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
