GI 1 Approach to the Patient with Gastrointestinal Disease PDF

GENERAL PATHOLOGY Approach to the patient with gastrointestinal disease: functional anatomy and physiology;digestive disease anamnesis and exploration; investigations; abdominal pain > - most comum symp...

GENERAL PATHOLOGY Approach to the patient with gastrointestinal disease: functional anatomy and physiology;digestive disease anamnesis and exploration; investigations; abdominal pain > - most comum sympt pain most common pain > carse of - physiological or inespecific pain acute pain -endicitis to loven - back REFERED PAIN crumps tradiation of pain > - period ↳ why ? > - Uterire contractions to stop bleeding * Dr. Antonio Barrasa  Intended learning objectives To introduce to the clinical presentation of the patient with gastrointestinal diseases – Abdominal pain To introduce investigations in gastrointestinal disease – Imaging – Endoscopy – Laboratory – Functional tests Dr. Antonio Barrasa  Functional anatomy & physiology Digestive tube Secretions Mouth Salivary glands Pharynx Gastric secretion Esophagus Bile Stomach Pancreatic juice Duodenum Bowel secretion Ileum Jejunum Hormones Colon Rectum Anus 3  non digestive pains digestie un GI symptomatology Lobs of vieter inophrisolin ↳ period 2 pan Ø Abdominal pain viscal loca lized somutic pain poorly diffuse Ø Visceral pain Since · localization receptors - pareti pun - Ginvolvent no Ø Results from dilatation, inflammation or infraction of viscus in bowel of diffinito en el but can hort - Ø Diffuse and normally periumbilical a lot, intensity main Ø Parietal pain & next to muscle diff receptors Ø Results from involvement of parietal peritoneum - when involument paristal peritora Ø More precise and well localized of ① precis Ø Non digestive pain (urinary, gynecological, muscular) - Ø Most common causes are functional: inflammatory bowel syndrome and functional dyspepsia Ø Heart burn > another - type of puni sensation of Fire in chest Ø Due to passage of gastric contents into the esophagus (or more rarely to hypersensibility of the esophagus) Ø Half the population suffer an episode from time to time Common pance : all the people with y born have gallbladden · 12 0 x, ↳ Se of abol pain in upperquadrant back daily refering to some & suffer abum if I bur reflux > - ↳ a mutter of · aperdiatis intensity but not all reflex > - heart burn Dr. Antonio Barrasa · inflamations , not all a bon > - hyatre hernia  digestie &non digestre Symptoms GI symptomatology ex : naused period pais replivoticcolic vomit. due to PNS reaction Ø Nausea and vomiting ent From pain to narrend tend case Ø GI diseases T roducing bile & etc... Avisk of haven & keepp vomitting From gif ohs, we bond (ifimp Ø Bowel obstruction pain , contents - -rech Stretch intense. contents go up causes PAIN) travel Ø Gastroparesis stomach ↳ when doesnot mon ex : nesen in - matter of logrid Ø Intestinal pseudoobstruction > - in innenear movement Laby vinthine Ø Medications and drugs non-digestice syndrome nursea. thatcares Ø Endocrine disorders Ø Labyrinthine and central nervous system disorders Ø Functional disorders as IBS and functional dysfagia Dr. Antonio Barrasa  F gragitation > - morenet. a coordinated Sis swallowing to in the opp direction Nausea & vomiting Control centers – Area postrema of IV ventricle in the medulla oblongata of the brainstem sallining rest to – Vomit center vomitente > - Afferent systems – Central nervous system – Peripheral receptors Efferent mechanism – Vagus tell before haused * Prodromic phase - body , GI motor phase > -62 contraction Ejective phase ↳ esphagus opens. image Dr. Antonio Barrasa  Nausea & vomiting > - loosing acid S gastricarid adosis +s > Love , Aft metabolic ro m. - bekome alkal. Consequences compensate metabolic alkalosis with hypoventilation – Hydroelectrolitic disturbances – Peptic esophagitis & Mallory-Weiss -confer -Terupture in mucasa in esophing as carsity – Intraabdominal hyperpressure bleeding – Airways aspiration of contents 5 trackea leave gastric contents in mouth- aspirate in , bronch; lung Gimmy Handriks zgutanplayer ↳ died his espirating own vomitting. Dr. Antonio Barrasa Put Yon Eside Security position. GI symptomatology color blood > - yellowish Abilirrbin in Ø Jaundice - Ø Hepatic or biliary tree diseases or tumors stars) Ø Altered bowel habits the C one of develloped. Constipation is a pandemic in countries. Ø Normal: Ø-3 passage/d to 1 passage/3 days ↳ gastro colic reflex habits reason for altered bond most common Ø Bad dietetic habits > - Ø Medications and drugs Ø Endocrine disorders Ø Tumors and inflammation famous. very Ø Altered bacterial composition - now ↳ intestinal bacteria syndrome Dr. Antonio Barrasa - > of overgrowth  Evaluation of the patient with GI disease other system : ananmesis e exploration Just like any in > - Good Ø History Ø Personal & family history Ø Medications and eating habits Ø Timing and pattern of symptoms Ø Relation to other factors Ø Rome criteria ↳ poo > - ? cuterin For IB S Ø-Bristol stool chart Simuge Dr. Antonio Barrasa  Evaluation of the patient with GI disease I-torchpalpation skin z-soft 3 3 -leeper palpation Ø Physical examination last thing) hurts bothsides /. Ø General inspection it where of exactly the to side same Start : o Equadrants -neuer - ØTInspection, look ake palpation and percussion of the abdomen - - tros aorta , (22a) > mor a Saucultation - , LISTEN First because Ø Search for hernias and masses *** - pulpation can uduce after clobed mards sounds 2 of patient. Ø Rectal and vaginal examination ( - - ↳ rectal palpations -colonoscopy > Common sense in digetie pathologytal to explore 5 (groin) - senses hernia holes ↳ diabetes - polyuria - * diab wellts ↳ hear groin henia > 2 most cre - common - too much Surgery in rrination ↳ SPAIN TITI *diab insipida Dr. Antonio Barrasa stevile urination  Evaluation of the patient with GI disease hidden Common sorre or 6Isyet-must bleeding. Ø Laboratory appear inflamations in of GIS > - Ø Blood cell counting: -anemia, leukocytosis,… - calteed in Ø Biochemistry: Liver and pancreas enzymes, acid-base O va , dinaba - abnormalities,& urea,… bleeding DUREA/ > upper 62 > mabre for es - CREATININE (normal) - - Ø Serology: Viral studies, antibodies in immune diseases,… - for Hepatitis ecolon cance Ø Tumor markers: CEA, Ca 19-9, α-fetoprotein - markes in liver > - shouldn't oder tumor in put without zumo- Ø Ascites: Tumoral, inflammatory, exudative - Ø Stools: Parasites, calprotectine, cultures, occult blood, fat - content,… colon cance screening > - hidden blood in stools look for Ab Dr. Antonio Barrasa  - Evaluation of the patient with GI disease Radiology. Plain Xray Fast and easy. Little definition Hard to read Especially useful for air, calcifications and bones: Hollow viscus perforation Obstruction Lymph node calcifications Bone fractures Overcome by CATscan Dr. Antonio Barrasa  Colon ↳ obstructed Filled with gaz Colonic obs -most common carse , Coloncance Contrast with parium obstruction O - of an core apple-  Evaluation of the patient with GI disease Contrast radiology Barium or non-ionic contrast Mayor indications: Characterization of- fistulas Motor syndromes (GORD, achalasia, constipation) ↳gasterosphage Limitations regugitation ↳ of reflux swallowing , contrast Radiation Poor mucosal detail Time consuming Dr. Antonio Barrasa  Evaluation of the patient with GI disease Ultrasonography ultrasound device. to have essential an > - Advantages: Fast and cheap - seeit moving - ① p Live acquisition of pictures Attachable to devices Ideal for solid organs, fluids, bowel walls, interventionism Drawbacks trancaled pic of live ② Subjective - Interferences byG air => transanal-ultrasound + endoscopy ultrasound transesophage Dr. Antonio Barrasa  Evaluation of the patient with GI disease CT scanning Chance for endovenous, oral, rectal, … contrast Advantages Great definition for gas, fluid and bone - Whole body study virtualy & do"endoscopy- - 3D reconstruction - reconstruct Drawbacks Pelvis Radiation Scecum apendicholitis- Dr. Antonio Barrasa  Evaluation of the patient with GI disease MR Imaging > - diff technolyy , very por ful mugrets geat to see Fd Chance for endovenous contrast Advantages Great definition for soft tissues and fluids 3D reconstruction Drawbacks Timely and expensive stor Metals bluden Dr. Antonio Barrasa & I rectal cancer  Evaluation of the patient with GI disease contact with environment of bowels in Endoscopy Tinmentpart , Advantages Great definition of mucosae. Augmented reality. Biopsies and therapeutic procedures Drawbacks perforations Debledding Invasive , stool colomoscopy -Remore Preparations ec : > - Fromp atient banch * Sedations> propophol - Dr. Antonio Barrasa  Evaluation of the patient with GI disease Upper GI Endoscopy stomach strunch > - GASTRIC CANCER L most comm gastric verplasm) durdenum Dr. Antonio Barrasa  Evaluation of the patient with GI disease Colonoscopy tumu vlseative cholitis Dr. Antonio Barrasa  Evaluation of the patient with GI disease T see bile & pannatic 2 dich Endoscopic Retrograde CholangioPancreatography - ↳ exitt oppe Fill uth contraste ↳ see -adiography Dr. Antonio Barrasa  Evaluation of the patient with GI disease Functional studies Ø Phmetry: Mesures ph in esophagus Ø Manometry: Ø Esophageal: To study GERD Ø Rectal: To study constipation and incontinence Ø Colonic transit time study Ø Breath tests > see if Fernet - Ø Absorption & digestion studies Dr. Antonio Barrasa  manometer see pressue in esphagus construct Rside- Iside Crustipation mov  Abdominal pain Types of pain Nociceptive Acute – Somatic (parietal) Chronic – Visceral Neuropathic Referred (dermatomes) Psychogenic Dr. Antonio Barrasa  Abdominal pain Ø Abdominal pain Ø Visceral pain Ø Results from dilatation, inflammation or infraction of viscus Ø Diffuse and normally periumbilical Ø Parietal pain Ø Results from involvement of parietal peritoneum Ø More precise and well localized Ø Non digestive pain (urinary, gynecological, muscular) Ø Most common causes are functional: inflammatory bowel syndrome and functional dyspepsia Dr. Antonio Barrasa  Abdominal pain Most common causes of abdominal pain (90%) are mild and require medical treatment such as gastroenteritis, dyspepsia, dysmenorrhea, or other unspecific abdominal disturbances. When it is acute abdominal pain, according to WHO – Unspecific abdominal pain 34% – Acute Appendicitis 28% – Cholecystitis 10% Dr. Antonio Barrasa  Acute abdominal pain Classification Inflammatory Perforative Hemorrhagic Obstructive intestinal Obstructive enterovascular Mixed Dr. Antonio Barrasa  Abdominal pain localization Tomado de: https://www.msdmanuals.com/professional/gastrointestinal- disorders/acute-abdomen-and-surgical-gastroenterology/acute-abdominal-pain Dr. Antonio Barrasa [email protected] Dr. Antonio Barrasa