Intro III GI Exam

1. Mouth 2. Throat (pharynx) 3. Esophagus 4. Stomach 5. Duodenum (1st part of small intestine)

What does the upper GI tract consist of (5)?

1. Jejunum (2nd part of small intestine) 2. Ileum (3rd part of small intestine) 3. Colon 4. Anus

What does the lower GI tract consist of?

Large intestine

What is another word for colon?

22 feet

How long is the small intestine?

6 feet

How long is the large intestine?

Cecum

Where do the ileum and colon attach?

Digestion

breakdown of foods into smaller particles and individual nutrients

1. Movement of liquids and solids via peristalsis

2. Lubrication of foods

3. Mechanical breakdown

4. Resorption of nutrients and water

5. Excretion of waste

What are the 5 parts of digestion?

In the mouth with the action of salivary amylase (initial breakdown)

Where does digestion begin with? With what?

Bolus moved by muscular waves by peristalsis to pharynx

Once food is chewed, what is it called? How does it move and to where

Epiglottis, which closes off stomach

After the pharynx, what does the bolus pass through?

Stomach breaks down food into smaller particles, takes 3-6 hours

Once food moves past the epiglottis, what occurs?

Chyme

What are tiny, broken-down particles of food in the stomach called?

Into duodenum (where most of digestion takes place) then to jejunum and ileum

Once broken down, where does chyme flow?

Digestion if complete after 3-5 hours

What happens after food flows into the jejunum and ileum? How long does this take?

Colon

Where does the waste flow into?

Absorb the water from the waste

What is the colon's job?

24-30 hours

What is the total transit time of digestion?

Right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant

What are the 4 quadrants of the abdominal region?

Epigastric region (above), periumbilical region (around), and pelvic region

What are the regions of the abdomen?

1. Gallbladder

2. Liver

3. Right kidney

What are the 3 structures of the RUQ?

1. Stomach

2. Gallbladder

3. Pancreas

4. Duodenum

5. Heart

6. Esophagus

What are the 6 structures of the epigastrium?

1. Spleen

2. Stomach

3. Left kidney

What are the 3 structures of the LUQ?

1. Jejunum

2. Ileum

3. Cecum

4. Appendix

5. Right colon

What are the 5 structures of the periumbilical region?

1. Ileum

2. Appendix

3. Cecum

4. Right ureter

What are the 4 structures of the RLQ?

1. Bladder

2. Uterus

3. Sigmoid

What are the 3 structures of the hypogastric region?

1. Sigmoid colon

2. Left ovary

3. Left ureter

What are the 3 structures of the LLQ?

subjective!

Pain is __________________

Pain Scale

numerical scale for patients to communicate pain

1-10 (not bad to worst pain imaginable)

What does the Pain Scale range from?

1. Intra-abdominal

2. Extra-abdominal

What are the 2 types of sources of abdominal pain?

Extra-abdominal

something is going on in another system, but presenting in abdomen

1. Gallbladder

2. Small or large bowel

3. Appendix

4. Stomach

5. Liver

What are 5 sources of intra-abdominal pain?

Ulcer formation and gastritis

What diseases may be associated with intra-abdominal pain caused by the stomach?

1. Heart (acute myocardial infarction)

2. Ovary

3. Testes

4. Muscle strain

5. Lungs

6. Psychological illness or history of abuse

What are 6 sources of extra-abdominal pain?

Pneumonia

What disease may be associated with extra-abdominal pain caused by the lungs?

Ectopic pregnancy, ovarian cysts

In females, what diseases may be associated with extra-abdominal pain caused by the pelvic region?

Testicular pain/torsion

In males, what disease may be associated with extra-abdominal pain caused by the pelvic region?

Anything from intra or extra-abdominal sources

What is the differential diagnosis of abdominal pain in the general population?

1. Bowel obstruction

2. Diverticulitis

3. Gastroenteritis (virus irritating GI tract)

4. Urinary tract infection (causes weird symptoms)

4 specific differential diagnoses for elderly (>50)

1. Setting

2. Location

3. Chronology

4. Quality and quantity

5. Aggravating factors

6. Alleviating factors

7. Associated manifestations

Abdominal pain: 7 factors of history

1. Inspection

2. Auscultation

3. Percussion

4. Palpation

Abdominal pain: 4 parts of PE (in order)

1. Discoloration

2. Bruising

3. Lumps/bumps/masses

4. Open wounds

5. Scares

What are 5 inspection findings for abdominal pain?

Auscultation

listen to all 4 quadrants for bowel sounds

1. Normoactive

2. Hyperactive (loud, gurgly all over quadrants)

3. Hypoactive (underactive)

What are the 3 types of bowel sounds in auscultation?

Percussion

use hands to identify density, tap abdomen and listen for different sounds, tells what is below where pain is

1. Light palpation (with one hand, don't start where pain is, end there)

2. Deep palpation (use 2 hands)

What are the 2 types of palpation?

1. Enlarged organs

2. Tenderness

What does palpation assess for?

1. X-rays

2. Ultrasound

3. CT scan

4. Lab studies

5. MRI

6. P.E.

What are the 6 tests available to test for abdominal pain?

1. Abrupt onset of pain that persists

2. Persistent vomiting (worry abt dehydration, esp in pregnant women)

3. Rapid pulse, rapid breathing, elevated BP (abnormal vitals)

4. Abdominal distention (tumor/growth)

5. High fever and chills (infection)

What are 5 red flags for abdominal/pelvic pain?

1. Dry mouth

2. Skin tenting

What are 2 things you can do to check for dehydration?

Over 100 BPM

What is an elevated heart rate?

Right upper quadrant, below the liver

What is the location of the gallbladder?

3-4 inches

What is the size of the gallbladder?

Storage place for bile

What is the function of the gallbladder?

Liver

What produces bile?

Body digesting fats

What does bile help with?

Gallbladder contracts, pushes bile into common bile duct, to the small intestine for aid in breakdown of fats

What is the path of bile from the gallbladder?

Gallstones

pebble-like, hardening of bile, developed in gallbladder

1. Cholesterol

2. Pigment

What are the 2 most common types of gallstones?

1. Most cases are asymptomatic (found when imaging for another reason)

2. Pain may be intermittent or constant

2 facts to know about gallstones

Cholecystitis

inflammation of the gallbladder

Cholelithiasis

stones in the gallbladder

Choledocholithiasis

stones in common bile duct (or anywhere in bile system)

1. Family history OR fair complexion

2. Females

3. Fat

4. Forty

5. Fertile

Gallbladder disease risk factors (Classic 5 F's)

Signs

provider finds upon examination, objective

1. RUQ tenderness

2. Dehydration (if persistent vomiting)

3. Murphy's sign

What are 3 signs of gallbladder disease?

Cessation of breathing; press in on RUQ, take a deep breathe, if positive can't complete breathe

What is Murphy's sign?

Murphy's sign

cessation of deep inspiration secondary to pain

Symptoms

what pt complains about, subjective

1. Abdominal pain (RUQ or epigastric)

2. Abdominal pain timing

3. Associated symptoms

What are 3 symptoms of gallbladder disease?

1. Dull ache

2. Can be poorly localized

3. Might have pain that radiates to right shoulder or infrascapular region

Gallbladder disease symptoms: Describe abdominal pain (3)

1. 30-60 minutes after eating a meal

2. May last 1 hour or a couple (pt dependent)

Gallbladder disease symptoms: Describe abdominal pain timing (2)

1. Associated infection (fever/chills)

2. N/V

Gallbladder disease symptoms: Describe associated symptoms (2)

1. Hepatitis (inflammation of liver)

2. Right kidney issues

3. Gallbladder issues

What are 3 differential diagnoses of gallbladder disease (RUQ pain)?

1. Labs- elevated WBC count (CBC, complete blood count, indicates infection)

2. Abdominal ultrasound

3. Endoscopic retrograde cholangiopancreatography (ERCP)

4. Helical CT

5. Oral cholecystogram

6. HIDA (Hepatobiliary Iminodiacetic Acid Scan)

What are tests to diagnose gallbladder disease?

Abdominal ultrasound

What is the first-line test for gallbladder disease?

Scope with light into duodenum, catheter through scope, dye injected, and images are taken to outline gallbladder

Describe an ERCP test

Images are taken in cross section, rather than overlapping

What is a helical CT?

Oral cholecystogram

x-ray of gallbladder after contrast tablets are taken the night before

HIDA

nuclear medicine scan; radioactive tracer is injected, scanner tracks flow of tracer

Watchful waiting

What is the management for asymptomatic gallstones like?

Cholecystectomy for recurrent, persistent symptoms

What is management like for symptomatic gallstones?

1. if pain is not constant, can wait to treat

2. low-fat diet or reduce risk factors

2 types of conservative treatment for symptomatic gallstones

Sits across back of abdomen, behind or adjacent to stomach

Where is the pancreas located?

6 inches (15 cm)

What is the size of the pancreas?

1. Produce insulin (hormones essential for sugar regulation)

2. Produces digestive enzymes

What are the 2 functions of the pancreas?

Islets of Langerhans

What cells in the pancreas produce insulin?

Amylase and lipase

What are the two digestive enzymes the pancreas produces?

Exocrine tissue and endocrine tissue

What are the 2 types of tissue the pancreas is made of?

digestive enzymes

What does the exocrine tissue of the pancreas produce?

Insulin and glucagon

What does the endocrine tissue of the pancreas secrete?

Pancreatitis

inflammation of the pancreas

When digestive enzymes, usually contained within ducts in the pancreas, leak into the rest of the pancreas and irritate it

When does pancreatitis occur?

1. Acute (sudden)

2. Chronic (occur over many years)

2 types of pancreatitis and description

1. Increased triglycerides

2. Excessive, persistent alcohol intake (most common cause of acute pancreatitis)

3. Gall stones

4. Certain medications

What are the 4 risk factors for pancreatitis?

1. Decreased bowel sounds

2. Abdominal rigidity (muscles tighten bc its so painful)

What are 2 common signs of pancreatitis?

1. Upper abdominal pain, often radiates to back (feels like knife through back)

2. 10/10 pain scale

3. Pain may increase with eating

4. Usually sudden onset, worsens with time

What are the 4 most common symptoms of pancreatitis?

1. Anorexia (lack of appetite)

2. N/V

3. Fever (if infection is present)

What are 3 other symptoms of pancreatitis?

1. Alcohol abuse

2. Gall stones

What are the most common causes of pancreas disease?