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Flashcards in Intro to GI Deck (49):
1

Most common GI complaints?

- pain and nausea

2

Most common causes of abdominal pain in ED?

- non-specific abd pain
- appendicitis
- biliary tract dz

3

Common acute pain syndromes?

- appendicitis
- acute diverticulitis
- cholecystitis
- pancreatitis
- perforation of an ulcer
- intestinal obstruction
- ruptured AAA
- pelvic disorders

4

Chronic abdominal syndromes?

- IBS
- chronic pancreatitis
- diverticulosis
- GERD
- IBD
- duodenal ulcer
- gastric ulcer

5

What could be the cause of epigastric pain?

- PUD
- GERD
- MI
- AAA
- pancreatic pain
- gallbladder and common bile duct obstruction

6

Causes of RUQ pain?

- acute cholecystitis and biliary colic
- acute hepatitis or abscess
- hepatomegaly due to CHF
- perforated duodenal ulcer
- herpes zoster
- myocardial ischemia
- right lower lobe pneumonia

7

Causes of LUQ pain?

- acute pancreatitis
- gastric ulcer
- gastritis
- splenic enlargement, rupture or infarction
- myocardial ischemia
- left lower lobe pneumonia

8

Causes of RLQ pain?

- appendicitis
- regional enteritis
- small bowel obstruction
- leaking aneurysm
- ruptured ectopic pregnancy
- PID
- twisted ovarian cyst
- ureteral calculi
- hernia
- testicular torsion

9

Causes of LLQ pain?

- diverticulitis
- leaking aneurysm
- ruptured ectopic pregnancy
- PID
- twisted ovarian cyst
- ureteral calculi
- hernia
- regional enteritis
- testicular torsion

10

Causes of periumbilical pain?

- disease of transverse colon
- gastroenteritis
- small bowel pain
- appendicitis
- early bowel obstruction

11

Causes of diffuse abdominal pain?

- gen. peritonitis
- acute pancreatitis
- sickle cell crisis
- mesenteric thrombosis
- gastroenteritis
- crohns/ulcerative colitis
- dissecting or rupturing aneurysm
- intestinal obstruction
- psychogenic illness

12

Causes of referred pain?

- pneumonia (lower lobes)
- inferior MI
- pulmonary infarction

13

Visceral pain?

- originates in abdominal organs covered by peritoneum

14

Colicky pain?

- crampy pain

15

Parietal pain?

- from irritation of parietal peritoneum

16

Referred pain?

- produced by pathology in one location felt at another location

17

Work up of abdominal pain?

- lab tests:
U/A, CBC,
additional: amylase, lipase, LFTs, H pylori

- dx studies:
plain x-rays
contrast studies (barium)
U/S
CT
endoscopy
sigmoidoscopy, colonoscopy

18

Impt hx questions you should ask your pt about abdominal pain?

- the way the pain begins: if pain comes on suddenly it suggests sudden event like ischemia or biliary colic
- location of the pain: diverticulitis: LLQ, Appendicitis: RLQ
gallblader: RUQ
- pattern of the pain: obstruction of pain initially causes waves of crampy abdominal pain, obstruction of bile ducts by gallstones causes steady upper abd. pain that can last for a couple hours. Pancreatitis: severe, unrelenting, steady pain in upper abdomen and back. Acute appendicitis: starts near umbillicus, and moves to RLQ
- duration of pain: IBS - waxes and wanes over months or years. Biliary colic lasts no more than a couple hours, pancreatitis can last for a couple days, GERD - periodic pain
- What makes the pain worse: pain due to inflammation - aggravated by sneezing, coughing, or any jarring motion
- What relieves the pain: IBS and constipation relieved temp by BM. Obstruction of stomach or upper small intestine - may be relieved temp by vomiting
- eating or antacids helps relieve ulcer pain
- pain that wakes pt from sleep most likely due to non-fxnl causes

19

Importance of assoc signs and sxs of abdominal pain?

- fever suggests infection
- diarrhea or rectal bleeding suggests intestinal cause of pain
- presence of fever and diarrhea suggest inflammation of intestines that may be infectious or non-infectious (ulcerative colitis or crohns)

20

Impt lab tests in abdominal pain complaint?

- CBC
- LFTs
- pancreatic enzymes: amylase and lipase
- UA

21

What does elevated white count suggest?

- inflammation or infection (such as appendicitis, pancreatitis, diverticulitis, colitis)
-

22

Amylase and lipase would be elevated in?

- pancreatitis

23

WBCs in stool (diarrhea) suggests?

- intestinal inflammation

24

Blood in the urine?

- suggests kidney stones

25

Liver enzymes may be elevated?

- gallstone attacks

26

Abdominal US is useful in dx?

- gallstones, cholecystitis, appendicitis, or ruptured ovarian cysts

27

CT usefulness?

- dx pancreatitis, pancreatic cancer, appendicitis, diverticulitis
- abscesses in abdomen
- CT of small intestine: crohns

28

Barium xrays of stomach and intestines useful in dx?

- ulcers, reflux, inflammation, and blockage in the intestines

29

EGD useful in dx?

- ulcers, gastritis, stomach cancer

30

Colonoscopy and flexible sigmoidoscopy useful in dx?

- infectious colitis
- ulcerative colitis
- colon cancer

31

How are causes of abdominal pain dx?

- characteristics of pain
- findings on physical exam
- lab, radiological, and endoscopic testing
- surgery

32

Timing of Nausea and causes?

- appearing shortly after a meal, nausea or vomiting may be caused by food poisoning, gastritis, ulcer or bulimia
- 1 to 8 hrs after a meal - may indicate food poisoning. Salmonella can take longer to produce sxs
- Have to rule out pregnancy as well!!

33

Vomiting stimuli?

- severe pain
- distension of stomach or duodenum
- torsion or trauma to ovaries, testes, uterus, bladder or kidney
- activation of chemoreceptor trigger zone in medulla

34

Projectile vomiting could be a sx of?


- direct stimulation of vomiting center by neurologic lesion or neuro inflammation
- this is spontaneous vomiting not preceded by nausea
- sx of GI obstruction

35

Etiologies of N and V?

- pain
- viral gastroenteritis
- GI inflammation, infection
- severe pain such as nephrolithiasis
- chemo
- neuro
- CV
- meds
- post-op

36

Physical manifestations of N and V?

- dehydration
- metabolic alkalosis
- hypokalemi/natremia/chloremia
- sxs assoc with underlying etiology

37

A pt presents with chronic, progressive dysphagia of solids and liquids. Barium study shows a dilated esophagus with a distal "bird beak" appearance. Likely dx?

- achalasia

38

A 48 female diabetic pt presents with a multimonth hx of chronic nausea, early satiety, and postprandial bloating. Most likely dx?

- diabetic gastroparesis

39

What clinical sign can assist in dx of cholecystitis?

- murphy sign: pain on inspiration with palpation of RUQ

40

Most common site of pancreatic cancer?

- head of pancreas (80%)
- painless jaundice - think pancreatic cancer

41

What is the tumor marker that can assist in dx pancreatic cancer?

- CA 19-9

42

A 43 y/o pt presents wtih 6 wk hx of malodorous diarrhea that leaves an oily sheen to the surface of toilet water. You suspect a malabsorption disorder. What is best study to screen for fat malabsorption?

- microscopic stool exam using Sudan stain

43

What GI disease is most commonly assoc with dermatitis herpetiformis?

- celiac disease

44

Gold std for ID colorectal cancer?

- colonoscopy

45

72 y/o female pt presents with 2 day hx of progressively worsening LLQ abd pain assoc with constipation and chills. Most likely dx?

- diverticulitis

46

1st line tx of C. difficile colitis

flagyl

47

82 yo male pt presents with acute onset of crampy LLQ abdominal pain with urge to defectate and expulsion of bloody diarrhea. Assoc sxs include nausea, fever, and tachycardia. Plain film abdominal x-rays reveal thumbprinting changes. Most likely dx?

- ischemic colitis

48

What 2 dermatologic signs may assist in dx of acute pancreatitis?

- cullen sign (periumbilical bruising)
- grey turner sign (flank bruising)

49

Most common digestive complaint in US?

- constipation