GI Flashcards
small volume profuse watery diarrhea, BLOODY,
More than 3 bowel moments every days
Less than 2 weeks in duration
-Fever > 38.5 C
-(LLQ) Abdominal cramps
-Tenesmus
-Fecal urgency
-symptoms of dehydration
Acute INFLAMMATORY Infectious Diarrhea
Large volume watery diarrhea, NON BLOODY, More than 3 bowel moments every days
Less than 2 weeks in duration
-nausea
-vomiting
-cramps
Acute NON-INFLAMMATORY Infectious Diarrhea
Diarrhea present for greater than 4 weeks
Chronic Diarrhea
-Most commonly seen in ALCOHOLICS and LONG TERM NSAIDs USE, and critically ill patients
-Often asymptomatic
-Epigastic pain
-Nausea and vomitting
-Hematemesis
-Upper GI bleeding with “coffee grounds” emesis or bloody aspiration on NG Tube
-May present as dyspepsia, bloating, and postprandial fullness/discomfort
Gastritis
CAUSED BY:
-Diminishing intake of fiber and fluid _Systemic disease
-Medication
-Structural abnormalities
-Slow colonic transit
-Irritable Bowel Syndrome
-Hirschsprung disease
infrequent stool
S/S
-excessive straining
-sense of incomplete evacuation
-need for digital manipulation
_Most common digestive complaint in the United States
Constipation
Painless, bleeding, prolapse, and mucoid discharge
Not visible or palpable (may protrude through the anus with gentle straining)
Prolapsed hemorrhoids are visible purple nodules covered by mucosa
Bright red blood streaks visible on toilet paper/stool or bright red blood that drips into the toilet
PRIMARY LOCATIONS:
-Right anterior and posterior
-Left lateral
Internal Hemorrhoids
-Visible bluish perianal nodule
-PAINFUL
-Tender to palpation
External Hemorrhoids
Linear or rocket shaped ulcer that is usually less than 5mm in length
Severe, tearing pain during
defecation followed by throbbing discomfort that may lead to constipation
_Bright red blood on stool or toilet paper
anal fissure
_Dull, aching, or throbbing pain that becomes worse immediately before defecation, is lessened after defecation, but persist between bowel movements
_Aggravated by straining, coughing, or sneezing
_Pain and tenderness interfere with walking or sitting
Anorectal Abscess
-Nonhealing” anorectal abscess following drainage
-Chronic purulent drainage and a pustule-like lesion in the erianal or buttock area
-Intermittent rectal pain during defecation and sitting
-Intermittent and malodorous perianal drainage and pruritus
Anorectal fistula
caused by ingrown hair
Occur in the midline of the gluteal crease
Recurrent infection at the base of the spine
swelling
pain
persistent discharge
tender mass
Pilonidal Disease
_Lower abdominal cramps and fecal urgency
_ Periods of symptomatic flare ups and remissions
bloody diarrhea
anemia
_More common in non smoker and and former smoker
Inflammatory Bowel Disease
(Ulcerative Colitis)
_NON bloody diarrhea
_NON bloody diarrhea
_Weight loss and malaise
_General sense of well-being “poor”
Crohn’s Disease
-Chronic (more than 3 months) abdominal pain that occurs in association with altered bowel habits
Late teens to early 20’s
NORMAL physical exam
-Abdominal discomfort abdominal region) is relieved immediately after defecation
-Bloating or feeling abdominal
Dx CRITERIA (PAIN + 2/3):
1. Relieved with defecation
2. Associated with change in frequency of stool
3. Associated with change in form (appearance) of stool
NORMAL physical exam (no fevers, rashes, or bloody stool)
Irritable Bowel Syndrome (IBS)
mid line pain occurs 30-60 minutes after meals and upon bending over or reclining
-Reports relief from taking antacids or baking soda
-Complain of regurgitation
-Dysphagia
-Dyspepsia
-cough
-chest pain
-belching
-hoarseness
Gastroesophageal Reflux Disease (GERD)
Severe retrosternal chest pain
Odynophagia and dysphagia often beginning several hours to one month after taking a pill
History of taking pills without water or supine
Pill Induced Esophagitis
Odynophagia or pain on swallowing
LOCALIZED pain to a discrete retrosternal area swallowing
White mucosal plaque like lesions are noted on the endoscopy
Is most common in HIV infected patients and in patients with hematologic malignancies
Candida Esophagitis
Esophageal irritation from chronic GERD
Localized substernal chest pain
heartburn
Dysphasia
Esophageal Stricture
_Gradual onset of dysphagia with solid foods and some liquid
can be present for months
substernal chest pain and discomfort/fullness
Lifting neck or throwing shoulders back to enhance gastric emptying
Regurgitation
Esophageal Spasm
Gnawing, dull, aching or “hunger like” epigastic pain
Nausea and anorexia (gastric ulcers)
_Relief of pain with food or antacids and a recurrence of pain 2-4 hours later
TWO MAJOR CAUSES:
1. NSAIDs
2. H. Pylori
Peptic Ulcer Disease
Acute abdominal pain and fever
Left lower quadrant tenderness with palpable mass
Constipation or loose stool
Nausea and vomiting
Diverticulitis
HEMATEMESIS
_Bright red blood (indicates a bleed at or proximal to the LES
_“Coffee ground” emesis (indicates a bleed in the stomach or proximal duodenum)
MELENA
_“Tar colored” black stool (iron in hemoglobin + gastric acid)
HEMATOCHEZIA:
_Massive upper GI bleed > 1000ml
Upper GI Bleed
HEMATOCHEZIA (bright red blood per rectum)
Large volumes of bright red blood suggest colonic source
Maroon stool = right colon or small intestine
Melena = source proximal to ligament of treitz
Lower GI Bleeding
Heavy ALCOHOL user
S/S of upper GI bleed (hematemesis w/ or w/o melena)
History of retching, vomiting, or straning
Mallory Wiess Tear
Hartman’s Sign (crunching sound heard on auscultation)
_Possible crepitus with palpation over the chest
Boerhaave Syndrome
Periumbilical abdominal pain that progresses to more localized right lower quadrant pain
Tender McBurneys point
Nausea and anorexia
fever
rosving sign
rebound tenderness
obturator sign
Psoas Sign
Appendicitis
Acute onset of intermittent sharp RUQ pain
Pain precipitated by meals
No fever
Biliary Colic
Sudden onset of RUQ pain after eating a meal high in fat
Murphy’s sign
6 F’s: (Fat, Fertile, 40, Female, fever, flatulence)
Symptoms greater than 6 hours
Cholecystitis
Sudden onset of RUQ pain after eating a meal high in fat
Murphy’s sign
6 F’s: (Fat, Fertile, 40, Female, fever, flatulence)
Choleodocholithiasis
Charcot’s Triad:
RUQ pain
Fever
Jaundice
Cholangitis
Abrupt onset epigastric abdominal pain
Steady, ‘boring’, severe abdominal pain that is made worse with walking and lying supine
Pain radiates to the back
Relief with sitting upright and leaning forward
Grey Turner and Cullen’s sign
Mild jaundice
Nausea and vomiting
Weakness, fever, and anxiety
MOST COMMON CAUSE:
alchol
gallstones
Pancreatitis
Lower anterior abdominal mass
Abdominal contents herniate DIRECTLY through Hasselbach’s triangle
Caused by muscular weakness
Direct Inguinal Hernia
Scrotal mass
Abdominal contents herniate through the inguinal canal
Caused by a patent processus vaginalis
Frequently incarcerate and strangulate
Indirect Inguinal Hernia
“Out-y belly button”
Typically congenital
Usually resolve by 5 years old
Rarely incarcerate
Umbilical Hernia
Mechanical
-Crampy, intermittent abdominal pain _Unable to find comfortable position -Abdominal distention
-Vomiting
-Possible diarrhea
-Tympanic abdomen on percussion _Constipation and bloating
-Active HIGH PITCHED bowel sounds with occasional “rushes”
Paralytic Ileus:
-Less intense abdominal pain that is more constant
-Constipation
-Diminished bowel sounds
Small Bowel Obstruction
Constant aching diffuse lower
abdominal pain
Bloating and distention
Constipation and inability to pass flatus
Possible feculent vomitus
Large Bowel Obstruction
Very ill appearing
Unstable vitals: (fever, tachycardia, hypotension)
Typically DO NOT WANT to move _Board-like abdomen
May have absent bowel sounds
Percussion: absence of dullness over the liver suggest free air/ perforation)
Secondary Peritonitis
Patient may have no pain
Little external evidence of injury
Seat belt sign
Blunt Abdominal Trauma
Hypovolemic shock syndrome
S/S of peritonitis
Penetrating Abdominal Trauma
