Differential Diagnosis - Gi

Front 1

GI symptoms associated with?

Back 1

Fibromyalgia, Lupus, RA & Chronic Fatigue

Front 2

GI can refer pain to:

Back 2

1) Sternum
2) Scapula, shoulder and neck
3) Mid back
4) Low back
5) Hip
6) Pelvis and sacrum

Front 3

General characteristics of GI visceral pain patterns?

Back 3

1) Usually midline
2) Dermatome of which the organ in innervated by (sympathetically)
3) Diffuse pain

Front 4

Sympathetic innervation of pain in epigastric region?

Back 4

T3-T5

Front 5

Sympathetic innervation of pain in perimbilical region?

Back 5

T9-T11

Front 6

Sympathetic innervation of pain in lower abdominal?

Back 6

T10-T12

Front 7

Epigatsric pain can be referred from?

Back 7

Heart, esophagus, stomach, duodenum, gall bladder, liver and other mediastinal organs corresponding to T3-T5

Front 8

Periumbilical pain can be referred from?

Back 8

Small intestine, pancreas, appendix and the lower back

Front 9

Lower abdominal pain can be referred from?

Back 9

Large intestine/Colon

Front 10

What are the mechanism(s) that cause pain in the abdominal viscera?

Back 10

1) Tension
2) Increased concentration of tissue metabolites d/t ischemia

Front 11

Characteristics of visceral pain?

Back 11

Aching, gnawing, boring, vague burning

Front 12

What refers to the shoulder?

Back 12

Right: Liver, diaphragm, pancreatitis (head)
Left: Heart, pancreatitis (tail)

Front 13

What refers to the mid-back/scapula?

Back 13

Gallbladder, stomach, small intestine

Front 14

What refers to the pelvis, flank, low-back and sacrum?

Back 14

Sigmoid and rectum

Front 15

What can cause motor effects above the umbilicus?

Back 15

Stomach, gall bladder, liver and diaphragm

Front 16

What can cause motor effects below the umbilicus?

Back 16

Ileum, jejunum, cecum and colon

Front 17

Dysphagia?

Back 17

Sensation of food catching in the throat

Front 18

Causes of Dysphagia?

Back 18

1) Peptic esophagitis with narrowing
2) GERD
3) Neoplasms

Front 19

Odynophagia?

Back 19

Pain during swallowing

Front 20

Causes of Odynophagia?

Back 20

1) Esophagitis (may be secondary to GERD)
2) Esophageal spasms

Front 21

How to test for odynophagia vs cardiac pain?

Back 21

Standing upright will help relieve the pain if it is esophagitis. Lying supine will help relieve pain if it's cardiac.

Front 22

GI bleeding refers pain to?

Back 22

Midthoracic and RUQ

Front 23

S&Sx of GI bleeding?

Back 23

1) Blood in stool
2) Mid-thoracic pain
3) RUQ pain

Front 24

Types/characteristics of bloody stool?

Back 24

a) Coffee grounds = perforated peptic or duodenal ulcer
b) Bloody diarrhea may accompany other signs of ulcerative colitis.
c) Bright red blood = pathology of rectum or anus
d) Melena = large quantities of blood in stool
e) Reddish/Mahagony stool = lower GI/Colon; possibly d/t certain food

Front 25

Describe radiating epigastric pain

Back 25

Sharp pain at breastbone that radiates to the back

Front 26

How to test for odynophagia vs cardiac pain?

Back 26

Standing upright will help relieve the pain if it is esophagitis. Lying supine will help relieve pain if it's cardiac.

Front 27

Which type of ulcer will food help decrease pain?

Back 27

Decrease the pain with gastric ulcers NOT duodenal ulcers

Front 28

GI bleeding refers pain to?

Back 28

Midthoracic and RUQ

Front 29

GI sign of vertebral compression?

Back 29

Eating very little food but feeling full (early satiety)

Front 30

S&Sx of GI bleeding?

Back 30

1) Blood in stool
2) Mid-thoracic pain
3) RUQ pain

Front 31

Obstipation?

Back 31

Intractible constipation

Front 32

Types/characteristics of bloody stool?

Back 32

a) Coffee grounds = perforated peptic
b) Bloody diarrhea may accompany other signs of ulcerative colitis.
c) Bright red blood = pathology of rectum or anus
d) Melena = large quantities of blood in stool
e) Reddish/Mahagony stool = lower GI/Colon; possibly d/t certain food

Front 33

Obstipation can often result in pain where?

Back 33

Back pain

Front 34

Describe radiating epigastric pain

Back 34

Sharp pain at breastbone that radiates to the back

Front 35

Causes of chronic/frequent diarrhea?

Back 35

IBD, neoplasms

Front 36

Which type of ulcer will food help decrease pain?

Back 36

Decrease the pain with duodenal ulcers NOT gastric ulcers

Front 37

GI sign of vertebral compression?

Back 37

Eating very little food but feeling full (early satiety)

Front 38

Obstipation?

Back 38

Intractible constipation

Front 39

Obstipation can often result in pain where?

Back 39

Back pain

Front 40

Causes of diarrhea?

Back 40

1) Chronic: IBD, neoplasms
2) Drug induced: Antibiotics, overuse of laxatives, anorexia

Front 41

Fecal incontinence?

Back 41

Partial obstruction of rectum

Front 42

Causes of fecal incontinence?

Back 42

CA, Colitis, Radiation therapy, anal distortion (secondary to child birth, hemorrhoids or hemorrhoid surgery)

Front 43

Reactive arthritis?

Back 43

Acute onset of arthritis

Front 44

Potential causes of reactive arthritis?

Back 44

Microbial infection of GI

Front 45

Causes for suspicion of reactive arthritis?

Back 45

Symmetrical symptoms, inflammation of bony insertions of tendons/ligaments

Front 46

GI causes of shoulder pain?

Back 46

L:
1) Air/blood in abd. cavity
i.e., reptured spleen or eptopic pregnancy
2) Pancreatic disease (tail)
R:
1) Pancreatic disease (head)

Front 47

Causes of Obturator or Psoas abscess?

Back 47

Direct extension of intra-abdominal infections like:
1) Diverticulitis
2) Crohn's Disease
3) Pelvic Inflammatory Disease
4) Appendicits

Front 48

S&Sx of Obturator or Psoas abscess?

Back 48

Fever, night sweats, lower abdominal/pelvic/back pain, antalgic gait.
May be able to palpate tender mass.

Front 49

S&Sx of GERD

Back 49

Heart burn, regurgitation, bitter taste in mouth, excess burping

Front 50

Atypical Sx of GERD?

Back 50

Chest pain unrelated to activity, sensation of lump in throat, dysphagia, odynophagia, wheezing, coughing, hoarseness of voice, wt. loss and anemia

Front 51

Peptic Ulcer?

Back 51

Loss of tissue lining the lower esophagus, stomach and duodenum

Front 52

Primary cause of Peptic Ulcers?

Back 52

H. Pylori

Front 53

Potential complications of Peptic Ulcers are left untreated?

Back 53

Significant bleeding issues, perforation and infection

Front 54

S&Sx of Peptic Ulcers?

Back 54

Back pain, N&V, loss of apetite, wt. loss, epigastric pain and heartburn that typically comes in waves and is exaggerated by food.

Front 55

S&Sx of GI complications from NSAIDS?

Back 55

Upset stomach, indigestion, heart burn, skin conditions and changes of the CNS (HAs, depression, confusion)

Front 56

Severe S&Sx of GI complications from NSAIDS?

Back 56

Renal involvement, associated muscle weakness, fatigue

Front 57

Diverticulosis?

Back 57

Mucosa of the colon balloons out through the weakness in the muscle of the intestinal wall

Front 58

Diverticulitis?

Back 58

Infection/inflammation accompanying a micro-perforation of diverticuli

Front 59

S&Sx of Diverticulitis?

Back 59

1) Left lower abdominal pain + tenderness
2) Left pelvic pain + bloody stools

Front 60

S&Sx of appendicites?

Back 60

N&V, low grade fever (adults), high grade fever (children), groin pain, rigid splinted abd. wall, Tender McBurney's with rebound effect

Front 61

Causes of acute pancreatitis?

Back 61

Chronic ECOH abuse, toxicity form glucocorticoids and acetaminophen

Front 62

S&S of acute pancreatitis?

Back 62

Epigastric pain that radiates to back, fever & vomiting, tachycardia, malaise, weakness, bluish color around flanks

Front 63

S&Sx of chronic pancreatitis?

Back 63

All the symptoms of acute but add constipation, flatulents and wt. loss

Front 64

S&Sx of pancreatic cancer?

Back 64

Anorexia, wt. loss, epigastric pain, upper abd. pain that radiates to back

Front 65

Associated disorders of pancreatic cancer?

Back 65

Jaundice secondary to obstruction of bile duct

Front 66

Ulcerative colitis?

Back 66

Inflammation & ulceration of inner lining of the large intestine and rectum

Front 67

Crohn's Disease

Back 67

Inflammation of the terminal end of small intestine & colon BUT can be anywhere along the alimentary canal

Front 68

S&Sx of IBD?

Back 68

Diarrhea, constipation, fever, abdominal pain, rectal bleeding, night sweats, decreased appetite, skin lesions, migratory arthralgia

Front 69

IBS?

Back 69

functional d/o of motility of small and large intestines. Associated with psychosocial issues.

Front 70

S&Sx of IBS?

Back 70

Painful abd. cramps, constipation, N&V, flatulents and bad breath

Front 71

S&Sx of Colorectal Cancer?

Back 71

Rectal bleeding, hemorrhoids, abd., pelvic, back or sacral pain. Pain may radiate down to legs. Change in bowel patterns.

Front 72

S&Sx of advanced Colorectal Cancer?

Back 72

Constipation -> Obstipation, diarrhea with lots of mucous, N&V, wt. loss, fatigue & dyspnea, abd. distention