GI intro

difficulty swallowing

dysphagia

painful swallowing

odynophagia

blood in vomit

hematemesis

blood in stool (black/tar like)

melena

bright red blood per rectum

hematochezia

where does digestion start

in mouth w saliva

loss of appetite

anorexia

condition of impaired digestion (gas/bloated/fullness/burning/heartburn/nausea/belching)

dyspepsia

what should we remember about GI complaints

abdominal disorders can have referred pain and non-GI disorders can cause abdominal pain

what things should be included in the social hx for GI problems

sexual and OB/GYN hx, food/diet habits

what meds should we specifically ask about for pts w GI issues

antacids

what are some red flags for severe GI problems

infants and old ppl, weird vitals, severe tenderness to palpation, severe pain out of proportion w exam, tearing/ripping pain, pulsatile mass in abdomen, taut abdominal distention, peritoneal findings, rigid abdomen, recent abdominal surgery, cardiac risk factors

common labs for GI problems

CBC, CMP, amylase, lipase, urinalysis, pregnancy (all women 10-60yo), coagulation studies, fecal occult blood test guaiac), stool studies (fecal leukocytes, C diff toxin, fecal fat, cultures, O&P, antigen tests), intra-abdominal fluid studies

imaging we can use for GI issues

plain film radiography

abdominal X rays

CT

ultrasound

MRI

upper endoscopy (aka EGD)

esophageal 24hr pH monitoring

esophageal manometry

barium esophogram

what are plain film radiographs used for

mainly used to identify free air in abdomen, bowel obstruction, proper tube placement

abnormal GI Xrays

dilated loops, no gas in rectum, air/fluid levels. “free air”

what imaging is most often used in GI due to its speed and sensitivity (DONT do on preg pts)

CT

when do we use contrast w a CT

better differentiation of organs and fluids (given orally or rectally or IV, but IV requires good kidney fxn and should be combined w fluids and you have to skip metformin dose for 2days post IV contrast)

high frequency sound waves and computer to create images, most often used for biliary tract disorders, good to assess solid vs liquid stuff

ultrasound

ddx for right lumbar pain or left lumbar pain

ureteric colic, pyelonephritis

ddx for umbilical pain

early appendicitis, mesenteric adenitis, meckels diverticulitis, lymphomas

ddx for hypogastric pain

testicular torsion, urinary retention, cystitis, placental abruption

ddx for right iliac pain

apendicitis, chrons disease, caeceum obstruction, ovarian cyst, ectopic pregnancy, hernias

ddx for left iliac pain

diverticulitis, ulcerative colitis, constipation, ovarian cyst, hernias

ddx for right hypochondriac (upper right) pain

gallstones, cholangitis, hepatitis, liver abcsess, cardiac issues, lung issues

ddx for left hypochondriac (upper left) pain

spleen abscess, acute splenomegaly, spleen rupture

ddx for epigastric pain

esophagitis, peptic ulcer, perforated ulcer, pancreatitis

benefits of doing an MRI

NO RADIATION, good sensitivity and specificity, dx imaging of choice for peds and preg for intra-abdominal complaints

bad sides/contraindications for MRI

more expensive and takes longer, dont do if theyre clausterphobic or have any metal implants

visualization of the esophagus, stomach, and duedoneum that facilitates interventions and testing

upper endoscopy (EGD)

visualization of the colon and distal small intestines that facilitates interventions and testing

colonoscopy

visualization of the sigmoid colon, that facilitates interventions and testing

sigmoidoscopy

test to measure esophageal pressures

esophageal manometry

allows imaging of swallowing mechanics and anatomy of GI tract

barium esophogram (barium swallow test) ironically doesnt use barium anymore

what is often the difference between outpatient and inpatient therapy for a non-surgical disorder

PO tolerance

how can hypotension cause GI issues

can lead to supply/demand ischemia within bowels