GI Intro Flashcards
Oropharyngeal dysphagia
Problems in transferring the food bolus from the oropharynx to the upper esophagus
Esophageal dysphagia
Impaired transport of the food bolus through the body of the esophagus
May be accompanied by the feeling of food getting “stuck”
Odynophagia
Commonly associated with
Sharp pain on swallowing that may limit oral intake
Commonly associated with erosive disease
Candida
Herpesvirus
CMV
Caustic ingestions
Pyrosis
Also known as heartburn
Feeling of substernal burning, often radiating to the neck
Caused by the reflux of gastric contents into the esophagus
Dyspepsia
Described as?
Also known as indigestion
Persistent or recurrent pain or discomfort in the upper abdomen
Commonly described as early satiety, postprandial fullness, gnawing or burning
Usually indicates an underlying problem
Types:
Ulcer-like
Dysmotility-like
Reflex-like
Types of Dyspepsia
Ulcer-like
Where is the pain?
Pain localized in the epigastrium
Frequently occurs before meals and is relieved by eating food, antacids, or H2 blockers
Types of Dyspepsia
Dysmotility-like
Discomfort rather than pain along with early satiety, postprandial fullness, nausea, vomiting, bloating
Symptoms are worsened by food
Types of Dyspepsia
Reflux-like
Heartburn and/or acid regurgitation
Dyspepsia
Contributing factors:
Overeating
Eating too quickly
Drinking too much alcohol or coffee
Medications: aspirin, NSAIDs, antibiotics, diabetes drugs, antihypertensive drugs
Dyspepsia
Alarm Sx
Alarm symptoms:
Weight loss
Odynophagia
Progressive dysphagia
Constant or severe pain
Persistent vomiting
Hematemesis
Melena
Failure to respond to standard therapy
Dyspepsia
Dx
History
Clarify the chronicity, location, and quality of the pain
Determine the relationship of the pain with meals
Labs & Diagnostics
Labs: CBC with diff, BMP, and FOBT
C14-urea breath test- Screening for H. pylori infection
≤ 45 years with no alarm symptom
Dyspepsia
Upper endoscopy
Indications:
Patients > 60 years
> 45-59 years with alarm symptoms
Biopsies for H. pylori should be obtained
Esophageal manometry and pH studies - reflux symptoms
vomiting
general
Forceful expulsion of gastric contents produced by involuntary contractions of the abdominal musculature when the gastric fundus and lower esophageal sphincter are relaxed
Controlled by the brainstem (medulla)
4 main causes
vomiting
Visceral afferent stimulation
type 1
Biliary or gastrointestinal distention, mucosal or peritoneal irritation, dysmotility (gastroparesis), infections, GI irritants (alcohol, NSAIDs)
vomiting
Vestibular disorders
type 2
Meniere syndrome, motion sickness
vomiting
CNS disorders
type 3
Certain sights, smells, or emotional experiences, ↑ intracranial pressure, migraine headache, infections (meningitis)
vomiting
Irritation of chemotherapy trigger zones
type 4
Drugs, chemotherapeutic agents, toxins, hypoxia, uremia, acidosis, radiation therapy
Vomiting, diarrhea, and fever = A
Vomiting undigested food = B
A. infectious gastroenteritis
B. achalasia
Vomiting partially digested food >3 hours after ingestion =
gastric outlet obstruction or gastroparesis
Vomiting, obstipation, and abdominal distension =
bowel obstruction
Vomiting, headache, mental status change, and/or papilledema =
CNS etiology
Vomiting with tinnitus or vertigo =
inner ear disorder
Intractable vomiting during pregnancy =
hyperemesis gravidarum
vomiting
Labs & Diagnostics
Urine pregnancy test → ♀ of child-bearing age
UA, CBC, BMP or CMP → severe vomiting, vomiting >1 day, or signs of dehydration
Flat and upright abdomen x-rays → s/s of obstipation or perforation
Chronic vomiting
Referral to GI for upper endoscopy, small bowel x-rays, assessment of gastric emptying
vomiting
Tx
Nothing to eat or drink
NPO for 4-6 hours then a trial of clear liquids in small quantities
IV hydration for dehydration
vomiting
Antiemetic medications
Serotonin 5-HT3-receptor antagonists
Ondansetron (Zofran)
Dopamine antagonists -Induce sedation
Metoclopramide (Reglan)
Promethazine (Phenergan)
vomiting
Antihistamines & anticholinergics
for CNS conditions
Meclizine
Transdermal scopolamine
Vomiting
Cannabinoids (marijuana)
Excessive use can lead to nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome)
Hiccups and causes
Usually benign, self-limited
Causes:
Gastric distention (carbonated beverages, air swallowing, overeating)
Sudden temperature changes (hot to cold liquids)
Alcohol ingestion
Emotional states (excitement, stress, laughing)
Persistent hiccups could be a sign of serious underlying illness
Lasting >48 hours
Often the results of irritation of the vagus or phrenic nerves
Examples: pleurisy of the diaphragm, pneumonia, liver cancer, pancreatitis, disorders of the stomach or esophagus, uremia
hiccups
Simple remedies:
Lifting of the uvula
Eating 1 teaspoon of granulated sugar
Interruption of the respiratory cycle by holding a breath
Valsalva maneuver
Irritation of the diaphragm by holding the knees to the chest
Relief of gastric distention by belching or insertion of a nasogastric tube
hiccups
Tx Pharmacotherapy
Chlorpromazine (Thorazine) 25-50 mg PO or IM
Eructation
Commonly known as a belch
Involuntary or voluntary release of gas from the stomach or esophagus
Occurs most frequently after meals when gastric distention results in transient lower esophageal sphincter (LES) relaxation
Stomach gas common comes from swallowed air
Rapid eating
Gum chewing
Smoking
Ingestion of carbonated beverages
Bloating
Complaint of increased abdominal pressure or fullness that is or is not accompanied by visible distention
Causes:
Diet: eating fatty foods; eating too fast; overeating
Lactose intolerance
Constipation
Gastroesophageal reflux disease (GERD)
Irritable bowel syndrome (IBS)
Ascites
The accumulation of protein-containing fluid within the abdomen
Patient may experience weight gain, increased abdominal distention, abdominal discomfort, loss of appetite, shortness of breath
Tends to occur in chronic rather than acute disorders
Causes
Liver disease (most common)
Cancer
Heart failure
Kidney failure
Pancreatitis
Tuberculosis
Ascites
Physical examination
Percussion of the abdomen = dull sound due to fluid
Clinically detectable when there is at least500 mL of fluidpresent
Ascites
Imaging
Abdominal ultrasound or CT scan of the abdomen and pelvis
Ascites
Diagnostics paracentesis
Process of obtaining a sample of ascites fluid by inserting a needle through the wall of the abdomen
Fluid is sent to the lab for analysis
Analysis can help determine theunderlyingcauseand identifysignsofinfection
Ascites
Complication
Spontaneous bacterial peritonitis
Spontaneous bacterial peritonitis
Potentially fatal infection of the ascites fluid that develops for no apparent reason
Common among patients with ascites due to cirrhosis (alcoholics)’
Signs & Symptoms
Abdominal discomfort/tenderness
Fever
Confused/disoriented
Drowsy
Treatment
Prompt treatment with IV antibiotics
Explain the difference between a sign and a symptom.
What are the 4 categories of signs and 3 main types of symptoms
Explain the following symptoms: dysphagia, odynophagia, pyrosis, dyspepsia, eructation, bloating.
What is the most common cause of odynophagia?
What factors contribute to dyspepsia?
Name symptoms that are alarming when associated with dyspepsia.
What are the four causes for vomiting?
Explain which labs and diagnostics you could order for a patient with vomiting.
What is the association of cannabinoids and vomiting?
