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DU PA GI Approach
Duke PA Approach to the Patient with Gastrointestinal Disease
| Question | Answer |
|---|---|
| accessory organs to the GI system | salivary glands, liver, gall bladder, pancreas |
| many GI disorders are __, which means there is a lack of laboratory or radiographic abnormalities | functional |
| chronic or recurrent pain or discomfort in the upper abdomen. Incorporates a variety of symptoms including early satiety or fullness. | dyspepsia |
| dyspepsia is a diagnosis of __ | exclusion |
| hematemesis is more commonly associated with __ | upper GI bleeds |
| hematochezia is more commonly associated with __ | lower GI bleeds |
| __ fibers are more associated with visceral pain | C |
| __ fibers are more associated with parietal pain and is more sharp in nature | A |
| __ pain is poorly localized, and is produced by dermatome that innervates the involved tissue | visceral |
| __ pain is initiated by pain receptors in parietal peritoneum, is sharp and well localized | somatic |
| __ is poorly localized, and is felt in areas that may be remote from site of disease | referred |
| __ has a very high predictive rate for appendicitis | anorexia |
| patients with __ pain resist movement | peritoneal |
| if movement (jumping jacks) causes abdominal pain think __ | peritoneal |
| abdominal pain that doesn't interfere with sleep is associated with __ | IBS |
| __ pain gets better after a bowel movement | IBS |
| any inoccent diagnosis is always a diagnosis of __ | exclusion |
| some common causes of chronic abdominal pain | GERD, non-ulcer dyspepsia, IBS, IBD, chronic pancreatitis, infectious diarrhea |
| pain or discomfort is the predominant feature of __, this distinguishes it from GERD | Dyspepsia |
| only patients with __ of dyspepsia require management | dyspepsia |
| in the setting of dyspepsia some warning signs for cancer are | bleeding, anemia, weight loss >10% of body weight, progressive dysphagia, odynophagia, persistant vomiting, history of PUD, FH of malignancy, abdominal mass |
| 20th century disease associated with western lifestyle | diverticular disease |
| diverticulosis is most commonly found in what region | sigmoid colon |
| __% of patients with diverticular disease will develop diverticulitis | 20 |
| presence of small mucosal herniations in colonic wall | diverticulosis |
| inflammation of diverticula | diverticulitis |
| diverticular pain is most common in the __ region | LLQ, suprapubic |
| can present as left sided appendicitis | diverticulitis |
| associated symptoms of diverticulitis | fever, malaise, constipation, diarrhea, nausea, vomiting, dysuria, urinary frequency |
| lab evaluation with diverticulitis | leukocytosis with left shift |
| Imaging for diverticulitis | CT, plain films assess-free air, ileus, obstruction |
| classic antibiotic treatment for diverticulitis | cipro and metronidazole |
| treatment for diverticulitis | clear liquids, 7-10 day course of antibiotics (cipro/metronidazole) |
| complications of diverticulitis | bleeding,intra-abdominal abscesses, fistulas, obstruction |
| diverticular disease accounts for 50% of episodes of __ | lower GI bleed |
| acute upper GI bleeding is __x more common than lower GI bleeding | 3 |
| most common causes of acute upper GI bleed | peptic ulcers, esophageal varices |
| most common causes of lower GI bleed | diverticulosis, vascular malformation |
| most common presentation of lower GI bleed | hematochezia |
| defined as increased frequency or fluidity of stool | diarrhea |
| diarrhea <6 weeks duration | acute diarrhea |
| diarrhea >6 weeks duration | chronic diarrhea |
| most common cause of acute diarrhea | infection |
| majority of acute diarrheas are __ in etiology | viral |
| double digit stools per day | C. dif |
| most common protozoan cause of chronic diarrhea | giardia |
| bulky, frothy stools | osmotic diarrhea |
| If I don't eat I don't get diarhea | osmotic diarrhea |
| greasy, frothy stools, diarrhea, and weight loss | fat malabsorption |
| steatorrhea | fat malabsorption |
| bloating, soft diarrhea | carbohydrate malabsorption |
| edema, muscle wasting | protein malabsorption |
| gold standard test for steatorrhea | fecal fat analysis |
| functional causes of constipation | low fiber diets, sedentary activities, slow transit time |
| new onset constipation in middle age and up should get __ | colonoscopy |
| drugs that cause constipation | calcium channel blockers, diuretics, anticholinergics |
| endocrine/metabolic disorders that cause constipation | diabetes, renal failure, hypercalcemia, hypothyroidism, hypokalemia |
| neurological causes of constipation | MS, Parkinson's, spinal cord disorders, Hirschsprung's disease, psychosis |
| acute causes of N/V | appendicitis, cholecystitis, pancreatitis, peritonitis, small or large bowel obstruction |
| chronic causes of N/V | esophageal disorders, PUD, gastric malignancy |
| difficulty swallowing | dysphagia |
| difficulty swallowing both liquids and solids | motility disorders |
| difficulty swallowing solids | mechanical obstruction |
| painful swallowing | odynophagia |
| pathophysiology of odynophagia | inflammation of esophageal mucosa |
| pyrosis | heart burn |
| classsic symptom of GERD | pyrosis |
| early satiety is worrisome for __ in older patients | malignancy |
| if you think your patient has a GI bleed you need to get __ | orthostatics |
| reason for not doing a rectal exam | you don't have a finger and the patient doesn't have a rectum |
| there should not be stool in the __ | rectal vault |
| if stool is present in the rectal vault do a __ | stool guaiac |
| with acute abdomen the most helpful thing to get is __ | CBC |
| study of choice for acute appendicitis in adults | CT |
| study of choice for acute appendicitis in children | ultrasound |
| the lower 10-15 cm of the colon | rectum |
| divides the squamous epithelium from mucosal or columnar epithelium in the anus | dentate line |
| marks where sensory fibers end in the anus | dentate line |
| pruritis ani | anal itching |
| chronic scratching can result in __ | lichenification, fissures, and infection |
| systemic illnesses that may cause pruritis ani | diabetes, malignancies, thyroid disease |
| ingested irritants that may cause pruritis ani | tomatoes, citrus, caffeinated drinks |
| infections that may cause pruritis ani | intertrigo, HPV, HSV, scabies, pinworms |
| medications that may cause pruritis ani | colchicine |
| sever pain with or immediately after bowel movement (described by patient as a cut) suggests | anal fissure |
| dull, aching pain after bowel movement suggests | extensive inflammation of internal hemorrhoids |
| BRBPR | bright red blood per rectum |
| bright red blood on paper after wiping | almost always from an anal rectal lesion (usually hemorrhoids) |
| most common reason for BRBPR in younger people | ulcerative colitis |
| when anal fissures are lateral suspect __ | underlying conditions such as TB, syphilis, occult abscesses or carcinoma |
| treatment for anal fissures | stool softeners, barrier ointments, sitz baths, topical steroids, nitro 2% ointment, botox |
| abnormal openings between anal canal and perianal skin | fistulas |
| painless bleeding after defecation is most common presentation for | internal hemorrhoids |
| rarely bleed but often exquisitely painful, especially if thrombosed | external hemorrhoids |
| exquisitely tender, bleed easily, usually caused by hard to pass stool | anal fissure |
| treatment for external hemorrhoids | sitz baths, topical steroids, stool softeners, early removal of clot if thrombosed, recovery is often prolonged |
Created by:
bwyche
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