Gastrointestinal Overview - Brown Flashcards
Barium Enema
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
barium inserted into colon and radiographs taken
helpful to diagnose: diverticulitis, polyps, tumors
limitations: abnormalities need to be followed up by colonoscopy, patient discomfort
CT Scan
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
incremental images
helpful to diagnose: acute abdominal conditions, tumors
limitations: radiation exposure, cost
Esophagogastroduodenoscopy (EGD)
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
scope inserted through patient’s mouth, down esophagus to stomach and part of small intestine
helpful to diagnose: mucosal ulcerations or abnormalities; visualiztion and biopsy
limitations: unable to determine reflux or swallowing problems
Colonoscopy
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
** gold standard ** - scope visualizes the entire colon, can also perform biopsies
helpful to diagnose: polyps, mucosal abnormalities, diverticula, tumor
limitations: limited if stool present, chance of perforation
GI History
Identify and describe key elements of history and physical exam in the diagnostic approach to GI disorders
History of Present Illness
- OLD CHARTS
- Significance - relationship to life events, stress
Past Medical History
- Significant Illness: DM
- Previous Surgeries: adhessions
- Preventative Care: EKG, colonoscopy
- Allergies
Family History
- Cancer
- Somatic pain conditions
- Aneurysm
- Polyposis
Social History
- life stress
- eating
- sleeping
- working
- coping ability
- family/support
- recent travel
- addictions: tobacco, alcohol, drugs
GI Physical Exam
Identify and describe key elements of history and physical exam in the diagnostic approach to GI disorders
- OBSERVE: patient’s gait, guarding, ability to climb on table
- POSITION: patient supine with knees slightly flexed
- INSEPECT
- AUSCULTATE
- PERCUSS
- PALPATE
- may need to perform pelvic and rectal exam, hemoccult
Ultrasonography
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
safer test - no inoizing radiation
helpful to diagnose:
- cholecystitis/cholelithiasis
- cholangitis
- abscesses
- diverticulitis
- SB inflammation
limitations:
- blind to many areas of the abdomen
Flexible Sigmoidoscopy
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
done in the office - scope inserted through anus and inspects distal 1/3 of colon, capable of visualization and biopsy
helpful to diagnose: abnormalities of mucosa (polyps, diverticula, tumors, ulceration)
limitations: max 60 cm, grin and bear it, difficult if stool is present, patient comfort, chance of peforation
Common GI Symptoms
- Dyspepsia
- Nausea
- Vomiting
- Constipation
- Diarrhea
- GI Gas
GI Diagnostic Work-Up: Laboratory
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
- CBC with differentials
- Electrolytes
- BUN, Creatinine
- Liver Enzymes
- Lipase
- Amylase
- TSH
- hCG
- Urinalysis
- Stool Cultures
- Hemoccult
- H. Pylori
Biopsychosocial Factors & GI Disorders
Describe the role of biopsychosocial factors in GI disorders
- affect the clinical expression of GI illness and disease
- genetic predisposition
- early learning
- cultural background
Plain Film X-Rays
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
usefulness:
- bowel gas pattern
- intrabdominal free air
- air-fluid levels
- densities
- tumors
Enteric Nervous System (ENS)-Central Nervous System (CNS) Axis
- brain-gut interaction
-
CRF, VIP, 5-hydroxytryptamine, serotonin derivatives, nitric oxide, cholecystokinin
- regulate gastric motility, secretion, sensation and inflammation
Esophageal Manometry
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
tube from nose to esophagus - measures esophageal function by pressure readings of muscle contractions (motility)
helpful to diagnose: motility disorders
limitations: no visualization
Barium Swallow
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
radiologist visualizes stomach and esophagus under fluroscopy
helpful to diagnose: stricture, hiatal hernia, swallowing problems
limitations: unable to visualize or biopsy
24-hour pH probe
Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing
tube from the nose to esophagus to LES, pH sensor at tip determines acid expsoure
or can “clip” the probe to the esophagus, eventually detaches and passes in the stool
helpful to diagnose: GERD *gold standards
limitations: inconvenient
