T1 - Semiologia das Doenças Digestivas Flashcards
7 Grandes Síndromes em Gastroenterologia?
• Disfagia
• Náuseas e vómitos
• Dor abdominal
• Diarreia
• Obstipação
• Hemorragia digestiva
• Icterícia
Abordagem Algorítmica?
Sintomas e Sinais
# Dados analíticos
# Dados de Imagem
Cada decisão clínica em Gastro resulta da integração em rede de multiplos algoritmos
Aboradgem à Disfagia?
Dysphagia occurs when a patient has difficulty transferring solid or liquid bolus from the oral cavity to the esophagus.
There are two types of dysphagia: oropharyngeal dysphagia and esophageal dysphagia:
• Oropharyngeal dysphagia occurs when there is difficulty initiating the swallow.
• Esophageal dysphagia occurs when swallowing food or liquid has the sensation of “getting stuck” in the throat or chest.
Depending on the cause of the dysphagia the treatment is tailored to the underlying disorder.
Abordagem à Disfagia - Causa?
Orofaríngea
- SNC
- SNP
- Placa Motora
- Muscular
Esofágica
- Anormalidades vasculares
- Tummores mediastínicos
- Alterações pós-cirúrgicas
- Alterações de motilidade (primárias ou secundárias)
Approach to Nausea and Vomiting?
The differential diagnosis of nausea and vomiting is extraordinarily broad, and includes:
• Disorders of the abdominal viscera.
• Drug, toxin, or other exposures.
• Infection.
• Central nervous system disease.
• Metabolic and endocrine disease.
• Other miscellaneous causes.
- help determine or confirm the etiology of the symptoms, and
- determine consequences of the symptoms, such as dehydration.
Approach to Abdominal Pain?
Acute abdominal pain is one of the most common presenting symptoms, especially in an emergency department setting
Approach to Diarrhea?
Diarrhea is the second most common presenting complaint in the practice of gastroenterology.
Approach to Constipation?
The prevalence of constipation depends on the de nition used and ranges 2–25% in North America. The direct and indirect costs of constipation are very significant.
• As few as three bowel movements per week can be considered “normal” when this does not represent a change from one’s usual baseline.
• The Rome III criteria for functional constipation are an attempt to standardize patient symptoms, provide guidance for clinicians evaluating patients, and allow comparisons between different studies.
Approach to Constipation - Continuation?
The investigation of constipation should be individualized.
• Chronic constipation in a relatively young patient (<50 years old) in the absence of alarm systems does not require extensive imaging but
• The acute onset of constipation in an older patient (>50 years) who also exhibits alarm symptoms and signs including unexplained weight loss, rectal bleeding, positive fecal blood testing, or anemia must undergo extensive evaluation on an urgent basis.
Approach to Gastrointestinal Bleeding - 1?
• The proper identification and management of those with bleeding are important skills for gastroenterologists.
• Patients may present with acute or chronic blood loss. Clinical scores can be used to help determine the risk of death from a bleed.
• Endoscopic stigmata used to assess risk of rebleeding include active bleeding, visible vessel, adherent clot, at spot, or a clean-based ulcer.
• Differentiating upper from lower sources is important because lower sources of bleeding are generally less life-threatening and endoscopic therapy has a less important role.
Approach to Gastrointestinal Bleeding - 2?
• Common endoscopic therapies include band ligation for variceal bleeding and bipolar cautery, heater probe cautery, argon plasma coagulation, endoscopic clips, and injection therapy with epinephrine for peptic ulcer disease.
• In the patient with bleeding in whom both upper endoscopy and colonoscopy have been non-diagnostic, capsule endoscopy, radiology, and/or device-assisted enteroscopy can be considered to examine for a small bowel source of blood loss.
Approach to Gastrointestinal Bleeding - Disease Classification?
• Gastrointestinal bleeding can occur from an upper (UGIB) source or lower (LGIB) source depending on the location proximal or distal to the ligament of Treitz
- For UGIB, it is important to determine if bleeding results from varices or non-variceal hemorrhage.
- It is important to differentiate UGIB from LGIB because sources of LGIB are generally less life- threatening and endoscopic therapy has a less important role
• Gastrointestinal bleeding may also be classified as obscure, defined as bleeding that persists or recurs without an obvious etiology after esophagogastroduodenoscopy (EGD), colonoscopy, and radiologic evaluation of the small bowel
- Obscure bleeding can also be further categorized as obscure overt or obscure occult bleeding depending on whether or not there is clinically evident bleeding
Approach to Gastrointestinal Bleeding - Incidence and Prevalence?
• UGIB results in over 300000 hospital admissions in the United States each year
• Mortality of UGIB is approximately 3.5–10% in some older studies
• LGIB has been estimated to account for 20% of all major gastrointestinal bleeds
• The annual incidence of LGIB in the United States requiring hospitalization is 21 per 100 000
• Mortality of major LGIB is approximately 2–4%
Approach to Gastrointestinal Bleeding - Etiology?
Common sources of UGIB include variceal hemorrhage, peptic ulcer disease, esophagitis, Mallory–Weiss tear, vascular abnormalities including Dieulafoy lesions, aortoenteric fistula, malignancy, and Cameron erosions.
- In patients with acute LGIB, diverticulosis and angioectasias account for 80% of the bleeding sites.
Approach to the Patient with Jaundice?
• Jaundice occurs when there is an elevation in the plasma total bilirubin level that is visible clinically.
• There are several methods of classifying jaundice in the adult patient that provide some indication of the etiology, the simplest being to separate jaundice into unconjugated versus conjugated hyperbilirubinemia.
• In the adult patient, the main causes of jaundice are related to intrinsic liver disease or interruption of bile flow due to obstruction of the biliary tree.
• The approach to jaundice should include a thorough history and physical examination, appropriate laboratory studies and further directed investigation including imaging and liver biopsy.
