GI test 2: Approach to pt with lower GI condition-diagnostics Flashcards
Special test for peritonitis?
blumberg sign
Special tests for appendicitis?
McBurney’s point, Rovsing’s sign, rebound tenderness, psoas sign, obturator sign
Ascites tests?
fluid wave & shifting dullness
Cholecystitis test?
Murphy’s sign
Kidney inflammation test?
CVA tenderness
Other exams for lower GI sxs?
DRE, gynecological exam, male genitalia exam
2 things that can cause RUQ pain?
hepatitis, cholecystitis/cholelithiasis, cholangitis, biliary colic, Budd Chiari syndrome, pancreatitis, pneumonia/pleuris
2 things that can cause epigastric pain?
GERD, gastritis, PUD, pancreatitis, myocardial ischemia, pericarditis, ruptured aortic aneurysm
2 things that can cause LUQ pain?
spleen infarct, splenic rupture, gastritis, gastric ulcer, pancreatitis, hiatal hernia
2 things that can cause R flank pain?
kidney inflam, pyelonephritis
2 things that can cause periumbilical pain?
early appendicitis, gastroenteritis, bowel obstruction, peritonitis
2 things that can cause L flank pain?
kidney inflam, pyelonephritis
2 things that can cause RLQ pain?
appendicitis, IBD, cecal diverticulitis, inguinal hernia, nephrolithtiasis, female: ovarian cyst, salpingitis, endometriosis, ectopic pregnancy; male: testicular or epididymal inflam
2 things that can cause suprapubic pain?
cystitis, acute urinary retention, female: uterine cramps, cervicitis, endometriosis, PID; male: acute prostatitis
2 things that can cause LLQ pain?
diverticulitis, IBD, IBS, nephrolithiasis, same female & male conditions as RLQ
Things that can cause diffuse abd pain
early appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS, abd wall hematoma, infections, metabolic d/o’s, thoracic d/o’s, toxic events
Clinical definition of diarrhea
> 200 g/day of stool weight or >3 BM a day
4 types of diarrhea
- osmotic= too much water into bowels
- secretory= increase in active secretion or inhibition of absorption
- exudative= mucous, blood, protein from inflam
- motility= increase or decrease contact b/w GI contents & mucosal surface
Causes of osmotic diarrhea?
maldigestion= pancreatic dz, celiac dz
osmotic laxatives
ions
Causes of secretory diarrhea?
enterotoxins hormones gastric hypersecretion laxatives bile salts fatty acids
Causes of exudative diarrhea?
idiopathic (Crohn's, UC) infectious ischemic vasculitis radiation injury
Causes of motility diarrhea?
increased motility= hyperthyroidism, postgastrectomy
decreased motility= DM, hypothyroid, scleroderma
RED FLAGS WITH DIARRHEA & COMPLICATIONS
RED FLAGS: blood, pus in stool, fever, signs of dehydration, chronicity, unintended wt loss, failure to thrive in kids
COMPLICATIONS: dehydration, electrolyte imbalance
What is constipation?
difficulty passing, infrequent stool, hardness of stool, incomplete feeling afterwards
Two main categories of constipation?
acute (organic)
chronic (functional or organic)
RED FLAGS WITH CONSTIPATION
abd distention, vomiting, blood in stool, wt loss, severe or worsening sxs
What causes gas?
colonic bac fermenting nutrient, swallowed air
What are the 3 types of gas?
belching
bloating/distention
flatus
RED FLAGS WITH GAS
wt loss, blood in stool
What are the two forms a GI bleed can present as?
gross or occult blood
What is hematochezia?
gross blood suggesting lower GI bleed
What are some causes of small bowel bleeding?
angioma, AV malformation, tumors, meckel’s diverticulum
What are some causes of colon, anal bleeding?
anal fissure, colitis, carcinoma & polyps, diverticular dz, IBD, hemorrhoids
What is dyschezia? What is happening to cause it?
difficulty stooling- feel urge but can’t go, often from incoordination of rectal muscles & sphincter
Why do an O&P x 3?
to find protozoa, worms, worm eggs & other parasites
commonly detect parasites like giardia, cryptosporidium & worms like roundworms, hookworms, tapeworms, flukes & flatworms
Why do a stool culture?
immunocompromised pt, severe inflam diarrhea, in those w/IBD to distinguish b/w a flare & infxn
What will a fecal occult blood analysis tell you about?
detect upper GI bleed
What will a fecal leukocyte analysis tell you?
help confirm or deny bac cause of diarrhea
What is the point of a fecal lactoferrin test?
marker for fecal WBCs, help distinguish b/w inflam diarrhea (bac infxn, IBD) & non-inflam (viral, IBS)
What is a fecal lysozyme test used for?
measure success of tx for IBD, N= absence of colonic inflam, suggests irritation only
What is a comprehensive digestive stool analysis include?
markers for digestion, absorption, metabolism plus micro
When is a salival secretory IgA test low? High?
low= celiac, IBD, chronic infxn, chronic stress high= acute GI infxn
