GI MDT S/S Hallmarks Flashcards
(40 cards)
_More than 3 bowel movements every day
_Less than 2 weeks in duration
_Transmitted by fecal-oral contact, food, and water with incubation periods of 12-72 hours
_Caused by a BACTERIA, parasites, or toxins
_BLOODY, small volume stools
_Fever > 38.5 C
Acute Infectious Diarrhea
INFLAMMATORY
_More than 3 bowel every movements a days
_Less than 2 weeks in duration
_Transmitted by fecal-oral contact, food, and water with incubation periods of 12-72 hours
_Caused by a VIRUS or enterotoxins
_Large volume watery diarrhea
_NON BLOODY
Acute Infectious Diarrhea
NON-INFLAMMATORY
_Diarrhea present for greater than 4 weeks
Osmotic: Medication, Zollinger-Ellison Syndrome
Inflammatory: Inflammatory Bowel Disease, Malignancy
Secretory: Increase secretory activity Chronic infections: Parasites or giardia
Malabsorption syndromes: Celiac disease, Whipple, Crohn disease, lactose intolerance
Motility disorders: Irritable Bowel Syndrome
Chronic Diarrhea
_Typically diagnosed at endoscopy
_Endoscopy often performed because of dyspepsia, or upper GI bleeding
_Most commonly seen in ALCOHOLICS and LONG TERM NSAIDs USE, and critically ill patients
_Often asymptomatic
_Epigastric pain
_Nausea and vomiting
_Hematemesis
_Upper GI bleeding with “coffee grounds” emesis or bloody aspiration on NG Tube
Erosive and Hemorrhagic Gastritis
TYPES:
_H. Pylori
_Pernicious anemia
_Eosinophilic
_Typically asymptomatic
_May present as dyspepsia, bloating, and postprandial fullness/discomfort
Non-erosive and Non-specific Gastritis
_Most common digestive complaint in the United States
CAUSES:
_Diminishing intake of fiber and fluid
_Systemic disease
_Medication
_Structural abnormalities
_Slow colonic transit
_Irritable Bowel Syndrome
_Hirschsprung disease
_Infrequent stool
_Excessive straining
_Sense of incomplete evacuation
_Need for digital manipulation
Constipation
_Located above the dentate line
_No nerve innervation
Subepithelial Cushions:
_Submucosa (connective tissue, blood vessels)
_Muscularis
PRIMARY LOCATIONS:
_Right anterior and posterior
_Left lateral
_Painless, bleeding, prolapse, and mucoid discharge
_Not visible or palpable (may protrude through the anus with gentle straining)
_Prolapsed hemorrhoids are visible purple nodules covered by mucosa
_Bright red blood streaks visible on toilet paper/stool or bright red blood that drips into the toilet
Internal Hemorrhoids
_Arise from the inferior hemorrhoidal veins located below the dentate line
_Below the dentate line
_Possess nerve innervation
_PAINFUL
_Visible bluish perianal nodule
_Tender to palpation
External Hemorrhoids
_Occur most commonly in the posterior midline at 6 o’clock
_Acute anal fissures look like cracks in epithelium
_Chronic anal fissures can result in fibrosis and the development of skin tags
CAUSE:
_Trauma to the anal canal from straining, constipation, or high interval sphincter tone
_Linear or rocket shaped ulcer that is usually less than 5mm in length
_Severe, tearing pain during defecation followed by throbbing discomfort that may lead to constipation
_Bright red blood on stool or toilet paper
Anal Fissure
_Begins with the obstruction of an anal gland that opens in the base of an anal rectal crypt
_More common in young middle aged males
_As they persist, a fistula formation may develop
DIFFERENT ABSCESS SITES:
_Perianal most common
_Intersphincteric space
_Ischiorectal space
_Deep postanal space
_Supralevator less common
_Dull, aching, or throbbing pain that becomes worse immediately before defecation, is lessened after defecation, but persist between bowel movements
_Aggravated by straining, coughing, or sneezing
_Pain and tenderness interfere with walking or sitting
Anorectal Abscess
_A chronic manifestation of the acute perirectal process that forms an anal abscess
_Commonly referred as “fistula-in-ano”
_Nonhealing” anorectal abscess following drainage
_Chronic purulent drainage and a pustule-like lesion in the perianal or buttock area
_Intermittent rectal pain during defecation and sitting
_Intermittent and malodorous perianal drainage and pruritus
Anorectal fistula
_Asymptomatic hair containing cyst and sinuses to large symptomatic abscesses of the sacrococcygeal region
_Caused by ingrown hair
_Occur in the midline of the gluteal crease
_Swelling
_Pain
_Persistent discharge
_Tender mass
_Recurrent infection at the base of the spine
Pilonidal Disease
_A chronic recurrent disease characterized by diffuse mucosal inflammation involving ONLY the colon
_More common in non smoker and former smokers
_Pseudo-polyps
_Bloody diarrhea
_ Periods of symptomatic flare ups and remissions
_Lower abdominal cramps and fecal urgency
_Anemia
_Continuous inflammation of the mucosa layer distal to proximal of the colon
Ulcerative Colitis
_Is a chronic, recurrent disease characterized by patchy transmural inflammation involving ANY segment of the gastrointestinal tract from the mouth to the anus.
_Obtain surgical/hospitalization history
_Most common area ileitis or ileo-colitis
_Skip lesions
_NON bloody diarrhea
_Fever
_Weight loss and malaise
_General sense of well-being
_Cramping abdominal pain _Possible intra-abdominal abscess
Crohn’s Disease
_Chronic (more than 3 months) abdominal pain that occurs in association with altered bowel habits
_Late teens to early 20’s
NORMAL physical exam (no fevers, rashes, or bloody stool)
_Abdominal discomfort (lower abdominal region) is relieved immediately after defecation
_Bloating or feeling abdominal distention
Dx CRITERIA (PAIN + 2/3):
1. Relieved with defecation
2. Associated with change in frequency of stool
3. Associated with change in form (appearance) of stool
Irritable Bowel Syndrome (IBS)
_A condition that develops when the reflux of stomach contents causes troublesome symptoms or complications
_The LOWER ESOPHAGEAL SPHINCTER plays a vital role in frequency and severity
COMPLICATIONS
Barrett Esophagus:
Peptic Stricture:
_Heartburn occurs 30-60 minutes after meals and upon bending over or reclining
_Reports relief from taking antacids or baking soda
_Complain of regurgitation
_Dysphagia
_Dyspepsia
_Cough
_Chest pain
_Belching
_Hoarseness
Gastroesophageal Reflux Disease (GERD)
_History of taking pills without water or supine
_Bed bound patients are at greater risk
_Severe retrosternal chest pain
_Odynophagia and dysphagia often beginning several hours to one month after taking a pill
Pill Induced Esophagitis
_Is most common in HIV infected patients and in patients with hematologic malignancies
_May occur in patients with uncontrolled diabetes and those being treated with systemic corticosteroids
_Odynophagia or pain on swallowing
_LOCALIZED pain to a discrete retrosternal area swallowing
_White mucosal plaque like lesions are noted on the endoscopy
Candida Esophagitis
CAUSE:
_Esophageal irritation from chronic GERD
_Eosinophilic esophagitis
UNCOMMON CAUSES:
_Strictures secondary to external beam radiation, esophageal sclero therapy, caustic ingestions
_Localized substernal chest pain
_Heartburn
_Dysphagia
Esophageal Stricture
_Idiopathic motility disorder which causes loss of peristalsis in the lower distal 2/3 of the esophagus and impaired relaxation of the lower esophageal sphincter
_Gradual onset of dysphagia with solid foods and some liquid
_Can be present for months
_Substernal chest pain and discomfort/fullness
_Lifting neck or throwing shoulders back to enhance gastric emptying
_Regurgitation
Esophageal Spasm
_A break in the gastric or duodenal mucosa that arises when the normal mucosal defensive factors are impaired or overwhelmed
_Ulcers are 5X more common in duodenum
_Ulcers extend through the muscularis mucosa
TWO MAJOR CAUSES:
1. NSAIDs
2. H. Pylori
_Gnawing, dull, aching or “hunger like” epigastric pain
_Nausea and anorexia (gastric ulcers)
_Relief of pain with food or antacids and a recurrence of pain 2-4 hours later
Peptic Ulcer Disease
_Inflammation of the diverticulum (a sac like protrusion on the colonic wall)
_Acute abdominal pain and fever
_Left lower quadrant tenderness with palpable mass
_Constipation or loose stool
_Nausea and vomiting
Diverticulitis
_Bleeding that occurs proximal to the ligament of Treitz
COMMON PRESENTATION:
1. Hematemesis
2. Melena (develops after 50 ml of upper GI blood loss)
HEMATEMESIS:
_Bright red blood (indicates a bleed at or proximal to the LES
_“Coffee ground” emesis (indicates a bleed in the stomach or proximal duodenum)
MELENA:
_“Tar colored” black stool (iron in hemoglobin + gastric acid)
HEMATOCHEZIA:
_Massive upper GI bleed > 1000ml
UPPER GI Bleed
_Bleeding that occurs distal to the ligament of Treitz
COMMON CAUSE:
_Diverticulitis
_IBD (Ulcerative Colitis)
_Hemorrhoids
_Fissures
_Commonly presents as HEMATOCHEZIA (bright red blood per rectum)
_Large volumes of bright red blood suggest colonic source
_Maroon stool = right colon or small intestine
_Melena = source proximal to ligament of Treitz
LOWER GI Bleed
