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GI > Intro to GI > Flashcards

Intro to GI Flashcards

1
Q

Most common GI complaints?

A
  • pain and nausea
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2
Q

Most common causes of abdominal pain in ED?

A
  • non-specific abd pain
  • appendicitis
  • biliary tract dz
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3
Q

Common acute pain syndromes?

A
  • appendicitis
  • acute diverticulitis
  • cholecystitis
  • pancreatitis
  • perforation of an ulcer
  • intestinal obstruction
  • ruptured AAA
  • pelvic disorders
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4
Q

Chronic abdominal syndromes?

A
  • IBS
  • chronic pancreatitis
  • diverticulosis
  • GERD
  • IBD
  • duodenal ulcer
  • gastric ulcer
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5
Q

What could be the cause of epigastric pain?

A
  • PUD
  • GERD
  • MI
  • AAA
  • pancreatic pain
  • gallbladder and common bile duct obstruction
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6
Q

Causes of RUQ pain?

A
  • acute cholecystitis and biliary colic
  • acute hepatitis or abscess
  • hepatomegaly due to CHF
  • perforated duodenal ulcer
  • herpes zoster
  • myocardial ischemia
  • right lower lobe pneumonia
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7
Q

Causes of LUQ pain?

A
  • acute pancreatitis
  • gastric ulcer
  • gastritis
  • splenic enlargement, rupture or infarction
  • myocardial ischemia
  • left lower lobe pneumonia
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8
Q

Causes of RLQ pain?

A
  • appendicitis
  • regional enteritis
  • small bowel obstruction
  • leaking aneurysm
  • ruptured ectopic pregnancy
  • PID
  • twisted ovarian cyst
  • ureteral calculi
  • hernia
  • testicular torsion
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9
Q

Causes of LLQ pain?

A
  • diverticulitis
  • leaking aneurysm
  • ruptured ectopic pregnancy
  • PID
  • twisted ovarian cyst
  • ureteral calculi
  • hernia
  • regional enteritis
  • testicular torsion
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10
Q

Causes of periumbilical pain?

A
  • disease of transverse colon
  • gastroenteritis
  • small bowel pain
  • appendicitis
  • early bowel obstruction
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11
Q

Causes of diffuse abdominal pain?

A
  • gen. peritonitis
  • acute pancreatitis
  • sickle cell crisis
  • mesenteric thrombosis
  • gastroenteritis
  • crohns/ulcerative colitis
  • dissecting or rupturing aneurysm
  • intestinal obstruction
  • psychogenic illness
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12
Q

Causes of referred pain?

A
  • pneumonia (lower lobes)
  • inferior MI
  • pulmonary infarction
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13
Q

Visceral pain?

A
  • originates in abdominal organs covered by peritoneum
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14
Q

Colicky pain?

A
  • crampy pain
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15
Q

Parietal pain?

A
  • from irritation of parietal peritoneum
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16
Q

Referred pain?

A
  • produced by pathology in one location felt at another location
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17
Q

Work up of abdominal pain?

A
  • lab tests:
    U/A, CBC,
    additional: amylase, lipase, LFTs, H pylori
- dx studies:
plain x-rays
contrast studies (barium)
U/S
CT 
endoscopy
sigmoidoscopy, colonoscopy
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18
Q

Impt hx questions you should ask your pt about abdominal pain?

A
  • the way the pain begins: if pain comes on suddenly it suggests sudden event like ischemia or biliary colic
  • location of the pain: diverticulitis: LLQ, Appendicitis: RLQ
    gallblader: RUQ
  • pattern of the pain: obstruction of pain initially causes waves of crampy abdominal pain, obstruction of bile ducts by gallstones causes steady upper abd. pain that can last for a couple hours. Pancreatitis: severe, unrelenting, steady pain in upper abdomen and back. Acute appendicitis: starts near umbillicus, and moves to RLQ
  • duration of pain: IBS - waxes and wanes over months or years. Biliary colic lasts no more than a couple hours, pancreatitis can last for a couple days, GERD - periodic pain
  • What makes the pain worse: pain due to inflammation - aggravated by sneezing, coughing, or any jarring motion
  • What relieves the pain: IBS and constipation relieved temp by BM. Obstruction of stomach or upper small intestine - may be relieved temp by vomiting
  • eating or antacids helps relieve ulcer pain
  • pain that wakes pt from sleep most likely due to non-fxnl causes
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19
Q

Importance of assoc signs and sxs of abdominal pain?

A
  • fever suggests infection
  • diarrhea or rectal bleeding suggests intestinal cause of pain
  • presence of fever and diarrhea suggest inflammation of intestines that may be infectious or non-infectious (ulcerative colitis or crohns)
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20
Q

Impt lab tests in abdominal pain complaint?

A
  • CBC
  • LFTs
  • pancreatic enzymes: amylase and lipase
  • UA
21
Q

What does elevated white count suggest?

A
  • ## inflammation or infection (such as appendicitis, pancreatitis, diverticulitis, colitis)
22
Q

Amylase and lipase would be elevated in?

A
  • pancreatitis
23
Q

WBCs in stool (diarrhea) suggests?

A
  • intestinal inflammation
24
Q

Blood in the urine?

A
  • suggests kidney stones
25
Q

Liver enzymes may be elevated?

A
  • gallstone attacks
26
Q

Abdominal US is useful in dx?

A
  • gallstones, cholecystitis, appendicitis, or ruptured ovarian cysts
27
Q

CT usefulness?

A
  • dx pancreatitis, pancreatic cancer, appendicitis, diverticulitis
  • abscesses in abdomen
  • CT of small intestine: crohns
28
Q

Barium xrays of stomach and intestines useful in dx?

A
  • ulcers, reflux, inflammation, and blockage in the intestines
29
Q

EGD useful in dx?

A
  • ulcers, gastritis, stomach cancer
30
Q

Colonoscopy and flexible sigmoidoscopy useful in dx?

A
  • infectious colitis
  • ulcerative colitis
  • colon cancer
31
Q

How are causes of abdominal pain dx?

A
  • characteristics of pain
  • findings on physical exam
  • lab, radiological, and endoscopic testing
  • surgery
32
Q

Timing of Nausea and causes?

A
  • appearing shortly after a meal, nausea or vomiting may be caused by food poisoning, gastritis, ulcer or bulimia
  • 1 to 8 hrs after a meal - may indicate food poisoning. Salmonella can take longer to produce sxs
  • Have to rule out pregnancy as well!!
33
Q

Vomiting stimuli?

A
  • severe pain
  • distension of stomach or duodenum
  • torsion or trauma to ovaries, testes, uterus, bladder or kidney
  • activation of chemoreceptor trigger zone in medulla
34
Q

Projectile vomiting could be a sx of?

A
  • direct stimulation of vomiting center by neurologic lesion or neuro inflammation
  • this is spontaneous vomiting not preceded by nausea
  • sx of GI obstruction
35
Q

Etiologies of N and V?

A
  • pain
  • viral gastroenteritis
  • GI inflammation, infection
  • severe pain such as nephrolithiasis
  • chemo
  • neuro
  • CV
  • meds
  • post-op
36
Q

Physical manifestations of N and V?

A
  • dehydration
  • metabolic alkalosis
  • hypokalemi/natremia/chloremia
  • sxs assoc with underlying etiology
37
Q

A pt presents with chronic, progressive dysphagia of solids and liquids. Barium study shows a dilated esophagus with a distal “bird beak” appearance. Likely dx?

A
  • achalasia
38
Q

A 48 female diabetic pt presents with a multimonth hx of chronic nausea, early satiety, and postprandial bloating. Most likely dx?

A
  • diabetic gastroparesis
39
Q

What clinical sign can assist in dx of cholecystitis?

A
  • murphy sign: pain on inspiration with palpation of RUQ
40
Q

Most common site of pancreatic cancer?

A
  • head of pancreas (80%)

- painless jaundice - think pancreatic cancer

41
Q

What is the tumor marker that can assist in dx pancreatic cancer?

A
  • CA 19-9
42
Q

A 43 y/o pt presents wtih 6 wk hx of malodorous diarrhea that leaves an oily sheen to the surface of toilet water. You suspect a malabsorption disorder. What is best study to screen for fat malabsorption?

A
  • microscopic stool exam using Sudan stain
43
Q

What GI disease is most commonly assoc with dermatitis herpetiformis?

A
  • celiac disease
44
Q

Gold std for ID colorectal cancer?

A
  • colonoscopy
45
Q

72 y/o female pt presents with 2 day hx of progressively worsening LLQ abd pain assoc with constipation and chills. Most likely dx?

A
  • diverticulitis
46
Q

1st line tx of C. difficile colitis

A

flagyl

47
Q

82 yo male pt presents with acute onset of crampy LLQ abdominal pain with urge to defectate and expulsion of bloody diarrhea. Assoc sxs include nausea, fever, and tachycardia. Plain film abdominal x-rays reveal thumbprinting changes. Most likely dx?

A
  • ischemic colitis
48
Q

What 2 dermatologic signs may assist in dx of acute pancreatitis?

A
  • cullen sign (periumbilical bruising)

- grey turner sign (flank bruising)

49
Q

Most common digestive complaint in US?

A
  • constipation

GI (21 decks)

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