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SA Gastroenterology (Spring 2015) > L6: Clinical Approach to GI Disease (Gallagher) > Flashcards

L6: Clinical Approach to GI Disease (Gallagher) Flashcards

1
Q

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

A 
diarrhea
vomiting
change in appetite
weight loss
tenesmus
abd pain
salivation
dehydration
hematochezia and melena
regurgitation
shock
anemia
dyschezia
flatus and borborygmus
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2
Q

vomiting can be a sign of:

A 
Dz of:
GI
Intra-abdominal
systemic
endocrine
metabolic
neurological
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3
Q

Hx in the vomiting patient

A 
acute or chronic?
relationship to eating?
appearance
diarrhea (before or after onset)
active vs. passive
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4
Q

most acute vomiting result of:

A

single insult to the stomach, proximal GIT, or pancreas

-tx: fasting w/ symptomatic and supportive care

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5
Q

regurgitation

A

theEFFORTLESS expulsion of esophageal or gastric contents

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6
Q

chars. of regurgitation

A
  • effortless expulsion
  • few premonitory signs
  • ptyalism (excess saliva) in esophageal inflammatory or obstructive dz
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7
Q

chars. of vomiting

A
  • abd. contractions
  • retching
  • premonitory signs present
  • ptyalism, pacing, swallowing, tachycardia (nausea)
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8
Q

appearance of regurgitation

A
  • semi-formed, may smell fermented
  • often contains mucus (swallowed saliva)
  • blood rare
  • never bile stained
  • variable pH and time after eating
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9
Q

appearance of vomitus

A
  • 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
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10
Q

Extra GI diarrhea

A

assoc. with systemic disease with GI manifestations

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11
Q

Hx in the diarrhea patient

A 
duration
tenesmus or dyschezia
urgency
appearance of feces (mucus, fresh blood or melena, volume and consistency)
frequency
past history of diarrhea
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12
Q

feces volume: SI vs. LI diarrhea

A

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

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13
Q

mucus: SI vs. LI diarrhea

A

SI: rare
LI: common

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14
Q

blood: SI vs. LI diarrhea

A

SI: melena (rare)
LI: hematochzia

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15
Q

urgency: SI vs. LI diarrhea

A

SI: uncommon
LI: common

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16
Q

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

A

SI: absent
LI: common

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17
Q

frequency: SI vs. LI diarrhea

A

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

18
Q

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

A

SI: absent
LI: occasional

19
Q

weight loss: SI vs. LI diarrhea

A

SI: common
LI: rare

20
Q

vomiting: SI vs. LI diarrhea

A

SI: can occur
LI: uncommon

21
Q

flatulence: SI vs. LI diarrhea

A

SI: can occur
LI: absent

22
Q

halitosis (bad breath) : SI vs. LI diarrhea

A

SI: can occur
LI: absent

23
Q

sources of abdominal pain

A

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

24
Q

tenesmus

A
  • severe straining related to distal alimentary or urogenital systems
  • if alimentary: distal colon, rectum, or anus involved
25
Q

dyschezia

A

painful or difficult defecation

26
Q

hematochezia

A

fresh blood in feces

27
Q

melena

A

digested dark red/black blood in feces

28
Q

dysentery

A

bloody diarrhea (e.g. parvovirus)

29
Q

constipation

A

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

30
Q

causes of constipation

A
  • 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
31
Q

causes of flatus

A
  • swallowed air (ie. brachiocephalics)
  • gas produced by bacterial degradation of unabsorbed nutrients (ie. soy carb fermentation)
  • WITH DISEASE: nutrient malabsorption, dietary sensitivity
32
Q

causes of salivation

A
  • chemical poisoning
  • esophageal foreign body
  • esophagitis
  • nausea
  • stomatitis
  • direct oral (lingual) stimulation
  • port-systemic shunt
33
Q

causes of weight loss in GI dz

A
  • dec. nutrient intake
  • maldigestion/malabsorption
  • malassimilation
  • excessive utilization
  • inc. loss of nutrients
34
Q

causes of shock in GI dz

A
  • severe fluid or blood loss
  • sepsis, or some combo
  • supportive therapy important*
35
Q

causes of anemia in GI dz

A
  • GI hemorrhage (tumor, ulcer, bleeding disorder, parasites)

- defective RBC prod. (malabsorption, bone marrow depress, folate or B12 def.)

36
Q

causes of change in appetite

A 
INAPPETANCE OR ANOREXIA:
-acute disturbance
-inflammatory disease
-tumor
-fungal
POLYPHAGIA or PICA:
-malabsorption
37
Q

diagnostic methods

A
  • clinical labs
  • rads
  • therapeutic trials*
  • specific diagnostic procedures
38
Q

“essential” clinical lab studies

A
  • hemogram (PCV/TP)
  • blood chemistry profile
  • routine urinalysis
  • fecal exam
39
Q

components of fecal exam

A

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

40
Q

“confirmatory” clinical lab studies

A
  • cPLI, fPLI
  • serum trypsin-like immunoreactivity (TLI)
  • serum folate and cobalamin
  • fecal alpha proteinase inhibitor
41
Q

radiographic signs of GI disease

A
  • ileus (obstructive or paralytic)
  • effusion
  • FB
  • mass or visceral displacement
  • pneumoperitoneum
  • abnormal contrast study
  • often normal in chronic disease!*
42
Q

specific diagnostic procedures

A

Biopsy (endoscopy, exploratory laparotomy, laparoscopy)

-endoscopy esp. good because allows direct observation and is non-invasive

SA Gastroenterology (Spring 2015) (9 decks)

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