Introduction Flashcards
Diseases Gatroenterologist Treat
GERD GI CA Pancreatic CA Hepatitis Chirrhosis IBS Colitis Crohn's disease Inflammatory Bowel Disease (IBD)
Symptoms of Digestive Problems
Constipation Nausea Vomiting Diarrhea Heartburn Indigestion Rectal bleeding Weight loss Abdominal pain
Common Acute Pain Syndromes
Appendicitis Acute diverticulitis Cholecystitis Pancreatitis Perforation of an ulcer Intestinal obstruction Ruptured AAA Pelvic disorders
Chronic Abdominal Pain Syndromes
IBS Chronic pancreatitis Diverticulosis GERD IBD Duodenal ulcer Gastric ulcer
Epigastric Pain
PUD GERD MI AAA Pancreatic pain Gallbladder & common bile duct obstruction
Right Upper Quadrant Pain
Acute Cholecystitis Biliary Colic Acute Hepatitis Hepatic Abscess Hepatomegaly due to CHF Perforated duodenal ulcer Herpes zoster Myocardial ischemia Right lower lobe pneumonia
Left Upper Quadrant Pain
Acute pancreatitis Gastric Ulcer Gastritis Splenic enlargement, rupture or infarction Myocardial ischemia Left lower lobe pneumonia
Right Lower Quadrant Pain
Appendicitis Regional Enteritis Small bowel obstruction Leaking Aneurysm Ruptured ectopic pregnancy PID Twisted ovarian cyst Ureteral calculi Hernia Testicular torsion
Left Lower Quadrant Pain
Diverticulitis Leaking aneurysm Ruptured ectopic pregnancy PID Twisted ovarian cyst Ureteral calculi Hernia Testicular torsion
Peri-umbilical Pain
Disease of transverse colon Gastroenteritis Small bowel pain Appendicitis Early bowel obstruction
Diffuse Pain
Generalized peritonitis Acute pancreatitis Sickle cell crisis Mesenteric thrombosis Gastroenteritis Crohns/Ulcerative colitis Dissecting or rupturing aneurysm Intestinal Obstruction Psychogenic illness
Visceral Abdominal Pain
Originates in abdominal organs covered by peritoneum
Colic Abdominal Pain
Crampy pain
Parietal Abdominal Pain
From irritation of parietal peritoneum
Referred Abdominal Pain
Produced by pathology in one location felt at another location
Laboratory & Diagnostic Tests of Abdominal Pain
UA CBC Amylase, lipase, LFT's, H. pylori Plain X-rays Contrast studies- barium Ultrasound CT scanning Endoscopy Sigmoidoscopy or colonoscopy
Characteristics of Pain
Way it begins (sudden onset, insidious) Location of pain Pattern of pain Duration of pain Worsens the pain Relieves the pain Signs/Symptoms
Where is Appendicitis Pain Found?
Peri-umbilical
RLQ
Where is Diverticulitis Pain Found?
LLQ
Gallbladder Pain is felt where?
RUQ
What kind of pain does obstruction of the intestine cause?
Waves of crampy abdominal pain
What kind of pain does obstruction of the bile ducts cause?
Upper abdominal pain that lasts minutes to hours
What kind of pain does acute pancreatitis cause?
Severe, unrelenting, steady pain in the upper abdomen & upper back
What kind of pain does acute appendicitis cause?
Start near the umbilicus and moves to the RLQ
Character of pain may change over time
How long does the pain of IBS last?
Waxes and wanes over months or years and may last decades
How long does biliary colic last?
No more than several hours
How long does the pain of pancreatitis last?
One or more days
Pain of acid-related disease
Show periodicity
Period of weeks or months which pain is worse
Inflammation Pain Aggravated By:
Sneezing
Coughing
Jarring motion
What does the presence of a fever suggest?
Infection
What does diarrhea or rectal bleeding suggest?
Intestinal cause of the pain
What does the presence of fever and diarrhea suggest?
Inflammation of the intestines that may be infectious or non-infectious
What does an elevated white count suggest in abdominal pain?
Inflammation or infection: appendicitis, pancreatitis, diverticulitis, or colitis
What does elevated in amylase and lipase suggest in abdominal pain?
Pancreatitis
What may be elevated in a gallstone attack?
Liver enzymes
What does blood in the urine suggest?
Kidney stones
What are abdominal ultrasounds useful fin diagnosing?
Gallstones
Cholecystitis
Appendicitis
Ruptured ovarian cysts
What can a CT of the abdomen detect?
Pancreatitis Pancreatic CA Appendicitis Diverticulitis Abscesses of the abdomen Crohn's disease
What can capsule enteroscopy be used to diagnose?
Crohn’s disease
Small bowel tumors
Bleeding lesions
What can barium X-rays diagnose?
Ulcers
Reflux
Inflammation
Blockage in the intestines
What is an EGD useful for detecting?
Ulcers
Gastritis
Stomach CA
What is a colonoscopy or flexible sigmoidoscopy useful for diagnosing?
Infectious colitis
Ulcerative colitis
Colon CA
How is the cause of abdominal pain diagnosed?
Characteristics of pain
Findings on PE
Laboratory, radiological, & endoscopic testing
Surgery
Define Nausea
Sensations of unease and discomfort in the upper stomach with an urge to vomit
Define Qualm
Attack of nausea
Define Vomiting
Forcible voluntary or involuntary emptying of stomach contents through the mouth
Shortly after a meal, N/V may be caused by what?
Food poisoning
Gastritis
Ulcer
Bulimia
N/V 1-8 hours after a meal may indicate what?
Food poisoning
Salmonella
Stimuli of Vomiting
Severe pain
Distention of stomach or duodenum
Torsion/trauma to ovary, testes, uterus, bladder, or kidney
Activation of chemoreceptor trigger zone in the medulla
Define Retching
Involuntary movement of abdominal muscles
Define Projectile Vomiting
Spontaneous vomiting not proceeded by nausea
N/V Etiologies
Pain Viral gastroenteritis GI inflammation, infection Severe pain such as nephrolithiasis Chemo Neurologic Cardiovascular Medications Post-operative
Physical Manifestations of N/V
Dehydration Metabolic alkalosis Hypokalemia Hyponatremia Hypochloremia Symptoms with underlying etiology
Treatment for N/V
Antiemetic medications
What does a dilated esophagus with a distal “bird beak” appearance?
Achalasia
What is the multi month history of chronic nausea, early satiety, and postprandial bloating?
Diabetic gastroparesis
What is the clinical sign that can assist in the diagnosis of cholecystitis?
Murphy sign- pain on inspiration with palpation of the RUQ
Where is the most common site of pancreatic cancer?
Head of pancreas- painless jaundice
What is the tumor marker that can assist in diagnosing pancreatic cancer?
CA 19-9
What is the best study to screen for fat malabsorption?
Microscopic stool examination using Sudan stain
What gastrointestinal disease is most commonly associated with dermatitis herptiformis?
Celiac disease
What is the gold standard for identifying colorectal cancer?
Colonoscopy
What diagnosis is most likely with symptoms of worsening LLQ abdominal pain associated with constipation and chills?
Diverticulitis
What is the first-line treatment of C. difficile colitis?
Metronidazole (Flagyl)
What is the most likely diagnosis when plain film abdominal x-rays reveal thumb printing?
Ischemic colitis
What are the symptoms of ischemic colitis?
Crampy LLQ abdominal pain Urge to defecate Expulsion of bloody diarrhea Nausea Fever Tachycardia
What two dermatologic signs may assist in the diagnosis of acute pancreatitis?
Cullens sign (peri-umbilical bruising) Grey Turner sign (flank bruising)
What is the most common digestive complaint in the US?
Constipation
