Flashcards in L18 Signs And Symps Of GI Dis/intro To Abdo Wall Deck (13)
LO3: do a struc physic exam of abdo on norm subj.
-hand signs, jaund, spider naevi, organomegaly.
-jaund first in sclera. Poss itchy. Know types jaund adn causes. Detected earlier biochem. CA panc head.
-hands- Palmar erythema, nail changes eg leukonica, bruising liv prod CFs, asterixis, flapp tremor on wrist extends, clubbing IBD.
-gynecomastia poss liv fail. Caput medusa Porto sys anastomoses dilat vess arnd umb, Sev port HTN, not need scope. Port sys anastomoses sites- oesoph, rectum, Caput.
-dyspepsia= upper GI symps- upper abdo pain/bloat/nausea etc, chronic/recurr pain or discomfort in upper abdo.
Chronic pep ulcer dis, recurr, transient. GORD. Malig. Func/non ulcer when symps but nothing found, v comm. functional dyspepsia= 3 mnth of dyspepsia with no struc causes fnd.
-tx- empirical as supp. Non invas Hp test/erad. Early endosc.
LO2: abdo pain.
-Abdo pain- v comm presentat, 2% admission. Multip causes. Can be mislead- need sensib appr.
-small bowel eg-
intra or retro perit? Intra perit= poten sp btw parietal and visc perit. Retro= asc and desc colon and BVs.
Intra perit strucs refer pain to shared areas of abdo wall, the emb dig they belong to. Foregut= epigastric. Midgut= umbilical. Hind gut= supra pubic.
-eg's of foregut pain-
Ulcers=epigastric pain. 1st part duod and lesser curve stom comm. endosc as diffic distinguish clinic. Dull/ burn pain. ? Hp in duod as metaplasia.
Pancreatitis= epigastric pain, can also get back pain as retro perit struc. V painf, lot vom, CA present late.
Gallstone=epigastric pain, also RUQ. Often colicky pain late but act fairly constant. Black stone bili, yell chol, can be mixed. Often asymp. Gallbl conc bile, compons can precip. Stones can form outs gallbl but rarer in bil tree. Stones stick in cystic duct= bil colic pain of gallbl contrac when blocked. Into tract can relieve pain. If stone stays long can get gallbl inflamm cholecystitis. Odema. If stone to CBD no bile from liv or gallbl to gut so bili in blood incr=jaund. Also lack bili in gut. gut bact breakd bili to urobilinogen and stercobilin. If none ent gut then faeces pale. Urine dark as conjug hyperbili as been through liv=sol. No flow= bact multip= asc cholangitis. If asc to liv can=sepsis as v vasc. If stone where CBD and panc duct meet=pancreatitis. Can't discharge enz in inactiv form so activ in panc= lot enz esp amylase in blood.
LO2: midgut pain.
-real colicky pain as try move Ag blockage eg SI hernia, adhesion, LI twist. Small bowel pain ev 2-3 min as fast movem. LI ev 10-15 min.
-SI obstruc- vom early, abdo distens, X Ray show cent abdo distended loops or circ folds ext full width of bowel lumen.
-classic midgut appendicitis- block base append us LT expans. Stasis= infec. Occas foreign bod or faecolith. Init distens stretch visc perit no dedic nerve supp not loc pain so vague peri umb pain. Bigger= irrit parietal perit= RIF pain.
LO2: hind gut pain.
-hind gut 2/3 along TC.
-sigm volvulus 8% int obstruc. Twists on itself or its mesentery=enlarge. Supra pubic pain, lot distens. Bowel obstruc- absol constip. Blood supp interrupt- tiss death.
-loss appet. Subj unpleasant food/surr. Anxiety. Anger or fear. Symp of physic disord. Symp of psych disord. Medicat etc.
-symp of physic disord- CA partic GIT, chemo/AB, preg, dep, endoc disord.
-weight loss- intent vs unintentional. Over 5% unit should be investig. Enough nutr? If yes look for physic cause eg abs, horm, metab, nutr input.
-subj sensation of need to vom. DIAG- vom centre in medulla, input from cereb cortex, labyrinths Ach, periph pain Rs histamine, chemo and baroRs in gut, chemoR trigger zone outs BBB at base of 4th ventricle, trigg by drop, emetics, serotonin.
Food poisoning staph/salmonella/ecoli. Gastroenteritis viral eg Norwalk. Cholecystitis. Appendicitis. Vir hep. Pancreatitis. Int block. Pain.
-faeces hydrat or gut motil. Classif if less than 3x a week, varies. Change in bowel habit more imp.
-causes- diet, medical eg opioid analgesic or tricyclics, dehydration eg slower transit more abs, immobil, dis eg neuro stroke, DM, colorectal stricture, functional when no organic prob.
-diff for indiv so, good hx necess. More strolls or change in consis.
Incr transit time- decr abs. High osmot laod= water out. Also if too fast for colon abs water.
Sec (infec)- eg cholera toxin open Cl chann, Cl and water pump into gut.
Osmot (lactose intol)- high osmot load.
Abn int motil (thyrotoxicosis, IBS).
Exudative (colitis, CA).
Malabs ( panc enz/ bile salt defic).
-diffic swall solid and liq. Diffic init swall likely neuro prob. Fluid harder than solid if coord prob. Eg stroke often thicken fluid. Prog dysphagia to sol sugg obstruc or comp oesoph, ?CA, fibrous structure etc. Diff from painful swall (odynophagia).
Diffic init- neuro cause. Food stick in oesoph- anat prob. Oesoph CA or eg cardia.
LO2: bleeding, often hidden.
-from the top:
Haematemesis. acute/chronic pep ulcer. Mallory Weiss tear in mucus where stom meet oesoph eg alc, lot vom. Oesoph or gastric varices. Erosive oesophagitis. Gastric or oesoph CA. Malaena if upper GI bleed, haem alt by gut bact etc, chronic bleed eg ulcer.
-varices- DIAG- port ven sys.
IMV, SMV, scenic vein and L gastric vein LDL join portal vein. Oesoph azygos and veins from upper extremities join SVC which ent heart. Liver to IVC to heart.
Hepat veins into IVC, to heart, narr/block hepat vein due to eg liv fibrosis= port HTN.
L gastric drains part stom, also br from LO. If port HTN can't drain down L gastric- at Porto systemic anastomoses drain by other means to systemic circ w/o through liv. Mucosal veins inflate, eg through azygos to heart. In oesoph dilat mucosal vein v fraglie= blood to stom lot.
-from bottom- Fresh blood not malaena= haematochesia. R side colon tend bleed more than L.
Angiodysplasia- abn BV in mucosa. Diverticulitis dis- outpouch inflamm and bleed. Colonic carcinoma- eg rectum. Haemorrhoids/anal fissure- mixed ven and art BV account for 20% of contin, enlarge= bleed, itch etc, can be int. IBD- UC blood and mucous as shed mucosa, starts distal, contin, can rem colon, unlike crohns where lot affected. Massive upper GI bleed.
LO2: abdo distens
-fat, fluid, faeces, flatus, foetus.
-fluid ascites- abn amnt fluid collec in perit cav. Eg live fail, prot HTN, CA.
Jaund adn distens may be ascites. Need drain rep for comfort. If port HTN hydrostatic press in veins incr then leak out. Not enough. Also need lower oncotic press (force fluid leave) eg liv fail reduc albumin.
-flatus- aerophagia- air swall. Gas prod in gut esp if dig Incompl .