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Diagnosis and Management 1 > GI > Flashcards

GI Flashcards

1
Q

Patients in whom abd pain is particular concern

A

Very old, very young, HIV+, immunosuppresed

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2
Q

What kind of abd pain is most common>

A

Visceral

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3
Q

What does visceral pain feel like>

A

Vague, dull, nauseating, poorly localized. Worse with distention and contraction.

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4
Q

What are foregut structures? Where do they cause pain?

A

Stomach, duodenum, liver, pancreas; cause upper abd pain

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5
Q

What are midgut structures? Where do they cause pain?

A

Small bowel, proximal colon, appendix; cause periumbilical pain

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6
Q

What are hindgut structures? Where do they cause pain?

A

Distal colon, GU tract; cause lower abd pain

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7
Q

Diseases that cause epigastric pain

A

Indigestion, cholecystitis

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8
Q

Diseases that cause periumbilical pain

A

intestinal obstruction, early appendicitis

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9
Q

Diseases that cause suprapubic pain

A

S/L intestine, UTI, IBD

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10
Q

Definition/Cause Referred Pain

A

Pain perceived distant from source; Due to lack of dedicated sensory pathways in brain for internal organs

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11
Q

Common examples of referred pain (Scapular, Groin, Shoulder)

A

Scapular - Biliary colic
Groin - Renal colic
Shoulder - Irritation of diaphragm from blood or infection

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12
Q

Definition and sxs of parietal/somatic pain

A

Comes from parietal peritoneum (lining of abd organs); sharp and well localized

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13
Q

Common causes of parietal pain

A

Acute inflammation, ischemia, infection; acute appendicitis, acute cholecystitis (vs. biliary colic causing visceral pain)

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14
Q

Psychogenic Pain - Description

A

Hx of multiple systems in pain, CHRONIC, non progressive, sxs of depression

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15
Q

Tips for assessing psychogenic pain

A

Do deep palpation with stethescope to assess true severity while pt distracted

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16
Q

What is seratonin

A

Neurotransmitter and hormone, important role in mood, sleep, appetite, temp regulation, pain perception, sex and secretion of other hormones

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17
Q

Where is most seratonin found (2 places)

A

GI tract, blood platelets

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18
Q

Seratonin role in GI system

A

Initiate gut motility, allow stomach to expand, transmit info to CNS

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19
Q

HPI for abd pain

A

localization, characterization, referral?, course/onset/resolution, aggrivating/aleviating, associated sxs

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20
Q

Examples of charictarization by disease (duodenal ulcer, intestinal obstruction, acute appendicitis)

A

Duodenal ulcer - burning/gnawing
Intestinal obstruction-crampy
Acute appendicitis - Aching

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21
Q

Most serious accociated sxs for abd pain

A

Weight loss, blood in stool, jaundice, N/V, fever

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22
Q

Social factors that affect GI

A

Caffine, ETOH, smoking, stress

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23
Q

What to include in abd PE (added for acute pain?)

A

Chest exam for pneumonia, CVAT, hernias, pulses; vitals (high RR and HR = pain, low BP can be low fluid volume); for acute include pelvic and rectal for occult blood

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24
Q

Sxs acute (surgical) Abd

A
  • Pain acute, persistent >6hrs
  • Symptoms progressed
  • Pain localized with rebound -tenderness, gaurding, rigidity
  • Pain worse with movement or cough
  • Lying still with knees to chest
  • Irritable infant lying still with flexed hips, quiet
  • N/V/A associated
  • Absent bowel sounds
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25
Q

Sigs of worse N/V

A
  • Vomitus smelles like feces or is bilious

- Pain occurs before vomitting (pain during or after = gastroenteritus)

26
Q

How long must you listen before absent bowel sounds?

A

3 min

27
Q

PE for acute abdomen

A 
orthostatic BP and pulse (orthostatic indicates hemorrhage or third spacing)
Cold/clammy (blood shunting)
Tachy
Impaired mentation
Oliguria
Fever
28
Q

What is peritonitis

A

Inflammation of peritoneal cavity caused by any condition that causes inflammation

29
Q

What can cause peritonitis

A
  • Appendicitis
  • Diverticulitis
  • Stranguilating intestinal obstruction
  • pancreatitis
  • PID
  • Mesenteric ischemia
  • Intraperitoneal blood
  • Barium
  • Peritoneo-systemic shunts
  • Drains
  • Dialysis catheters
  • Ascities
30
Q

Peritonitis presentation in elderly

A
  • Mild fever
  • Tachy
  • Reduced bowel sounds
  • Vague abd discomfort
  • Also include cardiac/respiratory differentials
31
Q

R/LUQ non GI sources of pain

A
  • Herpes zoster
  • Lower lobe pneumonia
  • MI
  • Radiculitis (nerve pain)
32
Q

What is GERD

A

-Reflux of gastric contents (gastric acid and digestive enzymes) into esopphagus

33
Q

Causes of GERD

A
  • Relxation of LES
  • Decreased secondary peristalsis
  • Decreased resistance to caustic liquids
  • Large hiatal hernia (stomach herniating through diaphragm)
  • Tobacco, strenuous exercise, ETOH
  • Calcium channel blockers -> decreased LES tone
34
Q

Common GERD Food Triggers

A

Spicy, fried, fatty, citrus, caffine

35
Q

Clinical features of GERD

A
  • Heartburn within 30-60 minutes of eating
  • Worse lying down, bending over, tight clothes
  • May also have: regurgitation, nocturnal aspiration, ulcers, hemorrhage, dental erosion, laryngitis, asthma,Barrett’s esophagus
  • Chest pain with heavyness or pressure radiating to neck, jaw, shoulder
36
Q

GERD Hx

A

-Onset, agg/all, smoking?, NSAID/ASA, difficulty swallowing, weight loss, change in stool

37
Q

When can you diagnose GERD just on history?

A
38
Q

GERD PE

A

Ht/Wt, abd exam, occult blood in stool, usually no dx testing

39
Q

Atypical GERD presentation/Referral

A

-Dysphagia, wt loss, melena; refer for endoscopy

40
Q

Phase 1 GERD Therapy

A

Wt loss if obese, smoking cessation, elevate HOB, Smaller meals, no eating 2-3 hrs before bed, reduce high fat, chocolate, citrus, mints, coffee, alchohol, antacids PRN

41
Q

Phase II GERD Therapy

A
  • H2 blockers BID: Zantac, Pepcid

- PPI used when H2 fails or erosive esophagitis (Prevacid, Lansoprazole, Nexium, Protonix, Pantoprazole)

42
Q

H2 Antagonists

A

-Zantac, Pepcid
-First line for GERD
MOA: suppress acid in stomach
Directions: Take before, after, with meal
-BID
-OTC doses lower then prescription

43
Q

PPI

A
  • Prevacid, Prilosec, Nexium
  • If H2 fail or GERD returns
  • MOA: Shut down acid producing proton pumps
  • Directions: 30 min beforemeal
  • Qday
44
Q

Possible effets of long term PPI sue

A
  • Pneumonia
  • C.diff
  • Hypomagnesemia
  • Decreased Ca+ absorbtion
  • Interfere with B12 absorbtion
45
Q

What H2 blocker should you avoid/why?

A

Cimetidine; CYP450 interactions

46
Q

Evaluation of GERD tx

A

1-2 weeks. If controlled, continue tx 8-12 wks. After 8, D/C or lower meds. Some need low-dose maintenace. If unresolved in 8 weeks refer to gastroenterologist

47
Q

Barret’s Esophagus definition/cause

A 
Complication of GERD
Tissue injurty due to chronic exposure to pepsin, gastric acid, bile
Premalignant condition of esophagus
Typically White males >50
Presents as heartburn or dysphagia
48
Q

Premalignant stages of Barrett’s

A

Low or high grade dysplasia

Metaplastic columnar epitheliazation of distal esophagus

49
Q

Risk of adenocarsinoma with Barrett’s

A

-

50
Q

Gastroparesis define/cause

A

Impaired gastric emptying r/t autonomic neuropathy; complication of uncontrolled DM

51
Q

Effects of gastroparesis

A

Affects food absorbtion –> impaired glycemic control, N/V, sesation of always full

52
Q

Gastroparesis Dx

A

Endoscopy, gastric emptying study

53
Q

Gastroparesis Tx

A

Control hyperglycemia, dietary modifications, metroclopramide (reglan) short term (not in elderly)

54
Q

Dysphagia definition

A

Swallowing disorder

Oropharyngeal or esophogeal

55
Q

Oropharyngeal vs esophogeal dysphagia causes

A

Esophogeal usually has structural causes, oropharyngeal usually functional causes

56
Q

Possible effects of dysphagia

A

Mild - Severe, malnutrition, dehydration, choking, aspiration, pneumonia, death

57
Q

Transfer dysphagia (oropharyngeal)

A
  • Usually neurological –> difficulty initiating swallow
  • Common in elderly
  • Caused by stroke, tumor, degenerative diseases, benzos, L-dopa
  • Difficulty with liquids–> regurg, choking, aspiration
58
Q

Achalasia

A
  • Most common motor dysphagia
  • Loss of peristalsis, LES fails to relax causing obstruction
  • Substernal chest pain for most
  • Difficulty with liquid and solid, cold makes it worse
59
Q

Scleroderma (Dysphagia)

A

Causes loss of tone and propulsion in esophagus, more commonly leads to reflux

60
Q

Dysphagia History

A

Onset: Gradual/chronic suggest motor, rapid and progressive suggest obstruction

  • Swallowing difficulty liquid or solid, is cold worse?
  • Effect of swallowing - Helps in motor, can cause regurg in obstruction
  • Wt loss
  • PMH neuro disease, chronic reflux, esophagitis
  • Nocturnal respiratory trouble or pneumonia (r/t tracheal aspiration)
  • Heart burn suggestions inflammatory stricture/disease
61
Q

Dysphagia Differentials (Intermittent, w/ swallowing, solids, Diplopia, reflux and skin changes, tremor)

A

Intermittent - LES
With swallow - Mucosal inflammation
Difficulty with solids and heartburn - stricture
With diplopia think myasthenia
With reflux, skin changes, cold extremities - scleroderma or Raynaud’s
-With tremor - Parkinson’s

Diagnosis and Management 1 (2 decks)

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