GI Correlations Flashcards
1
Q
Acholic
A
white clay colored stools d/t lack of bile release into GI tract
–>light due to lack of bile salts in stool
2
Q
Anorexia
A
lack of appetite
3
Q
Acute abdomen
A
serious intra-abdominal condition
–>pain, tenderness, rigidity needing emergency surgery consideration
4
Q
Borborygmi
A
rumbling noise d/t gas through intestines
5
Q
Cachexia
A
profound and marked ill health and malnutrition
6
Q
Cholestasis
A
suppression or stopping of bile flow d/t causes within or outside liver
7
Q
Coffee-ground emesis
A
blood congealed and separated within gastric contents
8
Q
Colic
A
acute paroxysmal abdominal pain
9
Q
Courvoisier’s Sign
A
enlarged non-tender GB secondary to pancreatic disorder or cancer
10
Q
Cullen Sign
A
bruising around umbilicus secondary to hemorrhage
11
Q
Curling or stress ulcer
A
duodenal peptic ulcer in a patient with superficial burns
12
Q
Cushing or stress ulcer
A
peptic ulcer d/t severe head injury or lesions of CNS
13
Q
Dyspepsia
A
postprandial epigastric discomfort
14
Q
Dysphagia
A
difficulty in swallowing
15
Q
Dysplasia
A
abnormal tissue development
16
Q
Edentulous
A
no teeth
17
Q
Esophagitis
A
inflammation of esophagus
18
Q
ERCP
A
Endoscopic retrograde cholangiopancreatography
19
Q
Eructation
A
burping
20
Q
EUS
A
endoscopic ultrasound
21
Q
Flatus
A
gas in GI tract expelled through anus
22
Q
Gastritis
A
inflammation of stomach with histo and endoscopic changes
23
Q
Gastropathy
A
epithelial or endothelial damage WITHOUT inflammation
24
Q
GGT
A
gamma-glutamyl transferase
->used to determine cause of elevated ALP
both elevated in liver disease
25
Grey Turner sign
flank bruising secondary to hemorrhage
26
Globus pharyngeus
FB sensation in throat that doesn't interfere with swallowing
-->d/t GERD most times in anxiety or OCD
27
Guarding
protective response resulting from pain or fear
-->voluntary
28
Heel strike
pt supine, strike heel, pain indicates peritonitis (often secondary to appendicitis)
29
Hematemesis
vomiting blood
30
Hematochezia
passage of bright red or maroon stools
31
Icterus
AKA jaundice
32
Iliopsoas muscle test
flex hip against resistance, increase abd pain positive for irritation of psoas muscle (appendicitis)
33
KUB Xray
plain abd xray of Kidneys, Ureter, Bladder
34
LGIB
lower GI bleeding
35
Lloyd punch
CVA tenderness
| -->kidney inf or stone
36
McBurney's Point
1/3 distance between ASIS and umbilicus, appendicitis
37
Melena
dark colored stool c/w broken down hemosiderin in bowel
-->tarry
**upper GI bleed proximal to ligament of treitz
38
Mittelschmerz
lower ap in middle of menses (basically feel ovulation)
-->no rebound tenderness
39
MRCP
magnetic resonance cholangiopancreatography
40
Murphy Sign
palpate deep under R costal margin during inspiration-->pain or sudden stop of inspiratory effort
-->cholecystitis or cholelithiasis
41
Nausea
subjective sensation of impending urge to vomit
42
Obstipation
severe intractable constipation caused by intestinal obstruction
43
Odynophagia
painful swallowing
44
Pneumobilia
abnormal presence of gas in biliary system or bile ducts
45
Pneumomediastinum
abnormal presence of air or gas in mediastinum d/t trauma or diagnostic
-->can interfere with respiration and circulation
**Pneumothorax, pneumopericardium
46
Pneumoperitoneum
abnormal presence of air or gas in peritoneal cavity
47
Psoas sign
retrocecal appendix via RLQ pain on passive R hip extension
48
Pyrosis
heartburn
49
Rebound tenderness
pain on removal of pressure
-->peritoneal inflammation or acute abd
50
Regurgitation
effortless reflux WITHOUT n, v
51
Retching
peristalsis of stomach and esophagus with closed glottis
52
Rigidity
hard involuntary reflex of contraction of abd wall
53
Rovsing's sign
pain in RLQ on palp of LLQ-->referred rebound of appendicitis
54
Steatorrhea
fatty, greasy stools
55
Tenesmus
ineffectual and painful straining at stool or urination
56
UGIB
upper GI bleeding
57
Ulcer
local defect of surface of organ/tissue produced by shedding of inflammed necrotic tissue
58
Ureterolithiasis
stone from kidney making its way through ureter to bladder
| -->hematuria
59
Virchow's Node
palpable LN in left supraclavicular fossa
-->abd cancer
60
GI Red Flag Sx/Signs
```
Dysphagia (difficulty swallow)
Odynophagia (pain swallow)
Hematemesis
Melena
Unintent. weight loss
Persistent vomiting
Constant and severe pain
Unexp. iron def. anemia
Palpable mass
Lymphadenopathy
Fam hx upper GI cancer
```
-->require further workup
61
Process for working through DDX
Develop Broad DDX
-->CC, age, sex, race
Narrow
--> HPI, PMHX, SX, FHX, ROS, PE
Develop working DDX
-->most common/likely
Purse
-->therapy, confirm/exclusion testing
Assessment and Plan
62
Abdominal pain in LUQ
gastritis
| PUD (peptic ulcer disease)
63
Abdominal pain in Epigastric
pancreatitis
| PUD/GERD
64
Abd pain in periumbilical region
SBO
LBO
appy
AAA
65
Abd pain in LLQ
diverticulitis
66
Abd pain in RUQ
GB
67
DDX of epigastric pain (dyspepsia)
- PUD
- Fxnl dyspepsia (no explanation for cause)
- Atypical GERD
- Gastric cancer
- Food poisoning
- Viral gastroenteritis
- Biliary tract disease
68
DDX of severe epigastric pain
- atypical PUD that can be complicated by perforation or penetration
- acute pancreatitis, cholecystitis, choledocholithiasis, esophageal rupture, volvulus or ischemia, ruptured AAA, MI
69
DDX of upper GI bleed
- PUD
- Erosive gastritis
- Arteriovenous malformations
- Mallory-Weiss tear
- Esophageal varices
70
What type of pain is not localized, usually felt in midline and secondary to distension of hollow organs?
visceral pain
71
What is an example of visceral pain?
periumbilical pain with early appendicitis
72
What kind of pain is localized, aggravated by movement or coughing and alleviated by remaining still?
parietal or somatic pain
-->secondary to inflammation in parietal peritoneum
73
What are examples of parietal pain?
RLQ tenderness or Rosving's sign (palp LLQ-->pain RLQ)
74
Causes of N, V
Numerous
-->appearance, frequency, projectile
*can be r/t GI, vestibular, CNS
75
Causes of oropharyngeal dysphagia
Trouble initiating swallowing
-->neuro disorders, infectious, structural, metabolic
*aspirate, cachectic
76
Causes of esophageal dysphagia
- solids, liquids or both
- progressive or not
- constant vs intermittent
-->mechanical obstruction (solids worse than liquids), motility (both)
77
Lab tests for GI workup
```
CBC
CMP (includes liver)
BMP
UA
Preg test
Lipase/amylase
Pt/Ptt (liver failure)
Fractionated bilirubin (presents with jaundice)
```
78
What is a CBC with differential?
CBC but includes percentage of absolute differential counts (PMN. lymph, basophils, eosinophils, monocytes)
79
What is in a BMP?
```
Na
K
Cl
CO2
BUN
Creatinine
Ca
```
-->CMP includes liver tests (bilirubin, ALT/AST, albumin, etc)
80
What labs would you order when considering pancreatitis?
lipase
| amylase
81
What labs you order when considering liver problems?
GGT (gamma-glutamyl transferase)
Fractionate bilirubin
PT/INR
-->bleeding risk
82
What labs would you order when looking for Zolinger Ellison Gastrinoma?
Fasting gastrin
| Secretin stimulation test
83
How do you write labs with the X on paper?
Top is Hgb
Left is WBC
Bottom is Hct
Right is Platelet
84
How would you write a BMP on paper?
---/---/---<
Top Na
Bottom K
Top Cl
Bottom CO2
Top BUN
Bottom Creat
< is glucose
85
Describe acute abdominal series
single view chest xray and a flat upright xray of ad
-->good for initial screening but not diagnostic
***check for free air, SBO or constipation
86
KUB
limited diagnostic benefit, single supine xray of abd
87
Describe Barium esophagography
Barium swallow xray
--differentiate between mechanical lesions and motility disorders
88
What study is more sensitive for detecting subtle esophageal narrowing d/t rings, achalasia and proximal esophageal lesions?
barium study
-->bird beak in achalasia
89
What is upper endoscopy/EGD?
Use for persistent heartburn, dysphagia, odynophagia, structural abdn detected on barium esophagography
-->direct visualization, allows biopsy and dilation of strictures
90
What do you use to visualize upper and lower GI tract?
EGD vs colonoscopy
91
What is US good for in abd?
```
GB
FAST scan for trauma
Bladder
Kidneys
Aorta and vessels
Heart
```
-->limited by air and fat
92
What is ERCP?
invasive way to visualize hepatobiliary and pancreatic ducts
-->provide intervention
93
What test is specific for testing the function of the gallbladder?
HIDA: hepatobiliary iminodiacetic acid scan
if HIDA + CCK low--> biliary dyskinesia
94
What gives you the most information about abd pathology?
CT ABD/Pelvis with or without contrast
95
What have similar pathophysiology, dx work up and treatment?
GERD/Gastritis/PUD
96
GERD
Common: 10-20%
Sx: heartburn (postprandial)and regurg/reflux
Dx: can dx based on clinical sx alone
--->Upper endoscopy with alarm features
97
What are tmt for GERD?
```
antacids
lifestyle mod
-->weight loss, elevate head in bead, avoid ETOH and smoking, avoid dietary triggers
Surface agents
H2 blockers (zantac)
Proton pump inhibitors (omeprazole)
```
98
PUD
Peptic ulcer disease
-->common
Defect in gastric or duodenal mucosa that extends through muscularis mucosa
RF: H pylori and NSAIDS
Sx: asymp in 70%, upper abd pain
99
What is the most common cause of upper GI bleeds?
PUD
100
What type of PUD is typically in the lesser curvature of the antrum of the stomach?
Gastric ulcer
101
What type of PUD is sharp and burning epigastric pain that worsens 30-90 minutes after eating?
gastric ulcer
102
What type of PUD occurs at proximal duodenum OR distal to 2nd portion of duodenum?
duodenal ulcer
103
What type of PUD is more common?
duodenal ulcer
104
Is H pylori implicated in gastric or duodenal PUD?
both
105
What type of PUD has gnawing epigastric pain that worsens 3-5 hours after eating, may be temp relieved by food?
duodenal ulcer
106
Describe H pylori
flagella, motile, spiral, gram negative that produces urease
colonizes gastric antral mucosa
107
What is the most prevalent chronic bacterial disease known?
H pylori
-->associated with many GI pathologies
108
What are risks for H pylori infection?
poverty, overcrowding, limited education, ethnicity, rural, birth outside US
109
What is H pylori pathophysiology?
urease hydrolyzes gastric luminal urea-->ammonia-->neutralize gastric acid and protects bacteria so that it can penetrate gastric mucus layer
-->causes increased gastric acid secretion and immune responses
110
How to dx H pylori?
- Urea breath test-->1st line
- Fecal antigen test-->1st line
- Detection of Ab in serum
- -->not really used anymore d/t positive after 1-2 years of treatment
- Upper endoscopy with gastric biopsy
- ->Warthin-Starry's silver stain
111
What test is used to confirm eradication of H pylori?
urea breath test, some fecal antigen test
112
What can cause high chance of false negative H pylori tests?
if pt continues to take proton pump inhibitor meds after 14 days prior to tests
113
What is hematochezia usually due to?
lower GI bleed
114
What location divides upper and lower GI bleeds?
ligament of treitz
115
What organs constitute upper GI bleed?
esophagus, stomach, duodenum
116
What organs constitute lower GI bleed?
jejunum, ileum, colon, rectum
117
What are historical pearls in UGIB?
hematemesis, coffee ground emesis, melena, retching
- prior episodes GI bleeding and interventions
- liver disease, aortic graft, ETOH abuse, H pylori and NSAID use
118
Why ask about hx of UGIB?
60% with hx are bleeding from same site
119
What medications can cause GIB?
aspirin, NSAIDs, glucocorticoids, anticoagulants, Beta blockers
120
What meds can look like GIB?
meds with iron or bismuth, red dye, beets
121
What are examples of UGIB?
- PUD
- gastritis and esophagitis
- varices of esophagus and stomach
122
What are examples of LGIB?
- diverticulosis
- inflammatory bowel diseases (crohn's, ulcerative colitis)
- anorectal disease
- colitis
123
What are varices most often results of?
portal HTN d/t alcoholic liver disease
**high mortality rate
124
What is classic presentation of gallstones?
biliary colic
| -->episodic to constant RUQ pain that is worse after eating greasy foods
125
Wat is cholecystitis?
inflammation of GB secondary to obstruction in neck of GB or cystic duct
-->liver fxn tests nml because it can still drain bile via liver (but not GB)
126
What is choledocholithiasis?
stone in common bile duct
-->liver function tests elevated because liver and GB both can't drain
127
What is ascending cholangitis?
air in biliary tree d/t stone in common bile duct-->biliary tree inflamed and infected
128
What is gallstone pancreatitis?
gallstone stuck in pancreatic duct
-->elevated liver fxn test and pancreatic enzymes (lipase,amylase)
129
What is dysfunctional GB?
no stones, GB doesn't empty well
-->sx of biliary colic
-->DX with HIDA scan
130
What are risk factors for pancreatitis?
Gallstones
| ETOH abuse
131
Classic presentation of pancreatitis
acute onset of constant, severe epigastric pain that can radiate to the back
N, V, epigastric TTP
132
How to dx pancreatitis
CBC, CMP, lipase, UA, preg
-->imaging if needed: CT scan with contrast; US of GB, liver or pancreas
133
Classic presentation of appendicitis
RLQ AP, anorexia, N, V, can have F
visceral-->localizes to RLQ (parietal)
134
How to dx appendicitis
CBC, CMP, UA, preg test
Imaging if needed: CT AP w/ contrast, US of RLQ in kids
135
Diverticulosis vs Diverticulitis
losis: presencte of diverticulum (sac-like protrusions of colonic wall) that is not pathologic until inflammed
it is: erosion of diverticular wall by increase pressure or impacted food particles-->inflammation and necrosis lead to perforation
136
Risk factors for diverticulosis/itis
obesity
physical inactivity
diet of low fiber, high fat, red meat
137
Classic presentation of diverticulitis
abd pain localized to LLQ
| may have N, V, F
138
What dx for diverticulitis
mirror image of appendicitis
139
Is achalasia uncommon?
yes
-->failure of LES to relax
1 is unknown cause, 2 d/t motor abn
140
What is typical of barium esophagogram in achalasia?
bird's beak in distal esophagus
141
What confirms primary achalasia
esophageal manometry
142
What is Chagas disease
secondary achalasia
-->in endemic regions of Mexico, central and south America d/t parasite Trypanosoma cruzi
143
Zollinger-Ellison Syndrome
gastrinoma that is very rare
25% a/w multiple endocrine neoplasia
-->intractable ulcer or ulcers in atypical locations
144
What are parasympathetics of esophagus through transverse colon
vagus N (OA and AA)
145
What are parasympathetics for desc colon, sigmoid colon and rectum
pelvic splanchnic N (S2-4)
146
What is the symp level of appendix
T12
147
what is the symp level of esophagus
T2-8
148
What is the symp level of stomach
T5-9
149
What is symp level of liver
T6-9
150
what is the symp level of GB
T6-9
151
What is the symp level of SI
T5-9, T9-12
152
What is the symp level of colon
T9-L2
153
What is the symp level of pancreas
T5-11
154
What causes projectile vomiting in children?
pyloric stenosis until proven otherwise
155
What causes MALT lymphoma?
H pylori
