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GI Flashcards

1
Q

Peptic Ulcer Dz Causes

A

Causes:

  • H. Pylori (90% duodenal ulcers, 75% gastric ulcers)
  • NSAIDS & Glucocorticoids
  • More common in men 3:1
  • >1/2 PPD smkr
  • Alcohol and other dietary factors do NOT cause PUD
  • Stress?
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2
Q

PUD Signs / Symptoms

A
  1. Gnawing epigastric pain
  2. Relief with eating (duodenal) “RED”
  3. Pain worsens with eating (gastric) “PEG”
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3
Q

PUD Physical Findings

A
  1. Mild epigastric tenderness
  2. GI Bleeding (20%) Melena, hematemesis, coffee-ground emesis (ususally duodenal ulcer)
  3. Perforation (5-10%) severe epigastric pain, board-like abd, quiet bowel sounds, rigidity, free air
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4
Q

Are duodenal ulcers more common in the young or the old?

A
  • Duodenal=Young “DIY”
  • Gastric=OLD “GO”
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5
Q

Are duodenal ulcers located in the fundus or the antrum of the stomach?

A

Antrum

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6
Q

3 causes of Perforation

A
  1. PUD
  2. Ruptured Appendix
  3. Ruptured Diverticula
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7
Q

Melena Definition

A

Blak, tarry stools

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8
Q

PUD Diagnostics

A
  • Anemia on CBC
  • H.Pylori testing
  • Consider endoscopy after 6-8 weeks of tx
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9
Q

What time frame should endoscopy be considered for PUD?

A

After 2-8 weeks of treatment

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10
Q

First line PUD Out-pt Management

A

H2Antagonists - take at night

  1. Cimetadine/ tagamet 800mg
  2. Ranitidine/ zantac 300 mg
  3. Famotidine/ pepcid 40mg
  4. Nizatidine/ axid 300mg

Increase to BID then if no improvement, change to PPI

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11
Q

Second Line Out-Pt PUD Management

A

PPI’s - 30 min before meals in the morning

  1. Lansoprazole/ Prevacid 15mg
  2. Rabeprazole/ Aciphex 20mg
  3. Omeprazole/ Protonix 40mg
  4. Dexlansoprazole / Dexilant 30mg
  5. Esmoprazole / Nexium 20mg
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12
Q

List common PPI’s

A

Lansoprazole

Rabeprazole

Pantoprazole

Omeprazole

*give 30 min before meals*

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13
Q

Mucosal Protective Agents

A

Give 2 hrs apart from other medications

  1. Sucralfate 1 gm QID /Carafate requires acidic environment -avoid antacids and H2 blockers
  2. Bismuth subsalicylate (Pepto-bismol) -tx traveler’s diarrhea and gastroenteritis, direct action against H.Pylori, promotes prostaglandin production, stimulates gastric bicarbonate
  3. Mistoprostol / Cytotec QID with food - pt’s with RA, prophylaxis against NSAID ulcers, may stimulate uterine contraction and induce abortion
  4. Antacids- local help with heartburn symptoms, does not reduce gastric acidity
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14
Q

ABD Conditions by Quadrant

A

LLQ- diverticulitis

RUQ- gallbladder

RLQ-appendix

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15
Q

List common H2 receptor antagonists

A

Cimetidine

Ranitidine

Famotidine

Nizatidine

*Give at night*

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16
Q

What test is used for H.Pylori?

A

Breath test

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17
Q

H.Pylori Eradication Therapy Resistance

A

*Must use combination therapy*

Resistance develops quickly to metronidazole/flagyl and clarithromycin/ biaxin

Does not develop quickly to amoxicillin or tetracycline

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18
Q

H.Pylori Therapy ATB Options

A

2 ATB’s + either a PPI OR bismuth

  • ATB are BID dosing (AOC, MOC, MOA)

A moxicillin + omeprazole + clarithromycin x 7 days

O meprazole

C larithromycin

MOC (Metronidazole + omeprazole+clarithromycin x 7 days)

O meprazole

A moxicllin x 7-14 days

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19
Q

H. pylori therapy Bismuth regimens

A

Bismuth regimens are QID dosing

Bismuth 2 tabs QID

Metronidazole 250mg QID

Tetracycline 500mg QID

OR

BMT + omeprazole- above regimen +omeprazole 20mg BID x 7 days

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20
Q

What is the recommended anti-ulcer therapy duration after H.Pylori treatment?

A

Duodenal= Omeprazole or lansoprazole for additional 7 weeks

H2 blockers or sucralfate for 6-8 weeks

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21
Q

What medication is associated with a decrease in nosocomial PNA?

A

Carafate

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22
Q

What condition can lead to esophageal cancer?

A

Untreated GERD => Barrett’s esophagus=> cancer

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23
Q

Which mucosal protective agent is used in RA pt’s as prophylaxis against NSAID induced ulcers?

A

Misoprostol/Cytotec

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24
Q

Which mucosal protective agent has direct effects against

H. Pylori?

A

Bismuth subsalicylate

25
When is FFP indicated in PUD/Bleeding ulcers?
When coagulopathy is present
26
In-Hospital Managment PUD/Bleeding Ulcers/Perf
1. IV access, begin fluids, blood products 2. O2 3. Endoscopy, **GI angio** 4. Urinary cath 5. NPO/ NG tube fore gastric lavage (**bleeding stops spontaneously in 80% of cases)** 6. XRays show **free air in 75% of cases** 7. Monitor abd assessment - quiet, rigid with rebound tenderness 8. IV H2 blockers 9. **If coagulopathy present, give FFP**, monitor PT,PTT, INR 10. **If thrombocytopenia \<50,000**, transuse plts 11. GI surgical eval-scope
27
GERD
Characterized by reflux of gastric contents into the esophagus Causes: * Incompetent lower esophageal sphincter (LES) * delayed gastric emptying
28
GERD Signs/ Symptoms
* Retrosternal burning * Bitter taste in mouth * Belching, hiccoughs, dysphagia * Excessive salivation * Frerquently **occurs at night** * Relieved by sitting up, antacids, water, food
29
GERD Diagnositcs
Consider referral for EGD R/o Barrett's esophagus, PUD
30
GERD Management
Non-pharm: * Elevate HOB * Avoid triggers: alcohol, caffiene, spices, peppermint * stop smoking * Weight reduction if obese Pharm: * Antacids PRN * **H2 blockers in high doses at night or BID** * PPI if H2 ineffective * GI/Surg consult PRN
31
List 3 causes of Hepatitis
Inflammation of the iver with resultant liver dysfunction Causes: * Viral * Autoimmune * Alcoholic
32
Which viral type of hepatitis is bad in pregnancy?
Type E=endemic
33
Hepatitis A
A=Ass Enteral virus, transmitted via the fecal oral route and rarely parenterally * Contaminated water and food, intimate contact
34
During what timeframe are blood and stool infectious in Hep A?
Blood and stool are infectious during 2-6 week incubation period
35
Which types of hepatitis have an available vaccine?
A&B
36
How is Hepatitis B transmitted?
B=Blood Blood borne, DNA virus in body fluids, transmitted via blood and sexual activity and mother to fetus
37
How is Hep C transmitted?
C=Contaminated needles Blood borne, RNA virus, 50% tranmitted via IV drug use
38
List symptoms in the pre-icteric phase of Hepatitis
* Fatigue * Malaise * Anorexia * N/V * Aversion to smoking/alcohol
39
List symptoms in Icteric phase of Hepatitis
* Weight loss * Jaundice * RUQ abd pain * **Clay colored stool** * **Dark urine** * **Low grade fever** * **Hepatosplenomegaly**
40
Wht findings might be seen in UA of pt's with hepatitis?
Proteinuria Bilirubinuria
41
What are AST/ALT findings in hepatitis?
Elevated 500-2000
42
Hep A serology findings in Active disease
Anti-HAV, IgM
43
Recovered Hep A serology findings
Anti-HAV, IgG
44
HAV-IgG indictes what?
Previous exposure and immunity
45
What is the first evidence of HBV infection?
HBsAg Remains positive in asymptomatic carriers and chronic Hep B
46
Which marker indicates highly infectious sera in Hep B?
HBeAg
47
List markers of Active HBV
HBsAg HBeAg IgM
48
List markers of Chronic HBV infection
Anti-HBe (indicates decreased infectivity) IgM IgG
49
List markers of Recovered HBV
Anti-HBc Anti-HBsAg
50
Which test is used to differentiate prior exposure from current viremia for Hep C?
PCR
51
List serology for Acute and Chronic HCV
Anti-HCV HCV RNA
52
What drug is used for sedation in hepatits patients?
Oxazepam (serax)
53
List general tx strategies for hepatitis
Rest during active phase Increase fluids to 3-4 liters per day No ETOH or other drugs detoxed by liver No protein diet Vit K if INR\>1.5 Lactulose for elevated ammonia
54
Is diverticulits more common in women or men?
Women
55
What diet is associated with diverticulits?
Low fiber
56
Wht bowel symptoms might be found in diverticulitis?
Constipation or loose stools
57
Name quadrant associated with diverticultis
LLQ Pts with perforation have perionteal signs
58
Diagnostic testing consideration in diverticultis
* Stool heme is present in 25% * Sigmoidoscopy shows inflammed mucosa * CT to eval abscess * **XR for all pts to eval for free air**
59
List in-pt management strategies for diverticultis
* NPO * IVF * IV ATB * Tx as with

ACNP Certification (17 decks)

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