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ACNP Certification > GI > Flashcards

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
Q

When is FFP indicated in PUD/Bleeding ulcers?

A

When coagulopathy is present

26
Q

In-Hospital Managment PUD/Bleeding Ulcers/Perf

A
  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
Q

GERD

A

Characterized by reflux of gastric contents into the esophagus

Causes:

  • Incompetent lower esophageal sphincter (LES)
  • delayed gastric emptying
28
Q

GERD Signs/ Symptoms

A
  • Retrosternal burning
  • Bitter taste in mouth
  • Belching, hiccoughs, dysphagia
  • Excessive salivation
  • Frerquently occurs at night
  • Relieved by sitting up, antacids, water, food
29
Q

GERD Diagnositcs

A

Consider referral for EGD

R/o Barrett’s esophagus, PUD

30
Q

GERD Management

A

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
Q

List 3 causes of Hepatitis

A

Inflammation of the iver with resultant liver dysfunction

Causes:

  • Viral
  • Autoimmune
  • Alcoholic
32
Q

Which viral type of hepatitis is bad in pregnancy?

A

Type E=endemic

33
Q

Hepatitis A

A

A=Ass

Enteral virus, transmitted via the fecal oral route and rarely parenterally

  • Contaminated water and food, intimate contact
34
Q

During what timeframe are blood and stool infectious in

Hep A?

A

Blood and stool are infectious during 2-6 week incubation period

35
Q

Which types of hepatitis have an available vaccine?

36
Q

How is Hepatitis B transmitted?

A

B=Blood

Blood borne, DNA virus in body fluids, transmitted via blood and sexual activity and mother to fetus

37
Q

How is Hep C transmitted?

A

C=Contaminated needles

Blood borne, RNA virus, 50% tranmitted via IV drug use

38
Q

List symptoms in the pre-icteric phase of Hepatitis

A
  • Fatigue
  • Malaise
  • Anorexia
  • N/V
  • Aversion to smoking/alcohol
39
Q

List symptoms in Icteric phase of Hepatitis

A
  • Weight loss
  • Jaundice
  • RUQ abd pain
  • Clay colored stool
  • Dark urine
  • Low grade fever
  • Hepatosplenomegaly
40
Q

Wht findings might be seen in UA of pt’s with hepatitis?

A

Proteinuria

Bilirubinuria

41
Q

What are AST/ALT findings in hepatitis?

A

Elevated 500-2000

42
Q

Hep A serology findings in Active disease

A

Anti-HAV, IgM

43
Q

Recovered Hep A serology findings

A

Anti-HAV, IgG

44
Q

HAV-IgG indictes what?

A

Previous exposure and immunity

45
Q

What is the first evidence of HBV infection?

A

HBsAg

Remains positive in asymptomatic carriers and chronic Hep B

46
Q

Which marker indicates highly infectious sera in Hep B?

47
Q

List markers of Active HBV

A

HBsAg

HBeAg

IgM

48
Q

List markers of Chronic HBV infection

A

Anti-HBe (indicates decreased infectivity)

IgM

IgG

49
Q

List markers of Recovered HBV

A

Anti-HBc

Anti-HBsAg

50
Q

Which test is used to differentiate prior exposure from current viremia for Hep C?

51
Q

List serology for Acute and Chronic HCV

A

Anti-HCV

HCV RNA

52
Q

What drug is used for sedation in hepatits patients?

A

Oxazepam (serax)

53
Q

List general tx strategies for hepatitis

A

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
Q

Is diverticulits more common in women or men?

55
Q

What diet is associated with diverticulits?

56
Q

Wht bowel symptoms might be found in diverticulitis?

A

Constipation or loose stools

57
Q

Name quadrant associated with diverticultis

A

LLQ

Pts with perforation have perionteal signs

58
Q

Diagnostic testing consideration in diverticultis

A
  • Stool heme is present in 25%
  • Sigmoidoscopy shows inflammed mucosa
  • CT to eval abscess
  • XR for all pts to eval for free air
59
Q

List in-pt management strategies for diverticultis

A
  • NPO
  • IVF
  • IV ATB
  • Tx as with

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