Lower GI - Part III Flashcards
DDX for RUQ pain
Hepatitis Cholecystitis/Cholelithiasis Peptic Ulcer Disease Pancreatitis Myocardial Ischemia Pericarditis Ruptured Aortic Aneurism
DDX for Epigastric pain
GERD Gastritis Peptic Ulcer Disease Pancreatitis Myocardial Ischemia Pericarditis Ruptured aortic aneurism
DDX for LUQ pain
Spleen infarct Splenic rupture Gastritis Gastric Ulcer Pancreatitis Hiatal Hernia (incarcerated)
DDX for Right Flank pain
Kidney Inflm
Pyelonephritis
DDX for Periumbilical pain
Early appendicitis
Gastroenteritis
Bowel obstruction
Peritonitis
DDX for Left Flank pain
Kidney inflm
Pyelonephritis
DDX for RLQ pain
Appendicitis Inflammatory bowel disease Cecal diverticulitis Inguinal hernia Nephrolithiasis Female: Ovarian cyst, Salpingits, Enometriosis, Ectopic pregnancy Male: testicular or epididymal inflm
DDX for Suprapubic pain
Cystitis
Acute urinary retention
Female: Uterine cramps, Cervicitis, Endometriosis, PID
Male: acute prostatitis
DDX for LLQ pain
Diverticulitis Inflammatory bowel disease Irritable bowel syndrome Nephrolithiasis Female: Ovarian cyst, Salpingits, Enometriosis, Ectopic pregnancy Male: testicular or epididymal inflm
Diffuse early abdominal pain DDX
early appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS
Extra abdominal causes of abdominal pain
early appendicitis, gastroenteritis, intestinal obstruction, mesenteric ischemia, peritonitis, IBS, abdominal wall (hematoma), infectious (herpes zoster), metabolic (DKA, porphyria, sick cell disease), thoracic (MI, PE, radiculitis), toxic (spider bite, heavy metal poisoning, opioid withdrawal)
Diarrhea
defined by >200g/day of stool weight (normal is 100-200g/d)
increase in stool fluidity
or >3 BM a day
Pathophysiology of diarrhea
1) osmotic (too much water is drawn into the bowels, increase amount of poorly absorbable solutes)
2) secretory (increase in active secretion (Cl, water) or an inhibition of absorption (Na, water) with little to no structural damage
3) exudative (mucus, blood, protein inflammation)
4) motility (inc. or decreased contact btwn GI contents and mucosal surface)
Red flags of diarrhea
blood, pus, fever, signs of dehydration, chronicity, unintended wt loss, failure to thrive in kids
complications include: dehydration & electrolyte imbalance
definition of constipation
difficult to pass, infrequent, hardness of stool, incomplete feeling
Causes of acute constipation
obstruction, adynamic ileus, medications
Causes of chronic constipation
carcinoma, hypothyroid, CNS disorders, slow transit, irritable bowel syndrome
Red flags of constipation
abdominal distention, vomiting, blood in stool, weight loss, sever or worsening symptoms
definition of gas
colonic bacterial fermentation of nutrients, air swallwoing
Types and causes of gas
1) belching - caused by air swallowing, carbonated beverages, voluntary
2) bloating/distention - caused by air swallowing, IBS, gastroparesis, eating d/o, gynecologic
3) flatus - diet, carbohydrate insufficiency, celiac, pancreatic insufficiency
Red flags of gas
weight loss, blood in stool (can be benign like in hemorrhoids,)
definition of GI bleeding
gross or occult blood
hematochezia (gross blood)- suggests lower GI bleed
causes of small bowel bleeding (occult)
angioma, A-V malformation, tumors, Meckel’s diverticulum
causes of colon, anus bleeding (frank)
anal fissure, colitis, carcinoma, polyps, diverticular disease, IBD, hemorrhoids
definition of dyschezia
difficulty evacuating (feel urge, but cannot defecate
cause of dyschezia
from discoordination of rectal muscles and sphincter: hypotonia, prolapse
stool findings correlating with small intestines
watery in appearance, large in volume, increased frequency, blood possible but never gross pH possibly < 5 hpf
stool findings correlating with colon
mucoid and/or bloody in appearance, small in volume, highly increase in frequency, blood commonly gross, pH >5 WBC commonly >10 hpf
Labs: O& P (ova and parasites)
to find protozoa, worms, worm eggs, other parasites
if one family member is positive, usu tx whole family
Stool culture
perform: immunocompromised patient, severe, inflammatory diarrhea, in those with IBD to distinguish between flare and infection
Fecal occult blood (hemoccult)
to detect upper GI bleed
Fecal leukocytes
when assessed along with occult blood can help confirm bacterial cause of diarrhea
Fecal lactoferrin (latex agglutination assay)
marker for fecal WBCs. Used to distinguish between inflammatory diarrhea (bacterial infxn, IBD) and non-inflammatory causes (viral infxn, IBS)
Fecal lysozyme
N= absence of colonic inflammation and suggests irritation only
used as a marker to measure success of treatment for IBD
Comprehensive digestive stool analysis (CDSA)
markers for digestion, absorption, metabolism, plus microbiology
Salival secretory secretory IgA (sIgA)
low in: celiac, IBD, allergy, chronic infx, chronic stress, more susceptible to GI infection
high in: acute GI infxn
serology
eg Celica testing for antibodies
bowel transit time
variable, but usu start to see test substance at 12-14 hrs
Anoscopy
in-office procedure for visualizing hemorrhoids
