GI

Question 1

Mgmt of GERD

Answer 1

Empiric therapy with PPI (omeprazole) elimination of food triggers-chocolate, caffeine, ETOH, acidic foods.

Question 2

Most common cause of peptic ulcer disease, 2nd cause

Answer 2

H. Pylori, NSAIDS

Question 3

Murphy sign indicates

Answer 3

Cholecystitis

*painful arrest of inspiration triggered by palpating edge of inflamed gallbladder

Question 4

Blumberg’s sign

Answer 4

Elicited by gentle but deeply palpating an area of abdominal tenderness, then rapidly releasing the pressure. Pain is typically worse with release, usually indicating Abd wall or peritoneal inflammation (rebound tenderness)

Question 5

Markel’s sign

Answer 5

The pt stands on tip toes, then let the body weight fall quickly onto heels. The sign is positive if abdominal pain increases and localizes with the maneuver and is suggestive of peritoneal inflammation.

Question 6

Treatment of Diverticulosis

Answer 6

Increase fiber intake or add fiber supplements (psyllium)

Question 7

Treatment of Diverticulitis

Answer 7

Mild- Oral antibiotics, clear liquids, rest.

Acute- hospitalization, IV antibiotic, bowel rest (poss NG tube), analgesia

Question 8

Ulcerative colitis (UC)

Answer 8

Involves only the mucosal surface of the colon, which ultimately results in friability, erosions and bleeding. Mucosal destruction leads to sx-bleeding, cramping, urge to defecate.

Question 9

UC stool sample findings

Answer 9

Positive for blood and Fecal Leukocytes are always positive

Question 10

Treatments of UC

Answer 10

Anti diarrheal meds- lomotil, immodium
Meds- steroids, immunosuppressants.
Nutrition- avoid caffeine, raw fruits, and veggies. Needs high calorie, high protein bland diet.

Question 11

Crohn’s disease definition

Answer 11

Inflammatory condition that starts at the submucosa of the intestine, and spreads to involve the mucosa and serosa.

Question 12

Clinical presentation of CD

Answer 12

Bloody stool intermittently, steatorrhea, fever, anorexia, wt loss.
Typical lesions are granulomatous with projections of inflamed tissue with a COBBLESTONE APPEARANCE

Question 13

Management of CD

Answer 13

Steroids, sulfasalazine, immuno-suppressant agents (infliximab (Remicade)
Surgery is last resort

Question 14

Irritable bowel syndrome description

Answer 14

Chronic, functional disorder of the gastrointestinal tract characterized by chronic abdominal pain and altered bowel habits in the absence of organic disease.

Question 15

IBS criteria

Answer 15

Recurrent abdominal pain or discomfort at least 3 days per mth in the last 3 mths with 2 or more of the following: improved with defecation, onset associated with a change in frequency of stool, onset associated with a change in form (appearance of stool)

Question 16

Mgmt of IBS

Answer 16

Avoid lactose, gluten and gas-producing foods.
Fiber (Psyllium), amitza, linzess, lactulose, milk of mg.
Loperamide, bile-acid sequestrants, lotronex

Question 17

Sx with erosive gastritis

Answer 17

Intermittent nausea, burning and pain. Limited to upper abdomen (epigastric) WORSE WITH EATING
Associated with excessive NSAID use

Question 18

Sx with acute pancreatitis

Answer 18

Acute epigastric pain that radiates, bloating, nausea, vomiting.
Hypo active bowel sounds, abdomen distention, ELEVATED LIPASE/AMYLASE

Question 19

Sx with duodenal ulcer

Answer 19

Intermittent upper abdomen pain. GNAWING, burning pain 2-3 hrs after eating. RELIEVED BY EATING or with antacids (to neutralize the acid)

Question 20

Sx with diverticulitis

Answer 20

Intermittent left lower quadrant pain, accompanied by fever, cramping, nausea and 4-5 loose stools per day

Question 21

Normal percussion size of liver

Answer 21

Hepatic span by percussion 7cm at the midclavicular line

Question 22

Adults born I what year range should be tested for HCV regardless of risk factors?

Answer 22

1945-1965

Question 23

Marker for acute Hep A?

Past Hep A?

Answer 23

Acute- HAV IgM (immediate) positive

Past- Anti-HAV and HAV IgG (gone) positive

Question 24

Marker for acute Hep B?

Answer 24

HBV core IgM (immediate)
HBsAg (Ag=always growing)
HBeAg (notes a time when HBV is Extra contagious)

Question 25

Marker for chronic Hep B?

Answer 25

HBsAg (always growing)

*pt without symptoms, NL or slightly elevated hepatic enzymes.

Question 26

Marker for Hep B in the past/antibody?

Answer 26

(Anti-HBs) HBsAb (b=bye, as no HBV on board.

Shows protective antibody- unable to get Hep B in future

Question 27

Marker for acute Hep C?

Answer 27

Anti-HCV (present)
HCV RNA (positive) 
Along with elevated hepatic enzymes

Question 28

Marker for chronic Hep C?

Answer 28

Anti-HCV (present)
HCV RNA (positive) 
Along with normal to slightly elevated hepatic enzymes

Question 29

Marker for past (cured) Hep C?

Answer 29

Anti-HCV (present (non-protective antibody) 
HCV RNA (absent)
Along with normalization of hepatic enzymes