GI

Question 1

Antacids

Answer 1

Counteracts acids in stomach
Affects absorption of other medications

Take 2 hours apart from other meds and with a glass of water

Maalox, mylanta, tums, pesto-bismal

Question 2

H2 blockers

Answer 2

Supresses gastric secretion

Zantac / Pepcid

Question 3

Prokinetic Agents

Answer 3

Increases LES tone and promotes gastric emptying

Take prior to meals

Reglan

Question 4

PPI

Answer 4

Supresses gastric acid secretion better than H2 blockers

Prilosec Prevacid ( omeprazole, lansoprazole)

Question 5

GERD

Answer 5

LES dysfunction
Acid reflux = irritation of mucosa

Infective esophageal clearance of reflux caused by decreased saliva and decreased esophageal peristalsis at night

Delayed gastric emptying

Risk factors : anything that decreases LES
- anticholinergics, morphine, CCB, nitrates, alcohol, caffeine, spicy food, chocolate

• large meals, lying down after meals , tight clothing, obesity

Findings
- heartburn, burning 30-60 after eating, exacerbations by lying down or bending over, regurgitation, sour stomach

Atypical - asthma, cp, cough, sore throat

PE: mid epigastric tenderness, no blood in stool

Question 6

GERD management

Answer 6

1. Lifestyle
2. Antacids ( mild to moderate)
   H2 blockers ( severe)
   Alginate acid ( acts as barrier ) - Gaviscon
3. PPI
   
   • tx - 4-8 weeks with higher dose
   • maintainance - lover dose
4. Reglan w/ H2 or PPI
   Be aware CNS affects

Question 7

Peptic ulcer Disease

Answer 7

Painful ulcerations in the stomach
Either gastric or small intestine ( duodenal)

From : NSAIDS, H, Pylori, acid hypersecretory states

Pain better after meals = duodenal
Pain worse after meals = gastric
N/v/weight loss

PE: mild, localized epigastric tenderness to deep palpation

Question 8

PUD treatment

Answer 8

• stop NSAIDS, smaller meals

H.plyori - two antibitoics and a PPI for 7-14 days
- flagly 500 mg, amoxicillin 1 gm BID,
- Prilosec 20 mg BID or Prevacid 30 BID
After treament continue on PPI or H2B PRN

Non Hpylori 
   - gastric 
          Prilosec 40 mg 4-8 weeks
          Prevacid 30 mg 4-8 weeks
 - duodenal 
     - Prilosec 20 mg 4-8 wks
    - Prevacid 15 mg 4 weeks

Question 9

Diarrhea

Answer 9

Increased stool freq > 3 BM per day of liquidity stool

Actute < 2 weeks
Chronic > 4 weeks

Acute noninflammatory
- watery, non bloody stool, abd cramping, bloating , n/v, caused by a virus
- no dx unless > 7 days
Acute inflammatory
- blood , pus or fever
- LLQm urgency, tensesmus, toxic bacteria.

Question 10

Chronic diarrhea

Answer 10

Osmotic - water retention in bowel 
Secretory - cholera
Inflammation - chrons, colitis 
Meds
Malabsorption

Question 11

PE, DX, diarrhea

Answer 11

PE: fever, weight loss, dehydration, tachy, poor skin tumor, hyperactive bowel sounds, generalized tenderness, stool may have blood

DX: stool culture, c.diff, CBC, electrolytes , sigmiodocosopy or colonoscopy for colitis
Labs for malabsorption
Fatty stool - 24 stool

Question 12

Diarrhea treatment

Answer 12

Diet, rehydration, antidiarrheal agents, antibiotics

Question 13

C-diff

Answer 13

Flagyl for mild to moderate cases - 500 mg 14 days

Vancomycin 125 mg 10 day - severe

No role for probiotics in lit

Avoid anti-peristaltics agents

Question 14

Constipation

Answer 14

< 3 BM a week 
Dry, hard, straining 
Elderly predisposed 
 - meds, poor eating, dental, mobility
Multifactorial 
 - slow colonic transit time, decreased colonic motility due to aging, cognitive impairments

Question 15

Constipation H and PE

Answer 15

Change in pattern, character or color, any new medications, diet, fluid intake

PE: distention, abdominal tenderness, palpable stool in colon, decreased bowel sounds , rectal exam

Question 16

Constipation dx studies

Answer 16

Stool for occult blood, CBC - anemia , electrolytes, TFT, X-ray - obstruction

Question 17

Constipation tX

Answer 17

Fiber (15 g/day)
Purines, fluid, exercise, bowel training,

1. Hydrophilic colloids or bulk forming - Metamucil or surfactants ( stool softerners)
2. Osomotic laxatives - sorbitol, lactulose
   Stimulant laxatives
   - may cause dependency
3. Enemas

Question 18

IBD’s

Answer 18

UC - only occurs in the large intestine

Chrons - autoimmune that can occur anywhere

IBS - syndrome known for chronic abd pain, diarrhea, constiaption, - no inflammation

Question 19

UC

Answer 19

Autoimmune

Inflammation of the superficial mucosa lay of colon

Onset adolescence to early adulthood

Etiology : envirnoment vs genetic

Question 20

UC s/s

Answer 20

Depends on the extent and severity of dx

• gradual, bloody diarrhea, tenesmus, colicky abdominal pain, weight loss,

Mild < 4 bowel movements / day with or w/o blood no signs of toxcity and normal ESR

Moderate > 4 BM day, minimal signs of tox

Severe > 6 BM day, fever, tachy, anemia, ESR elevated

Question 21

UC dx and management

Answer 21

CBC, CRP, ESR, stool culture, colonoscopy

GI for confirmation
Goal to induce remission and prevent relapses
- topical administrationof 5 ASA suppository
- oral prednisone
- colectomy

Question 22

Chron’s disease

Answer 22

Autoimmune
Transmural inflammation of GI tract
Most commonly involving the distal ileum
13-30 ages

Question 23

Chrons s/s PE

Answer 23

RLQ abd pain and cramping
Fatigue, diarrhea , rectal bleeding weight loss, fever

PE: arthralgias, iritis, erythema nodosum

Question 24

Chrons management

Answer 24

GI referral

5 ASA, antibiotics, corticosteroids, immunodoluating drugs

Surgical intervention

Question 25

IBS

Answer 25

Chronic functional disorder of the GI tract characterized by chronic abdominal pain altered bowel habits in the absence of any disease S/s : - relief with defecation - onset of frequency of stool > 3 day or longer than 3 weeks - appearance change - last 12 weeks in the last 12 months

Question 26

IBS eval / tx

Answer 26

Rule out any underlying organic diseases low FODMAP Antispasmodic reduce cramping Psychotropics, behaviorist therapies

Question 27

Celiac Disease

Answer 27

Immunologic repose to gluten PE: malabsorption, diarrhea, steatorrhea, weight loss, abdominal distention, muscle weakness May see pallor, bruising, bone pain, hyperactive bowel sounds Tests: Anti-tissue transglutaminas TTG antibodies To: remove gluten Celiac has a association with other autoimmune disorders ( Addison, graves, Type 1 DM)

Question 28

Diverticulosis

Answer 28

Small pouches in the lining of the colon that bulges outward through weak spots - caused by low liber diet that results in hypertrophy of bowel wall from years of moving hard stool - common > 60 50 % have it - common in the sigmoid colon S/s: Chronic constipation, abdominal pain, fluctuating bowel habits PE: usually normal but may have mild LLQ tenderness with a palpable mass

Question 29

Diverticulitis

Answer 29

Acute inflammation of diverticulum S/s: crampy LLQ or mid abd pain Pain worse after meals and improved after BM Fever, n/v PE: abd distended, diminished bowel signs, tender LLQ, rebound tenderness, rectal exam Labs : CBC = WBC, elevated ESR, stool = blood X-ray for perforation, ileus or obstruction TX: low residue diet, avoid seeds, nuts and corm, increase fluids, Mild = flagly, Cipro or tremethorpin -sulfa Mod = hospital

Question 30

Appendicitis

Answer 30

Obstruction of appendix by inflammation Common 10-30 yrs Early : vague periumbilical or epigastric pain, no appetite n/v low grade fevers Within 12 hours pain progresses and is worked by walking or coughing RLQ, chills PE: RLQ localized tenderness with guarding When cough = localized pain = peritoneal irritation + psoas + obturator signs

Question 31

Hemorrhoids

Answer 31

Varicosities of the hemorrhoidal venous plexus Internal - above pectinate line External - below pectinate line Internal = may prolapse and strangulate causing thromobisis Rectal bleeding - painless and bright red Throbosed = blue in color, firm, tender to palpation

Question 32

Acute abdomen

Answer 32

Rule out Cardiac Pain, shock, vomiting, muscular rigidity, abdominal distention