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MI Differential Diagnosis > Screening for GI disease > Flashcards

Screening for GI disease Flashcards

1
Q

list places where the GI system may refer pain to

A
  1. Sternal region
  2. Shoulder and neck
  3. Scapular region
  4. Mid-back
  5. Low back
  6. Hip
  7. Pelvis
  8. Sacrum
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2
Q

what are the most common GI disoders that refer pain to the MSK system?

A
  1. involve ulceration or infection of the mucosal lining
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3
Q

List S/S of GI disorders

A
  1. Abdominal pain
  2. Dysphagia
  3. Odynophagia
  4. GI bleeding
  5. Epigastric pain
  6. Symptoms affected by food
  7. Early satiety with weight loss
  8. Constipation
  9. Diarrhea
  10. Fecal incontience
  11. Arthralgia
  12. Referred shoulder pain
  13. Psoas abscess
  14. Tenderness over McBurney’s point
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4
Q

The site of primary GI visceral pain generally ___________

A

correspond to dermatomes

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5
Q

T/F: GI pain fibers are only sensitive to stretching or tension

A

TRUE

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6
Q

T/F: GI pain is generally well localized

A

FALSE

not well localized

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7
Q

list possible reasons for abdominal pain

A
  1. Inflammation
  2. Organ distension (tension pain)
  3. Necrosis (ischemic pain)
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8
Q

Abdominal pain descriptors

A
  1. Deep aching
  2. Boring
  3. Gnawing
  4. Vague burning
  5. Deep grinding
  6. Colicky
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9
Q

what is dysphagia?

A

sensation that food is catching or sticking in the esophagus

requires prompt attention from MD

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10
Q

what is odynophagia?

A

pain during swallowing

may be caused by esophagitis or esophageal spasm

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11
Q

occult GI bleeding may appear as _______

A

mid-thoracic pain

with radiation of pain to R upper quadrant

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12
Q

T/F: MDs should evaluate any type of bleeding

A

TRUE

be sure to ask about presence of blood in vomit or stool

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13
Q

Clinical S/S of GI bleeding

A
  1. Coffee ground emesis
  2. Bloody diarrhea
  3. Bright red blood
  4. Melena
  5. Reddish or mahogany-colored stools
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14
Q

what can coffee ground emesis indicate?

A

perforated peptic or duodenal ulcer

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15
Q

what does bright red blood indicate in GI diseases?

A

pathology close to rectum or anus

(rectal fissures, hemorrhoids or colorectal cancer)

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16
Q

what is melena and what can it indicate?

A

black, tarry stool

  • result of large quantities of blood in the stool
  • indicates upper GI tract or could be secondary to overuse of NSAIDs
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17
Q

what can reddish/mahogany-colored stools indicate?

A
  1. may occur secondary to food/medications
  2. may be due to a bleed in the lower GI/colon
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18
Q

describe epigastric pain with radiation

A

intense or sharp pain behind breastone with radiation to back

may occur secondary to long-standing ulcers

19
Q

describe heartburn

A
  • begins at xiphoid process and radiates up toward neck and throat
  • bitter or sour taste, abdominal bloating, gas or general abdominal discomfort
20
Q

T/F: an MD must evaluate and diagnose cause of epigastric pain/heartburn

A

TRUE

21
Q

describe pain associated with gastric ulcers

A

may occur within 30-90 mins after eating

food not likely to relieve pain

22
Q

describe pain associated with duodenal or pyloric ulcers

A

may occur 2-4 hours after meals

food may relieve symptoms

may report pain during the night between 12-3 am → stomach is most empty

23
Q

describe the symptom of early satiety

A

feeling hungry but gets the sensation of fullness after 1-2 bites

can be a symptom of:

  • obstruction
  • stomach cancer
  • gastroparesis
  • peptic ulcer disease
  • tumor
24
Q

red flags associated with constipation

A

unexplained constipation with sudden and unaccountable changes in bowel habits or blood in the stool

25
Q

T/F: severe constipation can cause mid-thoracic pain

A

FALSE
can cause back pain

26
Q

changes in bowel habits may occur due to

A
  1. diet
  2. smoking
  3. side effects of meds
  4. acute or chronic diseases of the digestive system
  5. extra-abdominal diseases
  6. depression
  7. emotional stress
  8. inactivity
  9. prolonged bed rest
  10. lack of exercise
27
Q

meds that can cause constipation

A
  1. narcotics
  2. aluminum or calcium containing antacids
  3. tricyclic antidepressants
  4. phenothiazines
  5. calcium channel blockers
  6. iron salts
28
Q

what are some causes of diarrhea?

A
  1. food
  2. alcohol
  3. use of laxatives
  4. med side effects
  5. travel
29
Q

PT considerations for diarrhea

A
  1. C. Diff → contact precautions
  2. creatine use
  3. laxative abuse
30
Q

what is fecal incontinence?

A

inability to control evacuation of stool

associated with a sense of urgency, diarrhea and abdominal cramping

31
Q

what are some causes of fecal incontinence?

A
  1. partial obstruction of rectum
  2. colitis
  3. radiation therapy
  4. anal distortion secondary to traumatic childbirth
  5. hemorrhoids
  6. hemorrhoidal surgery
32
Q

T/F: many GI conditions have an arthritic components

A

TRUE

Crohn’s disease often accompanied by rheumatic manifestations

33
Q

describe arthralgia associated with GI conditions

A

typically known as reactive arthritis

  • asymmetric
  • migratory
  • affecting only 1-2 joints → not bilateral like in rheumatologic conditions
34
Q

describe L shoulder pain relating to GI conditions

A
  1. may be a result of free air following laproscopic surgery or blood in the abdominal cavity
    • usually from ruptured spleen or retroperitoneal bleeding
  2. screen for percipitating trauma/injury → ie sharp blow, fall, MVA
  3. Kehr’s sign
35
Q

what is Kehr’s sign?

A

pain in shoulder with pressure placed on left upper abdomen

36
Q

what GI conditions cause R shoulder pain

A

perforated duodenal or gastric ulcer may refer here

37
Q

Pancreatic cancer may refer to _______

A

either the R or L shoulder

38
Q

Abscesses of the psoas and obturators may cause ______

A

lower abdominal pain

inflammation or infection may spread to these muscles from adjacent secondary to no protective barrier

39
Q

Clinical S/S of Psoas Abscess

A
  1. fever
  2. night sweats
  3. abdominal pain
  4. loss of appetite or other GI upset
  5. Back, pelvic, abdominal, hip and/or knee pain
  6. antalgic gait
  7. palpable tender mass
40
Q

List screening tests for a psoas abscess

A
  1. Heel tap
  2. Hop test
  3. Iliopsoas muscle test
  4. Palpate iliopsoas muscle
41
Q

test for obturator abscess

A

obturator muscle test

  • positive test for muscle affected by peritoneal infection or inflammation from a perforated appendix reproduces R lower quadrant abdominal or pelvic pain with testing of the muscle
42
Q

what is included in the review of systems for GI

A
  1. abdominal pain
  2. indigestion; heartburn
  3. difficulty in swallowing
  4. N/V; loss of appetite
  5. Diarrhea or constipation
  6. Change in stools; change in bowel habits
  7. fecal incontinence
  8. rectal bleeding; blood in stool; blood in vomit
  9. skin rash followed by joint pain (Crohn’s disease)
43
Q

Other GI related follow-up questions

A
  1. Do you notice a change in symptoms after eating?
  2. Do you notice a change in symptoms after a bowel movement or after passing gas?
  3. Do you have abdominal pain at the same time as your back pain?

MI Differential Diagnosis (16 decks)

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