Family Nurse Practitioner (FNP) > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

Evaluate, diagnose, and treat common gastrointestinal complaints and disorders using evidence-based guidelines. (101 cards)

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1
Q

What does Cullen sign indicate?

A

Bruising at the periumbilicus, often due to retroperitoneal bleeding.

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2
Q

What does Grey Turner sign suggest?

A

Bruising on the flanks, suggests hemorrhage or trauma.

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3
Q

What is hematochezia?

A

Blood seen in stool, may be seen with inflammatory bowel disease or hemorrhoids.

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4
Q

What is the normal adult liver span in the midclavicular line?

A

Less than 16 cm.

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5
Q

What is Markle sign and what does it indicate?

A

Patient forcefully drops the heel down to the ground, causing abdominal pain; may indicate peritonitis or appendicitis.

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6
Q

What is Murphy’s sign?

A

Pain with palpation to the RUQ while the patient inhales, may indicate cholecystitis.

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7
Q

What does a positive psoas/obturator test indicate?

A

Pain while extending the psoas muscle or pain on passive internal rotation of the right thigh, may indicate appendicitis.

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8
Q

What is Rovsing’s sign?

A

Deep palpation at the LLQ causes pain in the RLQ, may indicate peritonitis or appendicitis.

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9
Q

What is splenomegaly?

A

Spleen is not normally palpable; spleen greater than 20 cm is enlarged.

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10
Q

What is steatorrhea?

A

Fatty/oily appearing stool, foul smelling stool; may indicate celiac disease.

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11
Q

What is tenesmus?

A

Sensation that the patient needs to have a bowel movement, regardless if colon is empty or if the patient just had a bowel movement.

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12
Q

What does a tympanic abdomen indicate?

A

Hollow/drum-like abdominal sounds, may indicate bowel obstruction.

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13
Q

What are the classic symptoms of GERD?

A

Heartburn in the retrosternal area and regurgitation after a meal.

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14
Q

When can a clinical diagnosis of GERD be made?

A

In the presence of classic symptoms, without red flags.

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15
Q

What are the red flags for GERD that warrant endoscopy?

A
  • New onset of symptoms in patients 60 years and older
  • Evidence of G.I. bleeding
  • Presence of IDA
  • Anorexia or unexplained weight loss
  • Difficulty with swallowing
  • Persistent vomiting
  • G.I. cancer in a first-degree relative
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16
Q

What are the non-pharmacological treatments for GERD?

A

Avoid triggers:

  • carbonated beverages
  • spicy foods
  • fatty or fried foods
  • excess coffee
  • peppermint
  • excess weight gain
  • restrictive clothing
  • tobacco smoking
  • stress
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17
Q

What are the pharmacological treatments for mild/intermittent GERD symptoms?

A

Histamine 2 receptor antagonist

(famotidine, nizatidine, cimetidine)

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18
Q

What are the pharmacological treatments for frequent/severe GERD symptoms?

A

Proton pump inhibitor

(omeprazole, lansoprazole, pantoprazole)

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19
Q

What is Barrett’s esophagus?

A

Pre-malignant condition resulting from repeated exposure to stomach acid.

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20
Q

What are the risk factors for Barrett’s esophagus?

A
  • History of GERD for a minimum of 5 years
  • Age 50 years and older
  • Male gender
  • Caucasian
  • Hiatal hernia
  • Central obesity
  • Reflux symptoms during sleep
  • History or current use of tobacco
  • First-degree relative with Barrett’s esophagus
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21
Q

How is Barrett’s esophagus diagnosed?

A

Upper endoscopy and biopsy.

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22
Q

What is the treatment for Barrett’s esophagus?

A

Daily proton pump inhibitor indefinitely.

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23
Q

What is peptic ulcer disease?

A

Disruption of the mucosal lining of the stomach or duodenum, resulting in an ulcer.

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24
Q

What are risk factors for peptic ulcer disease?

A
  • Smoking
  • Alcohol use
  • Advanced age
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25
What are the **symptoms** of peptic ulcer disease?
Epigastric pain (often worse after eating), sensation of fullness, early satiety, and nausea.
26
How is peptic ulcer disease **diagnosed**?
Suspected in patients with indigestion or dyspepsia, especially those who frequently use NSAIDs or have a history of H. pylori infection; confirmed with upper endoscopy or abdominal CT.
27
What is the **treatment** for peptic ulcer disease?
Daily proton pump inhibitor (PPI) and test for H. pylori infection.
28
What is **Helicobacter pylori** induced gastritis?
Most common, chronic inflammatory, bacterial infection of the stomach.
29
What are the **diagnostic options** for H. pylori infection?
* Endoscopy * Urea breath testing * Stool antigen testing
30
What is the **treatment** for Helicobacter pylori infection **with risk** for macrolide resistance?
Bismuth quadruple therapy: * Bismuth * Metronidazole * Tetracycline * PPI
31
What is the **treatment** for H. pylori infection **without risk** factors for macrolide resistance?
Clarithromycin triple therapy: * Clarithromycin, amoxicillin, and PPI * *or* Clarithromycin, metronidazole, and PPI (if amoxicillin allergy)
32
What defines **diarrhea**?
Three or more episodes in a 24-hour period.
33
What are **common viral pathogens** causing diarrhea?
* Norovirus * Rotavirus * Adenoviruses
34
What are **common bacterial pathogens** causing diarrhea?
* Salmonella * Campylobacter * Shigella * Enterotoxigenic Escherichia coli * Clostridioides difficile
35
What is the **symptomatic treatment** for diarrhea?
Loperamide (Immodium) or Bismuth salicylate (Pepto-Bismol). ## Footnote Do not use loperamide if fever or bloody stool present, UNLESS being co-treated with antibiotics
36
What are the **indications** for empiric antibiotics in diarrhea?
* Severe illness * Inflammatory diarrhea * High-risk patients
37
What symptoms indicate inflammatory diarrhea?
* Bloody diarrhea * Small volume stools with mucus present ## Footnote Inflammatory diarrhea results from mucosal damage (often due to infection or inflammatory bowel disease), leading to blood, mucus, and leukocytes in the stool. It typically presents with fever, abdominal pain, and tenesmus (painful urge to defecate).
38
What patients with diarrhea are considered **high risk**?
* ≥70 years * Cardiac disease * Immunocompromised * Inflammatory bowel disease * Pregnancy ## Footnote High-risk patients are more likely to develop severe dehydration, electrolyte imbalances, or infectious complications and may require earlier diagnostic evaluation or hospitalization.
39
What is the **treatment** for C. difficile infection?
Oral vancomycin or fidaxomicin.
40
What defines **constipation**?
**Fewer than three** bowel movements per week, plus any two of the following: straining, lumpy hard stools, sensation of incomplete evacuation, use of digital maneuvers, sensation of rectal obstruction, blockage with 25% of bowel movements.
41
What are the **red flags** for constipation?
* Hematochezia * Weight loss of ≥10 pounds * Family history of colon cancer or inflammatory bowel disease * Anemia * Positive fecal occult blood tests * Recent onset of constipation without an obvious explanation
42
What are the **treatment options** for constipation?
* Daily fiber intake of 20 to 25 g/day * Bulk laxatives: psyllium * Osmotic laxatives: low dose/high dose polyethylene glycol, lactulose * Stool softeners: docusate * Suppositories: glycerin, bisacodyl * Enema: tap water, soap suds
43
What is the **route of transmission** for Hepatitis A virus?
Fecal-oral route
44
What are the **symptoms** of Hepatitis A virus infection?
* Sudden onset of low-grade fever * Fatigue * Nausea * Vomiting * Clay-colored stools * Tea-colored urine * Jaundice
45
What is the **treatment** for Hepatitis A virus infection?
Symptomatic treatment and prevention with vaccine.
46
What is the **incubation period** for Hepatitis B virus?
60 to 150 days
47
What are the **diagnostic markers** for acute Hepatitis B infection?
Presence of HBsAG and IgM anti-HBc.
48
What is the **route of transmission** for Hepatitis C virus?
Blood
49
What is the **recommended screening** for Hepatitis C virus?
Universal one-time screening in adults 18 years and older, with repeat screening for patients with ongoing risk for exposure.
50
What is **diverticulitis**?
Inflammation and/or infection of diverticula.
51
What are the **symptoms** of diverticulitis?
Left-sided abdominal pain, generalized abdominal pain, low-grade fever, nausea, vomiting, diarrhea, constipation.
52
What is the **treatment** for uncomplicated diverticulitis?
Liquid to soft diet and pain management, with close follow-up in 2-3 days. ## Footnote Antibiotics are no longer indicated for uncomlicated diverticulitis
53
What is **appendicitis**?
Inflammation of the appendix.
54
What are the **symptoms** of appendicitis?
Migratory abdominal pain beginning at the periumbilicus and traveling to the RLQ, loss of appetite, fever, nausea, vomiting.
55
What is **pancreatitis**?
Acute inflammation of the pancreas.
56
What are the **risk factors** for pancreatitis?
* Alcoholism * Gallstones * Hypertriglyceridemia * Certain medications (e.g., diuretics, sulfonamides, valproic acid, tetracyclines)
57
What are the **symptoms** of pancreatitis?
Acute, severe upper abdominal pain that may radiate to the back, nausea, vomiting, fever, tachypnea, and tachycardia.
58
What is **cholecystitis**?
Inflammation of the gallbladder, often related to gallstones.
59
What is the **typical recovery time** for supportive care in pancreatitis?
Recovery typically occurs in 3 to 7 days.
60
What is cholecystitis often **related** to?
Gallstones
61
What are the **common presentations** of cholecystitis?
* Right upper quadrant (RUQ) pain that may radiate to the right shoulder or back * Steady and severe pain prolonged for more than four to six hours * Systemic symptoms such as fever, nausea, vomiting * Often follows the ingestion of a fatty meal
62
What is the **diagnostic tool** for cholecystitis?
Ultrasound
63
What **ultrasound finding** is indicative of cholecystitis?
Gallbladder wall thickening
64
What is the **treatment approach** for cholecystitis?
* Inpatient treatment with intravenous fluid therapy * Correction of electrolyte disorders * Control of pain * Broad spectrum antibiotics if secondary infection occurs
65
What **causes** pyloric stenosis?
Hypertrophy of the pyloric sphincter, causing obstruction and symptoms
66
At what **age** does pyloric stenosis typically occur?
Between 3 and 6 weeks of age
67
What are the **symptoms** of pyloric stenosis?
* Projectile, non-bilious vomiting immediately after feeding * Fussiness due to hunger * Possible olive-shaped mass in the right upper quadrant * Weight loss and dehydration if untreated
68
What are the **signs of dehydration** in the pediatric population?
* Decreased urinary output * Lethargy * Irritability * Sunken fontanelle * Tachycardia * Tachypnea or abnormal breathing * Decreased skin turgor * Capillary refill >3 seconds
69
What is the **diagnostic tool** for pyloric stenosis?
Ultrasound
70
What is the **treatment** for pyloric stenosis?
Refer for surgical correction
71
What is **intussusception**?
Intestine telescopes in on itself
72
What is the **most common age range** for intussusception?
Between 4 and 36 months
73
What are the **symptoms** of intussusception?
* Severe, intermittent, progressive abdominal pain * Inconsolability * Child draws the legs towards the abdomen * Becomes pale * Symptoms occur at 15 to 20 minute intervals, becoming more frequent and severe * Vomiting, becomes bilious as obstruction worsens
74
What is the **diagnostic tool** for intussusception?
Ultrasound
75
What are the **classic ultrasound findings** for intussusception?
* Target sign * Bull's eye * Coiled spring
76
What is the **treatment** for intussusception **without** bowel perforation?
Non-operative reduction using hydrostatic or pneumatic pressure by enema
77
What is the **treatment** for intussusception **with** evidence of bowel perforation?
Surgical repair
78
# Fill in the blank: Blood seen in stool is known as \_\_\_\_\_\_.
Hematochezia
79
What does a **positive Murphy’s sign** indicate?
Cholecystitis
80
Which test involves **pain** while extending the psoas muscle, indicating possible appendicitis?
Psoas test
81
What does **Rovsing’s sign** indicate?
Peritonitis or appendicitis
82
# True or False: The spleen is normally palpable.
False
83
What condition is indicated by **fatty/oily appearing stool**?
Steatorrhea, which may indicate celiac disease.
84
What is the **most common cause** of chronic inflammatory gastritis?
Helicobacter pylori infection
85
What are the **two major disorders** included in inflammatory bowel disease?
* Ulcerative colitis * Crohn’s disease
86
What is the **typical presentation** of Crohn's disease?
* Cramping abdominal pain * Intermittent diarrhea with or without blood * Fatigue * Weight loss
87
What **serologic marker** indicates immunity from the Hepatitis B vaccine?
Presence of anti-HBs only
88
What is the **recommended initial screening test** for Hepatitis C virus?
Anti-HCV
89
What is the **most common indication** for emergency abdominal surgery?
Appendicitis
90
What is the **normal range for lipase levels** in the blood?
0 to 160 U/L ## Footnote Values can vary based on lab.
91
What **imaging finding** on an abdominal CT with contrast is indicative of pancreatitis?
Focal or diffuse enlargement of the pancreas
92
What is the **primary treatment approach** for pancreatitis?
* Supportive care with pain management * IV fluids * Correction of electrolyte and metabolic abnormalities
93
What **complications** can occur with cholecystitis that may require additional treatment?
Secondary infection of gallbladder, or perforation
94
What **type of antibiotics** are often indicated for cholecystitis with secondary infection?
Broad spectrum antibiotics
95
What are the **components** of the upper digestive tract?
* Mouth * Pharynx * Esophagus
96
What is the **primary function** of the small intestine?
The primary site of nutrient absorption; chyme continues to be digested with the help of pancreatic enzymes and bile.
97
What **conditions** can cause low albumin levels?
* Liver disease * Malnutrition * Inflammation * Chronic illness
98
What does a **high alkaline phosphatase (ALP) level** indicate?
* Liver disease * Bone disorders * Bile duct obstruction
99
What is the **normal range for alanine aminotransferase** (ALT)?
7–56 IU/L ## Footnote Values can vary based on lab.
100
What is the **normal range for aspartate aminotransferase** (AST)?
10–40 IU/L ## Footnote Values can vary based on lab.
101
What does a **high bilirubin (total) level** indicate?
* Liver dysfunction * Jaundice * Hemolysis * Bile duct obstruction
Family Nurse Practitioner (FNP)
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