exam 2 - GI

Question 1

GI Meds: prokinetics

Answer 1

increase rate of motility

- metocloperamide (reglan)

Question 2

GI meds: antiemetics

Answer 2

phenergan/zofran

Question 3

GI meds: PPI

Answer 3

acide reflux - omeprazole, pantoprazole

Question 4

GI meds: mucosal protecting agent

Answer 4

duodenal ulcer

- carafe syrup

Question 5

GI meds: antidiarrheals

Answer 5

lomotil, loperamide
* not for acute episodes d/t most likely infectious etiology. Let patient’s body purge. Antidiarrheals would just prolong the illness

Question 6

GI meds: ABX & antimicrobials

Answer 6

• diverticulitis

Question 7

Probiotics

Answer 7

Gut flora

- lactobacillus

Question 8

GI red flags: malignancy

Answer 8

• orthostatic hypotension
• weight loss
• age over 50
• early satiety
• palpable mass
• fever
• smoker or hx of smoking
• hx of ETOH use

Question 9

GI red flags: cont.

Answer 9

• Iron deficiency anemia
• new onset pain
• change in bowel habits
• fecal incontinence
• melena/coffee ground emesis
• guiac positive stools
• dysphagia
• odynophagia
• long-term NSAID use
• persistent hoarseness
• Chest pain
• failure to improve with tx
• pain out of proportion to exam
• abdominal distention (obstruction)
• increase LFT/jaundice (blockage within bile system)
• abnormal physical exam

Question 10

How to assess for peritoneal irritation

Answer 10

• obturator and psoas

ask to jump up and down

Question 11

GI dx studies

Answer 11

• UA + Culture
• Serum studies
• Stool studies
• STI screen, Pap, vaginal cultures

Question 12

GI dx studies:

- UA + Culture

Answer 12

• r/o pregnancy, esp. if imaging needs t be done

Question 13

GI dx studies:

-Serum studies

Answer 13

CBC, CMP, Sed Rate, CRP, Thyroid

Question 14

GI dx studies:

- Stool studies

Answer 14

Ova&parasite, blood, WBC culture, pH, fecal fat collection if concerned for malabsorption

Question 15

GI dx studies:

- STI screen, Pap, vaginal cultures

Answer 15

gonn/chlam

Question 16

GI disorders indicated for ultrasound

Answer 16

(low dose radiation)

appendicitis, cholecystitis, pyloric stenosis, intussusception

Question 17

GI disorders indicated for CT

Answer 17

(exposure to radiation)

• pancreatitis
• intraabdominal mass

Question 18

Specialized Studies:
duodenal aspirate - 
esophageal pH - 
capsule endoscopy 
breath hydrogen test -
sweat chloride test-

Answer 18

duodenal aspirate - active infection
esophageal pH - rule in GERD pH < 4
breath hydrogen test - lactose intolerance
sweat chloride test- CF

Question 19

Upper GI disorders

Answer 19

dysphagia, vomiting and dehydration, pyloric stenosis, PUD, abdominal pain

Question 20

Lower GI Disorders

Answer 20

infantile colic, foreign body ingestion, appendicitis, intussusception, anal fissure,
FTT, acute diarrhea, intestinal parasites

Question 21

Pyloric Stenosis patho & presentation

Answer 21

hypertrophy of pyloric muscle

• non bilious projectile vomiting by 2-3 weeks of life
• insatiable appetite

Question 22

Pyloric Stenosis at risk

Answer 22

first born male infants

Question 23

Pyloric Stenosis: initial work up

Answer 23

infant with nonbiloius projectile vomiting, no weight gain

• ultrasound
• refer to GI (surgical)

Question 24

Peptic ulcer disease patho & presentation

Answer 24

ulceration of the gastric lining a/o duodenum

• epigastric pain/dyspepsia 2-5 hours after eating/worse at bedtime/alleviated by ingestion of food
• alleviated by food/antacids

Question 25

Peptic ulcer disease: potential for perforated peptic ulcer

Answer 25

more common in duodenal ulcers | abrupt severe abdominal pain a/w peritonitis

Question 26

Peptic ulcer disease causes

Answer 26

H. Pylori - most common cause | - transmitted fecal-oral route in childhood - remains in stomach/duodenum for decades

Question 27

PUD H. pylori testing

Answer 27

- ALL pts with documented ulcers need H. pylori testing via biopsy - ALL its being treated presumptively for H. pylori need testing via ELISA - Elisa IgG, urea breath test, or stool antigen test: need to be off PPI for 2 weeks prior to tes; test for cure (4 weeks after treatment) = urea breath or stool antigen

Question 28

PUD: H. pylori Tx

Answer 28

PPI + ABX (amoxicillin + clarithromycin) - recurrent/resistant = bismuth + tetracycline + PPI - stop NSAID use, smoking cessation

Question 29

PUD NSAID Use

Answer 29

- suppresses mucosal barrier - /c use + PPI (for at least 1 year) - cause use sucralfate and misoprostol (active ulcer maintenance)

Question 30

PUD Dx

Answer 30

< 55 y.o. with classic symptoms - can treat with out EGD (endoscopy)

Question 31

Red flag GI: Dx testing

Answer 31

``` EGD if red flag sx: > 55 y.o. not responding to empiric tx return of sx chronic NSAID use (assess for bleeding) Barium radiography in its who are not eligible for EGD ```

Question 32

Repeat endoscopy for complicated/uncomplicated gastric ulcers _____ weeks after tx

Answer 32

8 weeks | - uncomplicated: no repeated EGD