Gastrointestinal Diseases And Red Flags [Part 2 of 3]

August 5, 20130 Comments

Gastrointestinal Diseases And Red Flags Part 2 of 3


Table of Contents

16. Diagnosis of lower GI bleeding & GI bleeding summary

17. Bowel obstruction large and small bowel

18. Toxic megacolon

19. Steakhouse syndrome

20. Bezoar

21. Common pediatric abdominal emergencies

22. Common causes of abdominal pain and DDx

23. Appendicitis

24. Strangulated hernia

25. Alcohol withdrawal

26. Acute pancreatitis

In this section we start off with some of the finer points on how one would make the diagnosis of a GI bleed in a hospital setting just to give you an indication of what’s involved. Upper and lower GI bleed is then summarized. Just remember it is of utmost importance that you try to ascertain if the patient is currently, actively bleeding and if that patient is stable from a blood pressure/heart rate perspective. Not to worry I beat this one to death so you don’t have to. Remember to chart it and time and date it. I’ve been in two major cases in my life and in one because of my bullet proof charting they could not touch me. The second case I was a witness in a huge and I mean huge lawsuit at USC.

From there we cover bowel obstruction which is a red flag with characteristic features shared by large and small bowel pathology. Key features are discussed along with X rays. Toxic megacolon is another terrible red flag that can occur in select populations. Be sure not to be eating when we go over this one.

My favorite-Steakhouse Syndrome-is as you might have guessed when someone usually intoxicated swallows something way too large and it gets stuck in the esophagus. This is a real emergency and I’ll discuss its features with you and how to tell the difference between esophageal verses tracheal obstruction. Both can be bad but tracheal by far is worse. From there we spend some time talking about the things people typically swallow that get stuck. This is usually with toddlers and you need to be aware of some of the complications. But guess what? Even razor blades usually pass uneventfully if it gets past the Adams apple area (the cricopharyngeus muscle). Not everything is a red flag and I feel I must occasionally delight you with well…….. let’s make it a surprise shall we? Hint: there are all sorts of things people swallow.

Next I’ll briefly mention the most common pediatric abdominal emergencies. Even if you never treat children if you have a family this is good stuff to know. I have included my favorite diagram of common causes of abdominal pain by quadrants. This is something that you may wish to copy and keep handy on your clipboard-it’s invaluable.

Next I include the four main hernias all of which can strangulate and judging by the name you probably would have guessed that it’s a serious surgical emergency. And you would be right. It easy to tell between the four and I’ll give you hints as to which ones to be on the lookout for strangulation. If it does occur in any one of these you need to act quickly or you have dead bowel and that’s a deadly consequence.

Next, and I apologize for the way these two slides copied into a PDF, I cover the upregulation and downregulation of key neurotransmitters which helps explain whiskey fits and delirium tremens in alcohol withdrawal-a deadly consequence for some.

The last several slides deal with acute pancreatitis and how it presents. The pancreas is a retroperitoneal organ and so when it becomes inflamed the pain can also refer to the back as well as the front. Be sure to refer to the chart on abdominal pain to see which quadrant/region it often refers to anteriorly.

In this section we covered some fun pathologies and some very dangerous red flags which can easily end up presenting in your office. It’s always best to have this knowledge and never use it rather than need this knowledge and not know it right?

If you go over this presentation several times it will have a chance to sink in. I recommend doing this for both cardiovascular and GI since there are so many loose ends to keep tidy.

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About the Author ()

Christopher Rasmussen MD, MS is Founder and Professor at AdaptiveTCM where helps Traditional Chinese Medicine Practitioners treat complex patients with confidence through providing online CEUs and research. Dr. Rasmussen is currently writing a comprehensive, preventive medicine book, with an emphasis on inflammatory components of disease prevalent in today's patients.

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