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Differential Dx > GI Screening > Flashcards

GI Screening Flashcards

1
Q

the ____ nervous system independently innervates the GI tract

A

enteric

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2
Q

The four functions of the GI system are___ (hint: when there is dysfn you have a M.A.D.Stomach)

A

Motility
Absorption
Digestion
Secretion

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3
Q

what percentage of immune cells are located in the gut?

A

70-80%

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4
Q

what are the 5 general components to a clinical abdominal screening

A

visual inspection
auscultation
finger percussion
palpation
rebound tenderness

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5
Q

primary gastric pain patterns are often described using these 3 regional descriptors:

A

epigastric (lower chest)
periumbilical
lower abdomen/hypogastrium

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6
Q

The epigastric region is innervated by T3-T5 and has the most referral organs (7 total). The organs include: the heart, esophagus, stomach, and____

A

duodenum, pancreas, gallbladder and liver

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7
Q

The periumbilical region is innervated by T9-T11 and presents with viscerogenic referral pain secondary to dysfunction in ___

A

the small intestine and appendix

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8
Q

The lower abdominal region is innervated by T10-L2 and presents with viscerogenic referral pain secondary to dysfunction in___

A

the large intestine and/or colon
NOT bladder or uterus

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9
Q

A patient arrives with c/o rapid “pangs” in a poorly localized region of their stomach. They they say it’s a grinding and deep ache and they can’t seem to find a comfy position. Clinically, you may label this as ____pain

A

visceral

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10
Q

A patient describes their pain as deep and constant. They say that if they sit really still it seems to help. Clinically, you may label this as ____pain

A

inflammatory

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11
Q

A patient c/o a steady pain that comes on sharp and intense and only seems to get worse. On top of that, analgesics don’t seem to help. Clinically, you may label this as ____pain. It’’s likely secondary to ____

A

ischemic; vascular disease or bowel obstruction

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12
Q

pain from the ___ can refer to the mid back and vice versa

A

esophagus

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13
Q

Referred pain can result in ____ or _____ in its distribution

A

hyperalgesia, hyperesthesia

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14
Q

For GI specifically, what red flags that might cue us for an immediate medical referral?

A

alt back and abdominal pain (esp @ same level)
-dysphagia/ odynophagia
-GI bleeding
-radiating epigastric p! (may sound ~ GERD)
-back p! assoc w/ meals or BM

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15
Q

C3-C5 (somatically, the shoulder) may reflect dysfunction in _____

A

liver, resp diaphragm, and pericardium

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16
Q

T6-T9 (somatically, the mid back and scapular area) may reflect dysfunction in ___

A

gallbladder, stomach, pancreas and small intestine

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17
Q

T10 and T11 (low back?) may reflect dysfunction in ___

A

colon, appendix and pelvic viscera

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18
Q

T11- L1/ S2-S4 (somatically, the pelvis, flank, low back or sacrum)

A

sigmoid colon, rectum, ureter and testes

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19
Q

dysfunction of the stomach, gallbladder, liver, pylorus (upper GI tract) or resp diaphragm may cause guarding of muscles ___the umbilicus.

A

superior to

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20
Q

dysfunction of the ileum, jejunum, appendix, cecum, colon and rectum (lower GI tract) cause guarding in muscles ____the umbilicus

A

inferior to

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21
Q

If pain after eating can be alleviated by positioning, it could be one of 2 dx. If UPRIGHT position helps, it’s likely____

A

esophagitis

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22
Q

If pain after eating can be alleviated by positioning, it could be one of 2 dx. If SUPINE position helps, it’s likely____ and you should treat w/ _____

A

coronary ischemia; nitroglycerin

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23
Q

mid-thoracic p! + RUQ radiation can be a sign of___

A

occult GI bleed

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24
Q

(Pain by timing) If pain begins 30-90 min after eating, its likely due to ____

A

gastric ulceration

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25
Q

(Pain by timing) If pain begins 2-4 hours after eating, its likely due to ____and may be relieved by ___

A

duodenal or pyloric ulceration; eating

26
Q

The arthralgic patterns related to GI dysfunction are described as ____

A

asymmetric, migratory and oligoarticular (affecting a few)

27
Q

reactive arthritis can result from not only GI pathology but also _____ or _____

A

genitourinary or respiratory systems.

28
Q

RIGHT shoulder pain can indicate

A

perforated duodenal or gastric ulcers, pancreatic cancer (head), or liver trauma

29
Q

LEFT shoulder pain via Kehr’s sign (palpation pressure of upper abdomen) can indicate

A

retroperitoneal bleed or spleen rupture

30
Q

LEFT shoulder pain via Danforth’s sign (inspiration) can indicate

A

free air (post-surgery)
blood in abdomen
pathology of thoracic GI tract
pancreatic cancer (tail)

31
Q

what special tests might lead us to suspect an obturator or psoas abscess? (4)

A

iliopsoas muscle test
obturator muscle test
hop test
heel tap

32
Q

what physical exam findings might lead us to suspect an obturator or psoas abscess?

A

antalgic gait, painful ext ROM, painful flexion AROM, TTP and a tender mass

33
Q

what s/s might a patient report that would alert us of a potential obturator or psoas abscess?

A

“hectic” fever, palpable mass, lower trunk, hip and/or knee pain+ upset GI

34
Q

GERD is related to stomach acid backflow into the esophagus. what are the 3 typical s/s reports by patients experiencing this?

A

heartburn, regurgitation w/ bitter taste, belching

35
Q

a(n) ____is an acute lesion of the stomach lining that doesn’t extend through the mucosa. It can develop into a chronic ulcer and line the muscle with scar tissue.

A

erosion

36
Q

A red flag for peptic ulcers is ____ in someone with a hx of peptic ulcers OR long term NSAID use.

A

shoulder/back pain

37
Q

what s/s might a patient report that would alert us of a potential peptic ulcer?

A

heartburn, night p!, Rshoulder p!, visceral p!, N/V (that come in waves), bloody stool

38
Q

What is the difference between how gastric and duodenal ulcers respond to food?

A

duodenal : relief (also by milk, antacid, vomit) ; gastric: aggravated

39
Q

what is the difference between diverticulosis and diverticulitis?

A

diverticulosis: benign (and usually asymptomatic) ballooning of colon mucosa through walls vs

diverticulitis: infection/inflammation after diverticula is perforated

40
Q

what s/s might a patient report that would alert us of diverticulitis?

A

LLQ/RLQ pain, palpable mass, bloody stool, constipation

41
Q

what special tests/clinical examination fx might lead us to suspect diverticulitis?

A

decreased or absent bowel sounds, pinch an inch test, palpable mass

42
Q

what special tests/clinical examination fx might lead us to suspect appendicitis?

A

TTP @ McBurney’s Point
Rovsing Sign
pinch an inch test
hop test
rebound tenderness

43
Q

what s/s might a patient report that would alert us of appendicitis?

A

coated tongue + bad breath
dysuria, groin or testicular pain
upper trunk or R-sided p!
(p! in waves)

44
Q

acute pancreatitis can be the result of

A

GALLSTONES (majority of cases)
chronic alcoholism or other toxins
high triglyceride levels

45
Q

chronic pancreatitis is most commonly caused by ___

A

alcohol + smoking> irreversible scars

46
Q

what s/s might a patient report that would alert us of acute pancreatitis?

A

epigastric pain that radiates to the back, abdominal distension/p!, jaundice, bluish abdomen and flank, pain w/ walking and supine

47
Q

what s/s would indicate that acute pancreatitis has transitioned to chronic?

A

upper left lumbar pain, oily/fatty stool, clay-colored/pale stool

48
Q

what specific s/s might a patient report that would alert us of pancreatic cancer?

A

jaundice, light colored stools, sudden burning epigastric pain that radiates to the back L/R referral pain + cancer s/s

49
Q

What aggravating factors differentiate pancreatitis from pancreatic carcinoma?

A

walking/supine position esp post-meal, alcohol and large meals

50
Q

These are alleviating factors a patient may report for BOTH pancreatitis and pancreatic cancer.

A

sitting and leaning forward

51
Q

Inflammatory bowel Disease is an umbrella term for these 2 inflammatory intestinal conditions. Origin unknown, it involves these 3 types of influences.

A

ulcerative colitis and Chron’s disease; genetic, immunologic and environmental

52
Q

what is a red flag that is specific to IBD?

A

joint involvement w/ skin or eye lesions

53
Q

what differentiates Chron’s disease from ulcerative colitis?

A

the location of inflammation .
Chron’s- anywhere along intestinal tract (esp illeum/colon)
UC: colon+ rectum

54
Q

____ is more likely to develop colorectal cancer while ___ has risk fx of being in 20s, family Hx and smoking

A

UC; Chron’s

55
Q

what specific s/s might a patient report that would alert us of UC/CD?

A

typical GI s/s, rectal bleeds, skin lesions, migratory arthralgias and arthritis, uveitis, hip pain (IP abscess)

56
Q

what specific s/s might a patient report that would alert us of IBS?

A

typical GI s/s, foul breath, flatulence,etc.

57
Q

colorectal cancer screening should begin at the age of ___ and can be performed via these 2 methods:

A

45; stool based test or colonoscopy

58
Q

what are s/s that may alert us to early stage colorectal cancer ?

A

rectal bleeding/hemorrhoids, regional pain, back pain w/ radiation down legs, bowel changes

59
Q

what are s/s that may alert us to late stage colorectal cancer ?

A

N/V, consipaiton > obstipation, mucousy diarhea, abdominal distension, potentially fever

60
Q

Irritable Bowel Syndrome (IBS) is a functional dx of motility in the ____according to specfic _____

A

intestines; bowel symptom clusters

61
Q

Young ___ (males/females) are at highest risk of IBS. Risk factors include family Hx, emotional stress, abuse, and____ (2)

A

females, food intolerance and severe GI infection

Differential Dx (6 decks)

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