Adult - GI Flashcards
What conditions are part of the umbrella Peptic Ulcer Disease (PUD)?
gastric ulcer
duodenal ulcer
Is PUD more common in men or women?
men
Younger adults tend to get which type of ulcer?
duodenal
Older adults tend to get which type of ulcer?
> age 55
gastric
Geros Get Gastric
Of smoking, alcohol, and diet, which seem to contribute to the development of PUD?
smoking
Which medications contribute to the formation of peptic ulcer disease?
NSAIDs
ASA
glucocorticoids
What is the typical description of PUD pain?
gnawing
Which type of ulcer is relieved by eating?
duodenal
Which type of ulcer is aggravated by eating?
gastric
What are two potential complications of PUD?
GI bleeding
GI perforation
What are signs of bowel perforation?
severe epigastric pain
“board like abdomen”
QUIET bowel sounds (ominous)
–> ACUTE ABDOMEN = VERY SERIOUS
What are Xray findings in PUD?
free air under diaphragm
When would endoscopy be considered in PUD?
After 8 - 12 weeks of treatment
First line pharmacology in PUD
H2 receptor antagonist at HS
next step BID
third step PPI
Examples of H2 receptor antagonist
ranitidine (Zantac)
famotidine (Pepcid)
Examples of PPI
omeprazole (Prilosec)
lansoprazole (Prevacid)
What are the 3 leading causes of bowel perforation?
ulcer
diverticulitis
appendicitis
What are 3 mucosal protective agents?
bismuth subsalicylate
misoprostol
antacids - mylanta, maalox, MOM
When should mucosal protective agents be given?
2 hours apart from other medications
What is the only medication used as a prophylaxis against NSAID-induced ulcers?
misoprostol (Cytotec)
What is a side effect of misoprostol?
stimulates uterine contraction and can lead to pregnancy loss (used for chemical abortions)
When should PPIs be given?
30 minutes before meals
When should H2 blockers be given?
as scheduled - at HS or BID
What is the general pattern for H. pylori eradication options?
2 antibiotics and a PPI or Bismuth
What is in the MOC for H. pylori eradication?
metronidazole (Flagyl)
omeprazole (Prilosec)
clarithromycin (Biaxin)
What is in the AOC option for H. pylori eradication?
amoxicillin (Amoxil)
omeprazole (Prilosec)
clarithromycin (Biaxin)
What is in the MOA for H. pylori eradication?
metronidazole (Flagyl)
omeprazole (Prilosec)
amoxicillin (Amoxil)
What treatment follows H. pylori eradication therapy?
up to 2 months of “step-down therapy” with a PPI or H2 blocker
What is patient at risk for when d/c’ing PPI?
rebound GERD
What is the typical description of GERD pain?
burning or churning
vs. gnawing of PUD
Other than burning or churning, what are signs and symptoms of GERD?
bitter taste in mouth
belching
hiccups
What is a common complaint of GERD in the elderly?
dysphagia
r/o esophageal tumor
What time of day does GERD frequently occur?
at night, after a large meal, in recumbent position
What is a concern of long-standing GERD?
progression to Barrett’s esophagus
which can lead to esophageal cancer
What are four steps of therapy options in GERD?
antacids
H2 blockers
PPI if H2 ineffective
GI/surgical consult
When are diagnostics indicated in gastroenteritis?
not indicated unless symptoms persist > 72 hours or if blood is noted in stool
What diagnostics are used in gastroenteritis?
stool for culture, WBCs, and O & P
What medication can be used for traveler’s diarrhea prophylaxis?
bismuth salicylate
