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CM GI Approach to Pt
Anorectal Disorders
| Question | Answer |
|---|---|
| Dyspepsia | chronic or recurrent pain or discomfort in the upper abdomen. New definition discludes GERD/heartburn. This is a diagnosis of exclusion |
| Causes of Dyspepsia | altered gut motility, exaggerated visceral responses to noxious stimuli, altered processing of visceral stimuli |
| Most common cause of chronic abdominal pain | dyspepsia |
| Hematemesis is associated with bleeds where? | upper GI. |
| Hematochezia is associated with bleeds where? | Lower GI |
| Most common cause of odynophagia | infection |
| Melena can be caused by bleeding where? | upper or lower GI |
| C fibers are associated with what kind of pain? | more visceral, less localized |
| A fibers are associated with | somatic pain. Well localized |
| Abdominal pain with Anorexia has a high predictive value for what? | Appendicitis |
| gnawing sensation is associated with | peptic ulcer disease |
| patients with ____________ often resist movement | Peritoneal dz/irritation |
| Antispasmotics are effective in treating | IBS; presents with cramping pain |
| Questions to ask patients: | Quality: burning, gnawing, sharp, cramping, Constant, intermittent, radiate? Interfere wtih sleep? Duration: min, hours, days. Aggrav/Reliev: food, meals, BMs. Associated Sx: N/V |
| Causes of acute abdominal pain | acute pancreatitis, ,acute cholecystitis, acute appendicitis, diverticulitis, intestinal ischemia, PUD, bowel obstruction, infectious diarrhea, incarcerated hernia |
| Chronic abdominal pain causes | GERD, Non-ulcer dyspepsia, IBS, Inflammatory bowe disease, chronic pancreatitis, infectious diarrhea |
| Approximate Age cutoff for alarm and non-alarm symtpoms | 55 |
| Diverticulitis is most commonly found in what part of the Intestine? | Sigmoid colon (greatest pressure). Mostly associated with diet |
| Most common complication of diverticulosis | diverticulitis. Pain is most common presenting sx: LLQ, suprapubic, left sided appendicitis. Associated with fever, malaise, NV, dysuria |
| What will you see in a Diverticulitis lab evaluation? | Leukocytosis with a left shift |
| Tx for Diverticulitis | Clear liquids, 7-10 days of abx that covers anaerobes. Cipro + metronidazole. Close FU necessary; surgical consult if no improved in 72 hours. |
| Complications of Diverticulitis | bleeding, intra-abdominal abscesses that develop secondary to perforations, fistulas, obstruction |
| _______ GI bleeds are much more common | Upper; usually with hematemesis |
| Obscure GI bleeding | source of bleeding is not identified after endoscopic evaluation of both upper and lower GI tract |
| Occult Bleeding | detection of asymptomatic bleeding from GI tract; do giauic card |
| Stools > 3 times/day is considered | diarrhea. |
| Most common cause of acute diarrhea | Infection. Usually viral, but can be bacterial. |
| Questions to ask in diarrhea | Medications taking (ex: zoloft), diet, contaminated water or food |
| Double digit stools are associated with | C. dificile; they also usually have fever, abx use can be remote (months ago) |
| Risks for acute diarrhea | travel, abx use, day care, hospitalization, immunosuppressive therapy, men having sex with men, strenuous exercise (runner's diarrhea) |
| Common cause of chronic diarrhea | Giardia |
| Bloody diarrhea in adults is associated with | E. coli |
| Greasy frothy stools are associated with | Osmotic/malabsorption. If patient doesn't eat, it usually improves. |
| 3 types of chronic diarrhea | osmostic, secretory, inflammatory (infection can cause secretory or inflammatory diarrhea) |
| Diagnostic test of choice in malabsorption | Fecal fat (24-hour is goldstandard). fat malabsorption is statorrhea. |
| 3 subtypes of constipation | 1. slowed transit through the colon (nl is 35 hours), 2. Obstructive defecation (aka dyssynergic defecation), 3. Constipation predominant irritable bowel syndrome |
| Drugs that can cause constipation | CCBs, diuretics, anticholinergics (ex: nasal antihistamine use) |
| Vomiting without nausea is suggestive of | obstruction. associated with eating. |
| Dysphagia definition | mechanically having difficulty swallowing; can be oropharyngeal or esophageal |
| Odynophagia definition | Painful swallowing. Pathophysiology: inflammation of esophageal mucosa |
| Causes of odynophagia | infection, pill induced esophagitis, meds (doxy and tetracycline), ingestion of caustic substances |
| Pyrosis | GERD/heartburn |
| Diagnostic procedures for GERD | EGD, barium studies, esophageal manometry, 24 hours esophageal probes |
| Asthma is associated with | GERD |
| Early Satiety causes | Malignancy, delayed gastric emptying, gastric outlet obstruction caused by PUD, adhesions of small bowel obstruction, small bowel obstruction of Crohn's dz |
| PE in a patient with GI sx | assess patient's response to moevement, vital signs, fever, orthostasis, point to where it hurts (and examine this place last), talangiectasis or other stigmata of liver dz, eyes and skin: signs of anemia, extremities: edema, abdominal exam, rectal |
| Stool in the rectal vault indicates | patient has constipation |
| labs for GI sx | may include CBC, chemistries, LFTs, amylase and lipase, stool exam. Immunologic tests: Igs for IBD, Celiac Dz, H.pylori |
| Radiologic evaluation options for GI sx | plain film: abdominal series, barium swallow, US, CT, MRI, PET, endoscopy |
| Study of choice for acute appendicitis in adults | CT without contrast |
| Which hemorrhoids usually bleed and are painless? | Internal Hemorrhoids |
| Infectious causes of pruritis ani | yeast (30-40% of people have yeast in their stool), group a strep (especially in kids), Intertrigo, HPV, HSV, scabies, pinworms |
| Dull, aching pain after bowel movements suggests | extensive inflammation of internal hemorrhoids |
| BRBPR | Bright red blood per rectum |
| patient less than 40 yo with anorectal bleeding is usually secondary to | anorectal lesions: hemorrhoids (internal), fissures, polyps (rarely) |
| Common cause of rectal bleeding in young people | ulcerative colitis |
| Fissures that fail to heal need | surgical referral. |
| When fissures are lateral, suspect underlying conditions such as | TB, syphilis, occult abscesses or carcinoma. Chronic fissures might also be due to these |
| Treatment for anorectal abscesses | Tx with abx that cover anaerobes and then get them to a surgical consult. |
Created by:
ltm12