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AGACNP > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

What is cause of peptic ulcer disease?

A

90% of the time H. pylori is detected if duodenal ulcers, 75% it is detected with gastric ulcers

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2
Q

what are risk factors for peptic ulcer disease?

A

chronic use of NSAIDs, aspirin, glucocorticoids
smokers > 1/2 PPD
high stress

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3
Q

what are signs of acute abdomen? (perforation from various causes such as ulcer perforation)

A

severe pain, board like abdomen, quiet bowel sounds, rigidity

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4
Q

what is standard outpatient management of peptic ulcer disease?

A

H2 receptor blockers/ antagonists- famotidine daily
or
PPI- pantoprazole, omeprazole, lansoprazole- 30 minutes before meals

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5
Q

what is black box warning for PPIs?

A

increase osteoporosis with long term PPI use- not recommended

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6
Q

what is standard outpatient treatment for H. pylori erradication?

A

Quadruple therapy: 2 antibiotics + PPI +/- bismuth (pepo bismol) for 10-14 days.

Antibiotic considerations:
Triple therapy (first treatment regimen, however contraindicated if PCN allergy or previous exposure to macrolide, because of antibiotic resistance) PPI + clarithromycin + amoxicillin
Latest quadruple therapy: PPI + bismuth + metronidazole and tetracycline

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7
Q

What is effect of bismuth subsalicylate (pepto-bismol) on H. pylori?

A

direct antibacterial action against H. pylori

promotes prostaglandin production/ stimulates gastric bicarbonate

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8
Q

What are anti-ulcer pharmacotherapeutic recommendations? mucusal protective therapy?

A 
PPI- can be given for several weeks, but not recommended for longterm use
H2 blockers 6-8 weeks
Sucralfate (Carafate) - requires acidic environment, so avoid antacids and H2 blockers- associated with decreases in nosocomial pneumonia
Bismuth subsalicylate (pepto bismol)- antibacterial against H. pylori, promotes prostaglandin production/ stimualtes gastric bicarbonate (antacid effect)
Antacids (maalox)- do no reduce the amount of gastric acidity- neutralizes but not treating problem of too much gastric acid- that's what PPI does
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9
Q

how to detect GI ulcers bleeding/ perforated? what is treatment?

A

upright films shows free air most cases- air under diaphragm
tx: NG tube for lavage. bleeding stops spontaneously in 80% of cases
IV H2 blocker (famotidine)

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10
Q

Hepatitis A

A

oral-fecal transmission
Outbreaks: contaminated water and food, sexual contact
infectious blood/ stool for 2-6 week incubation period
acute illness, low mortality rate

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11
Q

hepatitis B

A

blood borne DNA virus- serum, saliva, semen and vaginal secretion transmission-
blood transfusions, sexual activity, mother-fetus

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12
Q

hepatitis C

A

blood borne RNA virus
blood transfusion, and 50% of cases r/t IV drug use
s/s fatigue, anorexia, n/v,
icteric involvement: weight loss, jaundice, RUQ pain, clay colored stool, dark urine, fever, hepatosplenomegaly.

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13
Q

hepatitis C diagnostics

A

ua: proteinuria, bilirubinuria
elevated LFTs: AST/ ALT
slightly elevated: LDH, bilirubin, alk phos, PT

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14
Q

Hepatitis A serology

A

** presence of antibody: Anti-HAV + immunoglobulins to indicated time frame of infection
acute illness: 1-3 months: anti-HAV (antibody) and IgM
chronic/ immunity: IgG and anti-HAV- exposed, immune,

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15
Q

hepatitis B serology

A

active Hep B: HBsAg (surface antigen), HBeAg (protein from core), Anti-HBc (antibody to core antigen), IgM
Chronic Hep B: HBsAg, Anti-HBc (antibody to core), Anti-HBe (antibody to protein), IgM, IgG (chronic)
Recovered: Anti-HBc (antibody to core), Anti-HBs (surface antibody indicates recovery)

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16
Q

Hepatitis C serology

A

Acute: Anti-HCV, HCV RNA
Chronic: Anti HCV, HCV RNA

PCR needed to differentiate prior exposure to current acute viral infection

17
Q

management of Hep C

A 
increase fluids
avoid liver toxic substances
no/ low protein diet
lactulose for elevated ammonia levels
antiviral drugs
18
Q

LLQ pain…. think…

A

diverticulitis- inflamation or localized performation of diverticula with abscess formation - extraluminal inflammation- seen on CT, not colonoscopy

19
Q

Labs/ diagnostics for diverticulitis

A

elevated ESR- inflammation
signmoidoscopy- inflammed mucosa
CT- evaluate abscess
abd film- evaluate free air- pneumoperitoneum= peritonitis- perf bowl- needs ex lap

20
Q

cholecystitis causes

A

most frequently caused by gallstones

post-prandial epigastric pain

21
Q

Murphy’s sign

A

indicates colecystitis
deep pain on inspiration while fingers placed under right rib cage
RUQ tenderness to palpation

22
Q

cholecystitis labs

A

High - serum bilirubin, serum ALT, AST, LDH, alk phos

23
Q

cholecystitis imaging

A

ultrasound- gold standard
plain films can show radiopaque gallstones
HIDA scan- can show gall bladder functioning

24
Q

what is ERCP?

A

ERCP: used to diagnose disease of gallbladder- bile system, pancreas and liver (endoscopic retrograde cholangiopancreatography

25
Q

pancreatitis

A

pain is worse when lying down, improved when sitting and leaning forward
tender to palpation, no guarding, rigidity
absent bowel sounds (paralytic ileus)

26
Q

Grey Turner’s sign

A

hemorrhagic pancreatitis-flank discoloration

27
Q

Cullen’s sign

A

“U”mbillical discoloration - hemorrhagic pancreatitis

28
Q

pancreatitis labs

A

serum amylase
lipase- elevated in 90% of cases- higher specificity for pancreatitis
elevated C-reactive protein- suggests pancreatic necrosis

**CT scan abdomen preferred imaging

29
Q

Ranson’s criteria

A 
evaluate prognosis of pancreatitis- risk factors
GWGLAHBCABE: George Washington Got Lazy After He Broke CABE
at admission: 
-Greater than 55 years of age
-WBC > 16000
-Glucose> 200
-LDH > 350
AST> 250
1st 48 hours
Hct drop > 10
BUN > 5 increase
Calcium < 8
Arterial O2 < 60
Base deficit > 4
Estimated fluid sequestration > 6L
30
Q

pancreatitis management

A

bed rest, NPO, IV fluids, NG suction, pain control, clear diet if pain free and bowel sounds present

31
Q

proximal vs distal bowel obstruction

A

proximal: vomiting closely timed with pain, minimal abdominal distention
distal: vomiting delayed response to pain (hours later), pronounced abdominal distension

32
Q

ulcerative colitis vs. Crohn’s disease

A

UC: idiopathic inflammatory condition- diffuse mucosal inflammation of colon; rectum and large bowel- episodic illness, ** bloody diarrhea, toxic megacolon risk
Crohn’s- upper bowel malabsorption syndrome

33
Q

Psoas sign (Iliopsoas Test0

A

pain with R thigh extension… appendicitis

RLQ pain

34
Q

Obturator sign

A

pain with internal rotation of flexed right thigh

appendicitis test

35
Q

Positive Rovsing’s sign

A

RLQ pain when pressure applied to LLQ (referred pain)

36
Q

what to consider if elderly patient is constipated ?

A

this is abnormal:
lack of fiber, decreased exercise, poor dentition, hx of laxative abuse, impaired mental status
common among parkinson’s patients

AGACNP (19 decks)

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