GI System Flashcards
what can GI tract issues mimic
MSK pain
pain can be referred to
sternum
shoulder/neck
scapula
mid-back
lower back
hip
pelvis
sacrum
signs and sxs
absolute signs
pain
most clinically significant sxs
absolute signs
nausea
vomiting
diarrhea
constipation
most clinically significant signs (1)
abdominal pain
dysphagia
odynophagia
GI bleeding
epigastic pain
sx affected by food
early satiety w/ weight loss
most clinically significant signs (2)
constipation/diarrhea
fecal incontinence
arthralgia
referred shoulder pain
psoas abscess
tenderness @ mcburnys point
neuropathy
epigastric pain
w/ radiation to back
tenderness @ mcburneys point
1/3 of the way b/w ASIS and umbilicus
appendix
sxs that dont warrant referral
abdominal pain
arthralgia
referred shoulder pain
psoas abscess
how is visceral pain usually described
deep aching
boring
gnawing
vague burning
deep grinding
when referred to somatic regions of low back, hip, shoulder…
sensation will be vague and poorly localized
liver, respiratory, diaphragm and pericardium
refer pain to the shoulder
gallbladder, stomach, pancreas and small intestine
refer pain to mid-back and scapular region
colon, appendix, pelvic viscera, sigmoid, rectum, ureters and testes
refer pain to pelvis, sacrum, flank and upper thigh
arthralgia
there is a relationship b/w “gut” inflammation and joint inflammation
what do many inflammatory GI conditions have
arthritic component affecting the joints
what is hypothesized about arthralgia
that an antigen crosses the guy mucosa
and enters the joint
which sets up and immune response
joint arthralgia associated w/ GI infection
usually asymmetric, migrating and oligoarticular
oligoarticular
affecting only 1-2 joints
what is arthralgia called when triggered by a microbial infection
reactive arthritis
accompanying sxs of arthralgia
fever
malaise
skin rash or lesions
nail bed changes
iritis and conjunctivitis
left shoulder pain
free floating air following laparoscopic surgery or blood in the abdominal cavity
right shoulder
perforated and duodenal ulcers
leaking gastric juices from posterior wall of stomach irritate the diaphragm and refers pain to the r shoulder
pancreatic cancer
head
tail
head of pancreas
r shoulder pain and mid back
tail of pancreas
L shoulder pain
obturator and psoas abscess
no protective barrier form abdominal structures
so any infectious or inflammatory processes affecting the abdominal cavity can cause an abscess and cause lower abdominal pain
clinical manifestations of obturator and psoas abscess
fever, night sweats
pain
may present w/ antalgic gait w/ leg in IR
pain –> obturator and psoas abscess
lower abdomen, back and pelvis
referred to the hip, medial thigh, groin and knee
may present w/ antalgic gait w/ leg in IR –> obturator and psoas abscess
causing a fxnal hip flexion contracture
what can be used to assess the possibility of systemic origin of painful hip or thigh
4 tests
4 tests
heel tap
hop test
iliopsoas muscle test
palpate iliopsoas
heel tap
left pt’s leg and tap the heel
if heel tap is positive
painful expression and reports of R-lower quadrant pain
hop test
if willing and able
have the pt hop on one leg
if hop test is positive
will clutch side and be unable to complete the movement
iliopsoas muscle test
cant rule out but can R/I w/ 95% certainty
positive iliopsoas MMT test
increased abdominal pain, flank pain or pelvic pain
palpate iliopsoas
tightness may result in radiating pain to the lower back
palpate iliopsoas –> inflammation and abscess
painful sxs in R/L lower quadrants
NSAID can have a
delirious effect on the entire GI tract
what do NSAIDs most commonly affect
gastroduodenal mucosa
what can NSAIDs cause
erosion of the mucosa
ulceration w/ life threatening bleeding and perforation
NSAIDs can..
be asymptomatic until advanced conditions
most common side effects of NSAIDs
upset stomach and pain
indigestion
heart burn
what should we look for w/ NSAID use
elevated BP and ankle/foot edema
d/t potent renal vasoconstrictor
risk factors of NSAIDs
> 65 y/o
hx of peptic ulcer dz or GI dz
smoking and alc
oral corticosteroids and anticoagulants
renal complications w/ HTN or CHF
combined w/ SSRI
combined w/ SSRI
celexa
zoloft
prozac
