Ch 8 GI and Hepatic Disorders Flashcards
risk factors to GERD
overweight/obesity
tobacco
fatty food
alcohol
caff/carbonated beverages
drugs that lower esophageal sphincter (estrogen, CCB)
Red flags with GERD to order upper endoscopy?
ALARMS
-Anemia (iron def)
-Loss of weight (involuntary)
-Anorexia (persistent)
-Recent onset of progressive sx’s even if using meds that normally help (PPI not working anymore)
-Melena or hematemesis
-Swallowing difficulty (dysphagia, odynophagia)
GERD Management
1st line: PPI (QD before meals)
Lifestyle: weight loss, avoid trigger foods (chocolate, acidic), eating w/in 2-3 hrs before bedtime, HOB elevation
PPI adverse effects
-micronutrients malabsorption (vitamin B12, calcium, magnesium, iron)
-increase fracture
-pneumonia
-C difficile infection risk
Do not use PPI’s for more than
2 months
what is a good alternative to PPI use
H2 receptor antagonist (famotidine)
If pt’s don’t respond to PPI…
refer to GI for eval with upper endoscopy, esp after failing max PPI dose
acute appendicitis preferred imaging
CT with contrast (preferred with BMI >26)
Abd ultrasound also accepted on kids and low BMI
acute appendicitis signs and sx’s
periumbilical pain and goes to RLQ
anorexia
nausea/vomiting
rebound tenderness
leukocytosis
markle test (heel jar test)
Mc burney’s point
Psoas signs
Obturator sign
major risk factors for acute pancreatitis?
alcohol use
gall stones
Acute pancreatitis management
SEND TO ED!
to manage pain, fluids, and alcohol withdrawal
acute pancreatitis clinical manifestations
epigastric tenderness
hypoactive bowel sounds
abdomen distended
hypertympanic
n/v
blumberg sign
rebound tenderness
intermittent LLQ abd pain
fever
cramping
nausea
4-5 loose stools
leukocytosis with neutrophilia
negative blumberg sign
diverticulitis
(leukocytosis + fever = bacterial)
diverticulitis management
get CT with contrast
gut rest
oral antimicrobial therapy
intermittent LUQ tender epigastric region
burning, gnawing pain 2-3 hrs PC
relief with food, antacids
awakening at 1-2 am with sx’s
duodenal ulcer
duodenal ulcer diagnosis testing
stool H pylori antigen or urea breath test
95% of cause of ulceration
NO H pylori serologic testing/blood testing bc it tests if it’s in the blood in the PAST but not current
duodenal ulcer treatment
antimicrobial therapy with PPI IF H pylori positive
upper endoscopy NOT routinely indicated unless indicated ie iron deficiency anemia
duodenal ulcer treatment
antimicrobial therapy with PPI IF H pylori positive
upper endoscopy NOT routinely indicated unless indicated ie iron deficiency anemia
colicky pain (2-3 minute periods of pain)
RUQ pain
nausea
vomiting
intermittent fever
positive Murphy’s sign
elevated AST, ALT, ALP
cholecystitis
elev ALP = when bile is not flowing freely
colicky = wave of pain when body is trying to push something down
cholecystitis management
get RUQ abdominal ultrasound
clear liquid diet/gut rest to low fat diet
refer surgery for GB removal
if vomiting a lot, admit!
sx’s of viral hepatitis (a,b,c)
jaundice
fever
fatigue
loss of appetite
nausea/vomiting
abdominal pain
joint pain
dark urine
clay colored stool
diarrhea
route of transmission for hep A
can it become chronic infection after acute infection?
fecal-oral route
NOT blood
- sexual contact, ingestion food/water
NO chronic
route of transmission for hep B
can it become chronic infection after acute infection?
bodily fluids, blood, birth, sex, sharing needles
yes if born infected
5% of new infected adults
