L6: Clinical Approach to GI Disease (Gallagher)

Question 1

14 signs of GI diseases (in desc. order of freq. and importance)**

Answer 1

diarrhea
vomiting
change in appetite
weight loss
tenesmus
abd pain
salivation
dehydration
hematochezia and melena
regurgitation
shock
anemia
dyschezia
flatus and borborygmus

Question 2

vomiting can be a sign of:

Answer 2

Dz of:
GI
Intra-abdominal
systemic
endocrine
metabolic
neurological

Question 3

Hx in the vomiting patient

Answer 3

acute or chronic?
relationship to eating?
appearance
diarrhea (before or after onset)
active vs. passive

Question 4

most acute vomiting result of:

Answer 4

single insult to the stomach, proximal GIT, or pancreas

-tx: fasting w/ symptomatic and supportive care

Question 5

regurgitation

Answer 5

theEFFORTLESS expulsion of esophageal or gastric contents

Question 6

chars. of regurgitation

Answer 6

• effortless expulsion
• few premonitory signs
• ptyalism (excess saliva) in esophageal inflammatory or obstructive dz

Question 7

chars. of vomiting

Answer 7

• abd. contractions
• retching
• premonitory signs present
• ptyalism, pacing, swallowing, tachycardia (nausea)

Question 8

appearance of regurgitation

Answer 8

• semi-formed, may smell fermented
• often contains mucus (swallowed saliva)
• blood rare
• never bile stained
• variable pH and time after eating

Question 9

appearance of vomitus

Answer 9

• no characteristic consistency
• varies from freshly ingested food through various stages of digestion to clear liquid + bile
• may contain food, mucus or grass
• variable pH and time after eating

Question 10

Extra GI diarrhea

Answer 10

assoc. with systemic disease with GI manifestations

Question 11

Hx in the diarrhea patient

Answer 11

duration
tenesmus or dyschezia
urgency
appearance of feces (mucus, fresh blood or melena, volume and consistency)
frequency
past history of diarrhea

Question 12

feces volume: SI vs. LI diarrhea

Answer 12

SI: N to inc.
LI: N to dec.

Question 13

mucus: SI vs. LI diarrhea

Answer 13

SI: rare
LI: common

Question 14

blood: SI vs. LI diarrhea

Answer 14

SI: melena (rare)
LI: hematochzia

Question 15

urgency: SI vs. LI diarrhea

Answer 15

SI: uncommon
LI: common

Question 16

tenesmus (constantly needing to go): SI vs. LI diarrhea

Answer 16

SI: absent
LI: common

Question 17

frequency: SI vs. LI diarrhea

Answer 17

SI: normal to mild inc. (2-3x)
LI: mod. to severe inc. (>5x)

Question 18

dyschezia (painful def.): SI vs. LI diarrhea

Answer 18

SI: absent
LI: occasional

Question 19

weight loss: SI vs. LI diarrhea

Answer 19

SI: common
LI: rare

Question 20

vomiting: SI vs. LI diarrhea

Answer 20

SI: can occur
LI: uncommon

Question 21

flatulence: SI vs. LI diarrhea

Answer 21

SI: can occur
LI: absent

Question 22

halitosis (bad breath) : SI vs. LI diarrhea

Answer 22

SI: can occur
LI: absent

Question 23

sources of abdominal pain

Answer 23

-GIT
-referred from thoracic cavity or spine
-related to other viscera
(often referred to as “acute abdomen”)

Question 24

tenesmus

Answer 24

• severe straining related to distal alimentary or urogenital systems
• if alimentary: distal colon, rectum, or anus involved

Question 25

dyschezia

Answer 25

painful or difficult defecation

Question 26

hematochezia

Answer 26

fresh blood in feces

Question 27

melena

Answer 27

digested dark red/black blood in feces

Question 28

dysentery

Answer 28

bloody diarrhea (e.g. parvovirus)

Question 29

constipation

Answer 29

infrequent defecation, excessively hard or dry feces, increased straining to defecate with passage of too small a volume of feces -often equated w/ tenesmus by clients

Question 30

causes of constipation

Answer 30

- dietary and environmental - painful defecation due to anorectal disease - obstruction to passage of feces - neurological disease (ie. spinal cord disease) - endocrine and metabolic - drug-induced

Question 31

causes of flatus

Answer 31

- swallowed air (ie. brachiocephalics) - gas produced by bacterial degradation of unabsorbed nutrients (ie. soy carb fermentation) - WITH DISEASE: nutrient malabsorption, dietary sensitivity

Question 32

causes of salivation

Answer 32

- chemical poisoning - esophageal foreign body - esophagitis - nausea - stomatitis - direct oral (lingual) stimulation - port-systemic shunt

Question 33

causes of weight loss in GI dz

Answer 33

- dec. nutrient intake - maldigestion/malabsorption - malassimilation - excessive utilization - inc. loss of nutrients

Question 34

causes of shock in GI dz

Answer 34

- severe fluid or blood loss - sepsis, or some combo * supportive therapy important*

Question 35

causes of anemia in GI dz

Answer 35

- GI hemorrhage (tumor, ulcer, bleeding disorder, parasites) | - defective RBC prod. (malabsorption, bone marrow depress, folate or B12 def.)

Question 36

causes of change in appetite

Answer 36

``` INAPPETANCE OR ANOREXIA: -acute disturbance -inflammatory disease -tumor -fungal POLYPHAGIA or PICA: -malabsorption ```

Question 37

diagnostic methods

Answer 37

- clinical labs - rads - therapeutic trials* - specific diagnostic procedures

Question 38

"essential" clinical lab studies

Answer 38

- hemogram (PCV/TP) - blood chemistry profile - routine urinalysis - fecal exam

Question 39

components of fecal exam

Answer 39

appearance microscopic exam (direct smear, flotation, rectal smear) culture? ELISA?

Question 40

"confirmatory" clinical lab studies

Answer 40

- cPLI, fPLI - serum trypsin-like immunoreactivity (TLI) - serum folate and cobalamin - fecal alpha proteinase inhibitor

Question 41

radiographic signs of GI disease

Answer 41

- ileus (obstructive or paralytic) - effusion - FB - mass or visceral displacement - pneumoperitoneum - abnormal contrast study * often normal in chronic disease!*

Question 42

specific diagnostic procedures

Answer 42

Biopsy (endoscopy, exploratory laparotomy, laparoscopy) | -endoscopy esp. good because allows direct observation and is non-invasive