Ch 8 GI and Hepatic Disorders

Question 1

risk factors to GERD

Answer 1

overweight/obesity
tobacco
fatty food
alcohol
caff/carbonated beverages
drugs that lower esophageal sphincter (estrogen, CCB)

Question 2

Red flags with GERD to order upper endoscopy?

Answer 2

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)

Question 3

GERD Management

Answer 3

1st line: PPI (QD before meals)
Lifestyle: weight loss, avoid trigger foods (chocolate, acidic), eating w/in 2-3 hrs before bedtime, HOB elevation

Question 4

PPI adverse effects

Answer 4

-micronutrients malabsorption (vitamin B12, calcium, magnesium, iron)
-increase fracture
-pneumonia
-C difficile infection risk

Question 5

Do not use PPI’s for more than

Answer 5

2 months

Question 6

what is a good alternative to PPI use

Answer 6

H2 receptor antagonist (famotidine)

Question 7

If pt’s don’t respond to PPI…

Answer 7

refer to GI for eval with upper endoscopy, esp after failing max PPI dose

Question 8

acute appendicitis preferred imaging

Answer 8

CT with contrast (preferred with BMI >26)
Abd ultrasound also accepted on kids and low BMI

Question 9

acute appendicitis signs and sx’s

Answer 9

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

Question 10

major risk factors for acute pancreatitis?

Answer 10

alcohol use
gall stones

Question 11

Acute pancreatitis management

Answer 11

SEND TO ED!
to manage pain, fluids, and alcohol withdrawal

Question 12

acute pancreatitis clinical manifestations

Answer 12

epigastric tenderness
hypoactive bowel sounds
abdomen distended
hypertympanic
n/v

Question 13

blumberg sign

Answer 13

rebound tenderness

Question 14

intermittent LLQ abd pain
fever
cramping
nausea
4-5 loose stools
leukocytosis with neutrophilia
negative blumberg sign

Answer 14

diverticulitis
(leukocytosis + fever = bacterial)

Question 15

diverticulitis management

Answer 15

get CT with contrast
gut rest
oral antimicrobial therapy

Question 16

intermittent LUQ tender epigastric region
burning, gnawing pain 2-3 hrs PC
relief with food, antacids
awakening at 1-2 am with sx’s

Answer 16

duodenal ulcer

Question 17

duodenal ulcer diagnosis testing

Answer 17

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

Question 18

duodenal ulcer treatment

Answer 18

antimicrobial therapy with PPI IF H pylori positive

upper endoscopy NOT routinely indicated unless indicated ie iron deficiency anemia

Question 19

duodenal ulcer treatment

Answer 19

antimicrobial therapy with PPI IF H pylori positive

upper endoscopy NOT routinely indicated unless indicated ie iron deficiency anemia

Question 20

colicky pain (2-3 minute periods of pain)
RUQ pain
nausea
vomiting
intermittent fever
positive Murphy’s sign
elevated AST, ALT, ALP

Answer 20

cholecystitis

elev ALP = when bile is not flowing freely
colicky = wave of pain when body is trying to push something down

Question 21

cholecystitis management

Answer 21

get RUQ abdominal ultrasound
clear liquid diet/gut rest to low fat diet
refer surgery for GB removal
if vomiting a lot, admit!

Question 22

sx’s of viral hepatitis (a,b,c)

Answer 22

jaundice
fever
fatigue
loss of appetite
nausea/vomiting
abdominal pain
joint pain
dark urine
clay colored stool
diarrhea

Question 23

route of transmission for hep A
can it become chronic infection after acute infection?

Answer 23

fecal-oral route
NOT blood
- sexual contact, ingestion food/water

NO chronic

Question 24

route of transmission for hep B
can it become chronic infection after acute infection?

Answer 24

bodily fluids, blood, birth, sex, sharing needles

yes if born infected
5% of new infected adults

Question 25

route of transmission for hep c
can it become chronic infection after acute infection?

Answer 25

direct blood contact or mucus
sharing needles

chronic in 50% newly infected