GI pathology

Question 1

List GI pathologies

Answer 1

1. Peptic ulcer
2. Inflammatory Bowel Disease
   
   • Crohn’s disease
   • Ulcerative colitis
3. Colorectal cancer
4. Pancreatic cancer
5. Appendicitis

Question 2

describe a peptic ulcer

Answer 2

loss of tissue lining lower esophagus, stomach and duodenum

can cause shoulder pain (usually R) or back

Question 3

what are some causes of peptic ulcers

Answer 3

1. infection with H. pylori
2. chronic NSAID use

Question 4

what are the 2 types of peptic ulcers?

Answer 4

1. erosions
   
   • acute lesions that do not extend through the mucosa
2. chronic ulcers
   
   • destroys musculature and replaces it with scar tissue

Question 5

Clinical S/S of Peptic Ulcers

Answer 5

1. Heartburn
2. Night pain (12am - 3am)
3. Radiating back pain
4. Stomach pain
5. R shoulder pain
6. Lightheadedness/fainting
7. N/V
8. Anorexia
9. Weight loss
10. Bloody stool
11. Black, tarry stools

Question 6

list GI complications of NSAID use

Answer 6

1. most obvious clinical negative effect is on the gastroduodenal mucosa
2. range from subclinical erosion of mucosa to ulceration with life-threatening bleeding and perforation
3. responsible for 40% of hospital admissions among pts with arthritis
4. NSAID-induced GI bleeding is major cause of morbidity and mortality among older population

Question 7

Risk factors for NSAID-induced gastropathy

Answer 7

1. age older than 65 yo
2. history of peptic ulcer disease or GI disease
3. smoking, alcohol use
4. oral corticosteroid use
5. anticoagulation or use of anticoagulants
6. renal complications in pt with HTN or CHF
7. use of acid suppressants
8. NSAIDs combined with selective serotonin reuptake inhibitors

Question 8

Clinical S/S of GI complications of NSAID use

Answer 8

1. Asymptomatic
2. Stomach upset/pain
3. Indigestion, heartburn
4. Skin reactions
5. Increased BP
6. New-onset back (thoracic) or shoulder pain
7. Melena
8. Tinnitus
9. CNS changes
10. Renal involvement

Question 9

CNS changes that can occur due to GI complications from NSAID use

Answer 9

1. HA
2. depression
3. confusion (older pts)
4. memory loss (older pts)
5. mood changes

Question 10

Renal involment symptoms from GI complications due to NSAID use

Answer 10

1. muscle weakness
2. unusual fatigue
3. restless legs syndrome
4. polyuria
5. nocturia
6. pruritus

Question 11

what conditions are included in inflammatory bowel disease

Answer 11

Crohn’s disease

Ulcerative colitis

Question 12

What is inflammatory bowel disease?

Answer 12

disorders of unknown etiology involving genetic and immunologic influences on GI tract

both chronic, medically incurable conditions

nutritional deficiencies are most common complications of IBD

Question 13

T/F: skin lesions may occur in inflammatory bowel disease

Answer 13

TRUE

these include:

• erythema nodsum
• pyoderma

Question 14

describe Crohn’s disease

Answer 14

• inflammatory disease most commonly attacks terminal end of small intestine (ileum) and colon
• occurs more commonly in young adults/adolescents

Question 15

describe ulcerative colitis

Answer 15

• inflammation and ulceration of lining of large intestine (colon/rectum)
• cancer of colon more common in people with UC

Question 16

IBD can be accompanied by what 2 non GI symptoms?

Answer 16

1. Skin rash
2. joint problems
   
   • usually responsive to treatment of IBD but do on occasion require separate management

Question 17

Clinical S/S of Crohn’s disease and ulcerative colitis

Answer 17

1. Diarrhea
2. Constipation
3. Fever
4. Abdominal pain
5. Rectal bleeding
6. Night sweats
7. Decreased appeptite, nausea, weight loss
8. skin lesions
9. uveitis
10. arthritis
11. Migratory arthralgias
12. Hip pain (iliopsoas abscess)

Question 18

describe colorectal cancer

Answer 18

1. 3rd leading cause of cancer deaths
2. incidence increases with age, beginning around 40
3. screening can sig reduce mortality
4. high-risk groups
   
   • previous hx of chronic IBD
   • adenomatous polyps
   • hereditary colon cancer

Question 19

Clinical S/S of Colorectal cancer in the early stages

Answer 19

1. rectal bleeding, hemorrhoids
2. abdominal, pelvic, back or sacral pain
3. back pain that radiates down the legs
4. changes in bowel patterns

Question 20

Clinical S/S of colorectal cancer in late stages

Answer 20

1. constipation progressing to obstipation
2. diarrhea with copious amounts of mucus
3. N/V
4. abdominal distension
5. weight loss
6. fatigue and dyspnea
7. fever

Question 21

where is most pancreatic cancer located?

Answer 21

• 70% arises in the head of the gland
• 20-30% occur in the body and tail

Question 22

Clincial S/S of pancreatic carcinoma

Answer 22

1. epigastric/upper abdominal pain radiating to the back
2. LBP may be only symptom
3. jaundice
4. anorexia and weight loss
5. light-colored stools
6. constipation
7. N/V
8. weakness

Question 23

how may pain be worsened or relieved in pancreatic carcinoma?

Answer 23

worsened with walking and lying supine

relieved by sitting and leaning forward

Question 24

when is appendicitis most common?

Answer 24

in adolescents and young adults

this is serious and usually requires surgery

Question 25

Clinical S/S of appendicitis

Answer 25

1. R lower quadrant/flank pain 2. periumbilica and/or epigastric pain 3. R thigh, groin, or testicular pain 4. Abdominal involuntary muscle guarding and rigidity 5. +McBurney's point or +pinch-an-inch test 6. rebound tenderness 7. N/V 8. Anorexia 9. Dysuria 10. low-grade fever 11. coated tongue and bad breath

Question 26

Tests for Appendicitis

Answer 26

McBurney's Point Rovsing Sign

Question 27

Clues for screening for GI diseases

Answer 27

1. previous hx of NSAID-induced GI bleeding 2. symptoms increase within 2 hours after taking NSAIDs or other meds 3. symptoms affected by food 4. back pain and abdominal pain at the same level * esp in presence of constitutional symptoms 5. Shoulder, back, pelvic or sacral pain 6. back, pelvic or sacral pain relieved/reduced by bowel movement 7. LBP accompanied by constipation 8. joint pain with arthalgia preceded by skin rash

Question 28

Guidelines for immediate medical attention

Answer 28

1. suspected appendicitis or iliopsoas/obturator abscess 2. suspected retroperitoneal bleeding from injured, damage or ruptured spleen or ectopic pregnancy

Question 29

Guidelines for medical referral

Answer 29

1. Pts who chronically rely on laxatives 2. joint involvment accompanied by skin or eye lesions if MD is unaware 3. hx of NSAID use with back or shoulder pain accompanied by S/S of peptic ulcer 4. back pain assocaited with meals or relieved by a bowel movement (esp if accompanied by rectal bleeding) 5. back pain of unknown cause that doesn't fit MSK pattern (esp w/hx of cancer)

Question 30

describe abdominal pain of MSK origin

Answer 30

1. sharp and focal 2. cramping and aching, or deep

Question 31

describe abdominal pain of visceral origin

Answer 31

1. dull 2. aching 3. cramping 4. burning 5. gnawing 6. wave-like 7. poorly localized

Question 32

T/F: both abdominal pain of MSK and visceral origin can present with nausea

Answer 32

TRUE

Question 33

list potential MSK sources of abdominal pain

Answer 33

1. psoas referral 2. lower T-spine 3. slipping rib syndrome 4. myofascial components