GI Pearls - Sheet1 Flashcards
Patient will present with → odynophagia (painful swallowing), dysphagia and retrosternal chest pain
Esophagitis
Patient will present with → dysphagia to both liquids and solids, bid/parrot beak on barium swallow
Motility Disorder - Achalasia
Patient will present with → dysphagia to solids and liquids with stabbing chest pain worse with hot or cold liquids or food and a corkscrew appearance on barium swallow
Motility Disorder - Diffuse esophageal spasms
Patient will present with → patient with myasthenia gravis, ALS or a stroke with dysphagia to solids and liquids with aspiration into the windpipe or regurgitation into the nose
Motility Disorder - Neurogenic dysphagia
Patient will present with → dysphagia to food and liquid with regurgitation of undigested food several hours after eating along with foul odor of breath
Motility Disorder - Zenker diverticulum
Patient will present with → history of scleroderma and dysphagia to both solids and liquids
Motility Disorder - Scleroderma
Patient will present with → dysphagia to solids in a patient with a history of GERD
Motility Disorder - Esophageal stenosis or stricture
Patient will present with → an episode of hematemesis, vomiting and retching after alcohol intake
Mallory-Weiss tear
Patient will present with → progressive dysphagia to solid foods along with weight loss, chest pain, hoarseness reflux and hematemesis
Esophageal neoplasms
Patient will present with → an intermittent, non progressive dysphagia for solid foods that occurs in consuming of a heavy meal with meat that was “wolfed down,” hence the pseudonym the “steakhouse syndrome.”
Strictures
Patient will present with → history of cirrhosis along with hematemesis, melena, hematochezia +/- signs of hypovolemia
Varices
Patient will present with → heartburn, generally worse after meals and when lying down and often relieved with antacids. Regurgitation and dysphagia may occurs.
Gastroesophageal reflux disease
Patient will present with → dyspepsia and abdominal pain in a patient with predisposing factors (i.e NSAID use)
Gastritis
Patient will present with → weight loss, early satiety, abdominal pain/fullness and dyspepsia
Stomach Neoplasms
Case 1: Patient will present with → abdominal discomfort that is worse with meals and gets better an hour or so later after eating. Case 2: Patient will present with → abdominal discomfort that improves with meals and gets worse an hour or so later after eating.
Peptic ulcer disease = Case 1: Gastric ulcer; Case 2: Duodenal ulcer
Patient will present with → projectile vomiting occurs shortly after feeding in an infant < 3 mo old, palpable “olive-like” mass at the lateral edge right upper quadrant
Pyloric stenosis
Patient will present with → colicky epigastric or right upper quadrant pain in a forty year old obese patient that becomes steady and increases in intensity. It often occurs after a high fat meal
Acute/chronic cholecystitis
Patient will present as → a 32 year old female with a history significant for ulcerative colitis who has been stable and free of problems for over 7 years. She describes worsening symptoms of fatigue, pruritis, anorexia and indigestion over the past 6 months. Her husband reports that her skin and eyes appear yellow although she adamantly denies alcohol consumption. Labs reveal an elevated alkaline phosphatase, mild elevations in AST and ALT. ERCP fails to show common bile duct obstruction
Cholangitis
Patient will present with → right upper quadrant pain “biliary colic” begins abruptly, continues in duration, resolves slowly lasting 20 min - hours associated with nausea precipitated by fatty foods and large meals.
Cholelithiasis
Patient will present with → nausea, vomiting, anorexia, aversion to her usual one pack a day tobacco habit, and right upper quadrant abdominal pain. She has been sick for the past 3 days. She does complain of passing dark-colored urine for the past 2 days. She has just returned from a 2-week trip to Mexico. She has had no exposure to blood products, has no history of intravenous drug use, and has no significant risk factors for sexually transmitted disease. On examination, she looks acutely ill. Her pulse is 100 beats/minute, blood pressure 110/70 mm Hg, respirations 18, and temperature 101°F. Her sclerae are icteric, and her liver edge is tender
Acute/chronic hepatitis
Patient will present with → (eg, anorexia, fatigue, weight loss). Late manifestations include portal hypertension, ascites, and, when decompensation occurs, liver failure
Cirrhosis
Patient will present as → previously stable patient with cirrhosis now presents with abdominal pain, weight loss, right upper quadrant mass, and unexplained deterioration
Liver neoplasms
Patient will present with → severe epigastric pain radiating to the back. The pain typically lessens when the patient leans forward or lies in the fetal position
Acute/chronic pancreatitis
Patient will present with → fatigue and weight loss. The patient describes vague diffuse epigastric pain for 2 months, which started after a couple of weeks of mild diarrhea. He has a 15-lb unintentional weight loss and no appetite. He is not interested in his usual activities. Social history is positive for heavy tobacco and alcohol use. On physical exam you note “dark urine”, painless jaundice and scleral icterus
Pancreatic neoplasms
Patient will present with → right lower quadrant pain and rebound tenderness located at McBurney’s point (junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior spine)
Appendicitis
Patient will present with → diarrhea, steatorrhea, flatulence, weight loss, weakness and abdominal distension are common. Infants and children may present with failure to thrive
Celiac disease
Patient will present with → bloating, abdominal pain, straining and pain with bowel movements. History of less than 2 bowel movements per week
Constipation = less than 2 bowel movements per week
Case 1: Patient will present with → sudden-onset abdominal pain, usually in the left lower quadrant, with or without fever (generally patients don’t have rectal bleeding). Case 2: Patient will present with → painless rectal bleeding, particularly in an elderly patient.
Diverticular disease= Case 1: Diverticulitis; Case 2: Diverticulosis
Case 1: Patient will present with → bloody puss filled diarrhea, rectal/lower quadrant pain, fever and urgency. Case 2: Patient will present with → abdominal pain, weight loss, diarrhea and oral mucosa aphthous ulcers. Longer standing disease may have severe anemia, polyarthralgia and fatigue.
Inflammatory bowel disease = Case 1: Ulcerative colitis (Inflammation isolated to colon and confined to mucosa and submucosa); Case 2: Crohn’s disease (Distribution from mouth to anus and will commonly present with thickened bowel wall, cobblestoning and “skip” lesions)
Patient will present as → a child with sudden onset of significant, colicky abdominal pain that recurs every 15 to 20 min, often with vomiting. Stool if passed will contain mucus and blood (currant jelly stools). A sausage like mass may be felt on abdominal examination.
Intussusception
Patient will present with → frequent bouts of constipation alternating with diarrhea. She frequently experiences abdominal discomfort, which is relieved with bowel movements
Irritable bowel syndrome
Patient will present with → sudden onset abdominal pain occurring 10 -30 minutes after eating in a patient with a HISTORY OF ATRIAL FIBRILLATION or CHF. It is associated with bleeding per rectum with or without diarrhea. Physical examination findings is usually disproportionate with abdominal pain. It occurs in the elderly and those that are at risk of emboli formation.
Ischemic bowel disease
Patient will present with → abdominal pain, bloating, flatulence, and diarrhea after ingestion of dairy products
Lactose intolerance
Patient will present with → painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
Colon Cancer
Patient will present with → Abdominal distention and high-pitched, hyperactive bowel sounds, vomiting of partially digested food and loss of bowel movements
Small Bowel obstruction
Patient will present with → rectal bleeding, cramps and abdominal pain. Obstruction may occur with a large lesion
Polyps
Patient will present with → history of ulcerative colitis, developed abdominal pain, vomiting, diarrhea, passage of blood and mucus per rectum and fever, markedly distended abdomen with peritonitis and shock. KUB shows markedly dilated colon > 6 cm
Toxic megacolon
Patient will present with → rectal pain and bleeding which occurs with or shortly after defecation, lasts for several hours, and subsides until the next bowel movement.
Anal fissure
Patient will present with → painful; perianal swelling, redness, and tenderness
Abscess/fistula
Patient will present with → bright red blood per rectum, pruritus and rectal discomfort OR Patients will present with → significant pain, but no bleeding
Hemorrhoids
