Common GI Disorders

Common GI Disorders

1. Acute Abd Pain

   • 1.5% of all out pt visits
   • 8% of all ER visits
     • Differential
       • Benign, self limited
         • mild viral GE
       • life threatening
         • AAA
       • GI
         • GB
           • STONES
             • 90% cholesterol
             • sm%pigmented
           • 12% US pop.
           • Risk: obese, rapid wt loss, bypass surg
             • women
               • on unopposed estrogen
             • FHX Stones
             • Indian
             • scandinavian
             • on TPN
           • Risk
             • 10% w stones dev sx in 5 yrs
             • 25% w stones dev sx in 10 yrs.
             • aft onset sx incr recur attacks inflam GB, Pancreatitis
       • ob/gyn
       • urologic
       • Vascular
       • psych
       • Musculoskeletal
       • atypical presentation in elderly

2. History

   • Pain
     • Location
     • onset
     • duration
       • radiation
     • Exacerbating sx
       • relieving factors
     • hx of similar sx
     • Key assoc sx
       • fever
       • chills
       • Anorexia
         • worse or better with eating
       • upper GI sx
         • Nausea
         • vomiting
           • hematemesis
         • Belching
       • Lower GI sx
         • change in bowels
           • constipation
             • Diarrhea
               • hematochezia
                 • Melena
           • Gas
             • Bloating
       • Urinary sx

3. Physical Exam

   • Vitals
   • Abd exam
     • rectal exam
     • Pelvic exam
     • GB-Murphy's sign
     • Psoas sign - Appy
     • Carnett's sign
       • abd wall pain
         • kidney stones
         • Pyelo
         • Peritonitis
   • cardio/pulmonary

4. TESTING

   • Lab
     • Driven by severity of pain and differential dx. from H/P. 
     • Pancreatitis
       • CBC
       • Amylase/ Lipase
       • CMP
     • Pregnancy test
   • IMAGING
     • amer college rad appropriateness criteria: location of pain to decide which test is recommended. Uses scale of 1-9 w higher #= more appropriate test. 
     • CT
       • ACR = RLQ
         • W/ IV contrast
         • AVOID IN PREGNANCY, CHILDREN
       • LLQ pain
         • CT W IV & PO contrast
       • ACR imaging test of choice for nonlocalized abd pain needing more testing.
     • Ultrasound
       • ACR - RUQ pain
       • suprapubic pain / GYN etiol
     • KUB
       • typically not recomm, limited value may show free air.