Diagnosis and management of Gastrointestinal disorders Flashcards
Peptic Ulcer Disease
Cause/ Incidence:
1. ___ ____ (present in > 90% of duodenal ulcers and > 75% of gastric ulcers)
H. pylori
Peptic Ulcer Disease
Cause/ Incidence:
2. Medications such as ____, ASA, and glucocorticoids
NSAIDs
Peptic Ulcer Disease
Cause/ Incidence:
3. More common in ____ (3:1)
men
Peptic Ulcer Disease
Cause/ Incidence:
4. ____ ulcers between ages 30 to 55
Duodenal
Peptic Ulcer Disease
Cause/ Incidence:
5. ______ ulcers between ages 55 to 65
Gastric
Peptic Ulcer Disease
Cause/ Incidence:
6. More common in > ½ PPD ____
smokers
Peptic Ulcer Disease
Cause/ Incidence:
7. ____ and dietary factors do not appear to cause ulcer disease
Alcohol
Peptic Ulcer Disease
Cause/ Incidence:
8. The role of ____ is uncertain: Type A personalities?
stress
Peptic Ulcer Disease
Signs/ Symptoms
1. Gnawing _____ pain
epigastric
Peptic Ulcer Disease
Signs/ Symptoms
2. Relief of pain with eating (______)
duodenal
Peptic Ulcer Disease
Signs/ Symptoms
3. Pain worsens with eating (____)
gastric
Peptic Ulcer Disease
Physical Findings
1. Often unremarkable; may note some mild epigastric ______
tenderness
Peptic Ulcer Disease
Physical Findings
2. GI bleeding (20% of cases) Melena, hematemesis, or ____-ground emesis
coffee
Peptic Ulcer Disease
Physical Findings
3. _____ (5 to 10% of cases)” Severe epigastric pain, “board-like” abdomen, quiet bowel sounds, rigidity, and other sigmas of an acute abdomen
Perforation
Peptic Ulcer Disease
Laboratory/Diagnostics
1. Normal; may note anemia on the ____
CBC
Peptic Ulcer Disease
Laboratory/Diagnostics
2. Consider endoscopy after __ to __ weeks of treatment
8 to 12
Peptic Ulcer Disease
Laboratory/Diagnostics
3. Consider ___ -___ testing Out-Patient Management
H. pylori
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
1. ______ (Tagamet) 800 mg/hours sleep
Cimetidine
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
2. ______ (Zantac) 300 mg/hours sleep
Ranitidine
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
3. _____ (Pepcid) 40 mg/hours sleep
Famotidine
Peptic Ulcer Disease
Acid-antisecretory Agents
H2 Receptor Antagonists
4. ________ (Axid) 300 mg/hours sleep
Nizatidine
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
1. _____ (Prevacid) 15 mg/day
Lansoprazole
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
2. ________ (Aciphex) 20 mg/day
Rabeprazole
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
3. ______ (Protonix) 40 nag/day
Pantoprazole
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
4. __________ (Prilosec) 20 mg/day
Omeprazole
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
5. __________ (Dexilant) 30 mg/day
Dexlansoprazole
Peptic Ulcer Disease
Proton Pump Inhibitors
(30 minutes before meals)
6. _________ (Nexium) 20 mg/day
Esomeprazole
Mucosal Protective Agents
(Give 2 hours apart from other medications)
- ____ _____ (Pepto-Bismol)
a. Has direct antibacterial action against H. pylori
b. Promotes prostaglandin production/stimulates
gastric bicarbonate
Bismuth subsalicylate
Mucosal Protective Agents
(Give 2 hours apart from other medications)
- ________ (Cytotec): Four times daily with food
a. Used as prophylaxis against NSAID-induced ulcers
b. Stimulates mucous and bicarbonate production
c. May stimulate uterine contraction and induce
abortion
d. Discontinue offending agent if possible
e. Proton pump inhibitor in patients who cannot
discontinue NSAIDs
Misoprostol
Mucosal Protective Agents
(Give 2 hours apart from other medications)
- _____ (Mylanta, Maalox, MOM, etc.)
a. Do not reduce the amount of gastric acidity
Antacids
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
1. Popular proton pump inhibitor regimen recommendations
a. MOC
Metronidazole (Flagyl) 500 mg twice a day with
meals, ______ (Prilosec) 20 mg twice a day
before meals, and clarithromycin (Biaxin) 500 mg
twice a day with meals for 7 days
omeprazole
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
1. Popular proton pump inhibitor regimen recommendations
b. AOC
_________ (Amoxil) 1 g twice a day with meals,
omeprazole (Prilosec) 20 mg twice a day before
meals, and clarithromycin (Biaxin) 500 mg twice a
day with meals for 7 days
amoxicillin
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
1. Popular proton pump inhibitor regimen recommendations
c. MOA
__________ (Flagyl) 500 mg twice a day with
meals, omeprazole (Prilosec) 20 mg BID before
meals, and amoxicillin (Amoxil) 1 g twice a day with
meals for 7 to 14 days
Metronidazole
H. pylori Eradication Therapy
Combination Options
- Bismuth regimens require four times a day dosing
a. BMT: _____ _____ 2 tabs four times a day,
metronidazole (Flagyl) 250 mg four times a day, and
tetracycline (Tetracyn) 500 mg four times a day (all
with meals and at bedtime)
Bismuth subsalicylate
H. pylori Eradication Therapy
Combination Options
2 antibiotics + either a proton pump inhibitor or bismuth
b. BMT + _________ (Prilosec): The above regimen +
omeprazole (Prilosec) 20 mg twice a day before meals
for 7 days
omeprazole
- Antiulcer therapy is recommended following the previous regimens for __ to ___ weeks to ensure symptom relief and ulcer healing
3 to 7
Antiulcer therapy
a. For duodenal ulcer: _____ (Prilosec) 40 mg
every day or lansoprazole (Prevacid) 30 mg/day
continued for 7 additional weeks
Omeprazole
Antiulcer therapy
b. H2 blockers can be given for ___ to ___weeks
6 to 8
Peptic Ulcer:
Urgent Care/Emergent Initial Management for PUD:
1. Baseline lab studies: _____, PT/PTT, basic metabolic panel (BMP)
CBC
Peptic Ulcer: Urgent Care/Emergent Initial Management for PUD: 2. Refer for: a. O2 b. \_\_\_\_\_\_\_ c. Urinary catheterization d. Nasogastric tube for lavage e. NPO f. IV H2 Blockers g. GI/surgical evaluation
Endoscopy
A disorder characterized by backflow (reflux) of acidic gastric contents into the esophagus
Gastroesophageal Reflux Disease (GERD)
Causes/Incidence GERD:
- The _______ lower esophageal sphincter (LES)
- Delayed gastric emptying
incompetent
GERD Signs/Symptoms 1. \_\_\_\_\_\_ "burning" 2. Bitter taste in the mouth 3. Belching, hiccoughs, dysphagia 4. Excessive salivation 5. Frequently occurs at night and/or in a recumbent position 6. May be relieved by sitting up, antacids, water or food
Retrostemal
GERD
Physical Exam Findings
1. N_______
Noncontributory
GERD
Diagnostics
1. Consider referral for esophagogastroduodenoscopy (EGD) Rule out cancer, ______ esophagus, peptic ulcer disease, etc.
Barrett’s
GERD
Management
1. Non-pharmacologic measures
a. Elevate the head of the bed
b. Avoid alcohol, caffeine, spices, peppermint, etc.
c. Stop ______
d. Weight reduction if obese
2. Antacids PRN
3. H2 blockers (“-tidines”) in high doses at fight or divided twice a day dosing
4. Proton pump inhibitors (“-zoles”) if H2 blockers are ineffective
5. GI/surgical consult PRN
smoking
A nonspecific term usually applied to a syndrome of acute nausea, vomiting, diarrhea, and cramping resulting from an acute inflammation/irritation of the gastric mucosa
Gastroenteritis
Causes/Incidence of Gastroenteritis:
- Viruses: More common during the winter
- Bacterial
- _______
- Emotional stress
Parasitic
Signs/Symptoms of Gastroenteritis:
- Nausea/vomiting
- Watery ______
- Anorexia
- Abdominal cramping
- General “sick” feeling
diarrhea
Physical Exam Findings of Gastroenteritis:
- Hyperactive bowel sounds
- Abdominal _______
- Fever
- Tachycardia
- Hypotension
distention
Diagnostics of Gastroenteritis:
- Not indicated timeless symptoms persist > ___ hours or blood is noted in stool
- Stool for culture, WBCs and O and P
- The stool may be guaiac positive if a bacterial infection is present
72
Management of Gastroenteritis:
- Supportive care
- Fluids for ________: Clear liquids progressing
- In adults, antimotility medications are not recommended for mild disease; contraindicated in patients with bloody stool or fever
- Antibiotics are only indicated when an organism is isolated and symptoms are not resolved
- Traveler’s diarrhea prophylaxis: Bismuth subsalicylate (Pepto-Bismol)
rehydration
Inflammation of the liver with resultant liver dysfunction
Hepatitis
Causes/Incidence of Hepatitis:
- Viral: subtypes A, B, C (non-A, non-B), D, E, G
- _________
- Alcoholic
Autoimmune
Hepatitis ____
Enteral virus, transmitted via the oral-fecal route and, rarely, parenterally
A
Hepatitis A
1. Common source outbreaks result from contaminated water and food (e.g., _______, hurricane-stricken areas with poor sewage), as well as intimate sexual contact (body secretion exchange).
shellfish
Hepatitis A
2. Blood and stool are infectious during the two to six week ______ period.
incubation
Hepatitis A
3. The mortality rate is very ____, and fulminant hepatitis A is rare.
low
Hepatitis ____
Bloodborne DNA virus present in serum, saliva, semen, and vaginal secretions
1. Transmitted via blood and blood products, sexual activity, and mother-fetus
B
Hepatitis ____
Bloodborne RNA virus in which the source of infection is often uncertain
1. Traditionally associated with blood transfusion
2. 50% of cases are related to intravenous drug use
C
Signs/Symptoms Hepatitis:
1. ______: Fatigue, malaise, anorexia, n/v, headache, aversion to smoking, and alcohol
Pre-icteric
Signs/Symptoms Hepatitis:
- _____: Weight loss, jaundice, pruritus, right upper quadrant pain, clay-colored stool, dark urine
a. Low-grade fever may be present
b. Hepatosplenomegaly may be present
Icteric
Laboratory/Diagnostics Hepatitis:
1. WBC ___ to ____
low to normal
Laboratory/Diagnostics Hepatitis:
2. UA: ______, bilirubinemia
Proteinuria
Laboratory/Diagnostics Hepatitis:
3. ____ AST and ALT (500-2000 IU/L)
Elevated
Laboratory/Diagnostics Hepatitis:
4. LDH, bilirubin, alkaline phosphatase and PT ____ or slightly elevated
normal
Serology Tests
Hepatitis A
1. Anti-HAV (antibody for hepatitis A) and IgM (antibody to HAV which implies recent infection) peak during the first week of clinical illness and disappear in _____ months. These are diagnostic of acute Hepatitis A.
3-6 months
Serology Tests
Hepatitis A
- ____ (antibody to HAV) implies previous exposure and confers immunity. The presence of ____ alone is not diagnostic of acute HAV infection; it indicates previous exposure, non-infectivity, and immunity to recurring HAV infection.
IgG
Hepatitis B surface antigen (HBsAg) is the first evidence of HBV infection. It will remain positive in asymptomatic carriers and chronic hepatitis B patients.
_____ (antibody to HBcAg) and IgM appear shortly after HBsAg disappears and before anti-HBc (antibody specific to HBsAg) appears.
Anti-HBc
Hepatitis B surface antigen (HBsAg) is the first evidence of HBV infection. It will remain positive in asymptomatic carriers and chronic hepatitis B patients.
______ (antibody to HBcAg) and IgM appear shortly after HBsAg disappears and before anti-HBc (antibody specific to HBsAg) appears.
Anti-HBc