Unit 4- GI/GU Flashcards
(207 cards)
1
Q
Ask about during medical HX with GI
A
Hx problems- IBD, IBS, GERD, constipation, change in bowels
ABD surgery
Gyn hx in women- LMP, method of contraception, STD risk
Medications
2
Q
Order of abd assessment
A
Look- distension, surgical scars, peristalsis, pulsations, veins, tugor, hernias
listen- bowels, renal or aortic bruits
feel- painful area last, spleen/liver, rigidity, masses, pulsations, rebound tenderness
percuss- ascites, CVA tenderness, hepatosplenomegaly
3
Q
Murphys sign
A
RUQ pain on deep innspiration, inflamed gallbladder
4
Q
Rovsing sign
A
palpation of LLQ and pain in the RLQ = appendicitis
5
Q
Obturator test
A
pain in RLQ on internal rotation of right hip= appendicitis
6
Q
psoas sign
A
extension of right hip, and pain in the RLQ appendicitis
7
Q
Causes of diffuse abd pain
A
IBD, IBS, gasatroenteritis, AAA, bowel obstruction, ischemic bowel
8
Q
Causes of epigastric pain
A
MI, PUD, biliary disease, pancreatitis
9
Q
Causes of LUQ pain
A
spleen, renal disease
10
Q
Causes of periumbilical pain
A
early appendicitis, small bowel disease
11
Q
Causes of LLQ pain
A
diverticulitis, PID, ovarian cyst, ectopic prego
12
Q
Causes of RLQ pain
A
appendicitis, PID, ovarian cyst, ectopic prego
13
Q
voluntary guarding
A
usually symmetric, muscles
more tense on inspiration,
usually doesn’t hurt to rise from supine to sitting position (using abdominal muscles),
lessens with distraction.
14
Q
involuntary guarding
A
asymmetrical,
rigidity present on inspiration and expiration,
rising to sitting position greatly increases pain, doesn’t change with distraction
15
Q
Appendicitis sx
A
anorexia
periumbilical pain that migrates to RLQ
N/V
+mcburneys point, rebound tenderness
+obturator, Rovsing and psoas sign
16
Q
Cholelithiasis sx
A
colicky pain, located in epigastrium or RUQ and flank, occasionally R shoulder
Pain occurs within 1 hr after eating large meal, last several hours, residual aching can last for days
anorexia N/V Fever \+murphys sign guarding and rebound increase WBC, total bili, ALT, Alk phosp, and amylase
17
Q
Pancreatitis sx
A
abrupt onset of severe epigastric pain that radiates to the back
pain increase with movement or lying supine (pt prefer to sit up and lean forward)
N/V sweating anxiety abd tenderness without guarding rigidity or rebound distension Absent bowel sounds fever tachycardic pallor hypotension
Increase amylase and lipase, WBC, ALT
18
Q
Tx for appy
A
CT scan
surgery
19
Q
Tx for choliliathisis
A
bowel rest (NPO)
pain management
IV abx
lap choly
20
Q
Tx for pancreatitis
A
refer
KUB, CT
21
Q
What is gastroenteritis
A
acute infectious diarrhea
usually self limiting
very young or elderly more at risk
22
Q
causes of gastroenteritis
A
virus (70-80%)- rotavirus, adenovirus, water or person-to-person
Bacterial (10-20%)- s. aureus, c. diff
Parasites (<10%)- giardia
23
Q
sx of gastroenteritis
A
viral- large volume watery stool
last 1-2 days
N/V, crampy, fever, malaise, dehydration
bacterial- may have bloody diarrhea, c. diff can occur 8 weeks after abx,
parasitic- watery diarrhea prolonger, cramps
24
Q
get stool culture in gastroenteritis if
A
more than 3 days, <3mo old
>70 years
at risk (food service, day care worker)
25
tx for gasteroenteritis
supportive, assess for dehydration,
adults should avoid dairy, caffeien and alcohol
Eat rice, potatoes, wheat, banana, yogurt, soup, crackers
Imodium, Kaopectate
DO NOT use in severe or bloody diarrhea, high fever or systemic toxicity
26
diverticulitis define
inflammation of a diverticulum that ranges from icro perforation with localized inflammation, macro perforation with abscess or peritonitis
27
diverticulitis sx
aching abd pain usually LLQ, constipation or loose stools
N/V, low-grade fever, LLQ tenderness, palpable mass
+occult blood in stool, mild-moderate increase in WBC
pt dont seek attention until several days after onset
pt with perforation will have more severe sx
28
Tx of diverticulitis with mild sx
empiric abx without imaging, colonoscopy, CT colo, or barium enema
Clear liquid diet
usually improve in 3 days
high fiber diet
29
Tx of diverticulitis with severe sx
may need CT of abd in acute stage to eval severity
REFER for inpt, IV abx, possible surgery
30
GERD sx
heartburn usually 30-60 miin after meal with reclining, burning CP and regurgitation
Non-gi- asthma, chronic cough, laryngitis, sore throat, sleep disturbances
Alarm sx- >55yo, anemia, melena, hematemsis, dysphagia, weight loss, difficult/painful swallowing
31
tx for mild gerd
smaller meals, eliminate spicy or acidic foods, elevate HOB, dont lay down 3 hr post eat, weight loss
PRN antacids or H2 receptor antagonist- pepcid, zantac, tagament
32
tx of mod-severe gerd
empiric therapy PPI
PPI- once daily for 4-8 weeks
if no response=refer
+ response= keep taking PPI for 8-12 weeks
33
Causes of PUD
NSAIDS, h. pylori
34
sx of PUD
Dyspepsia
hunger-like burning pain in epigastrcic area, pain may awaken, sx wax and wane
up to 60% NSAID induced have no sx
normal or sightly tender epigastric, new onset guaiac stools
35
dx of PUD
upper endoscopy with biopsy
h pylori- upper breath test or fecal antigen
36
medications for PUD
acid antisecretory agents: PPI have replaced H2
| abx-eradicate h pylori
37
What is colic
healthy, well fed infant that cries for more than 3 hours/day, more than 3 days a week and more than 3 weeks
severe and paroxysmal crying that occurs mainly in late afternoon
knees drawn up and fists clenched- begins at 2-3 months
38
intussusception
most common in first 2 years of life
thriving infant 3-12 mo with paroxysmal, colicky pain, draws up knees and screams
use barium or air enema
39
intussusception s/sx
vomiting, diarrhea, 90% bloody BM with mucus within 12 hours
prostration and fever, tender distended abd, sausage shaped mass may be palpated in upper mid abd
40
umbilical hernias affect what population
full-term african american within 1st year of life
41
T or F: umbilical hernias need repaired in adults due to high risk of incarceration and strangulation
True
42
Inguinal hernias
75% of abd hernias
congenital in children but can be d/t obesity, chronic cough, ascites, chronic constipations with straining and lifting heavy objects
43
Management of hernias
DO NOT reduce strangulated- can cause gangrenous bowel to enter peritoneal cavity
REFER
44
alarm markers for referral of hernais
acute onset of colicky abd pain, N/V, edema
| discoloration at the site
45
intestinal malroation
healthy infant suddenly refusing to eat, vomits bile, becomes inconsalable- usually develops distention, occurs during first 3 weeks of life
use upper GI to and barium enema to confirm
surgery to fix
46
T or F: Pyloric stenosis is most common in females
FALSE, males
47
signs of pyloric stenosis
usually begins at 2-4 weeks old, projectile vomiting, rapidly becomes projectile after every feeding
appears hungry, eats frequently, constipation, dehydration, weight loss and fretful, olive size mass can be felt on deep palpation in RUQ
48
what does pyloric stenosis show on US?
hypoechoic ring with thickness >4mm
49
Tx of pyloric stenosis
hydration, correct electrolyte abnormality prior to surgical repair
50
Lactose intolerance
sx usually 4-6yo, intestinal dilation, bloating, increase flatulence, pain and diarrhea
onset of sx 2hr after ingestion of milk
tx- lactase supplement to dairy products
51
cows milk intolerance
occurs in infance, blood in stool, often manifestation of allergies
52
ectopic pregnancy
unilateral lower quad pain, continuous and crampy, vag bleeding and low-grade fever
EMERGENT referal to OB
53
Mittelschmerz
spillage of fluid from ruptured follicular cystic-irritates peritoneum-mid cycle pain
sx-sudden onset localized lower quad pain-persist for few minutes to as long as 8 hr
54
anovulatory cycles
lead to normal follicular cyst growing large over several cycles- considerable pain on rupture reveal intrauterine rego
EMERGENT referral
55
Tx of acute cystitis in women
cephalexin, nitrofurantoin, bactrim
Fluoroquinolone for uncomplicated UTI
56
most common cause of acute cystitis
e. coli
57
Labs for acute pyelo
leukocytosis and a left shift
| UA-pyuria, bacteriuria, hematuria, white cell casts
58
tx for acute pyelo
empiric therapy-ampicillin, cipro, levofloxacin, bactrim,
59
when to refer for acute pyelo
complications
urolithiasis
obstruction
60
5 types of stones
```
calcium oxalate
calcium phosphate
struvite
uric acid
cystine
```
61
contributing to the stones
high humidity and elevated temps
sedentary lifestyle: HTN, carotid calcification, cardiovascular disease, high protein and salt intake, inadequate hydration
*keep sodium <150/day
62
Urge incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients
a.
63
Transient incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients
c.
64
Functional incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients
E.
65
Stress incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients
b.
66
Overflow incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients
d.
67
Dyspepsia is
predominant epigastric pain for at least 1 mo, epigastric fullness, N/V, heartburn,
68
everyone older than ___ get endoscopy with dyspepsia
60,
or selected younger with alarm features
In all others test for h. pylori
69
T or F: prescribe empiric PI in those with h. pylori who dont improve after eradication
True
70
pancreatic disease
pancreatic carcinoma and chronic pancreatitis=chronic epigastric pain
71
what is functional dyspepsia
most common cause of dyspepsia
increased visceral afferent sensitivity, gastric delated emptying or impaired accommodation to food or stressors
often younger, signs of anxiety or depression
72
What is biliary tract dysfunction
abrupt onset of epigastric or RUQ pain r/t cholelithiasis, elithiasis, or choledocholithiasis
73
tx of dyspepsia
initial empiric in all younger than 60 with no alarm feature (PPI)
all others get upper endoscopy with subsequent tx and cause
obtain gastric bisy- during endoscopy to test for h. pylori
If positive for h. pylori give abx
74
diagnostic studies for dyspepsia
upper endo- choice for GI ulcer, erosive esophagitis, increased GI malignancy
abd CT scan
75
sx of N/V w/out abd pain causes
food poisoning, infectious gastroenteritis, drugs, systemic illness
76
sx of N/V w/ severe pain and vomiting
peritoneal irritation, acute gastroparesis, intestinal dysmotility, psychogenic disorders, CNS or systemic disorder
77
Causes of vomiting in the morning before breakfast
prego, uremia, ETOH, increased ICP
78
Causes of vomiting immediately after meals
bulimia and psychogenic
79
causes of vomiting of undigested food one to several hr post meal
gastroparesis or gastric outlet syndrome
80
special exam for severe or protracted vomiting
electrolytes for assess hypokalemia, azotemia, or metabolic alkalosis (due to gastric contents)
81
special exam for flat and upright abd xray or CT
severe pain or suspicion of obstruction to look for intraperitoneal air or dilated loops of small bowel
82
What does upper endo determine?
gastric outlet obstruction
83
What does an abd CT imaging determine?
cause of small intestinal obstruction
84
What does a nuclear scintigraph study or c-octanoic acid breath test determine?
gastroparesis, shows delayed emptying and no evidence of gastric outlet obstruction
85
example of a serotonin 5-ht-receptor antagonist
ondansetron- effective in preventing chemo and radiation induced emesis and pstop when given prior to treatment
efficacy is enhanced by combined therapy with a steroid
86
corticosteroids
enhance efficacy of serotonin antagonist for preventing acute and delayed N/V in pt receiving emetogenic chemo
87
dopamine antagonists
promethazine
work by blocking dopaminergic and have sedative effects
se:extrapyramidal reactions and depression
88
antihistamines and anticholinergics for n/V
meclizine, dimenhydrinate, scopolamine
work by stimulating labyrinth. give with oral vitamin B6 and doxylamine given FIRST LINE during PREGO
se: drowsiness
89
Cannabinoids for N/V
stimulate appetite and antiemetic
dronabinol- good for chemo and CNS pt
90
T or F: Hiccups can cause metabolic acidosis
FALSE- can cause respiratory alkalosis
91
causes of hiccups
gastric distention, sudden temp change, ETOH, heightened emotion
recurrent: GI, CNS, CV, and thoracic disorders
92
Assessment of hiccups include looking at what body systems?
Neuro
serum creatinine
liver chem test
CXR
Unclear cause= CT/MRI or head, chest, and abd, EKG, upper endo
93
Drug given for hiccups
Chlorpromazine
94
What is primary constipation?
unattributed to any structural abnormality or systemic disease - most common
95
What is normal colonic time?
approx. 35 hr, anything >72=ABNORMAL
96
What is secondary constipation?
cauesd by systemic disorders, medications, or obstructing colonic lesions
neoro gut dysfunction, myopathies, endocrine disorders, or electrolyte abnormalities
97
What is fecal impaction
sever impaction in the rectal vault that may lead to obstruction either partial or complete large bowel
causes-meds, pyshiatric disease, bed rest, neuro/spinal disorders
98
fiber will exacerbate sx in these disorders
colonic inertia
defecatory disorders
opioid-induced
IBS
99
When to give laxatives
in intermittent or chronic bases for constipation that does not respond to dietary or lifestyle changes
100
osmotic laxatives
daily
increase secretions of water into lumen
Miralax
101
Purgative laxative
rapid tx
mag citrate
may cause hypermagnesemia
102
stimulant laxatives
pt with no response to osmotic agents
stimulate fluid secretion and colonic contraction
bisacodyl, senna, cascara
103
Chronic excessive belching
supragastric belching or true air swallowing= behavioral seen in psychiatric pt
104
etiology of flatus
increased ingestion of lactose, polyols, and fructants or disorder of malabsorption
105
Avoid what in flatus
gum chewing or carbonated beverages, assess lactose intolerance
106
bloating cause
production of excess gas or impaired gas propulsion
107
treatment of bloating
reduce fermentable sugars with restricted diet, reduce intake of dietary fat
Rifaximin
108
Acute diarrhea
<2 weeks, most commonly caused by invasive or noninvasive pathogrens
109
what is acute inflammatory diarrhea?
fever and bloody diarrhea
colonic tissue damage r/t invasion or a toxin
110
acute inflammatory diarrhea s/sx
small volume diarrhea, LLQ cramps, urgency and tenesmus
fecal leukocytes or lactoferrin
111
causes of infectious dysentery
e coli
| CMV
112
when should a stool sample be sent with diarrhea
7-14 days fr analysis for viral, protozoan, and bacterial pathogens
113
when to seek medical evaluation in diarrhea
```
6+ unformed stools in 24hr
profuse watery diarrhea and dehydration
frail older pt or nursing home
immunocompromised
exposure to abx
hospital-acquired diarrhea
systemic illness
```
114
tx for diarrhea
PO fluids
rest bowel
frequent feedings of tea, flat carbonated beverages and soft easily digested foods
antidiarrhea safe in pt with ild-mod diarrheal illness
loperaide
bismuth
abx- empiric tx, fluoroquinolones, bactrim
DONT GIVE macrolides
115
Chronic diarrhea last longer than
4 weeks
116
causes of chronic diarrhea
carbohydrate malabsorption*
laxative abuse
malabsorption syndromes
117
secretory conditions for chronic diarrhea
increased intestinal secretions or decreased absorption=high vlm watery diarrhea w/ normal osmotic gap
caused by endocrine tumors and micro colitis
118
inflammatory conditions for chronic diarrhea
IBS, UC, chrons
abd pain, fever, weight loss, hematochezia
119
malabsorptive conditions for chronic diarrhea
small mucosal intestinal disease, intestinal resections, lymphatic obstruction, small intestinal bacterial overgrowth, pancreatic insufficiency
weight loss, osmotic diarrhea, steatorrhea, and nutritional deficiencies
120
motility conditions for chronic diarrhea
IBS
| lower abd pain+altered bowel habits w/out evidence of serious organic disease
121
chronic infections conditions for chronic diarrhea
protozoans, intestinal nematodes, c.diff
122
systemic conditions conditions for chronic diarrhea
thyroid disease, DM, collagen vascular disorders
123
Which produces greasy or malodorous diarrhea
a. inflammatory
b. secretory process
c. malabsorption
c.
124
Which produces pus or bloody diarrhea
a. inflammatory
b. secretory process
c. malabsorption
a.
125
Which produces watery diarrhea
a. inflammatory
b. secretory process
c. malabsorption
b.
126
T or F: presence of nocturnal diarrhea, weight loss, anemia, positive FOBT warrant further eval
True
127
labs for malabsoprtion
anemia
- folate
- iron deficiency
- vit b12
hypoalbuminemia
128
labs for and inflammatory conditions
anemia
- folate
- iron deficiency
- vit b12
hypoalbuminemia
increased ESR/ C-reactive protein
129
labs for secretory diarrhea
hyponatremia
| nonanion gap metabolic acidosis
130
T or F: Hct is a good early indicator of blood loss
FALSE
131
causes of upper GI bleed
```
PUD
portal HTN
mallory-weiss tear
vascular anomalies
gastric neoplasms
erosive gastritis
erosive esophagitis
trauma
```
132
T or F: All pt with upper GI bleed should undergo endo within 48 hr of ED arrival
FALSE
within 24 hr
133
Gerd is exacerbated by
meals
bending
recumbency
134
Dysfunction of the gastroesophageal sphincter
transient relaxations of the LES- triggered by gastric distention by a vasovagal reflex
135
T or F: treatment is NOT warranted for pt with typical GERD suggesting uncomplicated reflux
TRUE
136
Heartburn and regurgitation should be treated with?
daily H2-receptor antagonists or
| PPI for 4-8 weeks
137
alarm features with GERD
troublesome dysphagia
odynophagia
weight loss
iron deficiency anemia
138
T or F: Barium esophagography should be done to diagnose gerd
FALSE
139
tx for mild GERD
lifestyle modificiations and medical interventions
eat smaller meals and eliminate acidic foods/fatty foods/chocolate/peppermint/alcohol/ cigarettes
weight loss
avoid laying down 3 hr post meal
antacids take before meals
140
Tx for GERD
once daily PPI (omeprazole, lansoprazole, pantoprazole)
141
gastritis is put into what 3 categories
erosive and hemorrhagic
nonerosive, nonspecific
specific types
142
erosive/hemorrhagic gastritis causes
alcoholics, critically ill, taking NSAIDS
often asymptomatic, may cause epigastric pain, N/V, anorexia , upper GI bleed
143
major risk factors for erosive/hemorrhagic gastritis
vents, coagulopathy, trauma, burns, shock, sepsis, CNS injury, liver/kidney disease, MODS
144
tests for erosive/hemorrhagic gastritis
upper endo, labs (low Hct)
145
stress gastritis
mucosal erosions and subepithelial hemorrhages may develop w/in 72hr critically ill pt.
tx-continuous PPI
146
NSAID gastritis
less incidence of endoscopically visible ulcers
increase risk of MI, CVA, death
upper endo if- severe pain, weight loss, vomiting, GI bleed, anemia
tx- po PPI
147
alcoholic gastritis
excessive consumption=dyspepsia, N/V, minor hematamesis
tx- H2 receptor, PPI
148
portal hypertensive gastropathy
gastric mucosal and submucosal congestion of capillaries and venules
asymptomatic, can cause chronic GI bleed
tx- propranolol
149
non-erosive types
h. pylori
pernicious anemia
eosinophilic gastritis
150
h. pylori gastritis
inflammation w PMNs and lymphocytes
higher in non-whites and immigrants
transmission- person to person
tx- abx
151
fecal antigen immunoassay and urea breath test
d/c PPI 7-14d and abx for at least 28 days
152
Pernicious anermia gastritis
rare autoimmune, involves fundic glands w/ resultant achlorhydria, decreased intrinsic factor secretion, vit B12 malabsorption
153
T or F: most NSAIDS induced ulcers are asymptomatic
True
154
What are the 2 causes of PUD
NSAIDs and chronic H pylori infection
Alcohol, dietary factors, stress DO NOT cause ulcer disease
155
Duodenal ulcers are caused by___
h pylori
156
Tx of Uncomplicated H pylori–associated
| ulcers:
PPI x14d
157
T or F: must confirm h pylori eradication for all pt more than 4 week after completion of abx therapy and 2 weeks after d/s of PPI
True
158
Hallmark sign of PUD
epigastric pain- dyspepsia
159
dyspepsia is relieved with what
food or antacids
160
sign of gastric outlet syndrome
significant vomiting and weight loss
161
nonhealing ulcers are suspicious for what?
malignancy
162
When should H2 receptor antagonist be given in uncomplicated peptic ulcers?
daily at bedtime
163
What is zollinger-ellison syndrome?
very rare
PUD severe and atypical gastric acid hypersecretion
gastrin-secreting gut tumors-excessive acid production by GI tract- mostly arise in gastrinoma triangle
164
what is the gastrinoma triangle?
portal hepatitis, neck of pancreas, 3rd portion of duodenum
165
T or F: ZES is very similar to PUD so will go undetected for many years
TRUE
166
ZES signs
diarrhea, GERD, steatorrhea, weight loss
NG aspirationof stomach acid stops diarrhea
167
ulcer patient with _____ or family hx of ulcers should be screened for ZES
hypercalcemia
168
What is the most sensitive and specific method for identifying ZES?
increased fasting gastric concentration >150
obtain when NOT taking H2 for 24hr or PPI for 6days
169
What is celiacs disease?
permanent dietary disorder to gluten due to immunologic
most present in childhood or adulthood
170
sign of celiacs
weight loss, chronic diarrhea, abd distention, growth retardation, dyspepsia, muscle wasting, hyperactive bowel sounds
dematitis, herpetiformis, IDA, osteoporosis
40% dont have symptoms
171
Dx celiac
abnormal serologic test+small bowel biopsy
IgA tissue transglutaminase antibody***
172
dietary supplements for celiacs disease
```
folate
iron
zinc
calcium
vit a, b6, b12, d, and e
```
173
sx of lactase deficiency
diarrhea
bloating
gas
abd pain post dairy
174
dx of lactase deficiency
hydrogen breath test
175
lactase deficiency
can arise from GI disorders that affect proximal small intestinal mucosa
chrons, celiac, viral gastroenteritis
176
What supplements do pt with lactase deficiency need?
calcium d/t risk for osteoporosis
177
sx of appendicitis
```
RLQ pain, +mcburneys point
low grade fever
leukocytosis
colicky pain
feel constipated
```
178
What can happen if appy left untreated?
gangrene
179
Gold standard screen for appy
CT scan
180
IBS
chronic functional disorder >6mo
characterized by abd pain w/ alterations in bowel habits
more common in women
181
T or F: IBS will interfere with sleep
FALSE
182
What to avoid in IBS
fatty foods, alcohol, caffeien, spicy foods, grains
183
T or F: drug therpay should be given to all IBS pt
FALSE
only given to mod-severe cases that dont respond to conservative measures
184
MEds for IBS
```
antispasmodic
antidiarrheal
anticonstipation
psychotropic agents
serotonin receptor antagonist
```
185
UC or Crohns has bloody diarrhea, fecal urgency, anemia, and low albumin?
UC
186
UC or Crohns is dx with sigmoidoscopy?
UC
187
UC or Crohns should have a colonoscopy?
not UC
188
UC or Crohns is tx w/ steroids
UC
189
UC or Crohns should not have antidiarrhealth agents
UC
190
UC or Crohns affects rectum to large bowel
UC
191
UC or Crohns affects anywhere from the mouth to anus?
crohns
192
UC or Crohns has continuous diffse inflammation
UC
193
UC or Crohns has patch inflammation
crohns
194
UC or Crohns has hematochezia
UC
195
UC or Crohns has mucus/pus
UC
196
UC or Crohns hassmall bowel disease
crohns
197
UC or Crohns has abd mass and where
chrons, RLQ
198
UC or Crohns has extra intestinal
BOTH
199
UC or Crohns has SBO
crohns
200
UC or Crohns has colonic obstruction
crohns
201
UC or Crohns has strictures and fistulas
crohns
202
UC or Crohns has thin and which one has thick bowel wall
thin=uc
| thick=crohns
203
UC or Crohns has insidious onset with intermittent low grade fevers, RLQ pain
crohns
204
UC or Crohns is associated with smoking
crohns
205
UC or Crohns is acommon with chronic inflammatory disease
crohns
206
UC or Crohns has arthralgia, arthritis, iritis
crohns
207
UC or Crohns will have at least one surgery
crohns
