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Differential Dx > GI Screening > Flashcards

GI Screening Flashcards

1
Q

What 3 aspects entails the psychoneuroimmunology?

A

Enteric system, immune system, and the brain.

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2
Q

Generally, where can GI disorders refer pain to?

A

sternal region, shoulder, neck, scapular region, mid-back, lower back, hip, pelvis, and sacrum

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3
Q

______ is the most common intraabdominal diseases that refer pain to the musculoskeletal system

A

ulceration or infection of the mucosal lining

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4
Q

Generally, the most common symptoms of GI disorders include…

A

nausea, vomiting, pain, diarrhea, and constipation

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5
Q

Visceral pain occurs in the midline because….

A

the digestive organs arise embryologically in the midline and receive sensory afferents from both sides of the SC.

Pain is generally not well localized and is multisegmental

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6
Q

Pain in the epigastric region occurs from the midsternum to the xiphoid procress from the…..

A

heart, esophagus, stomach, duodenum, gallbladder, liver, and other organs corresponding to T3-T5

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7
Q

Pain in the periumbilical region occurs from impairment of…..

A

small intestine, pancreas, and appendix

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8
Q

Pain occurs from the lower abdominal region from……

A

Large intestine, colon, bladder, or uterine pain

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9
Q

Visceral pain is felt as a response to what?

A

Stretching or tension in the wall of the organ. The rate that tension develops must be rapid enough to produce pain. Gradual distention (malignant tumors) may be painless until ulceration

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10
Q

Inflammatory pain arising from the visceral or parietal peritoneum is described as….

A

steady, deep, boring

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11
Q

Ischemia may produce visceral pain by increasing the concentration of tissue metabolites in the region of sensory nerve and has a presentation of…..

A

sudden onset and extremely intense

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12
Q

Descriptions of visceral pain include….

A

deep aching, boring, gnawing, vague burning, deep grinding

Referred pain from the dermatomes will be more intense and localized than typical visceral pain.

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13
Q

Visceral afferents from the liver, respiratory diaphragm, and pericardium at what level?

A

C3-C5

-goes to the shoulder

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14
Q

Visceral afferents from the gallbladder, stomach, pancreas, and small intestine go through celiac plexus at what level?

A

T6-T9

mid back and scapular regions

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15
Q

Visceral afferents from the colon, appendix, and pelvic viscera at what level?

A

T10-T11

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16
Q

Visceral afferents from sigmoid colon, rectum, ureters, and testes at what level?

A

T11-L1

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17
Q

_____ means excessive sensibility to sensory stimuli

_____ means excessive sensibility to painful stimuli

A

hyperesthesia

hyperalgesia

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18
Q

______ is the sensation of food catching or sticking in the esophagus

A

Dysphagia. It is from the lower esophageal sphincter failing to relax. It may be a symptom of a non-GI disease

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19
Q

_____ is pain during swallowing

A

odynophagia. It can be caused by esophagitis or esophageal spasm.

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20
Q

To differentiate esophagitis from coronary ischemia: upright positioning relieves ______ pain, whereas ______ pain is relieved by nitroglycerin or supine positioning

A

esophagitis pain

cardiac pain

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21
Q

Bloody diarrhea may accompany _______

A

ulcerative colitis

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22
Q

Bright red blood usually represents pathology close to the ________ and may be an indication of ______

A

rectum or anus

rectal fissures or hemorrhoids

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23
Q

Melena or black, tarry stool occurs as a result of _____

A

large quantities of blood in the stool. This will typically have an unusual, noxious odor

24
Q

Reddish or mahogany stools can occur from eating certain foods such as ______ but can also represent bleeding at ______

A

beets or a lot of red food coloring

lower GI/colon

25
Q

Anyone with epigastric pain accompanied b a burning sensation that begins at the xiphoid process and radiates up toward the neck and throat may be experiencing _____

A

heartburn

26
Q

Pain associated w/ gastric ulcers may begin ______ after eating. Pyloric ulcers may occur _____ after eating

A

30-90 minutes

2-4 hours

-Duodenal ulcer or cancer-related pain may report pain during the night between 12-3

27
Q

If the sensation of being full is out of proportion with the time of the previous meal and initial hunger, it is a symptom of _______

A

obstruction

28
Q

_____ is defined clinically as being a condition of prolonged retention of fecal content from decreased motility or difficulty expelling stool

A

Constipation.

Back pain may be the overriding symptom. Change in bowel habit may be a response to many other factors such as diet, smoking, medication, GI disease, personality, mood, emotional stress

Pressure on sacral nerves from stored fecal content may cause an aching discomfort in the sacrum, buttocks, or thighs

29
Q

_______ is defined as an abnormal increase in stool frequency and liquidity

A

May accompany enteric infection. (C. Diff - up to 20% of hospitalized pts). Athletes using supplements may have GI disorders.

30
Q

_______ is defined as an inability to control evacuation of stool and is associated with a sense of urgency, diarrhea, and abdominal cramping

A

Fetal Incontinence.

31
Q

Joint arthralgia associated with GI infection is termed ______

A

reactive arthritis. It is preceeded 1-3 weeks by diarrhea, urethritis, and regional enteritis. Inflammation of tendons and ligaments is termed enthesitis and is classic reactive arthritis.

32
Q

Perforated duodenal or gastric ulcers can leak gastric juices on the posterior wall of the stomach that irritate the diaphragm referring pain to the ________

A

shoulder - usually the right shoulder

pancreatic cancer can refer pain to the shoulder and is often missed

33
Q

A _____ of the obturator or psoas muscle is a possible cause of lower abdominal pain, usually the consequence of spread of inflammation or infection from an adjacent structure

A

abscess. Staphylococcus aureus is the most common cause. It can also be caused by kidney infection.

Manifestations include fever, night sweats, and pain to the lower abdominal, pelvic, or back pain.

Referred pain is often to the hip, medial thigh, or groin.

Antalgic gait may be secondary to reflex spasm

34
Q

Numbness and weakness of the lower extremities have been reported as a result of _____ deficiency in aging population or from ______ deficiency after gastric bypass

A

Vitamin B12

Thiamine

other symptoms can include irritability, memory loss, dementia

35
Q

______ is an array of problems related to the backward movement of stomach acids and other stomach contents

A

GERD

36
Q

Typical Symptoms: heartburn, regurgitation w/ bitter taste, belching.
Atypical Symptoms: chest pain unrelated to activity, lump in throat, dysphagia, odynophagia, sore throat, laryngitis, weight loss, anemia all suggest _____

A

GERD

-may use Prilosec, Prevacid, Nexium

37
Q

______ is a loss of tissue lining the lower esophagus, stomach, and duodenum. It may involved the muscular coat, destroy musculature replacing it w/ scar tissue

A

Peptic ulcer

H. pylori ulcers are primarily located in the lining of the duodenum

38
Q

______ causes epigastric pain descried as heartburn or as burning, gnawing, cramping, aching over midline near xiphoid. It may come in waves and radiate below costal margins into back or right shoulder

A

Peptic ulcer

-it is predominant in the morning and on empty stomach. It will also have night pain, stomach pain, radiating back pain, lightheadedness, nausea, vomiting, anorexia, weight loss, bloody stools

39
Q

Infection w/ H. pylori bacteria increases the risk of ulcer disease threefold or more in people taking _____

A

NSAIDs or low-dose aspirin

40
Q

______ is a benign condition in which the mucosa or the colon balloons out through the weakened areas in the wall. _______ describes the infection and inflammation that accompany a microperforation.

A

Diverticulosis

Diverticulitis

41
Q

______ is a serious disease needing surgery. Classic S/S are nausea, vomiting, and low-grade fever.

A

Appendicitis

Pain usually begins in the umbilical region localized to RLQ. In retrocecal appendicitis, the pain may be referred to the thigh or right testicle.

42
Q

______ can result in a “boardlike” abdomen due to the spasm of the rectus abdominus muscles.

A

Appendicitis

43
Q

McBurney’s point is located by palpation by ______

A

Isolate the ASIS and the umbilicus then palpate for tenderness between these two surface anatomic points. A positive pinch-an-inch test

44
Q

Pancreas is an inflammation of the pancreas that may result in autodigestion of the pancreas by its own enzymes. This may result from _________

A

chronic alcoholism or toxicity from glucocorticoids, thiazide diuretics, acetamineophen

45
Q

Self limiting pattern of S/S. Pain is penetrating and radiates to the back made worse by walking and lying supine and is relieved by sitting and leaning forward. Symptoms may also include anorexia, nausea, vomiting, constipation, flatulence, weight loss

A

Pancreatitis

Acute - epigastric pain radiating to back, nausea, vomiting, diarrhea, anorexia, fever, sweating, tachycardia, malaise, weakness, bluish discoloration, jaundice

Chronic - epigastric pain radiating to back, upper L lumbar region, nausea, vomiting, constipation, flatulence, weight loss

46
Q

_______ is the 5th most common cause of death from cancer from women and 4th most common for men. Most common symptoms are anorexia and weight loss, epigastric/upper abdominal pain w/ radiation to the back, and jaundice secondary to obstruction

A

Pancreatic Carcinoma

-the pain may become worse after the person eats or lies down

47
Q

Crohn’s disease and ulcerative colitis are disorders of unknown etiology that describe ______

A

Inflammatory bowel disease

48
Q

_______ is an inflammatory disease that most commonly attacks the terminal end and the colon.

A

Crohn’s Disease

-Terminal ileum produces pain in the periumbilical region w/ possible referred pain to corresponding segment of the low back. There may also be relief of pain after passing stool or flatulence. 25% will have arthritis or migratory arthralgias

49
Q

______ is an inflammation and ulceration of the inner lining of the large intestine and rectum

A

Ulcerative Colitis

50
Q

The predominant symptom of ______ is rectal bleeding. Mainly the left colon is involved. There will also be diarrhea, 20 or more stools per day, nausea, vomiting, anorexia, weight loss

A

Ulcerative Colitis

-anemia or clubbing of fingers can also occur.

51
Q

______ has been called the common cold of the stomach. It is a functional disorder because the abnormal muscle contraction can’t be attributed to an abnormality of the bowel

A

Irritable Bowel Syndrome

52
Q

Painful abdominal cramps, constipation, diarrhea, nausea, vomiting, anorexia, flatulence, foul breath all describe _________

A

Irritable Bowel Syndrome

53
Q

______ is the 3rd leading cause of cancer deaths in the United States and leading cause of cancer deaths among non-smokers

A

Colorectal Cancer

54
Q

Presentation of colorectal carcinoma is related to ______

A

location of the neoplasm.

when vague cramping pain or aching pressure sensation occurs, it is usually associated w/ a palpable abdominal mass

55
Q

Symptoms of Colorectal Cancer may include:

A

Early: rectal bleeding, back pain radiating down the legs, changes in bowel patterns, and abdominal, pelvic, back, sacral pain

Advanced: constipation, diarrhea w/ lots of mucus, nausea, vomiting, abdominal distention, weight loss, fatigue, dyspnea, fever

56
Q

______ refers to a massive dilation of the cecum and proximal colon in the absence of actual mechanical causes such as colonic obstruction. May lead to spontaneous perforation of the colon which is life-threatening

A

acute colonic pseudo-obstruction

-symptoms include abdominal distention, nausea, vomiting, abdominal pain, or absent bowel movements

57
Q

Clues to Screening for GI disease

A
  • age over 45
  • NSAID history
  • symptoms increase 2 hours after NSAIDs
  • symptoms affected by food
  • GI and MS symptoms w/in 6 weeks
  • Back and abdominal pain at same level alternating
  • Shoulder, back, pelvic pain of unknown origin, affected by food, reduced by bowel movement
  • LBP w/ constipation
  • Positive iliopsoas or obturator sign
  • positive McBurney’s
  • Joint pain or arthralgia preceded by skin rash

Differential Dx (12 decks)

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