Week 7- GI Disorders Flashcards

1
Q

PART 1: S/Sx

A

PART 1: S/Sx

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2
Q

What areas can GI System pain refer to? (8)

A
  • Sternal region
  • Shoulder and neck
  • Scapular region
  • Mid-back
  • Low back
  • Hip
  • Pelvis
  • Sacrum
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3
Q

The most common GI Disorders that refer pain to the MSK system include those that involve _______ or _______ of the mucosal lining.

A

ulceration or infection

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4
Q

GI Disorder S/Sx. (14)

A
  • 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
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5
Q

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)
A
  • dermatomes
  • stretching or tension
  • not well localized
  • Inflammation, Organ distention, Necrosis
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6
Q

Why is visceral pain not well localized?

A

Innervation is multi-segmental and can span up to 8 SC segments, which makes it difficult to determine original source of pain.

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7
Q

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?
A
  • intense and localized
  • visceral pain usually precedes referred pain
  • shoulder, mid-back/scapular region, pelvis, flank, low back, or sacrum
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8
Q

Dysphagia:

  • What is it?
  • Does it require MD referral?
A
  • Sensation that food is catching/sticking in esophagus.

- Yes, requires prompt attention from MD.

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9
Q

Odynophagia:

  • What is it?
  • What can it be caused by? (2)
A
  • Pain during swallowing.

- esophagitis, esophageal spasm

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10
Q

GI Bleeding:

  • Occult GI bleeding may appear as ___-______ pain w/ radiation of pain to ______.
  • Should it be evaluated?
  • Important to ask about what else?
A
  • Mid-thoracic pain w/ radiation of pain to RUQ.
  • MD should evaluate any type of bleeding.
  • Presence of blood in vomit/stools.
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11
Q

GI Bleeding S/Sx and what each may be indicative of. (5)

A
  • 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)
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12
Q

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?
A
  • intense/sharp pain behind breastbone with radiation to back
  • heartburn
  • MD must evaluate and diagnose cause.
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13
Q

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?
A

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.
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14
Q

Should all patients who have increase or decrease in symptoms after eating food be referred?

A

Yes, should be screened more thoroughly and referred for medical evaluation.

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15
Q

Early Satiety:

  • What is this?
  • What can it be a symptom of? (5)
A
  • Feel hungry but gets the sensation of fullness after 1-2 bites.
  • Obstruction, stomach cancer, gastroparesis, peptic ulcer disease, tumor
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16
Q

Constipation:

  • What are some red flags with constipation?
  • Severe constipation can cause ____ pain.
A
  • Unexplained constipation with sudden and unaccountable changes in bowel habits or blood in stool.
  • back pain
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17
Q

Changes in bowel habits may occur due to what? (10)

A
  • 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
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18
Q

Diarrhea:

  • What are some causes?
  • What are some PT considerations?
A
  • food, alcohol, use of laxatives, medication side effects, travel
  • C.diff, creatine use, laxative abuse
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19
Q

Fecal Incontinence:

  • Associated with a sense of urgency, _______ and abdominal _________.
  • What are some causes? (6)
A
  • diarrhea and abdominal cramping
  • partial obstruction of rectum, colitis, radiation therapy, anal distortion secondary to traumatic childbirth, hemorrhoids, hemorrhoidal surgery
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20
Q

Arthralgia:

  • Do many GI conditions have arthritic component?
  • Arthralgia associated with GI infection has what (3) characteristics?
A
  • Yes, many GI conditions have arthritic component.

- ASYMMETRIC, MIGRATORY, affecting only 1-2 JOINTS

21
Q

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.

A

L Shoulder Pain:

  • ruptured spleen or retroperitoneal bleeding
  • Kehr’s Sign

R Shoulder Pain
-duodenal or gastric ulcer

L/R Shoulder Pain:
-pancreatic

22
Q

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 _________ _______.
A
  • lower abdominal pain

- no protective barrier

23
Q

Psoas Abscess S/Sx. (7)

A
  • 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
24
Q

What (4) things are done to screen for psoas abscess?

A
  1. ) Heel tap
  2. ) Hop test
  3. ) Iliopsoas muscle test
  4. ) Palpate Iliopsoas muscle
25
- 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.
26
What do we do if we note a cluster of S/Sx?
GI Review Of Systems
27
PART 2: PATHOLOOGIES
PART 2: PATHOLOGIES
28
What are some potential MSK sources of abdominal pain? (4)
- psoas referral - lower thoracic spine - slipping-rib syndrome - myofascial components
29
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.
30
Abdominal Pain MSK Clusters.
1. ) Does coughing, sneezing, or taking a deep breathe make your pain feel worse? (YES) 2. ) Do activities such as bending, sitting, lifting, twisting, or turning over in bed make your pain feel worse? (YES) 3. ) Has there been any change in your bowel habit since the start of your symptoms? (NO) 1. ) Does eating certain foods make your pain feel worse? (NO) 2. ) Has your weight changed since your symptoms started? (NO)
31
GI Pathologies. (5)
- Peptic Ulcer - Inflammatory Bowel Disease (Crohn's, Ulcerative Colitis) - Colorectal Cancer - Pancreatic Cancer - Appendicitis
32
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
33
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
34
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
35
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
36
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)
37
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
38
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
39
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
40
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
41
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
42
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
43
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
44
Appendicitis: - What is it? - Most common in _________/_________. - Does it usually require surgery?
- Inflammation of vermiform appendix. - adolescents/young adults - Yes
45
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
46
- 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
47
- 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.
48
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
49
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