Signs and Symptoms of GI Disease - Block 2

• -Def: Involuntary or voluntary release of gas from the stomach or esophagus.
• -Causes: Swallowed air, gum chewing, smoking, rapid eating, or carbonated drinks

• Volume: 500-1500ml/day
• Frequency: 6-20 times/day

Plant carbohydrates (hydrogen and methane)

Meat and eggs (sulfur dioxide)

Malabsorbtion

• -Lactose-free diet
• -Avoid common gas-producing foods
• -"Beano" -> reduces gas associated w/beans

• -increased frequency of bowel movements
• -increased stool liquidity
• -a sense of fecal urgency
• -fecal incontinence

-> Increase in stool weight >200 gm/day that may be associated with increased liquidity, stool frequency, perianal discomfort, and urgency with or without fecal incontinence

• Acute < 2 weeks
• Persistent 2-4 weeks
• Chronic >4 weeks

9-10L of fluid

Approx. 6 L

Approx. 2.5 L

• -1.5 L passes through colon
• -Colon absorbs more than 90% of this load
• -Approx 0.1 L is left in the feces

Reduction of this efficiency by as little as 1% may lead to diarrhea.

• -Infectious agents   -Bacterial toxins
• -Drugs  -Community outbreaks (viral, food)
• -Day care or swimming (protozoal)
• -Antibiotic-associated (C. Diffcile colitis)
• -Sexually transmitted
• -Traveler's diarrhea

• -Distinguish between mild and serious illness
• -For > 7 day duration: check stool culture, O & P, fecal leukocytes
• -Bloody diarrhea, fever, abd pain: Work-up
• -Physical exam: Tilts, addt'l tests depending on history

• -Diet: rest bowels -> avoid high-fiber foods, fats, milk products -> take in easily digestible foods
• -Rehydration: Oral rehydration is best.
• -Anti-diarrheal agents
• -Antibiotic therapy -> for select patients

Bananas, Rice, Applesauce, Toast

These foods are low in fiber and digestive residue.

• -acute diarrhea causes
• -lactose intolerance
• -previous gastric surgery
• -parasites
• -medications
• -systemic disease

True

• -Fecal leukocytes, stool culture, O & P
• -CBC, electrolytes, LFTs, albumin, TSH
• -Flex sig or C-scope w/biopsy
• -UGI, BE

• -Osmotic  -Secretory
• -Inflammatory  -Malabsorption syndromes
• -Motility disorders  -Chronic infections
• -Irritable bowel

-Stool volume decreases with fasting

• -Medications: antacids, Lactulose, sorbitol
• -Disaccharides deficiency- Lactulose intolerance
• -Factitious diarrhea - magnesium use

-Large volumes (>1 L/day) -> little change with fasting

• -Hormonal: Carcinoid, ZE, thyroid ca
• -Medications
• -Factitious diarrhea - laxative abuse
• -Villous adenoma
• -Bile salt malabsorption (post-op, Crohn's)
• -Celiac Sprue

• -fever
• -hematochezia
• -abdominal pain
• -> Systemic symptoms/signs: arthralgias, rash

• -ulcerative colitis
• -Crohn's disease
• -Malignancies - lymphoma, adenoma
• -Radiation enteritis

• -weight loss
• -fecal fat

• -Small bowel mucosa disease: Sprue, Crohn's, Whipple's, short bowel syndrome
• -Lymphatic obstruction- lymphoma, TB, carcinoid
• -Pancreatic disease- chronic pancreatitis, pancreatic carcinoma
• -Bacterial overgrowth-motility disorders (DM, vagotomy, scleroderma), fistulas, small intestinal diverticula

• -systemic disease
• -prior abdominal surgery

• -Post surgical: vagotomy, partial gastrectomy, blind loop with bacterial overgrowth
• -Systemic disorders: scleroderma, DM, hyperthyroidism
• -IBS

-Immunosuppressed patients

• -Parasites- Giardia lamblia, Entamoeba histolytica, Cyclospora
• -AIDS-related (viral, bacterial, protozoal)

-small bowel or proximal colon

-left colon or rectum

-mucosal damage or inflammation

-carbohydrate malabsorption

-fat malabsorption

• -Patient's normal bowel pattern
• -Medications  -Past medical history
• -Past surgical history
• -Family history  -Social history
• -Alarm symptoms

• -Onset and location  -Provocation or Palliation
• -Quality of the pain  -Region and radiation
• -Severity  -Time (history): determine whether pt's symptoms are acute or chronic
• -USE NARRATIVE FORMAT

• -Signs of dehydration  -bloody stool
• -Fever >101 
• -Passage of greater than 6 stools per 24 hrs or illness that lasts more than 48 hrs
• -Severe abdominal pain  -weight loss

• -24 hour stool collection for weight and quantitative fat
• -Stool laxative screen  -Stool osmolality
• -Fecal Leukocytes  -Stool for ova and parasites
• -stool cultures

• -CBC  -Electrolytes
• -Liver function tests
• -TSH  -PTT

• -Suspected sprue: serologic tests
• -Secretory diarrhea due to tumors: VIP, calcitonin, gastrin, glucagon, VMA, metanephine

• -Inflammatory bowel dz: Flex sig/C-scope
• -Malabsorption: Upper endoscopy w/Bx

• -Plain abdominal radiographs: Calcification of pancreas
• -UGI w/small bowel follow through: Lymphoma, Crohn's, carcinoid

• -Loperamide
• -Diphenoxylate with atropine (Lomotil)
• -Clonidine: Inhibits electrolyte secretion

BUT -> CORRECT THE UNDERLYING CONDITION!