GI

Question 1

Name two types of peptic ulcers:

Answer 1

duodenal ulcers (young 30-55), feel better with feeding

gastric ulcers (old 55-65), feel worse with feeding

signs of symptoms: GNAWING epigastric pain

Question 2

signs/symptoms of perforated ulcers:

Answer 2

severe epigastric pain

rigid boardlike abd

quiet bowel sounds

Question 3

What are three causes of a perfed bowel?

Answer 3

peptic ulcer disease

ruptured diverticulum

appendicitis (rare)

Question 4

This is tested by a urea breath test, can be present with duodenal or gastric ulcers

Answer 4

H. pylori

Question 5

What is the step-wise approach for outpatient management of peptic ulcer disease?

Answer 5

• 1st line, everybody gets this: H2 blockers*
• -tidine*
• ranitidince (zantac) famotidine (pepcid)*

2nd line: PPIs

-azole

lansoprazole (prevacid) omeprazole (prilosec) esomeprazole (nexmium)

Question 6

What musosal protective agent is used for traveler’s diarrhea and has direct action against H. pylori?

Answer 6

bismuth subsalicylate (peptobismal)

Question 7

What mucosal protective agent is used for NSAID induced ulcer prophylaxis and it therefore given to patients with RA who take chronic NSAIDS?

Answer 7

Misopristol (cytotec)

Question 8

H. pylori eradication therapy includes five possible 3 drug combinations. What three combinations use 2 abx + PPI?

AOC

MOC

MOA

Answer 8

A *amoxicillin+omeprazole+clarithromycin

O *Metronidazole + omeprazole + clarithromycin

M O C *Metronidazole + omeprazole + amoxicillin

O

A

Question 9

H. pylori eradication therapy includes five possible 3 drug combinations. What are the two regimens that include 2 abx + 1 bismuth?

THE BMT BMTO is not as popular due to qid dosing

Answer 9

BMT: bismuth+metronidazole+tetracycline

BMTO: bismuth+metronidazole+tetracycline+omeprazole

Question 10

If you suspect a bowel perf, what imaging would you order and what would it show?

Answer 10

upright or decubitus abd xray show in about 75% of cases

you would expect it to show free air under the abd

Question 11

1) When the normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine.
2) this is a serious complication of GERD.
3) this finding increases the risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus.

Answer 11

Barrett’s esophagus

Question 12

What are normal platelet count?

Answer 12

150-400

Question 13

With hepatitis A, the blood and stool are infectious during the _______ week incubation period:

Answer 13

2-6 week incubation period

Question 14

Hep B is transmitted through:

Answer 14

blood

sexual activity

mother-fetus

Question 15

Which two types of hepatitis have a vaccine?

Answer 15

A and B

Question 16

Why do patients in the icteric phase have jaundice?

Answer 16

from unconjugated bilirubin

Question 17

What is the Normal AST ALT lab values?

Answer 17

35-50

Question 18

Your patients hepatitis serology shows Anti-HAV, IgM. What does that mean?

Answer 18

anti-HAV means their body has produced an antibody for hepatitis A

IgM means iMMEDIATE or Miserable, they are actively infected

so

they have active hep A infection

Question 19

You patients hepatitis serology shows anti-HAV, IgG. How do you interpret that?

Answer 19

recovered hepatitis A

(G=Gone)

Question 20

In hepatitis serology, HBeAg signifies what?

Answer 20

It indicates viral replication and infectivity of Hep B.

It means they can transmit hep B

Question 21

If your patient’s hepatitis serology shows HBsAg, HBeAg, Anti-HBc, IgM, what does that mean?

Answer 21

They have active transmittable hep B

HBeAg (antigen is the bad guy) = transmittable

IgM=miserable, iMediate

Question 22

Your patients hepatitis serology shows: HBsAg, Anti-HBc, anti-HBe, IgM, IgG. What is the diagnosis?

Answer 22

Chronic hep B

IgM and IgG

Question 23

Your patients hepatitis serology shows: Anti-HBc, Anti-HBsAg.

What is the diagnosis?

Answer 23

recovered Hep B

anti- the body has developed antibodies

Question 24

Your patients hepatitis serology shows:

anti-HCV, HCV RNA

What are the TWO possible diagnoses and how would you further differentiate the diagnosis?

Answer 24

acute or chronic Hep C

PCR is used to differentiate prior exposure (chronic hep C) from current viremia (acute hep C)

Question 25

Diverticulitis is inflammation of diverticula with abscess formation. What are two physical findings?

Answer 25

low grade fever LLQ abd tenderness to palpation

Question 26

A female patient with a low fiber diet is diagnosed with diverticulitis. You admit her to the hospital. What is the diet order for a patient with diverticulitis?

Answer 26

A patient with diverticulitis should be made NPO

Question 27

All patients diagnosed with diverticulitis should have plain abdominal films done to look for evidence of:

Answer 27

free air under the diaghragm which would indicate bowel perforation

Question 28

You have a fat fair forty and female patient with a positive Murphy's sign and c/o RUQ abd pain after eating fatty foods. You suspect what?

Answer 28

Cholecystitis (inflammation of the gallbladder)

Question 29

What labs are typically elevated in cholecystitis?

Answer 29

ALT AST LDH alk phos \*possible amylase

Question 30

What is the most common cause of pancreatitis?

Answer 30

gallbladder disease/cholecystitis

Question 31

What are three common causes of pancreatitis?

Answer 31

cholecystitis hyperlipidemia HEAVY alcohol use

Question 32

If a patient had a paralytic ileus, what would their bowel sounds be?

Answer 32

absent bowel sounds

Question 33

Grey Turner's sign and Cullen's sign are often found in pancreatitis. What are they?

Answer 33

Grey turners: flank discoloration Cullens sign: umbilical discoloration

Question 34

A patient with pancreatitis is admitted to the hospital and made NPO. When can they advance their diet and start clear liquids?

Answer 34

When they are pain free and have bowel sounds

Question 35

Two signs of hypocalcemia are Chvosteks and Trousseau's. Describe them.

Answer 35

Chvosteks: cheek tetany Trousseaus: carpal tunnel tetany

Question 36

A patient presents with vomiting, high pitched tinkling bowel sounds, abdominal distention, and the plain abd films show dilated loops of bowel and air-fluid levels. What is their diagnosis and treatment?

Answer 36

Diagnosis: bowel obstruction treatment: in complete obstruction ALL cases require surgical intervention or they will die

Question 37

A patient presents with episodes and remission of bloody diarrhea and sigmoidoscopy is cobblestone appearing. What is the diagnosis?

Answer 37

Ulcerative colitis

Question 38

A smoking vasculopath presents with sudden onset *abd pain out of proportion* to physical exam findings. What is the diagnosis and what is the treatment?

Answer 38

dx: mesenteric infarct tx: emergent surgical intervention

Question 39

A patient presents with a positive Psoas sign, positive obturator sign, and positive Rovsings sign. What is the diagnosis?

Answer 39

appendicitis \*Psoas: pain with R thigh extension obturator: pain with internal rotation of flexed R thigh positive Rovsings sign: RLQ abd pain when pressure is applied to LLQ abd