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GI Pt Assessment
Gastroenterology
| Question | Answer |
|---|---|
| Functional abd pain lacks: | laboratory or radiographic abnormalities |
| Functional abd pain: Dx should always be: | diagnosis of exclusion |
| chronic or recurrent pain or discomfort in the upper abdomen = | dyspepsia; epigastric pain (not GERD or PUD) |
| Functional abd pain: Causes: | altered gut motility; exaggerated visceral responses to noxious stimuli; altered processing of visceral stimuli |
| pyrosis, AKA: | heartburn |
| Abd: alarm sx (malig): | early satiety; dysphagia; altered bowel habits |
| odynophagia = | painful swallowing (food or liquid) |
| 3 types of abd pain | visceral (dermatomes), somatic (pain rec in parietal peritoneum), referred |
| Referred abd pain: classic symptom = | right shoulder pain (biliary pain/gall bladder) |
| Periumbilical pain that is crampy that pts can sleep thru: | classic sx of IBS |
| Dyspepsia: tx: pts >55 yo OR those with alarm sx: | Prompt endoscopy |
| Dyspepsia: tx: Patients < 55yrs and no alarm symptoms | Test & treat for H. pylori and initiate trial of PPI; OR initiate trial of PPI |
| Dyspepsia: alarm sx | bleeding, anemia, wt loss >10% body wt, progressive dysphagia, odynophagia, persistent vomiting, h/o PUD, FH gastric malig, abd mass |
| Predominant feature of dyspepsia (which distinguishes it from GERD): | pain or discomfort |
| Most common complication of diverticulosis: | Diverticulitis |
| Diverticulitis: most common presenting sx: | pain, often LLQ w/inc WBC/left shift (resembles left-sided appendix); poss acute GI bleed |
| Diverticulitis: Imaging study of choice | CT |
| Diverticulitis: Tx | clear liquids; 7-10 days Abx (cipro & flagyl); close f/u |
| Diverticulitis complications | Bleeding; intra abscess; fistulas; obstruction |
| Acute lower GI bleed: most common causes: | diverticular disease; vascular malformations |
| Most common cause of acute lower GI bleed in young pts: | anorectal lesion |
| Obscure GI bleed = | source of bleeding is not identified after endoscopic evaluation of both upper & lower GI tract |
| Occult GI bleed = | detection of asymptomatic bleeding from GI tract |
| Chronic diarrhea: 3 types: | osmotic (aka malabsorption), secretory and inflammatory |
| Malabsorption: most common sx | diarrhea & wt loss; but sx can manifest outside GI tract (classic dz = celiac dz) |
| Fat malabsorption: testing gold standard: | fecal fat analysis |
| CHO malabsorption: S/S | bloating; soft diarrhea |
| Protein malabsorption: S/S | Edema (d/t 3rd spacing); muscle wasting |
| 3 subtypes of constipation | slowed transit thru colon; obstructive defecation (aka dyssynergic); constipation-predominant IBS |
| constipation: causes | functional (e.g. diet); drugs; endocrine/ metabolic; neuro; structural lesions |
| Most common cause of dysphagia | esophageal disease |
| Rectal pain: severe pain (like a cut) immed after BM: | anal fissure |
| Rectal pain: dull, aching after BM: | extensive inflammation of internal hemorrhoids |
| Proctalgia fugax: | unique, spasmodic anal pain that is usually unrelated to bowel movements |
| Anal fissures: position | usu posterior (may be anterior); if lateral: suspect TB, syphilis, occult abscesses or carcinoma |
| diverticular dz DDx | colon ca, appy, IBD, IBS, ischemic colitis, UTI, PID |
| Charcot’s triad = | Fever, RUQ pain, Jaundice; ascending cholangitis |
| Air under diaphragm, rigid board-like abdomen | Perforated viscus, perforated ulcer |
| Elderly, Hx atherosclerosis. Dull crampy periumbilical pain post-prandial | Mesenteric ischemia |
| Neonate w/ projectile vomiting. Olive sized mass. | Pyloric stenosis |
| Choking, cyanosis, respiratory distress, increased secretions in 1st hours of life | Tracheoesophageal fistula |
| Painless rectal bleeding in pediatrics | Meckel diverticulum |
| Supraclavicular LAD (L > R) | Virchow node: metastatic abdominal cancer |
| Hard periumbilical nodule | Sister Mary Joseph nodule; indicates metastatic gastric and pancreatic cancers |
| PUD, Pernicious anemia (Type A Gastritis), H. pylori are RFs for: | Gastric Ca |
| Family history of young age colon cancer, multiple polyps found on colonoscopy | Familial adenomatous polyposis (Gardner syndrome) |
| Pediatric with perianal pruritis esp at night; positive cellophane tape test | Pruritis ani: Pinworms (enterobiasis). Tx is Mebendazole |
| s/p gastric bypass surgery or gastric surgery. N, abd cramping, dizziness after eating. No masses, bleeding | Dumping syndrome |
| palmar erythema, spider angiomata | EtOH dz (folate / B12 def) |
| petechiae, purpura, peri-follicular hemorrhage | vit C def |
| Courvoisier sign, Sister Mary Joseph nodule = | Pancreatic cancer |
Created by:
Abarnard
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