Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

S7- Differential Diagnosis > Week 7- GI Disorders > Flashcards

Week 7- GI Disorders Flashcards

1
Q

PART 1: S/Sx

A

PART 1: S/Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Odynophagia:

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

- esophagitis, esophageal spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q
  • Describe the heel tap test.

- Describe the hop test.

A
  • 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
Q

What do we do if we note a cluster of S/Sx?

A

GI Review Of Systems

27
Q

PART 2: PATHOLOOGIES

A

PART 2: PATHOLOGIES

28
Q

What are some potential MSK sources of abdominal pain? (4)

A
  • psoas referral
  • lower thoracic spine
  • slipping-rib syndrome
  • myofascial components
29
Q

Describe the difference between abdominal pain of MSK origin vs visceral origin.

A

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
Q

Abdominal Pain MSK Clusters.

A
  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)
  4. ) Does eating certain foods make your pain feel worse? (NO)
  5. ) Has your weight changed since your symptoms started? (NO)
31
Q

GI Pathologies. (5)

A
  • Peptic Ulcer
  • Inflammatory Bowel Disease (Crohn’s, Ulcerative Colitis)
  • Colorectal Cancer
  • Pancreatic Cancer
  • Appendicitis
32
Q

Peptic Ulcer:

  • What is it?
  • Can cause ________ or _____ pain.
  • What are some things that can cause peptic ulcers? (4)
A
  • 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
Q

Peptic Ulcer S/Sx. (11)

A
  • 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
Q

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.
A
  • 40%

- GI bleeding

35
Q

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
A
  • 65yo
  • Hx of peptic ulcer/GI disease
  • smoking/alcohol
  • HTN or CHF
  • acid suppressants
36
Q

GI complications of NSAIDs S/Sx. (10)

A
  • 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
Q

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.
A
  • Crohn’s disease and ulcerative colitis
  • genetic and immunologic
  • nutritional
38
Q

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.
A

Crohn’s Disease:

  • small intestine (ileum) and colon
  • young adults/adolescents

Ulcerative Colitis:

  • large intestine (colon/rectum)
  • colon

IBD:
-arthritic component

39
Q

Crohn’s Disease and Ulcerative Colitis S/Sx. (12)

A
  • 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
Q

Colorectal Cancer:

  • ___ leading cause of cancer deaths.
  • Incidence increases with age, beginning around ___.
  • Screening can significantly reduce mortality.
  • Who are high-risk groups?
A
  • 3rd
  • 40
  • previous Hx of chronic IBD, adenomatous polyps and hereditary colon cancer
41
Q

Colorectal Cancer S/Sx (Early (4) vs Late Stages (7)):

A

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
Q

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 ___________.
A
  • 70%
  • 20-30%
  • walking and lying supine
  • sitting and leaning forward
43
Q

Pancreatic Carcinoma S/Sx. (8)

A
  • 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
Q

Appendicitis:

  • What is it?
  • Most common in _________/_________.
  • Does it usually require surgery?
A
  • Inflammation of vermiform appendix.
  • adolescents/young adults
  • Yes
45
Q

Appendicitis S/Sx. (11)

A

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
Q
  • How do we perform McBurney’s Sign?

- What are abnormal findings?

A
  • 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
Q
  • How do we perform Rovsing’s Sign?

- What are abnormal findings?

A
  • 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
Q

Guideline for Immediate Medical Attention:

  • Suspected ________ or _______/_______ abscess.
  • Suspected ___________ from injury, damage or ruptured ________ or ectopic pregnancy.
A
  • appendicitis or iliopsoas/obturator abscess

- retroperitoneal bleeding, spleen

49
Q

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.
A
  • laxitives
  • joint involvement
  • back/shoulder

S7- Differential Diagnosis (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions