GI System

Question 1

what can GI tract issues mimic

Answer 1

MSK pain

Question 2

pain can be referred to

Answer 2

sternum

shoulder/neck

scapula

mid-back

lower back

hip

pelvis

sacrum

Question 3

signs and sxs

Answer 3

absolute signs

pain

most clinically significant sxs

Question 4

absolute signs

Answer 4

nausea

vomiting

diarrhea

constipation

Question 5

most clinically significant signs (1)

Answer 5

abdominal pain

dysphagia

odynophagia

GI bleeding

epigastic pain

sx affected by food

early satiety w/ weight loss

Question 6

most clinically significant signs (2)

Answer 6

constipation/diarrhea

fecal incontinence

arthralgia

referred shoulder pain

psoas abscess

tenderness @ mcburnys point

neuropathy

Question 7

epigastric pain

Answer 7

w/ radiation to back

Question 8

tenderness @ mcburneys point

Answer 8

1/3 of the way b/w ASIS and umbilicus

appendix

Question 9

sxs that dont warrant referral

Answer 9

abdominal pain

arthralgia

referred shoulder pain

psoas abscess

Question 10

how is visceral pain usually described

Answer 10

deep aching

boring

gnawing

vague burning

deep grinding

Question 11

when referred to somatic regions of low back, hip, shoulder…

Answer 11

sensation will be vague and poorly localized

Question 12

liver, respiratory, diaphragm and pericardium

Answer 12

refer pain to the shoulder

Question 13

gallbladder, stomach, pancreas and small intestine

Answer 13

refer pain to mid-back and scapular region

Question 14

colon, appendix, pelvic viscera, sigmoid, rectum, ureters and testes

Answer 14

refer pain to pelvis, sacrum, flank and upper thigh

Question 15

arthralgia

Answer 15

there is a relationship b/w “gut” inflammation and joint inflammation

Question 16

what do many inflammatory GI conditions have

Answer 16

arthritic component affecting the joints

Question 17

what is hypothesized about arthralgia

Answer 17

that an antigen crosses the guy mucosa

and enters the joint

which sets up and immune response

Question 18

joint arthralgia associated w/ GI infection

Answer 18

usually asymmetric, migrating and oligoarticular

Question 19

oligoarticular

Answer 19

affecting only 1-2 joints

Question 20

what is arthralgia called when triggered by a microbial infection

Answer 20

reactive arthritis

Question 21

accompanying sxs of arthralgia

Answer 21

fever

malaise

skin rash or lesions

nail bed changes

iritis and conjunctivitis

Question 22

left shoulder pain

Answer 22

free floating air following laparoscopic surgery or blood in the abdominal cavity

Question 23

right shoulder

Answer 23

perforated and duodenal ulcers

leaking gastric juices from posterior wall of stomach irritate the diaphragm and refers pain to the r shoulder

Question 24

pancreatic cancer

Answer 24

head

tail

Question 25

head of pancreas

Answer 25

r shoulder pain and mid back

Question 26

tail of pancreas

Answer 26

L shoulder pain

Question 27

obturator and psoas abscess

Answer 27

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

Question 28

clinical manifestations of obturator and psoas abscess

Answer 28

fever, night sweats pain may present w/ antalgic gait w/ leg in IR

Question 29

pain --> obturator and psoas abscess

Answer 29

lower abdomen, back and pelvis referred to the hip, medial thigh, groin and knee

Question 30

may present w/ antalgic gait w/ leg in IR --> obturator and psoas abscess

Answer 30

causing a fxnal hip flexion contracture

Question 31

what can be used to assess the possibility of systemic origin of painful hip or thigh

Answer 31

4 tests

Question 32

4 tests

Answer 32

heel tap hop test iliopsoas muscle test palpate iliopsoas

Question 33

heel tap

Answer 33

left pt's leg and tap the heel

Question 34

if heel tap is positive

Answer 34

painful expression and reports of R-lower quadrant pain

Question 35

hop test

Answer 35

if willing and able have the pt hop on one leg

Question 36

if hop test is positive

Answer 36

will clutch side and be unable to complete the movement

Question 37

iliopsoas muscle test

Answer 37

cant rule out but can R/I w/ 95% certainty

Question 38

positive iliopsoas MMT test

Answer 38

increased abdominal pain, flank pain or pelvic pain

Question 39

palpate iliopsoas

Answer 39

tightness may result in radiating pain to the lower back

Question 40

palpate iliopsoas --> inflammation and abscess

Answer 40

painful sxs in R/L lower quadrants

Question 41

NSAID can have a

Answer 41

delirious effect on the entire GI tract

Question 42

what do NSAIDs most commonly affect

Answer 42

gastroduodenal mucosa

Question 43

what can NSAIDs cause

Answer 43

erosion of the mucosa ulceration w/ life threatening bleeding and perforation

Question 44

NSAIDs can..

Answer 44

be asymptomatic until advanced conditions

Question 45

most common side effects of NSAIDs

Answer 45

upset stomach and pain indigestion heart burn

Question 46

what should we look for w/ NSAID use

Answer 46

elevated BP and ankle/foot edema d/t potent renal vasoconstrictor

Question 47

risk factors of NSAIDs

Answer 47

>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

Question 48

combined w/ SSRI

Answer 48

celexa zoloft prozac