GI System

GERD Symptoms

• Heart burn - 30 min after eating and at night laying down

• Dysphagia

• Sour taste

• Hoarseness of voice

• Atypical pain of the head and neck

GERD complications

• Aspiration pneumonia

• Asthma

• Esophagitis

GERD treatment

• Maintain upright positions

• Eat meals at least 3-4 hrs before sleep

• Avoid supine

• Sleep on L) side preventing nocturnal reflex

• Exercise must be completed 2-3 hrs after eating/before meals

• Avoid spicy, chocolate, fatty food, peppermint

• Drugs: antacids, H2 receptor blockers, proton pump inhibitors

Mid-back/scapula pain referral

PEGS

• Pancreas

• Esophagus

• Gallbladder

• Stomach

Left shoulder pain referral

Heart, diaphragm, spleen, tail of pancreas

Right shoulder pain referral

Gallbladder pathology, liver, head of pancreas, peptic ulcers

Pelvic/low back/sacrum pain referral

Colon, appendix, pelvic viscera

Pancoast Tumor (upper lung tumor)

• Pain referred in C8-T2 nerve distribution (mimics TOS)

• Pain top of ipsilateral shoulder

RUQ pain pattern

GPP
Gallbladder pathology, peptic ulcers, head of pancreas

RLQ pain pattern

AC
Appendix, Crohn’s Disease

LLQ pain pattern

DUI
Diverticulitis, ulcerative colitis, IBS

LUQ pain pattern

“Don’t be Silly Kid”
Tail of pancreas, spleen pathology, diaphragm, L) kidney

Kehr Sign

Spleen rupture - pain in L) shoulder

Special test for Cholecystitis

Murphy’s Sign: palpate near right subcostal margin as pt takes a deep breath → +ve if pain and tenderness is elicited during inspiration

Pancreatitis signs & symptoms

Cullen’s Sign and Grey Turner’s Signs
Radiate to back and worse in spine

Hiatal hernia pain pattern

Left shoulder

Femoral hernia pain pattern

Lateral pelvic wall

Inguinal hernia pain pattern

Groin pain

Umbilical hernia pain pattern

Pain around umbilical ring

Cholecystitis

• Blockage or impaction of gallstones in the cystic duct resulting in inflammation of the gallbladder

• Nausea, vomiting, low grade fever

• Pain increases with ingestion of fatty food

Gastic (stomach) ulcers

• Ulcerative lesions in the stomach caused by chronic use of NSAIDS, stress, anxiety, H. pylori bacteria

• Pain increases with PRESENCE of food due to acid secretion, pain after eating

• Pain relieved with antacids, medically treating the H. pylori infection

Duodenal ulcers

• Ulcerative lesions in the duodenum caused by H. pylori infection

• Pain increases with ABSENCE of food, early mornings and in between meals

• Pain relieved by medically treating H. pylori infection

Peptic ulcer - stool

• Coffee ground emesis

• Melena (dark) tarry stools

Ulcerative Colitis (IBD)

• Only large intestine and rectum

• Continuous lesions

• Symptoms: rectal pain, bleeding, bloody diarrhea with mucus/pus, fecal urgency, weight loss, LBP, LLQ pain

Crohn’s Disease

Can’t see - conjunctivitis

Can’t pee - urethritis

Can’t climb a tree - OA of big joints

• Occurs anywhere in GI tract

• Skip lesions

• Symptoms: pain relieved by passing gas, RLQ abdominal pain, weight loss, joint arthritis (reactive)

IBS

• Spastic, nervous or irritable colon

• Causes: emotional stress, anxiety, high fat, lactose foods

• Symptoms: nausea, vomiting, bloating, foul breath, diarrhea → disappear while sleeping (more relaxed)

• Pain relieved by defecation

• Ribbon-like stools

• LLQ pain

• Treatment: stress reduction, dietary modification, exercise

Appendicitis

• Inflammation of the vermiform appendix

• Progression can lead to a swollen/gangrenous appendix → if perforated can lead to peritonitis

Appendicitis signs & symptoms

• Pain in RLQ, comes in waves → progresses to steady

• Anorexia, nausea, vomiting, elevated temperature, leukocytosis, fever

• Tender at McBurney’s points, Rovsing’s sign for pain migration, Blumberg’s sign for rebound tenderness

• Immediate medical attention required!

Liver Diease

Light (clay) coloured stool, dark coloured urine, Palmar erythema, easy bruising, Astherixis