GI Screening

Question 1

What 3 aspects entails the psychoneuroimmunology?

Answer 1

Enteric system, immune system, and the brain.

Question 2

Generally, where can GI disorders refer pain to?

Answer 2

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

Question 3

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

Answer 3

ulceration or infection of the mucosal lining

Question 4

Generally, the most common symptoms of GI disorders include…

Answer 4

nausea, vomiting, pain, diarrhea, and constipation

Question 5

Visceral pain occurs in the midline because….

Answer 5

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

Question 6

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

Answer 6

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

Question 7

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

Answer 7

small intestine, pancreas, and appendix

Question 8

Pain occurs from the lower abdominal region from……

Answer 8

Large intestine, colon, bladder, or uterine pain

Question 9

Visceral pain is felt as a response to what?

Answer 9

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

Question 10

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

Answer 10

steady, deep, boring

Question 11

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

Answer 11

sudden onset and extremely intense

Question 12

Descriptions of visceral pain include….

Answer 12

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

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

Question 13

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

Answer 13

C3-C5

-goes to the shoulder

Question 14

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

Answer 14

T6-T9

mid back and scapular regions

Question 15

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

Answer 15

T10-T11

Question 16

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

Answer 16

T11-L1

Question 17

_____ means excessive sensibility to sensory stimuli

_____ means excessive sensibility to painful stimuli

Answer 17

hyperesthesia

hyperalgesia

Question 18

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

Answer 18

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

Question 19

_____ is pain during swallowing

Answer 19

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

Question 20

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

Answer 20

esophagitis pain

cardiac pain

Question 21

Bloody diarrhea may accompany _______

Answer 21

ulcerative colitis

Question 22

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

Answer 22

rectum or anus

rectal fissures or hemorrhoids

Question 23

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

Answer 23

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

Question 24

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

Answer 24

beets or a lot of red food coloring

lower GI/colon

Question 25

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 _____

Answer 25

heartburn

Question 26

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

Answer 26

30-90 minutes 2-4 hours -Duodenal ulcer or cancer-related pain may report pain during the night between 12-3

Question 27

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 _______

Answer 27

obstruction

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

Fetal Incontinence.

Question 31

Joint arthralgia associated with GI infection is termed ______

Answer 31

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.

Question 32

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

Answer 32

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

Question 33

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

Answer 33

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

Question 34

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

Answer 34

Vitamin B12 Thiamine other symptoms can include irritability, memory loss, dementia

Question 35

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

Answer 35

GERD

Question 36

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 _____

Answer 36

GERD -may use Prilosec, Prevacid, Nexium

Question 37

______ 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

Answer 37

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

Question 38

______ 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

Answer 38

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

Question 39

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

Answer 39

NSAIDs or low-dose aspirin

Question 40

______ 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.

Answer 40

Diverticulosis Diverticulitis

Question 41

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

Answer 41

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.

Question 42

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

Answer 42

Appendicitis

Question 43

McBurney's point is located by palpation by ______

Answer 43

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

Question 44

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

Answer 44

chronic alcoholism or toxicity from glucocorticoids, thiazide diuretics, acetamineophen

Question 45

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

Answer 45

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

Question 46

_______ 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

Answer 46

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

Question 47

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

Answer 47

Inflammatory bowel disease

Question 48

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

Answer 48

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

Question 49

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

Answer 49

Ulcerative Colitis

Question 50

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

Answer 50

Ulcerative Colitis -anemia or clubbing of fingers can also occur.

Question 51

______ 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

Answer 51

Irritable Bowel Syndrome

Question 52

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

Answer 52

Irritable Bowel Syndrome

Question 53

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

Answer 53

Colorectal Cancer

Question 54

Presentation of colorectal carcinoma is related to ______

Answer 54

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

Question 55

Symptoms of Colorectal Cancer may include:

Answer 55

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

Question 56

______ 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

Answer 56

acute colonic pseudo-obstruction -symptoms include abdominal distention, nausea, vomiting, abdominal pain, or absent bowel movements

Question 57

Clues to Screening for GI disease

Answer 57

- 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