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level: Level 1 of Gastro

Questions and Answers List

level questions: Level 1 of Gastro

QuestionAnswer
Abdominal pain depends on....- Type of stimuli • Type of nociceptors • Way of conduction • Patient’s personality • Cultural patterns • Other
Etiology of abdominal painDiseases of digestive tract • Diseases of other intraabdominal organs (kidney, urinary tract) • Disease of organs, systems located outside the abdomen (pleura, lung) • Systemic diseases (endocrine, metabolic) • Effect of drugs • Effect of toxic substances - organic diseases - functional disorders
Acute abdominal pain – surgical- Acute pain • Vomiting • Abdominal distention • No gases, no stool, bloody stool • Fever • Severe general state • Peritoneal symptoms
Acute abdomen causesAcute appendicitis • Ileus • Intussusception • Volvulus • Incarceretion of hernia • Peritonitis • Perforation • Meckel’s divericulitis • Acute pancreatitis • Trauma
Location and radiation of abdominal painEsophageal diseases – pain behind sternum,radiating to back and left shoulder • Peptic ulcer disease – epigastrium, radiating to back • Small bowel –around the umbilicus • Colon – abdominal pain, radiating to back • Hepatomegaly (stretching of hepatic capsule) – right epigastrium • Gall bladder – right subcostal region • pancreas – epigastrium, radiating to back • Kidneys – costo-vertebral angle, back, side • Ureter – radiation to testicle, to thight • Small pelvis – subgastrium, back
Factors affecting abdominal painMeal – alleviates (duodenal peptic ulcer disease), intensifies (gastric peptic ulcer disease, pancreatitis, ileus) • Alcalising drugs, hydrochloric acid reducing drugs (gastric and esophageal disease) • Milk – dyscomfort, abdominal distention – lactose intolerance • Supine position – intensifies, contaction of the legs - alleviates • Abdominal massage – alleviates in functional pain • Bowel opening (stool, gase) – alleviates in functional pain
What are the accompaninig symptoms of accute abdomenFrom gastrointestinal tract • Nausea • Vomiting • Diarrhoea • Gastrointestinal bleeding • anorexia From other systems: • Fever, weight loss, icterus, painful micturition, cough artritis, eye changes, genital bleeding, fatigue
Etiology of vomiting- Gastrointestinal diseases • Urinary tract diseases • Infections • Central nervous system diseases • Metabolic diseases • Functional diseases
Accompanying symptoms of vomiting- Nausea • Sweating, salivation, chills, paleness, tachycardia, abdominal pain
Nausea and vomiting – questions from history- Since when they occur, intensification • Time of day, meals • Projectile vomiting • Vomit content: food content, bile, blood, coffee grounds vomiting, stagnant vomiting, fecal vomiting • Accompanying symptoms: headache, abdominal pain, fever, diarrhoea • Epidemiological history: contact with people with contagious diseases, similar symptoms in other members of family
What can the appearance of vomit tell us?coffe ground: internal bleeding in upper GI green: bile present in vomit
Vomiting – clinical examples•Non-forceful, regurgitation – gastroesophageal reflux - Bile vomiting, stagnant, green vomiting, no gases, no stool, abdominal tenderness – ileus (intestinal obstruction), surgical abdomen •Morning vomiting, headache, bulging fontanelle, seizures – brain tumor •Vomiting and loose stools – acute diarrhoea •Forceful vomiting – pyloric stenosis •Vomiting and hepatosplenomegaly – chronic liver disease, inborn error of metabolism •Vomiting and blood in stool – intussesception, bacterial gastroenteritis
StoolsNumber • Consistence • Content: mucus, fresh blood, melena (dark black, tarry feces, caused by hemoglobin in the blood being altered by digestive enzymes and intestinal bacteria), pus • Colour: yellow, green, brown, black (melena), acholic (white, lack of bile, cholestasis)
How do we divide GI bleeding?into upper and lower
Upper GI bleedding causes- blood from respiratory system - esophageal varices - varices of cardia in stomach - Mallory Weiss syndrome - peptic ulcer - haemorrhagic esophagitis - dudodenal ulcer
Upper gastrointestinal bleeding - history- Is it blood? – contents: dyes, tea, juice, beetroot • Coffee grounds vomiting – peptic ulcer, • Fresh blood – esophageal varices • Blood clot – esophageal varices • Small pieces of blood • Stool – melena?, bloody stool – in massive upper gastrointestinal bleeding • Other sources of blood – swallowed blood in breast fed infants, upper respiratory tract bleeding, sinuses, tooth, bleeding gums • How plentiful bleeding
What are the different causes of upper Gi bleeding in neonates?Apparent bleeding (swallowed blood in brest fed children, mother’s nipple with wound) •Cow’s milk protein allergy •Trauma (nasogastric tube) •ulcer •esophagitis •Coagulopathies (congenital, acquired) •Vascular malformation
What are the different causes of upper Gi bleeding in infants?•Gastroesophageal reflux •Vomiting •Hemorrhagic gastritis •Peptic ulcer •Vascular malformation naczyniowe •Duplication of digestive tract •Ileus •coagulopathy
What are the different causes of upper Gi bleeding in older children?Vomiting •Gastro-esophageal reflux •Drug-induced (NSAID, salicylates) •Peptic ulcer •Chemical inflammation •Vascuar malformation •Cogulopathy •Crohn’s disease
Causes of lower GI bleeding?- vascular changes - necrotising enterocolitis (Crohns disease) - Meckels diverticulum - polyps - colitis - anal varices
Lower gastrointestinal bleeding - historyAnal bleeding – small bloody fragments, vessels, red colured mucus • Melena • Stool with fresh blood • Loose • Formed • constipated • Admixture of blood, covered in blood
What are the ethiology of lower GI bleeding in children younger than 2 years?•Cow’s milk allergy •Bacterial gastroenteroclitis (EPEC, Salmonella) •Intussusception, volvulus (ileus) •Necrotising enterocolitis (neonates) •Meckel’s diverticulitis •Coagulopathies (congenital, acquired)
What are the ethiology of lower GI bleeding in children older than 2 years?•Bacterial gastroenterocolitis (Campylobacter, EPEC, Salmonella, Yersinia, Cl.difficile) •Inflammatory bowel diseases •Meckel’s diverticulum •Polyp •Vascular malformation •Duplication of digestive tract •Gastrointestinal lymphoma •Anal varices •Anal fissure •Foreign body
AscitesRare symptom in children • Fluid in peritoneal cavity • Patophysiology: hypoalbuminemia, sodium retention, renal failure, fluid retention, portal hipertension, obstruction of the outflow of lymph • Diagnosis: end stage liver failure, hepatic cirrhosis, nephrotic syndrome, heart failure, tuberculosis, neoplasm
Jaudice etiology• Overproduction of bilirubin (hemolysis, massive hematoma, rhabdomyolisis) • Disrupted metabolism - hepatatis – viral, alcoholic, postdrug, other, Gilbert’s syndrome (inherited, genetic liver disorder, affecting ability to process bilirubin) • obstructed excretion (mechanical bile obstruction – cholelithiasis, tumor near bile duct, pancreatic tumor), cholestasis - condition where bile cannot flow from the liver to the duodenum (hepatitis, drug-induced)
Constipationinfrequent bowel defacation, difficult passage of stools that persists for several weeks or longer • Stool: dry, hard • Accompanying symptoms: abdominal pain, painfull defecation, anal bleeding, loose stools, underwear staing • The most frequent habitual constipation • Frquency of defecation: • First week: 4 a day • Breast feeding: 4-7 a day, but also 1 per 7 days • 1 year – 2 daily • Older – 1 a day
Failure to pass meconium within 24 houts of life, diagnostic concernHirschsprung disease
Faltering growth/growth failure, diagnostic concernHypothyroidism, coeliac disease, other
Gross abdominal distension, diagnostic concernHirschsprung disease, gastrointestinal dysmotility
Abnormal lower limb neurology or deformity, e.g. talipes or secondary urinary incontinence, diagnostic concernLumbosacral pathology
Sacral dimple above natal cleft, over the spine – naevus, hairy patch, central pit, or discoloured skin, diagnostic concernSpina bifida occulta
Abnormal appearance/position/patency of anus, diagnostoc concernAbnormal anorectal anatomy
Perianal bruising or multiple fissures, diagnostic concerneSexual abuse
Perianal fistulae, abscesses, or fissures, diagnostic concernePerianal Crohn’s disease
Oropharyngeal (upper, pre-esophageal) dysphagia - difficulty swallowingCNS diseases, prematurity, cerebral palsy, metabolic diseases, long term tube feeding
Esophageal (lower) dysphagia - difficulty passing through the esophagus- Post-inflammatory stricture of the esophagus • Esophageal stricture with scarring (after atresia, burns) • Esophageal neoplasms (rare in children)
Anal itchingAnal skin infections (bacterial, fungal) • Anal fissure • Haemorrhoids • Rectal prolapse • Gastrointestinal parasitic diseases
Urinary tract symptomsPain • Urinary incontinence • Haematuria / Haematuria • Swelling of the penis / scrotum
When do children acuire voiding controll?5 y.o.
Classification of urinary incontinencenocturnal day + night time incontinence day time incontinence
How do we define haematuria / haematuria?the presence of 5 or more erythrocytes in the field of view on microscopic examination of the urine sediment in all 3 urine samples taken at least 1 week apart
Osteoarticular systemEdema • Reddening • Warming • Traffic restriction • Pain - Number of joints involved • Symptoms from other organs