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MI Differential Diagnosis > GI pathology > Flashcards

GI pathology Flashcards

1
Q

List GI pathologies

A
  1. Peptic ulcer
  2. Inflammatory Bowel Disease
    • Crohn’s disease
    • Ulcerative colitis
  3. Colorectal cancer
  4. Pancreatic cancer
  5. Appendicitis
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2
Q

describe a peptic ulcer

A

loss of tissue lining lower esophagus, stomach and duodenum

can cause shoulder pain (usually R) or back

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3
Q

what are some causes of peptic ulcers

A
  1. infection with H. pylori
  2. chronic NSAID use
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4
Q

what are the 2 types of peptic ulcers?

A
  1. erosions
    • acute lesions that do not extend through the mucosa
  2. chronic ulcers
    • destroys musculature and replaces it with scar tissue
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5
Q

Clinical S/S of Peptic Ulcers

A
  1. Heartburn
  2. Night pain (12am - 3am)
  3. Radiating back pain
  4. Stomach pain
  5. R shoulder pain
  6. Lightheadedness/fainting
  7. N/V
  8. Anorexia
  9. Weight loss
  10. Bloody stool
  11. Black, tarry stools
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6
Q

list GI complications of NSAID use

A
  1. most obvious clinical negative effect is on the gastroduodenal mucosa
  2. range from subclinical erosion of mucosa to ulceration with life-threatening bleeding and perforation
  3. responsible for 40% of hospital admissions among pts with arthritis
  4. NSAID-induced GI bleeding is major cause of morbidity and mortality among older population
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7
Q

Risk factors for NSAID-induced gastropathy

A
  1. age older than 65 yo
  2. history of peptic ulcer disease or GI disease
  3. smoking, alcohol use
  4. oral corticosteroid use
  5. anticoagulation or use of anticoagulants
  6. renal complications in pt with HTN or CHF
  7. use of acid suppressants
  8. NSAIDs combined with selective serotonin reuptake inhibitors
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8
Q

Clinical S/S of GI complications of NSAID use

A
  1. Asymptomatic
  2. Stomach upset/pain
  3. Indigestion, heartburn
  4. Skin reactions
  5. Increased BP
  6. New-onset back (thoracic) or shoulder pain
  7. Melena
  8. Tinnitus
  9. CNS changes
  10. Renal involvement
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9
Q

CNS changes that can occur due to GI complications from NSAID use

A
  1. HA
  2. depression
  3. confusion (older pts)
  4. memory loss (older pts)
  5. mood changes
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10
Q

Renal involment symptoms from GI complications due to NSAID use

A
  1. muscle weakness
  2. unusual fatigue
  3. restless legs syndrome
  4. polyuria
  5. nocturia
  6. pruritus
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11
Q

what conditions are included in inflammatory bowel disease

A

Crohn’s disease

Ulcerative colitis

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12
Q

What is inflammatory bowel disease?

A

disorders of unknown etiology involving genetic and immunologic influences on GI tract

both chronic, medically incurable conditions

nutritional deficiencies are most common complications of IBD

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13
Q

T/F: skin lesions may occur in inflammatory bowel disease

A

TRUE

these include:

  • erythema nodsum
  • pyoderma
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14
Q

describe Crohn’s disease

A
  • inflammatory disease most commonly attacks terminal end of small intestine (ileum) and colon
  • occurs more commonly in young adults/adolescents
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15
Q

describe ulcerative colitis

A
  • inflammation and ulceration of lining of large intestine (colon/rectum)
  • cancer of colon more common in people with UC
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16
Q

IBD can be accompanied by what 2 non GI symptoms?

A
  1. Skin rash
  2. joint problems
    • usually responsive to treatment of IBD but do on occasion require separate management
17
Q

Clinical S/S of Crohn’s disease and ulcerative colitis

A
  1. Diarrhea
  2. Constipation
  3. Fever
  4. Abdominal pain
  5. Rectal bleeding
  6. Night sweats
  7. Decreased appeptite, nausea, weight loss
  8. skin lesions
  9. uveitis
  10. arthritis
  11. Migratory arthralgias
  12. Hip pain (iliopsoas abscess)
18
Q

describe colorectal cancer

A
  1. 3rd leading cause of cancer deaths
  2. incidence increases with age, beginning around 40
  3. screening can sig reduce mortality
  4. high-risk groups
    • previous hx of chronic IBD
    • adenomatous polyps
    • hereditary colon cancer
19
Q

Clinical S/S of Colorectal cancer in the early stages

A
  1. rectal bleeding, hemorrhoids
  2. abdominal, pelvic, back or sacral pain
  3. back pain that radiates down the legs
  4. changes in bowel patterns
20
Q

Clinical S/S of colorectal cancer in late stages

A
  1. constipation progressing to obstipation
  2. diarrhea with copious amounts of mucus
  3. N/V
  4. abdominal distension
  5. weight loss
  6. fatigue and dyspnea
  7. fever
21
Q

where is most pancreatic cancer located?

A
  • 70% arises in the head of the gland
  • 20-30% occur in the body and tail
22
Q

Clincial S/S of pancreatic carcinoma

A
  1. epigastric/upper abdominal pain radiating to the back
  2. LBP may be only symptom
  3. jaundice
  4. anorexia and weight loss
  5. light-colored stools
  6. constipation
  7. N/V
  8. weakness
23
Q

how may pain be worsened or relieved in pancreatic carcinoma?

A

worsened with walking and lying supine

relieved by sitting and leaning forward

24
Q

when is appendicitis most common?

A

in adolescents and young adults

this is serious and usually requires surgery

25
Q

Clinical S/S of appendicitis

A
  1. R lower quadrant/flank pain
  2. periumbilica and/or epigastric pain
  3. R thigh, groin, or testicular pain
  4. Abdominal involuntary muscle guarding and rigidity
  5. +McBurney’s point or +pinch-an-inch test
  6. rebound tenderness
  7. N/V
  8. Anorexia
  9. Dysuria
  10. low-grade fever
  11. coated tongue and bad breath
26
Q

Tests for Appendicitis

A

McBurney’s Point

Rovsing Sign

27
Q

Clues for screening for GI diseases

A
  1. previous hx of NSAID-induced GI bleeding
  2. symptoms increase within 2 hours after taking NSAIDs or other meds
  3. symptoms affected by food
  4. back pain and abdominal pain at the same level
    • esp in presence of constitutional symptoms
  5. Shoulder, back, pelvic or sacral pain
  6. back, pelvic or sacral pain relieved/reduced by bowel movement
  7. LBP accompanied by constipation
  8. joint pain with arthalgia preceded by skin rash
28
Q

Guidelines for immediate medical attention

A
  1. suspected appendicitis or iliopsoas/obturator abscess
  2. suspected retroperitoneal bleeding from injured, damage or ruptured spleen or ectopic pregnancy
29
Q

Guidelines for medical referral

A
  1. Pts who chronically rely on laxatives
  2. joint involvment accompanied by skin or eye lesions if MD is unaware
  3. hx of NSAID use with back or shoulder pain accompanied by S/S of peptic ulcer
  4. back pain assocaited with meals or relieved by a bowel movement (esp if accompanied by rectal bleeding)
  5. back pain of unknown cause that doesn’t fit MSK pattern (esp w/hx of cancer)
30
Q

describe abdominal pain of MSK origin

A
  1. sharp and focal
  2. cramping and aching, or deep
31
Q

describe abdominal pain of visceral origin

A
  1. dull
  2. aching
  3. cramping
  4. burning
  5. gnawing
  6. wave-like
  7. poorly localized
32
Q

T/F: both abdominal pain of MSK and visceral origin can present with nausea

A

TRUE

33
Q

list potential MSK sources of abdominal pain

A
  1. psoas referral
  2. lower T-spine
  3. slipping rib syndrome
  4. myofascial components
34
Q
A

MI Differential Diagnosis (16 decks)

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