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Flashcards in Adult - GI Deck (38):
1

What conditions are part of the umbrella Peptic Ulcer Disease (PUD)?

gastric ulcer
duodenal ulcer

2

Is PUD more common in men or women?

men

3

Younger adults tend to get which type of ulcer?

duodenal

4

Older adults tend to get which type of ulcer?

> age 55

gastric

Geros Get Gastric

5

Of smoking, alcohol, and diet, which seem to contribute to the development of PUD?

smoking

6

Which medications contribute to the formation of peptic ulcer disease?

NSAIDs
ASA
glucocorticoids

7

What is the typical description of PUD pain?

gnawing

8

Which type of ulcer is relieved by eating?

duodenal

9

Which type of ulcer is aggravated by eating?

gastric

10

What are two potential complications of PUD?

GI bleeding
GI perforation

11

What are signs of bowel perforation?

severe epigastric pain
"board like abdomen"
QUIET bowel sounds (ominous)

--> ACUTE ABDOMEN = VERY SERIOUS

12

What are Xray findings in PUD?

free air under diaphragm

13

When would endoscopy be considered in PUD?

After 8 - 12 weeks of treatment

14

First line pharmacology in PUD

H2 receptor antagonist at HS

next step BID

third step PPI

15

Examples of H2 receptor antagonist

ranitidine (Zantac)
famotidine (Pepcid)

16

Examples of PPI

omeprazole (Prilosec)
lansoprazole (Prevacid)

17

What are the 3 leading causes of bowel perforation?

ulcer
diverticulitis
appendicitis

18

What are 3 mucosal protective agents?

bismuth subsalicylate
misoprostol
antacids - mylanta, maalox, MOM

19

When should mucosal protective agents be given?

2 hours apart from other medications

20

What is the only medication used as a prophylaxis against NSAID-induced ulcers?

misoprostol (Cytotec)

21

What is a side effect of misoprostol?

stimulates uterine contraction and can lead to pregnancy loss (used for chemical abortions)

22

When should PPIs be given?

30 minutes before meals

23

When should H2 blockers be given?

as scheduled - at HS or BID

24

What is the general pattern for H. pylori eradication options?

2 antibiotics and a PPI or Bismuth

25

What is in the MOC for H. pylori eradication?

metronidazole (Flagyl)
omeprazole (Prilosec)
clarithromycin (Biaxin)

26

What is in the AOC option for H. pylori eradication?

amoxicillin (Amoxil)
omeprazole (Prilosec)
clarithromycin (Biaxin)

27

What is in the MOA for H. pylori eradication?

metronidazole (Flagyl)
omeprazole (Prilosec)
amoxicillin (Amoxil)

28

What treatment follows H. pylori eradication therapy?

up to 2 months of "step-down therapy" with a PPI or H2 blocker

29

What is patient at risk for when d/c'ing PPI?

rebound GERD

30

What is the typical description of GERD pain?

burning or churning

vs. gnawing of PUD

31

Other than burning or churning, what are signs and symptoms of GERD?

bitter taste in mouth
belching
hiccups

32

What is a common complaint of GERD in the elderly?

dysphagia

(r/o esophageal tumor)

33

What time of day does GERD frequently occur?

at night, after a large meal, in recumbent position

34

What is a concern of long-standing GERD?

progression to Barrett's esophagus
which can lead to esophageal cancer

35

What are four steps of therapy options in GERD?

antacids
H2 blockers
PPI if H2 ineffective
GI/surgical consult

36

When are diagnostics indicated in gastroenteritis?

not indicated unless symptoms persist > 72 hours or if blood is noted in stool

37

What diagnostics are used in gastroenteritis?

stool for culture, WBCs, and O & P

38

What medication can be used for traveler's diarrhea prophylaxis?

bismuth salicylate