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NUR 718 exam 1 > chronic GI > Flashcards

chronic GI Flashcards

1
Q

visceral pain

A

dull, poorly localized

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2
Q

parietal pain

A

sharp, localized

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3
Q

colicky pain

A

comes and goes

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4
Q

burning pain

A

caused by irritation from gastric contents

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5
Q

gastroparesis treatment

A

reglan
small, low-fat meals

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6
Q

ondansetron MOA and AE

A

serotonin 5-HT3 receptor antagonist

can cause constipation and worsten nausea (bowel reg!)

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7
Q

antiemetics

A

serotonin receptor antaonists
corticosteroids
dopamine antagonists
antihistamines and anticholinergics
cannabinoids

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8
Q

abdominal pain red flags

A

duration <48 hours
pain followed by vomiting
age >65 years
hx of abdominal surgery
guarding
rebound tenderness
rigidity

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9
Q

dyspepsia red flags

A

dysphagia or odynophagia
unintentional weight loss
anemia
hematemesis
melena
recurrent vomiting
palpable mass
jaundice

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10
Q

GERD symptoms

A

epigastric or retrosternal burning or discomfort
symptoms worse when lying down
chronic cough/laryngitis/enamel erosiion/halitosis
trigger foods - ETOH, coffee, soda

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11
Q

biliary tract disease symptoms

A

RUQ or epigastric pain occurring after fatty meal
pain lasts 1-6 hours
may have associated N/V
pain is usually colicky

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12
Q

GI malignancy risk factors

A

> 60 years old
significant weight loss
dysphagia
long history of GERD
hx of smoking
family history of stomach or esophageal cancer

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13
Q

common meds causing dyspepsia

A

NSAIDs
iron
bisphosphonates
antibiotics

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14
Q

dyspepsia differentials

A

PUD
GERD
biliary tract disease
malignancy
medication induced
food intolerance
pancreatitis
IBS
gastroparesis

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15
Q

common food causes of dyspepsia

A

lactose intolerance
celiac disease

alcohol

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16
Q

symptoms of pancreatitis

A

epigastric pain radiating to back
pain of abrupt onset, severe, lasting several hours
history of heavy ETOH use
history of gallstones

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17
Q

symptoms of IBS

A

alteration of bowel habits w/wo abdominal pain and no organic cause

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18
Q

gastroparesis

A

delayed gastric emptying

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19
Q

gastroparesis risk factors

A

history of metabolic disorder - DM (A1C)
abdominal surgery w vagal nerve injury

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20
Q

who gets an endoscopy?

A

adults >60 or w dyspepsia alarm symptoms

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21
Q

dysphagia diagnostics

A

esophagram - least invasive
EGD - gold standard

PUD - repeat EGD @ 6 weeks

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22
Q

which ulcers are more common for each age

A

55-70 gastric
30-55 duodenal

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23
Q

causes of PUD

A

H. pylori
acid hypersecretion
gastric ischemia
meds (NSAIDS, ASA, K, bisphosphonates)
idiopathic

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24
Q

is H. pylori gram positive or negative?

A

negative

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25
Q

gastric vs duodenal ulcer symptoms

A

gastric - pain aggravated by food, loss of weight/appetite
duodenal - pain relieved by food, radiates to back, weight gain not uncommon

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26
Q

PUD s/s

A

burning, gnawing epigastric pain (may be nocturnal)
N/V uncommon
GI bleeding

epigastric tenderness w palpation
abd rigidity if perf
melena
weight changes?

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27
Q

tests for H. pylori

A

urea breath test
stool antigen
serum not evidence based

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28
Q

diagnostic for Zolling-Ellison syndrome

A

fasting gastrin

29
Q

H. pylori treatment

A

triple therapy 10-14 days

PPI BID &
Amoxicillin 1g BID - flagyl if allergy
Clarithromycin 500 mg BID

check for eradication @ 4 weeks

30
Q

H. pylori quadruple therapy

A

PPI
Bismuth
Metronidazole
Tetracycline

31
Q

PUD first line management

A

PPIs
BID recommended
benefit - duration >24 hours
gastric ulcers - 8 weeks, then QD
duodenal ulcers - 4 weeks, then QD

32
Q

use of H2RAs in PUD

A

mild symptoms w no complications
taken at bedtime
inhibit P-450

33
Q

PUD additional meds

A

add onto PPI

antacids - cheap, neutralize acid
carafate - coats ulcer
bismuth - stimulate bicarb production, antimicrobial against H. pylori

34
Q

when to consult GI for PUD

A

GI bleed
s/s of ulcer perf
s/s of gastric outlet obstruction
if no improvement after 2 weeks of treatment

35
Q

fdsafd

A

dsafads

36
Q

GERD risk factors

A

family history
age
hiatal hernia
obesity
LES tone-reducing drugs - Ca channel blockers, TCAs, anticholinergics
ETOH
smoking
aggravating foods - mint, coffee, citrus, fats

37
Q

GERD important rule out

A

acute MI/CAD

38
Q

GERD treatment

A

PPI QD x 8 weeks

refractory - increase to BID for 2-3 month, add H2RA noc, consider zollinger-ellision, pH testing

consult GI - EGD/ barium esophagraphy

surgery - laparoscopic fundoplication tighten LES, LINX procedure w magnet

39
Q

Zollinger-Ellison syndrome

A

gastric tumor causing elevated levels of gastrin

->PUD, GERD

40
Q

GERD complications

A

esophageal ulcer, hemorrhage, or perf
esophagitis leading to dysphagia
esophageal stricture
barrett’s esophagus**
adenocarcinoma of esophagus

41
Q

Barrett’s esophagus

A

squamous mucosa esophageal lining becomes columnar epithelial

starts with GERD, metaplasia occurs w injury

precursor to esophageal adenocarcinoma

42
Q

indication for surgical referral (acute abd)

A

fever
chills
leukocytosis
rebound tenderness
guarding
rigidity

43
Q

abdominal compartment syndrome

A

sustained intra-abdominal pressure of >20 mm Hg

44
Q

s/s of abdominal compartment syndrome

A

dyspnea, pain, weakness

rigid/tense abdomen, progressive oliguria, hemodynamic instability

45
Q

abd compartment syndrome treatment

A

optimize fluid balance
NG, rectal tube
pro kinetic agents - neostigmine, erythromycin
surgical decompression
dialysis

46
Q

mesenteric ischemia risk factors

A

advanced age
smoking
hypercoagulatable states
a fib
MI/structural heart defects, CHF, atherosclerosis, AS
vasculitis
abd surgery/IR procedure
oral contraception
hypotension/shock/pressors

47
Q

s/s of mesenteric ischemia

A

acute abd pain out of proportion to physical findings, generalized or periumbilical

early - hypoactive BS, abd distention, but grossly normal exam
later - acute abd, hemodynamic instability & CV collapse

48
Q

mesenteric ischemia management

A

surgical consult - laparotomy
NG decompression
chronic - angioplasty stenting, TPN
broad spectrum abx - 3rd gen cephalosporin or quinolone & flagyl
inotropes, fluids, blood products
papaverine
anticoagulation

49
Q

rule out for mesenteric ischemia

A

abdominal aneurysm

50
Q

mesenteric ischemia complications

A

food fear - sitophobia
stricture
short gut syndrome - TPN or small bowel transplant

51
Q

broad spectrum abx

A

third gen cephalosporin or quinolone

ceftazidime, ceftriaxone, cefdinir

52
Q

primary constipation treatment

A

bulk laxative w/wo stool softeners

psyllium, Metamucil

53
Q

acute constipation w fecal impaction tx

A

enemas, suppositories, polyethylene glycol, stimulant laxatives (senna, colace)

54
Q

opioid induced constipation tx

A

opioid receptor agonists - methylnaltrexone

55
Q

CI to magnesium-containing laxatives

A

renal disease

56
Q

diarrhea definition

A

> 3 loose/liquid BMs per day

57
Q

risk for colonic perf

A

c. diff, salmonella, shigella

58
Q

infections risk for intestinal obstruction

A

shigella & helminth

59
Q

Reiter syndrome triad

A

conjunctivitis
urethritis
reactive arthritis

may occur following GI infection

60
Q

bloody diarrhea rule out

A

HUS & TTP

61
Q

organisms that cause bloody diarrhea

A

SEECSY

salmonella
E. coli ehec, etec
entamoeba (protozoa)
campylobacter
shigella
yersinia entercolitica

62
Q

abx of choice for diarrhea empiric therapy

A

fluoroquinolone

sulfa/doxy are alternatives

63
Q

chronic diarrhea

A

present longer than 4 weeks, >3 stools/day

64
Q

microscopic colitis

A

10-15 wattery stools/day
confirm w colonic biopsy
budesonide therapy

65
Q

meds for chronic diarrhea

A

loperamide, diphenoxylate with atropine, codeine, clonidine, octreotide, bile salt binders

66
Q

s/s of diverticulitis

A

LLQ abd pain
fever
leukocytosis
N/V
diarrhea maybe w blood
perf - gen pain, peritoneal signs

67
Q

main cause of diverticulitis

A

constipation

68
Q

common gut bacteria

A

anaerobic & gram negative

69
Q

abx for diverticulitis

A

augmentin OR cipro & flagyl
ceftriaxone & flagly or zosyn IV

NUR 718 exam 1 (6 decks)

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