Systems - GI - 1st half
Card Set Information
Systems - GI - 1st half
Systems GI 1st half
Systems - GI - 1st half
Five red flags in Chronic Abd. Pain
signs of GI blood loss
: malnutrition, chronic diarrhea, dysphagia, vomiting)
Some causes of chronic abdominal pain
-abdominal wall pain
What are the Rome III criterion for IBS?
1) Need to have had symptoms for the past three months with them starting at least 6 months ago
2) abd pain and discomfort for 3 days/month with 2 of the following:
-improvement with defecation
-associated with a change in stool freq
-associated with a change in stool appearance
Rare causes of chronic abd. pain
-Celiac artery compression syndrome
: usually associated with epigastric bruit and weight loss
-Narcotic bowel syndrome
: happens when using narcotics
-Painful rib syndrome
: tenderness over the costal margins
- Eosinophlic Gastroenteritis
: due to eosinophlic infiltration
- sickle cell anemia can cause abdominal pain because of vaso-occlusive crises
Symptoms of esophageal disease
4 questions for esophageal dysphagia
progressive vs non-progressive
painful vs painless
intermittent vs continuous
solid vs liquid
agents that reduce LES tone
Dietary: Caffiene, fatty meal, chocolate, peppermint, smoking, alcohol
Meds: morphine, Ca++ channel blocker, nitrates, anticholinergics
Red flags of GERD
Melena (black stool)
Refractory to therapy
What are some of the complications of GERD
Tx for GERD
1) Lifestyle mods
: diet, don't eat just before bed, physchosocial stress?
3) acid reduction
: PPIs, H2
top 3 UGI/ top 3 LGI causes of bleeding
UGI: duodenal/gastric ulcer, gastritis/esophagitis, esophageal varices, (also Mallory-Weis tear)
LGI: angiodysplasia, diverticulosis, cancer
UGI bleeding DDX (8)
LGI bleeding DDX (8)
Signs and Symptoms of acute and chronic bleeds
acute: fatigue (weakness), shock, MI, renal failure
chronic: anemia, weakness, fatigue
Recall the 4 grades of hemorrhoids
2) prolapse, but retract by themselves
3) prolapse, but need manipulation to reduce
describe 4 common clinical manifestations of congenital intestinal obstruction
1) bilious emesis
2) abdominal distention
3) failure to pass meconium (should happen in 1st 48 hours)
4) maternal h/o polyhydroamnios
What is the most common EA/TEF presentation?
EA with distal TEF
What is on the DDx for "double bubble"
How to initially manage peds bowel obstruction
1) Hx and PE
2) NG tube
3) correct fluids/lytes
What anomalies to think of if you see one on a newborn?
What is the electrolyte balance you expect to see in pyloric stenosis
-vomiting a ton! so....
-hypocholeremia (low Cl-)
-metabolic alkalosis (losing stomach acid)
-hypokalemia (low K+ as it is exchanged in the kidneys to try and overcome the alkalosis)
What is the rule of 2's for Meckel's diverticulum?
2% of population affected->2% become symptomatic
2 feet from terminal ileum
usually present by age 2
5 things to ask when dealing with uninvestigated dyspepsia
1) upper GI
: cardiac, dietary related
2) alarm bells
: VBAD (vomiting, bleeding, abdominal pain and weight loss, dysphagia)
4) H. pylori
Name 5 symptoms that support IBS Dx
abnormal stool freq
abnormal stool form
abnormal stool passage (e.g. tenesmus)
passage of mucus
bloating or abdominal distension
What red flags to watch out for in IBS diagnosis
arthritis, skin rash
age greater than 50
abnormal PE or lab findings
list 8 common GI-associated Hx symptoms
: gradual to acute
change in BM
list 8 common GI associated PE signs
absent bowel signs
What is Barrett's esophagus?
normal squamous epithelium replaced by metastatic, columnar, or glandular epithelium due to GERD usually
When do we offer a scope to someone with GERD
-patients with red flags
-PPIs for more than ten years
Gastric Ca S&S
Recurrent abdominal pain criteria
greater than 3 yo
at least 3 attacks of pain
recur over a 3 month period
severe enough to affect activity
red flags in kids for abdominal pain (8)
persistent RUQ or RLQ pain
GI blood loss
family Hx of IBD, celiac, or PUD
pain that wakes them up at night
major etiology for PUD
What is the Tx for H. Pylori
3 drugs (PPI+1000mg amoxicillin+500 mg clarithromycin)
2 times a day for
Red flags when looking at functional constipation in kids
Weight loss/failure to thrive
abnormal neuro exam
Basically ruling out the organic causes: neuro, endocrine, intestinal obstruction
What are the red flags that make you think about gastric cancer?
What is the diagnostic criteria for functional constipation?
History longer than 8 weeks PLUS any 2 of the following:
-stool freq < 3x/week
-large stool in rectum or palpable on abdo exam
-fecal incontinence 1x per week or more
What does it mean if the rectum to colon ratio is less than 1 (i.e. colon diameter is bigger than rectum diameter)
Hirschsprung's disease. #1 cause of intestinal obstruction in newborn
Most common cause of intestinal obstruction in kids < 2yo
Red flags for people with intestinal symptoms (6)
4 categories of diarrhea
Iron deficiency anemia is WHAT until proven otherwise?
What are the 4 F's in biliary colic?
How is the inflammation pattern different in Crohn's and UC?
UC: continuous from rectum, only in colon, only mucosa and submucosa
CD: skip lesions, gum to bum, transmural (fistulas)
What is a common extra-intestinal manifestation of UC?
primary sclerosing cholangitis
What is first line tmt in IBD?
What is Charcot's triad? What does it suggest?
RUQ pain, fever/chills, jaundice
suggests ascending cholangitis
If you have intermittent abdo pain precipitated by eating food. What 3 things should you be thinking of?
1) obstruction (SBO, gastric outlet)
3) ischemic bowel
What are some foods that aggravate GERD?
What is the 6F's that can cause abdominal distention?
Go through the approach to esophageal dysphagia (solid vs solid and liquid, progressive vs intermittent, etc)
Describe the effects of histamines, gastrin, ACh, and prostaglandins on H+ secretion in the stomach
What must you ALWAYS do with a gastric ulcer that you dont need to do with a duodenal ulcer
Biopsy it!! (duodenal ones are rarely malignant)
When looking at bleeding in CRC, what side would you expect to see melena, hematochezia
melena -> right sided
hema-> left sided