non-hispanic African American #1 - Native Americans and Native Alaskans - Family Hx of cancer or polyps - Prior Hx IBD - Hereditary nonpolyposis colon cancer - Hx of radiation to the abdomen or pelvic region
42
# Early in disease progression I present with... - Rectal bleeding, hemorrhoids - Abdominal, pelvic, back or sacral pain - Back pain that radiates down legs - Changes in bowel patterns | who am I?
Colorectal Cancer (Early)
43
# Later in disease progression I present with... - Constipation --> obstipation - Diarrhea w/copious amounts of mucus - N/V - Abdominal distention - Weight loss - Fatigue/dyspnea - Fever (less common) | who am I?
Colorectal cancer (late)
44
Small Intestine Primary and Referred Pain
PRIMARY: mid-abdominal pain REFERRAL: back w/sufficient stimulus/low pain threshold
45
Large Intestine Primary and Referred Pain Pattern
PRIMARY: lower mid-abdominal, poorly localized REFERRAL: sacrum
46
# I present with... - "Heartburn" - Night pain (12-3a) - Epigastric, stomach pain - Radiating to back, right shoulder - Light-headedness or fainting - N/V - Anorexia - Weight loss - Melena | who am I?
Peptic Ulcer
47
# I present with... - Gen. abdominal pain (L/RLQ) - Loss of appetite, N/V, - Decreased/absent bowel sounds - (+) pinch an inch - Palpable abdominal mass/tenderness - Abdominal bloating, Flatulence - Bloody stools - Constipation/irregular BM - Fever, | who am I?
Diverticular Disease
48
# I present with - Periumbilical +/- epigastric pain - RLQ, flank, right thigh, groin or testicular pain - Abdominal involuntary muscular guarding and rigidity - N/V - Anorexia - Dysruria - Low-grade fever - Coated tongue and bad breath | who am I?
Appendicitis
49
What special tests would be positive with appendicitis?
- McBurney's Point - Pinch an Inch - Rebound tenderness in RLQ - Rovsing sign - Hop test
50
# Acutely I present with... - Epigastric pain radiating to the back - N/V/D/anorexia - Abd. distention and pain - Fever + sweating - Tachycardia - Malaise - Weakness - Bluish discoloration of abdomen or flanks - Jaundice | who am I?
Pancreatitis (acute)
51
# Chronically I present with... - Epigastric pain radiating to the back - Upper left lumbar region pain - N/V - Weight loss - Oily or fatty stools - Clay-colored or pale stools | who am I?
Chronic Pancreatitis
52
# I present with - Back pain - Epigastric pain - Jaundice - Anorexia and weight loss - Light-colored stools - Constipation - N/V - Weakness | who am I?
Pancreatic cancer

Differential Diagnosis (8 decks)

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