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.
