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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
gastric vs duodenal ulcer symptoms
gastric - pain aggravated by food, loss of weight/appetite duodenal - pain relieved by food, radiates to back, weight gain not uncommon
26
PUD s/s
burning, gnawing epigastric pain (may be nocturnal) N/V uncommon GI bleeding epigastric tenderness w palpation abd rigidity if perf melena weight changes?
27
tests for H. pylori
urea breath test stool antigen serum not evidence based
28
diagnostic for Zolling-Ellison syndrome
fasting gastrin
29
H. pylori treatment
triple therapy 10-14 days PPI BID & Amoxicillin 1g BID - flagyl if allergy Clarithromycin 500 mg BID check for eradication @ 4 weeks
30
H. pylori quadruple therapy
PPI Bismuth Metronidazole Tetracycline
31
PUD first line management
PPIs BID recommended benefit - duration >24 hours gastric ulcers - 8 weeks, then QD duodenal ulcers - 4 weeks, then QD
32
use of H2RAs in PUD
mild symptoms w no complications taken at bedtime inhibit P-450
33
PUD additional meds
add onto PPI antacids - cheap, neutralize acid carafate - coats ulcer bismuth - stimulate bicarb production, antimicrobial against H. pylori
34
when to consult GI for PUD
GI bleed s/s of ulcer perf s/s of gastric outlet obstruction if no improvement after 2 weeks of treatment
35
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36
GERD risk factors
family history age hiatal hernia obesity LES tone-reducing drugs - Ca channel blockers, TCAs, anticholinergics ETOH smoking aggravating foods - mint, coffee, citrus, fats
37
GERD important rule out
acute MI/CAD
38
GERD treatment
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
Zollinger-Ellison syndrome
gastric tumor causing elevated levels of gastrin ->PUD, GERD
40
GERD complications
esophageal ulcer, hemorrhage, or perf esophagitis leading to dysphagia esophageal stricture barrett's esophagus** adenocarcinoma of esophagus
41
Barrett's esophagus
squamous mucosa esophageal lining becomes columnar epithelial starts with GERD, metaplasia occurs w injury precursor to esophageal adenocarcinoma
42
indication for surgical referral (acute abd)
fever chills leukocytosis rebound tenderness guarding rigidity
43
abdominal compartment syndrome
sustained intra-abdominal pressure of >20 mm Hg
44
s/s of abdominal compartment syndrome
dyspnea, pain, weakness rigid/tense abdomen, progressive oliguria, hemodynamic instability
45
abd compartment syndrome treatment
optimize fluid balance NG, rectal tube pro kinetic agents - neostigmine, erythromycin surgical decompression dialysis
46
mesenteric ischemia risk factors
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
s/s of mesenteric ischemia
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
mesenteric ischemia management
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
rule out for mesenteric ischemia
abdominal aneurysm
50
mesenteric ischemia complications
food fear - sitophobia stricture short gut syndrome - TPN or small bowel transplant
51
broad spectrum abx
third gen cephalosporin or quinolone ceftazidime, ceftriaxone, cefdinir
52
primary constipation treatment
bulk laxative w/wo stool softeners psyllium, Metamucil
53
acute constipation w fecal impaction tx
enemas, suppositories, polyethylene glycol, stimulant laxatives (senna, colace)
54
opioid induced constipation tx
opioid receptor agonists - methylnaltrexone
55
CI to magnesium-containing laxatives
renal disease
56
diarrhea definition
>3 loose/liquid BMs per day
57
risk for colonic perf
c. diff, salmonella, shigella
58
infections risk for intestinal obstruction
shigella & helminth
59
Reiter syndrome triad
conjunctivitis urethritis reactive arthritis may occur following GI infection
60
bloody diarrhea rule out
HUS & TTP
61
organisms that cause bloody diarrhea
SEECSY salmonella E. coli ehec, etec entamoeba (protozoa) campylobacter shigella yersinia entercolitica
62
abx of choice for diarrhea empiric therapy
fluoroquinolone sulfa/doxy are alternatives
63
chronic diarrhea
present longer than 4 weeks, >3 stools/day
64
microscopic colitis
10-15 wattery stools/day confirm w colonic biopsy budesonide therapy
65
meds for chronic diarrhea
loperamide, diphenoxylate with atropine, codeine, clonidine, octreotide, bile salt binders
66
s/s of diverticulitis
LLQ abd pain fever leukocytosis N/V diarrhea maybe w blood perf - gen pain, peritoneal signs
67
main cause of diverticulitis
constipation
68
common gut bacteria
anaerobic & gram negative
69
abx for diverticulitis
augmentin OR cipro & flagyl ceftriaxone & flagly or zosyn IV

NUR 718 exam 1 (6 decks)

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