Overview of GI Flashcards
GI tract Consists of? (4)
Esophagus, Stomach, Small Intestine, Large Intestine
Mucosal Layers of the GI tract
Provide barrier to luminal contents
Site of transfer of luminal contents
Biliary conduits (Pancreatic and Biliary Tract)
Deliver bile and enzymes to promote breakdown of luminal contents
Making a Ddx in the GI tract
Take away that when creating a Ddx you need to consider all of these**
Esophagus, Stomach, Small Intestine, Large Intestine
Mucosal Layers
Biliary conduits (Pancreatic and Biliary Tract)
Lymphatic System
Vascular Supply
Nerve Innervation
Function of the mouth
Processing of Food (food mixed with salivary amylase)
Function of the esophagus
Propulsion of food bolus to stomach - partially controlled by lower esophageal sphincter (LES); (Transit time: seconds)
Function of the stomach
Further processing of food (via mixing with pepsin and acid); Secretion of intrinsic factor for B12 absorption (Transit time: minutes to few hours)
Function of the small intestine
Nutrient absorption (via specialized enzymes and transporters); waste elimination to colon (Transit time: few hours) Proximal Small Intestine: Rapid absorption of nutrient breakdown products & minerals Distal Intestine (i.e., ileum): absorption of B12 & bile acids
Function of the colon
Preparation of waste material for evacuation: stool dehydration; fermentation of undigested carbs/fatty acids (Transit time: >24 hours for most individuals)
Proximal Colon: Mix and Absorb material
Distal Colon: Expel stool
Disorders of the Pancreas
Impaired Digestion/Absorption Altered Secretion Hypersectretion Altered Gut Transit-- Obstruction - neoplastic obstruction, acid-induced stricture - ***Most common cause of colonic obstruction = colon cancer) Immune Dysregulation Compromised vascular supply Neoplasm
Disorders of the Esophagus (6)
Esophagitis Gastroesophageal reflux disease (GERD) Motility disorders Mallory-Weiss tear Esophageal Neoplasms Esophageal Strictures
Disorders of the stomach (6)
Gastroesophageal reflux disease (GERD) Gastritis Gastric Neoplasms Peptic ulcer disease Pyloric stenosis Gastroparesis
Disorders of the gallbladder and biliary tract
Cholelithiasis Acute and chronic cholecystitis Choledocholithiasis Biliary Cirrhosis Cholangitis Acute Bacterial Primary Sclerosing
Hepatic Disorders
Jaundice Hyperbilirubinemia Acute and chronic hepatitis Alcoholic Liver Disease Hepatic Cirrhosis Steatohepatitis Ascites Portal Hypertension Hemachromatosis Hepatic Neoplasms
Disorders of the pancreas
Acute pancreatitis
Chronic pancreatitis
Pancreatic neoplasms
Disorders of the small intestines and the colon
Appendicitis Celiac disease Constipation Diarrhea Diverticular disease Inflammatory bowel disease Intussusception Irritable bowel syndrome (IBS) Ischemic bowel disease Lactose intolerance Intestinal Neoplasms Obstruction Intestinal Polyps Toxic megacolon Conditions related to Post-Bariatric Surgery Malabsorption Syndromes Angiodysplasia
Disorders of the rectum
Anal fissure Abscess/fistula Fecal impaction Hemorrhoids Rectal neoplasms
Others
Hernias
Vitamin and nutritional deficiencies
Epidemiology of GI disorders
in U.S 60-70 million patients affected by GI conditions /diseases
(Around 20% of the Population!)
141.8 Billion in 2004
abdominal pain is #23 out of #35 of the top primary Dx
GI disease prevention
Screening for GI Disorders Dietary Lifestyle Activity Lifestyle Tobacco Use Alcohol Use Family History ROS Screening for alcohol use and abuse Screening for hepatitis risk factors Screening for colon cancer
Colorectal Cancer Epidemiology
3rd most common cancer in adults (both males and females) Nearly 10% of all cancer deaths >90% patients > age 50 Neoplastic changes to adenomatous polyps Nearly 15% have positive family history
Current USPSTF Guidelines for Routine Screening of Colorectal Cancer: For patients at average risk!
No one screening option clearly superior
All begin at age 50
Colonoscopy every 10 years
High Sensitivity Fecal Occult Blood Test (FOBT)
Annually with six samples (sensitivity 24% - compared to 5% for single sample)*
Positive tests -> colonoscopy
Flex Sigmoidoscopy q 5 years with FOBT q 3 yrs
Guidelines for patients at high risk (USPSTF Guidelines)
First degree relative <60 years of age, 2+ first degree relatives with colorectal cancer OR adenomatous polyps
Screening Colonoscopy at age 40 OR 10 years before youngest case in immediate family (whichever is earlier)
Colonoscopy Surveillance
F/U colonoscopy within 3-6 years
Single small adenoma (1 cm)
Multiple adenomas
Adenoma with high-grade dysplasia or villous change
F/U colonoscopy within 1 year
History of resection of colorectal cancer
Some GI Symptoms
Nausea & Vomiting Heartburn/Reflux Dysphagia Odynophagia Sensation of food trapping Hematemesis Abdominal pain Abdominal distension Diarrhea/Constipation Pruritis Jaundice Changes in bowel habits Hemorrhoids Hematochezia Melena Changes in stool caliber Changes in belching or flatulence
MC GI symptoms (6)
Abdominal pain Heartburn Nausea & Vomiting Altered Bowel Habits GI Bleeding Jaundice
Ddx for RUQ pain
Nephrolithiasis* Appendicitis* Cholecystitis* Choledocalithiasis Cholangitis Gastritis Hepatic Abscesses Hepatic Tumors
Ddx for RLQ pain
Appendicitis* Bowel Incarceration Cecal Diverticulitis Cholecystitis* Meckel Diverticulitis Nephrolithiasis*
Ddx for LUQ pain
Diverticulitis* Nephrolithiasis* Peptic Ulcer Disease (PUD) Perforated Ulcer Splenic Disease Pyelonephritis*
Ddx LLQ pain
Diverticulitis* Ectopic Pregnancy Incarceration Inflammatory Bowel Disease (IBD)* Nephrolithiasis* Pelvic Inflammatory Disease (PID) Perforated colon Pyelonephritis*
Ddx for midepigastric pain
PUD Perforated Ulcer Pancreatitis Abdominal Aortic Aneurysm Esophageal Varices Hiatal Hernia Esophageal Rupture (Boerhaave Syndrome) Mallory-Weiss Tear
Work up of GI Disorders
Labs
Luminal content evaluation (e.g., stool biopsies, ova & parasite (O&P) testing)
Endoscopic Procedures with and without Histopathology
Imaging tests
