Common GI Disorders

1. Differential
   1. Benign, self limited
      1. mild viral GE
   2. life threatening
      1. AAA
   3. GI
      1. GB
         1. STONES
            1. 90% cholesterol
            2. sm%pigmented
         2. 12% US pop.
         3. Risk: obese, rapid wt loss, bypass surg
            1. women
               1. on unopposed estrogen
            2. FHX Stones
            3. Indian
            4. scandinavian
            5. on TPN
         4. Risk
            1. 10% w stones dev sx in 5 yrs
            2. 25% w stones dev sx in 10 yrs.
            3. aft onset sx incr recur attacks inflam GB, Pancreatitis
   4. ob/gyn
   5. urologic
   6. Vascular
   7. psych
   8. Musculoskeletal
   9. atypical presentation in elderly

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

1. rectal exam
2. Pelvic exam
3. GB-Murphy's sign
4. Psoas sign - Appy
5. Carnett's sign
   1. abd wall pain
      1. kidney stones
      2. Pyelo
      3. Peritonitis

Nota:

• Driven by severity of pain and differential dx. from H/P. 

1. Pancreatitis
   1. CBC
   2. Amylase/ Lipase
   3. CMP
2. Pregnancy test

Nota:

• amer college rad appropriateness criteria: location of pain to decide which test is recommended. Uses scale of 1-9 w higher #= more appropriate test. 

1. CT
   1. ACR = RLQ

      Nota:

      • W/ IV contrast
      1. AVOID IN PREGNANCY, CHILDREN
   2. LLQ pain
      1. CT W IV & PO contrast
   3. ACR imaging test of choice for nonlocalized abd pain needing more testing.
2. Ultrasound
   1. ACR - RUQ pain
   2. suprapubic pain / GYN etiol
3. KUB

   Nota:

   • typically not recomm, limited value may show free air.