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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
(Pain by timing) If pain begins 2-4 hours after eating, its likely due to ____and may be relieved by ___
duodenal or pyloric ulceration; eating
26
The arthralgic patterns related to GI dysfunction are described as ____
asymmetric, migratory and oligoarticular (affecting a few)
27
reactive arthritis can result from not only GI pathology but also _____ or _____
genitourinary or respiratory systems.
28
RIGHT shoulder pain can indicate
perforated duodenal or gastric ulcers, pancreatic cancer (head), or liver trauma
29
LEFT shoulder pain via Kehr's sign (palpation pressure of upper abdomen) can indicate
retroperitoneal bleed or spleen rupture
30
LEFT shoulder pain via Danforth's sign (inspiration) can indicate
free air (post-surgery) blood in abdomen pathology of thoracic GI tract pancreatic cancer (tail)
31
what special tests might lead us to suspect an obturator or psoas abscess? (4)
iliopsoas muscle test obturator muscle test hop test heel tap
32
what physical exam findings might lead us to suspect an obturator or psoas abscess?
antalgic gait, painful ext ROM, painful flexion AROM, TTP and a tender mass
33
what s/s might a patient report that would alert us of a potential obturator or psoas abscess?
"hectic" fever, palpable mass, lower trunk, hip and/or knee pain+ upset GI
34
GERD is related to stomach acid backflow into the esophagus. what are the 3 typical s/s reports by patients experiencing this?
heartburn, regurgitation w/ bitter taste, belching
35
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.
erosion
36
A red flag for peptic ulcers is ____ in someone with a hx of peptic ulcers OR long term NSAID use.
shoulder/back pain
37
what s/s might a patient report that would alert us of a potential peptic ulcer?
heartburn, night p!, **R**shoulder p!, visceral p!, N/V (that come in waves), bloody stool
38
What is the difference between how gastric and duodenal ulcers respond to food?
duodenal : relief (also by milk, antacid, vomit) ; gastric: aggravated
39
what is the difference between diverticulosis and diverticulitis?
diverticulosis: benign (and usually asymptomatic) ballooning of colon mucosa through walls vs diverticulitis: infection/inflammation after diverticula is perforated
40
what s/s might a patient report that would alert us of diverticulitis?
LLQ/RLQ pain, palpable mass, bloody stool, constipation
41
what special tests/clinical examination fx might lead us to suspect diverticulitis?
decreased or absent bowel sounds, pinch an inch test, palpable mass
42
what special tests/clinical examination fx might lead us to suspect appendicitis?
TTP @ McBurney's Point Rovsing Sign pinch an inch test hop test rebound tenderness
43
what s/s might a patient report that would alert us of appendicitis?
coated tongue + bad breath dysuria, groin or testicular pain upper trunk or R-sided p! (p! in waves)
44
acute pancreatitis can be the result of
GALLSTONES (majority of cases) chronic alcoholism or other toxins high triglyceride levels
45
chronic pancreatitis is most commonly caused by ___
alcohol + smoking> irreversible scars
46
what s/s might a patient report that would alert us of acute pancreatitis?
epigastric pain that radiates to the back, abdominal distension/p!, jaundice, bluish abdomen and flank, pain w/ walking and supine
47
what s/s would indicate that acute pancreatitis has transitioned to chronic?
upper left lumbar pain, oily/fatty stool, clay-colored/pale stool
48
what specific s/s might a patient report that would alert us of pancreatic cancer?
jaundice, light colored stools, sudden burning epigastric pain that radiates to the back L/R referral pain + cancer s/s
49
What aggravating factors differentiate pancreatitis from pancreatic carcinoma?
walking/supine position esp post-meal, alcohol and large meals
50
These are alleviating factors a patient may report for BOTH pancreatitis and pancreatic cancer.
sitting and leaning forward
51
Inflammatory bowel Disease is an umbrella term for these 2 inflammatory intestinal conditions. Origin unknown, it involves these 3 types of influences.
ulcerative colitis and Chron's disease; genetic, immunologic and environmental
52
what is a red flag that is specific to IBD?
joint involvement w/ skin or eye lesions
53
what differentiates Chron's disease from ulcerative colitis?
the location of inflammation . Chron's- anywhere along intestinal tract (esp illeum/colon) UC: colon+ rectum
54
____ is more likely to develop colorectal cancer while ___ has risk fx of being in 20s, family Hx and smoking
UC; Chron's
55
what specific s/s might a patient report that would alert us of UC/CD?
typical GI s/s, rectal bleeds, skin lesions, migratory arthralgias and arthritis, uveitis, hip pain (IP abscess)
56
what specific s/s might a patient report that would alert us of IBS?
typical GI s/s, foul breath, flatulence,etc.
57
colorectal cancer screening should begin at the age of ___ and can be performed via these 2 methods:
45; stool based test or colonoscopy
58
what are s/s that may alert us to early stage colorectal cancer ?
rectal bleeding/hemorrhoids, regional pain, back pain w/ radiation down legs, bowel changes
59
what are s/s that may alert us to late stage colorectal cancer ?
N/V, consipaiton > obstipation, mucousy diarhea, abdominal distension, potentially fever
60
Irritable Bowel Syndrome (IBS) is a functional dx of motility in the ____according to specfic _____
intestines; bowel symptom clusters
61
Young ___ (males/females) are at highest risk of IBS. Risk factors include family Hx, emotional stress, abuse, and____ (2)
females, food intolerance and severe GI infection

Differential Dx (6 decks)

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