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Urgent Care Guide > GI 3 > Flashcards

GI 3 Flashcards

1
Q

GERD alarming features include
9

A
  1. New onset of dyspepsia in patient ≥60 years
  2. Evidence of gastrointestinal bleeding (hematemesis, melena, hematochezia, occult blood in stool)
  3. Iron deficiency anemia
  4. Anorexia
  5. Unexplained weight loss
  6. Dуsрhаgiа
  7. Оԁуոοрhagiа
  8. Persistent vomiting
  9. Gastrointestinal cancer in a first-degree relative
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2
Q

GERD - classic symptoms can be a clinical dx, what are they
2

A

regurgitation
heart burn

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3
Q

GERD - risk for Barret’s esophagus starts w/ 5 years or more of GERD symptoms + three additional parameters - do what

A

hold off on tx, need GI w/u

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4
Q

GERD - mild mod sx, fewer than 2 episodes a week tx initially

A

lifestyle changes
low H2RA as needed i.e. famotidine 10 mg PO daily x 4 weeks +/- antacids

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5
Q

GERD - mod severe sx, 2 or more episodes a week or severely impairing life tx initially

A

lifestyle changes
standard dose PPI - pantoprazole 40 mg daily x 8 weeks

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6
Q

GERD - when do you see them again after starting H2RA (histamine 2 receptor antagonist)

A

4 weeks - if failed, move onto PPI

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7
Q

GERD - when do you see them again after starting PPI

A

8 weeks

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8
Q

PUD lifestyle changes include
2

A
  1. quit smoking
  2. limit alcohol to one drink/day
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9
Q

PUD is suspected in patients w/
3

A

dyspepsia
hx of h. pylori
NSAID use

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10
Q

GERD - when to send to ER
2

A
  1. aucte abd
  2. NV w/ signs of dehydration or inability to tolerate PO
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11
Q

hematochezia

A

bright red blood, generally present in LGIB

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12
Q

bright red blood, generally present in LGIB

A

hematochezia

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13
Q

melena is an indicator of

A

UGIB

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14
Q

indicator of UGIB

A

melena

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15
Q

LGI bleed - patients may c/o
2

A

blood or black stools
streaking on toilet paper

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16
Q

LGI bleed - hx may include
3

A
  1. GI malignancy
  2. recent GI procedure
  3. GI disorder
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17
Q

LGI bleed - always ask about ____ of sx

A

duration

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18
Q

LGI bleed - indications of ongoing hemorrhage or severe bleed
4

A
  1. abd aortic aneurysm repair
  2. previous hx of GI bleed
  3. hx of bleeding for > 4 hours prior to presentation
  4. anticoags or antiplts
19
Q

LGI bleed - VS and skins
5

A
  1. skin normal to pale
  2. diaphoretic
  3. tachycardia
  4. bradycardia
  5. hypotension may indicate severe bleeding
20
Q

LGI bleed - PE abd/GI/GU
2

A
  1. +/- tenderness
  2. +/- distention
21
Q

LGI bleed - rectal PE
2

A
  1. +/- bleeding
  2. hemorrhoids or fissure may be evident
22
Q

LGI bleed - img/testing

A

none usually in UC
-fecal occult blood test
-consider anoscopy
-consider EKG if unstable
-consider CBC and PT/INR

23
Q

LGI bleed - fissures tx and f/u
3

A

stool softeners
topical analgesia
f/u w/ PCP, GI, surgery

24
Q

LGI bleed - when to refer to ER
3

A
  1. hemodyn unstable
  2. acute abd
  3. active bleeding
25
Q

cholecystitis

A

infection or inflammation of gallbladder caused by obstruction of cystic duct

26
Q

biliry colic

A

intermittent obstruction causing episodic pain (< 6 hrs; once per week)

defined as pain in the abdomen, due to obstruction usually by stones in the cystic duct or common bile duct of the biliary tree

27
Q

cholecystitis risk factors
5

A

5 F’s
1. female
2. fat
3. fertile
4. forty
5. fair skinned

28
Q

cholecystitis/biliary colic - sx typically occur when

A

soon after eating a fatty meal

29
Q

cholecystitis sx include

A

severe, constant RUQ pain that may radiate to right should/scapula

30
Q

severe, constant RUQ pain that may radiate to right should/scapula

A

cholecystitis sx

31
Q

biliary colic sx

A

dull, achy, RUQ abd pain, lasting < 6 hrs

32
Q

dull, achy, RUQ abd pain, lasting < 6 hrs

A

biliary colic sx

33
Q

cholecystitis/biliary colic - s/sx can include (besides abd pain)
4

A
  1. fever
  2. anorexia
  3. NV
  4. jaundice
34
Q

what sign is most sensitive to cholecystitis

A

Murphy’s sign - push in around ribcage/liver area and have them take deep breath, pain is positive sign as gallbladder is shifted down and pressed by hand during this

35
Q

cholecystitis/biliary colic - PE may show
5

A
  1. jaundice
  2. positive Murphy’s sign
  3. rebound tenderness
  4. guarding
  5. NV +/-
36
Q

cholangitis

A

inflammation of the bile ducts

37
Q

inflammation of the bile ducts

A

cholangitis

38
Q

suspected cholangitis when
2

A
  1. Charcot’s triad - fever, RUQ pain, jaundice
  2. Reynold’s pentad - Charcot’s triad + hypotension and AMS
39
Q

cholecystitis/biliary colic - img/testing

A

none usually in UC setting

40
Q

cholecystitis/biliary colic - DD
4

A
  1. pancreatitis
  2. hepatitis
  3. Gastritis
  4. PUD
41
Q

biliary colic tx
3

A
  1. consider antiemetics
  2. consider IV fluids
  3. consider NSAIDs
42
Q

biliary colic - if pain resolves, may d/c w/ (f/u)

A

PCP or surgical f/u

43
Q

cholecystitis/biliary colic - when to refer to ER

A

all suspected cases of cholecystitis

Urgent Care Guide (38 decks)

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