Name two types of peptic ulcers:
duodenal ulcers (young 30-55), feel better with feeding
gastric ulcers (old 55-65), feel worse with feeding
signs of symptoms: GNAWING epigastric pain
signs/symptoms of perforated ulcers:
severe epigastric pain
rigid boardlike abd
quiet bowel sounds
What are three causes of a perfed bowel?
peptic ulcer disease
This is tested by a urea breath test, can be present with duodenal or gastric ulcers
What is the step-wise approach for outpatient management of peptic ulcer disease?
1st line, everybody gets this: H2 blockers
ranitidince (zantac) famotidine (pepcid)
2nd line: PPIs
lansoprazole (prevacid) omeprazole (prilosec) esomeprazole (nexmium)
What musosal protective agent is used for traveler's diarrhea and has direct action against H. pylori?
bismuth subsalicylate (peptobismal)
What mucosal protective agent is used for NSAID induced ulcer prophylaxis and it therefore given to patients with RA who take chronic NSAIDS?
H. pylori eradication therapy includes five possible 3 drug combinations. What three combinations use 2 abx + PPI?
O *Metronidazole + omeprazole + clarithromycin
M O C *Metronidazole + omeprazole + amoxicillin
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
If you suspect a bowel perf, what imaging would you order and what would it show?
upright or decubitus abd xray show in about 75% of cases
you would expect it to show free air under the abd
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.
What are normal platelet count?
With hepatitis A, the blood and stool are infectious during the _______ week incubation period:
2-6 week incubation period
Hep B is transmitted through:
Which two types of hepatitis have a vaccine?
A and B
Why do patients in the icteric phase have jaundice?
from unconjugated bilirubin
What is the Normal AST ALT lab values?
Your patients hepatitis serology shows Anti-HAV, IgM. What does that mean?
anti-HAV means their body has produced an antibody for hepatitis A
IgM means iMMEDIATE or Miserable, they are actively infected
they have active hep A infection
You patients hepatitis serology shows anti-HAV, IgG. How do you interpret that?
recovered hepatitis A
In hepatitis serology, HBeAg signifies what?
It indicates viral replication and infectivity of Hep B.
It means they can transmit hep B
If your patient's hepatitis serology shows HBsAg, HBeAg, Anti-HBc, IgM, what does that mean?
They have active transmittable hep B
HBeAg (antigen is the bad guy) = transmittable
Your patients hepatitis serology shows: HBsAg, Anti-HBc, anti-HBe, IgM, IgG. What is the diagnosis?
Chronic hep B
IgM and IgG
Your patients hepatitis serology shows: Anti-HBc, Anti-HBsAg.
What is the diagnosis?
recovered Hep B
anti- the body has developed antibodies
Your patients hepatitis serology shows:
anti-HCV, HCV RNA
What are the TWO possible diagnoses and how would you further differentiate the diagnosis?
acute or chronic Hep C
PCR is used to differentiate prior exposure (chronic hep C) from current viremia (acute hep C)
Diverticulitis is inflammation of diverticula with abscess formation. What are two physical findings?
low grade fever
LLQ abd tenderness to palpation
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?
A patient with diverticulitis should be made NPO
All patients diagnosed with diverticulitis should have plain abdominal films done to look for evidence of:
free air under the diaghragm which would indicate bowel perforation
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?
Cholecystitis (inflammation of the gallbladder)
What labs are typically elevated in cholecystitis?
What is the most common cause of pancreatitis?
What are three common causes of pancreatitis?
HEAVY alcohol use
If a patient had a paralytic ileus, what would their bowel sounds be?
absent bowel sounds
Grey Turner's sign and Cullen's sign are often found in pancreatitis. What are they?
Grey turners: flank discoloration
Cullens sign: umbilical discoloration
A patient with pancreatitis is admitted to the hospital and made NPO. When can they advance their diet and start clear liquids?
When they are pain free and have bowel sounds
Two signs of hypocalcemia are Chvosteks and Trousseau's. Describe them.
Chvosteks: cheek tetany
Trousseaus: carpal tunnel tetany
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?
Diagnosis: bowel obstruction
treatment: in complete obstruction ALL cases require surgical intervention or they will die
A patient presents with episodes and remission of bloody diarrhea and sigmoidoscopy is cobblestone appearing.
What is the diagnosis?
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?
dx: mesenteric infarct
tx: emergent surgical intervention
A patient presents with a positive Psoas sign, positive obturator sign, and positive Rovsings sign. What is the diagnosis?
*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