GI pathology Flashcards
List GI pathologies
- Peptic ulcer
- Inflammatory Bowel Disease
- Crohn’s disease
- Ulcerative colitis
- Colorectal cancer
- Pancreatic cancer
- Appendicitis
describe a peptic ulcer
loss of tissue lining lower esophagus, stomach and duodenum
can cause shoulder pain (usually R) or back
what are some causes of peptic ulcers
- infection with H. pylori
- chronic NSAID use
what are the 2 types of peptic ulcers?
- erosions
- acute lesions that do not extend through the mucosa
- chronic ulcers
- destroys musculature and replaces it with scar tissue
Clinical S/S of Peptic Ulcers
- Heartburn
- Night pain (12am - 3am)
- Radiating back pain
- Stomach pain
- R shoulder pain
- Lightheadedness/fainting
- N/V
- Anorexia
- Weight loss
- Bloody stool
- Black, tarry stools
list GI complications of NSAID use
- most obvious clinical negative effect is on the gastroduodenal mucosa
- range from subclinical erosion of mucosa to ulceration with life-threatening bleeding and perforation
- responsible for 40% of hospital admissions among pts with arthritis
- NSAID-induced GI bleeding is major cause of morbidity and mortality among older population
Risk factors for NSAID-induced gastropathy
- age older than 65 yo
- history of peptic ulcer disease or GI disease
- smoking, alcohol use
- oral corticosteroid use
- anticoagulation or use of anticoagulants
- renal complications in pt with HTN or CHF
- use of acid suppressants
- NSAIDs combined with selective serotonin reuptake inhibitors
Clinical S/S of GI complications of NSAID use
- Asymptomatic
- Stomach upset/pain
- Indigestion, heartburn
- Skin reactions
- Increased BP
- New-onset back (thoracic) or shoulder pain
- Melena
- Tinnitus
- CNS changes
- Renal involvement
CNS changes that can occur due to GI complications from NSAID use
- HA
- depression
- confusion (older pts)
- memory loss (older pts)
- mood changes
Renal involment symptoms from GI complications due to NSAID use
- muscle weakness
- unusual fatigue
- restless legs syndrome
- polyuria
- nocturia
- pruritus
what conditions are included in inflammatory bowel disease
Crohn’s disease
Ulcerative colitis
What is inflammatory bowel disease?
disorders of unknown etiology involving genetic and immunologic influences on GI tract
both chronic, medically incurable conditions
nutritional deficiencies are most common complications of IBD
T/F: skin lesions may occur in inflammatory bowel disease
TRUE
these include:
- erythema nodsum
- pyoderma
describe Crohn’s disease
- inflammatory disease most commonly attacks terminal end of small intestine (ileum) and colon
- occurs more commonly in young adults/adolescents
describe ulcerative colitis
- inflammation and ulceration of lining of large intestine (colon/rectum)
- cancer of colon more common in people with UC
IBD can be accompanied by what 2 non GI symptoms?
- Skin rash
- joint problems
- usually responsive to treatment of IBD but do on occasion require separate management
Clinical S/S of Crohn’s disease and ulcerative colitis
- Diarrhea
- Constipation
- Fever
- Abdominal pain
- Rectal bleeding
- Night sweats
- Decreased appeptite, nausea, weight loss
- skin lesions
- uveitis
- arthritis
- Migratory arthralgias
- Hip pain (iliopsoas abscess)
describe colorectal cancer
- 3rd leading cause of cancer deaths
- incidence increases with age, beginning around 40
- screening can sig reduce mortality
- high-risk groups
- previous hx of chronic IBD
- adenomatous polyps
- hereditary colon cancer
Clinical S/S of Colorectal cancer in the early stages
- rectal bleeding, hemorrhoids
- abdominal, pelvic, back or sacral pain
- back pain that radiates down the legs
- changes in bowel patterns
Clinical S/S of colorectal cancer in late stages
- constipation progressing to obstipation
- diarrhea with copious amounts of mucus
- N/V
- abdominal distension
- weight loss
- fatigue and dyspnea
- fever
where is most pancreatic cancer located?
- 70% arises in the head of the gland
- 20-30% occur in the body and tail
Clincial S/S of pancreatic carcinoma
- epigastric/upper abdominal pain radiating to the back
- LBP may be only symptom
- jaundice
- anorexia and weight loss
- light-colored stools
- constipation
- N/V
- weakness
how may pain be worsened or relieved in pancreatic carcinoma?
worsened with walking and lying supine
relieved by sitting and leaning forward
when is appendicitis most common?
in adolescents and young adults
this is serious and usually requires surgery
Clinical S/S of appendicitis
- R lower quadrant/flank pain
- periumbilica and/or epigastric pain
- R thigh, groin, or testicular pain
- Abdominal involuntary muscle guarding and rigidity
- +McBurney’s point or +pinch-an-inch test
- rebound tenderness
- N/V
- Anorexia
- Dysuria
- low-grade fever
- coated tongue and bad breath
Tests for Appendicitis
McBurney’s Point
Rovsing Sign
Clues for screening for GI diseases
- previous hx of NSAID-induced GI bleeding
- symptoms increase within 2 hours after taking NSAIDs or other meds
- symptoms affected by food
- back pain and abdominal pain at the same level
- esp in presence of constitutional symptoms
- Shoulder, back, pelvic or sacral pain
- back, pelvic or sacral pain relieved/reduced by bowel movement
- LBP accompanied by constipation
- joint pain with arthalgia preceded by skin rash
Guidelines for immediate medical attention
- suspected appendicitis or iliopsoas/obturator abscess
- suspected retroperitoneal bleeding from injured, damage or ruptured spleen or ectopic pregnancy
Guidelines for medical referral
- Pts who chronically rely on laxatives
- joint involvment accompanied by skin or eye lesions if MD is unaware
- hx of NSAID use with back or shoulder pain accompanied by S/S of peptic ulcer
- back pain assocaited with meals or relieved by a bowel movement (esp if accompanied by rectal bleeding)
- back pain of unknown cause that doesn’t fit MSK pattern (esp w/hx of cancer)
describe abdominal pain of MSK origin
- sharp and focal
- cramping and aching, or deep
describe abdominal pain of visceral origin
- dull
- aching
- cramping
- burning
- gnawing
- wave-like
- poorly localized
T/F: both abdominal pain of MSK and visceral origin can present with nausea
TRUE
list potential MSK sources of abdominal pain
- psoas referral
- lower T-spine
- slipping rib syndrome
- myofascial components
