GI Flashcards
Classic pain of acute pancreatitis is
severe epigastric pain radiates to LUQ
A gastrinoma located on the pancreas or the stomach; secretes gastrin, which stimulates high levels of acid production in the stomach. As a result, multiple and severe ulcers in the stomach and duodenum develop. Complaints of epigastric to midabdominal pain. Stools may be a tarry color. Screening by serum fasting gastrin level. Refer to gastroenterologist.
Zollinger–Ellison Syndrome
With patient in supine position, have patient raise right leg while applying downward pressure on the leg (see lesson “Figure 10.2 Psoas test”). Positive finding if RLQ abdominal pain occurs with passive right hip extension. Indicates irritation to the iliopsoas group of hip flexors in the abdomen. A positive finding suggests retrocecal appendicitis presentation due to retroperitoneal inflammation.
Psoas/Iliopsoas signs
Positive if internal rotation of the hip causes RLQ abdominal pain. Rotate right hip through full range of motion. Positive sign is pain with movement or flexion of the hip. Associated with a pelvic appendix; however, low sensitivity so this assessment is not frequently performed.
obturator sign
Deep palpation of the LLQ of the abdomen results in referred pain to the RLQ, which is a positive Rovsing’s sign
rovsigns sign
Instruct patient to raise heels and then drop them suddenly. An alternative is to ask the patient to jump in place. Positive if RLQ pain is elicited or if patient refuses to perform because of pain.
Markle Test (heel jar test)
An abdominal maneuver that is used to determine if abdominal pain is from inside the abdomen or if it is located on the abdominal wall. Patient is supine with arms crossed over their chest. Instruct patient to lift shoulders off the table so that the abdominal muscles (rectus abdominus) tighten. Also, can be performed by a straight-leg-raising maneuver. If source of pain is the abdominal wall, it will increase the pain (positive); if the source is likely from an intra-abdominal organ, the pain will decrease.
Carnetts sign
Cullen signs is
bruising around umbilicus
Grey turner is
Bluish, brusing around flank
IgM Antibody Hepatitis A Virus (IgM Anti-HAV)
Acute infection; patient is contagious.
Hepatitis A virus (HAV) still present (infectious); no immunity yet.
Screening test for hepatitis A
HBsAg-positive status always means
an infected patient (new infection or chronic).
sensitive tests used for pancreatic inflammation (pancreatitis).
amylase and lipase
A person must have hepatitis ___ to become infected with hepatitis D.
B
Treatment for C diff is
fidaxomicin for 10 days or Vanco
alt flagyl
most common pathogen foor viarl gastroenteritis is
norovirus
Acute onset of high fever, bloody diarrhea, severe abdominal pain with at least six stools in a 24-hour period. Incubation period ranges from 1 to 6 hours if due to contaminated food (enterotoxin) or 1 to 3 days if bacterial infection. Symptoms usually resolve in 1 to 7 days. Antibiotics can reduce the duration of diarrhea but may lead to bacterial resistance and eradication of normal flora. Bacterial pathogens include Escherichia coli, Salmonella, Shigella, Campylobacter, C. difficile (antibiotic use, recent hospitalization), and Listeria (pregnant patients increased risk).
Bacterial gastroenteritis
Symptoms develop within 7 days of exposure and typically last ≥7 days. It is usually watery diarrhea. Travelers’ diarrhea starts within 3 to 7 days after exposure and usually resolves in 5 days. It is usually self-limited. Protozoal pathogens include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
Protozoal gastro
worrisome or worsening symptoms noticed in patients with GERD—
odynophagia (pain with swallowing), dysphagia (difficulty swallowing), early satiety, weight loss, iron-deficiency anemia (blood loss), or male >50 years—refer to ED and/or gastroenterologist.
Patients with Barrett’s esophagus have up to 30 times higher risk of
cancer of the esophagus (adenocarcinoma type).
Do not give antidiarrheal medications if patient has acute onset of bloody diarrhea, fever, abdominal pain, or pain that worsens with defecation because it may be caused by
Escherichia coli O157:H7 (a shiga toxin–producing E. coli [STEC]), amebiasis, Salmonella, Shigella, or other pathogens. May need to go to ED.
Two major risk factors are associated with peptic ulcer disease (PUD),
Helicobacter pylori infection and use of NSAIDs. Other risk factors include smoking, alcohol, and genetic and dietary factors. Duodenal and gastric ulcer incidence increases with age. Incidence increases in countries where infection with H. pylori exists. Most patients (up to 70%) are asymptomatic.
Gold standard test for Peptic ulcer disease is
endoscopy
H. pylori–positive ulcers require antibiotics for
14 days Plus PPI orally twice a day
Treatment for H. pylori–Positive Ulcers
Triple therapy:
Clarithromycin (Biaxin) 500 mg twice a day PLUS amoxicillin 1 g twice a day OR metronidazole (Flagyl) 500 mg twice a day if allergic to amoxicillin × 14 days PLUS
Standard-dose PPI orally twice a day × 14 days
Hepatitis C has highest risk of
cirrhosis and liver cancer.
Screening test for hepatitis C virus is called the
HCV antibody (anti-HCV). If positive, next step is to order HCV RNA test. If positive, patient has hepatitis C.
HBsAg: Negative
Anti-HBs: Positive
Anti-HBc: Positive
Immune to hepatitis B due to natural infection.
HBsAg: Positive
IgM anti-HBc: Positive
Anti-HBs: Negative
Anti-HBc: Positive
Patient is acutely infected with hepatitis B infection.
appendicitis go to test is the
CT scan
blumbergs sign is
rebound tenderness
positive murphy
cholecystitis
cholecystitis test
U/S
if no gallstones done we an order next HIDA scan
chvostek and Trousseaus seen when
hypocalcemia
chvostek sign
face
Trousseaus signs
BP cuff inflate
Hyercalecmia can indicate an
underlying malignancy
PPIS end in
prazole
PPI’s can lead to three things
osteoporosis
C diff
B12 deficiency
GERD BP med we avoid
calcium channel blockers
when do we recommend colonscopy screening
age 45
or CDC says age 50
do them every 10 years with annual fecal occult blood test
s/s of colorectal cancer
stool changes
weight loss
most colon polyps
descending colon
Chrons disease affects
mouth to anus
skip lesions
ulcerative coliits
affects rectum left start
Abx recommended for C-diff
vancomycin
PPI all drugs that end in
Prazole - omeprazole (Prilosec)
Llong term use of PPI cause
B12 def
osteoporosis
C diff
PPI should be taken
30 min- 60 min before meals
PPI usually given only for
8 weeks
H2 blockers end in
tidiness
Cimetidine (Tagamet) (more drug interactions dont use)
Famotidine
antacids can cause
constipation
antacids with magnesium can cause
diarrhea
sucralfate (carafate)
taken before meals to coat the stomach line
sucralfate (carafate) typically used for ___ weeks or less
8 weeks
Ondansetron (zofran) becareful when using with what
SSRI - seratonin syndrome
Zofran can cause
QT prolongation
Prochollorperzine (compro)
antiemetic can cause sedation
anticholinergic effects
To much procholerpzine can cause
tardive dyskinesia
Promethazine
sedation is big can cause resp depression in children under 2
A patient with severe nausea is prescribed prochlorperazine (Compro). What side effects will the nurse practitioner ensure to educate the patient about?
dry mouth and urinary retention
The parent of a 20-month-old child asks the nurse practitioner for a prescription of promethazine (Phenergan) for their child during a severe case of gastroenteritis. The child has normal kidney and hepatic function and weighs 14 kg. What response is most appropriate?
not give to child under the age of 2
lactulose (enulose)
given for pts with cirrhosis to help remove amnonia
how do we determine if lactulose if affective
level of consciousness improve
loperamide (Imodium))
is an idiopathic autoimmune inflammatory disease located at the mucosa and submucosa of the colon. Classic symptoms include urgency, abdominal pain, tenesmus, bloody diarrhea, and weight loss. Fever and anorexia may be associated with severe cases of ulcerative colitis.
ulcerative coliits
A 22-year-old woman with a medical history of ankylosing spondylitis presents to the clinic. She reports frequent bowel movements over the past week, and her stools look like jelly and sometimes have blood in them. Since her last visit 6 months ago, she has unintentionally lost approximately 15 lbs. What is the most likely diagnosis?
ulcerative colitis
which abx increases risk of c diff
clindomyocin
A 48-year-old patient presents to the clinic after a positive tape test for enterobiasis. Which of the following is the most appropriate therapy for this diagnosis?
oral mebendazole (vermox) once and repeat in 2 weeks
A patient with a positive tape test for enterobiasis should be treated pharmacologically. One option is two doses of an oral anthelmintic, such as oral mebendazole (A). The second dose is given 2 weeks after the initial dose. An alternative option is an oral albendazole, which follows the same dosing regimen. The second dose is given 2 weeks after the initial dose. Another treatment option is pyrantel pamoate, which is available OTC.
Enterobiasis is a pinworm infection in the intestines. The most common symptom of enterobiasis is perianal itching due to inflammation from the presence of eggs and worms, noted primarily at night. Other symptoms can include insomnia and restlessness, which occur due to persistent pruritus. Household members should be empirically treated for enterobiasis due to high transmission rates, and all clothing and bedding should be washed.
A 23-year-old woman presents to the office for her weekly vitamin B12 injection. While she is at the office, she reports that she has been experiencing some mild acid reflux recently. She states that she has been taking an antacid every night before dinner to help, but she feels as if it has gotten worse. Which of the following is the most appropriate plan of care for this patient?
Initiate a prescription for famotidine (pepcid)
Both proton pump inhibitors, such as omeprazole (Prilosec), and H2 blockers, such as (Pepcid), can be considered first-line in the treatment of gastroesophageal reflux disease (GERD). When symptoms are mild, H2 blockers (B) are typically the preferred treatment option. When symptoms are more severe, proton pump inhibitors are typically the preferred option. In addition, when proton pump inhibitors are used long-term, they have a higher risk than H2 blockers of worsening a B12 deficiency anemi
tissue transglutaminase-IgA antibody level (C) is ordered when
celiac disease is suspected
A 52-year-old man presents to the clinic for an annual physical. He states that his spouse would like him to have a colonoscopy done, but states that he read that the chances of colon cancer are rare if you have no family history. Which of the following is the most appropriate response about current colon cancer screening recommendations?
Colon cancer screening guidelines vary slightly, but the consensus is that screening for colon cancer with a colonoscopy should be initiated no later than age 45 years and repeated every 10 years (C) if test results are negative. This patient is due for his first screening colonoscopy, regardless of his family history.
The U.S. Preventive Services Task Force (2022) recommends colon cancer screening by colonoscopy beginning at age 45 years in individuals with an average risk of colon cancer. The American Cancer Society recommends screening for people with an average risk of colon cancer beginning at age 45 years. Patients who are at moderate risk for developing colon cancer include those with a personal history of polyps, inflammatory bowel disease (e.g., Crohn disease), and a family history of colon cancer. Patients at moderate risk will likely need earlier and more frequent screening. While a colonoscopy is the most accurate screening test for colon cancer, there are a wide variety of colon cancer screening tests available for patients to assist in adherence.
