Summary
Summary Gastrointestinal tract Most common disorders
In this document you will find a revision including all the common disorders of the GI tract, diagnosis, signs and symptoms, lab findings, treatment options
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Some examples from this set of practice questions
1.
What is the most common extrahepatic manifestation of celiac disease involving the skin?
Answer: Dermatitis herpetiformis
2.
What part is most commonly affected in SMALL intestine obstruction?
Answer: Ileus
3.
what is the most common part affected in LARGE bowel obstruction?
Answer: sigmoid colon
4.
Why do you avoid enemas when diagnosing a patient with suspected intestinal obstruction?
Answer: distortion of XRAY image
5.
What is the most common cause of intestinal ischemia? 1)non-occlusive disease 2)arterial thrombotic disease 3)arterial embolism 4)venous thrombotic disease
Answer: 3-arterial embolism
6.
What is the most common cause of intestinal ischemia in a YOUNG patient? 1)venous thrombotic disease 2)arterial embolism 3)non-occlusive disease 3)arterial thrombotic disease
Answer: 1-venous thrombotic disease
7.
What symptom is expected in a patient with pancreatic cancer in the HEAD of the pancreas?
Answer: jaundice
8.
what sign is expected in a patient with pancreatic cancer in the BODY or TAIL of the pancreas?
Answer: pain and weight loss
9.
What marker can be used to diagnose pancreatic cancer?
Answer: CA 19-9
10.
What marker can be used to diagnose colorectal carcinoma?
Answer: CEA
Content preview
CELIAC DISEASESymptoms:
Abdominal bloating
Diarrhea
Vomiting
Constipation
Foul smelling stools
Anemia
Fatigue
Osteoporosis
headache
Mouth ulcers
Infertility or miscarriage
Tigling numbness in hands and feet
DERMATITIS HERPETIFORMIS
Depression, irritability, poor memory, trouble concentrating
Piter, grooved, discolored teeth (children)
Celiac disease reaction with GLUTEN (rye, barley, wheat)
DERMATITIS HERPETIFORMIS:
itchy blistering rash around elbows, knees, scalp and buttocks.
Teenege years more in Males
Clears with gluten free
Wheat Allergy: skin rash, wheexing,abdominal pain, diarrhea
SCREENING:
1. Immediate family member
2. Exposure to gluten <3m
3. Major life event eg:surgery, pregnancy in people genetically predisposed
4. Type 1 Diabetes, thyroid disease other autoimmune diseases
5. Genetic disorders Down syndrome, turner syndrome
The average of person with symptoms to be diagnosed is 4 YEARS
SEROLOGIC TESTING:
1. IgA anti tissue transgluminase tTG
2. IgA endomysial antibody
3. IgG or IgA deamidated gliadin peptides
4. IgA 5% defic
,GENETIC TEST:
DQ2
DQ8 gene
High negative predictive value
More common in DQ2
DIAGNOSIS:
Biopsy of small intestine to confirm blood test
Endoscopically
Damage of the small villi
60% children and 40% adults will have no symptoms.
->damaged intestinal lining-> MALABSORPTION, OSTEOPOROSIS, INFERTILITE AND
NEUROLOGIC SYMPTOMS
If DIABETES 1 > risk for celiac
Untreated will cause lower blood glucose
Can occur alongside with other autoimmune diseases
If osteoporosis-> Vit D+ Calcium
Supplaments: Fe, Ca, vit D,zinc,folic acid
If resistant to gluten free diet-> STEROIDS (oral or IV)
,INTESTINAL OBSTRUCTION
Small intenstine most commontly affected ILEUS
Large bowel only 15% in SIGMOID COLON
Location of obstruction
Presence of ischemia ->discriminate for treatmnet
Degree of obstruction
1)MECHANICAL OBSTUCTION
Jejunum or ileum obstruction 4x more than large colon
EXTRINCIC: surgery,hernia,wound,masses,70% adhesion
INTRINSIC:hematoma,tumor,intussusception,stricute,stenosis
INTRALUMINAR:foreign body, fecal or bareim impaction,stones,meconium in infant
POSTOPERATIVE PTS: 90% due to adhesions, nonsurgical due to hernia
2)PARALYTIC ILEUS:
Diminished motor activity
Toxin or trauma
No physical obstruction or interruption of blood supply
Disappears after 2-3 d
Spinal cord injury, GIT surgery, peritonitis,pneumonia,would dehiscence
2)STANGULATION OBSTRUCTION:
Commpromised blood supply leading to gangrene
Caused by prolonged mechanical obstruction
RISK FACTOR: Abdominal surgery which causes adhesions, CD, cancer of abdomen
SYMPTOMS:
Abdominal distention
Abdominal fullness
Gas
Pain and cramping
Breth odor
Constipation
Diarrhea
Vomiting
Fever, peritoneal irritation
Increased WBC
Toxicity and shock in ALL typer
DIAGNOSIS:
, 1. Physical exam
2. Fecal aspiration with NGtube
3. XRAY: presence of gas or fluid, BIRD BEAK LESION in colonic volvulus, Foreign
material
4. Barium enema in ILEUS
LABORATORY TESTS:
Decresead Na,K,CL
Increase WBC
Increased SERUM AMYLASE-> irritation of the pancreas
SIGMOIDOSCOPY OR COLONOSCOPY -> to identify the source of obstruction
TREATMENT:
1. Correction of fluid , Ringers solution
2. NG tube to decompress
3. TPN to correct protein def
4. Anaglestic and sedatives
5. Antibiotics to prevent peritonitis
6. AMBULATION IN PARALYTIC ILEUS
SURGERY:
Closed bowel procedure:lysis of adhesions,intussusetion of hernias
Enterotomy for foreign bodies
Resection of bowel for obstructing regions
Intestinal bypass around obstruction
Temporary ostomy
MAINTAIN electrolyte and fluid balance->measure intake and output+vital signs
MAINTATIN normal bowel elimination-> stool samples, fluid, record stool,NG tube
MAINTAIN VENTILATION:FOWLERS POSITION->40-60 degrees to relieve abdominal dist
MONITORA abgs
Avoid ENEMAS -> may distort xray image
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