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Flashcards in GI DISORDERS Deck (87):
1

Medications causing PUD

NSAIDS, ASA, glucocorticoids

2

% of Hpylori presence for duodenal and gastric ulcers

90% in duodenal and 75% of gastric

3

S/Sx of PUD

gnawing epigastric pain
relief with eating (DUODENAL)
pain worsens with eating (GASTRIC)

4

physical findings for PUD

often unremarkable
May note some eipgastric tenderness
GIB: melena, hematemesis, coffee-ground
perforation

5

signs of perforation

severe epigastric pain, "board-like" abdomen, quiet bowel sounds, RIGIDITY, and and signs of the acute abdomen

6

When would you do a endoscopy

after 8-12 weeks of treatment

7

Labs/ diagnostics of PUD

CBC, may show anemia
EGD
H pylori

8

Treatment regimen for PUD

Start dosing with h2 receptor antagonist at night
then start BID
then add PPI
the refer

9

Examples of H2 receptor antagonists

cimetidine
ranitidine
famotidine
nizatidine

10

examples of PPIs

Lansoprazole
rabeprazole
pantoprazole
omeprazole
dexlansoprazole
esomepreazole

11

what is the risk of prolonged PPIs

rebound GERD
hip fractures

12

Management of PUD

acid-antisecretory agents
mucosal protective agents
H-pylori eradication
referral for urgent

13

what are the mucosal protective agents

bismuth subsalicylate (pepto-bismal) and misoprostal (cytotec) and antacids

14

What does bismuth subsalicylate do?

promotes prostaglandin production/ stimulates gastric bicarbonate
has direct antibacterial action against H pylori

15

How do you take mucosal protective agents

2 hours apart from other medication

16

misoprostol mechanism

stimulates mucous and bicarb production

17

what is misoprostal used for

prophylaxis against NSAID induced ulcers

18

Types of antacids

mylanta, maalox, MOM. do not reduce the amount of gastric acidity

19

What should you use in patients with PUD who cannot dc NSAIDs

PPI

20

General Hpylori eradication therapy

2 antibiotics + either PPI or bismuth

21

MOC of h pylori eradication

metro BID with meals+ omeprazole 20mg BID before meals, and clarithromycin 500mg BID wit meals FOR & DAYS

22

AOC of h pylori eradication

AMOX 1 gram BID with meals, omeprazole 20mg BID before meals and clarithromycin 500mg BID with meals for 7 days

23

How do you do bismuth regimens for h pylori eradication

bismuth 2 tabs QID, metro 250mg QID and tetracycline 500mg QID

you can do the above regimen +omeprazole 20mg BID for meals for 7 days

24

how long do you do anti ulcer therapy after eradication

3-7 weeks. For duodenal ulcer 7 weeks . h2 blockers for 6-8 weeks

25

define GERD

a disorder characterized by back flow of acidic gastric contents into the esophagus

26

causes of GERD

incompetent lower esophageal sphincter
delayed gastric emptying

27

s/sx of GERD

retrosternal "burning"
bitter taste in the mouth
belching, hiccoughs, DYSPHAGIA
excessive salivation
nighttime or recumbent
may be relieved with sitting up, antacids, water or food

28

When is an EGD warranted for GERD

consider to rule out cancer, Barretts esophagus, PUD

29

Management of GERD

non-pharmacologic measures
antacids PRN
H2 blockers in high doses at night or divided during the day
PPIs if H2 blockers ineffective
GI consult

30

Diagnostics for gastroenteritis

not indicated unless symptoms persist >72 hours or blood is noted in the stool
stool for culture, WBCs, and O&P
stool may be positive for O&P if infection present

31

What is prophylaxis for travelers diarrhea

bismuth subsalicyte

32

how long are stool and blood infectious with Hep A

2-6 week incubation period

33

what are s/sx of the pre-icteric hep stage

fatigue, malaise, anorexia, n/v, headache, aversion to smoking and ETOH

34

icteric phase s/sx of hep

weight loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine. May have low grade fever and hepatosplenomegaly may be present

35

general lab values for hepatitis

WBC low to normal
UA: proteinuria, bilirubinuria
Elevated AST and ALT
LDH, bilirubem ALk phos and PT normal or slightly elevated

36

What is normal AST

10-40

37

what is normal ALT

7-56

38

what is the active antibody

IgM

39

what is the recovered antibody

IgG

40

what is the first evidence of the Hep B infection

HBsAg

41

which lab indicates HBV replication and infectivity

HBeAg

42

When does Anti-HBe appear?

Appears after HBeAg disappears. It signifies diminished viral replication and decreased infectivity

43

What labs are for active Hep B

HBsAg, HBeAg, Anti-HBc, and IgM

44

What labs are for Chronic Hep B

HBsAgn Anti-HBc, Anti-HBe, IgM, IgG

45

Recovered hep B labs

Anti-HBc, Anti-HBsAg

46

What are the labs for both active and chronic Hep C

Anti-HCV, HCV RNA

47

What differentiates prior HCV exposure from current viremia

Polymerase chair reaction

48

What kind of diet do hep patients need to be on?

low protein

49

Diverticulitis définition

inflammation or localized perforation of the diverticula with abscess formation

50

cause of diverticultis

low fiber diet?

51

symptoms of diverticulitis

mild to moderate abdominal pain LLQ
constipation or loose stools may be present
n/v

52

Physical findings of diverticulitis

low grade fever
LLQ tenderness to palpation
patients with perforation present with a more dramatic picture and peritoneal signs

53

labs/ diagnostics of diverticulitis

mild-moderate leukocytosis
Elevated ESR
stool heme
signmoidoscopy shows inflamed mucosa
may consider CT to evaluate abscess
PLAIN FILM TO LOOK FOR EVIDENCE OF FREE AIR= PERFORATION

54

3 tops causes of perforation

#1 PUD
#2 diverticulitis
#3 appendicitis

55

What is abdominal pain relieved by in IBS

defecation

56

Cholecystitis

inflammation of the gallbladder, associated with gallstones in >90% of cases

57

S/SX of cholecystitis

OFTEN PRECIPITATED BY A LARGE OR FATTY MEAL
sudden appearance of steady, severe pain in epigastrium or right hypochondrium
Vomiting in many clients affords relief

58

physical findings in cholecystitis

MURPHYS SIGN*** deep pain on inspiration while fingers are placed under the right rib case
RUQ tenderness to palpation
palpable gallbladder in 15% of cases
Muscle guarding and rebound pain
fever

59

What is the gold standard for cholecystitis

Ultrasound

60

labs for cholecystitis

WBCs, serum bili, AST, ALT, LDH and amylase may be elevated

61

What are causes of bowel obstruction

Hernia
adhesions
volvulus
Tumor
fecal impaction
ileus (functional obstruction)

62

s/sx of bowel obstruction

cramping preumbilical pain initially; later becomes constant and diffuse
Vomiting within minutes of pain (proximal), within hours of pain (distal)

63

What kind of history makes someone more prone to adhesions

surgical hx

64

physical findings of bowel obstruction

minimal abdominal distention (proximal)
Pronounced abdominal distention (distal)
mild tenderness but no peritoneal findings
HIGH PITCHED TINKLING SOUNDS
unable to pass stop/gas

65

What kind of abdominal sounds occur with perforation?

absent

66

What will plain films show in bowel obstruction?

Plain films show dilated loops of bowel and air-fluid levels
Horizonal pattern in SBO
frame pattern in LBO

67

What is ulcerative colitis?

Ulcerative colitis is an idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon.

68

What is involved in ulcerative colitis?

involves the rectum and may extend upward involving the whole colon

69

What is involved in Crohns disease

upper bowel malabsorption syndrome

70

What is the hallmark of UC

bloody diarrhea is the hallmark symptom

71

What establishes the diagnosis in UC

sigmoidoscopy

72

management of UC

mesalamine SUPP or enemas for 3-12 weeks
hydrocortisone suppositories and enemas

73

Who is at increased risk of colon CA

family history of colon CA
other adenocarcinoma
high fat diets
refined carb diets
polyps
inflammatory bowel disease

74

diagnostics for colon CA

stool may be guac positive
colonoscopy
CBC
CEA elevated

75

What is normal CEA

nonsmokers

76

How long might it take for perforation to develop in appendicitis

36 hours

77

what causes appendicitis

facalith-undigested food particles
foreign body
inflammation
neoplasms

78

s/sx of appendicitis

BEGINS WITH VAGUE, COLICKY UMBILICAL PAIN
AFTER SEVERAL HOURS, PAIN SHIFTS TO THE RIGHT LOWER QUADRANT
nausea with 1-2 episodes of vomiting
Pain worsened and localized with coughing

79

physical findings of appendicitis

RLQ pain with rebound tenderness
PSOAS SIGN
OBTURATOR SIGN
ROVSINGS SIGN
low grade fever (high fever suggests perforation or another diagnosis)

80

Psoas sign

pain with right thigh extension

81

obturator sign

pain with internal rotation of flexed right thigh

82

rovsings sign

right lower quadrant pain when pressure is applied to LLQ

83

What is diagnostic of appendicitis

CT or ultrasound

84

What will WBC be for appendicitis

10-20

85

What happens to liver in geros

decreased liver size and liver blood flow

86

What happens to gastric motility in geros

decreased gastric motility with delayed emptying, increased intestinal transit time

87

What is constipation caused by in geros

NOT A NORMAL FINDING
most common causes include lack of fiber, decreased exercise, poor dentition, hx of laxative abuse, and impaired mental status