GI Flashcards
why is it important to ask about a history of mouth ulcers?
symptoms of Crohns or ulcerative colitis
if a patient has severe abdo pain pain ad a history of relapsing epigastric pain what could it be?
perforated peptic ulcer
why is important to as about abdo surgery?
result in adhesions-> intestinal obstruction
damage to bile duct in cholecystectomy->biliary stricture->jaundice
what hereditary condition predisposes to bowel cancer?
familial adenomatous polyposis
what GI disorders is cigarette smoking associated with?
increased risk gastric and oesophageal cancer
worsens GOR
what medications are associated with GI disorders?
NSAIDs: GI bleeding
codeine and some antidepressants: constipation
phenytoin, tetracyclines and amiodarone: damage liver
paracetamol overdose: acute liver cell necrosis
chlorpromazine, sulponamides, sulphonylureas, rifampicin, nitrofurantoin, combine OCP: hypersensitivity=cholestasis
anticholinergic, CCB, theophylline and nitrates: increase GOR
opiates, dopamine agonists and cytotoxics: vomiting
why is the radiation of the pain important in abdo pain?
to back=pancreatic disease, perforated peptic ulcer or ruptured AAA
up to neck=oesophageal reflux
loin to groin=renal colic
shoulder tip=diaphragm irritation
why is the character of the pain important in abdo pain?
colicky=obstruction of hollow viscus e.g. bowel, ureter
dull or burning=potential peptic ulceration
why is the intermittency of tha pain important in abdo pain?
episodic=peptic ulcer disease
steady=pancreatic
what may relieve different causes of abdo pain?
rolling around=trying to relieve colicky pain
aggravated by moving or coughing=peritonitis
antacids or vomiting=relieve peptic ulcer pain or GOR
defecation=relieved IBD
sitting or leaning forward=relieves pancreatic pain
how may eating effect GI pain?
precipitate pain from gastric ulcer
relieve that of a duodenal ulcer
fatty foods precipitate GB pain
why is it important to ask about bowel changes in abdo pain?
disturbance plus pain and bloating=ibd
constipation or diarrhoea and colicky pain=malignancy or stricture
increased freq and incomplete emptying=renal malignancy
why is it important to ask about pregnancy in abdo pain?
cause could be threatened abortion and ruptured ectopic pregnancy before realise pregnant
what is the difference between progressive and intermittent dysphagia?
progressive=carcinoma or stricture, progressive from solids to liquids
intermittent=motility disorder e.g. achalasia
when is dysphagia painful?
if infection or ulceration of oesophagus
if the dysphagia eases after the first few swallows what is it likely to be?
oesophageal spasm
if there is regurgitation what does this suggest?
cause is in pharynx e.g. neurological disease
or severe GOR
why is it important to ask about heartburn in dysphagia?
predisposes to stricture formation and development of oesophageal carcinoma
how can a lump in the throat be associated with dysphagia?
can be caused by retrosternal goitre
why is it important to ask about cough in dysphagia?
bronchial carcinoma
what medication is associated with dysphagia?
tetracyclines
which foods aggravate reflux sx?
alcohol, chocolate, caffeine, fatty meals
which positions aggravate reflux?
bending, stooping, lying down
what causes acute vs longstanding vomiting?
acute: infection, small bowel obstruction
pregnancy, drugs, peptic ulcer disease, gastric outlet obstruction, hepatobiliary disease, alcoholism, increased icp, psychogenic disorder
how does the time of day effect cause of vomiting?
early morning: pregnancy, alcoholism, increased icp
1hr or more after meal: gastric outlet obstruction or gastroparesis
what can cause abdo pain and vomiting?
pancreatitis, small bowel obstruction, biliary disease
what does a large vol of vomit suggesr?
intestinal obstruction
what causes projectule vomiting?
gastric outlet obstruction
how does the colourof vomit suggest the cause?
green=small bowel obstruction
red/brown=blood=ulceration
faeculant=late sign of large bowel obstruction
how to bowel habits effect cause of vomiting?
diarrhoea=infection
constipation=intestinal obstruction
what are the causes of acute, chronic and fluctuating jaundice?
progressive=malignacy, chronic liver disease
short=hepatitis, gallstones
fluctuating=bile duct stones
what does abdominal pain and jaundice indicate?
gallstones
what does vomiting and jaundice indicate?
acute hepatobiliary disease
advanced carcinoma of head of the pancreas->duodenal obstruction
how is bruising linked to jaundice?
obstructive jaundice->shortage of bile salts-> decreased vit K absorption-> decreased clotting factors->easy bruising and bleeding
why is travel important in the history of jaundice?
viral hepatitis: B and C higher in Africa and parts of Asia
why are blood transfusions important in the history of jaundice?
HBV and HCV transmitted via blood
why is drug use and homosexuality important in the history of jaundice?
HBV and HCV
HBV
why is the time course important in diarrhoea?
acute=infective
chronic=irritable bowel, endocrine disturbance
what causes mucus in the stool?
rectal ulcer, fistula or villous adenoma or IBS