347.2 🩺 國考版

347.2.1 高頻考點

347.2.1.1 Pain Types

  • Visceral: poorly localized, midline, autonomic
  • Parietal: sharp, localized, peritonitis
  • Referred: shared embryology

347.2.1.2 Dysphagia Workflow

  • Oropharyngeal: stroke, ALS, MG, Zenker — modified barium swallow
  • Esophageal:
    • Structural: rings, strictures, malignancy, EoE
    • Motility: achalasia, DES, scleroderma
    • EGD + manometry

347.2.1.3 Dyspepsia (Rome IV)

  • Functional or organic
  • Alarm features → EGD
  • H. pylori testing
  • PPI trial

347.2.1.4 Diarrhea Classification

  • Acute (< 14 d): infectious mostly
  • Chronic (> 14 d): secretory, osmotic, inflammatory, malabsorptive, motility

347.2.1.5 GI Bleeding

  • UGIB: hematemesis, melena, coffee-ground; PUD #1
  • LGIB: hematochezia; diverticulosis common
  • Obscure: capsule endoscopy

347.2.1.6 Constipation Causes

  • Functional, drugs (opioids), endocrine (hypothyroid, DM, hyperCa), neurogenic

347.2.1.7 Jaundice Workup

  • Pre-hepatic: hemolysis (unconjugated)
  • Hepatic: hepatocellular (mixed)
  • Post-hepatic: cholestasis (conjugated)
  • Imaging: US first

347.2.1.8 Endoscopy Indications

  • Dyspepsia + alarm features
  • GI bleeding
  • Surveillance (Barrett, polyps, IBD, esophageal varices, gastric ulcer)
  • Diagnostic biopsy

347.2.1.9 Stool Studies

  • Culture, ova/parasites
  • C. diff toxin
  • Fecal calprotectin (IBD vs IBS)
  • Fecal elastase (pancreatic insufficiency)
  • Fecal fat (malabsorption)

347.2.1.10 Rome IV Criteria

  • Functional GI disorders
  • IBS, functional dyspepsia, constipation, etc.

347.2.2 易混淆比范

Symptom Causes Workup
Dysphagia OP vs esophageal Modified barium / EGD / manometry
Dyspepsia Functional vs organic H. pylori, EGD if alarm
Acute diarrhea Infection Stool studies
Chronic diarrhea Multiple Comprehensive workup
Constipation Functional, drugs, endocrine History, anorectal
UGIB PUD, varices EGD
LGIB Diverticulosis Colonoscopy
Jaundice Pre/hepatic/post LFT + US

347.2.3 Special Topics

347.2.3.1 Alarm Features in Dyspepsia

  • Age ≥ 60 (some say 55)
  • Weight loss
  • Dysphagia
  • GI bleeding (melena, hematemesis)
  • Vomiting
  • Family history of GI cancer
  • Anemia
  • Early satiety

347.2.3.2 Hematemesis vs Hemoptysis

  • Hematemesis: dark, mixed with food, pH acidic
  • Hemoptysis: bright red, frothy, alkaline, coughed up