GI tract


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GI tract

abbreviation for gastrointestinal tract. See digestive tract.

non-cardiac chest pain

Internal medicine Chest pain that simulates cardiac nosologies, but is unrelated to cardiovascular disease; 50% of Pts with NCCP have known reflex and may have postprandial or noctural Sx. See Gastroesophageal reflux disease.
Non-cardiac chest pain shamelessly taken, virtually verbatim from www.vnh.org/GMO/
ClinicalSection/08Chestpain.html, from Dept Navy, Bureau of Med & Surg; Internally Peer Reviewed
Sources of chest pain The heart, great vessels, pericardium; GI tract; lungs & pleura; chest wall
How to minimize YOUR risks of managing Acute chest pain Identification of ischemic chest pain requires a high index of suspicion; when the diagnosis of acute MI is overlooked and Pts are sent home–the mortality during the next 72 hrs is about 25%–how did you spell  that phrase again, “…out-of-court settlement.”–vs ± 6% for Pts with infarction who are hospitalized; being liberal in admissions for evaluation of CAD; incidence of acute MI in Pts hospitalized with acute chest pain is between 25 and 30%; despite conservative admission rates, clinicians misdiagnose ±5-10% of Pts with acute MI–ie, you're in good company if you screw up
History The Hx rules decision making; elements of the Hx important in discriminating cardiac from noncardiac chest pain are quality, severity, duration and frequency; knowledge of exacerbating features and maneuvers that ameliorate the discomfort are helpful; cardiac risk factors should not overly influence clinical thinking; the presence of risk factors simply implies that a person is more likely to develop overt signs of ASHD in the future, but are not exclusionary criteria
Pain character Chest pain due to coronary ischemia is classically a dull heavy pressure–but Pts have been pretty colorful in use of adjectives to describe this pain; they may have classic pain, DON'T expect a classic description of anginal pain; the pain may be confined to the chest or accompanied by aching in one or both arms, more often the left; neck or mandibular pain or aching confined to the shoulder, wrist, elbow, or forearm may manifest solely or with typical chest pressure; small zones of pain are generally not of myocardial origin; radiation of pain to the digits, brief zaplets of pain or discomfort that persists for days are not due to myocardial ischemia; effort or emotional stress commonly provokes angina; angina may occur at rest if perfusion is compromised; pain subsides within 1 to 5 mins if the triggering activity is discontinued; nitroglycerin hastens this relief
EKG The 12-lead ECG has limited value in excluding the presence of CAD; excluding the Dx of angina pectoris or acute MI because of a normal ECG is as great an error as inferring a diagnosis of CAD from the incorrect interpretation of nonspecific electrocardiographic abnormalities
Cocaine Cocaine causes ↓ coronary blood flow due to vasoconstriction; rhabdomyolysis, a complication of cocaine use, provides another mechanism for the chest pain; all chest painers should be questioned about cocaine use and, when appropriate, have a urine drug screen
GI tract Pain from the GI tract, especially the esophagus, may give rise to angina-like chest discomfort; GERD is the most common esophageal cause of noncardiac chest pain; it is described as a burning sensation or squeezing pain located in the retrosternal area between the xyphoid and suprasternal notch; listen for clues about association of Sx with meals, posture, and relief by belching or antacids; medical management involves dietary modifications, smoking cessation, and histamine type 2 (H2) antagonists or antacids; GI referral is warranted when these interventions are unsuccessful in alleviating Sx; the pain of peptic ulcer disease may also occur high in the epigastrium or lower chest; relationship
to meals and relative nonresponse to nitroglycerine helps distinguish this pain from
angina pectoris
Esophagus spasm Diffuse esophageal spasm is a neuromuscular disorder characterized by chest pain and difficulty in swallowing; NOTE Nitroglycerin promptly relieves esophageal spasm causing confusion in the diagnosis; vigorous disordered contractions in the body of the esophagus are induced by ingestion of cold liquids or normal swallowing during a meal; anxiety and stress are also common precipitating factors; there is usually no exertional component but ↑ abdominal pressure from lifting, sit-ups, or running can cause reflux; diagnosis rests on history and verification of esophageal spasm by manometric studies
Pulmonary origin Pain of pulmonary origin characteristically has a distinct pleuritic quality varying with the respiratory cycle; intercostal nerves supply sensory afferents to the costal parietal pleura; inflammation arising from this region is appreciated in the adjacent chest wall; referred pain originating in the diaphragm is appreciated in the ipsilateral shoulder; differentiating features of pulmonic from musculoskeletal pain are the more intense nature of pleuritic pain and the worsening of musculoskeletal pain by extension, abduction, or adduction of the arm and shoulder; pain centered around involved muscle groups may also distinguish musculoskeletal from pleuritic chest pain; (a) Spontaneous pneumothorax tends to occur in young adult males producing sharp pleuritic chest discomfort and dyspnea; (b) Pulmonary embolus may produce pleuritic pain, however, dyspnea, and tachypnea are most frequent. Inciting factors for pulmonary embolus include the post-operative period after long recumbent or inactive periods and following trauma where the same immobility may result in venous stasis and thrombosis.
Chest wall Tietze's syndrome or costochondritis is a self-limiting discomfort. Its quality is sharp or burning and is exacerbated by mechanical activity of the chest wall, specifically respiration; the second or third costal cartilages on either side are the most common area of involvement, but any of the costochondral articulations can be involved; NSAIDs or aspirin may offer temporary relief but reassurance tends to be as useful.
Etc Rarely, no etiology is found on standard evaluation of chest pain from the cardiology or GI consultation; one should then rule out panic disorder, visceral hypersensitivity in irritable bowel syndrome, and other exotica

paraneoplastic syndrome

Oncology A co-morbid condition due to the indirect–remote or 'biologic' effects of malignancy, which may be the first sign of a neoplasm or its recurrence; PSs occur in > 15% of CAs, are caused by hormones, growth factors, biological response modifiers, and other as-yet unidentified factors, and may regress with treatment of the primary tumor. See Ectopic hormone.
Paraneoplastic syndromes
GI tract, eg anorexia, vomiting, protein-losing enteropathy, liver disease
Hematologic, eg leukemoid reaction, reactive eosinophilia, peripheral 'cytoses or 'cytopenias, hemolysis, DIC, thromboembolism, thrombophlebitis migrans
Hormonal effects
Metabolic disease, eg lactic acidosis, hypertrophic pulmonary osteoarthropathy, hyperamylasemia, hyperlipidemia
Neuromuscular, eg peripheral neuropathy, myopathy, CNS, spinal cord degeneration, inflammation
Renal, eg nephrotic syndrome, uric acid nephropathy
Skin, eg bullous mucocutaneous lesions, acquired ichthyosis, acanthosis nigricans, dermatomyositis
Others, eg callus formation, hypertension, and amyloidosis
References in periodicals archive ?
For each chosen organ location in the GI tract (crop, ventriculus, distal large intestine, and cloaca), the percentage arrival of the 30 BIPS administered and the mean and SD for the arrival and passing times for barium and BIPS were calculated.
We don't know how much norepinephrine increases in the GI tract during stress, so we can't pinpoint the levels that might require intervention and treatment.
The lead shot pellet was released from the GI tract in January 2003.
The finding spurred Gordon's group to investigate the microbe's control over the system of blood vessels that runs through the GI tract.
Caution is needed in attributing blood loss or iron deficiency to exercise-related causes without considering underlying organic disease of the GI tract requiring diagnostic evaluation.
In the event of relapse or resistance to treatment, cholestyramine (Questran) resin can be used in addition to attempts to clear the GI tract of C.
In fistulated dogs, oral delivery of SYN-004 resulted in efficient degradation of ceftriaxone in the GI tract, and
Some of the melatonin, however; remains in the GI tract to exert a protective action on the GI tissues.
Likewise, when you combine foods that have a sour quality, or fermented foods such as yogurt, with sweet foods such as milk or fruit, the sour quality can cause the milk to separate and ferment in the stomach, leading to toxic buildup in the GI tract and the deeper tissues over time.
Many trainers believe these painful diaphragm spasms are associated with gravitational forces and occur when running tugs at the connective tissues in your GI tract.
Ara h2 is resistant to acidic conditions and digestion with GI tract enzymes (Astwood et al.
Reported cases indicate that lesions farther down the GI tract, in the mid-jejunum, terminal ilium, or cecum, tend to develop around a single site or a few sites of ulceration and edema, more analogous to cutaneous lesions.