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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
Q

Difference between physiologic and pathologic reflux

A

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
Q

3 reasons why reflux of gastrointestinal contents happens

A

-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
Q

How to prevent esophogeal CA?

A

If control GERD and inflammation (where bugs grow) u can decrease risks. 50 and smokers- BIG risk!!

27
Q

Who gets endoscopy?

A

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
Q

What high risk pt.’s w brand new heartburn need referral?

A

Male Smokers >50 yrs

29
Q

Nonpharm mngt for GERD

A

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
Q

Two PRN meds for GERD and 1 nonPRN

A

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
Q

Antacids

When provide relief?
What do they do?

A

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
Q

H2 antagonists

When provide relief?
What do they do?

A

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
Q

Proton pump inhibitors. PPI

When provide relief?
What do they do?

A

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
Q

Recivitism

A

High rate of recurrence of sxs if meds are reduced or stopped

Sxs return when meds are stopped

35
Q

Complication of GERD?

A

Barrett’s esophagus:
Premalignant… Metaplastic columnar epithelium replaces stratified squamous epithelium

  • consequence of chronic GERD
  • predisposes patient to adenocarcinoma of the esophagus
36
Q

What is most common cause of Diarrhea?

  • E. Coli
  • viral infxn
  • Salmonella
  • bacteria
A

VIRAL!

37
Q

If Diarrhea lasts longer than 2-3 days consider

A

Lactose intol

-salmonella

38
Q

Name acronyms

IBS. Vs. IBD

A

IBS. Irritable bowel syndrome. 25% people have!

IBD- inflammitory bowel disease (ulcerative colitis and Crohn’s disease)

39
Q

What is the GI syndrome characterized by recurrent abdominal pain associated w altered defecation in the absence of disease

A

IBS

Irritable bowel syndrome

Neurotransmiter issue - Serotonin!

40
Q

Sxs of IBS

A

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
Q

Red flag alarms with IBS

A

Rectal bleeding
Wt loss
Anemia elevated inflam markers, electrolyte disturbances

All Inconsistant with IBS!!!

42
Q

EXAM**

What is classic distribution of IBD?

A

(UC and Crohn’s)

Bimodal distribution: onset 15-40 yrs and 50-80 yrs with Bloody, nocturnal diarrhea, fever, fatigue

Refer GI - endoscopy

43
Q

Ulcerative Colitis (InflamBD)

What area affects?
Sxs?

A

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
Q

Main things to remember for

IBS
IBD - UC and Crohn’s

A

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
Q

IBD. Crohn’s disease (CD)

Area affects
What is diarrhea like?
Extra intestinal sxs?
How to diagnose?

A

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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