Screening for GI disease Flashcards
list places where the GI system may refer pain to
- Sternal region
- Shoulder and neck
- Scapular region
- Mid-back
- Low back
- Hip
- Pelvis
- Sacrum
what are the most common GI disoders that refer pain to the MSK system?
- involve ulceration or infection of the mucosal lining
List S/S of GI disorders
- Abdominal pain
- Dysphagia
- Odynophagia
- GI bleeding
- Epigastric pain
- Symptoms affected by food
- Early satiety with weight loss
- Constipation
- Diarrhea
- Fecal incontience
- Arthralgia
- Referred shoulder pain
- Psoas abscess
- Tenderness over McBurney’s point
The site of primary GI visceral pain generally ___________
correspond to dermatomes
T/F: GI pain fibers are only sensitive to stretching or tension
TRUE
T/F: GI pain is generally well localized
FALSE
not well localized
list possible reasons for abdominal pain
- Inflammation
- Organ distension (tension pain)
- Necrosis (ischemic pain)
Abdominal pain descriptors
- Deep aching
- Boring
- Gnawing
- Vague burning
- Deep grinding
- Colicky
what is dysphagia?
sensation that food is catching or sticking in the esophagus
requires prompt attention from MD
what is odynophagia?
pain during swallowing
may be caused by esophagitis or esophageal spasm
occult GI bleeding may appear as _______
mid-thoracic pain
with radiation of pain to R upper quadrant
T/F: MDs should evaluate any type of bleeding
TRUE
be sure to ask about presence of blood in vomit or stool
Clinical S/S of GI bleeding
- Coffee ground emesis
- Bloody diarrhea
- Bright red blood
- Melena
- Reddish or mahogany-colored stools
what can coffee ground emesis indicate?
perforated peptic or duodenal ulcer
what does bright red blood indicate in GI diseases?
pathology close to rectum or anus
(rectal fissures, hemorrhoids or colorectal cancer)
what is melena and what can it indicate?
black, tarry stool
- result of large quantities of blood in the stool
- indicates upper GI tract or could be secondary to overuse of NSAIDs
what can reddish/mahogany-colored stools indicate?
- may occur secondary to food/medications
- may be due to a bleed in the lower GI/colon
describe epigastric pain with radiation
intense or sharp pain behind breastone with radiation to back
may occur secondary to long-standing ulcers
describe heartburn
- begins at xiphoid process and radiates up toward neck and throat
- bitter or sour taste, abdominal bloating, gas or general abdominal discomfort
T/F: an MD must evaluate and diagnose cause of epigastric pain/heartburn
TRUE
describe pain associated with gastric ulcers
may occur within 30-90 mins after eating
food not likely to relieve pain
describe pain associated with duodenal or pyloric ulcers
may occur 2-4 hours after meals
food may relieve symptoms
may report pain during the night between 12-3 am → stomach is most empty
describe the symptom of early satiety
feeling hungry but gets the sensation of fullness after 1-2 bites
can be a symptom of:
- obstruction
- stomach cancer
- gastroparesis
- peptic ulcer disease
- tumor
red flags associated with constipation
unexplained constipation with sudden and unaccountable changes in bowel habits or blood in the stool
T/F: severe constipation can cause mid-thoracic pain
FALSE
can cause back pain
changes in bowel habits may occur due to
- diet
- smoking
- side effects of meds
- acute or chronic diseases of the digestive system
- extra-abdominal diseases
- depression
- emotional stress
- inactivity
- prolonged bed rest
- lack of exercise
meds that can cause constipation
- narcotics
- aluminum or calcium containing antacids
- tricyclic antidepressants
- phenothiazines
- calcium channel blockers
- iron salts
what are some causes of diarrhea?
- food
- alcohol
- use of laxatives
- med side effects
- travel
PT considerations for diarrhea
- C. Diff → contact precautions
- creatine use
- laxative abuse
what is fecal incontinence?
inability to control evacuation of stool
associated with a sense of urgency, diarrhea and abdominal cramping
what are some causes of fecal incontinence?
- partial obstruction of rectum
- colitis
- radiation therapy
- anal distortion secondary to traumatic childbirth
- hemorrhoids
- hemorrhoidal surgery
T/F: many GI conditions have an arthritic components
TRUE
Crohn’s disease often accompanied by rheumatic manifestations
describe arthralgia associated with GI conditions
typically known as reactive arthritis
- asymmetric
- migratory
- affecting only 1-2 joints → not bilateral like in rheumatologic conditions
describe L shoulder pain relating to GI conditions
- may be a result of free air following laproscopic surgery or blood in the abdominal cavity
- usually from ruptured spleen or retroperitoneal bleeding
- screen for percipitating trauma/injury → ie sharp blow, fall, MVA
- Kehr’s sign
what is Kehr’s sign?
pain in shoulder with pressure placed on left upper abdomen
what GI conditions cause R shoulder pain
perforated duodenal or gastric ulcer may refer here
Pancreatic cancer may refer to _______
either the R or L shoulder
Abscesses of the psoas and obturators may cause ______
lower abdominal pain
inflammation or infection may spread to these muscles from adjacent secondary to no protective barrier
Clinical S/S of Psoas Abscess
- fever
- night sweats
- abdominal pain
- loss of appetite or other GI upset
- Back, pelvic, abdominal, hip and/or knee pain
- antalgic gait
- palpable tender mass
List screening tests for a psoas abscess
- Heel tap
- Hop test
- Iliopsoas muscle test
- Palpate iliopsoas muscle
test for obturator abscess
obturator muscle test
- positive test for muscle affected by peritoneal infection or inflammation from a perforated appendix reproduces R lower quadrant abdominal or pelvic pain with testing of the muscle
what is included in the review of systems for GI
- abdominal pain
- indigestion; heartburn
- difficulty in swallowing
- N/V; loss of appetite
- Diarrhea or constipation
- Change in stools; change in bowel habits
- fecal incontinence
- rectal bleeding; blood in stool; blood in vomit
- skin rash followed by joint pain (Crohn’s disease)
Other GI related follow-up questions
- Do you notice a change in symptoms after eating?
- Do you notice a change in symptoms after a bowel movement or after passing gas?
- Do you have abdominal pain at the same time as your back pain?
