1. Lifestyle changes 2. Antacids PRN 3. H2 blockers, then H2 blockers BID 4. Then PPI 5. Then consider GI referral

GI Flashcards by Christine Ackerman

Signs and Symptoms of Peptic Ulcer disease

Gnawing epigastric pain
Relief of pain with eating (duodenal ulcers)
Pain worsens with eating (gastric ulcers)
GI bleeding

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Signs of bowel perforation

Severe pain
“board-like” abdomen, rigidity
quiet, ominous bowel sounds

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Lab and diagnosis of peptic ulcer disease

Normal except maybe some anemia on CBC
Consider endoscopy after 8-12 weeks of treatment
Consider H. pylori testing

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Outpatient management of peptic ulcer disease

H2 Blockers first, then BID H2 blockers, then PPI, then refer for scope.

Breakthrough- Pepto bismol (bismuth subsalicyclate), Antacids like Mylanta, Maalox)

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People on chronic PPI therapy should also have what supplement?

Calcium with vitamin D

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Medications for Prevention of Peptic Ulcer Disease

People who can’t get off NSAIDs need PPI ordered daily

Misoprostol (Cytotec)- prophylaxis against NSAID induced ulcers (may stimulate uterine contraction and cause abortion)

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H. pylori eradication options

2 antibiotics + PPI or bismuth
1. MOC- metronidazole, omeprazole, clarithromycin
2. AOC- amoxicillin, omeprazole, clarithromycin
3. MOA- metronidazole, omeprazole, amoxicillin
Then- antiulcer therapy for 3-7 weeks with PPI

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GERD causes

incompetent lower esophageal sphincter (LES)

delayed gastric emptying

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Signs/symptoms of GERD

retrosternal "burning"
bitter taste in mouth
belching, hiccups, dysphagia
worse at night/laying down
may be relieved with sitting up, antacids, water

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Anyone with long-term GERD problems should…

Be referred for EGD to rule out Barrett’s esophagus or cancer
(by 5 years)

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Treating GERD

Lifestyle changes
Antacids PRN
H2 blockers, then H2 blockers BID
Then PPI
Then consider GI referral

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What can be used for traveler’s diarrhea prophylaxis?

Pepto bismol (bismuth subsalicyclate)

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When is further testing warranted for gastroenteritis in adults?

Symptoms lasting greater than 72 hours, or blood noted in stool
Check stool culture, WBC, and for ova and parasites

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Causes of hepatitis

Viral- A, B, C (and more)
Autoimmune
Alcoholic

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Common routes of hepatitis B transmission

Blood and blood products
Sexual activity
Mom to baby

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Common routes of hepatitis C transmission

Often unknown
Traditionally associated with blood transfusion
About half of all cases related to IV drug use

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Signs/symptoms of hepatitis

Pre-icteric: flu-like symptoms, aversion to smoke and alcohol
Icteric: weight loss, jaundice, pruritis, RUQ pain, clay colored stool, dark urine, low grade fever, hepatosplenomegaly

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Lab signs of hepatitis

WBC low to normal
UA shows proteinuria, bilirubinuria
AST/ALT elevated
Alk phos, PT may be normal or slightly elevated

Which form of hepatitis has identical serology for acute and chronic forms of disease?

How do you differentiate prior exposure from active infection?

Hepatitis C

Follow up with PCR testing

Signs and symptoms of diverticulitis

LLQ pain
constipation or loose stools
nausea/vomiting
low grade fever

What are your top 3 differentials for bowel perforation?

Peptic ulcer disease
Diverticulitis
Appendicitis

Labs/tests for diverticulitis

WBC and ESR elevated
Hemoccult positive in many cases
CT scan
Abdominal x-ray: should be NO FREE AIR ABOVE DIAPHRAGM

Irritable bowel syndrome signs and symptoms

Abdominal cramping
Pain relieved by defacation
Preoccupied with bowel symptoms
Changes in stool consistency/pattern
Often correlated with anxiety/depression

Management of IBS

Emotional support- counseling/therapy
SSRIs for those who are depressed
High fiber diet

Murphy's sign

Deep pain on inspiration while fingers are placed under right rib cage Positive points to cholecystitis

Signs and symptoms of cholecystitis

Pain precipitated by large or fatty meal RUQ pain and tenderness to palpation Guarding and rebound pain Fever

How do you diagnose cholecystitis?

Abdominal ultrasound

Causes of bowel obstruction

``` Hernia Adhesions Volvulus (pediatrics) Tumors Fecal impaction Ileus ```

Signs/symptoms of bowel obstruction

``` Minimal distention (higher obstruction) Pronounced distention (lower obstruction) Mild tenderness High pitched, tinkling bowel sounds Unable to pass stool/gas ```

How do you test for bowel obstruction?

Abdominal x-ray shows dilated loops of bowel and air fluid levels - Horizontal pattern in SBO - Frame pattern in LBO

Definition of ulcerative colitis

idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon

Definition of Crohn's disease

Upper bowel malabsorption syndrome

Sx and Dx of ulcerative colitis

Bloody diarrhea Negative stool studies Sigmoidoscopy/colonoscopy confirms diagnosis

Management of Ulcerative Colitis

Mesalamine suppositories or enemas for 3-12 weeks | Hydrocortisone suppositories or enemas

Colon cancer risk factors

family history of colon, ovarian, or endometrial cancer high fat high refined carbohydrate diet personal history of polyps or inflammatory bowel disease

Signs and symptoms of colon cancer

Often asymptomatic Changes in bowel habits Thin, skinny stools Weight loss

How quickly can appendicitis lead to gangrene and perforation?

Within 36 hours

Incidence of appendicitis

Up to 10 percent of the population | Most commonly presented in men 18-30 years old

Causes of appendicitis

Fecalith (things that don't digest well get lodged) Foreign body Inflammation Cancer

Signs and symptoms of appendicitis

Vague, colicky umbilical pain that shifts to RLQ Nausea with 1-2 episodes of vomiting Pain worsened and localized with coughing

Causes of Peptic Ulcer Disease

H. pylori Medications (NSAIDs, ASA, steroids) Type A personalities (alcohol and diet do not appear to contribute)

Physical exam findings with appendicitis

RLQ guarding with rebound tenderness Psoa's sign (RLQ pain with right thigh extension) Rovsing's sign (RLQ pain with pressure applied to LLQ) Obturator sign (RLQ pain with internal rotation of flexed right thigh) McBurney's point pain (1/3 distance between iliac crest and umbilicus)

How do you diagnose appendicitis?

Ultrasound or CT scan

Is constipation a normal finding in gerontological population?

No, but may be commonly caused by lack of fiber, decreased exercise, dehydration, poor dentition, history of laxative abuse, and impaired mental status