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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
What are the symptoms of a small bowel obstruction?
* Vomiting * Abdominal distention
26
What may be shown on an x-ray of a small bowel obstruction?
* Central abdominal distended loops * Circular folds extending the full width of the bowel lumen
27
What is the classic midgut pain scenario?
Appendicitis
28
What may cause hindgut pain?
Sigmoid volvulus
29
What % of intestinal obstructions are due to sigmoid volvuluses?
8%
30
What happens in a sigmoid volvulus?
Twists in on itself or its mesentery, causing a bowel obstruction and interruption to blood supply
31
What is the result of a bowel obstruction in a sigmoid volvulus?
Absolute constipation
32
What is the result of the interuption to the blood supply in a sigmoid volvulus?
Tissue death
33
What is anorexia?
Loss of appetite
34
What may cause anorexia?
* Subjectively unpleasant food or surroundings * Anxiety * Anger/fear * Symptom of a physical disorder * Symptom of a psychological disorder
35
What physical disorders may anorexia be a symptom of?
* Cancer *(in particular, of the GI tract)* * Chemotherapy * Certain antibiotics * Pregnancy * Depression * Endocrine disorders
36
At what point should weight loss be investigated?
More than 5% intentional weight loss
37
What is nausea?
The subjective sensation of the need to vomit
38
Where is the vomiting centre?
In the medulla
39
What sources of information feed into the vomiting centre?
* Labyrinths *(in the inner ear)* * Cerebral cortex * Peripheral pain receptors * Chemo- and baroreceptors * 5-HT * Dopamine * Emetic drugs
40
Describe the passage of information from the labyrinths to the vomiting centre?
* Labyrinths to vestibular, via acetylcholine * Vestibular to vomiting centre, via acetylcholine
41
What neurotransmitter is responsible for communication between peripheral pain receptors and the vomiting centre?
Histamine
42
What may trigger chemo- and baroreceptors to stimulate the vomiting centre?
Distension or irritation
43
How do substances such as emetic drugs, dopamine and 5-HT communicate with the vomiting centre?
Via the chemoreceptor trigger zone (CTZ)
44
Where does the CTZ lie?
At the base of the 4th ventricle
45
What are the common causes of vomiting?
* Food poisoning * Gastroenteritis * Cholecystitis * Appendictis * Viral hepatitis * Pancreatitis * Intestinal blockage * Pain
46
What microorganisms can cause food poisoning?
* Staphlococcal * Salmonella * E-coli
47
What causes viral gastroenteritis?
Norwalk
48
When is someone classified as having constipation?
When they defecate less than 3 times a week *(varies)*
49
What is more important to consider than the frequency of defication?
Changes in bowel habits
50
What are the potentila causes of constipation?
* Diet * Medication * Dehydration * Immobility * Disease * Functional
51
What medication can cause constipation?
* Opiod analgesics * Tricyclics
52
What diseases can cause constipation?
* Neurological, *e.g. stroke* * Diabetes * Colorectal stricture
53
What is functional constipation?
When there is no reason for constipation
54
What is a possible cause for functional constipation in paediatrics?
Pain
55
What is classified to be diarrhoea?
* More stools * Change in consistancy *Different for individuals*
56
What is required to make a diagnosis of diarrhoea?
A good history
57
What are the categories of diarrhoea?
* Secretory * Osmotic * Abnormal intestinal motility * Exudative * Malabsorption
58
What causes secretory diarrhoea?
Infection
59
What causes osmotic diarrhoea?
Lactose intolerance
60
What causes abnormal intestinal motility diarrhoea?
* Thyrotoxicosis * IBS
61
What causes exudative diarrhoea?
* Colitis * Cancer
62
What causes malabsorption diarrhoea?
Pancreatic enzyme/bile salt deficiency
63
What is dysphagia?
Difficulty swallowing *(both solids and liquids)*
64
What should dysphagia be differentiated from?
Odynophagia
65
What is odynophagia?
Painful swallowing
66
What are the broad categories of dysphagia?
* Difficulty initating swallowing * Food sticking in oesophagus
67
What is the cause of difficulty initating swallowing?
Neurological
68
What is the cause of food sticking in the oesphagus?
Anatomical problems
69
What are the broad categories of GI bleeding?
* From the top * From the bottom
70
What can cause bleeding from the top of the GI tract?
* Haematemesis * Acute or chronic peptic ulcer * Mallory-Weiss tear * Oesophagea or gastric varices * Erosive oesophagitis * Gastric or oesophageal cancer
71
What is a Mallory-Weiss tear?
A tear in the oesophagus from repetitive retching
72
What can cause bleeding from the bottom of the GI tract?
* Angiodysplasia * Diverticular disease * Colonic carcinoma * Haemorrhoids or anal fissure * Inflammatory bowel disease * Massive upper GI bleed
73
What is angiodysplasia?
Vascular malformation of the gut blood vessels
74
What cau cause a massive upper GI bleed?
Malaena
75
Draw a diagram illustrating the portal venous system
76
What can cause abdominal distention?
* Fat * Fluid * Faeces * Flatus * Foetus
77
What is ascites?
Abnormal amounts of fluid collecting in the peritoneal cavity
78
What can cause ascites?
* Liver failure * Portal hypertension * Cancer
79
What can cause flatus?
* Aerophagia * Gas production in gut *(especially if digestion has been incomplete)*
80
What is aerophagia?
Air swallowing
81
What should be looked for during a GI practical examination?
* Hand signs * Jaundice * Spider naevi * Organomegaly

ESA 3 - Gastrointestinal System (12 decks)

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