Gastro intestinal disorders Flashcards
Adult patient complains of the acute onset of fever, nausea, and vomiting that is associated with rapid onset of abdominal pain that radiates to the mid back will get it in the epigastric region. Abdominal exam reveals guarding and tenderness over the epigastric area or the upper abdomen
Acute pancreatitis
Abdominal exam reveals a positive Cullen’s sign And gray turner sign.
Acute pancreatitis
Blue discoloration around umbilicus
Positive Cullen’s sign (acute pancreatitis)
Blue discoloration on the flanks
Gray turners sign (acute pancreatitis)
Elderly patient with acute onset of high fever, anorexia, nausea/vomiting, and left lower quadrant abdominal pain
Acute diverticulitis
Rebound tenderness, positive Rovsing’s sign, board like abdomen are all signs of
Acute abdomen
If a CBC shows a presence of band forms what does that mean
Severe bacterial infection as bands are immature neutrophils
A young adult complains of an Acute onset of Periumbilical pain that is steadily getting worse. Overtime the pain starts to localize at McBurney’s point the patient has no appetite
Acute appendicitis
Pain at McBurney’s point is indicative of
Acute appendicitis
Overweight female complains of severe right upper quadrant or epigastric pain that occurs within one hour of eating a fatty meal. Pain may radiate to the upper shoulder. Accompanied by nausea/vomiting and anorexia.
Acute cholecystitis
Right upper quadrant
Gallbladder
Left lower quadrant
Diverticulitis
A gastrinoma located on the pancreas or the stomach that secretes gastrin, stimulates high levels of acid production in the stomach. The end result is a development of multiple and severe ulcers in the stomach and Duodenum. Complains of epigastric to mid abdominal pain and stools may be a Tarry color
Zollinger-Ellison Syndrome
How do you screen for Zollinger-Ellison syndrome
Serum fasting gastrin level
Right lower quadrant intermittent abdominal pain. Lower abdominal pain one hour after eating. Diarrhea with mucus. Fever, malaise, and mild weight loss. Abnormal liquid stools. High-risk for colon cancer
Crohn’s disease
Right lower quadrant
ApPendix
This maneuver is used for acute appendicitis. Flex hip 90° and ask patient to push against resistance and straighten the leg
Psoas/Illiopsoas
Used for acute appendicitis. Rotate right hip through full range of motion. Positive sign if pain with the movement or flexion of the hip
Obturator sign
Deep palpation of the lower left quadrant of the abdomen results in referred pain to the right lower quadrant
Rovsing’s sign
Area located between the superior iliac crest and amble I guess in the right lower quadrant. Tenderness or pain is a sign of possible acute appendicitis
McBurney’s point
Instructed patient to raise heels, and then drop them suddenly. And alternative is to ask the patient to jump in place. Positive if pain is elicited or if patient refuses to perform because of the pain
Markel test
With abdominal palpation, the abdominal muscles reflexively become tense or boardlike
Involuntary guarding
Patient complains that the abdominal pain is worse when the palpating hand is released compared to the pain felt during deep palpation
Rebound tenderness
Press deeply on the upper right quadrant under the coastal border During inspiration. Mid inspiratory arrest is a positive sign
Murphy’s maneuver or Murphy’s sign
What is located in the right upper quadrant
Gallbladder
What is located in the right lower quadrant
Appendix
Left upper quadrant pain equals
Gastritis or pancreatitis
If a patient presents with cholecystitis, right lower lobe pneumonia, or acute hepatitis what area of the stomach would be involved
Right upper quadrant
Patient presents with appendicitis, ovarian cyst, diverticulitis, endometriosis, urethral calculi what part of stomach will be involved
Right lower quadrant
Patient presents with diverticulitis what part of the stomach will be involved
Left lower quadrant
The patient presents with gastritis, pancreatitis, MI, left lower lobe pneumonia what part of the stomach will be involved
Left upper quadrant
Chronic GERD causes damage to squamous epithelium of the esophagus and may result in what disorder which is a pre-cancer and increases the risk of cancer of the esophagus
Barrett’s esophagus
Feeling of a lump in the throat
Clovis
Heartburn, dysphagia, hoarseness, chest pain, nausea, excessive salivation, and feeling of lump in throat are all symptoms of
Pathologic GERD
What position should a person be in after eating if they have Gerd
Patient must remain up right after eating meals
A premalignant lesion of the esophagus that is secondary to Gerd is termed
Barrett’s Esophagus
What are some lifestyle modifications for patients with Gerd
Avoid recumbence after eating, elevate head of bed when sleeping, reduce size of meals, reduce amount of fat, acid, spices, caffeine, sweets, peppermint, chocolate, and alcohol, and smoking cessation
What medication can be taken for mild Gerd symptoms
Antacid
What medication for Gerd provides relief for about 30 minutes and is the quickest but short-lived
Antacid
What medication decreases acid production and provides relief for 6-12 hours, but takes 60-120 minutes to provide relief
H2 agonists
Cimetidine (Tagamet), Ranitidine (Zantac), Famotidine (Pepcid), and Nizatidine (Axid) are all
H2 antagonist
What type of medication reduces gastric secretion and should be taken for four to eight weeks
Proton pump inhibitor’s
Prazole suffix is for
Proton pump inhibitor’s
When is referral to gastroenterologist recommended for Gerd
Symptoms persist for four weeks of b.i.d. PPI use, in conjunction with weight loss, in conjunction with anemia, in conjunction with difficulty swallowing, in conjunction with epigastric mass, and in conjunction with recurrent vomiting
Common long time complication of Gerd might be
Barrett’s esophagus
How is Barrett’s Esophagus diagnosed
Upper endoscopy with biopsy
Can a patient with Gerd have mints or caffeine
No
If a patient presents with severe mid epigastric pain that radiates to the mid back what does this indicate
Acute pancreatitis
If a patient has a positive psoas and obturator sign, then they have
Acute appendicitis
Any patient with at least a decade or more history of chronic heartburn should be referred to a gastroenterologist for an endoscopy to rule out
Barrett’s Esophagus
Young adult complains of intermittent episodes of moderate to severe cramping pain in the lower abdomen, especially on the left lower quadrant. Bloating with flatulence. Relief obtained after defecation. Stools range from diarrhea to constipation or both types with increased frequency of bowel movements.
Irritable bowel syndrome
Tenderness in the lower quadrants during an abdominal exam during an exacerbation. Otherwise the exam is normal. Rectal exam is normal with no blood or puss. Heme-negative stool’s.
Irritable bowel syndrome
How do you treat irritable bowel syndrome
Increase dietary fiber. Supplement fiber with Metamucil. Anti-spasmodic’s(Bentyl) as needed. Decrease life stress.
Which also is more common duodenal or gastric
Duodenal
What bacteria is a common cause for both duodenal and gastric ulcers
H pylori
What type of drug taken chronically can cause peptic ulcers
NSAID and bisphosphonates such as Fosamax and Actonel
Middle aged adult complains of epigastric episodic pain, burning/gnawing pain, or AChe. Pain relieved by food and or antacids with recurrence 2 to 4 hours after a meal. Self-medicating with over-the-counter ant acid’s. Maybe taking NSAIDs or aspirin.
Peptic ulcer disease
What labs are indicated for peptic ulcer disease
CBC for anemia, fecal occult blood testing. If positive referral to gastroenterologist
How do you treat H pylori negative ulcers
Combine lifestyle changes with PPI’s or H2 blocker’s. Use PPIs or H2-blockers for 4 to 8 weeks.
How do you treat H pylori positive ulcers
Triple therapy with clarithromycin i.e. Biaxin b.i.d. plus amoxicillin 1 g b.i.d. for 14 days plus ppi b.i.d. for 6 to 8 weeks to allow also to heal
What is quadruple therapy for H pylori positive ulcers? This is the preferred treatment 💪🏽
Bismuth subsalicylate tab 600 mg four times a day plus Flagyl 250 mg QID plus tetracycline 500 mg QID for two weeks plus PPI daily for 4 to 6 weeks after or longer
The serology (tigers) for h. Pylori will show
IGg levels elevated plus signs of PUD. Treat with antibiotics plus PPI.
How do you treat irritable bowel syndrome
Increase fiber intake
Elderly patient presents with acute onset of fever with left lower quadrant abdominal pain with anorexia, nausea, vomiting. Abdominal palpation reveals tenderness on the left lower quadrant and hematochezia and anemia if hemorrhaging
Diverticulitis
What is hematochezia
Bloody stool
What are the labs for diverticulitis
CBC with leukocytosis, neutrophilia greater than 70% and shift to the left. The presence of Band forms. Refer to ED.
What is the treatment plan for diverticulitis
Ciprofloxacin 500 mg b.i.d. plus flagyl 500 mg TID for 10 to 14 days. Close follow up. If no response in 48 to 72 hours or worsens refer to ED
What is the treatment for diverticulosis
High-fiber diet with fiber supplement such as Metamucil. Avoidance of nuts and seeds is not necessary.
Acute inflammation of the pancreas secondary to many factors such as alcohol abuse, gallstones, elevated triglyceride levels, infections.
Acute pancreatitis
Elevated triglycerides greater than 800 mg are at very high risk for
Acute pancreatitis
Adult patient complains of the acute onset of fever, nausea, and vomiting that is associated with rapid onset of abdominal pain that radiates to the mid back located in the epigastric region. Abdominal exam reveals guarding and tenderness over the epigastric area or the upper abdomen. Positive Collins and great Turner’s sign. May have alias signs and symptoms of shock refer patient to ED
Acute pancreatitis
Hypo active bowel sounds
Ileus
What are the labs for acute pancreatitis
Elevated pancreatic enzymes such as serum amylase, lipase, and trypsin . Elevated AST, ALT, GGT, Bilirubin , Leukocytosis, Patient needs abdominal ultrasound and computed tomography.
Can acute pancreatitis cause diabetes
Yes
What are the labs for Clostridium difficile colitis
CBC with leukocytosis, stool assay for C. Dificil toxins.
What is the treatment for C. difficle
Flagyl TID for 10 to 14 days. Avoid opiates because they can worsen or prolong the disorder. Increase fluid intake and eat food as tolerated
What are some extra intestinal manifestations of Inflammatory bowel disease
Arthritis, rashes, eyes (uveitis, iritis)
If a stool specimen is positive for leukocytes i.e. white blood cells this may be associated with
Infection, inflammation, salmonella infection, Crohn’s disease, ulcerative colitis
At what age is colorectal cancer screening via colonoscopy recommended (gold standard)
50 or older
How long does it take for a polyp to turn to cancer
10 years
If using guaiac based fecal occult blood test for colorectal screening how often should it be used
Annually with three specimens
If using fecal immunochemical tests for colorectal cancer screening for how often should it be used
Annually with a single specimen. More sensitive than FOBT
If using stool FIT DNA i.e. Colo guard for Colorectal cancer screening how often should it be used
1 to 3 years
How often should a flexible sigmoidoscopy be used
Every five years
What lab measures the integrity of the liver
ALT/AST
What lab measures sympathetic activity of the liver
PT/albumin
What lab measures excretory function of the liver
Billirubin and ALP
If there is an elevation in AST/ALT, that means
Loss of liver cells
If there is an elevation in alkaline phosphate that means
Bone or liver problems
A pregnant patient is found to have elevated alkaline phosphatase level. Is the etiology likely to be pathological?
No. This is an expected finding
And adolescent is found to have elevated alkaline phosphatase level. Is the etiology likely to be pathological?
No. This is an expected finding due to growing
What is the differential diagnosis for elevated ALT/AST?
Infectious, metabolic, alcohol or hepatotoxicity drug use, Automimmune liver disease, hereditary liver disease
If the ALT is greater than the AST what is the likely cause
Viral hepatitis. think the L in ALT stands for liver
If the AST is greater than eight ALT what is the likely cause?
Alcohol, drugs, liver disease. Think a as in acetaminophen, S as in statins and T as in tequila
If the AST to ALT ratio is greater than two, what is the likely cause?
Alcoholic liver disease is extremely likely
If the AST to ALT ratio is greater than one what is the likely cause?
Consider alcohol, liver disease
If the AST to ALT ratio is greater is less than one what is the likely cause?
Fatty liver disease
Liver infiltrated by FAT. Number one reason for liver transplant in the United States and can progress to cirrhosis
Nonalcoholic fatty liver disease
In viral hepatitis is the ALT greater or less than the AST
Greater
What types of hepatitis can cause chronic infections
B, C, and D
Which immunoglobulin for hepatitis markers is the first one to be produced during an acute infection i.e. a cute infection
IgM
M=minute
Which immunoglobulin for hepatitis is produced when the infection is gone
IGG
G=gone
(+) anti-HAV IgG
Immune
(+) anti-HAV IgM
Acute infection
(-) anti-HAV IgM & (-) IgG
No immunity, needs immunization
HBsAg
Hep B surface antigen
Antigen=infection
anti-HBs
Hepatitis B surface antibody
Antibody=immunity
anti-HBc
Totally hepatitis B core antibody
Core= rotten to the core
Patient has it now, or in the past
Indicates current or previous infection
IgM anti-HBc
IgM antibody to hep B antigen
Acute hep b in less than or equal to 6 months
HBsAg -
anti-HBc -
anti-HBs -
Susceptible
Needs immunization
HBsAg -
anti-HBc +
anti-HBs +
Immune due to natural infection
HBsAg -
anti-HBc -
anti-HBs +
Immune due to hepatitis b vaccine
HBsAg +
anti-HBc +
IgM anti-HBc +
anti-HBs -
Acutely infected
HBsAg +
anti-HBc +
IgM anti-HBc -
anti-HBs -
Chronically infected
- HBsAg
- anti-HBs
- anti-HBc
No immunity, no infection. Needs immunization
- HBsAg
+ anti-HBs - anti-HBc
Immunity secondary to immunization
+ HBsAg
- IgM anti-HBc
+ anti-HBc
- anti-HBs
Chronic hep b
- HBsAg
+ anti-HBs
+ anti-HBc
Immune secondary to infection
+ HBsAg
- anti-HBs
+ IgM anti-HBc
+ anti-HBc
Acute infection
What lab do you order for hepatitis C
Anti-HCV
If the patient was exposed with in the last six months to hepatitis C what other lab needs to be ordered
HCV RNA
How long does it take for anti-HCV to become positive after exposure
Eight weeks
If an anti-– HCV test is positive what is the confirmatory test
HCV RNA
If a patient has hepatitis can they take Lipitor
No
If a patient has hepatitis what is their treatment plan
Referred to G.I.
What are lifestyle modifications for hepatitis
Abstinence from alcohol, avoiding large doses of acetaminophen, iron, and drugs metabolized by the liver. Also blood precautions for patients with hepatitis B and C
Left lower quadrant pain with fever
Diverticulitis
What is the definitive test for diverticulitis and how is it treated
CT scan and it is treated with Ciproflioxicin nd Flagyl
Adult with positive McBurney’s point
Appendicitis
What is the definitive test for appendicitis
CT scan
Pain in the upper right quadrant
Cholecystitis
What is the initial test for cholecystitis and if it is inconclusive what is the next test
Ultrasound and then if inconclusive hida scan
Abdominal pain associated with a dilated loops of bowel
Bowel obstruction
What is the initial test for bowel obstruction
Flats and erect of abdomen that will show Ileus
Absent bowel sounds
Ileus
What is the initial test for Ileus
Flat and erect of abdomen
Adults with acute Periumbilical pain
Appendicitis
Elevated Bilirubin level, other LFTs normal
Gilberts disease
Inspiratory arrest with deep palpation on the right upper quadrant
Cholecystitis
+ Murphy’s sign
Elevated triglyceride levels and acute abdominal pain
Pancreatitis
What is the serum test for pancreatitis
Amylase and lipase
Painless bleeding with bowel movements
Colorectal cancer
Painful bleeding with bowel movements
Anal Fissure, hemorrhoids, ulcerative colitis
Tinkling bowel sounds accompanied by abdominal pain
Bowel obstruction
What is the definitive test for towel obstruction
Flat and erect of abdomen
Adults with acute pain in the left upper quadrant for the past 60 minutes
MI
What is the initial test for an MI
EKG
Which medication may worsen the symptoms of Gerd
Calcium channel blocker such as amlodipine
What type of Gerd medication increases the risk of fractures
Ppi
If a patient presents with diarrhea and a CBC demonstrates anemia and an increase in the sedimentation rate and CRP what is the most likely cause
Inflammatory bowel disease
Nocturnal diarrhea with blood
Inflammatory bowel disease such as ulcerative colitis or Crohn’s disease
What hereditary liver disease demonstrates copper in the liver
Wilson’s disease
Excessive alcohol consumption may cause these two diseases
Hepatitis or pancreatitis
Positive Murphy’s sign
Cholecystitis
Imaging study of choice is CT scan of lower abdomen for these two diseases
Diverticulitis and appendicitis
What is the imaging study of choice for children with appendicitis
Ultrasound
Which hepatitis is transmitted via sexual, blood, blood products, or organs
Hepatitis B
Which type of hepatitis is transmitted via intravenous drug use that 50%, blood or blood products, sexual intercourse
Hepatitis C
Sexually Active adult complains of a new onset of fatigue, nausea, and dark colored urine for several days. New sexual partner in less than three months
Acute hepatitis
What type of hepatitis has the highest risk of cirrhosis and liver cancer
Hepatitis C
A lone elevation in the GGT is a sensitive indicator of
Possible alcoholism
Is alkaline phosphatase normally elevated during the teen years
Yes
In order for a person to become infected with hepatitis C what must that person have
Hepatitis B
Is the ALT or AST more sensitive to liver damage
ALT
Does Metformin cause constipation
No
What medication could be used to increase appetite in an anorexic patient
Megestrol
Muscle mass that is lost due to aging is called
Sarcopenia
The three most common causes of bacterial diarrhea in the US are
Salmonella, Campylobacter, and Shigella
How often should a patient with ulcerative colitis have colonoscopies
Every 1 to 5 years
How many hours after eating do duodenal ulcer symptoms show
2 to 5 hours
The most common place for indirect inguinal hernia’s to develop is
The internal inguinal ring
What is a major symptom of GERD
Pyrosis (heartburn)
How soon would a C. Difficile enzyme immunoassay yield results?
About 24 hours
Bright red blood in the stools is characteristic of
Cancer of the sigmoid colon
Is an inguinal hernia nodular, silky, firm, or bumpy
Silky
If a patient is on a Statin and calcium channel blocker and drinks grapefruit juice, what happens
Elevated liver enzyme’s
The most common reason that older adults develop peptic ulcer disease
H. Pylori infection
An 85-year-old adults has chronic constipation. How should this be managed initially
Avoid all constipating medication and foods when possible
What type of reflux rarely occurs At night time
Physiologic reflux
What would be a common finding in a patient with biliary colic
Pain in upper abdomen in response to eating fatty foods
A syndrome of underlying illness that is accompanied by loss of muscle mass
Cachexia
What syndrome is associated with Biliary atresia in an infant
Acholic stools (clay colored stools)
What type of hernia would present as a small midline protrusion through a defect in the linea alba
Epigastric hernia
When performing a rectal exam what is the best position to put the patient in
Lateral decubitus or left side lying position
Bowel sounds may be increased in the presence of
Early intestinal obstruction
Inspiratory arrest with deep palpation of the upper right quadrant is
A positive Murphy’s sign
What are signs and symptoms associated with diabetic gastroparesis
Vomiting of undigested food, weight loss, erratic glucose levels, and Gerd
A feeling of constantly needing to pass stool is termed
Tenesmus
When performing a rectal exam a purulent bloody discharge mixed with fecal matter is oozing from the rectum. This finding is consistent with
Anorectal fistula
Stools that a pencil like in shape or more likely
An early side of colon cancer
When performing a digital rectal exam a soft pedunculated lesion is palpated. This finding is most likely
Rectal polyp
If abdominal pain persists when the patient raises his head and shoulders the origin of the tenderness is probably
In the abdominal wall
A patient presents with complaints of black tarry stool for the last week. This symptom is seen in conditions related to
Ascending colon
An enlarged liver with a firm nontender edge maybe suggestive of
Cirrhosis
Where are the patient would you palpate the liver
Approximately 3 cm below the right coastal region in the midclavicular line
When performing a rectal exam a reddish moist protruding mass is noted At the anal opening. This finding is most likely
A prolapsed internal hemorrhoid
What is the definitive test for Hirschsprung’s disease
Rectal biopsy
When percussing an abdomen and tympany is audible what can this suggest
Intestinal obstruction, increased gas production, or paralytic ileus
Deep palpation of the abdomen requires what part of the fingers
Palmar surfaces of the fingers
What assessment finding is the result of the presence of a stone in the common bile duct
Jaundice
An enlarged liver with a smooth tender edge may suggest
Right-sided heart failure
Indicators of Oropharyngeal dysphagia include
Drawling, nasopharyngeal regurgitation, and cough from aspiration
On examination of the abdomen, loud rumbling noises are audible without a stethoscope. These sounds are termed
Borborygmus
When performing a rectal exam if the anal sphincter presents with laxity consider
A neurologic disease
A patient complains of an unpleasant abdominal fullness after a light meal. This complaint may be consistent with
Diabetic gastroparesis
Peritoneal inflammation produces abdominal pain and tenderness. What technique can be used to assess a tender abdomen suspected to be secondary to peritoneal inflammation
Ask the patient to cough prior to palpation
Bowel sounds may be decreased in the presence of
Peritonitis
Helminths can be transmitted by
The bite of a blood sucking insect
What symptom is seen in infants with pyloric stenosis
Visible peristalsis
Acholic stools are associated with
Obstructive jaundice
Chronic intake of NSAIDs can cause what disorder
Gastritis
Referred pain to the opposite side of the abdomen after release of palpation
Rovsing’s sign
What is not a symptom of irritable bowel syndrome
Weight loss
A 70-year-old patient presents with left lower quadrant abdominal pain, a markedly tender palpable abdominal wall, fever, and leukocytosis. Of the following terms which correctly describes the suspected condition
Diverticulitis
Is alkaline phosphatase usually elevated in nephrotic syndrome?
No
A patient who has been prescribed Imodium for symptoms of IBS should be advised to seek immediate medical assistance if he experiences
Vomiting
The patient reports to the nurse practitioner that he was diagnosed with hepatitis B one year ago and has not been seen by a healthcare provider since then. What information shared this patient be given
About 10% of affected persons become carriers, and are at increased risk for hepatocellular carcinoma
What other conditions can present similarly to acute cholecystitis
GER, angina and PUD
An eight-year-old female has been brought to the nurse practitioner on five occasions in the past nine weeks with a complaint of abdominal pain. The evaluation each time is negative, but her mother is convinced that the child is truly experiencing pain. The most likely diagnosis is
Recurrent abdominal pain which is defined as at least three episodes of abdominal pain over a three-month period.
What type of medication is recommended for short term uncomplicated peptic ulcer disease
Misoprostol (cytotec)
