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AANP FNP: Adult > GI > Flashcards

GI Flashcards

1
Q

Signs and Symptoms of Peptic Ulcer disease

A

Gnawing epigastric pain
Relief of pain with eating (duodenal ulcers)
Pain worsens with eating (gastric ulcers)
GI bleeding

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2
Q

Signs of bowel perforation

A

Severe pain
“board-like” abdomen, rigidity
quiet, ominous bowel sounds

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3
Q

Lab and diagnosis of peptic ulcer disease

A

Normal except maybe some anemia on CBC
Consider endoscopy after 8-12 weeks of treatment
Consider H. pylori testing

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4
Q

Outpatient management of peptic ulcer disease

A

H2 Blockers first, then BID H2 blockers, then PPI, then refer for scope.

Breakthrough- Pepto bismol (bismuth subsalicyclate), Antacids like Mylanta, Maalox)

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5
Q

People on chronic PPI therapy should also have what supplement?

A

Calcium with vitamin D

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6
Q

Medications for Prevention of Peptic Ulcer Disease

A

People who can’t get off NSAIDs need PPI ordered daily

Misoprostol (Cytotec)- prophylaxis against NSAID induced ulcers (may stimulate uterine contraction and cause abortion)

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7
Q

H. pylori eradication options

A

2 antibiotics + PPI or bismuth
1. MOC- metronidazole, omeprazole, clarithromycin
2. AOC- amoxicillin, omeprazole, clarithromycin
3. MOA- metronidazole, omeprazole, amoxicillin
Then- antiulcer therapy for 3-7 weeks with PPI

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8
Q

GERD causes

A

incompetent lower esophageal sphincter (LES)

delayed gastric emptying

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9
Q

Signs/symptoms of GERD

A 
retrosternal "burning"
bitter taste in mouth
belching, hiccups, dysphagia
worse at night/laying down
may be relieved with sitting up, antacids, water
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10
Q

Anyone with long-term GERD problems should…

A

Be referred for EGD to rule out Barrett’s esophagus or cancer
(by 5 years)

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11
Q

Treating GERD

A
  1. Lifestyle changes
  2. Antacids PRN
  3. H2 blockers, then H2 blockers BID
  4. Then PPI
  5. Then consider GI referral
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12
Q

What can be used for traveler’s diarrhea prophylaxis?

A

Pepto bismol (bismuth subsalicyclate)

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13
Q

When is further testing warranted for gastroenteritis in adults?

A

Symptoms lasting greater than 72 hours, or blood noted in stool
Check stool culture, WBC, and for ova and parasites

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14
Q

Causes of hepatitis

A

Viral- A, B, C (and more)
Autoimmune
Alcoholic

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15
Q

Common routes of hepatitis B transmission

A

Blood and blood products
Sexual activity
Mom to baby

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16
Q

Common routes of hepatitis C transmission

A

Often unknown
Traditionally associated with blood transfusion
About half of all cases related to IV drug use

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17
Q

Signs/symptoms of hepatitis

A

Pre-icteric: flu-like symptoms, aversion to smoke and alcohol
Icteric: weight loss, jaundice, pruritis, RUQ pain, clay colored stool, dark urine, low grade fever, hepatosplenomegaly

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18
Q

Lab signs of hepatitis

A

WBC low to normal
UA shows proteinuria, bilirubinuria
AST/ALT elevated
Alk phos, PT may be normal or slightly elevated

19
Q

Which form of hepatitis has identical serology for acute and chronic forms of disease?

How do you differentiate prior exposure from active infection?

A

Hepatitis C

Follow up with PCR testing

20
Q

Signs and symptoms of diverticulitis

A

LLQ pain
constipation or loose stools
nausea/vomiting
low grade fever

21
Q

What are your top 3 differentials for bowel perforation?

A
  1. Peptic ulcer disease
  2. Diverticulitis
  3. Appendicitis
22
Q

Labs/tests for diverticulitis

A

WBC and ESR elevated
Hemoccult positive in many cases
CT scan
Abdominal x-ray: should be NO FREE AIR ABOVE DIAPHRAGM

23
Q

Irritable bowel syndrome signs and symptoms

A 
Abdominal cramping
Pain relieved by defacation
Preoccupied with bowel symptoms
Changes in stool consistency/pattern
Often correlated with anxiety/depression
24
Q

Management of IBS

A

Emotional support- counseling/therapy
SSRIs for those who are depressed
High fiber diet

25
Q

Murphy’s sign

A

Deep pain on inspiration while fingers are placed under right rib cage

Positive points to cholecystitis

26
Q

Signs and symptoms of cholecystitis

A

Pain precipitated by large or fatty meal
RUQ pain and tenderness to palpation
Guarding and rebound pain
Fever

27
Q

How do you diagnose cholecystitis?

A

Abdominal ultrasound

28
Q

Causes of bowel obstruction

A 
Hernia
Adhesions
Volvulus (pediatrics)
Tumors
Fecal impaction
Ileus
29
Q

Signs/symptoms of bowel obstruction

A 
Minimal distention (higher obstruction)
Pronounced distention (lower obstruction)
Mild tenderness
High pitched, tinkling bowel sounds
Unable to pass stool/gas
30
Q

How do you test for bowel obstruction?

A

Abdominal x-ray shows dilated loops of bowel and air fluid levels

  • Horizontal pattern in SBO
  • Frame pattern in LBO
31
Q

Definition of ulcerative colitis

A

idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon

32
Q

Definition of Crohn’s disease

A

Upper bowel malabsorption syndrome

33
Q

Sx and Dx of ulcerative colitis

A

Bloody diarrhea
Negative stool studies
Sigmoidoscopy/colonoscopy confirms diagnosis

34
Q

Management of Ulcerative Colitis

A

Mesalamine suppositories or enemas for 3-12 weeks

Hydrocortisone suppositories or enemas

35
Q

Colon cancer risk factors

A

family history of colon, ovarian, or endometrial cancer
high fat high refined carbohydrate diet
personal history of polyps or inflammatory bowel disease

36
Q

Signs and symptoms of colon cancer

A

Often asymptomatic
Changes in bowel habits
Thin, skinny stools
Weight loss

37
Q

How quickly can appendicitis lead to gangrene and perforation?

A

Within 36 hours

38
Q

Incidence of appendicitis

A

Up to 10 percent of the population

Most commonly presented in men 18-30 years old

39
Q

Causes of appendicitis

A

Fecalith (things that don’t digest well get lodged)
Foreign body
Inflammation
Cancer

40
Q

Signs and symptoms of appendicitis

A

Vague, colicky umbilical pain that shifts to RLQ
Nausea with 1-2 episodes of vomiting
Pain worsened and localized with coughing

41
Q

Causes of Peptic Ulcer Disease

A

H. pylori
Medications (NSAIDs, ASA, steroids)
Type A personalities
(alcohol and diet do not appear to contribute)

42
Q

Physical exam findings with appendicitis

A

RLQ guarding with rebound tenderness
Psoa’s sign (RLQ pain with right thigh extension)
Rovsing’s sign (RLQ pain with pressure applied to LLQ)
Obturator sign (RLQ pain with internal rotation of flexed right thigh)
McBurney’s point pain (1/3 distance between iliac crest and umbilicus)

43
Q

How do you diagnose appendicitis?

A

Ultrasound or CT scan

44
Q

Is constipation a normal finding in gerontological population?

A

No, but may be commonly caused by lack of fiber, decreased exercise, dehydration, poor dentition, history of laxative abuse, and impaired mental status

AANP FNP: Adult (14 decks)

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