Gastrointestinal Overview - Brown Flashcards Preview

Adult/Ped Medicine 4 > Gastrointestinal Overview - Brown > Flashcards

Flashcards in Gastrointestinal Overview - Brown Deck (16):
1

Barium Enema

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

barium inserted into colon and radiographs taken

helpful to diagnose: diverticulitis, polyps, tumors

limitations: abnormalities need to be followed up by colonoscopy, patient discomfort

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1

CT Scan

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

incremental images

helpful to diagnose: acute abdominal conditions, tumors

limitations: radiation exposure, cost

2

Esophagogastroduodenoscopy (EGD)

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

scope inserted through patient's mouth, down esophagus to stomach and part of small intestine

helpful to diagnose: mucosal ulcerations or abnormalities; visualiztion and biopsy

limitations: unable to determine reflux or swallowing problems

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3

Colonoscopy

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

** gold standard ** - scope visualizes the entire colon, can also perform biopsies

helpful to diagnose: polyps, mucosal abnormalities, diverticula, tumor

limitations: limited if stool present, chance of perforation

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4

GI History

 

Identify and describe key elements of history and physical exam in the diagnostic approach to GI disorders

History of Present Illness

  • OLD CHARTS
  • Significance - relationship to life events, stress

Past Medical History

  • Significant Illness: DM
  • Previous Surgeries: adhessions
  • Preventative Care: EKG, colonoscopy
  • Allergies

Family History

  • Cancer
  • Somatic pain conditions
  • Aneurysm
  • Polyposis

Social History

  • life stress
  • eating
  • sleeping
  • working
  • coping ability
  • family/support
  • recent travel
  • addictions: tobacco, alcohol, drugs

5

GI Physical Exam

 

Identify and describe key elements of history and physical exam in the diagnostic approach to GI disorders

  • OBSERVE: patient's gait, guarding, ability to climb on table
  • POSITION: patient supine with knees slightly flexed
  • INSEPECT
  • AUSCULTATE
  • PERCUSS
  • PALPATE
  • may need to perform pelvic and rectal exam, hemoccult

6

Ultrasonography

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

 

safer test - no inoizing radiation

helpful to diagnose:

  • cholecystitis/cholelithiasis
  • cholangitis
  • abscesses
  • diverticulitis
  • SB inflammation

limitations:

  • blind to many areas of the abdomen

7

Flexible Sigmoidoscopy

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

done in the office - scope inserted through anus and inspects distal 1/3 of colon, capable of visualization and biopsy

helpful to diagnose: abnormalities of mucosa (polyps, diverticula, tumors, ulceration)

limitations: max 60 cm, grin and bear it, difficult if stool is present, patient comfort, chance of peforation

8

Common GI Symptoms

  • Dyspepsia
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • GI Gas

9

GI Diagnostic Work-Up: Laboratory

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

  • CBC with differentials
  • Electrolytes
  • BUN, Creatinine
  • Liver Enzymes
  • Lipase
  • Amylase
  • TSH
  • hCG
  • Urinalysis
  • Stool Cultures
  • Hemoccult
  • H. Pylori

10

Biopsychosocial Factors  & GI Disorders

 

Describe the role of biopsychosocial factors in GI disorders

  • affect the clinical expression of GI illness and disease
    • genetic predisposition
    • early learning
    • cultural background

11

Plain Film X-Rays

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

usefulness:

  • bowel gas pattern
  • intrabdominal free air
  • air-fluid levels
  • densities
  • tumors

13

Enteric Nervous System (ENS)-Central Nervous System (CNS) Axis

  • brain-gut interaction
  • CRF, VIP, 5-hydroxytryptamine, serotonin derivatives, nitric oxide, cholecystokinin
    • regulate gastric motility, secretion, sensation and inflammation

14

Esophageal Manometry

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

tube from nose to esophagus - measures esophageal function by pressure readings of muscle contractions (motility)
 
helpful to diagnose: motility disorders
 
limitations: no visualization

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15

Barium Swallow

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

radiologist visualizes stomach and esophagus under fluroscopy
 
helpful to diagnose: stricture, hiatal hernia, swallowing problems
 
limitations: unable to visualize or biopsy

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16

24-hour pH probe

 

Describe the diagnostic work-up involved with GI disorders and identify preferred diagnostic testing

tube from the nose to esophagus to LES, pH sensor at tip determines acid expsoure

or can "clip" the probe to the esophagus, eventually detaches and passes in the stool

helpful to diagnose: GERD *gold standards

limitations: inconvenient