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Diagnosis and Management 1 > GI > Flashcards

GI Flashcards

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1
Q

Patients in whom abd pain is particular concern

A

Very old, very young, HIV+, immunosuppresed

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2
Q

What kind of abd pain is most common>

A

Visceral

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3
Q

What does visceral pain feel like>

A

Vague, dull, nauseating, poorly localized. Worse with distention and contraction.

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4
Q

What are foregut structures? Where do they cause pain?

A

Stomach, duodenum, liver, pancreas; cause upper abd pain

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5
Q

What are midgut structures? Where do they cause pain?

A

Small bowel, proximal colon, appendix; cause periumbilical pain

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6
Q

What are hindgut structures? Where do they cause pain?

A

Distal colon, GU tract; cause lower abd pain

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7
Q

Diseases that cause epigastric pain

A

Indigestion, cholecystitis

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8
Q

Diseases that cause periumbilical pain

A

intestinal obstruction, early appendicitis

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9
Q

Diseases that cause suprapubic pain

A

S/L intestine, UTI, IBD

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10
Q

Definition/Cause Referred Pain

A

Pain perceived distant from source; Due to lack of dedicated sensory pathways in brain for internal organs

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11
Q

Common examples of referred pain (Scapular, Groin, Shoulder)

A

Scapular - Biliary colic
Groin - Renal colic
Shoulder - Irritation of diaphragm from blood or infection

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12
Q

Definition and sxs of parietal/somatic pain

A

Comes from parietal peritoneum (lining of abd organs); sharp and well localized

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13
Q

Common causes of parietal pain

A

Acute inflammation, ischemia, infection; acute appendicitis, acute cholecystitis (vs. biliary colic causing visceral pain)

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14
Q

Psychogenic Pain - Description

A

Hx of multiple systems in pain, CHRONIC, non progressive, sxs of depression

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15
Q

Tips for assessing psychogenic pain

A

Do deep palpation with stethescope to assess true severity while pt distracted

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16
Q

What is seratonin

A

Neurotransmitter and hormone, important role in mood, sleep, appetite, temp regulation, pain perception, sex and secretion of other hormones

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17
Q

Where is most seratonin found (2 places)

A

GI tract, blood platelets

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18
Q

Seratonin role in GI system

A

Initiate gut motility, allow stomach to expand, transmit info to CNS

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19
Q

HPI for abd pain

A

localization, characterization, referral?, course/onset/resolution, aggrivating/aleviating, associated sxs

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20
Q

Examples of charictarization by disease (duodenal ulcer, intestinal obstruction, acute appendicitis)

A

Duodenal ulcer - burning/gnawing
Intestinal obstruction-crampy
Acute appendicitis - Aching

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21
Q

Most serious accociated sxs for abd pain

A

Weight loss, blood in stool, jaundice, N/V, fever

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22
Q

Social factors that affect GI

A

Caffine, ETOH, smoking, stress

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23
Q

What to include in abd PE (added for acute pain?)

A

Chest exam for pneumonia, CVAT, hernias, pulses; vitals (high RR and HR = pain, low BP can be low fluid volume); for acute include pelvic and rectal for occult blood

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24
Q

Sxs acute (surgical) Abd

A
  • Pain acute, persistent >6hrs
  • Symptoms progressed
  • Pain localized with rebound -tenderness, gaurding, rigidity
  • Pain worse with movement or cough
  • Lying still with knees to chest
  • Irritable infant lying still with flexed hips, quiet
  • N/V/A associated
  • Absent bowel sounds
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25
Sigs of worse N/V
- Vomitus smelles like feces or is bilious | - Pain occurs before vomitting (pain during or after = gastroenteritus)
26
How long must you listen before absent bowel sounds?
3 min
27
PE for acute abdomen
``` orthostatic BP and pulse (orthostatic indicates hemorrhage or third spacing) Cold/clammy (blood shunting) Tachy Impaired mentation Oliguria Fever ```
28
What is peritonitis
Inflammation of peritoneal cavity caused by any condition that causes inflammation
29
What can cause peritonitis
- Appendicitis - Diverticulitis - Stranguilating intestinal obstruction - pancreatitis - PID - Mesenteric ischemia - Intraperitoneal blood - Barium - Peritoneo-systemic shunts - Drains - Dialysis catheters - Ascities
30
Peritonitis presentation in elderly
- Mild fever - Tachy - Reduced bowel sounds - Vague abd discomfort - Also include cardiac/respiratory differentials
31
R/LUQ non GI sources of pain
- Herpes zoster - Lower lobe pneumonia - MI - Radiculitis (nerve pain)
32
What is GERD
-Reflux of gastric contents (gastric acid and digestive enzymes) into esopphagus
33
Causes of GERD
- Relxation of LES - Decreased secondary peristalsis - Decreased resistance to caustic liquids - Large hiatal hernia (stomach herniating through diaphragm) - Tobacco, strenuous exercise, ETOH - Calcium channel blockers -> decreased LES tone
34
Common GERD Food Triggers
Spicy, fried, fatty, citrus, caffine
35
Clinical features of GERD
- Heartburn within 30-60 minutes of eating - Worse lying down, bending over, tight clothes - May also have: regurgitation, nocturnal aspiration, ulcers, hemorrhage, dental erosion, laryngitis, asthma,Barrett's esophagus - Chest pain with heavyness or pressure radiating to neck, jaw, shoulder
36
GERD Hx
-Onset, agg/all, smoking?, NSAID/ASA, difficulty swallowing, weight loss, change in stool
37
When can you diagnose GERD just on history?
38
GERD PE
Ht/Wt, abd exam, occult blood in stool, usually no dx testing
39
Atypical GERD presentation/Referral
-Dysphagia, wt loss, melena; refer for endoscopy
40
Phase 1 GERD Therapy
Wt loss if obese, smoking cessation, elevate HOB, Smaller meals, no eating 2-3 hrs before bed, reduce high fat, chocolate, citrus, mints, coffee, alchohol, antacids PRN
41
Phase II GERD Therapy
- H2 blockers BID: Zantac, Pepcid | - PPI used when H2 fails or erosive esophagitis (Prevacid, Lansoprazole, Nexium, Protonix, Pantoprazole)
42
H2 Antagonists
-Zantac, Pepcid -First line for GERD MOA: suppress acid in stomach Directions: Take before, after, with meal -BID -OTC doses lower then prescription
43
PPI
- Prevacid, Prilosec, Nexium - If H2 fail or GERD returns - MOA: Shut down acid producing proton pumps - Directions: 30 min beforemeal - Qday
44
Possible effets of long term PPI sue
- Pneumonia - C.diff - Hypomagnesemia - Decreased Ca+ absorbtion - Interfere with B12 absorbtion
45
What H2 blocker should you avoid/why?
Cimetidine; CYP450 interactions
46
Evaluation of GERD tx
1-2 weeks. If controlled, continue tx 8-12 wks. After 8, D/C or lower meds. Some need low-dose maintenace. If unresolved in 8 weeks refer to gastroenterologist
47
Barret's Esophagus definition/cause
``` Complication of GERD Tissue injurty due to chronic exposure to pepsin, gastric acid, bile Premalignant condition of esophagus Typically White males >50 Presents as heartburn or dysphagia ```
48
Premalignant stages of Barrett's
Low or high grade dysplasia | Metaplastic columnar epitheliazation of distal esophagus
49
Risk of adenocarsinoma with Barrett's
-
50
Gastroparesis define/cause
Impaired gastric emptying r/t autonomic neuropathy; complication of uncontrolled DM
51
Effects of gastroparesis
Affects food absorbtion --> impaired glycemic control, N/V, sesation of always full
52
Gastroparesis Dx
Endoscopy, gastric emptying study
53
Gastroparesis Tx
Control hyperglycemia, dietary modifications, metroclopramide (reglan) short term (not in elderly)
54
Dysphagia definition
Swallowing disorder | Oropharyngeal or esophogeal
55
Oropharyngeal vs esophogeal dysphagia causes
Esophogeal usually has structural causes, oropharyngeal usually functional causes
56
Possible effects of dysphagia
Mild - Severe, malnutrition, dehydration, choking, aspiration, pneumonia, death
57
Transfer dysphagia (oropharyngeal)
- Usually neurological --> difficulty initiating swallow - Common in elderly - Caused by stroke, tumor, degenerative diseases, benzos, L-dopa - Difficulty with liquids--> regurg, choking, aspiration
58
Achalasia
- Most common motor dysphagia - Loss of peristalsis, LES fails to relax causing obstruction - Substernal chest pain for most - Difficulty with liquid and solid, cold makes it worse
59
Scleroderma (Dysphagia)
Causes loss of tone and propulsion in esophagus, more commonly leads to reflux
60
Dysphagia History
Onset: Gradual/chronic suggest motor, rapid and progressive suggest obstruction - Swallowing difficulty liquid or solid, is cold worse? - Effect of swallowing - Helps in motor, can cause regurg in obstruction - Wt loss - PMH neuro disease, chronic reflux, esophagitis - Nocturnal respiratory trouble or pneumonia (r/t tracheal aspiration) - Heart burn suggestions inflammatory stricture/disease
61
Dysphagia Differentials (Intermittent, w/ swallowing, solids, Diplopia, reflux and skin changes, tremor)
Intermittent - LES With swallow - Mucosal inflammation Difficulty with solids and heartburn - stricture With diplopia think myasthenia With reflux, skin changes, cold extremities - scleroderma or Raynaud's -With tremor - Parkinson's

Diagnosis and Management 1 (2 decks)

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