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ESA 3 - Gastrointestinal System > Signs and Symptoms of Abdominal Disorders > Flashcards

Signs and Symptoms of Abdominal Disorders Flashcards

1
Q

What are the common presentations of abdominal disorders?

A
  • Dyspepsia
  • Abdominal pain
  • Constipation
  • Diahorrea
  • Dysphagia
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2
Q

What is meant by dyspepsia?

A
  • Upper abdominal pain and bloating
  • Chronic or recurrent pain or discomfort in the upper abdomen
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3
Q

What are the causes of dyspepsia?

A
  • Chronic peptic ulcer disease
  • GORD
  • Malignancy
  • Functional / non-ulcer

Some debate over this

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4
Q

What % of dyspepsia is functional / non-ulcer?

A

60%

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5
Q

What is meant by functional / non-ulcer dyspepsia?

A

No functional problem found to account for symptoms

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6
Q

When is dyspepsia classified as functional?

A

When there is 3 months of dyspepsia with no structural causes found

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7
Q

What is the course of treatment for dyspepsia?

A
  • Empirical acid suppression
  • Non invasive H-pylori testing/eradication
  • Early endoscopy
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8
Q

How common is abdominal pain?

A

Very common, 2% of all hospital admissions

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9
Q

What must be taken into consideration when a patient presents with abdominal pain?

A

That there are many causes, and it can be misleading, so we must therefore adopt a sensible approach

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10
Q

Is abdominal pain related to the small bowel intra- or extra-peritoneal?

A

Intra-peritoneal

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11
Q

Why is it important to question what embryological division abdominal pain related to the small bowel belongs to?

A

Because intra-peritoneal structures refer pain to shared areas of the abdominal wall

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12
Q

Where does the foregut refer pain to?

A

Up to the 2nd part of the duodenum to the epigastric area

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13
Q

Where does the midgut refer pain to?

A

Up to the distal third of the transverse colon to the peri-umbilical area

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14
Q

Where does the hindgut refer pain to?

A

Supra-pubic

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15
Q

What may cause foregut pain?

A
  • Ulcers
  • Pancreatitis
  • Gallstones
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16
Q

What kind of foregut pain is produced when caused by ulcers

A

Epigastric pain

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17
Q

Where does epigastric pain caused by ulcers commonly occur?

A

In the first part of the duodenum or lesser curve of the stomach

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18
Q

Where does pancreatitis cause pain?

A
  • Epigastric pain
  • Back pain (retroperitoneal structure)
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19
Q

Where do gallstones cause pain?

A
  • Epigastric pain
  • Can also get right upper quadrant (RUQ) pain
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20
Q

What is gallstones pain sometimes referred to as?

A

Colicky pain

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21
Q

Why is referring to gallstones pain as colicky a slight misnomer?

A

Because the pain is fairly constant

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22
Q

What is midgut pain sometimes referred to as?

A

‘Real’ colicky pain

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23
Q

At what frequency is colicky pain in the small bowel?

A

Every 2-3 minutes

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24
Q

At what frequency is colicky pain in the large bowel?

A

Every 10-15 minutes

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25
Q

What are the symptoms of a small bowel obstruction?

A
  • Vomiting
  • Abdominal distention
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26
Q

What may be shown on an x-ray of a small bowel obstruction?

A
  • Central abdominal distended loops
  • Circular folds extending the full width of the bowel lumen
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27
Q

What is the classic midgut pain scenario?

A

Appendicitis

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28
Q

What may cause hindgut pain?

A

Sigmoid volvulus

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29
Q

What % of intestinal obstructions are due to sigmoid volvuluses?

A

8%

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30
Q

What happens in a sigmoid volvulus?

A

Twists in on itself or its mesentery, causing a bowel obstruction and interruption to blood supply

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31
Q

What is the result of a bowel obstruction in a sigmoid volvulus?

A

Absolute constipation

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32
Q

What is the result of the interuption to the blood supply in a sigmoid volvulus?

A

Tissue death

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33
Q

What is anorexia?

A

Loss of appetite

34
Q

What may cause anorexia?

A
  • Subjectively unpleasant food or surroundings
  • Anxiety
  • Anger/fear
  • Symptom of a physical disorder
  • Symptom of a psychological disorder
35
Q

What physical disorders may anorexia be a symptom of?

A
  • Cancer (in particular, of the GI tract)
  • Chemotherapy
  • Certain antibiotics
  • Pregnancy
  • Depression
  • Endocrine disorders
36
Q

At what point should weight loss be investigated?

A

More than 5% intentional weight loss

37
Q

What is nausea?

A

The subjective sensation of the need to vomit

38
Q

Where is the vomiting centre?

A

In the medulla

39
Q

What sources of information feed into the vomiting centre?

A
  • Labyrinths (in the inner ear)
  • Cerebral cortex
  • Peripheral pain receptors
  • Chemo- and baroreceptors
  • 5-HT
  • Dopamine
  • Emetic drugs
40
Q

Describe the passage of information from the labyrinths to the vomiting centre?

A
  • Labyrinths to vestibular, via acetylcholine
  • Vestibular to vomiting centre, via acetylcholine
41
Q

What neurotransmitter is responsible for communication between peripheral pain receptors and the vomiting centre?

A

Histamine

42
Q

What may trigger chemo- and baroreceptors to stimulate the vomiting centre?

A

Distension or irritation

43
Q

How do substances such as emetic drugs, dopamine and 5-HT communicate with the vomiting centre?

A

Via the chemoreceptor trigger zone (CTZ)

44
Q

Where does the CTZ lie?

A

At the base of the 4th ventricle

45
Q

What are the common causes of vomiting?

A
  • Food poisoning
  • Gastroenteritis
  • Cholecystitis
  • Appendictis
  • Viral hepatitis
  • Pancreatitis
  • Intestinal blockage
  • Pain
46
Q

What microorganisms can cause food poisoning?

A
  • Staphlococcal
  • Salmonella
  • E-coli
47
Q

What causes viral gastroenteritis?

A

Norwalk

48
Q

When is someone classified as having constipation?

A

When they defecate less than 3 times a week (varies)

49
Q

What is more important to consider than the frequency of defication?

A

Changes in bowel habits

50
Q

What are the potentila causes of constipation?

A
  • Diet
  • Medication
  • Dehydration
  • Immobility
  • Disease
  • Functional
51
Q

What medication can cause constipation?

A
  • Opiod analgesics
  • Tricyclics
52
Q

What diseases can cause constipation?

A
  • Neurological, e.g. stroke
  • Diabetes
  • Colorectal stricture
53
Q

What is functional constipation?

A

When there is no reason for constipation

54
Q

What is a possible cause for functional constipation in paediatrics?

A

Pain

55
Q

What is classified to be diarrhoea?

A
  • More stools
  • Change in consistancy

Different for individuals

56
Q

What is required to make a diagnosis of diarrhoea?

A

A good history

57
Q

What are the categories of diarrhoea?

A
  • Secretory
  • Osmotic
  • Abnormal intestinal motility
  • Exudative
  • Malabsorption
58
Q

What causes secretory diarrhoea?

A

Infection

59
Q

What causes osmotic diarrhoea?

A

Lactose intolerance

60
Q

What causes abnormal intestinal motility diarrhoea?

A
  • Thyrotoxicosis
  • IBS
61
Q

What causes exudative diarrhoea?

A
  • Colitis
  • Cancer
62
Q

What causes malabsorption diarrhoea?

A

Pancreatic enzyme/bile salt deficiency

63
Q

What is dysphagia?

A

Difficulty swallowing (both solids and liquids)

64
Q

What should dysphagia be differentiated from?

A

Odynophagia

65
Q

What is odynophagia?

A

Painful swallowing

66
Q

What are the broad categories of dysphagia?

A
  • Difficulty initating swallowing
  • Food sticking in oesophagus
67
Q

What is the cause of difficulty initating swallowing?

A

Neurological

68
Q

What is the cause of food sticking in the oesphagus?

A

Anatomical problems

69
Q

What are the broad categories of GI bleeding?

A
  • From the top
  • From the bottom
70
Q

What can cause bleeding from the top of the GI tract?

A
  • Haematemesis
  • Acute or chronic peptic ulcer
  • Mallory-Weiss tear
  • Oesophagea or gastric varices
  • Erosive oesophagitis
  • Gastric or oesophageal cancer
71
Q

What is a Mallory-Weiss tear?

A

A tear in the oesophagus from repetitive retching

72
Q

What can cause bleeding from the bottom of the GI tract?

A
  • Angiodysplasia
  • Diverticular disease
  • Colonic carcinoma
  • Haemorrhoids or anal fissure
  • Inflammatory bowel disease
  • Massive upper GI bleed
73
Q

What is angiodysplasia?

A

Vascular malformation of the gut blood vessels

74
Q

What cau cause a massive upper GI bleed?

A

Malaena

75
Q

Draw a diagram illustrating the portal venous system

A
76
Q

What can cause abdominal distention?

A
  • Fat
  • Fluid
  • Faeces
  • Flatus
  • Foetus
77
Q

What is ascites?

A

Abnormal amounts of fluid collecting in the peritoneal cavity

78
Q

What can cause ascites?

A
  • Liver failure
  • Portal hypertension
  • Cancer
79
Q

What can cause flatus?

A
  • Aerophagia
  • Gas production in gut (especially if digestion has been incomplete)
80
Q

What is aerophagia?

A

Air swallowing

81
Q

What should be looked for during a GI practical examination?

A
  • Hand signs
  • Jaundice
  • Spider naevi
  • Organomegaly

ESA 3 - Gastrointestinal System (12 decks)

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