Q4 GI

Question 1

What are typical, atypical and alarming symptoms of GERD/

Answer 1

Typical: aggravated by recumbent position, bending over or high-fat meals. Heart burn sub sternal, waxing and waning, hypersalivation, regurgitation and belching.
Atypical: chronic cough, hoarseness, laryngitis, wheezing, asthma
Alarm: dysphagia, odynophagia, weight loss, bleeding

Question 2

Tx algorithm for GERD - draw on FreeForm!

Question 3

Effectiveness at Controlling GERD:
Antacid<H2-RA<PPI

Question 4

How long should a patient attempt lifestyle modifications and antacids/H2-RA/PPI self-therapy before seeking help if symptoms are not resolving?

Answer 4

2 weeks.

Question 5

Why should metoclopramide not be used in GERD? SEs?

Answer 5

Can increase LES pressure due to increased gastric emptying.

EPS and TD

Question 6

PUD - causes?

Answer 6

H Pylori
NSAID
Stress
ZES - gastrin secreting tumor
Smoking

Question 7

Immunomodulator for IBD MOA?

Answer 7

Target immune response or cytokines involved in IBD.

Question 8

What is the onset for immunomodulator meds for IBD?

Answer 8

3-12 months.

Question 9

MOA for biologics used to treat IBD?

Answer 9

Biologics (-mab)
Target and reduce TNF-alpha associated with inflammatory processes.

Question 10

What is the CNS involvement in emesis?

Answer 10

CTZ - chemoreceptor Trigger Zone in the 4th ventricle of the brain. Stimulated by noxious stimuli, GI irritants, psychological etc.

Question 11

How should you approach the treatment of nausea and vomiting?

Answer 11

Treat the underlying cause.

Question 12

CNIV therapy regiment
Low
Moderate
High

Answer 12

Low - Dexamethasone OR 5-HT antagonist
Mod - Dexamethasone AND 5-HT
High - NK1 receptor antagonist + 5HT and Dexamethasone and Olanzapine.

Question 13

Patients with STC or drug induced constipation are likely/unlikely to respond to increased dietary fiber? Which type of constipation responds well to increased dietary fiber?

Answer 13

Unlikely
NTC.

Question 14

What type of fiber is best for moving things along through the gut? What are some foods that have this type of fiber?

Answer 14

INsoluble fiber
Whole wheat, corn bran, green leafy veggies, couscous and root vegetable skin (like potatoes.

Question 15

How much water should men and women drink daily?

Answer 15

Men = 3.7L and women = 2.7

Question 16

Bulk-forming agents and emollients usually cause a softening of stool in ______

Answer 16

1-3days

Question 17

What are some agents that result in soft stool in 6-12hrs

Answer 17

Bisacodyl and senna

Question 18

What are some agents that cause watery evacuation of stool in 1-6hrs?

Answer 18

Mg citrate
Mg sulfate,
Bisacodyl suppository
Mg oxide

Question 19

How do bulk forming products work?

Answer 19

They swell in intestinal fluid and form a gel that aids in fecal elimination by enhancing peristalsis.
Must be taken with at least 240ml of fluid.

Question 20

Diphenoxylate can be an abused drug because it causes a euphoric effect. What deters this?

Answer 20

Mixed with Atropine - negates the euphoric effect.

Question 21

What is the MOA of Loperamide and diphenoxylate (Imodium and Lomotil)?

Answer 21

Antiperistaltic/antimotility.

Question 22

What is the MOA of bismuth subsalicylate? (Peptobismol)
Clinical considerations?

Answer 22

Antisecretory
Avoid in those allergic to aspirin and salicylates.
Turns stool black

Question 23

What is another agent that can be used to treat severe secretory diarrhea associated with chemotherapy, bowel resections, and GI tumors?

Answer 23

Octreotide - IV or SQ

Question 24

OTC options for pain and bloating in IBS?

Answer 24

Peppermint oil, Matricaria recutita (German camomile)
Primrose oil.

Question 25

Albumin vale of 1.1 or greater indicates?

Answer 25

Portal HTN.

Question 26

Cirrhosis is a high ________ state, so we want to treat with meds that _______ like ______

Answer 26

Aldosterone
Decrease aldosterone
Diuretics - spironolactone.

Question 27

What is the MOA of carvedilol and what are some clinical considerations with use in portal HTN?

Answer 27

Carvedilol is a NSBB, however it has alpha-1 antagonistic effects too. It is a more potent vasodilator, but has more decrease in MAP than other NSBBs. It should not be used as a monotherapy, and usually not used in cirrhosis patients.

Question 28

Why is vit K administered in cirrhosis? What route?

Answer 28

It helps with synthesis of clotting factors. It should be given SQ because decreased bile production in cirrhosis patients means DEAK vitamins are less absorbed orally.

Question 29

What antibiotic is used to treat cirrhosis related encephalopathy?

Answer 29

Rifaxamin

Question 30

What are some drugs associated with pancreatitis?

Answer 30

Furosemide, HCTZ, Flagyl, sulfonamides, rifampin, valproic acid, estrogens, OCPs, Tylenol, met Forman, corticosteroids.

Question 31

Fluid administration rate for acute pancreatitis

Answer 31

1-2L bolus and then 250ml/hr

Question 32

What is a concern with opioid (PCA) use in pancreatitis?

Answer 32

Increased risk for ileus

Question 33

When should abx be prescribed in acute pancreatitis?

Answer 33

NOT prophylactically.
If no improvement/deterioration after 7-10 days

Question 34

Ineffective therapies for acute pancreatitis

Answer 34

Somatostatin analogues, atropine (to reduce pancreatic secretion), histamine2-receptor antagonists, probiotics or immunomodulation.

Question 35

Lifestyle modification for chronic pancreatitis

Answer 35

Avoid fatty foods, no ETOH or smoking.
Small meals.
PERT.

Question 36

Hep B vaccine can also help prevent what other hep?

Answer 36

D

Question 37

What hep does not have a vaccine in the US?

Answer 37

E and (C?)