GI Hepatic Lecture 7

Question 1

Globus Sensation - arises from

Answer 1

GERD

emotions

Question 2

Heart burn (acid reflux) vs Dyspepsia/Reflux

burning pain behind sternum
GERD & acid reflux
worse when lying down & after eating
can move up from stomach

Answer 2

Dyspepsia/Reflux

burning pain in upper abdomen
heart burn
bloating/belching/nausea & vomiting
often caused by peptic ulcer or GERD or bowel disorders

Question 3

7 common presenting complaints of GI

Answer 3

dysphagia
dyspepsia/Reflux
nausea
vomiting
pain
GI bleeding
change in bowel - diarrhoea & jaundice

Question 4

Dyspepsia/Reflux can be caused by……..

Answer 4

oesophageal or gastric cancer
GERD - worse when lying down
peptic ulcer

Question 5

Globus sensation - Red flags

Answer 5

Neck or throat pain
Weight loss
Abrupt onset after age 50
Pain, choking, or difficulty with swallowing
Regurgitation of food
Muscle weakness
Palpable or visible mass
Progressive worsening of symptoms

Question 6

Dyspepsia Red Flags

Answer 6

Acute episode with dyspnoea, diaphoresis*, or tachycardia
Anorexia
Nausea or vomiting
Weight loss
Blood in the stool
Dysphagia or odynophagia
Failure to respond to therapy with H2 blockers or proton pump inhibitors (PPIs)

Question 7

Causes of acute nausea/vomiting

try to find factors associated with attacks - food,drugs,movement,injury, change in bowel habits

Answer 7

GI infection
food poisoning
drugs
head trauma/migraine
abdominal visceral pain
pregnancy

Question 8

causes of chronic nausea/vomiting

over 1 month

Answer 8

motility disturbance
endocrine/metabolic disorder
intracranial pathology
partial obstruction of GI tract

Question 9

Red Flags - nausea/vomiting

Answer 9

The following suggest serious pathology in combination with nausea and vomiting:

Signs of hypovolemia
Headache, stiff neck, or mental status change
Peritoneal signs (e.g., guarding, rigidity, rebound tenderness)
Distended, tympanitic abdomen

Question 10

Name the 3 types of abdominal pain

Answer 10

1 - visceral - dull, poorly localised pain, often associated with autonomic features
2 - somato - parietal - more local than visceral, coming from parietal peritoneum
3 - referred - pain felt remotely from affected organ

Question 11

Peritonitis - what is it?
How is it caused?
What signs?

Answer 11

inflammation of the peritoneal cavity
may arise from perforation of the GI tract or inflamm. abdo condition
signs - guarding, rigidity, rebound tenderness on exam

Question 12

acute waves of sharp constricting pain that “take the breath away” is likely to stem from what?

Answer 12

renal or biliary colic

Question 13

waves of dull pain with vomiting is likely to stem from what?

Answer 13

intestinal obstruction

Question 14

Colicky pain that becomes steady is likely to stem from what?

Answer 14

appendicitis
strangulating intestinal obstruction
mesenteric ischemia

Question 15

tearing pain is likely to stem from what?

Answer 15

dissecting aneurysm

Question 16

dull ache is likely to stem from what?

Answer 16

appendicitis, diverticulitis, pyelonephritis

Question 17

Acute abdominal pain - red flags

Answer 17

Severe pain
Signs of shock (eg, tachycardia, hypotension, diaphoresis, confusion)
Signs of peritonitis
Abdominal distention

Question 18

Chronic abdominal pain - red flags

Answer 18

Fever
Anorexia, weight loss
Pain that awakens patient
Blood in stool or urine
Jaundice
Oedema
Abdominal mass or organomegaly

Question 19

Irritable bowel syndrome is recurrent abdominal discomfort accompanied by at least 2 of the following……

Answer 19

relief by defacation
change in frequency of stool
change in consistency of stool

(no cause is known but thought to have physiological & psychological factors)

Question 20

Types of GI bleeding

Answer 20

haematemesis - vomiting of blood, either bright red or coffee coloured (almost always from upper GI)
melaena - pasage of blood in the stool (may be from throughout GI tract)

Note - 50% of upper GI bleeds are due to peptic ulcer

Question 21

Diarrhoea - caused by?

Answer 21

certain drugs
unabsorbable water that stays in the bowel
infection
diverticular bleeding & ischemic colitis manifest with bloody diar.
in a young person recurrent bouts of bloody diar. suggest inflam. bowel disease
large vol. of 1 litre a day - endocrine cause if GI is normal

Question 22

Acute, persistent & chronic timeframes?

Diarrhoea

Answer 22

acute - lasting less than 2 weeks
persistent - 2 - 4 weeks
chronic - lasting over a month

Question 23

Diarrhoea red flags

Answer 23

Blood or pus
Fever
Signs of dehydration
Chronic diarrhoea
Weight loss

Question 24

define constipation?

Answer 24

at least 12 non consecutive weeks in last year & involving 2 or more of - 
straining during 1 in 4 poos
lumpy hard poos in more than 1 in 4
incomplete evacuaation in 1 in 4
sensation of a blockade
less than 3 a week

Question 25

What causes constipation?

Answer 25

sudden change in physical activity change in diet, decreased fibre medication bowel obstruction

Question 26

Constipation - red flags

Answer 26

``` Distended, tympanitic abdomen Vomiting Blood in stool Weight loss Severe constipation of recent onset/worsening in elderly patients ```

Question 27

Jaundice red flags

Answer 27

marked abdo pain/tenderness altered mental state GI bleeding Kushlas babies - ecchymoses, petechiae & little purpura

Question 28

Causes of Dyspepsia/Reflux..........

Answer 28

achalasia (failure of smooth mms to relax) - worse with food & dysphagia that gradually worsens cancer - dysphagia coronary ischemia - may have extertional component oesophageal spasm - substernal pain with/wo dysphagia GERD - heartburn, reflux worse when lying down peptic ulcer disease - burning/gnawing pain relieved by antacids

Question 29

What is GERD? Who does it affect & symptoms? MUST KNOW

Answer 29

gastric oesophageal reflux disease - 25-40% of people will experience - Western diet All ages, both sexes Excessive retrograde movement of acid-containing gastric secretions or bile from duodenum & stomach into oes. Dysfunc. - oesophag. sphincter may be cause or stom. or oes. Symptoms - coughing/wheezing chest pain dysphagia regurgitation

Question 30

Gastric Ulcer - what does it affect/who, aet, symptoms etc? MUST KNOW

Answer 30

Affects stomach or duodenum - at any age Aet - H.Pylori & NSAIDS disrupt mucosal defence/repair, eradicate h.pylori 70% of cases, ulcer gone SYMP/SIGNS - burning pain, duodenal relieved by food, gastric ulcer worsened duodenal - more consistent pain, pain at night gastric - no pain pattern

Question 31

Appendicitis - what does it affect/who, aet, symptoms etc? MUST KNOW

Answer 31

Very common cause of pain & surgical emergency, 7% of pop - higher Western Aet - obstruction of appendiceal lumen leading to bacterial growth, inflamm. ischemia, Signs/symptoms - pain in area, nausea, vomiting, absent or few bowel movements

Question 32

Diverticulitis - what does it affect/who, aet, symptoms etc? MUST KNOW

Answer 32

diverticula or diverticulitis protruding through colonic wall Western countries - like all GI stuff Patho - fecal or undigested food in a diverticula Signs/Symptoms - pain/tenderness in lower left Q, if bowel obstruction then nausea, vomiting.

Question 33

Chron's disease - what does it affect/who, aet, symptoms etc? MUST KNOW

Answer 33

disease of the distal ileum, colon generally - spares the rectum. But can affect any part of GI. Epi - men & women, 15-30 & 60-70 Aet - unknown - genetic, environ, NSAIDs Patho - chronic inflamm. from T cell activation Signs/symp - rectal bleeding,fever, weight loss,nausea, vomiting, psychological issues

Question 34

Ulcerative Colitis - what does it affect/who, aet, symptoms etc? MUST KNOW

Answer 34

inflamm. disease that generally involves only large intestine (colon & rectum) Epi - men & women, 15-30, 60-70, 35-100 per 100 000 Aet - unknown, NSAIDs, genetic, environ Patho - usually begins in rectum, rarely the whole LI Signs/Symp - bloody diarr, urgency to defacate, mild lower abdo cramps, blood/mucous in stolls

Question 35

Irritable bowel syndrome - what does it affect/who, aet, symptoms etc? MUST KNOW

Answer 35

recurrent abdo pain accompanied by at least 2 of: relief by defacation, change in frequency of stool, change in consistency Epi - 10-20%, women 2-3 times more, adoles, 20s then bouts Aet - unknown, combo of psycho & physiological Patho - unknown, visceral hyperalgesia, psycho-social Signs/symp - abdo discomfort, change in stool patterns, dyspepsia (indigestion) - all these can be triggered by food, stress...