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AANP Study Cards > GI > Flashcards

GI Flashcards

1
Q

The RUQ contains

A

Liver, gallbladder, ascending colon, kidney and pancreas (sm. amt)

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2
Q

The LUQ contains

A

Stomach, pancreas, descending colon, kidney

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3
Q

The RLQ contains

A

Appendix, ileum, cecum, ovary

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4
Q

The LLQ contains

A

sigmoid colon, ovary

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5
Q

What is a + psoas sign

A

RLQ pain is produced when pt raises their right leg against resistance of pressure from the practitioners hand or when they lie on their left side and extend the right leg from the hip

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6
Q

What does a + psoas sign indicate

A

Peritoneal irritation/peritonitis

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7
Q

What is a + obturator sign

A

Inward rotation of the hip causes RLQ pain

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8
Q

What does a + obturator sign suggest

A

Peritonitis

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9
Q

What is a + Rosvigs Sign

A

Deep palpation of the LLQ produces pain in the RLQ

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10
Q

What does a + Rosvigs sign suggest

A

Peritonitis

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11
Q

What is McBurney’s Point

A

the area between the superior iliac crest and umbilicus in the RLQ

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12
Q

What does tenderness at McBurney’s Point suggest?

A

Appendicitis

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13
Q

What is a + Markle’s Jar Test

A

Pt raises heels and drops them suddenly which produces pain, also positive if pt refuses to do this r/t pain

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14
Q

What is rebound tenderness

A

Worsening abdominal pain when hand is released after abdominal palpation compared with pain on deep palpation

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15
Q

What is Murphy’s sign

A

Press deeply on the RUQ under the costal margin during inspiration. Midinspiratory arrest is a + Murphy’s

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16
Q

What does a + Murphy’s sign suggest?

A

Cholecystitis

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17
Q

What is Carnett’s Sign

A

Pt does an abdominal crunch if this worsens pain then the source is the abdominal wall

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18
Q

Sx of Appendicitis

A

Acute onset of periumbilical pain, pain at McBurney’s pint, anorexia, low grade fever, RLQ, rebound tenderness, guarding

+Psosa, obturator, heel jar, Rosvigs, Rebound tenderness

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19
Q

What is the modality of imaging for appendicitis

A

CT

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20
Q

Sx of Cholecystitis

A

RUQ pain or epigastric pain that worsens within 1 hr after a fatty meal, nausea, vomiting and anorexia

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21
Q

What is the imaging modality for cholecystitis

A

Ultrasound

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22
Q

If U/S is inconclusive for cholecystitis what would you order

A

HIDA scan

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23
Q

What condition produces an elevation in bilirubin but normal LFTs

A

Gilbert’s syndrome

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24
Q

What are symptoms of colon cancer

A

Vague GI sx, may have IDA, changes in bowel habits/stools, bloody stools (heme +), dark tarry stools, mass on abdominal palpation

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25
Q

What is the gold standard screening for colorectal cancer?

A

Colonoscopy q10 years

Can also do FIT annually

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26
Q

What are the differences between Crohn’s and Colitis

A

Crohn occurs from mouth to anus, sx depends on affected area (watery diarrhea, bloody diarrhea, fever, anorexia, wt loss, dehydration, fatigue, periumbilical pain, fistuale, perianal disease

UC: Occurs in the colon/rectum
-sx: bloody diarrhea with mucus, cramps, bloating, gas, fever, anorexia, wt loss, fatigue, arthralgias, arthritis, IDA or anemia of chronic disease

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27
Q

Crohn’s and UC increase the risk of:

A

Colon cancer

Toxic Megacolon

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28
Q

What is GERD

A

acidic contents regurgitate from stomach into esophagus related to inappropriate LES relaxation

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29
Q

Food triggers for GERD

A

-chocolate, mints, caffeine, ETOH, carbonated drinks, tomatoes, citrus, fatty foods, spice

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30
Q

Med triggers for GERD

A

CCB, NSAIDs, nitrates, anticholinergics, iron, bisphosphonates, quinidines, theophylline, alpha adrenergic receptor agonists

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31
Q

Sx of GERD

A
  • chronic heartburn
  • associated with fatty or large meals
  • worsens when supine
  • acidic/sour taste in mouth
  • thinning enamel
  • chronic sore throat/cough
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32
Q

What is a complication of GERD

A

Barrett’s esophagus

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33
Q

What is the treatment of GERD

A

First Line: Lifestyle changes avoid large/fat meals, 3-4 hrs pre bedtime, avoid triggers, weight loss, smoking cessation

Pharm:
Antacid
H2 antagonist
PPI

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34
Q

What are longterm risks of PPI use?

A

Risk of osteoprosis, interstital nephritis, low magnesium, C. Diff, decreased iron absorption

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35
Q

When should you refer a patient with GERD

A
  • No relief after 4-8 weeks after PPI use

- Sx associated with weight loss, difficulty swallowing, bleeding

36
Q

C. Diff Diarrhea Risk Factors

A
  • Prior or current antibiotic therapy
  • Advanced age
  • Hospitalization
  • Chemo
37
Q

What Abx are most likely to cause C. Diff

A

-Clindamycin, fluroquinolones, cephalosporin, penicillin

38
Q

What are sx of C. Diff

A

-watery diarrhea, cramps, anorexia, nausea, low grade fever

39
Q

What is the 1st line treatment for C. Diff

A

Vancomycin 125mg PO QID x 10 days

40
Q

What is irritable bowel syndrome

A

A chronic functional disorder of the colon can be diarrhea or constipation dominant

41
Q

What are treatments for IBS

A
  • increase dietary fiber
  • avoid gassy foods (ie. beans, onions, cabbage, high fructose corn syrup)
  • antispasmodics (Dicylomine or hyoscyamine)
  • Decrease anxiety and stress
42
Q

Red Flags Diarrhea

A
  • Bleeding
  • Abdominal pain
  • Weight loss
  • Anemia
  • Elevated inflammatory markers
  • lyte disturbances
43
Q

Risk factors for Colorectal cancer

A
  • any polyps or hx of colorectal cancer
  • IBD
  • Family hx of CRC or polyps
44
Q

What are RED FLAGS in Peptic Ulcer Disease

A
  • Early satiety
  • Anorexia
  • Anemia
  • Recurrent Vomiting
  • Hematemesis
  • Weight loss
45
Q

What are sx of PUD

A
  • recurrent epigastric pain
  • Burning, gnawing ache
  • Pain that is relieved by antacids or food
  • Black tarry stools
  • Blood in stools
  • Coffee ground emesis
  • IDA
46
Q

What labs are indicated in PUD

A
  • CBC
  • FOBT
  • H. Pylori (urea breath test)
  • Upper endoscopy + Biopsy
47
Q

What is the gold standard test for PUD

A

Upper endoscopy and biopsy

48
Q

If a patient has multiple ulcers or are resistant to treatment, what should you test and what are you looking for?

A
  • Gastrin levels

- Zollinger-Ellison Syndrome

49
Q

What is the treatment for a Negative H. Pylori Ulcer

A
  • smoking and ETOH cessation
  • stop NSAIDs
  • Combo lifestyle changes with PPI/H2 antagonist
  • If no response x4-8 weeks refer
50
Q

What is the treatment of a +H. Pylori Ulcer

A
  • Quad Therapy

- Triple Therapy

51
Q

Quad therapy consists of

A
  1. Bismuth 600mg QID
  2. Metronidazole 250mg QID
  3. Tetracycline 500mg QID
  4. PPI standard dose
52
Q

Triple therapy consists of

A
  1. Clarithromycin 500mg BID
  2. Amoxicillin 1g BID or Metronidazole 500mg BID
  3. PPI standard dose
53
Q

What is the difference in pain presentation between a gastric ulcer and a duodenal ulcer

A
  • Gastic ulcers pain recurs shortly post meals

- Duodenal ulcers pain occurs 2-4hrs post meal

54
Q

What are diverticula

A

Small pouch like herniations on the external surface of the colon, secondary to chronic fiber insufficiency

55
Q

What is diverticulitis

A

Infection of diverticula (the small pouch like herniation on the external surface of the colon)

56
Q

What are sx of diverticulitits

A
  • LLQ pain
  • fever
  • If obstruction occurs, may have nausea +/- vomiting +/- ileus
57
Q

What are labs are indicated in suspected diverticulitits

A
  • CBC (will see left shift)

- FOBT (+)

58
Q

What is the gold standard for dx diverticulitis

A

CT

59
Q

What is the outpatient management of diverticulitis

A
  • only outpatient in uncomplicated cases
  • Liquid Diet
  • Amox/Clav or Cipro & Flagyl
60
Q

What is acute pancreatitis

A

Inflammation of the pancreas secondary to:

  • ETOH
  • Elevated triglycerides
  • Gallstones
  • Infections
61
Q

A triglyceride level of ____ will cause a high risk of acute pancreatitis

A

800mg/dL

62
Q

Sx of acute pancreatitis include:

A
  • Fever
  • N/V
  • Abdominal pain with radiation to midback
  • guarding
  • tenderness
  • Cullens
  • Grey-Turner’s Signs
63
Q

What is Cullen’s Sign

A

Bluish discoloration around the umbilicus

64
Q

What is grey turner’s sign

A

Bluish discoloration around the flanks

65
Q

What does IgM mean regarding immunity

A

Think “minute” as in you are recently infected

66
Q

What does IgG mean regarding immunity

A

Thing “gone” as in you have immunity

67
Q

Acute Hep A infection is indicated by:

A

IgM Anti-HAV

68
Q

The presence of Hep A immunity is indicated by the following lab test:

A

IgG Anti- HAV

69
Q

What does a + HBsAg mean

A

The patient has the virus and is currently infected

70
Q

What does a + Anti-HBs mean

A

Patient is immune

71
Q

What does HBeAg mean

A

Chronic Hep B infection

72
Q

What does Anti-Hbc mean

A
  • This appears at onset of Hep B infection and stays for life
  • Can help you see whether immunity is from infection or vaccination
73
Q

What is the screening test for Hep C

A

Anti HCV

74
Q

If the Anti HCV is + what should you order

A

HCV RNA

75
Q

If ALT and AST are elevated but ALT > AST think:

A

L- Liver

Likely hepatitis

76
Q

If ALT and AST are elevated but AST > ALT think:

A

AST- Acetaminophen, statins, tequila aka drugs, statins and ETOH

77
Q

What ration of AST:ALT make ETOH the most likely cause?

A

2

78
Q

An elevation of AST ALT with a ratio of <1 is likely:

A

NAFLD

79
Q

When is an elevation in ALP normal?

A
  • In pregnancy

- Adolescents

80
Q

Where is ALP found

A

Bones and liver

81
Q

What is the gold standard for colorectal cancer screening?

A

Colonoscopy q10 years

82
Q

What is NAFLD

A
  • Hepatic steatosis without 2ndary cause

- Can progress to cirrhosis

83
Q

What abdominal conditions warrant an X-ray

A

Ileus, obstruction, perforation

84
Q

What abdominal conditions warrant an U/S

A

Gallbladder, pelvic organs, appendix*, liver

85
Q

What abdominal conditions warrant a CT

A

Appendix, diverticulitis, acute abdomen

86
Q

What abdominal conditions warrant an MRI

A

Hepatocellular carcinoma

Metastatic Disease

87
Q

If an ultrasound is inconclusive for cholecystitis what is another test you can order to confirm

A

HIDA

AANP Study Cards (20 decks)

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