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NP Boards > GI > Flashcards

GI Flashcards

1
Q

relief w/ eating food

A

duodenal ulcer

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2
Q

no relief w/ eating food

A

gastric ulcer

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3
Q

board like/rigid abdomen, quiet bowel sounds

A

perforation(5-10% of PUD cases….less common)

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4
Q

Melena, hematemesis

% of PUD?

A

gi bleed (20% of PUD cases…more common)

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5
Q

H2 Blockers

A

Ranitidine (Zantac), Famotidine (Pepcid)

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6
Q

Lansoprazole (Prevacid) 15mg/day

Omeprazole (PRilosec) 20mg/day

A

PPI

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7
Q

PUD Management

  1. order of tx
  2. assistive meds
A
  1. H2B (1st line med) q HS ==> BID ==> + PPI ==> refer
  2. Mucal protective agents (give 2 hrs apart from other meds)
    ex: bismuth subsalicylate (pepto-bismol)
    misoprostol (cytoect) QID w/ food
    maalox
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8
Q

H. Pylori tx

  1. generally
  2. most popular regimen
A
  1. two antibiotics + proton pump inhibitor or bismuth
  2. A) Flagyl 500mg BID, + Clarithormycin (Biaxin) 500mg BID both w/ meals, + omeprazole (Prilosec) 20mg bid b/f meals all for 7 days.
    B) Same as above except Amoxicillin instead of flagyl
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9
Q

GERD
A) S/S
B) diagnostics

A

A) retrosternal burning
bitter taste in mouth
belching, hiccoughs, dysphagia
B) EGD to r/o barrett’s (throat cancer)

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10
Q

Symptom of Dysphasia in older vs younger pt

A

older ==> symptom of GERD

younger ==> symptom of possible cancer

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11
Q

GERD mgt

1) lifestyle
2) meds

A

1) elevate head of bed, no spicy etoh caffeine, no smoking, wt reduction
2) antacids prn ==> H2 blockers (tidines) @HS ==> PPI “zoles” ==> referr

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12
Q

syndrome of acute nausea, vomiting, diarrhea, and cramping from inflammation/irritation of gastric mucosa, nonspecific.

A

Gastroenteritis

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13
Q

Gastroenteritis mgt

A

not indicated unless persist > 72hrs or if note blood in stool…then==>
Stool culture, O&P, WBC, fecal occult

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14
Q

Gastroenteritis causes

A

virus (most common in winter)
bacterial
parasitic
emotional stress

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15
Q

Route

1) Hep A
2) Hep B
3) Hep C

A
  1. oral-fecal
  2. all body fluids (bld, saliva, semen, vaginal secretions)
  3. Blood (from transfusion, 50% IV drug use)
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16
Q

Hepatitis C S/S

  1. early
  2. later
  3. labs
A
  1. Pre-icteric: fatigue/malaise, anorexia, n/v, HA, aversion to to smoking/etoh
  2. Icteric: wt loss, jaundice, pruritus, RUQ pain, dark urine, hepatosplenomegaly
  3. Elevated AST & ALT (500 -2000)
17
Q

Hepatitis Labs:

A

Elevate AST/ALT,

18
Q

PCR (polymerase chain reaction)

A

IDS prior exposure from current viremia in hep C

19
Q
  1. IgM, Anti-HAV
  2. IgG, Anti HAV
  3. IgG, IgM, HBsAg
  4. IgM, HBsAg
A
  1. Hep A Immediate - acute
  2. Hep A gone - gone?
  3. Hep B chronic
  4. Hep B aqute
    5.
20
Q

Diverticulitis

  1. higher incidence in?
  2. s/s of problem?
  3. diagnostics
  4. need to r/o?
A
  1. higher incidence in those with low dietary fiber
  2. LLQ pain problem
  3. sigmoidoscopy show inflammation, CT to r/o abbess
  4. abd films to r/o free air
21
Q

Irritable Bowel Snydrome

  1. incidence/causes
  2. diagnositcs
  3. mgt
A
  1. F>M, stress theory (control issue?)
  2. normal findings on sigmoidocopy, barium studies, rectal exam
  3. emotional support, high fiber diet, SSRI for depression
22
Q

deep pain on inspiration while fingers are placed under the right rib cage.

A

+ murphy sign ==> cholecystitis

23
Q

Gold Standard for Cholecystitis diagnosis

A

ultrasound (plan film may show gallstones)

24
Q

Cholecystitis s/s

A

Murphy’s sigh, RUQ tenderness, muscle garding, rebond pian, fever, palpable gallbladder in 15% of cases

25
Q

Bowel Obstruction s/s

A
  • high pitched, tinkling bowel sounds (think water over rocks)
  • unable to pass gas/stool
  • plain films: dilated loops of bowel and air fluid levels (horizonital shape if SBO & frame patten if LBO)
  • vomiting within minutes of pain (proximal BO) and within hours of pain (distal BO)
26
Q

Ulcerative colitis

  1. s/s
  2. diagnosis
  3. mgt
A
  1. hallmark symptom: bloody diarrhea “the squirts”
  2. sigmoidoscopy shows inflammation/ulcers of colon, stool studies negative
  3. Hydrocortisone suppositories & enemas, Mesalamine (Canasa) suppositories or enemas (anti-inflammatory drug)
27
Q

1 reason for filling toilet up with blood

A

ulcerative colitis

28
Q

Ulcerative Colitis vs Crohn’s

A
  1. Ulcerative colitis==> diffuse mucosal inflammation of colon, also may involve rectum
  2. Crohn’s ==> upper bowel malabsorption syndrome w/ ulcers
29
Q

2 cancer killer in US

A

colorectal cancer

30
Q

ulcerative colitis mgt

A
  1. mesalamine (canasa) suppository (anti-inflammatory drug)

2. hydrocortisone suppositories and enemas

31
Q

risk factor for bowel obstruction

A
  • adhesions from prior abdominal surgeries

- colon cancer

32
Q

common presentation in Men 18 - 30 yrs

A

appendicitis

33
Q

Psoa’s sign

  1. what is positive?
  2. what does positive mean?
A
  1. pain with right thigh extension

2. appendicitis

34
Q

Obturator sign

  1. What is positive
  2. What does positive mean?
A
  1. Pain with internal rotation of flexed right thigh

2. appendicitis

35
Q

Rovsing’s sign

  1. What is positive
  2. What does positive mean?
A
  1. RLQ abd pain when presure applied to the LLQ.

2. appendicitis

36
Q

appendicitis diagnostics

A
  1. WBC: high - mildly elevated

2. CT or US is diagnostic

37
Q

Gerontology Considerations

A

Decreased:

  1. jaw muscles for chewing
  2. thirst/taste perception
  3. liver size & liver blood flow ==> altered drug absorption
    * Constipation NOT a normal finding in gero: common cause hx of laxative abuse

NP Boards (4 decks)

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