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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?

A

GERD

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
Q

Esophageal Pain descriptors and intensity

A

Sharp
Sticking
Stabbing
Burning
Mild to severe pain

26
Q

Peptic Ulcer Primary and Referred Pain Pattern

A

PRIMARY
- Epigastric/stomach pain

REFERRED
- Back, right shoulder

27
Q

Stomach and Duodenal Primary and Referred Pain

A

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
Q

Diverticular Disese is primarily seen in what population?

A

Older Adults >60Y

29
Q

Diverticulistis Primary Pain location

A

Gen. abdominal pain (LLQ/RLQ) +/- pelvic pain/tenderness

30
Q

Appendicitis Primary Pain

A

PRIMARY: Periumbilical +/- epigastric
REFERRAL: RLQ, flank, right thigh, groin, testicular

31
Q

Pancreatitis Primary and Referred Pain

A

PRIMARY: Epigastric
REFERRED: Back (Also upper left lumbar region w/chronic)

32
Q

Modifiable and Nonmodifiable Risk Factors for Pancreatic Carcinoma

A

MODIFIABLE
- Tobacco use
- Overweight
- DM
- Chronic pancreatitis
- Chemical exposure (occupational)

NON-MODIFIABLE
- Age (>70)
- Male
- AA
- Family Hx

33
Q

Primary and Referred Pain in Pancreatic Carcinoma

A

PRIMARY: epigastric (midline or to left)
REFERRED:
- Back pain (mid-low)
- Left shoulder (tail of pancreas)
- Right shoulder (head of pancreas)

34
Q

Factors Influencing development of Crohn’s Disease

A
  • 20-29 YO
  • Parent/sibling w/Hx IBD
  • Smoker
35
Q

What portion of the intestines does Crohn’s disease most likely affect?

A

Ileum + colon

36
Q

Where does ulcerative colitis mostly affect?

A

large intestine + rectum

37
Q

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?

A

Inflammatory Bowel Disease (IBD)

38
Q

I present with…

  • Painful abdominal cramps
  • Constipation/diarrhea
  • N/V
  • Anorexia
  • Flatulence
  • Foul breath

who am I?

A

Irritable Bowel Syndrome (IBS)

39
Q

Who is most likely to develop IBS?

A

</=50 YO Females

40
Q

Risk Factors For Irritable Bowel Syndrome (IBS)

A
  • Family Hx
  • Emotional Stress, tension, anxiety
  • Food intolerance
  • Hx of physical or sexual abuse
  • Severe digestive tract infection
41
Q

Increased Risk Factors to develop colorectal cancer:

A
  • 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
Q

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?

A

Colorectal Cancer (Early)

43
Q

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?

A

Colorectal cancer (late)

44
Q

Small Intestine Primary and Referred Pain

A

PRIMARY: mid-abdominal pain
REFERRAL: back w/sufficient stimulus/low pain threshold

45
Q

Large Intestine Primary and Referred Pain Pattern

A

PRIMARY: lower mid-abdominal, poorly localized
REFERRAL: sacrum

46
Q

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?

A

Peptic Ulcer

47
Q

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?

A

Diverticular Disease

48
Q

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?

A

Appendicitis

49
Q

What special tests would be positive with appendicitis?

A
  • McBurney’s Point
  • Pinch an Inch
  • Rebound tenderness in RLQ
  • Rovsing sign
  • Hop test
50
Q

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?

A

Pancreatitis (acute)

51
Q

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?

A

Chronic Pancreatitis

52
Q

I present with

  • Back pain
  • Epigastric pain
  • Jaundice
  • Anorexia and weight loss
  • Light-colored stools
  • Constipation
  • N/V
  • Weakness

who am I?

A

Pancreatic cancer

Differential Diagnosis (8 decks)

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