Pathophysiology Module 8: GI

Hematemesis

- Coffee-ground

- Has been sitting around or further away from exit

Frank blood

- Bright red blood

- Acute or near exit

Melena

- Black + tarry stool

- Has been sitting around

Occult blood

- Hidden blood

- Need test to detect

Seatorrhea

Fatty floating stool

Clay-colored

Stool without bile

Fecal-smelling vomitus

- Deep brown color

- Indicates blockage in intestine

Diarrhea originating from SI

Stools: large, loose

Pain: RLQ (provoked by eating)

Diarrhea originating from LI

Stools: large, frequent

Pain: LLQ

Acute diarrhea

Cause: Viral / bacteria infections and some meds

Timing: self-limiting

Chronic diarrhea

Cause: IBS, malabsorption, chemotherapy, radiation

Timing: > 4 weeks

Constipation manifestations

- Pain during

- Inability to pass stool after straining/pushing >10 mins

- No BM > 3 days

- Hypoactive bowel sounds

Dumping syndrome

- Rapid gastric emptying

- Occurs when surgery on GI tract (gastrectomy)

- Caused by high sugar meals

Dumping syndrome early manifestations

Bloating, stomach cramps, D, N/V

When: 10-30 mins

What: Rapid movement into SI

Dumping syndrome late manifestations

Flushing/sweating, dizzy / light head, rapid HR

When: 1-3 hrs

What: Large amounts of insulin released -> low blood sugar

Duodenal ulcer

- Occurs in duodenum

- Caused by excessive acid and H. pylori

- Relieved with food

Gastric ulcer

- Occurs in stomach

- Caused by malignancy and NSAIDs

- Worsens with eating

Hepatitis A & E virus

2 types viral hepatitis transmitted through oral/fecal route

Hepatitis B, C, & D

3 types of viral hepatitis transmitted through blood and body fluids

Hepatitis A & B

2 types of viral hepatitis that have vaccines

Crohn's Disease

Type of inflammatory bowel disease that...

- Develops in adolescence

- Occurs from mouth to anus

- Skipp lesions; cobblestone appearance

Manifestations:

- RLQ pain

- Diarrhea

- Steatorrhea

- Melena

Ulcerative colitis

Type of inflammatory bowel disease that...

- Develops in 2nd + 3rd decade of life

- Occurs in rectum + colon mucosa

- Looks like inflamed, frail tissue; ulcers; granulation of tissue

Manifestations:

- Diarrhea (20x a day)

- Tinesmus

- Proctitis

- N/V

Crohn's disease & UC both...

- Lead to weight loss

- Involve abdominal cramping

- Have fever, fatigue, malaise, and arthralgia as indicators of inflammation

Celiac disease

- Unable to digest gluten

- Primarily childhood disease (manifests around 4-6 months old)

Hepatitis

- RUQ pain

- Low grade fever

- Jaundice

- Increased AST/ALT levels (AST:ALT = 1)

Appendicitis

- Sharp RLQ pain localized to McBurney's point

- N/V, fever, chills, leukocytes

IBS

- Non-inflammatory, intermittent abdominal pain (C or D) exacerbated by eating

- Relieved with defecation, triggered by stress

Pyloric stenosis

- Projectile vomitting after eating

- Failure to gain weight

- Dehydration

- Occurs 3 weeks of life

Diverticulitis

- LLQ abdominal tenderness

- Abdominal cramping → large amt frank blood

Peritonitis

- Abdominal rigidity

- Rebound tenderness (Blumberg's sign)

Hiatal hernia

- Soft upper abdominal mass

- Frequent belching

- Indigestion / heartburn

Stress ulcer

- Develops from major physiological stressor

- Stomach

- First indicator: hemorrhage with frank blood vomiting

Cholesystitis

- RUQ pain radiating to R scapula

- Murphy's sign

- Pain worse after fatty meal

Gastritis

- Abdominal cramping

- N/V

- Epigastric pain

- Fever and malaise

Cirrhosis

- Ascites, jaundice, portal hypertension

- Dark urine, clay-colored stool

- Varicosities in esophagus

- Increased AST & ALT (AST>ALT)

Intestinal (bowel) obstruction

- Borborygmi

- Decreased / absent bowel sounds

- Fecal-smelling vomitus

Dysphagia

- Odynophagia

- Drooling, pocketing of food in cheeks

- Choking, coughing

Chronic pancreatitis

- Seatorrhea

- Upper abdominal pain

- Losing weight without trying

- C, flatulence

Cholelithiasis

Gallstones

- Biliary colic

- Pain radiates to right scapula

- Clay-colored stools, jaundice

GERD

- Heartburn often confused with angina

- Dry cough

- Sensation of lump in throat

Acute pancreatitis

- Upper abdominal pain radiates to back

- Pain worsens with eating

- N/V

- Pain relieved by pulling knees to chest

- Cullen's sign & Grey Turner sign

Intussuception

- Intervals of sudden abdominal pain

- Palpable sausage-shaped mass in RUQ

- Stools resemble red currant jelly

Hirschsprung's disease

Congenital aganglionic megacolon

- Abdominal distention

- Failure to pass meconium within 24-48hrs in newborn