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Clin Path Sem 2 2014 > GI Hepatic Lecture 7 > Flashcards

GI Hepatic Lecture 7 Flashcards

1
Q

Globus Sensation - arises from

A

GERD

emotions

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2
Q

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

A

Dyspepsia/Reflux

burning pain in upper abdomen
heart burn
bloating/belching/nausea & vomiting
often caused by peptic ulcer or GERD or bowel disorders

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3
Q

7 common presenting complaints of GI

A 
dysphagia
dyspepsia/Reflux
nausea
vomiting
pain
GI bleeding
change in bowel - diarrhoea & jaundice
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4
Q

Dyspepsia/Reflux can be caused by……..

A

oesophageal or gastric cancer
GERD - worse when lying down
peptic ulcer

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5
Q

Globus sensation - Red flags

A 
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
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6
Q

Dyspepsia Red Flags

A

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)

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7
Q

Causes of acute nausea/vomiting

try to find factors associated with attacks - food,drugs,movement,injury, change in bowel habits

A 
GI infection
food poisoning
drugs
head trauma/migraine
abdominal visceral pain
pregnancy
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8
Q

causes of chronic nausea/vomiting

over 1 month

A

motility disturbance
endocrine/metabolic disorder
intracranial pathology
partial obstruction of GI tract

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9
Q

Red Flags - nausea/vomiting

A

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
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10
Q

Name the 3 types of abdominal pain

A

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

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11
Q

Peritonitis - what is it?
How is it caused?
What signs?

A

inflammation of the peritoneal cavity
may arise from perforation of the GI tract or inflamm. abdo condition
signs - guarding, rigidity, rebound tenderness on exam

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12
Q

acute waves of sharp constricting pain that “take the breath away” is likely to stem from what?

A

renal or biliary colic

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13
Q

waves of dull pain with vomiting is likely to stem from what?

A

intestinal obstruction

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14
Q

Colicky pain that becomes steady is likely to stem from what?

A

appendicitis
strangulating intestinal obstruction
mesenteric ischemia

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15
Q

tearing pain is likely to stem from what?

A

dissecting aneurysm

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16
Q

dull ache is likely to stem from what?

A

appendicitis, diverticulitis, pyelonephritis

17
Q

Acute abdominal pain - red flags

A

Severe pain
Signs of shock (eg, tachycardia, hypotension, diaphoresis, confusion)
Signs of peritonitis
Abdominal distention

18
Q

Chronic abdominal pain - red flags

A 
Fever
Anorexia, weight loss
Pain that awakens patient
Blood in stool or urine
Jaundice
Oedema
Abdominal mass or organomegaly
19
Q

Irritable bowel syndrome is recurrent abdominal discomfort accompanied by at least 2 of the following……

A

relief by defacation
change in frequency of stool
change in consistency of stool

(no cause is known but thought to have physiological & psychological factors)

20
Q

Types of GI bleeding

A

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

21
Q

Diarrhoea - caused by?

A

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

22
Q

Acute, persistent & chronic timeframes?

Diarrhoea

A

acute - lasting less than 2 weeks
persistent - 2 - 4 weeks
chronic - lasting over a month

23
Q

Diarrhoea red flags

A 
Blood or pus
Fever
Signs of dehydration
Chronic diarrhoea
Weight loss
24
Q

define constipation?

A 
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
25
Q

What causes constipation?

A

sudden change in physical activity
change in diet, decreased fibre
medication
bowel obstruction

26
Q

Constipation - red flags

A 
Distended, tympanitic abdomen
Vomiting
Blood in stool
Weight loss
Severe constipation of recent onset/worsening in elderly patients
27
Q

Jaundice red flags

A

marked abdo pain/tenderness
altered mental state
GI bleeding
Kushlas babies - ecchymoses, petechiae & little purpura

28
Q

Causes of Dyspepsia/Reflux……….

A

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

29
Q

What is GERD?

Who does it affect & symptoms?

MUST KNOW

A

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

30
Q

Gastric Ulcer - what does it affect/who, aet, symptoms etc?

MUST KNOW

A

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

31
Q

Appendicitis - what does it affect/who, aet, symptoms etc?

MUST KNOW

A

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

32
Q

Diverticulitis - what does it affect/who, aet, symptoms etc?

MUST KNOW

A

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.

33
Q

Chron’s disease - what does it affect/who, aet, symptoms etc?

MUST KNOW

A

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

34
Q

Ulcerative Colitis - what does it affect/who, aet, symptoms etc?

MUST KNOW

A

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

35
Q

Irritable bowel syndrome - what does it affect/who, aet, symptoms etc?

MUST KNOW

A

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…

Clin Path Sem 2 2014 (13 decks)

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