GI Intro Flashcards by Leslie Mancini

Oropharyngeal dysphagia

Problems in transferring the food bolus from the oropharynx to the upper esophagus

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Esophageal dysphagia

Impaired transport of the food bolus through the body of the esophagus
May be accompanied by the feeling of food getting “stuck”

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Odynophagia
Commonly associated with

Sharp pain on swallowing that may limit oral intake

Commonly associated with erosive disease
Candida
Herpesvirus
CMV
Caustic ingestions

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Pyrosis

Also known as heartburn
Feeling of substernal burning, often radiating to the neck
Caused by the reflux of gastric contents into the esophagus

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Dyspepsia
Described as?

Also known as indigestion

Persistent or recurrent pain or discomfort in the upper abdomen
Commonly described as early satiety, postprandial fullness, gnawing or burning

Usually indicates an underlying problem

Types:
Ulcer-like
Dysmotility-like
Reflex-like

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Types of Dyspepsia

Ulcer-like
Where is the pain?

Pain localized in the epigastrium
Frequently occurs before meals and is relieved by eating food, antacids, or H2 blockers

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Types of Dyspepsia

Dysmotility-like

Discomfort rather than pain along with early satiety, postprandial fullness, nausea, vomiting, bloating
Symptoms are worsened by food

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Types of Dyspepsia

Reflux-like

Heartburn and/or acid regurgitation

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Dyspepsia

Contributing factors:

Overeating
Eating too quickly
Drinking too much alcohol or coffee
Medications: aspirin, NSAIDs, antibiotics, diabetes drugs, antihypertensive drugs

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Dyspepsia

Alarm Sx

Alarm symptoms:
Weight loss
Odynophagia
Progressive dysphagia
Constant or severe pain
Persistent vomiting
Hematemesis
Melena
Failure to respond to standard therapy

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Dyspepsia

History
Clarify the chronicity, location, and quality of the pain
Determine the relationship of the pain with meals

Labs & Diagnostics
Labs: CBC with diff, BMP, and FOBT
C14-urea breath test- Screening for H. pylori infection
≤ 45 years with no alarm symptom

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Dyspepsia

Upper endoscopy
Indications:

Patients > 60 years
> 45-59 years with alarm symptoms
Biopsies for H. pylori should be obtained
Esophageal manometry and pH studies - reflux symptoms

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vomiting

general

Forceful expulsion of gastric contents produced by involuntary contractions of the abdominal musculature when the gastric fundus and lower esophageal sphincter are relaxed

Controlled by the brainstem (medulla)

4 main causes

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vomiting

Visceral afferent stimulation

type 1

Biliary or gastrointestinal distention, mucosal or peritoneal irritation, dysmotility (gastroparesis), infections, GI irritants (alcohol, NSAIDs)

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vomiting

Vestibular disorders

type 2

Meniere syndrome, motion sickness

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vomiting

CNS disorders

type 3

Certain sights, smells, or emotional experiences, ↑ intracranial pressure, migraine headache, infections (meningitis)

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vomiting

Irritation of chemotherapy trigger zones

type 4

Drugs, chemotherapeutic agents, toxins, hypoxia, uremia, acidosis, radiation therapy

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Vomiting, diarrhea, and fever = A
Vomiting undigested food = B

A. infectious gastroenteritis
B. achalasia

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Vomiting partially digested food >3 hours after ingestion =

gastric outlet obstruction or gastroparesis

Vomiting, obstipation, and abdominal distension =

bowel obstruction

Vomiting, headache, mental status change, and/or papilledema =

CNS etiology

Vomiting with tinnitus or vertigo =

inner ear disorder

Intractable vomiting during pregnancy =

hyperemesis gravidarum

vomiting

Labs & Diagnostics

Urine pregnancy test → ♀ of child-bearing age
UA, CBC, BMP or CMP → severe vomiting, vomiting >1 day, or signs of dehydration
Flat and upright abdomen x-rays → s/s of obstipation or perforation

Chronic vomiting
Referral to GI for upper endoscopy, small bowel x-rays, assessment of gastric emptying

# vomiting Tx Nothing to eat or drink

NPO for 4-6 hours then a trial of clear liquids in small quantities IV hydration for dehydration

# vomiting Antiemetic medications

Serotonin 5-HT3-receptor antagonists Ondansetron (Zofran) Dopamine antagonists -Induce sedation Metoclopramide (Reglan) Promethazine (Phenergan)

# vomiting Antihistamines & anticholinergics

for CNS conditions Meclizine Transdermal scopolamine

# Vomiting Cannabinoids (marijuana)

Excessive use can lead to nausea, vomiting, and abdominal pain (cannabinoid hyperemesis syndrome)

Hiccups and causes

Usually benign, self-limited Causes: Gastric distention (carbonated beverages, air swallowing, overeating) Sudden temperature changes (hot to cold liquids) Alcohol ingestion Emotional states (excitement, stress, laughing)

Persistent hiccups could be a sign of serious underlying illness

Lasting >48 hours Often the results of irritation of the vagus or phrenic nerves Examples: pleurisy of the diaphragm, pneumonia, liver cancer, pancreatitis, disorders of the stomach or esophagus, uremia

# hiccups Simple remedies:

Lifting of the uvula Eating 1 teaspoon of granulated sugar Interruption of the respiratory cycle by holding a breath Valsalva maneuver Irritation of the diaphragm by holding the knees to the chest Relief of gastric distention by belching or insertion of a nasogastric tube

# hiccups Tx Pharmacotherapy

Chlorpromazine (Thorazine) 25-50 mg PO or IM

Eructation

Commonly known as a belch Involuntary or voluntary release of gas from the stomach or esophagus Occurs most frequently after meals when gastric distention results in transient lower esophageal sphincter (LES) relaxation Stomach gas common comes from swallowed air Rapid eating Gum chewing Smoking Ingestion of carbonated beverages

Bloating

Complaint of increased abdominal pressure or fullness that is or is not accompanied by visible distention Causes: Diet: eating fatty foods; eating too fast; overeating Lactose intolerance Constipation Gastroesophageal reflux disease (GERD) Irritable bowel syndrome (IBS)

Ascites

The accumulation of protein-containing fluid within the abdomen Patient may experience weight gain, increased abdominal distention, abdominal discomfort, loss of appetite, shortness of breath Tends to occur in chronic rather than acute disorders Causes Liver disease (most common) Cancer Heart failure Kidney failure Pancreatitis Tuberculosis

# Ascites Physical examination

Percussion of the abdomen = dull sound due to fluid Clinically detectable when there is at least 500 mL of fluid present

# Ascites Imaging

Abdominal ultrasound or CT scan of the abdomen and pelvis

# Ascites Diagnostics paracentesis

Process of obtaining a sample of ascites fluid by inserting a needle through the wall of the abdomen Fluid is sent to the lab for analysis Analysis can help determine the underlying cause and identify signs of infection

# Ascites Complication | Spontaneous bacterial peritonitis

Spontaneous bacterial peritonitis Potentially fatal infection of the ascites fluid that develops for no apparent reason Common among patients with ascites due to cirrhosis (alcoholics)' Signs & Symptoms Abdominal discomfort/tenderness Fever Confused/disoriented Drowsy Treatment Prompt treatment with IV antibiotics

Explain the difference between a sign and a symptom. What are the 4 categories of signs and 3 main types of symptoms Explain the following symptoms: dysphagia, odynophagia, pyrosis, dyspepsia, eructation, bloating. What is the most common cause of odynophagia? What factors contribute to dyspepsia?

Name symptoms that are alarming when associated with dyspepsia. What are the four causes for vomiting? Explain which labs and diagnostics you could order for a patient with vomiting. What is the association of cannabinoids and vomiting?