GI Correlations Flashcards
Acholic
white clay colored stools d/t lack of bile release into GI tract
–>light due to lack of bile salts in stool
Anorexia
lack of appetite
Acute abdomen
serious intra-abdominal condition
–>pain, tenderness, rigidity needing emergency surgery consideration
Borborygmi
rumbling noise d/t gas through intestines
Cachexia
profound and marked ill health and malnutrition
Cholestasis
suppression or stopping of bile flow d/t causes within or outside liver
Coffee-ground emesis
blood congealed and separated within gastric contents
Colic
acute paroxysmal abdominal pain
Courvoisier’s Sign
enlarged non-tender GB secondary to pancreatic disorder or cancer
Cullen Sign
bruising around umbilicus secondary to hemorrhage
Curling or stress ulcer
duodenal peptic ulcer in a patient with superficial burns
Cushing or stress ulcer
peptic ulcer d/t severe head injury or lesions of CNS
Dyspepsia
postprandial epigastric discomfort
Dysphagia
difficulty in swallowing
Dysplasia
abnormal tissue development
Edentulous
no teeth
Esophagitis
inflammation of esophagus
ERCP
Endoscopic retrograde cholangiopancreatography
Eructation
burping
EUS
endoscopic ultrasound
Flatus
gas in GI tract expelled through anus
Gastritis
inflammation of stomach with histo and endoscopic changes
Gastropathy
epithelial or endothelial damage WITHOUT inflammation
GGT
gamma-glutamyl transferase
->used to determine cause of elevated ALP
both elevated in liver disease
Grey Turner sign
flank bruising secondary to hemorrhage
Globus pharyngeus
FB sensation in throat that doesn’t interfere with swallowing
–>d/t GERD most times in anxiety or OCD
Guarding
protective response resulting from pain or fear
–>voluntary
Heel strike
pt supine, strike heel, pain indicates peritonitis (often secondary to appendicitis)
Hematemesis
vomiting blood
Hematochezia
passage of bright red or maroon stools
Icterus
AKA jaundice
Iliopsoas muscle test
flex hip against resistance, increase abd pain positive for irritation of psoas muscle (appendicitis)
KUB Xray
plain abd xray of Kidneys, Ureter, Bladder
LGIB
lower GI bleeding
Lloyd punch
CVA tenderness
–>kidney inf or stone
McBurney’s Point
1/3 distance between ASIS and umbilicus, appendicitis
Melena
dark colored stool c/w broken down hemosiderin in bowel
–>tarry
**upper GI bleed proximal to ligament of treitz
Mittelschmerz
lower ap in middle of menses (basically feel ovulation)
–>no rebound tenderness
MRCP
magnetic resonance cholangiopancreatography
Murphy Sign
palpate deep under R costal margin during inspiration–>pain or sudden stop of inspiratory effort
–>cholecystitis or cholelithiasis
Nausea
subjective sensation of impending urge to vomit
Obstipation
severe intractable constipation caused by intestinal obstruction
Odynophagia
painful swallowing
Pneumobilia
abnormal presence of gas in biliary system or bile ducts
Pneumomediastinum
abnormal presence of air or gas in mediastinum d/t trauma or diagnostic
–>can interfere with respiration and circulation
**Pneumothorax, pneumopericardium
Pneumoperitoneum
abnormal presence of air or gas in peritoneal cavity
Psoas sign
retrocecal appendix via RLQ pain on passive R hip extension
Pyrosis
heartburn
Rebound tenderness
pain on removal of pressure
–>peritoneal inflammation or acute abd
Regurgitation
effortless reflux WITHOUT n, v
Retching
peristalsis of stomach and esophagus with closed glottis
Rigidity
hard involuntary reflex of contraction of abd wall
Rovsing’s sign
pain in RLQ on palp of LLQ–>referred rebound of appendicitis
Steatorrhea
fatty, greasy stools
Tenesmus
ineffectual and painful straining at stool or urination
UGIB
upper GI bleeding
Ulcer
local defect of surface of organ/tissue produced by shedding of inflammed necrotic tissue
Ureterolithiasis
stone from kidney making its way through ureter to bladder
–>hematuria
Virchow’s Node
palpable LN in left supraclavicular fossa
–>abd cancer
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
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
Abdominal pain in LUQ
gastritis
PUD (peptic ulcer disease)
Abdominal pain in Epigastric
pancreatitis
PUD/GERD
Abd pain in periumbilical region
SBO
LBO
appy
AAA
Abd pain in LLQ
diverticulitis
Abd pain in RUQ
GB
DDX of epigastric pain (dyspepsia)
- PUD
- Fxnl dyspepsia (no explanation for cause)
- Atypical GERD
- Gastric cancer
- Food poisoning
- Viral gastroenteritis
- Biliary tract disease
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
DDX of upper GI bleed
- PUD
- Erosive gastritis
- Arteriovenous malformations
- Mallory-Weiss tear
- Esophageal varices
What type of pain is not localized, usually felt in midline and secondary to distension of hollow organs?
visceral pain
What is an example of visceral pain?
periumbilical pain with early appendicitis
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
What are examples of parietal pain?
RLQ tenderness or Rosving’s sign (palp LLQ–>pain RLQ)
Causes of N, V
Numerous
–>appearance, frequency, projectile
*can be r/t GI, vestibular, CNS
Causes of oropharyngeal dysphagia
Trouble initiating swallowing
–>neuro disorders, infectious, structural, metabolic
*aspirate, cachectic
Causes of esophageal dysphagia
- solids, liquids or both
- progressive or not
- constant vs intermittent
–>mechanical obstruction (solids worse than liquids), motility (both)
Lab tests for GI workup
CBC CMP (includes liver) BMP UA Preg test Lipase/amylase Pt/Ptt (liver failure) Fractionated bilirubin (presents with jaundice)
What is a CBC with differential?
CBC but includes percentage of absolute differential counts (PMN. lymph, basophils, eosinophils, monocytes)
What is in a BMP?
Na K Cl CO2 BUN Creatinine Ca
–>CMP includes liver tests (bilirubin, ALT/AST, albumin, etc)
What labs would you order when considering pancreatitis?
lipase
amylase
What labs you order when considering liver problems?
GGT (gamma-glutamyl transferase)
Fractionate bilirubin
PT/INR
–>bleeding risk
What labs would you order when looking for Zolinger Ellison Gastrinoma?
Fasting gastrin
Secretin stimulation test
How do you write labs with the X on paper?
Top is Hgb
Left is WBC
Bottom is Hct
Right is Platelet
How would you write a BMP on paper?
—/—/—<
Top Na
Bottom K
Top Cl
Bottom CO2
Top BUN
Bottom Creat
< is glucose
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
KUB
limited diagnostic benefit, single supine xray of abd
Describe Barium esophagography
Barium swallow xray
–differentiate between mechanical lesions and motility disorders
What study is more sensitive for detecting subtle esophageal narrowing d/t rings, achalasia and proximal esophageal lesions?
barium study
–>bird beak in achalasia
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
What do you use to visualize upper and lower GI tract?
EGD vs colonoscopy
What is US good for in abd?
GB FAST scan for trauma Bladder Kidneys Aorta and vessels Heart
–>limited by air and fat
What is ERCP?
invasive way to visualize hepatobiliary and pancreatic ducts
–>provide intervention
What test is specific for testing the function of the gallbladder?
HIDA: hepatobiliary iminodiacetic acid scan
if HIDA + CCK low–> biliary dyskinesia
What gives you the most information about abd pathology?
CT ABD/Pelvis with or without contrast
What have similar pathophysiology, dx work up and treatment?
GERD/Gastritis/PUD
GERD
Common: 10-20%
Sx: heartburn (postprandial)and regurg/reflux
Dx: can dx based on clinical sx alone
—>Upper endoscopy with alarm features
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)
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
What is the most common cause of upper GI bleeds?
PUD
What type of PUD is typically in the lesser curvature of the antrum of the stomach?
Gastric ulcer
What type of PUD is sharp and burning epigastric pain that worsens 30-90 minutes after eating?
gastric ulcer
What type of PUD occurs at proximal duodenum OR distal to 2nd portion of duodenum?
duodenal ulcer
What type of PUD is more common?
duodenal ulcer
Is H pylori implicated in gastric or duodenal PUD?
both
What type of PUD has gnawing epigastric pain that worsens 3-5 hours after eating, may be temp relieved by food?
duodenal ulcer
Describe H pylori
flagella, motile, spiral, gram negative that produces urease
colonizes gastric antral mucosa
What is the most prevalent chronic bacterial disease known?
H pylori
–>associated with many GI pathologies
What are risks for H pylori infection?
poverty, overcrowding, limited education, ethnicity, rural, birth outside US
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
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
What test is used to confirm eradication of H pylori?
urea breath test, some fecal antigen test
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
What is hematochezia usually due to?
lower GI bleed
What location divides upper and lower GI bleeds?
ligament of treitz
What organs constitute upper GI bleed?
esophagus, stomach, duodenum
What organs constitute lower GI bleed?
jejunum, ileum, colon, rectum
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
Why ask about hx of UGIB?
60% with hx are bleeding from same site
What medications can cause GIB?
aspirin, NSAIDs, glucocorticoids, anticoagulants, Beta blockers
What meds can look like GIB?
meds with iron or bismuth, red dye, beets
What are examples of UGIB?
- PUD
- gastritis and esophagitis
- varices of esophagus and stomach
What are examples of LGIB?
- diverticulosis
- inflammatory bowel diseases (crohn’s, ulcerative colitis)
- anorectal disease
- colitis
What are varices most often results of?
portal HTN d/t alcoholic liver disease
**high mortality rate
What is classic presentation of gallstones?
biliary colic
–>episodic to constant RUQ pain that is worse after eating greasy foods
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)
What is choledocholithiasis?
stone in common bile duct
–>liver function tests elevated because liver and GB both can’t drain
What is ascending cholangitis?
air in biliary tree d/t stone in common bile duct–>biliary tree inflamed and infected
What is gallstone pancreatitis?
gallstone stuck in pancreatic duct
–>elevated liver fxn test and pancreatic enzymes (lipase,amylase)
What is dysfunctional GB?
no stones, GB doesn’t empty well
–>sx of biliary colic
–>DX with HIDA scan
What are risk factors for pancreatitis?
Gallstones
ETOH abuse
Classic presentation of pancreatitis
acute onset of constant, severe epigastric pain that can radiate to the back
N, V, epigastric TTP
How to dx pancreatitis
CBC, CMP, lipase, UA, preg
–>imaging if needed: CT scan with contrast; US of GB, liver or pancreas
Classic presentation of appendicitis
RLQ AP, anorexia, N, V, can have F
visceral–>localizes to RLQ (parietal)
How to dx appendicitis
CBC, CMP, UA, preg test
Imaging if needed: CT AP w/ contrast, US of RLQ in kids
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
Risk factors for diverticulosis/itis
obesity
physical inactivity
diet of low fiber, high fat, red meat
Classic presentation of diverticulitis
abd pain localized to LLQ
may have N, V, F
What dx for diverticulitis
mirror image of appendicitis
Is achalasia uncommon?
yes
–>failure of LES to relax
1 is unknown cause, 2 d/t motor abn
What is typical of barium esophagogram in achalasia?
bird’s beak in distal esophagus
What confirms primary achalasia
esophageal manometry
What is Chagas disease
secondary achalasia
–>in endemic regions of Mexico, central and south America d/t parasite Trypanosoma cruzi
Zollinger-Ellison Syndrome
gastrinoma that is very rare
25% a/w multiple endocrine neoplasia
–>intractable ulcer or ulcers in atypical locations
What are parasympathetics of esophagus through transverse colon
vagus N (OA and AA)
What are parasympathetics for desc colon, sigmoid colon and rectum
pelvic splanchnic N (S2-4)
What is the symp level of appendix
T12
what is the symp level of esophagus
T2-8
What is the symp level of stomach
T5-9
What is symp level of liver
T6-9
what is the symp level of GB
T6-9
What is the symp level of SI
T5-9, T9-12
What is the symp level of colon
T9-L2
What is the symp level of pancreas
T5-11
What causes projectile vomiting in children?
pyloric stenosis until proven otherwise
What causes MALT lymphoma?
H pylori
