GI Flashcards
Signs and Symptoms of Peptic Ulcer disease
Gnawing epigastric pain
Relief of pain with eating (duodenal ulcers)
Pain worsens with eating (gastric ulcers)
GI bleeding
Signs of bowel perforation
Severe pain
“board-like” abdomen, rigidity
quiet, ominous bowel sounds
Lab and diagnosis of peptic ulcer disease
Normal except maybe some anemia on CBC
Consider endoscopy after 8-12 weeks of treatment
Consider H. pylori testing
Outpatient management of peptic ulcer disease
H2 Blockers first, then BID H2 blockers, then PPI, then refer for scope.
Breakthrough- Pepto bismol (bismuth subsalicyclate), Antacids like Mylanta, Maalox)
People on chronic PPI therapy should also have what supplement?
Calcium with vitamin D
Medications for Prevention of Peptic Ulcer Disease
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)
H. pylori eradication options
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
GERD causes
incompetent lower esophageal sphincter (LES)
delayed gastric emptying
Signs/symptoms of GERD
retrosternal "burning" bitter taste in mouth belching, hiccups, dysphagia worse at night/laying down may be relieved with sitting up, antacids, water
Anyone with long-term GERD problems should…
Be referred for EGD to rule out Barrett’s esophagus or cancer
(by 5 years)
Treating GERD
- Lifestyle changes
- Antacids PRN
- H2 blockers, then H2 blockers BID
- Then PPI
- Then consider GI referral
What can be used for traveler’s diarrhea prophylaxis?
Pepto bismol (bismuth subsalicyclate)
When is further testing warranted for gastroenteritis in adults?
Symptoms lasting greater than 72 hours, or blood noted in stool
Check stool culture, WBC, and for ova and parasites
Causes of hepatitis
Viral- A, B, C (and more)
Autoimmune
Alcoholic
Common routes of hepatitis B transmission
Blood and blood products
Sexual activity
Mom to baby
Common routes of hepatitis C transmission
Often unknown
Traditionally associated with blood transfusion
About half of all cases related to IV drug use
Signs/symptoms of hepatitis
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
Lab signs of hepatitis
WBC low to normal
UA shows proteinuria, bilirubinuria
AST/ALT elevated
Alk phos, PT may be normal or slightly elevated
Which form of hepatitis has identical serology for acute and chronic forms of disease?
How do you differentiate prior exposure from active infection?
Hepatitis C
Follow up with PCR testing
Signs and symptoms of diverticulitis
LLQ pain
constipation or loose stools
nausea/vomiting
low grade fever
What are your top 3 differentials for bowel perforation?
- Peptic ulcer disease
- Diverticulitis
- Appendicitis
Labs/tests for diverticulitis
WBC and ESR elevated
Hemoccult positive in many cases
CT scan
Abdominal x-ray: should be NO FREE AIR ABOVE DIAPHRAGM
Irritable bowel syndrome signs and symptoms
Abdominal cramping Pain relieved by defacation Preoccupied with bowel symptoms Changes in stool consistency/pattern Often correlated with anxiety/depression
Management of IBS
Emotional support- counseling/therapy
SSRIs for those who are depressed
High fiber diet
Murphy’s sign
Deep pain on inspiration while fingers are placed under right rib cage
Positive points to cholecystitis
Signs and symptoms of cholecystitis
Pain precipitated by large or fatty meal
RUQ pain and tenderness to palpation
Guarding and rebound pain
Fever
How do you diagnose cholecystitis?
Abdominal ultrasound
Causes of bowel obstruction
Hernia Adhesions Volvulus (pediatrics) Tumors Fecal impaction Ileus
Signs/symptoms of bowel obstruction
Minimal distention (higher obstruction) Pronounced distention (lower obstruction) Mild tenderness High pitched, tinkling bowel sounds Unable to pass stool/gas
How do you test for bowel obstruction?
Abdominal x-ray shows dilated loops of bowel and air fluid levels
- Horizontal pattern in SBO
- Frame pattern in LBO
Definition of ulcerative colitis
idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon
Definition of Crohn’s disease
Upper bowel malabsorption syndrome
Sx and Dx of ulcerative colitis
Bloody diarrhea
Negative stool studies
Sigmoidoscopy/colonoscopy confirms diagnosis
Management of Ulcerative Colitis
Mesalamine suppositories or enemas for 3-12 weeks
Hydrocortisone suppositories or enemas
Colon cancer risk factors
family history of colon, ovarian, or endometrial cancer
high fat high refined carbohydrate diet
personal history of polyps or inflammatory bowel disease
Signs and symptoms of colon cancer
Often asymptomatic
Changes in bowel habits
Thin, skinny stools
Weight loss
How quickly can appendicitis lead to gangrene and perforation?
Within 36 hours
Incidence of appendicitis
Up to 10 percent of the population
Most commonly presented in men 18-30 years old
Causes of appendicitis
Fecalith (things that don’t digest well get lodged)
Foreign body
Inflammation
Cancer
Signs and symptoms of appendicitis
Vague, colicky umbilical pain that shifts to RLQ
Nausea with 1-2 episodes of vomiting
Pain worsened and localized with coughing
Causes of Peptic Ulcer Disease
H. pylori
Medications (NSAIDs, ASA, steroids)
Type A personalities
(alcohol and diet do not appear to contribute)
Physical exam findings with appendicitis
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)
How do you diagnose appendicitis?
Ultrasound or CT scan
Is constipation a normal finding in gerontological population?
No, but may be commonly caused by lack of fiber, decreased exercise, dehydration, poor dentition, history of laxative abuse, and impaired mental status
