Screening for GI disease

Question 1

list places where the GI system may refer pain to

Answer 1

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

Question 2

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

Answer 2

1. involve ulceration or infection of the mucosal lining

Question 3

List S/S of GI disorders

Answer 3

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

Question 4

The site of primary GI visceral pain generally ___________

Answer 4

correspond to dermatomes

Question 5

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

Answer 5

TRUE

Question 6

T/F: GI pain is generally well localized

Answer 6

FALSE

not well localized

Question 7

list possible reasons for abdominal pain

Answer 7

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

Question 8

Abdominal pain descriptors

Answer 8

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

Question 9

what is dysphagia?

Answer 9

sensation that food is catching or sticking in the esophagus

requires prompt attention from MD

Question 10

what is odynophagia?

Answer 10

pain during swallowing

may be caused by esophagitis or esophageal spasm

Question 11

occult GI bleeding may appear as _______

Answer 11

mid-thoracic pain

with radiation of pain to R upper quadrant

Question 12

T/F: MDs should evaluate any type of bleeding

Answer 12

TRUE

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

Question 13

Clinical S/S of GI bleeding

Answer 13

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

Question 14

what can coffee ground emesis indicate?

Answer 14

perforated peptic or duodenal ulcer

Question 15

what does bright red blood indicate in GI diseases?

Answer 15

pathology close to rectum or anus

(rectal fissures, hemorrhoids or colorectal cancer)

Question 16

what is melena and what can it indicate?

Answer 16

black, tarry stool

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

Question 17

what can reddish/mahogany-colored stools indicate?

Answer 17

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

Question 18

describe epigastric pain with radiation

Answer 18

intense or sharp pain behind breastone with radiation to back

may occur secondary to long-standing ulcers

Question 19

describe heartburn

Answer 19

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

Question 20

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

Answer 20

TRUE

Question 21

describe pain associated with gastric ulcers

Answer 21

may occur within 30-90 mins after eating

food not likely to relieve pain

Question 22

describe pain associated with duodenal or pyloric ulcers

Answer 22

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

Question 23

describe the symptom of early satiety

Answer 23

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

Question 24

red flags associated with constipation

Answer 24

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

Question 25

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

Answer 25

FALSE can cause back pain

Question 26

changes in bowel habits may occur due to

Answer 26

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

Question 27

meds that can cause constipation

Answer 27

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

Question 28

what are some causes of diarrhea?

Answer 28

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

Question 29

PT considerations for diarrhea

Answer 29

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

Question 30

what is fecal incontinence?

Answer 30

inability to control evacuation of stool associated with a sense of urgency, diarrhea and abdominal cramping

Question 31

what are some causes of fecal incontinence?

Answer 31

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

Question 32

T/F: many GI conditions have an arthritic components

Answer 32

TRUE Crohn's disease often accompanied by rheumatic manifestations

Question 33

describe arthralgia associated with GI conditions

Answer 33

typically known as reactive arthritis * asymmetric * migratory * affecting only 1-2 joints → not bilateral like in rheumatologic conditions

Question 34

describe L shoulder pain relating to GI conditions

Answer 34

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

Question 35

what is Kehr's sign?

Answer 35

pain in shoulder with pressure placed on left upper abdomen

Question 36

what GI conditions cause R shoulder pain

Answer 36

perforated duodenal or gastric ulcer may refer here

Question 37

Pancreatic cancer may refer to \_\_\_\_\_\_\_

Answer 37

either the R or L shoulder

Question 38

Abscesses of the psoas and obturators may cause \_\_\_\_\_\_

Answer 38

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

Question 39

Clinical S/S of Psoas Abscess

Answer 39

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

Question 40

List screening tests for a psoas abscess

Answer 40

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

Question 41

test for obturator abscess

Answer 41

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

Question 42

what is included in the review of systems for GI

Answer 42

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)

Question 43

Other GI related follow-up questions

Answer 43

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?