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>
<p>2 divisions of GI bleeds</p>
<p>upper and lower: divided by ligament of Treitz (duodenum and above)</p>
<p>upper GI bleed signs</p>
<p>-bright red or coffee grounds
| -melena (coal black, "bismuth") stool</p>
<p>lower GI bleeds</p>
<p>-hematochezia (maroon-colored/bright red stools)</p>
<p>causes of upper GI bleeds</p>
<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>
<p>causes of lower GI bleeds</p>
<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>
<p>characteristics of ulcers</p>
<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>
<p>duodenal vs. gastric PUD</p>
<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>
<p>Zollinger-Ellison syndrome</p>
<p>tumor causing overproduction of gastric acid and peptic ulcers</p>
<p>causes of diarrhea</p>
<p>90% infectious (gastroenteritis)
- bacteria: salmonella, e. coli
- virus: rotavirus, norovirus, cytomegalovirus
- protozoa: cryptosporidium, microsporidium</p>
<p>small vs. large bowel infectious diarrhea</p>
<p>s: large watery volume, no fever, no blood or WBC
| l: frequent small "more formed" but painful, FEVER, blood, WBC, mucus</p>
causes of chronic diarrhea
- IBS (MCC)
- motility dysfunction
- IBD
- celiac disease
5 mechanisms of diarrhea
- osmotic: lactase deficiency; osmotic laxative overuse
- secretory: stimulant laxative overuse; alcoholism; hormone-secreting tumors: carcinoid syndrome; “short-bowel” syndrome
- steatorrheal (fat absorption impairment): pancreatic insufficiency; celiac disease (immuno)
- hypermotility: IBS; hyperthyroidism
- inflammatory: UC; Crohn’s; collagenous/lymphocytic colitis; eosinophylic gastroenteritis; immunodeficiency w/ chronic infection
constipation definition
2+ of following:
- straining +25%
- lumpy/hard +25%
- incomplete sense +25%
- anorectal blockage sense +25%
- manual maneuvers +25%
- <3 spontaneous BM/w
what increases risk of constipation
- age
- MEDS
- decreased fluids
- low fiber diet
- immobility
- chronic disease
chronic constipation diseases
- irritable bowel disease (MCC)
- neuro d/o: diabetes, Parkinson’s, MS
- hypothyroidism
- idiopathic: slow transit; dyssynergic defecation
constipation inducing drugs
- analgesics
- anticholinergics
- Fe, Al, barium
- opiates, antihypertensives, Ca channel blockers
big 4 factors of IBD
- genetics
- environmental triggers
- intestinal microbiome
- immune dysregulation (>TH17,
Tx of IBD
biologicals that block tumor necrosis factor
Crohn vs UC
crohn: penetrates entire bowel wall (ilium), cobblestoning, fistula, stricture (“string sign”)
UC: just superficial ulceration, pseudopolyps
extraintestinal complications of CD/UC
- erythema nodosum
- pyoderma gangrenosum
- arthritis
perforation of inner bowel lining and vessel through muscle wall
diverticula- LLQ pain, fever if diverticulitis
protrusion of anal vessels
hemorrhoids
anal glandular secretion stasis and infection
perirectal abscess:
- supralevator
- intersphinteric
- ischiorectal
- perianal
autoantibody response to wheat product kills intestinal villi
celiac disease (common in those w/ dermatitis herpetiformis)- multiorgan autoimmune disease
increased bowel sensitivity/altered motility
IBS
seratonin levels and IBS symptoms
increased 5-HT: diarrhea
decreased 5-HT: constipation
area of appendicitis pain
McBurney’s Point
2 methods of acute bowel obstruction
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
