Week 7- GI Disorders Flashcards
PART 1: S/Sx
PART 1: S/Sx
What areas can GI System pain refer to? (8)
- Sternal region
- Shoulder and neck
- Scapular region
- Mid-back
- Low back
- Hip
- Pelvis
- Sacrum
The most common GI Disorders that refer pain to the MSK system include those that involve _______ or _______ of the mucosal lining.
ulceration or infection
GI Disorder S/Sx. (14)
- Abdominal pain
- Dysphagia
- Odynophagia
- GI bleeding
- Epigastric pain
- Symptoms affected by food
- Early satiety with weight loss
- Constipation
- Diarrhea
- Fecal incontinence
- Arthralgia
- Referred shoulder pain
- Psoas abscess
- Tenderness over McBurney’s point
Abdominal Pain (Primary GI Visceral Pain Patterns):
- Site of pain generally corresponds to ________.
- Pain fibers only sensitive to _______ or _______.
- Is it well localized?
- What are some reasons for abdominal pain? (3)
- dermatomes
- stretching or tension
- not well localized
- Inflammation, Organ distention, Necrosis
Why is visceral pain not well localized?
Innervation is multi-segmental and can span up to 8 SC segments, which makes it difficult to determine original source of pain.
Abdominal Pain (Referred GI Pain Patterns):
- Often more _______ and _________.
- Referred pain to the MSK system can occur in the absence of visceral pain, however, _______ pain usually precedes ________ pain.
- What are some areas referred pain can be perceived?
- intense and localized
- visceral pain usually precedes referred pain
- shoulder, mid-back/scapular region, pelvis, flank, low back, or sacrum
Dysphagia:
- What is it?
- Does it require MD referral?
- Sensation that food is catching/sticking in esophagus.
- Yes, requires prompt attention from MD.
Odynophagia:
- What is it?
- What can it be caused by? (2)
- Pain during swallowing.
- esophagitis, esophageal spasm
GI Bleeding:
- Occult GI bleeding may appear as ___-______ pain w/ radiation of pain to ______.
- Should it be evaluated?
- Important to ask about what else?
- Mid-thoracic pain w/ radiation of pain to RUQ.
- MD should evaluate any type of bleeding.
- Presence of blood in vomit/stools.
GI Bleeding S/Sx and what each may be indicative of. (5)
- Coffee ground emesis (perforated peptic/duodenal ulcer)
- Bloody diarrhea (ulcerative colitis)
- Bright red blood (pathology close to rectum/anus)
- Melena (upper GI tract or secondary to NSAID overuse)
- Reddish or mahogany-colored stools (secondary to food/medications, bleed in lower GI/colon)
Epigastric Pain w/ Radiation:
- ________/______ pain behind _________ with radiation to ______. (can occur secondary to long-standing ulcers)
- __________ beginning at xiphoid and radiate toward neck/throat. Bitter/sour taste, abdominal bloating, gas or general abdominal discomfort.
- Does it require evaluation?
- intense/sharp pain behind breastbone with radiation to back
- heartburn
- MD must evaluate and diagnose cause.
Symptoms Affected by Food:
Pain associated w/ gastric ulcers:
- May occur within ___-___ after eating.
- Food _________ to relieve pain.
Pain associated w/ duodenal/pyloric ulcers:
- May occur ___-___ after eating.
- Food _______ to relieve pain.
- When may these patients report pain?
Pain associated w/ gastric ulcers:
- 30-90 minutes
- not likely
Pain associated w/ duodenal ulcers:
- 2-4 hours
- may relieve pain
- Pain during night between 12-3am.
Should all patients who have increase or decrease in symptoms after eating food be referred?
Yes, should be screened more thoroughly and referred for medical evaluation.
Early Satiety:
- What is this?
- What can it be a symptom of? (5)
- Feel hungry but gets the sensation of fullness after 1-2 bites.
- Obstruction, stomach cancer, gastroparesis, peptic ulcer disease, tumor
Constipation:
- What are some red flags with constipation?
- Severe constipation can cause ____ pain.
- Unexplained constipation with sudden and unaccountable changes in bowel habits or blood in stool.
- back pain
Changes in bowel habits may occur due to what? (10)
- Diet
- Smoking
- Side effects of medication
- Acute or chronic diseases of the digestive system
- Extraabdominal diseases
- Depression
- Emotional stress
- Inactivity
- Prolonged bed rest
- Lack of exercise
Diarrhea:
- What are some causes?
- What are some PT considerations?
- food, alcohol, use of laxatives, medication side effects, travel
- C.diff, creatine use, laxative abuse
Fecal Incontinence:
- Associated with a sense of urgency, _______ and abdominal _________.
- What are some causes? (6)
- diarrhea and abdominal cramping
- partial obstruction of rectum, colitis, radiation therapy, anal distortion secondary to traumatic childbirth, hemorrhoids, hemorrhoidal surgery
Arthralgia:
- Do many GI conditions have arthritic component?
- Arthralgia associated with GI infection has what (3) characteristics?
- Yes, many GI conditions have arthritic component.
- ASYMMETRIC, MIGRATORY, affecting only 1-2 JOINTS
Shoulder Pain:
L Shoulder Pain:
- May be result of free air following laproscopic surgery or blood in abdominal cavity (usually from ruptured _______ or _________ bleeding).
- Screen for precipitating trauma/injury.
- ______ Sign: Pain in shoulder w/ pressure placed on left upper abdomen.
R Shoulder Pain:
-Perforated _________ or __________ may refer here.
L/R Shoulder Pain:
-________ cancer may refer to either shoulder.
L Shoulder Pain:
- ruptured spleen or retroperitoneal bleeding
- Kehr’s Sign
R Shoulder Pain
-duodenal or gastric ulcer
L/R Shoulder Pain:
-pancreatic
Obturator or Psoas Abscess:
- Abscess of these muscles may cause _________ pain.
- Inflammation or infection may spread to these muscles from adjacent structures secondary to no _________ _______.
- lower abdominal pain
- no protective barrier
Psoas Abscess S/Sx. (7)
- 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
What (4) things are done to screen for psoas abscess?
- ) Heel tap
- ) Hop test
- ) Iliopsoas muscle test
- ) Palpate Iliopsoas muscle
- Describe the heel tap test.
- Describe the hop test.
- Heel Tap = Have pt lift leg and tap bottom of involved side. If pt reports lower quadrant pain, indicates potential inflammation.
- Hop Test = Pt unable to hop on one leg on either side because of pain associated in lower abdomen on ipsilateral side.
What do we do if we note a cluster of S/Sx?
GI Review Of Systems
PART 2: PATHOLOOGIES
PART 2: PATHOLOGIES
What are some potential MSK sources of abdominal pain? (4)
- psoas referral
- lower thoracic spine
- slipping-rib syndrome
- myofascial components
Describe the difference between abdominal pain of MSK origin vs visceral origin.
MSK Origin:
- Sharp and focal
- Cramping and aching, or deep
Visceral Origin:
-Dull, aching, cramping, burning, gnawing, wave-like and poorly localized.
-Both can present with nausea.
Abdominal Pain MSK Clusters.
- ) Does coughing, sneezing, or taking a deep breathe make your pain feel worse? (YES)
- ) Do activities such as bending, sitting, lifting, twisting, or turning over in bed make your pain feel worse? (YES)
- ) Has there been any change in your bowel habit since the start of your symptoms? (NO)
- ) Does eating certain foods make your pain feel worse? (NO)
- ) Has your weight changed since your symptoms started? (NO)
GI Pathologies. (5)
- Peptic Ulcer
- Inflammatory Bowel Disease (Crohn’s, Ulcerative Colitis)
- Colorectal Cancer
- Pancreatic Cancer
- Appendicitis
Peptic Ulcer:
- What is it?
- Can cause ________ or _____ pain.
- What are some things that can cause peptic ulcers? (4)
- Loss of tissue lining lower esophagus, stomach, and duodenum.
- shoulder (usually R) or back pain
- Infection w/ H.pylori, chronic NSAID use, erosions, chronic ulcers
Peptic Ulcer S/Sx. (11)
- R Shoulder Pain***
- Radiating back pain***
- Heartburn
- Night pain (12am-3am)
- Stomach pain
- Lightheadedness/fainting
- N/V
- Anorexia
- Weight loss
- Bloody stools
- Black, tarry stools
GI and NSAIDs:
- Most obvious clinical negative effect is on the gastroduodenal mucosa.
- Range from subclinical erosion of mucosa to ulceration with life-threatening bleeding and perforation.
- Responsible for ___% of hospital admissions among pts with arthritis.
- NSAID-induced GI ________ is a major cause of morbidity/mortality among older populations.
- 40%
- GI bleeding
NSAID -Induced Gastropathy Risk Factors:
- Age >___yo
- Hx of ________/____ disease
- ______/_______ use
- Oral corticosteroid use
- Anticoagulation or use of anticoagulants
- Renal complications in pt with ____ or ____
- Use of _____________
- NSAIDs combines with selective serotonin reuptake inhibitors
- 65yo
- Hx of peptic ulcer/GI disease
- smoking/alcohol
- HTN or CHF
- acid suppressants
GI complications of NSAIDs S/Sx. (10)
- New-onset back or shoulder pain***
- Asymptomatic
- Stomach upset/pain
- Indigestion, heartburn
- Skin reactions
- Increased blood pressure
- Melena
- Tinnitus
- CNS changes (HA, Depression, Confusion, Memory loss, Mood changes)
- Renal involvement (muscle weakness, unusual fatigue, restless leg syndrome, polyuria, nocturia, pruritus)
Inflammatory Bowel Disease:
- Refers to __________ and __________.
- Disorders of unknown etiology involving ________ and __________ influences on GI tract.
- Both are chronic and medically incurable conditions.
- __________ deficiencies are most common complications of IBD.
- Crohn’s disease and ulcerative colitis
- genetic and immunologic
- nutritional
Crohn’s Disease:
- Inflammatory disease most commonly attacks terminal end of __________ and ______.
- Occurs more commonly in ___________/__________.
Ulcerative Colitis:
- Inflammation and ulceration of lining of __________.
- Cancer of ______ more common in people with UC.
IBD:
- UC and Crohn’s disease can be accompanied by ________ component.
- Joint problems usually are responsive to treatment of IBD but do on occasion require separate management.
Crohn’s Disease:
- small intestine (ileum) and colon
- young adults/adolescents
Ulcerative Colitis:
- large intestine (colon/rectum)
- colon
IBD:
-arthritic component
Crohn’s Disease and Ulcerative Colitis S/Sx. (12)
- Skin lesions***
- Arthritis***
- Migratory arthralgias***
- Hip pain (iliopsoas abscess)***
- Uveitis
- Diarrhea
- Constipation
- Fever
- Abdominal pain
- Rectal bleeding
- Night sweats
- Decreased appetite, nausea, weight loss
Colorectal Cancer:
- ___ leading cause of cancer deaths.
- Incidence increases with age, beginning around ___.
- Screening can significantly reduce mortality.
- Who are high-risk groups?
- 3rd
- 40
- previous Hx of chronic IBD, adenomatous polyps and hereditary colon cancer
Colorectal Cancer S/Sx (Early (4) vs Late Stages (7)):
Early Stages:
- Rectal bleeding
- Abdominal, pelvic, back or sacral pain***
- Back pain that radiates down the legs***
- Changes in bowel patterns
Late Stages
- Constipation progressing to obstipation
- Diarrhea with copious amounts of mucus
- N/V
- Abdominal distention
- Weight loss
- Fatigue and dyspnea
- Fever
Pancreatic Carcinoma:
- ___% of pancreatic cancer arise in the head of the gland.
- ___-___% occur in the body and tail.
- Pain is worse with ________ and __________.
- Pain is relieved by _______ and ___________.
- 70%
- 20-30%
- walking and lying supine
- sitting and leaning forward
Pancreatic Carcinoma S/Sx. (8)
- Epigastric/upper abdominal pain radiating to the back***
- Lower back pain may be only symptom***
- Jaundice
- Anorexia and weight loss
- Light-colored stools
- Constipation
- N/V
- Weakness
Appendicitis:
- What is it?
- Most common in _________/_________.
- Does it usually require surgery?
- Inflammation of vermiform appendix.
- adolescents/young adults
- Yes
Appendicitis S/Sx. (11)
RLQ flank pain***
- N/V***
- Low-grade fever***
- Periumbilica and/or epigastric pain
- R thigh, groin, or testicular pain
- Abdominal involuntary muscle guarding and rigidity
- McBurney’s Sign, + Rovsing’s Sign or + pinch-an-inch test
- Rebound tenderness
- Anorexia
- Dysuria
- Coated tongue and bad breath
- How do we perform McBurney’s Sign?
- What are abnormal findings?
- Procedure: Pt in supine, standing on R side perform deep palpation 1/2 between ASIS and umbilicus. Quickly release and assess for rebound tenderness.
- Abnormal Findings: Tenderness
- How do we perform Rovsing’s Sign?
- What are abnormal findings?
- Procedure: Pt in supine, perform deep palpation 1/2 between ASIS and umbilicus on L side. Quickly release and assess for rebound tenderness.
- Abnormal Findings: RLQ tenderness wit remote rebounding testing at left LLQ.
Guideline for Immediate Medical Attention:
- Suspected ________ or _______/_______ abscess.
- Suspected ___________ from injury, damage or ruptured ________ or ectopic pregnancy.
- appendicitis or iliopsoas/obturator abscess
- retroperitoneal bleeding, spleen
Guidelines for MD Referral:
- Pts who chronically rely on _________.
- ______ involvement accompanied by skin/eye lesions if MD is unaware.
- Hx of NSAID with _____/________ pain accompanied by S/Sx of peptic ulcer.
- laxitives
- joint involvement
- back/shoulder
