GI Hepatic Lecture 7 Flashcards
Globus Sensation - arises from
GERD
emotions
Heart burn (acid reflux) vs Dyspepsia/Reflux
burning pain behind sternum
GERD & acid reflux
worse when lying down & after eating
can move up from stomach
Dyspepsia/Reflux
burning pain in upper abdomen
heart burn
bloating/belching/nausea & vomiting
often caused by peptic ulcer or GERD or bowel disorders
7 common presenting complaints of GI
dysphagia dyspepsia/Reflux nausea vomiting pain GI bleeding change in bowel - diarrhoea & jaundice
Dyspepsia/Reflux can be caused by……..
oesophageal or gastric cancer
GERD - worse when lying down
peptic ulcer
Globus sensation - Red flags
Neck or throat pain Weight loss Abrupt onset after age 50 Pain, choking, or difficulty with swallowing Regurgitation of food Muscle weakness Palpable or visible mass Progressive worsening of symptoms
Dyspepsia Red Flags
Acute episode with dyspnoea, diaphoresis*, or tachycardia
Anorexia
Nausea or vomiting
Weight loss
Blood in the stool
Dysphagia or odynophagia
Failure to respond to therapy with H2 blockers or proton pump inhibitors (PPIs)
Causes of acute nausea/vomiting
try to find factors associated with attacks - food,drugs,movement,injury, change in bowel habits
GI infection food poisoning drugs head trauma/migraine abdominal visceral pain pregnancy
causes of chronic nausea/vomiting
over 1 month
motility disturbance
endocrine/metabolic disorder
intracranial pathology
partial obstruction of GI tract
Red Flags - nausea/vomiting
The following suggest serious pathology in combination with nausea and vomiting:
Signs of hypovolemia Headache, stiff neck, or mental status change Peritoneal signs (e.g., guarding, rigidity, rebound tenderness) Distended, tympanitic abdomen
Name the 3 types of abdominal pain
1 - visceral - dull, poorly localised pain, often associated with autonomic features
2 - somato - parietal - more local than visceral, coming from parietal peritoneum
3 - referred - pain felt remotely from affected organ
Peritonitis - what is it?
How is it caused?
What signs?
inflammation of the peritoneal cavity
may arise from perforation of the GI tract or inflamm. abdo condition
signs - guarding, rigidity, rebound tenderness on exam
acute waves of sharp constricting pain that “take the breath away” is likely to stem from what?
renal or biliary colic
waves of dull pain with vomiting is likely to stem from what?
intestinal obstruction
Colicky pain that becomes steady is likely to stem from what?
appendicitis
strangulating intestinal obstruction
mesenteric ischemia
tearing pain is likely to stem from what?
dissecting aneurysm
dull ache is likely to stem from what?
appendicitis, diverticulitis, pyelonephritis
Acute abdominal pain - red flags
Severe pain
Signs of shock (eg, tachycardia, hypotension, diaphoresis, confusion)
Signs of peritonitis
Abdominal distention
Chronic abdominal pain - red flags
Fever Anorexia, weight loss Pain that awakens patient Blood in stool or urine Jaundice Oedema Abdominal mass or organomegaly
Irritable bowel syndrome is recurrent abdominal discomfort accompanied by at least 2 of the following……
relief by defacation
change in frequency of stool
change in consistency of stool
(no cause is known but thought to have physiological & psychological factors)
Types of GI bleeding
haematemesis - vomiting of blood, either bright red or coffee coloured (almost always from upper GI)
melaena - pasage of blood in the stool (may be from throughout GI tract)
Note - 50% of upper GI bleeds are due to peptic ulcer
Diarrhoea - caused by?
certain drugs
unabsorbable water that stays in the bowel
infection
diverticular bleeding & ischemic colitis manifest with bloody diar.
in a young person recurrent bouts of bloody diar. suggest inflam. bowel disease
large vol. of 1 litre a day - endocrine cause if GI is normal
Acute, persistent & chronic timeframes?
Diarrhoea
acute - lasting less than 2 weeks
persistent - 2 - 4 weeks
chronic - lasting over a month
Diarrhoea red flags
Blood or pus Fever Signs of dehydration Chronic diarrhoea Weight loss
define constipation?
at least 12 non consecutive weeks in last year & involving 2 or more of - straining during 1 in 4 poos lumpy hard poos in more than 1 in 4 incomplete evacuaation in 1 in 4 sensation of a blockade less than 3 a week
What causes constipation?
sudden change in physical activity
change in diet, decreased fibre
medication
bowel obstruction
Constipation - red flags
Distended, tympanitic abdomen Vomiting Blood in stool Weight loss Severe constipation of recent onset/worsening in elderly patients
Jaundice red flags
marked abdo pain/tenderness
altered mental state
GI bleeding
Kushlas babies - ecchymoses, petechiae & little purpura
Causes of Dyspepsia/Reflux……….
achalasia (failure of smooth mms to relax) - worse with food & dysphagia that gradually worsens
cancer - dysphagia
coronary ischemia - may have extertional component
oesophageal spasm - substernal pain with/wo dysphagia
GERD - heartburn, reflux worse when lying down
peptic ulcer disease - burning/gnawing pain relieved by antacids
What is GERD?
Who does it affect & symptoms?
MUST KNOW
gastric oesophageal reflux disease - 25-40% of people will experience - Western diet
All ages, both sexes
Excessive retrograde movement of acid-containing gastric secretions or bile from duodenum & stomach into oes.
Dysfunc. - oesophag. sphincter may be cause or stom. or oes.
Symptoms - coughing/wheezing
chest pain
dysphagia
regurgitation
Gastric Ulcer - what does it affect/who, aet, symptoms etc?
MUST KNOW
Affects stomach or duodenum - at any age
Aet - H.Pylori & NSAIDS disrupt mucosal defence/repair, eradicate h.pylori 70% of cases, ulcer gone
SYMP/SIGNS - burning pain,
duodenal relieved by food, gastric ulcer worsened
duodenal - more consistent pain, pain at night
gastric - no pain pattern
Appendicitis - what does it affect/who, aet, symptoms etc?
MUST KNOW
Very common cause of pain & surgical emergency, 7% of pop - higher Western
Aet - obstruction of appendiceal lumen leading to bacterial growth, inflamm. ischemia,
Signs/symptoms - pain in area, nausea, vomiting, absent or few bowel movements
Diverticulitis - what does it affect/who, aet, symptoms etc?
MUST KNOW
diverticula or diverticulitis protruding through colonic wall
Western countries - like all GI stuff
Patho - fecal or undigested food in a diverticula
Signs/Symptoms - pain/tenderness in lower left Q, if bowel obstruction then nausea, vomiting.
Chron’s disease - what does it affect/who, aet, symptoms etc?
MUST KNOW
disease of the distal ileum, colon generally - spares the rectum. But can affect any part of GI.
Epi - men & women, 15-30 & 60-70
Aet - unknown - genetic, environ, NSAIDs
Patho - chronic inflamm. from T cell activation
Signs/symp - rectal bleeding,fever, weight loss,nausea, vomiting, psychological issues
Ulcerative Colitis - what does it affect/who, aet, symptoms etc?
MUST KNOW
inflamm. disease that generally involves only large intestine (colon & rectum)
Epi - men & women, 15-30, 60-70, 35-100 per 100 000
Aet - unknown, NSAIDs, genetic, environ
Patho - usually begins in rectum, rarely the whole LI
Signs/Symp - bloody diarr, urgency to defacate, mild lower abdo cramps, blood/mucous in stolls
Irritable bowel syndrome - what does it affect/who, aet, symptoms etc?
MUST KNOW
recurrent abdo pain accompanied by at least 2 of: relief by defacation, change in frequency of stool, change in consistency
Epi - 10-20%, women 2-3 times more, adoles, 20s then bouts
Aet - unknown, combo of psycho & physiological
Patho - unknown, visceral hyperalgesia, psycho-social
Signs/symp - abdo discomfort, change in stool patterns, dyspepsia (indigestion) - all these can be triggered by food, stress…
