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Clinical Medicine I > GI > Flashcards

GI Flashcards

1
Q

<p>cardinal symptoms of disease</p>

A

<p>-pain

- nausea and vomiting
- GI bleeding</p>

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2
Q

<p>descriptors:

- stabbing, tearing, burning, squeezing, twisting, pressure
- sickening, terrifying, nauseating, demoralizing
- increase HR, abdominal rigidity, increase BP, increase cortisol</p>

A

<p>-tissue destruction

- emotional aspect
- involuntary autonomic response</p>

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3
Q

<p>3 types of sensory afferent neurons</p>

A

<p>1. large-diameter myelinated (A-beta)

2. small-diameter myelinated (A-delta)
3. unmyelinated (C)</p>

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4
Q

<p>these sense or detect pain, heat/cold, mechanics, pH, irritants</p>

A

<p>nocioceptors</p>

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5
Q

<p>pain that increases with time</p>

A

<p>sensitization:

- peripheral (nerve terminal)
- central (dorsal horn)</p>

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6
Q

<p>pain modulators</p>

A

<p>descending pathways that decrease pain</p>

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7
Q

<p>receptors that "wake up" to transmit pain even from touch/pressure/movement</p>

A

<p>silent nocioceptors (typically in organs)</p>

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8
Q

<p>chronic vs. acute abdominal pain- which is more emergent</p>

A

<p>acute- chronic abdominal pain is not deadly</p>

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9
Q

<p>questions to ask with abdominal pain</p>

A

<p>-age

- OLDCARTS
- NAV, anorexia
- diarrhea, constipation, other bowel changes
- menstrual hx</p>

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10
Q

<p>causes of abdominal localized or referred pain</p>

A

<p>-parietal peritoneum inflammation: peritonitis (infection, gastric acid, trauma, blood)

- obstruction of hollow viscera (colic)
- vascular disorders
- abdominal wall injuries/conditions</p>

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11
Q

<p>consequences of parietal peritoneum inflammation</p>

A

<p>-no desire to move

- any pressure, stretch, tension, movement causes pain
- tonic spasm of abdominal wall
- sepsis</p>

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12
Q

<p>GI terminology:

- indigestion
- regurgitation
- dysphagia
- aphagia
- aphasia
- odynophagia
- neoplasm</p>

A

<p>-"heartburn"

- acid flowing back up into esophagus
- difficulty swallowing
- inability to swallow
- inability to speak
- painful swallowing
- new growth</p>

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13
Q

<p>cranial nerves involved in swallowing</p>

A

<p>motor: V, VII, IX, X, XII

| sensory: V, IX, X</p>

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14
Q

<p>voluntary vs. involuntary parts of swallowing</p>

A

<p>proximal 1/3- voluntary

| distal 2/3- myenteric plexus peristalsis; long reflex triggers LES relax/open/close</p>

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15
Q

<p>causes of oropharyngeal dysphagia</p>

A

<p>-stroke

- Parkinson's
- cancer
- head and neck surgery
- Myasthenia Gravis
- ALS</p>

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16
Q

<p>causes of esophageal dysphagia</p>

A

<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>

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17
Q

<p>tumors of head/neck presentation</p>

A

<p>-non-healing ulcer

- mass
- sore throat
- hoarseness
- dysphagia
- odynophagia
- ear pain (otalgia)
- bleeding</p>

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18
Q

<p>oropharyngeal dysphagia s/s</p>

A

<p>-aspiration (+/- pneumonia)

- drooling
- dysarthria (difficulty speaking)</p>

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19
Q

<p>causes of indigestion</p>

A

<p>-GERD

- peptic ulcer disease
- gastroparesis (poor stomach mobility: neuropathy, diabetes)
- non-ulcer dyspepsia (idiopathic)</p>

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20
Q

<p>mechanisms of LES closure failure</p>

A

<p>-hypotension (weak contraction)

- transient hypotension due to gastric dilation
- anatomic distortion (hiatal hernia Type I or II)</p>

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21
Q

<p>complications of GERD</p>

A

<p>-metaplasia: change from squamous cell to columnar

- Barrett's esophagus
- bleeding</p>

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22
Q

<p>GERD associated conditions</p>

A

<p>-chronic cough

- asthma
- laryngitis
- dental erosions</p>

23
Q

<p>esophageal disorders</p>

A

<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>

24
Q

<p>vomiting stimuli</p>

A

<p>-visceral nerves

- poisons/alcohol
- vestibular apparatus
- brain</p>

25
Q

<p>2 divisions of GI bleeds</p>

A

<p>upper and lower: divided by ligament of Treitz (duodenum and above)</p>

26
Q

<p>upper GI bleed signs</p>

A

<p>-bright red or coffee grounds

| -melena (coal black, "bismuth") stool</p>

27
Q

<p>lower GI bleeds</p>

A

<p>-hematochezia (maroon-colored/bright red stools)</p>

28
Q

<p>causes of upper GI bleeds</p>

A

<p>-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</p>

29
Q

<p>causes of lower GI bleeds</p>

A

<p>-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</p>

30
Q

<p>characteristics of ulcers</p>

A

<p>-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)</p>

31
Q

<p>duodenal vs. gastric PUD</p>

A

<p>d: pain 1-3h after eating (~3am), antacid relief

g: pain during/after eating, no antacid relief
both: epigastric/RUQ pain, nausea, weight loss</p>

32
Q

<p>Zollinger-Ellison syndrome</p>

A

<p>tumor causing overproduction of gastric acid and peptic ulcers</p>

33
Q

<p>causes of diarrhea</p>

A

<p>90% infectious (gastroenteritis)

- bacteria: salmonella, e. coli
- virus: rotavirus, norovirus, cytomegalovirus
- protozoa: cryptosporidium, microsporidium</p>

34
Q

<p>small vs. large bowel infectious diarrhea</p>

A

<p>s: large watery volume, no fever, no blood or WBC

| l: frequent small "more formed" but painful, FEVER, blood, WBC, mucus</p>

35
Q
A
36
Q

causes of chronic diarrhea

A
  • IBS (MCC)
  • motility dysfunction
  • IBD
  • celiac disease
37
Q

5 mechanisms of diarrhea

A
  1. osmotic: lactase deficiency; osmotic laxative overuse
  2. secretory: stimulant laxative overuse; alcoholism; hormone-secreting tumors: carcinoid syndrome; “short-bowel” syndrome
  3. steatorrheal (fat absorption impairment): pancreatic insufficiency; celiac disease (immuno)
  4. hypermotility: IBS; hyperthyroidism
  5. inflammatory: UC; Crohn’s; collagenous/lymphocytic colitis; eosinophylic gastroenteritis; immunodeficiency w/ chronic infection
38
Q

constipation definition

A

2+ of following:

  • straining +25%
  • lumpy/hard +25%
  • incomplete sense +25%
  • anorectal blockage sense +25%
  • manual maneuvers +25%
  • <3 spontaneous BM/w
39
Q

what increases risk of constipation

A
  • age
  • MEDS
  • decreased fluids
  • low fiber diet
  • immobility
  • chronic disease
40
Q

chronic constipation diseases

A
  • irritable bowel disease (MCC)
  • neuro d/o: diabetes, Parkinson’s, MS
  • hypothyroidism
  • idiopathic: slow transit; dyssynergic defecation
41
Q

constipation inducing drugs

A
  • analgesics
  • anticholinergics
  • Fe, Al, barium
  • opiates, antihypertensives, Ca channel blockers
42
Q

big 4 factors of IBD

A
  1. genetics
  2. environmental triggers
  3. intestinal microbiome
  4. immune dysregulation (>TH17,
43
Q

Tx of IBD

A

biologicals that block tumor necrosis factor

44
Q

Crohn vs UC

A

crohn: penetrates entire bowel wall (ilium), cobblestoning, fistula, stricture (“string sign”)
UC: just superficial ulceration, pseudopolyps

45
Q

extraintestinal complications of CD/UC

A
  • erythema nodosum
  • pyoderma gangrenosum
  • arthritis
46
Q

perforation of inner bowel lining and vessel through muscle wall

A

diverticula- LLQ pain, fever if diverticulitis

47
Q

protrusion of anal vessels

A

hemorrhoids

48
Q

anal glandular secretion stasis and infection

A

perirectal abscess:

  • supralevator
  • intersphinteric
  • ischiorectal
  • perianal
49
Q

autoantibody response to wheat product kills intestinal villi

A

celiac disease (common in those w/ dermatitis herpetiformis)- multiorgan autoimmune disease

50
Q

increased bowel sensitivity/altered motility

A

IBS

51
Q

seratonin levels and IBS symptoms

A

increased 5-HT: diarrhea

decreased 5-HT: constipation

52
Q

area of appendicitis pain

A

McBurney’s Point

53
Q

2 methods of acute bowel obstruction

A

1) mechanical:
- fibrous bands (adhesions)
- hernia (indirect: pass thru inguinal canal; direct: perforate inguinal canal)
- encases in metastases
- volvulus: 180 twist
- intussusception: telescoping/invagination
- CA inside
- Crohn’s fibrosis
2) functional:
- adynamic/paralytic ileus: no peristalsis due to inflammation/surgical stun

Clinical Medicine I (8 decks)

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