Gastrointestinal Flashcards by Colleen Caribardi

What is dysphagia?

The sensation of food catching or sticking in the esophagus

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What are the causes of dysphagia?

Motor –> loss of coordinated local muscle activity

Mechanical –> mechanical obstructive disorder

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What are s/s of dysphagia originating from a motor cause?

Gradual onset with slow progression

Equal difficulty to swallow solids and liquids

Swallowing is worse with cold substances

Bolus passage is facilitated by swallowing, valsalva, or throwing the head and shoulders backward

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What are s/s of dysphagia originating from a mechanical cause?

Fast onset with fast progression

Swallowing is more difficult with solids

No change in swallowing difficulty when having different temperatures of food

Bolus can possibly regurgitated

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What is odynophagia?

Pain with swallowing

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What are the causes of odynophagia?

Esophagitis (GERD or coronary ischemia)

Esophageal spasm

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What position relieves esophagitis pain?

sitting upright

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What is dyspepsia?

Indigestion/heartburn

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What are the causes of dyspepsia?

Organic, functional, medication

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What are the s/s of dyspepsia?

Retrosternal pain
Epigastric pain

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What is the treatment for dyspepsia?

Antacids

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What is the physical cause of GERD?

ineffective lower esophageal sphincter

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GERD commonly affects those who are >____ y/o.

> 40 y/o

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What are s/s of GERD?

Heartburn, Belching, Dysphagia

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What are treatments for GERD?

Medication (zantac, prolisec, prevacid, nexium)

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GERD has a relationship with ____.

asthma

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What causes a peptic ulcer?

Digestive acids irritate/erode the lining of the digestive tract

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What pain pattern is caused by a peptic ulcer? Where can it manifest and possibly radiate?

a. Coursing in waves and lasts for several minutes

b. Epigastric pain (heartburn); back pain @ t8-t10 region

c. radiates to inferior costal margins in the back

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What are causes of peptic ulcers?

H-pylori

NSAID use

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What are the risk factors for NSAID induced gastropathy?

> 65 y/o with the use of medications (prozac, zoloft, celexia, paxil)

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Gastric ulcers are associated with increased ____ use especially in the elderly, causing pain with eating.

NSAID use

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(true/false) Gastric ulcers are always benign

FALSE (they can be malignant)

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What is the appearance of stool in a patient with an esophageal ulcer?

Black/tar/coffee-ground

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What is duodenal ulcers associated with?

H-pylori

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What are s/s of duodenal ulcers?

Dull/gnawing/burning pain... empty stomach

Where is pain found if caused by a duodenal ulcer?

epigastric midthoracic (T6-T10) Supraclavicular area

Pain 30-90 minutes after eating food is caused by a _____ origin.

gastric

Pain 2-4 hours after eating food is caused by a _____ origin.

duodenal

(true/false) Foods can produce or alleviate symptoms

true

Any substance that is a ____ can decrease symptoms of an ulcer/GERD

base (ex: milk)

If a person has midthoracic pain/R scapular pain after indigestion of fatty foods, it can be an indication of a possible ____ disorder.

gallbladder disorder

What is black/tar stool an indication for?

Large upper GI bleed

Bright/bloody red colored stool is indicative of what?

lower GI bleed

Reddish/non-bloody stool is caused by what?

foods (ex: beets)

Light grey/pale stool is associated with what?

Obstructive jaundice and/or an increase in fat contact

Stool that floats is indicative of what?

cystic fibrosis/increased fat content

What are possible s/s of lower GI bleeds?

Red bloody stool difficulty initiating bowel movements lightheadedness Fatigue

What are s/s of constipation and fecal impaction?

Abdominal fullness bloating fever agitation mental status change

What should you do when fecal impaction is suspected?

call MD

What are possible causes of diarrhea?

Infectious agents Laxative abuse Colon cancer Irritable bowel syndrome Crohn’s disease Ulcerative colitis Diabetic enteropathy

What are the manifestations of dehydration?

Thirst and dry mouth Postural hypotension Rapid breathing Rapid pulse (> 100 bpm) Confusion irritability, lethargy HA

Difficulty initiating bowel movements can cause what?

Constipation (mistaken for acute LBP)

Difficulty initiating bowel movements can be an indication of what?

Inflammation OR cancer at the anorectal region

What dermatome(s) is epigastric pain found in?

T3-T5

What sympathetic nerve distribution is periumbilical pain found in?

T10

What sympathetic nerve distribution is lower abdominal pain found in?

T10-L2 with referred pain to the sacrum

Lower abdominal pain (T10-L2 sympathetic nerve distribution) can refer to where?

the sacrum

What dermatome(s) is esophageal pain in?

T6-T10

What dermatome(s) is gallbladder pain in?

T6-T9

What dermatome(s) is colon/appendix pain in?

T10, T11

What dermatome(s) is sigmoid colon/genital pain found in?

T11-S4

What are early stages of abdominal pain?

Changes in the skin within the affected dermatome

What is arthralgia? What is it commonly associated with?

pain within a joint commonly associated with a gut problem OR followed by a gut problem

What is the general presentation of arthralgia?

General presentation: asymmetric, migratory pain found in 1-2 joints Specific presentation: - nails separate from nail beds and are thin and discolored - skin has rashes and lesions - conjunctivitis

What can shoulder pain be caused by if there is GI involvement?

- Free air/blood in the abdominal cavity caused by ruptured spleen (Kehr's sign), trauma, ruptured ectopic pregnancy, Liver trauma - Enlarged organ (Splenomegaly) - Pancreatic disease

What are patient interview red flags indicating possible appendicitis?

- pain may initially be epigastric/periumbilical but the moves to the RLQ - flank pain or pain in thigh and testicles (depending on position) - nausea and anorexia AFTER pain onset

What are physical exam red flags indicating possible appendicitis?

- abdominal rigidity w/ rebound tenderness - (+) mcBurney's point - (+) psoas and obturator sign

What are tests used to rule out appendicitis?

Mcburney's point Iliopsoas muscle palpation

What is the psoas sign?

Pain at the psoas during passive EXT of the RIGHT thigh --> pain in the R lateral buttock

What is the obturator sign?

Pain during passive IR of the flexed thigh --> pain on lateral side of knee

What is diverticulosis?

a condition that occurs when small pouches, or sacs, form and push outward through weak spots in the wall of your colon.

What is diverticulitis?

inflammation or infection within the colon wall

What are s/s of diverticulitis?

- over intestinal bleeding - L lower adominal pain - L pelvic pain - Bloody stool - increased WBC

Where is palpation done for diverticular diseases?

suprapubic area

How is diverticular disease diagnosed?

Diverticular disease may look like ___.

appendicitis

What is pancreatitis?

Inflammation of the pancreas resulting in auto digestion

Approx 70% of predisposing risk factors for pancreatitis are what?

Gallstones and alcoholism

What GI diagnosis is the most common to lead to admission to a hospital?

Pancreatitis (other than gallbladder)

Where is pain found for pancreatitis?

Upper shoulder (epigastric)

What are s/s of pancreatitis?

- N/V (MOST COMMON) - upper shoulder pain (epigastric) - constant pain - increased temperature - tachycardia

Pancreatic cancer is found in what population?

African American men < 45 y/o

(true/false) Pancreatic cancer is common.

FALSE (it is rare)

Pancreatic cancer can be associated with what?

What are s/s of pancreatic cancer?

- jaundice - back pain (indication of advanced disease) - low/dull R abdominal pain

How is pancreatic cancer diagnosed?

US and CT

What are risk factors for pancreatic cancer?

smoking and high fat diet

What is considered as the “common cold of the stomach?"

IBS

What is IBS?

A functional disorder of motility in the small and large intestines with no identifiable abnormality of the bowel.

What is the most common GI disorder in the west?

IBS

What are s/s of IBS?

- pain abdominal cramps - flatulence - anorexia - belching - abdominal distention - bowel changes

What are examples of INFLAMMATORY bowel disease?

- ulcerative colitis - crohn's disease (regional enteritis / ileitis)

About 15% of patients w/ inflammatory bowel disease (Crohn’s disease or ulcerative colitis) have ______. clinically

sacroiliitis

What are s/s of crohn's disease?

- purple or red skin rash (LEs most commonly affected) - joint pain/arthritic component - intermittent fever - sweats, malaise, anemia

What is ulcerative colitis?

Inflammation and ulceration of the inner lining of the large intestine (colon) & rectum

What is more common to form with ulcerative colitis?

colon cancer

What are s/s of ulcerative colitis?

- rectal bleeding - nocturnal diarrhea - fever - N/V - weight loss

Ulcerative colitis that is associated with colon cancer commonly develops at what age?

< 16 y/o UC is commonly present for > 30 yrs

What is crohn's disease?

Chronic inflammation of all layers of the bowel wall

What population is crohn's disease commonly found in?

15-30 y/o

What are the 5 subtypes of Crohn's disease?

Gastroduodenal Jejunoileitis Ileitis = ileum (lowest/last part of small intestine) Ileocolitis = most common Colitis

What are patient interview red flags for colon cancer?

- bowel disturbance (rectal bleeding and red stool) - weight loss - Family PMH of colon cancer - pain not altered by positioning or movement

(true/false) colon cancer is in the 3rd most common cancer.

true

What are physical exam red flags for colon cancer?

- TTP of adomen - ascites (fluid in the abdomen)

What can be the first signs for colon cancer?

Metastases to liver, lung, bone, or brain

What is the most common MET site of colon cancer?

T-spine and ribcage

What are precursors to cancerous lesions for colon cancer?

polyps

Colon cancer and colorectal cancer are commonly found in what population?

> 50 y/o

Colorectal cancer is commonly misdiagnosed as ______ due to similar presentation.

Diverticular disease

(true/false) colorectal cancer can be asymptomatic until it is fully progressed

true

What are s/s associated with a better prognosis with colorectal disease?

rectal bleeding

What are s/s associated with a worse prognosis for colorectal cancer?

Constipation

What are s/s for colorectal cancer when symptomatic?

- rectal bleeding - constipation - colicky pain - sacral pain and LBP (usually in advanced stage)

Gastrointestinal Flashcards

(103 cards)