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Flashcards in GI Deck (58):
1

57 year old female presents with LLQ pain

Diverticulitis

2

200 pound latina, lunch at KFC. Presents to office with RUQ pain

Gall bladder

3

21 year old male with worst peri-umbilical pain of his life

appendicitis

4

Rigid abdomen...

MOVE... consult surgery

5

PUD causes

H. pylori
NSAID/ASA
stress
smoker

6

Duodenal ulcers are more common in what age group

30-55

7

Gastric ulcers are more common in ages

55-65

8

Which type of ulcer feels better after eating?

Duodenal

9

Which type of ulcer gets WORSE after eating?

Gastric

10

Complications of Peptic Ulcer Disease.

20% GI bleed
5-10% Perf bowel

11

GI bleed
S/s

Melena
Hematemesis
Coffee-ground emesis

12

Melena

Black tarry stool

13

Hematemesis

Vomiting bright red blood

14

PUD - s/s

Gnawing epigastric pain
Relief w/ food - duo
Worse w/ food - gastric

15

PUD labs/diagnostics

H. pylori testing
CBC - anemia
Endoscopy after 8-12 weeks of treatment

16

PUD - H2 blockers

Initial dose is 1 time daily
- tidine
Increase to BID

17

PUD - PPI

30 minutes before meals
-azole

18

Coffee ground emesis

at least at duodenum

19

Perforation

Hole in lumen of bowel

20

Causes of perforation

PUD
Ruptured diverticulum
Appendicitis

21

PUD - stepwise approach

H2 blocker once daily
- H2 blocker BID
--PPI daily in AM

22

Mucosal Protective Agents

Sucralfate
Bismuth subsalicylate
Misoprostol
Antacids - mylanta

23

Misoprostol (cytotec)

Prophylaxis against NSAID induced ulcers

- can stimulate uterine contractions

24

H. Pylori - Eradication Therapy

PPI + 2 antibiotics

2 antibiotics and a PPI
MOC
AOC
MOA

25

MOC - H.Pylori eradication

Metronidazole
Omeprazole
Clarithromycin

26

AOC - H. Pylori eradication

Amoxicillin
Omeprazole
Clarithromycin

27

MOA - H. Pylori eradication

Metronidazole
Omepraozle
Amoxicillin

28

Bismuth regimens -
BMT for H. Pylori eradication

4 times a day makes it less attractive
Bismuth
Metronidazole
Tetracycline

29

Bismuth regimens -
BMT + PPI for H. Pylori eradication

Bismuth
Metronidazole
Tetracycline
Omeprazole

30

PUD - bleeding
Initial management

CBC, BMP, PT/PTT
Endoscopy
Upright films - to r/o free air
IV H2 blockers
NPO

31

Bowel sounds with perforation

Quiet
rigid
rebound tenderness

32

Bowel sounds with obstruction

High pitched tinkling

33

Hepatitis A

Oral - fecal
-- contamination
-- hurricanes
-- Mexico
-- oral sex

34

Hepatitis B

Every BODY fluid

35

Hepatitis C

Non-A, Non-B
-- 50% are IV drug use
-- leading cause of transplant

36

Hepatitis viral subtypes

A, B, C, D, E, G

37

Pre-icteric stage

Acute hepatitis

Anorexia
Fatigue
Malaise
aversion to smoking/alcohol

38

Icteric stage

Acute hepatitis

Fluorescent yellow
Clay colored stool
Wt loss
Dark urine
Low grade fever
Hepatosplenomegaly

39

Anti-HAV, IgG

recovered Hepatitis A exposure

40

Anti-HAV, IgM

Current Hepatitis A virus

41

Worker goes to Miami, sex worker encounter. 2 weeks later florescent yellow.

Hepatitis B

HBsAg

42

HBsAg

Hepatitis

43

HBeAg

Viremia

44

Active Hep B

HBsAg
HBeAg
Anti-HBc
IgM

45

Anti-HBe

Decreased infectivity

46

Active Hep B

HBsAg
HBeAg
Anti-HBc
IgM

47

Chronic Hep B

HBsAg
Anti-HBc
Anti-HBe
IgM
IgG

48

Recovered Hep B

Anti-HBc
Anti-HBsAg

49

Anti-HBc
Anti-HBsAg

Recovered Hep B

50

HBsAg
Anti-HBc
Anti-HBe
IgM
IgG

Chronic Hep B

51

HBsAg
HBeAg
Anti-HBc
IgM

Active Hep B

52

Hep C serology

Anti-HCV, HCV RNA

PCR to determine acute versus chronic

53

Hepatitis Mangement

Increase fluids - 3-4,000L
Avoid alcohol
No protein - ammonia
Serax - oxazepam
Vitamin K - PT > 15 sec
Lactulose - > ammonia

54

Diverticulosis

LLQ disease
Low fiber

55

Diverticulosis

Constipation/loose stools
N/V
Low grade fever
LLQ tenderness

56

Fair, fat, female - RUQ pain

Cholecystitis

57

Murphy's sign

Right rib cage pressure, elicits

58

Pancreatitis - causes

Heavy alcohol use
HLD
Hypercalcemia
Meds - long time lasix users