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NR511 - Differential Diagnosis > Final Exam - GI conditions > Flashcards

Final Exam - GI conditions Flashcards

1
Q

Ulcerative colitis affects what part of the GI tract?

A

Colon only

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2
Q

What is ulcerative colitis?

A

Inflammatory bowel disease-the mucosal surface of the colon is inflamed-most often occurs in the rectosigmoid areas, but may involve the entire colon

Results in friability, erosions, and bleeding

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3
Q

Symptoms of ulcerative colitis

A

Bloody, purulent diarrhea

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4
Q

What treatment can completely resolve ulcerative colitis?

A

Total surgical colectomy

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5
Q

Symptoms of diverticulitis

A

Bleeding not associated with pain or discomfort

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6
Q

What patients are at higher risk for diverticulitis?

A

Obese patients

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7
Q

Signs of inflamed diverticula

A

Normal signs and symptoms of infection
- fever
- chills
- tachycardia

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8
Q

How do patients with diverticulitis present?

A
  • LLQ pain and tenderness
  • anorexia
  • nausea
  • vomiting
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9
Q

Diagnosing diverticulitis

A

CT with contrast to rule out gyn problems (ovarian cyst or tumor) and bowel pathology like abscess

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10
Q

Management for diverticulitis

A

High fiber diet

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11
Q

Clostridium difficile

A

Infection of the large intestine that causes profuse, watery, mucoid diarrhea.

Can be dangerous or life threatening if not treated

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12
Q

C Diff risk factors

A
  • working in healthcare facility
  • long duration hospitalization
  • Long-term use of antibiotics that affects normal GI flora
  • Long-term use of medications that reduce GI acidity
  • consuming contaminated food/water
  • contact with infected soil, objects and surfaces
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13
Q

C Diff symptoms

A
  1. may be asymptomatic
  2. profuse, watery, mucoid diarrhea
  3. Mild to moderate infection
    - Watery diarrhea three or more times/day for two or more days
    - Mild abdominal cramping and tenderness
  4. Severe infection:
    - Watery diarrhea (10-15 stools/day)
    - Strong foul odor
    - Acute abdomen secondary to toxic megacolon with perforation
    - Abdominal distention
    - Fever
    - Nausea/vomiting/dehydration requiring hospitalization
    - Blood/pus in stool (severe cases)
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14
Q

C Diff diagnosis

A
  1. CBC
  2. Enzyme-linked immunodeficiency assay (ELISA): identifies toxins that produce C. diff bacteria
  3. Cell cytotoxicity assay: identifies the effects of bacterial toxins on human cells
  4. Polymerase chain reaction (PCR): detects bacterial genes
  5. Endoscopy: if the patient is unresponsive to treatment; will show pseudomembranes that suggest c-diff infection
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15
Q

C Diff treatment

A
  • Metronidazole
  • Probiotics- to restore the healthy growth of normal GI bacteria
  • Colectomy in severe cases
  • Maintain fluids
  • Clear liquid diet
  • Eat starchy foods to prevent diarrhea
  • Avoid caffeine, spicy foods, milk and greasy foods
  • May require a GI consult
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16
Q

Causes of GERD

A
  1. Lower esophageal sphincter (LES) dysfunction: reduced pressure or improper relaxation allows gastric acid to flow back into the esophagus
  2. Hiatal hernia: contributes to GERD by disrupting the normal barrier between the esophagus and stomach
  3. Esophageal motility disorders: impaired esophageal peristalsis and reduces esophageal clearance can lead to pooling of gastric acid in the esophagus
  4. Acidic acid contents
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17
Q

Symptoms of GERD

A
  1. Regurgitation at night
  2. heartburn (mild to sever)
  3. Dysphagia
  4. regurgitation,
  5. water brash (reflex salivation)
  6. sour taste in the mouth in the morning,
  7. odynophagia (pain with swallow)
  8. belching
  9. coughing,
  10. hoarseness
  11. wheezing, usually at night.
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18
Q

Treatment for GERD

A

6 weeks of omeprazole & diet modifications
- if no improvement of symptoms then endoscopy

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19
Q

Patient education for GERD

A

Avoid coffee, alcohol, chocolate, peppermint, and spicy foods; eat smaller meals; stop smoking; remain upright for 2 hours after meals; elevate the head of the bed on 6- to 8-in blocks; and refrain from eating for 3 hours before retiring.

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20
Q

Aggressive factors for Peptic Ulcer Disease

A
  1. H. pylori
  2. Gastric acid hypersecretion
  3. NSAIDS
  4. Lifestyle factors
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21
Q

Protective factors for Peptic Ulcer Disease

A
  1. Mucus and bicarbonate secretion
  2. Prostaglandins
  3. Mucosal blood flow
  4. Epithelial cell renewal
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22
Q

Peptic ulcer disease hallmark signs

A

a complaint of burning or gnawing (hunger) sensation or pain (dyspepsia) in the epigastrium, which is often relieved by foods or antacids

23
Q

Treatment for peptic ulcer disease

A

Amoxicillin, clarithromycin, and omeprazole for 2 weeks

24
Q

Physical exam findings with peptic ulcer disease

A
  • Tachycardia (associated with IDA)
  • Pale conjunctivae (associated with IDA)
  • Burning epigastric tenderness
  • Severe, generalized abdominal pain
  • Rectal exam (occult blood guiac positive)
25
Q

Risk factors for peptic ulcer disease

A
  1. H. Pylori
  2. NSAID use
  3. Smoking
  4. excessive alcohol use
  5. more common over 60
  6. stress can delay healing
26
Q

Risk factors for GERD

A
  1. Smoking
  2. stress
  3. obesity
  4. hiatal hernia
  5. pregnancy
  6. smoking
  7. certain foods/drinks
  8. medications
27
Q

Physical exam findings for Peptic Ulcer Disease

A
  • Abdominal tenderness (usually epigastric)
  • abdominal distention
  • occult blood in stool
  • guarding or rigidity (severe cases)
  • signs of anemia
28
Q

Physical exam findings for GERD

A
  • burning sensation in chest
  • regurgitation (sensation of acid refluxing in throat/mouth)
  • Odynophagia (pain or discomfort swallowing)
  • hoarseness
  • dental erosion
  • cough (chronic at night or after meals)
29
Q

Rotavirus

A

Viral infection most common in children under three

30
Q

Symptoms of rotavirus

A
  • low-grade fever,
  • loss of appetite,
  • copious watery diarrhea,
  • flatulence,
  • vomiting,
  • stomach cramps.
31
Q

Treatment for rotavirus

A
  • fluids
  • supportive care
  • antiemetics
32
Q

Symptoms of appendicitis

A
  • Constant periumbilical pain shifting to the right lower quadrant; vomiting following the pain; a small volume of diarrhea; may not always vomit
  • pain (dull, sharp, mild or severe); fever, chills, loss of appetite, malaise, diarrhea, nausea or vomiting
33
Q

Most common cause of appendicitis

A

Fecalith - stone made of feces typically found in the colon

34
Q

Labs for appendicitis

A

Mild elevation of the white blood cell count with an early left shift; and white blood cells (WBCs) or red blood cells (RBCs) in the urine are indications of appendicitis.

The WBC count becomes high only with gangrene or perforation of the appendix

35
Q

Obturator sign

A

Used to diagnose appendicitis.

Is elicited when, with the patient’s right hip and knee flexed, the examiner slowly rotates the right leg internally, which stretches the obturator muscle. Pain over the right lower quadrant (RLQ) is considered a positive sign.

36
Q

Treatment for appendicitis

A

Antimicrobial therapy and surgery

37
Q

Gastroenteritis

A

Bacterial or viral intestinal infection that spreads through contact usually fecal-oral.

Inflammation of the stomach and intestine.

38
Q

Symptoms of gastroenteritis

A
  • Watery diarrhea
  • Nausea and vomiting
  • Abdominal pain and cramping
  • Low grade fever, headache
    dehydration
  • anorexia
39
Q

Causes of gastroenteritis

A

Usually infectious: can be caused by bacteria, viruses, parasites, injury to the bowel mucosa, inorganic poisons (sodium nitrate), organic poisons (mushrooms or shellfish), and drugs.

Chronic causes include food allergies and intolerance, stress, and lactase deficiency.

If caused by bacterial toxin then called food poisoning

40
Q

Diagnosing gastroenteritis

A

Stool culture, Check stool for leukocytes, lactoferrin and blood and parasites

41
Q

Differential diagnoses for gastroenteritis

A
  • irritable bowel syndrome
  • IBD
  • ischemic bowel disease (especially in patients with peripheral vascular disease)
  • partial bowel obstruction
  • pelvic abscess
42
Q

H. pylori

A

Type of bacteria that infects your stomach.

It attacks your stomach and the first part of your small intestine (duodenum).

This can cause redness and swelling (inflammation).

Many people with the bacteria won’t have any symptoms.

It can cause open sores called peptic ulcers in your upper digestive tract.

43
Q

Cause of H. pylori

A

Caused by poor hygiene, untreated water

44
Q

Signs and symptoms of H. pylori

A

-ache or burning pain in stomach
- stomach pain worse when empty
-nausea
-loss of appetite
-burping
-bloating
- weight loss

45
Q

Treatment for H. pylori

A

Amoxicillin, clarithromycin and omeprazole for two weeks

46
Q

Causes of diarrhea

A

-acute viral gastroenteritis
IBS, IBD, ingestion of magnesium-containing antacids, lactose intolerance, antibiotic therapy, laxative abuse, and AIDS

47
Q

Differential diagnoses for diarrhea

A

IBS, medications, dietary factors, IBD, and colon cancer.

48
Q

Giardia

A

a protozoan that attaches to the mucosa of the small bowel.

49
Q

Causes of giardia

A

Ingestion of contaminated food or water

50
Q

Treatment for Giardia

A

Oral medications (metronidazole, tinidazole)

Quinacrine hydrochloride (Atabrine) 100 mg three times daily after meals for 5–7 days

OR

Metronidazole (Flagyl) 250 mg three times daily for 5–7 days.

51
Q

Symptoms of salmonella

A
  • Diarrhea
  • Abdominal cramps
  • Fever
  • Nausea
  • Vomiting
  • Headache
  • foul smelling stool
52
Q

Treatment for salmonella

A
  • Fluid replacement to prevent dehydration
  • Antibiotics in severe cases

No treatment is necessary unless associated with fever and systemic disease.

Treatment includes trimethoprim-sulfamethoxazole (Bactrim DS) or a quinoline, norfloxacin 400 mg or ofloxacin 400 mg PO twice daily for 7–10 days.

Stress proper handling of food, thorough cooking, and good hand washing.

53
Q

Symptoms of Giardia

A
  • Diarrhea
  • Abdominal cramps
    -Bloating
    -Gas
    -Nausea
  • Weight loss
54
Q

Cause of salmonella

A

Consumption of contaminated food, especially raw or undercooked poultry, eggs, meat, and dairy products

NR511 - Differential Diagnosis (8 decks)

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