RED FLAGS: Referred GI pain patterns —> where? 1. Esophagus 2. Midthoracic spine (nerve roots) 3. Visceral pain from liver, diaphragm, pericardium 4. Visceral pain from colon, appendix, pelvic viscera

1. Midback 2. Esophageal 3. Shoulder 4. Pelvis, low back, sacrum

OTH: GI System Flashcards by Katherine Nadelberg

Upper GI contains

Mouth, esophagus, stomach

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Middle GI contains

Small intestine (duodenum, jejunum, ileum)

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Lower GI contains

Large intestine (cecum, colon, rectum)

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What are the accessory organs of the GI system?

Salivary glands, liver, pancreas

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Neural control is achieved by ___. The ___ and ___ plexuses extend length of GI wall. ____ (mediated by __ N.) reflexes control secretions and motility of GI tract.

ANS
sympathetic and parasympathetic
Vasovagal (Vagus)

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Major GI hormones include

Cholecystokinin, gastrin, secretin

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N+V: nausea signals stimulation of ___ vomiting center. Can be triggered by food, drugs, ___oxia, shock, inflammation of __ __, distention, irritation of __ __, __ sickness. Prolonged vomiting leads to __ and ___ imbalance, resulting in ___ aspiration and mucosal/GI damage.

Medullary
Hypoxia, abdominal organs, GI tract, motion sickness
Fluid and electrolyte, pulmonary

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Diarrhea: Dehydration, ___ imbalance, dizziness, thirst, weight __. Triggers: ___ organisms ( ____, rotavirus, ____), dysentery, ___ enteropathy, ___ ___ syndrome, ____thyroidism, neoplasm, diverticulitis

Electrolyte, loss

Infectious (E. Coli, Salmonella), diabetic, irritable bowel, hyper

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Constipation: From diet lacking in ___ and ___, inadequate ___ consumption, __ age, ___ lifestyle, drugs (___and ___ meds). ____thyroidism, diverticula disease, __ __ syndrome, __, __ (2 NM conditions), tumors, __ obstruction, rectal __

Bulk, fiber, fluid
Increasing age, sedentary, CCB and anticholinergics
HYPOthyroidism, IBS, PD, SCI
Bowel, lesions

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What is obstipation? Who gets this?

Intractable constipation- fecal impaction, likely inability fart, retention of hard dry stools in rectum/colon
- post-op pts, long-term opiates, SCI
(Needs to be removed)

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RED FLAGS: constipation can cause ___ pain, tenderness in ___, ___, __ regions

Abdominal, anterior hip, groin, thigh

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Constipation may develop as result of __ __ and __ (i.e. LBP)

Muscle guarding

Splinting

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Dysphasia can result from CNS lesions (3 listed), strictures, ___ scarring, swelling, __, and __

stroke, PD, Alzheimer’s
Esophageal
CA, scleroderma

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What is achalasia?

Lower esophageal sphincter fails to relax (food gets trapped in esophagus)

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Abdominal pain can result from (3 listed)

Visceral pain in epigastric, periumbilical, lower abdomen —> what spinal levels are these associated with?

Inflammation 2. Ischemia 3. Mechanical stretching
Epigastric: T3-T5 symp distribution
Periumbilical: T10 sympathetic
Lower abdomen: T10-L2 sympathetic

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RED FLAGS: Referred GI pain patterns —> where?

Esophagus
Midthoracic spine (nerve roots)
Visceral pain from liver, diaphragm, pericardium
Visceral pain from colon, appendix, pelvic viscera

Midback
Esophageal
Shoulder
Pelvis, low back, sacrum

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What is heartburn? What increases it?

Painful burning sensation, reflux

From increased abdominal pressure: pregnancy, tight clothing, bending over, lying down after large meal

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4 causes of GI bleeds

Erosive gastritis
Peptic ulcer
Prolonged use of NSAIDs
Chronic alcohol

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How do you determine occult blood?

Stool sample lab test

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Inflammation of liver from viral or bacterial infection, chemical agents (alcohol, drugs, toxins)

Hepatitis

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autoimmune hepatitis, ___ cirrhosis, metabolic disorders (___ disease) are all causes of hepatitis

Biliary, WILSONNNNNN’s

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Hepatitis A: __ __ hepatitis
Transmission: ?
Acute or chronic?
Prevention?

Acute infectious
Oral-fecal routine (contaminated food/water, person-to-person)
ACUTE (mild—> severe)
Prevention: hand hygiene, sanitation, immunization

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Hepatitis B: ___ hepatitis
Transmission?
How long does it last?
Prevention?

Serum
Blood, body fluids, body tissues, blood transfusion, oral/sexual contact with contaminated person, contaminated needles
Mild (few weeks)- chronic (yrs)
Prevention: disposable needles, screen blood donors, health care worker pxns, immunization (EDUCATION)

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Hepatitis C?
Transmission? What is most common?
Acute or chronic?

Same transmission as B (body fluids)
Needle sharing most common
Can be acute OR chronic

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Hepatitis D How do you get it? What is prognosis?

Dependent on having Hep B | Poor prognosis- pts often with fulminant liver failure

Sx of hepatitis: initial stage (___)- low grade fever, anorexia, N+V, diarrhea, fatigue, malaise, headache, ___ tenderness, myalgia, arthralgia

Preicteric | Abdominal

What is second stage of hepatitis? (2 names)

Jaundice/icteric

What are symptoms of jaundice?

Fever, jaundice, enlarged liver with tenderness, abatement of earlier symptoms, dark or amber colored urine

What are the elevated lab values of hepatitis?

Hepatic transaminases, bilirubin

Chronic HBV and HCV may lead to what?

Chronic liver infection (necrosis, cirrhosis, failure)

Viral hepatitis is leading cause of ? Common reason for what?

Liver CA | Liver transplant

Cirrhosis is a result of ?

Chronic hepatitis

Cirrhosis sx? | ___, ___ edema, ____ contracture, ___ erythema, angiomas, ___megaly, ____megaly, ____(abdominal)

``` Jaundice Peripheral Dupuytren’s Palmar Hepatomegaly, splenomegaly Ascites ```

Tx?

Lasix, paracentesis to drain fluid

Late complication of cirrhosis may be __ __

Hepatic encephalopathy

What are 3 other changes (neuro) with cirrhosis?

Personality changes, intellectual impairment, slurred speech

What is asterixis?

Liver flap- myoclonus of hand with wrist in extension, seen with late cirrhosis, characteristic of hepatic encephalopathy, drug OD, WILSON’s disease

What is lactulose (cirrhosis)

Increase in BM and excrete ammonia in stool

What is cholelithiasis?

Gallstones present in gallbladder

What does cholelithiasis lead to?

If block common bile duct, biliary colic can occur

cholelithiasis/gallstones pain radiates to where?

RUQ pain with radiation to R SCAP

What is cholecystitis?

Partial or complete obstruction of common bile duct resulting in inflammation of gallbladder

Where is pain/where is it referred with cholecystitis? Other symptoms?

Pain in RUQ, radiates to R scap | N+V, low grade fever

What is Murphy’s sign? What does it indicate?

Palpate near R subcostal margin as pt takes deep breath | Pain indicates cholecystitis

3 causes of acute pancreatitis

1. Gallstones 2. Alcoholism 3. Substance abuse

Acute pancreatitis pain- where? Radiates where?

Acute band-like pain radiating to back, worse in supine

Symptoms of acute pancreatitis? | PXN for pt?

Hypotension, tachycardia, N+V | NPO**

Chronic pancreatitis is pain where?

Epigastric and LUQ

Sx of chronic pancreatitis? (6)

1. Anorexia 2. N+V 3. Constipation 4. Flatulence 5. Wt loss 6. Steatorrhea

What is GERD?

Reflux of gastric contents from stomach —> esophagus, causes heart burn

Why does GERD occur?

Failure of lower esophageal sphincter to regulate food flow from esophagus into stomach from increased gastric pressure

Over time, gastric acids (ph ?) damages esophagus. Heartburn is common ___ after eating and lying down at night.

<4 | 20-30 min

RED FLAGS: Atypical GERD pain may present as ____ pain. May sometimes be mistaken for ___ with ___ pain. Respiratory symptoms may include (3).

Head/neck heart attack, chest 1. Cough 2. Hoarseness 3. Irritation

Complications of GERD? (2)

Strictures | Barrett’s esophagus (precancerous)

PT interventions for GERD? (2)

1. Positional changes from full supine to more upright | 2. Contraindication: Valsalva (when is it ever not...)

Hiatal hernia: protrusion of ___ upward through ___, or displacement of stomach ___ junction upward into ___.

Stomach, diaphragm | Gastroesophogeal, thorax

Sx of hiatal hernia?

Heartburn from GERD

Gastritis of the stomach: from 5 causes

1. Severe burns 2. NSAIDs 3. corticosteroids 4. Allergy 5. Infection

Symptoms of gastritis? 3

Anorexia, N+V, pain

Chronic gastritis: from ____ (bacteria), __ CA, ___ anemia, autoimmune disease (__ and __)

H. Pylori Stomach Pernicious thyroid, addson’s

Pts taking NSAIDs long-term should be monitored for what?

Stomach pain, bleeding, N+V

What is peptic ulcer disease?

Ulcerative lesions of upper GI tract

Causes of peptic ulcer disease? (5)

1. H. Pylori 2. Aspirin 3. NSAIDs 4. Excess secretion of gastric acids 5. Stress

Sx of peptic ulcer disease: | ___ pain, __, __, __ (3 sensations), hemorrhage, dizziness, weakness, ____ ___

Epigastric Gnawing, burning, cramping Circulatory shock

Pain from peptic ulcer is located where? Radiates where?

Posterior wall of stomach —> radiates to back and possibly R shoulder

Gastric/small bowel resection, CF, celiac, Chron’s, chronic pancreatitis, and pernicious anemia can all lead to

malabsorption syndrome

Red flags for malabsorption syndrome: 1. ____ anemia 2. Easy ____/___ due to decreased Vitamin _ 3. Muscle __ and __ 4. Bone loss, pain, predisposition for __ 5. __, tetany, ___ 6. spasms due to decreased ___ 7. Peripheral __

1. Iron-deficiency 2. Bruising/bleeding 3. Weakness/fatigue 4. Fx 5. Neuropathy, paresthesias 6. Electrolytes 7. Edema

Inflammatory bowel disease (IBD)- from 2 chronic inflammatory intestine disorders ?

1. Chron’s | 2. Ulcerative colitis

Sx of IBD? What’s common in peds?

Abdominal pain, frequent attacks of diarrhea (that sucks), fecal urgency, wt loss - stunted growth in peds

Symptoms of malabsorption syndrome: anorexia, wt loss, abdominal ___, pain and ___, ___, ___ (greasy poop)

Bloating, cramps, indigestion, steatorrhea

Deficiency of ___ enzyme with malabsorption syndrome

Pancreatic lipase

Chronic IBD can lead to __ and __

Anxiety, depression

IBD red flag: jt pain (reactive arthritis), skin rashes —> referral to where?

Low back

Complications of IBD include (2)

Intentional obstruction, corticosteroid toxicity

Nutritional deficiencies are common with IBD due to what?

Intentional absorption disrupted

Granulomatous inflammation anywhere in the GI. What type of lesions with this?

CHRON’S — skip lesions

Ulcerative and exudative inflammation of large intestine and rectum. What kind of lesions with this condition?

ULCERATIVE CHOLITIS: NO skip lesions

Ulcerative cholitis: 3 symptoms

Blood diarrhea, mucus, pus

IBS has abnormal increased motility of __ ? | Aka __, ___, __ colon

Large and small intestines | Spastic, nervous, irritable

Tx for IBS

Stress reduction, meds for anxiety, regular physical activity

Pouch like herniation of mucosal layer of colon

Diverticular disease

Where is diverticular disease common

Sigmoid colon

Sx of diverticular disease: 1. Pain 2. Cramping in ___ 3. N+V 4. Slight __ 5. Increased __

2. LLQ 4. Fever 5. WBC

Diverticular disease: pts may complain of ___ pain. What is important part of tx?

Back pain | Regular exercise

Appendicitis: | Inflammation of vermiform appendix: becomes swollen, gangrenous, perforated. Pain characteristics?

Abrupt onset, located epigastric or periumbilical area

What is Rebound Tenderness? Also called what? Used for what condition?

pain in response to depression of abdominal wall at site distant from painful area — aka blumberg’s sign +Appendicitis, peritonitis

What is McBurney’s point? What does it indicate if positive?

Point tenderness at McBurney’s point: site of appendix, 1.5-2 inches above ASIS RLQ. + appendicitis

what is Rovsing’s sign? + is what?

pain RLQ with pressure on LLQ | + appendicitis

What is psoas sign? + for what?

pain RLQ with hip extension from inflammation of peritoneum overlying psoas + appendicitis

What is obturator sign? + for what?

RLQ pain with R hip IR and flexion to 90 with 90 knee flexion +indicative of inflammation of sheath of obturator N + appendicitis

What is merkle’s sign? + for what?

Pain in RLQ when pt drops from standing on toes to heels with jarring landing + appendicitis

WBC level indicative of appendicitis perforation? Tx?

Elevations in WBC >20,000 indicates surgery needed

Inflammation of peritoneum from bacterial infection

Peritonitis

Sx of peritonitis: 1. Abdominal __ 2. Severe __ pain 3. ___ from reflex guarding 4. ___ ___ (test +) 5. Decreased or absent __ __ 6. ___cardia

1. Distention 2. Abdominal 3. Rigidity 4. Rebound tenderness 5. Bowel sounds 6. Tachycardia

4 things found with peritonitis

1. Fever 2. Elevated WBC 3. Electrolyte imbalance 4. Hypotension

Peritonitis can lead to (4)

1. Toxemia 2. Shock 3. Circulatory failure 4. Resp distress

Tear/ulceration of lining of anal canal

Rectal fissure

Hemorrhoids: vericosities in ___/__ caused by vein congestion, internal or external. Symptoms?

Lower rectum/anus | Itching, pain