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NP Cert Exam > 6 Gastrointestinal Disorder > Flashcards

6 Gastrointestinal Disorder Flashcards

0
Q

RUQ nl physiology:

Also consider

A

RUQ: Cholecystitis, rt lower lobe pneumonia, acute hepatitis

Also consider. Biliary colic, pancreatitis, IBD, GERD, pleurisy, PE

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1
Q

Exam diagnostic tests-

What to order for RUQ pain?
LQ pain?
If u think bowel perferation?

A

Exam diagnostic tests-

What to order for RUQ pain? U/S!

or if Bowel perf or constipation suspected get a KUB. (Xray kidney ureter bladder)
For possible cholysistitis, Get a HIDA scan id US inconclusive

LQ pain? CT! For appendicitis, kidney stones, diverticulitis,
If u think bowel perferation?

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2
Q

Upper abdomen initial diagnostic testing

A 
CBC
UA, hCG
LFTs (Hep panel if abn)
Lipase/ amylase - pancreatitis
KUB flat/ upright if perf suspected (kidneys,ureter, bladder frontal radiograph)  ***best and cheapest imaging is KUB = constipated

Then US!!!

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3
Q

EXAM***

What are sxs of acute cholecystitis?

A 
Syndrome of 
RUQ pain
Fever
Leukocytosis (w Bands showing bad infxn)
Gallbladder inflammation (usually from a stone)
- pain is steady and severe
- usually have had previous attacks that went away
- malaise and fever
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4
Q

Acute cholecystitis. ***exam

What r US findings?
And classic sign?

A

Gallbladder wall thickening and edema

Sonographic “Murphy’s sign”: palpation of URQ pain

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5
Q

What happens when the cystic duct gets blocked?

A

Bile cannot drain from the gallbladder, infection sets in, acute cholecystitis

Fever, nausea, RUQ pain -Murphy’s sign

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6
Q

With RUQ pain and US inconclusive for acute cholecystitis, what next imaging study should be next?

A

HIDA scan

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7
Q

Acute cholecystitis treatment

A

Antibiotics

Surgery almost always reccomended to remove gallbladder

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8
Q

What is a HIDA scan?

A

Imaging to use when US inconclusive for gall bladder
HIDA is a dye used to demonstrate patency of of common bile duct and ampulla
Positive test= gall bladder was not visualized

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9
Q

Diagnosis?
May occur with or without gallbladder disease
RUQ severe pain and/or epigastric pain
Sever!!

A

Acute pancreatitis

Most go to ED pain so severe

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10
Q

3 etiologies of Pancreatitis

A

Gallstone induced: more common in women (blocks common bile duct
ETOH induced- more common in men(happens when they stop drinking
Hypertriglyceridemia- why we treat this now! In either gender when levels hit 2000-3000 watch out!!!

60-75% liklihood it is gallbladder or ETOH induced

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11
Q

Why do we treat triglycerides now?

A

To prevent Pancreatitis!!!

Not for cardiac reasons anymore- doesnt change outcomes

Nl levels are 150, and very high is >500
Very high levels 1000-3000. High risk for pancreatitis!!!

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12
Q

After 1-3 d of binge drinking, what can occur.

A

Pancreatitis!

Or from high triglycerides or gall bladder induced

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13
Q

LUQ pain and anatomy

Consider…

A

Pancreatitis, MI, left lower lobe pneumonia

Also consider. Gastritis, gastric ulcer, PUD, GERD, splenomegaly, pyelonephritis, PE, nephrolithiasis

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14
Q

KUB is a —- film

A

Scout film. Visualizes abdominal masses, calcifications, foreign bodies, intestinal obstruction, abdominal gas pattern, soft tissue shadows, organ configuration

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15
Q

What does dilated loops of bowel mean on a KUB?

A

Bowel obstruction! Move on it-refer!

Something cant pass so dilation gets bigger and bigger

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16
Q

A 56 yo man w abd pain has dilated loops of bowel on KUB xray. What is significance?

Constipation
Bosel obstruction
Diverticulitis
Colorectal disease

A

Bowel obstruction! Refer asap

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17
Q

With females and lower quadrant think:

A

Labs and exam first!

Labs: CBC. UA hCG. Lipase/amylase. CT!!

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18
Q

Lower quadrant imaging

A

CT

All picked up w CT

Appendicitis
Kidney stones
Diverticulitis
Appendicitis

19
Q

A 76 yo with lower abd pain present for several days

A

Think diverticulitis. Get CT

20
Q

What is McBurney’s point?

A

Point of maximum tenderness in RLQ showing inflammation of the vermiform appendix

21
Q

What r two appendicitis screens?

A

Appenicitis screens
Psoas sign. Raise right leg- pain bc appendix lies on ileo psoas muscle

Obturator sign- flex R knee at hip and internally rotate.

(Murphy’s sign is gallbladder- cup fingers under R rib breath in). Bc gallbladder higher up than appendix

22
Q

Clinical findings in Appendicitis

A

Mild leukocytosis (bands)
Mild elevations in bilirubin
Fever low grade

Needs surgical eval
Surgeon will do rectal bc all appendix’s hang in different positions- sometimes not in RLQ

23
Q

GERD

Acid levels of stomach and esophogus

A

Stomach-acid 1-3. Would burn finger
Esophagus acid level 3-5
So if stomach acid travels up esophagus will burn!

24
Difference between physiologic and pathologic reflux
physiologic- occurs after eating, is short lived, and rarely occurs during sleep pathologic reflux- associated w sxs- cough, hoarse, sore throat. Associated w mucosal injury Nocturnal sxs Big difference!
25
3 reasons why reflux of gastrointestinal contents happens
-Reduction of LES(lower esophageal sphincter)tone (If LES is lazy when acid comes it opens up!) - irritation of esophageal mucosa - increased gastric acid secretion
26
How to prevent esophogeal CA?
If control GERD and inflammation (where bugs grow) u can decrease risks. 50 and smokers- BIG risk!!
27
Who gets endoscopy?
Males >50 and smokers. BIG risk!!! - inadequate response to BID PPI -if pt using for at least 4-8 wks and still has sxs - dysphagia (difficulty swallowing) - odynophagia (pain w swallowing- esophogitis, esophogeal ulcer)
28
What high risk pt.'s w brand new heartburn need referral?
Male Smokers >50 yrs
29
Nonpharm mngt for GERD
***avoid recumbence after eating for 2-3 hrs**** Elevate HOB when sleeping Reduce size of meals Reduce amt of fat, acid, spices, caffeine, sweets, peppermint, chocolate, and alcohol (may reduce esophogeal tone) Smoking cessation
30
Two PRN meds for GERD and 1 nonPRN
Antacids H2 antagonists Proton Pump Inhibitor- need to take every day of week that ends in y. For 4-8 wks if typical sxs
31
Antacids When provide relief? What do they do?
Provide relief in 30 min Fastest but short acting Takes a pH from a 2 to 5, but in 30 min goes back to a 2
32
H2 antagonists When provide relief? What do they do?
PRN Take about 60-120 min to work Provide relief for 6-12 hrs Dont change pH, but decrease the amt of acid u r making Ex. Cimetidine, Ranitidine, famotidine, Nizatidine
33
Proton pump inhibitors. PPI When provide relief? What do they do?
Not PRN. Take BID for minimum of 4 wks. If sxs return - ENDOSCOPY!!!! Reduce gastric secretion- dont change pH Inhibits u from making protons ("H+"). When ur body smells food it it pairs with an "H" and a "Cl"- HCL to digest food. We make 2-3 d of "H" ahead so we have to take PPI ahead of time and can't be PRN
34
Recivitism
High rate of recurrence of sxs if meds are reduced or stopped Sxs return when meds are stopped
35
Complication of GERD?
Barrett's esophagus: Premalignant... Metaplastic columnar epithelium replaces stratified squamous epithelium - consequence of chronic GERD - predisposes patient to adenocarcinoma of the esophagus
36
What is most common cause of Diarrhea? - E. Coli - viral infxn - Salmonella - bacteria
VIRAL!
37
If Diarrhea lasts longer than 2-3 days consider
Lactose intol | -salmonella
38
Name acronyms IBS. Vs. IBD
IBS. Irritable bowel syndrome. 25% people have! IBD- inflammitory bowel disease (ulcerative colitis and Crohn's disease)
39
What is the GI syndrome characterized by recurrent abdominal pain associated w altered defecation in the absence of disease
IBS Irritable bowel syndrome Neurotransmiter issue - Serotonin!
40
Sxs of IBS
Crampy abd pain that varies in location and character Diarrhea, constipation, alternating D and C with nl bowel habits Mucus present Wont kill u *alternation- key characteristic Me :(
41
Red flag alarms with IBS
Rectal bleeding Wt loss Anemia elevated inflam markers, electrolyte disturbances All Inconsistant with IBS!!!
42
EXAM** What is classic distribution of IBD?
(UC and Crohn's) Bimodal distribution: onset 15-40 yrs and 50-80 yrs with Bloody, nocturnal diarrhea, fever, fatigue Refer GI - endoscopy
43
Ulcerative Colitis (InflamBD) What area affects? Sxs?
Chronic inflam of MUCOSAL LAYER of COLON (get colonoscopy to examine all of colon; sigmoidoscopy only does last third of colon) UC is Usually BLOODY (Crohn's usually not), bloody loose stools, abd pain, fever Almost always involves RECTUM Gradual onset of sxs
44
Main things to remember for IBS IBD - UC and Crohn's
Main things to remember for IBS- ALTERNATES diarrhea and contipation IBD - UC - BLOODY diarrhea, rectal/colon Crohn's- NOT BLOODY diarrhea, end of small bowel(ileum) and beg of colon, but can affect any part of GI from mouth to anus ie. Apthous ulcers, esphogitis
45
IBD. Crohn's disease (CD) Area affects What is diarrhea like? Extra intestinal sxs? How to diagnose?
IBD. Crohn's disease (CD) Area affects- transmural inflammation (across wall of organ)- usually end of small int(ileum) beg of colon. But can be What is diarrhea like? Usually not visibly bloody Extra intestinal manifestations? Arthritis, eyes (uveitis, iritis) How to diagnose?colonoscopy

NP Cert Exam (9 decks)

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