valuemd.

com

http://www.valuemd.com/gastro.php

GastroIntestinal Mnemonics
GASTROINTESTINAL
MNEMONICS
Bowel Segments
"Dow Jones Industrial Averages Closing Stock Report" is a good one, even though it misses the
Cecum...
Dow
Jones
Industrial
Averages
Closing
Stock
Report

Duodenum
Jejunum
Ileum
Appendix
Colon
Sigmoid
Rectum

Liver Lobes
The four lobes of the liver: caudate, quadrate, left and right, bring to mind the newspaper headline of the
wheelchair bound fellow who left a party right after his ugly girlfriend departed: "QUAD LEFT RIGHT after
COW-DATE"

Pertoneum Facts
The idea is to relate key letters of related parts...
stOMach and OMentum (which lays over the stomach)
The bacterium e. coLI is found in the Large Intestine
The OMentum covers the stOMach
The Lesser OMentum holds the Liver and stOMach
The Mesentery holds the sMall intestine
The mesoCOLON attaches the large intestine (COLON) to the posterior abdominal wall.
The periTONEa, which prevents the intestines from kinking, TONES the GI tract.

Sphincters of the Ailmentary Canal

APE OIL initials the five of them...
A
P
E
O
I
L

Anal
Pyloric
(Lower) Esophageal
Oddi
Ileocecum
iLeocecum

Stomach Parts
"The CAR is FUN 'til the BODY PILES" relates the four parts of the stomach: Cardiac, Fundus, Body,
Pylorus. The pylorus is where the food piles waiting for the sphincter to open.
Ulcerative colitis: definition of a severe attack A STATE:

Anemia less than 10g/dl

Stool frequency greater than 6 stools/day with blood
Temperature greater than 37.5
Albumin less than 30g/L
Tachycardia greater than 90bpm
ESR greater than 30mm/hr

Vomiting: extra GI differential VOMITING:

Vestibular disturbance/ Vagal (reflex pain)
Opiates
Migrane/ Metabolic (DKA, gastroparesis, hypercalcemia)
Infections
Toxicity (cytotoxic, digitalis toxicity)
Increased ICP, Ingested alcohol
Neurogenic, psychogenic
Gestation

Pancreatitis (acute): causes GET SMASHED:

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune (PAN)
Scorpion stings
Hyperlipidemia/ Hypercalcemia
ERCP
Drugs (including azathioprine and diuretics)
Note: 'Get Smashed' is slang in some countries for drinking, and ethanol is an important pancreatitis cause.

IBD: surgery indications "I CHOP":

Infection
Carcinoma
Haemorrhage
Obstruction
Perforation
"Chop" convenient since surgery chops them open.

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) cause is DNA mismatch repair DNA mismatch causes
a bubble in the strand where the two nucleotides don't match.
This looks like the ensuing polyps that arise in the colon.

IBD: extraintestinal manifestations A PIE SAC :

Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing of fingertips

Digestive disorders: pH level With vomiting both the pH and food come up.
With diarrhea both the pH and food go down.

H. Pylori treatment regimen (rough guidelines) "Please Make Tummy Better":

Proton pump inhibitor
Metronidazole
Tetracycline
Bismuth
Alternatively: TOMB:
Tetracycline
Omeprazole
Metronidazole
Bismuth

Bilirubin: common causes for increased levels "HOT Liver":

Hemolysis
Obstruction
Tumor
Liver disease

Ulcerative colitis: complications "PAST Colitis":

Pyoderma gangrenosum
Ankylosing spondylitis
Sclerosing pericholangitis
Toxic megacolon
Colon carcinoma

Cholangitis features CHOLANGITITS:

Charcot's triad/ Conjugated bilirubin increase
Hepatic abscesses/ Hepatic (intra/extra) bile ducts/ HLA B8, DR3
Obstruction
Leukocytosis
Alkaline phosphatase increase
Neoplasms
Gallstones
Inflammatory bowel disease (ulcerative colitis)
Transaminase increase
Infection
Sclerosing

Charcot's triad (gallstones) "Charge a FEE":

Charcot's triad is:
Fever
Epigastric & RUQ pain
Emesis & nausea

Haemachromatosis complications "HaemoChromatosis Can Cause Deposits Anywhere":

Hypogonadism
Cancer (hepatocellular)
Cirrhosis
Cardiomyopathy
Diabetes mellitus
Arthropathy

Pancreatitis: criteria PANCREAS:

PaO2 below 8
Age >55
Neutrophils: WCC >15
Calcium below 2
Renal: Urea >16
Enzymes: LDH >600; AST >200
Albumin below 32
Sugar: Glucose >10 (unless diabetic patient)

Pancreatitis: Ranson criteria for pancreatitis: at admission "GA LAW" (GA is abbreviation for the U.S. state
of Georgia):
Glucose >200
AST >250
LDH >350
Age >55 y.o.
WBC >16000

Pancreatitis: Ranson criteria for pancreatitis: initial 48 hours "C & HOBBS" (Calvin and Hobbes):
Calcium < 8
Hct drop > 10%
Oxygen < 60 mm
BUN > 5
Base deficit > 4
Sequestration of fluid > 6L

Pancreatitis: Ranson criteria for pancreatitis at admission LEGAL:

Leukocytes > 16.000
Enzyme AST > 250
Glucose > 200
Age > 55
LDH > 350

GIT symptoms BAD ANAL S#!T:

Bleeding
Abdominal pain
Dysphagia
Abdominal bloating
Nausea & vomiting
Anorexia/ Appetite changes
Lethargy
S#!ts (diarrhea)
Heartburn

Increased bilirubin (jaundice)

Temperature (fever)

Crohn's disease: morphology, symptoms CHRISTMAS:

Cobblestones
High temperature
Reduced lumen
Intestinal fistulae
Skip lesions
Transmural (all layers, may ulcerate)
Malabsorption
Abdominal pain
Submucosal fibrosis

Dysphagia: differential DISPHAGIA:

Disease of mouth and tonsils/ Diffuse oesophageal spasm/ Diabetes mellitus
Intrinsic lesion
Scleroderma
Pharyngeal disorders/ Palsy-bulbar-MND
Achalasia
Heart: eft atrium enlargement
Goitre/ myesthenia Gravis/ mediastinal Glands
Infections
American trypanosomiasis (chagas disease)
21

Dry mouth: differential "DRI":

2 of each:
Drugs/ Dehydration
Renal failure/ Radiotherapy
Immunological (Sjogren's)/ Intense emotions
Liver failure: decompensating chronic liver failure differential HEPATICUS:
Haemorrhage
Electrolyte disturbance
Protein load/ Paracetamol
Alcohol binge
Trauma
Infection
Constipation
Uraemia
Sedatives/ Shunt/ Surgery

Cirrhosis: causes of hepatic cirrhosis HEPATIC:

Hemochromatosis (primary)
Enzyme deficiency (alpha-1-anti-trypsin)
Post hepatic (infection + drug induced)
Alcoholic
Tyrosinosis

Indian childhood (galactosemia)

Cardiac/ Cholestatic (biliary)/ Cancer/ Copper (Wilson's)

Hepatic encephalopathy: precipitating factors HEPATICS:

Hemorrhage in GIT/ Hyperkalemia
Excess protein in diet
Paracentesis
Acidosis/ Anemia
Trauma
Infection
Colon surgery
Sedatives

Diabetic ketoacidosis: precipitating factors 5 I's:

Infection
Ischaemia (cardiac, mesenteric)
Infarction
Ignorance (poor control)
Intoxication (alcohol)

Whipple's disease: clinical manifestations SHELDA:

Serositis
Hyperpigmentation of skin
Eating less (weight loss)
Lymphadenopathy
Diarrhea
Arthritis

Celiac sprue gluten sensitive enteropathy: gluten-containing grains BROW:

Barley
Rye
Oats
Wheat
Flattened intestinal villi of celiac sprue are smooth, like an eyebrow.
Liver failure (chronic): signs found on the arms CLAPS:
Clubbing
Leukonychia
Asterixis
Palmar erythema
Scratch marks

Splenomegaly: causes CHIMP:

Cysts
Haematological ( eg CML, myelofibrosis)
Infective (eg viral (IM), bacterial)
Metabolic/ Misc (eg amyloid, Gauchers)
Portal hypertension