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GI Flashcards

1
Q

Name two types of peptic ulcers:

A

duodenal ulcers (young 30-55), feel better with feeding

gastric ulcers (old 55-65), feel worse with feeding

signs of symptoms: GNAWING epigastric pain

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2
Q

signs/symptoms of perforated ulcers:

A

severe epigastric pain

rigid boardlike abd

quiet bowel sounds

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3
Q

What are three causes of a perfed bowel?

A

peptic ulcer disease

ruptured diverticulum

appendicitis (rare)

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4
Q

This is tested by a urea breath test, can be present with duodenal or gastric ulcers

A

H. pylori

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5
Q

What is the step-wise approach for outpatient management of peptic ulcer disease?

A
  • 1st line, everybody gets this: H2 blockers*
  • -tidine*
  • ranitidince (zantac) famotidine (pepcid)*

2nd line: PPIs

-azole

lansoprazole (prevacid) omeprazole (prilosec) esomeprazole (nexmium)

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6
Q

What musosal protective agent is used for traveler’s diarrhea and has direct action against H. pylori?

A

bismuth subsalicylate (peptobismal)

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7
Q

What mucosal protective agent is used for NSAID induced ulcer prophylaxis and it therefore given to patients with RA who take chronic NSAIDS?

A

Misopristol (cytotec)

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8
Q

H. pylori eradication therapy includes five possible 3 drug combinations. What three combinations use 2 abx + PPI?

AOC

MOC

MOA

A

A *amoxicillin+omeprazole+clarithromycin

O *Metronidazole + omeprazole + clarithromycin

M O C *Metronidazole + omeprazole + amoxicillin

O

A

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9
Q

H. pylori eradication therapy includes five possible 3 drug combinations. What are the two regimens that include 2 abx + 1 bismuth?

THE BMT BMTO is not as popular due to qid dosing

A

BMT: bismuth+metronidazole+tetracycline

BMTO: bismuth+metronidazole+tetracycline+omeprazole

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10
Q

If you suspect a bowel perf, what imaging would you order and what would it show?

A

upright or decubitus abd xray show in about 75% of cases

you would expect it to show free air under the abd

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11
Q

1) When the normal tissue lining the esophagus changes to tissue that resembles the lining of the intestine.
2) this is a serious complication of GERD.
3) this finding increases the risk of developing esophageal adenocarcinoma, which is a serious, potentially fatal cancer of the esophagus.

A

Barrett’s esophagus

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12
Q

What are normal platelet count?

A

150-400

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13
Q

With hepatitis A, the blood and stool are infectious during the _______ week incubation period:

A

2-6 week incubation period

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14
Q

Hep B is transmitted through:

A

blood

sexual activity

mother-fetus

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15
Q

Which two types of hepatitis have a vaccine?

A

A and B

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16
Q

Why do patients in the icteric phase have jaundice?

A

from unconjugated bilirubin

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17
Q

What is the Normal AST ALT lab values?

A

35-50

18
Q

Your patients hepatitis serology shows Anti-HAV, IgM. What does that mean?

A

anti-HAV means their body has produced an antibody for hepatitis A

IgM means iMMEDIATE or Miserable, they are actively infected

so

they have active hep A infection

19
Q

You patients hepatitis serology shows anti-HAV, IgG. How do you interpret that?

A

recovered hepatitis A

(G=Gone)

20
Q

In hepatitis serology, HBeAg signifies what?

A

It indicates viral replication and infectivity of Hep B.

It means they can transmit hep B

21
Q

If your patient’s hepatitis serology shows HBsAg, HBeAg, Anti-HBc, IgM, what does that mean?

A

They have active transmittable hep B

HBeAg (antigen is the bad guy) = transmittable

IgM=miserable, iMediate

22
Q

Your patients hepatitis serology shows: HBsAg, Anti-HBc, anti-HBe, IgM, IgG. What is the diagnosis?

A

Chronic hep B

IgM and IgG

23
Q

Your patients hepatitis serology shows: Anti-HBc, Anti-HBsAg.

What is the diagnosis?

A

recovered Hep B

anti- the body has developed antibodies

24
Q

Your patients hepatitis serology shows:

anti-HCV, HCV RNA

What are the TWO possible diagnoses and how would you further differentiate the diagnosis?

A

acute or chronic Hep C

PCR is used to differentiate prior exposure (chronic hep C) from current viremia (acute hep C)

25
Q

Diverticulitis is inflammation of diverticula with abscess formation. What are two physical findings?

A

low grade fever

LLQ abd tenderness to palpation

26
Q

A female patient with a low fiber diet is diagnosed with diverticulitis. You admit her to the hospital. What is the diet order for a patient with diverticulitis?

A

A patient with diverticulitis should be made NPO

27
Q

All patients diagnosed with diverticulitis should have plain abdominal films done to look for evidence of:

A

free air under the diaghragm which would indicate bowel perforation

28
Q

You have a fat fair forty and female patient with a positive Murphy’s sign and c/o RUQ abd pain after eating fatty foods. You suspect what?

A

Cholecystitis (inflammation of the gallbladder)

29
Q

What labs are typically elevated in cholecystitis?

A

ALT

AST

LDH

alk phos

*possible amylase

30
Q

What is the most common cause of pancreatitis?

A

gallbladder disease/cholecystitis

31
Q

What are three common causes of pancreatitis?

A

cholecystitis

hyperlipidemia

HEAVY alcohol use

32
Q

If a patient had a paralytic ileus, what would their bowel sounds be?

A

absent bowel sounds

33
Q

Grey Turner’s sign and Cullen’s sign are often found in pancreatitis. What are they?

A

Grey turners: flank discoloration

Cullens sign: umbilical discoloration

34
Q

A patient with pancreatitis is admitted to the hospital and made NPO. When can they advance their diet and start clear liquids?

A

When they are pain free and have bowel sounds

35
Q

Two signs of hypocalcemia are Chvosteks and Trousseau’s. Describe them.

A

Chvosteks: cheek tetany

Trousseaus: carpal tunnel tetany

36
Q

A patient presents with vomiting, high pitched tinkling bowel sounds, abdominal distention, and the plain abd films show dilated loops of bowel and air-fluid levels. What is their diagnosis and treatment?

A

Diagnosis: bowel obstruction

treatment: in complete obstruction ALL cases require surgical intervention or they will die

37
Q

A patient presents with episodes and remission of bloody diarrhea and sigmoidoscopy is cobblestone appearing.

What is the diagnosis?

A

Ulcerative colitis

38
Q

A smoking vasculopath presents with sudden onset abd pain out of proportion to physical exam findings.

What is the diagnosis and what is the treatment?

A

dx: mesenteric infarct
tx: emergent surgical intervention

39
Q

A patient presents with a positive Psoas sign, positive obturator sign, and positive Rovsings sign. What is the diagnosis?

A

appendicitis

*Psoas: pain with R thigh extension

obturator: pain with internal rotation of flexed R thigh

positive Rovsings sign: RLQ abd pain when pressure is applied to LLQ abd

40
Q
A

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