GI Flashcards
<p>cardinal symptoms of disease</p>
<p>-pain
- nausea and vomiting
- GI bleeding</p>
<p>descriptors:
- stabbing, tearing, burning, squeezing, twisting, pressure
- sickening, terrifying, nauseating, demoralizing
- increase HR, abdominal rigidity, increase BP, increase cortisol</p>
<p>-tissue destruction
- emotional aspect
- involuntary autonomic response</p>
<p>3 types of sensory afferent neurons</p>
<p>1. large-diameter myelinated (A-beta)
2. small-diameter myelinated (A-delta)
3. unmyelinated (C)</p>
<p>these sense or detect pain, heat/cold, mechanics, pH, irritants</p>
<p>nocioceptors</p>
<p>pain that increases with time</p>
<p>sensitization:
- peripheral (nerve terminal)
- central (dorsal horn)</p>
<p>pain modulators</p>
<p>descending pathways that decrease pain</p>
<p>receptors that "wake up" to transmit pain even from touch/pressure/movement</p>
<p>silent nocioceptors (typically in organs)</p>
<p>chronic vs. acute abdominal pain- which is more emergent</p>
<p>acute- chronic abdominal pain is not deadly</p>
<p>questions to ask with abdominal pain</p>
<p>-age
- OLDCARTS
- NAV, anorexia
- diarrhea, constipation, other bowel changes
- menstrual hx</p>
<p>causes of abdominal localized or referred pain</p>
<p>-parietal peritoneum inflammation: peritonitis (infection, gastric acid, trauma, blood)
- obstruction of hollow viscera (colic)
- vascular disorders
- abdominal wall injuries/conditions</p>
<p>consequences of parietal peritoneum inflammation</p>
<p>-no desire to move
- any pressure, stretch, tension, movement causes pain
- tonic spasm of abdominal wall
- sepsis</p>
<p>GI terminology:
- indigestion
- regurgitation
- dysphagia
- aphagia
- aphasia
- odynophagia
- neoplasm</p>
<p>-"heartburn"
- acid flowing back up into esophagus
- difficulty swallowing
- inability to swallow
- inability to speak
- painful swallowing
- new growth</p>
<p>cranial nerves involved in swallowing</p>
<p>motor: V, VII, IX, X, XII
| sensory: V, IX, X</p>
<p>voluntary vs. involuntary parts of swallowing</p>
<p>proximal 1/3- voluntary
| distal 2/3- myenteric plexus peristalsis; long reflex triggers LES relax/open/close</p>
<p>causes of oropharyngeal dysphagia</p>
<p>-stroke
- Parkinson's
- cancer
- head and neck surgery
- Myasthenia Gravis
- ALS</p>
<p>causes of esophageal dysphagia</p>
<p>-benign strictures: Schatzki's, peptic stricture
- cancer: Barrett's esophagus, squamous cell, adenocarcinoma
- eosinophilic esophagitis
- infectious esophagitis
- achalasia (LES non-relax)
- diffuse esophageal spasm</p>
<p>tumors of head/neck presentation</p>
<p>-non-healing ulcer
- mass
- sore throat
- hoarseness
- dysphagia
- odynophagia
- ear pain (otalgia)
- bleeding</p>
<p>oropharyngeal dysphagia s/s</p>
<p>-aspiration (+/- pneumonia)
- drooling
- dysarthria (difficulty speaking)</p>
<p>causes of indigestion</p>
<p>-GERD
- peptic ulcer disease
- gastroparesis (poor stomach mobility: neuropathy, diabetes)
- non-ulcer dyspepsia (idiopathic)</p>
<p>mechanisms of LES closure failure</p>
<p>-hypotension (weak contraction)
- transient hypotension due to gastric dilation
- anatomic distortion (hiatal hernia Type I or II)</p>
<p>complications of GERD</p>
<p>-metaplasia: change from squamous cell to columnar
- Barrett's esophagus
- bleeding</p>
<p>GERD associated conditions</p>
<p>-chronic cough
- asthma
- laryngitis
- dental erosions</p>
<p>esophageal disorders</p>
<p>-GERD
- achalasia (peristalsis out of rhythm- immune attack of myenteric plexus due to infection)
- diffuse esophageal spasm ("corkscrew esophagus")
- eosinophilic esophagitis (narrowing due to inflammation)</p>
<p>vomiting stimuli</p>
<p>-visceral nerves
- poisons/alcohol
- vestibular apparatus
- brain</p>
2 divisions of GI bleeds
upper and lower: divided by ligament of Treitz (duodenum and above)
upper GI bleed signs
-bright red or coffee grounds | -melena (coal black, "bismuth") stool
lower GI bleeds
-hematochezia (maroon-colored/bright red stools)
causes of upper GI bleeds
-peptic ulcer disease* (stomach/duodenum) - esophageal varices rupture (due to portal vein hypertension) - Mallory-Weiss tears (from vomiting) - gastric/duodenal erosions - esophagitis/esophageal erosions - esophageal/gastric cancer
causes of lower GI bleeds
-diverticula vessel repture - vascular ectasias (rupture of vessels below bowel mucosa) - colitis: inflammatory (UC), infectious, ischemic - colon/small bowel cancer - hemorrhoids/anal fissures - post polyp-resection
characteristics of ulcers
-excavations: >5mm - erosions: <5mm - duodenal ulcers always benign - some gastric are cancers that ulcerate - caused by H. pylori or NSAIDS (block prostaglandins COX1-good and COX2-bad)
duodenal vs. gastric PUD
d: pain 1-3h after eating (~3am), antacid relief g: pain during/after eating, no antacid relief both: epigastric/RUQ pain, nausea, weight loss
Zollinger-Ellison syndrome
tumor causing overproduction of gastric acid and peptic ulcers
causes of diarrhea
90% infectious (gastroenteritis) - bacteria: salmonella, e. coli - virus: rotavirus, norovirus, cytomegalovirus - protozoa: cryptosporidium, microsporidium
small vs. large bowel infectious diarrhea
s: large watery volume, no fever, no blood or WBC | l: frequent small "more formed" but painful, FEVER, blood, WBC, mucus
