GI Flashcards
1
Q
abdominal pain
A
- Location (can you point with one finger)
- Radiation (does it start one place and go somewhere else)
- Quality (sharp, dull, shooting, etc)
- Severity (use pain scale, 0 no pain and 10 the worst pain in your life)
- Aggravating and relief (what makes it better, what makes it worse)
- Timing (worst in the morning, how long does it last, does it come and go)
- Impact of the pain (“it wakes me up at night, I cant focus”
2
Q
GERD
A
- 10-20% of western population
- Classic symptoms
- Heartburn
- Regurgitation
- Other symptoms
- Chronic cough, wheezing, hoarseness
- Chest pain
- Dysphagia – in longstanding GERD. Can be indicative of esophageal stricture
- Globus sensation – “lump in the throat”
- Water brash (hypersalivation) – unusual sx, foaming at the mouth, up to 10ml saliva/min
- Treatment
- Empirically treat with PPI
- Rule out Hiatal hernia – treated with surgery
- Change habits
- Imaging – not indicated unless high risk of Barretts Esophagus, Alarm Features, or failure to PPI treatment
- Upper endoscopy
- Barium swallow
- Alarm Features (suggestive of malignancy)
- New onset age 60 or over
- Evidence of GI Bleed
- Iron deficiency anemia
- Anorexia
- Unexplained weight loss
- Dysphagia
- Odynophagia
- Persistent vomiting
- GI cancer in 1st degree relative
3
Q
Barretts esophagus
A
- Replacement of normal esophageal epithelium and replaced by gastric and intestinal features.
- Caused by GERD, though occasionally asymptomatic
- Precursor to esophageal adenocarcinoma
- Key symptoms – GERD plus dysphagia
- Risk factors for Barretts
- Age over 50
- Male Sex
- White race
- Chronic GERD ( more than 5 years or more than 2x per week
- Hiatal Hernia
- Elevated BMI
- Intra-abdominal distribution of body fat
- Tobacco use
- Chronic GERD plus 2 or more, get upper endoscopy looking for abnormal columnar epithelieum >1cm, + biopsy
4
Q
Peptic ulcer disease
A
- A defect in the gastric or duodenal mucosa through the muscularis and into the deeper layers of the wall.
- Can present with dyspepsia or other GI sx or asymptomatic before presenting with hemorrhage or perforation
- Classic pain of duodenal ulcers occurs 2-5 hours after a meal when acid is secreted without a food buffer, and at night
- Peptic ulcers may have epigastric pain that worsens with eating, postprandial belching and epigastric fullness, early satiety, fatty food intolerance, nausea and occasional vomiting
5
Q
Duodenal ulcer with perforation
A
- Treatment for a perforated duodeal ulcer is surgery and resuscitation
- Can often be done laparoscopically, though open exploration is often required to clean out the abdomen and locate the tiny perforation
- Coverage with a Graham Omental patch and irrigation of the gastic contents from the abdomen.
- Replacement of electrolytes, IV hydration
- Broad spectrum antibiotics for spillage of GI flora into sterile space
- +/- NG tube, may be placed if vomiting or in the operating room when pt is anesthetized
- PPI
6
Q
Zollinger ellison syndrome
A
- Gastrin secreting Neuorendocrine tumor causing gastric acid hypersecretionà PUD
- Most commonly seen in duodenal wall, pancreas, lymph nodes
- 66% malignant
- Clinical manifestations: multiple peptic ulcers, refractory ulcers, “kissing ulcers”, abdominal pain, and diarrhea
- Diagnosis
- Fasting gastrin level is best screening test
- Secretin test, basal acid output is increased, Chromogranin A, Somatostatin receptor scintography
- Management – surgical resection of the tumor
7
Q
Gastric carcinoma
A
- Adenocarcinoma 90%, Lymphomas and leiomyosarcomas 4%
- Most commonly Males >40 y/o, usually presenting late in disease
- Risk Factors
- H Pylori
- salted, cured, smoked, pickled foods with nitrites
- pernicious anemia
- achlorhydria
- smoking
- ETOH
- Blood type A
- Clinical Manifestations
- Indigestion
- Weight loss
- Early Satiety
- Abdominal pain/fullness
- Nausea
- Post-prandial vomiting
- Dysphagia
- Melena
- Hematemesis
- May have FE Anemia
- Signs of Metastasis
- Supraclavicular Lymph Node (Virchow’s Node)
- Umbilical Lymph Node – (Sister Mary Joseph’s Node)
- Diagnosis
- Upper endoscopy with biopsy
- Treatment
- Gastrectomy
- XRT(radiation) and Chemo
8
Q
pyloric stenosis
A
- Functional cause of Gastric Outlet obstruction
- Seen in infants – hypertrophy of pylorus
- Can be found in adults secondary to peptic ulcer disease and malignancy
- Caused by a fibrotic stricture that persists after an ulcer heals, preventing the pylorus from functioning properly
- Can be lymphoma gastric, duodenal, gallbladder, cholangiocarcinoma or pancreatic cancers
9
Q
infantile pyloric stenosis
A
- Classic Presentation:
- 3-12 Week old infant
- Postprandial non-bilious “projectile” vomiting
- Infant demands to be re-fed soon after
- “Olive-like” mass on exam at lateral edge of rectus abdominus muscle in the right upper quadrant of the abdomen
- Labs show hypochloremic, metabolic acidosis due to loss of large volumes of hydrochloric acid
- Additional imaging to confirm diagnosis
- Ultrasound – done for infants, shows length of the pylorus and the muscle thickness
- Barium swallow studies
- Endoscopy – can allow for biopsies
- CT scan
- Surgical Treatment – Laparoscopic or open pyloromyotomy (longitudinal cut in the pylorus to cause the mucosa to bulge outward)
- Or endoscopic approach
10
Q
acute pancreatitis
A
- Most common causes
- GALLSTONES ( 5 F’s – Fat, Fertile, Forty, Female, Flatulent)
- Alcohol
- Elevated triglycerides
- Pancreatic tumor – especially in someone over 40 without a cause
- Classic symptoms:
- N/V, epigastric abdominal pain, worse supine, caused by alcohol ingestion or following fatty meals.
- Exam
- Cullen and Grey Turner’s Sign – peri-umbilical or flank ecchymosis (indicating retroperitoneal bleeding)
11
Q
chronic pancreatitis
A
- Syndrome involving progressive inflammatory changes which can lead to impaired exocrine and endocrine function. Recurrent Episodes of acute pancreatitis lead to chronic over time.
12
Q
pancreatic carcinoma
A
- Risk Factors:
- Smoking
- >60 years old, chronic pancreatitis, ETOH, DM, obesity
- Most have already metastasized by time of diagnosis – met to regional nodes and liver
- Clinical presentation:
- Painless jaundice
- Abdominal pain
- Pruritis
- Physical Exam – Courvoisier’s sign – palpable, non-tender distended GB
- Workup:
- CT scan – pancreatic protocol with and without contrast (2mm cuts)
- Labs – Elevated CEA, CA 19-9, may have other elevations if CBD obstruction or PD obstruction
13
Q
Meckels diverticulitis
A
- Persistent portion of embryonic vitteline duct (yolk stalk)
- Rule of 2’s
- 2 % of population, 2 feet from ileosecal valve, 2 inches in length, 2 types of ectopic tissue (gastric, pancreas)
- Presentation: Like an Appy
- Asymptomatic
- Painless rectal bleeding or ulceration
- Pain periumbilical that moves into the right groin
- Additional imaging: Often a CT scan has already been ordered in the ER
- Meckel’s Scan
- Management – Surgical Excision
14
Q
small bowel obstruction
A
- Causes:
- Post surgical adhesions 60%
- Hernias, Crohons disease, Malignancy
- S/Sx:
- Crampy abdominal pain, vomiting, diarrhea (early), Obstipation (late)
- Pain usually escalates from mild and intermittent à severe and constant
- PE:
- Abdominal distension, hyperactive bowel sounds with high-pitched tinkles on auscultation and visible peristalsis early à hypoactive late
- Imaging – Abdominal xray (often referred to KUB)
- Shows Air fluid levels in a “step ladder pattern”
- Shows dilated loops of bowel
- Management
- Admit to hospital
- NPO (bowel rest)
- Bowel decompression with NG tube to suction
- IV fluids
- If strangulated – surgery is indicated
- Initial first approach can be laparoscopic or open
15
Q
constipation
A
- Common older adult complaint
- Less than 2 BM/week, straining, hard stools, feeling of incomplete evacuation
- Can be caused by slow transit, Cancers, hypothyroid, DM, med reactions
- Treatments
- Fiber
- Bulk forming laxatives
- Stool softeners (stimulant laxatives)
- Osmotic laxatives
- Enema
- Lubricants
