GI Flashcards
1
Q
Dysphagia
A
Difficulty swallowing
Physiology or anatomical abnormalities
Needs prompts evaluation
2
Q
Oropharyngeal dysphagia
A
Involves dysfunction in the oral, pharyngeal, and laryngeal structures
Transfers dysphagia
Inability to initiate a swallow or transfer of food from the mouth to esophagus
Coughing, choking, nasopharyngeal regurgitation, aspiration, retained food in mouth after swallowing
3
Q
Esophageal dysphagia
A
Sensation of food getting stuck in the esophagus several seconds after initiating swallow
4
Q
Structural causes of dysphagia
A
More common in esophageal
Due to cricopharyngeal bar, zenkers divierticulum, cervical webs, oropharyngeal tumor, osteophytes, skeletal abnormalities, congenital
5
Q
Functional causes of dysphagia
A
More common in oropharyngeal
Can be iatrogenic from medication side effect, post surgical muscle problem, radiation, corrosives/infectious from diphtheria, Lyme disease, botulism, Mucositits (herpes, CMV, candida)/metabolic from amyloidosis, cushings, thryoidtoxicosis, Wilson’s disease/myopathic from connective tissue disease, MG, polymyositits, sarcoidosis, paraneoplastic syndrome/neurologic from brain stem tumor, head trauma, stroke, CP, GB, huntingtons, MS, polio, post polio syndrome, TD, ALS, PD, dementia
6
Q
Swallowing phases
A
Oral-chewing , CN 5, 6,9, 12
Pharyngeal-CN 5, 9, 10, sensory impulse to brainstem for involuntary swallow
Esophageal -peristalsis and UES closes
7
Q
Issues in each stage
A
Oral- pocketing, spillage; difficulty chewing
Pharyngeal- delayed swallow, failure to airway protect, nasal or oral regurg, residue remaining
8
Q
Meds that can cause issues with swallowing
A
Xerostomia- antidepressants, antispasmodic, anti hypertensives, anticholinergics, antihistamines; bronchodilators, sedatives
Mucosal injury- fosamax, tetracycline, NSAIDs, potassium, ferrous sulfate
Lower esophageal sphincter pressure-theophylline, nitrates, CCB, BB, HRT; anticholinergics
9
Q
Dysphasia diagnostics
A
Modified barium swallow
Cineesophagram
Oropharyngeal-videofluoroscopy, nasopharyngolaryngoscopy, fiberoptic endoscopic swallow eval
Esophageal-barium esophagram
Both- upper endoscopy
10
Q
Management of dysphagia
A
Oropharyngeal-swallow rehab, thick liquids, hand feeding
Achalasia- surgical or endoscopy myotomy, injection of lower sphincter with Botox
Spastic motility disorder-CCB, PDI
Strictures- dilation
Surgery if structural
Non oral feedings if aspiration is occurring
11
Q
Dyspepsia
A
Heartburn, chronic or recurrent upper abdominal pain with fullness, epigastric, pain or epigastric burning
More common and peptic ulcer disease, Gerd biliary colic medication induced
Consider prompt endoscopy and older adult because of increase rate of organic disease like cancer
Can be medication induced like with alcohol/steroids NSAIDs erythromycin , theophylline
H pylori, cancer
Perform H pylori testing on all patients either using a breath, test or fecal antigen or can do biopsy if doing endoscopy
Patient with large or non-healing ulcer should have a biopsy
Patient to her negative for H. pylori. Should try two months worth of PPIs.
Patient with functional dyspepsia trial of PPI
Patient with normal upper Endo consider further testing like abdominal imaging and gastric emptying study
12
Q
NSAID induced gastric complications
A
Most common adverse effects are this Pepsi gastritis, duodenitis, and peptic ulcer disease
Risk factors include those over 65, high dose, prior history of peptic ulcer disease, two or more concurrent use of NSAIDs, use of NSAIDs with an anticoagulant steroid anti-platelet or SSRI and the presence of H pylori
Interact coated pills can seem to help but does not protect against G.I. bleeding
Can consider switching to an NSAID that only inhibits cox too, but then you have a higher risk of cardiovascular events
Can consider use a PPI and misoprostol in those who require and NSAID therapy
13
Q
Gerd
A
Symptoms are complications, resulting from reflex of gastric contents into the esophagus beyond the oropharynx, nasopharynx larynx or lungs
Increases with age and then decreases after age 69
Equal prevalence across all genders and ethnic groups
Common in those who are overweight or obese with a BMI greater than 25
Causes include primary inappropriate, spontaneous relaxation of the LES, normal pressure 10-30, patients have less than 10, hiatal hernia, alcohol, caffeine, high fat foods, tomatoes, onions, citrus, chocolate
Meds can also increase risk, anticholinergics, beta blockers, calcium channel, blockers, diazepam, estrogen, nicotine, progesterone, and theoohylline
14
Q
GERD patho
A
For probable factors
Transient LES relaxation
Low pressure
Decreased ability of the esophagus to clear itself of material
Decrease gastric emptying
Extent a coal injury is related to length of time gastric context are in contact with the esophagus
15
Q
GERD clinical presentation
A
Older adults with long standing, Gerd can have atypical symptoms, such as dysphasia, odynophagia, vomiting , may have accompanying heartburn, epigastric, pain, nausea, bloating, asthma, cough, voice changes
Can mimic MI**
Can mimic asthma***
Water brash- salty tasting good in mouth
Symptoms usually are precipitated by food occur within one hour of eating, especially a large meal
16
Q
Which of the following is not a risk factor for dyspepsia and GERD
A
Secondary job
17
Q
Gerd is best described as
A
A chronic disease with relapsing symptoms
18
Q
GERD DX
A
Empiric trial of PPI’s
Upper endoscopy -for those with new symptoms and patient safety, older unsuccessful therapy, warning science long-standing symptoms of recurrent continuous treatment dysphasia
24 hour ambulatory esophageal pH testing
Prolonged pH monitoring for 48 to 96 hours using a wireless pH capsule
Esophageal manometry
19
Q
GERD management
A
Weight loss
Elevating head of bed and avoiding meals 2 to 3 hours before bedtime
Avoiding medication’s
Avoiding food triggers
Antacids over-the-counter histamine two blockers
Treat with PPIs for 48 weeks if a eight week there is no follow up drug can be titrated to be twice a day
Can do surgery patients have a large hiatal hernia
Smoking sensation
Low-fat diet
Small meals
Stay upright two hours post meal
Can do antacids with lifestyle change histamine two blockers like Pepcid Zantac PPIs , Reglan, but not a drug of choice
20
Q
Complications of GERD
A
Esophageal structures
Hemorrhage
Perforation
Chronic bleeding, iron deficiency, anemia
Bears esophagus, which can lead develop to cancer
21
Q
The core pathology of Gerd is
A
Impaired structure and function of the lower esophagus
22
Q
Which lifestyle modification has the strongest evidence support in reducing dyspepsia and Gerd symptoms?
A
Weight loss and head of bed elevation
23
Q
Which of the following Gerd symptoms has the greatest negative impact on patient’s quality of life
A
Nighttime heartburn
24
Q
Adverse G.I. effect with NST may increase with concurrent use of
A
SSRIs
25
Extra esophageal manifestations of Gerd may affect
Dental health, ear, nose, and throat and respiratory system
26
Gerd can be diagnosed by endoscopic finding of
Erosive esophagitis
27
Which of the following is not among the diagnostic criteria for functional heartburn?
Sense of solid and or liquid food sticking in the esophagus
28
Once daily PPI for eight weeks, healed reflux, esophagitis, and what portion of patients
More than 80%
29
Which of the following agents may benefit patients with PPI refractory Gerd especially those that have sleep disturbance
Melatonin
30
Peptic ulcer disease
Duodenal ulcers and gastric ulcers
Duodenal ulcers due to NSAIDs use or h pylori, imbalance of acid and progestin production,
RF: stress, cigarette, COPD, etoh, alcoholic cirrhosis, chronic ASA or NSAIDs, zollinger Ellison syndrome, family history, blood type O, HLA B5 antigen
31
Duodenal ulcer
Dyspepsia, bleeding, anemia, abdominal pain
May be incidental finding on upper endo
Gnawing pain 2-5 hours after meals or middle of the night
Pain decreases with food or antacids
Changes in intensity, duration and intensity common
Weight gain
Epigastric pain midline
Melena
Use PPI especially while using NSAIDs, 8 week trial, can increase if still symptomatic to BID or consult GI
H2B can be used for mild symptoms
Misoprostol
32
H pylori treatment
#1 bismuth 2 tabs QID, flagyl 500 mg QID, tetracycline 500 mg QID X 10 days, Prilosec 20 my BID for 8 weeks
#2 bismuth 2 tabs QID, flagyl 500 mg QID, tetracycline 500 mg QID X 14 days, H2B BID for 6 weeks
#3 biaxin 500 mg BID, amoxicillin 1 g BID X 14 days, PPI BID 8 weeks
#4 metronidazole 500 mg BID, biaxin 500 mg BID X 14 days, PPI BID 8 weeks
Confirm eradication 4 weeks post therapy
33
Gastric ulcers
Can be malignant cause
NSAIDs cause, H pylori causes, thinner cause, caffeine, etoh, smoking, family history
Epigastric pain few hours after eating or at night, gnawing pain
Pain increase with food and may be LLQ, bloating, belching, n/v, weight loss
PPI
34
Melena
Black tarry stool positive for occult blood
Upper GIB so bleeding may not be current
Iron supplements and pepto can also cause color change **
Causes-upper- PUD, gastric erosion, erosive esophagitis, esophageal varicose, lower-diverticulosis, CA, intestinal polyps, IBD; infectious colitis, meckels diverticulum, SB neoplasia
35
Abdominal pain
Inflammatory, metabolic or structural
Can be non GI- OBGYN related, pregnancy, AAA
36
N/V
Gastritis, food poisoning, etoh, SE, hepatitis, MI, PUD, digitalis toxicity
After meal- gastritis or digitalis toxicity
1-2 hrs post- biliary tract or pancreases
Projectile- neurological
Early AM- pregnancy, uremia, chronic etoh
Use- antihistamine; antidopaminergics, cholinergics, serotonin receptor antagonist
37
Most peptic ulcers occur between age 25 and
70
38
The two most common risk factors for peptic ulcer disease are H pylori
NSAID use
39
The most common chief complaint of those with peptic ulcer disease is
Dyspepsia
40
Pain from peptic ulcer disease is often located in the
Epigastric
41
Which of the following is not a cause of Melena
Bleeding in the left colon
42
A bowel pain could be the presenting symptoms of all these conditions except
Inflamed hemorrhoid
43
The common entity, causing nausea and vomiting with diarrhea and abdominal pain is
Gastroenteritis
44
Which of the following medications can contribute to peptic ulcer disease
Potassium chloride
45
One of the typical descriptions of discomfort associate with peptic ulcer disease is
Gnawing
46
Pain associated with peptic ulcer disease typically occurs in the middle of the night or how long after eating
2 to 5 hours
47
Alarm symptoms of a patient was suspected peptic ulcer disease include
Melena or anemia
48
A chronic illness is commonly thought to increase the risk of peptic ulcer disease is
CKD
49
Multiple ulcers or ulcers distal to the second portion of the Dwana raise a clinical suspicion of
Zollinger Ellison syndrome
50
The most common location for gastric ulcers is
Lesser curvature of the antrum
51
Constipation
Less than three stools per week
Usually associate with a low fiber diet
Three types, functional disorder, motility, and secondary constipation
Functional is usually due to a low fiber, diet sedentary patient
Disordered motility often seen an older adults slow transit times can also be seen IBS and diverticular disease
Secondary causes can be from meds, diabetes, depression, and adequate fluids also low potassium low calcium lesion hemorrhoids
52
Meds that can cause constipation
Parkinson drugs
Antipsychotics
Aluminum containing antacids
Anticholinergics
Antihistamines
Antihypertensive
Calcium supplements
Sympathomimetics
Iron
Anti-seizure meds
NSAIDs
Diuretics
cough medication
Opioids
53
Constipation presentation
If a patient complains stools are gradually decreasing in diameter suggest organic lesion
If it says they have fatty stools or greenish yellow stools, this could be suggestive of a pancreatic issue
If hypotensive tech could be dehydrated
Decreased bowel sounds could be indication for obstruction
Dullness over area where stool is at
Diagnostics include physical exam can also do abdominal x-ray labs sigmoidoscopy colonoscopy
Spidey diffuse brown pigmentation on mucosa often indication of laxative abuse
Biopsy may be needed to rule out disease, such as IBS
54
Constipation management
Exercise
Daily fiber of 20 to 40 g per day
Low-fat diet
64 ounces of water per day
Rollout secondary conditions
Can use bulking for med stool softeners laxatives
Can also use things like acupuncture ginger
55
Chronic constipation
Still frequency less than three per week and have luck your hard fey strain at defecation sense of incomplete defecation
Alarming signs include bleeding weight loss
Can be functional where there’s no specific
Slow transit
Diabetes, low thyroid, high calcium
Structures
Medication
Lack of mobility
Treatment same as regular constipation
56
Fecal impaction
Involuntary passage, inability control, passage of vehicle material through the anus
Minor in advertent passage of gas or soil of underwear with liquid stool
Major involuntary leakage of feces
Can consider sigmoidoscopy to rule out tumor, anorectal manometry, Endorectal US
Treat using bulking agents antidiarrheal’s
57
Diarrhea
Increase and frequency volume or fluid contents of bowel movement different types of asthmatic secretory morphologic change, altered fertility
Can be due to things like my absorption laxative abuse underlying disease
Secretory usually large volume water stools, usually due to tax on their virus or laxative abuse
Morphological due to ulcerative colitis, Crohn’s
Altered motility usually do diabetes, IBS dumping syndrome, parasites, anabiotic, and see if
58
Chronic diarrhea
Decrease in fecal consistently lasting greater than four weeks
Due to IBS male absorption, food, intolerance meds, artificial sweetener colitis
59
Diverticular disease
Outpouching of mucosa through the colon wall, if food gets stuck in here can cause inflammation and abscesses
More than half of people age 60 and over, have it uncommon in those younger than 40 equal among genders usually in developed nations
A diet high in fiber and vegetarian can reduce the incidents
Obesity is a large risk factor others include chronic constipation, irregular, uncoordinated, bowel movements weakness of the bowel muscle from aging
Most common in the sigmoid: a.k.a. the left: if there’s a rupture and bleed, most likely from the right, colon
Three different types,
diverticulosis asymptomatic
Diverticulitis inflammation, and pain usually with an abscess or fistula
Diverticular bleeding
60
Uncomplicated diverticulosis
Often an incident finding on screening exams
May have non-specific abdominal cramping, bloating, flatulence, irregular bowel movements
Can be fine on its own they may have crampy pain in the left lower quad with constipation diarrhea alternatives might be relieved with passing gas
Increase fiber can also do a fiber supplement bulking agent avoid foods like popcorn, not seeds
61
Diverticulitis
Complication of diverticular disease, almost always symptomatic
Inflammation possible abscesses may be micro or macro perforations can cause peritonitis
Patient can prevent with moderate colicky to study achy, abdominal pain usually over the left lower quad, mostly have fever and leukocytosis, constipation or loose stools may or may not be present
CT scan to confirm
Can also present with recurrent UTIs or vaginal discharge that is fecal in nature
Some distention hyperactive bowel sounds
Surgery if emergent with perforation or peritonitis otherwise a mild clear liquids antibiotics such as Augmentin, Flagyl Bactrim, Cipro
Hospitalization only needed a patient does not improve
If severe will need to be hospitalized with bowel rest, IV fluids IV antibiotics
62
Diverticular bleeding
Hemorrhage from colonic tick jelly starts without warning and older adults. Painless, rectal bleeding, massive bleeding can occur, though in low percentage usually comes from the right: large volume bright, red ruin blood without hypovolemia blood stops most of the time.
Made it to upper G.I. to rule out
Treatments usually conservative, but may need close observation, and ICU
63
Irritable bowel syndrome
Symptoms such as abdominal pain, bloating, constipation, diarrhea, or both can have weight loss as well. Usually family history can develop post gastroenteritis most common triggers include lactose fructose orbital, gluten.
Can present with non-radiating intermittent crampy pain a little left lower quad usually worse what two hours after meals worse with stress by defecation does not interrupt sleep, diarrhea, constipation physical exam usually unremarkable may have some Tempany to abdomen. Percussion may have some tenderness can do a flex more to confirm along with labs Management includes dietary behavioral male symptoms can be managed with increased fiber, gluten-free diet, probiotics, anti-antibiotics TCAS drugs for IBS c and IBS D
64
Celiac disease
Gluten sensitivity autoimmune usually common in women threefold increase of non-Hodgkin’s lymphoma usually asymptomatic they may complain of diarrhea, weight loss this Pepsi flatulence, atypical complaints, like fatigue, joint pain, depressed mood, amenorrhea, difficulty getting pregnant history of chronic diarrhea that’s foul, spelling, abdominal pain, weakness, fatigue osteopenia, osteoporosis, Physio exams probably normal severe cases you may see vitamin B 12 manifestationslabs to confirm especially antibodies. IGA will need EGD and biopsy to confirm can do antibody testing DEXA scan management really is just gluten-free diet.
65
66
Occult bleeding
A positive one warranty evaluation test with colonoscopy and if negative consider upper endoscopy if normal for both can consider like video capsule annual vehicle court test currently recommended one method for screening for colon cancer
67
Colonic angiodysplasia
Due to AV malformation’s vascular ecstasia
Occur often in the sea come in Essen: maybe asymptomatic have a colt, bleeding or overly overt bleeding
Diagnosed with endoscopy colonoscopy usually an incidental finding iron for chronic bleeding can do a ablation or surgical resection
68
Colonic ischemia
Usually occurs in acute setting but temporary reduction in blood flow with colon threatening and signs such as perennial science fever Mark leukocytosis increase lactate lack of response from fluid resuscitation can see on CT if not exclusive usually complain of acute crampy abdominal pain with hematochezia treatment is pour with IV therapy, IV fluids, emergent surgery and broad spectrum antibiotics
69
Bowel obstruction
Can involve any segment of a large or small bowel, or can result from mechanical blockage or disruption motility can be acute chronic can be partial or complete. Usually identified by location can be from foreign body fibrosis hernia scarring adhesions than 24 hours 8 L can accumulate in the stomach leading into nausea and vomiting Can cause severe fluid and electrolyte balances and hypovolemic shock, including alkalosis or acidosis usually present with sudden onset of colicky belly, pain with nausea and vomiting pain usually corresponds to peristaltic waves may have vomiting, and that is fecal matter may have constipation how to tender on palpation may have absent bowel sounds Diagnosed with a upper abdomen x-ray labs
This does require hospitalization, possibly surgery NG tube to decompress IV fluids be rest electrolyte replacement narcotics should not be given if it’s due to motility issue
70
Ogilvie syndrome
Acute massive dilation of colon without evidence of mechanical obstruction up to related neurological disease, such as Parkinson’s cardiovascular disease, trauma ortho use of narcotics infection like CDF patient usually present with abdominal pain. Patient may have a lack of fecal output or paradoxical diarrhea with CT scan treatment usually supportive can use anticholinesterase inhibitors for galactic compression colonoscopy
71
Appendicitis
Present with right lower quad, abdominal pain that require surgical intervention, a rare and older adults, but they do have a higher morbidity if they have it usually present with acute onset of mild to severe colicky epigastric or. Umbilical pain kind of vague at first, but it’s worse over the right lower quadrant made worse with walking or coughing men may have pain that radiates the testicles, nausea and vomiting occurs after the onset of pain
Will also have fever shaking when the patient is recumbent and they flex the right knee. They might have pain rebound tenderness. Bowel sounds can be present or not elevated blood pressure pelvic exam for women is needed if there is a certain sensation of pain assume that there’s a perforation and this is emergent. Tinnitus can happen.
Labs HCG x-ray CT as well
Management include surgery, pain management fluids, IV antibiotics cover with cephalosporin third generation if perforation suspected cover with ampicillin and gentamycin clindamycin Flagyl unison advanced diet as tolerated when bowel sounds return
72
What is perhaps the most bothersome IBS symptom for patients?
Abdominal bloating
73
Which of the following statements regarding the role of diet and IBS is true
Gluten is increasingly recognize an important symptoms trigger in patient with IBS
74
What percentage is the US population of celiac disease?
One percent
75
All the following the single, most important risk factor for celiac disease is
Having a first-degree relative with the disease
76
Which of the statements about the signs of symptoms of celiac are true
Many of the symptoms does he like mimic those of other diseases
77
Which of the following medication’s are not considered one of the commonly associated with constipation?
Lisinopril
78
The most common cause of osmotic diarrhea
CHO malabsorption
79
Management of diverticular disease includes, which of the following
Diet with 30 to 35 g of fiber each day
80
Which of the following antibodies comely appears in patients with celiac disease
Antigliadin antibodies
Antiendomysial antibodies
Tissue transglutaminase antibodies
81
Dermatitis herpesfortis
Usually presents an individual with degrees of villous atrophy
82
In addition to lifelong adherence to gluten-free diet, which of the following is recommended as an adjective treatment for the individual celiac disease
Management of complications and related symptoms
Age pacific gluten-free vitamins and mineral supplements
Medical nutrition therapy provided by a dietitian
83
Which of the following was a change in the Rome for IBS following criteria?
Remove all of the term abdominal discomfort
84
Which of the following is a common nonspecific symptom of IBS
Urge to defecate
Abnormal steel frequency
Mucus with bowel movements
85
Serology test for celiac disease he should be performed
Patients with IBS diarrhea or IBS mix who failed empiric therapy
86
Lifestyle modification that may improve IBS include
Avoid caffeine
87
Colonic angiodysplasia occurs most commonly in
The cecum and ascending colon in patients greater than 60 years old
88
The most common cause of a large ball obstruction is
Cancer of the colon
89
You suspect your patient has an appendicitis you palpate over the left lower quad of the belly. Then you suddenly release a pressure. Your patient complains of pain in the right lower quarter of their abdomen, this maneuver is considered a
Positive rovsing sign
90
Gastroenteritis
Multiple causes viral bacterial parasite
Infection of the small bowel causes watery secretory absorb of diarrhea
Infection of the large bowel often bloody diarrhea and belly pain
Nausea and vomiting six hours after eating
Diarrhea that starts late can be C. Perfringens, 24-48 hits post is C jejnui or salmonella
Presents with nausea, vomiting, diarrhea, fever, cramping, and belly pain maybe bloody or mucousy
Treatment depends on severity may need IV fluids, specially of older and low blood pressure can cause electrolyte abnormalities
Mild cases supplement with electrolyte drinks, antidiarrheal Imodium Pepto antiemetics can treat empirically
Can you use a azithromycin or
erythromycin
Brat diet
91
92
Salmonella
Most common
May have resistance to Cipro
Found from poultry contaminated cheese, dairy eggs, sometimes usually
Symptoms start one to three days after ingesting
Diarrhea, cramping nausea, vomiting in the last 4 to 7 days can cause colitis, bacteria or infection in severe cases
Treat with ampicillin gentamicin sulfa Cipro Z-pak ceftriaxone
93
Campylobacter jejuni
I’m pasteurized milk or dairy products, poultry, livestock cage animals
Symptoms began 2 to 3 days after consumption very similar to acute appendicitis
Sticky diarrhea, blood fecal, leukocytes, belly pain, fever, nausea, vomiting, and muscular pain no vomiting
Can last 2 to 10 days
If severe can cause hemorrhage, toxic colitis, meningitis bacteria can also cause IBS Gillian Barret
Treatment is reserved for severe cases and those amino compromise consider erythromycin Z-Pak or Cipro
94
Shigella
Highly infectious
Symptoms occur within an 8 to 40 hours after eating
Illness last 4 to 7 days
Patient will have mucoid watery, possibly bloody, diarrhea with belly pain, fever and tenesmus
Antimicrobial not typically advised but can do a CPAP Cipro Bactrim Rocephin save those for severe cases in immuno compromised
95
E. coli
Can be a sub type that produces shiga toxin
From contaminated raw milk, meat, sprouts, fruit juice, vegetable vegetables, petting zoo, cattle
So nose began one to eight days after eating
Severe belly, pain, cramping, watery, diarrhea, vomiting, low-grade fever, usually come in when there’s blood in the stool usually self limiting, but can last 5 to 10 days
Also, another sub type that produces enterotoxigenic, usually causes travelers diarrhea symptoms occur one to three days after eating watery diarrhea 3 to 7 days of abdominal cramping and nausea. Malaise and low-grade fever is not usually common antibiotics usually not needed but for severe illness can do Cipro or azithromycin.
96
Listeria
Resistant to freezing drying and heat pregnant women are high risk found in her animals. Birds were in life, contaminated of fruit, fruits and vegetables or fire, animals and pasteurized milk and cheese.
May have fever, nausea, diarrhea symptoms, 9 to 48 hours after eating in pregnancy. Sounds like the flu can cause bacteria and meningitis typically manifest 2 to 6 weeks after injection.
Prescribe amoxicillin Bactrim IV ampicillin penicillin gentamycin for a severe disease
97
Vibrio
Salt tolerant anaerobes
Symptoms begin one or three days after injection minimal symptoms may have profuse watery diarrhea that last 3 to 7 days colorless with flex also called rice. Water diarrhea is known to cause severe dehydration, metabolic acidosis and hypokalemia.
Aggressive hydration
Antibiotics like Doxy or tetracycline or drug a choice
98
Noncholera vibrio
Raw undercooked seafood
Symptoms began two to $40 after eating
Belly cramps, water, diarrhea, fever, chills, headache maybe some vomiting bacteria can happen if immuno compromised
Anabiotic doxycycline Cipro, Levaquin hospitalized patient can get Rocephin Doxy
99
Yersinia
Pigs are reservoir, comes from raw undercooked, pork oyster, fish, and pasteurized milk cheese ice cream
Symptoms 24 to 48 hours after eating
Appendicitis like ill, illness, diarrhea, vomiting, fever, belly, pain, factor eat a chemical occur antibiotics for severe disease like tetracycline gentamycin mycin
100
Clostridium perfringens
Meat, meat, products, gravy
Patients present water, diarrhea, cramping nausea, 8 to 22 hours after eating
Usually mild resolves quickly
Anabiotic therapy not usually indicated, but severe cases, ampicillin amoxicillin, Flagyl erythromycin
101
Botulism
Can cause neurotoxins
Found in canned items in aerobic environments
Occur told to 72 hours after eating, but can occur as late as 10 days
Can I have a weakness issue swallowing paralysis if not treated can become permanent if you suspect treat right away
Induce, vomiting, gastric, lavage, rapid prorogation, high enema to remove anti-toxin can be given by CDC
102
Bacillus cereus
For meat, milk, vegetables, fish strips, starchy foods, heat resistance can survive in cooking
Watery diarrhea, abdominal pain nausea 6 to 16 hours after eating quick resolution
An antibiotic’s not typically needed
103
Brucellosis
From milk or dairy from infected animals
Symptom 7 to 21 days after eating
Fever, chill, sweating, malaise, headache, myalgia, diarrhea that can be blood
Symptoms can last for weeks disease is usually more severe than adults
Treat with doxycycline plus gentamycin or famine for six weeks
104
Staph aureus
Rapid on nausea, vomiting within 30 minutes of eating
Abdominal pain diarrhea fever illness usually mild can recover within one of two days
Antibiotic not needed
105
Calcivirus
Norovirus and sapphires
Eating restaurants, food handlers is common vector
Present with nausea, vomiting, watery, diarrhea, belly cramps, fever, myalgia, headaches, usually 24 to 48 hours after eating resolves fairly quickly but you could shed the virus for up to two weeks. Usually diagnosis is made on clinical presentation. Treatment is fluids and electrolytes.
106
Hepatitis A
Vaccine
Jaundice occurs symptoms last from days to months
Patient is infectious for 12 weeks before onset of disease so about a week before the jaundice occurs
107
Rotavirus
Presents with vomiting, water, diarrhea, low-grade fever one to three days after eating
Symptoms usually last 4 to 8 days
108
Astrovirus and adenovirus
Common foodborne, illness, and children not so much adults
109
Cryptosporidium
Likes to live in the Jejunum in terminal ileum
Usually infected food handler, but also fresh produce animals raised for food
Patients usually have profuse water, diarrhea, cramps, upset, upset, stomach, and fever onset 2 to 10 days after eating
Can be symptomatic for up to 10 to 14 days
Shedding is intermittent
Treatment is reserved for severe disease. Hydration is good can give antibiotic such as nitazoxanide, paromomycin, Zithromax
110
Cyclospora cayetanensis
Common and tropical areas for veggies like broccoli, cauliflower carrots, salad
Begins one week after
Profuse, watery, diarrhea, loss of appetite, weight, loss, stomach, cramps, nausea, vomiting, and fatigue disease can process for 10 to 12 weeks and can relapse if not treated
Drug a choice is Bactrim for 7 to 10 days
111
Giardia
Lives in the small intestine, biliary track, and ineffective dose is one cyst
Symptoms begin one week after in
Usually water bar transmission
Persistent, watery, diarrhea, belly pain, bloating, nausea, body, and that last one to three weeks or longer diagnosis is made by cyst and the fecal smears at least three stools may be needed to get accurate diagnosis
Drug of choice is Flagyl
112
Toxoplasmosis
Protozoon parasite cats are the main reservoir that humans can get it from eating braw or undercooked meat, pork beef, clams, oysters
Usually have nonspecific symptoms like flu and larger lymph nodes can resolve within months years really only test and can confirm with antibodies
113
Entamoeba histolytica
Amoeba common in Mexican migrant workers for east usually fecal, oral, or sexually transmitted
Can be asymptomatic carriers they might have cramps, weight, loss, diarrhea, mucus, and the blood and large liver fever dysentery sigmoidoscopy to confirm drug of choice is gonna be fragile
114
C diff
History of antibiotic used within 90 days present with profuse watery diarrhea, maybe blood tinge a company with fever cramps and leukocytosis diagnosis is confirmed after isolate, toxin and stool
Drug a choice is Flagyl for 10 days vancomycin fidaxomycin
If the patient relapses and retry with the second course of what was given, if a patient relapse again then 14 days of therapy and twice a week for 6 to 8 weeks if they’re on the third relapse, consider a fecal transplant
115
Marine toxins
Flashing rash to upper torso, dizziness, burning sensation to skin, mouth and throat, throbbing headache, unusual taste, and mouth, peppery, pungent, bitter or metallic 3 to 6 hours is how long symptoms can last but can persist for days can cause tachycardia and low blood pressure from contaminated fish
Can cause reaction sconbroid AKA histamine toxicity
116
117
Mushroom toxic
From eating mushrooms that are poisonous can cause neurotoxicity gastrointestinal, irritation, supportive care
118
Which of the following is not consistent with inflammatory diarrhea
Involvement in the small intestine
119
Norovirus infection, which often results in nausea watery large volume diarrhea with 2440 hours can be caused by
Inanely cooked shellfish and medically cooked hamburger and ice drinks
120
Which of the following statements regarding infectious food related illness is true
Viruses replicate in human intestine not in food
121
All of the following bacteria, which is responsible for the highest instance of food, board disease occurring to food net surveillance data
Salmonella
122
Foodborne disease caused by which the following parasites occur occurs most frequently in the United States
Cryptosporidium
123
Which of the following pathogens is most likely found in rice or starchy foods?
Bacillus cereus
124
Which of the following is associated with high cause fatality rate
Listeria
125
Which of the following best describes foodborne disease with staph aureus
It occurs from ingesting improperly stored foods
126
Which of the following regarding? Cyclosporiasis it’s true.
Washing of contaminated produce, does not eliminate the risk of transmission
127
The most likely, long-term complication of campylobacter jejuni is
Guillian barre syndrome
128
Which of the following viral types of E. coli infection is better known as travelers diarrhea
Enterotoxigenic
129
Which of the following most accurate statements regarding H. pylori
It is a cause of both duodenal and gastric ulcers
130
Which of the following patient should be promptly referred for an endoscopy
A 65-year-old man with new onset, epigastric pain and weight loss
131
A 58-year-old man presents to the ER with a temp of 102 abdominal pain to the left lower quad and rebound tenderness which of the following diagnostic test is the best next step
CT abdomen
132
A 58 year-old man presents to the ER with coffee ground emesis. His blood pressure is 126/90 heart rate 76 no orthostatic EGD rebuild a clean base 2 mm gastric ulcer this patient should be managed with.
oral PPI and outpatient follow up with repeat EGD in three months
133
A 50-year-old male with bear esophagus undergoes his second EGD biopsies revealed metaplasia without dysplasia. He has heartburn at least three times a week. Recommend recommendations for this patient include.
Daily proton pump inhibitor to control heartburn symptoms
134
17-year-old male presents with abdominal pain 15 kg weight loss bloody diarrhea over the past three months. The next appropriate step would be.
EGD for small bowel biopsy and gluten free diet
135
A 45-year-old female nurse with two weeks of non-bloody diarrhea. The next appropriate step would be.
Test for c diff and do a Flagyl 500 mg three times a day for 14 days of positive
136
38-year-old man presents with gas, bloating non-bloody loose stool of eight months duration in the next appropriate step would be
Lactose breath or dairy free diet
137
Which of the following features is not consistent with a diagnosis of irritable bowel syndrome
Nocturnal awakening with pain or diarrhea
138
Which of the following patients is not a good idea for evaluation for celiac disease with either endoscopy or theological testing?
A 39-year-old male with family history of celiac has been into a gluten-free vegetarian diet for the last three years and now complains of gas and reflex
