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AGNP AANC Boards > GI > Flashcards

GI Flashcards

1
Q

What is a palpable spleen indicative of?

A

mono, sickle cell anemia

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2
Q

What are signs of an Acute Abdomen?

A 
Involuntary guarding
Abdominal Wall Rigidity
Rebound tenderness
Progressive severe abdominal pain
Bile stained or feculent vomitus
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3
Q

What are the + signs indicative of acute appendiciits?

A

Psoas Sign
Obturator Sign
Rovsings Sign

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4
Q

Psoas Sign

A

RLQ pain on passive leg extension

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5
Q

Obturator Sign

A

Internal rotation of right hip causes RLQ pain

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6
Q

Rovsing’s sign

A

Palpation of LLQ will caused referred pain in RLQ

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7
Q

Markle Test

A

Heel Jar
Pelvic/ abdominal pain when pt drops heel on floor

or when pt jumps up and down

+ = PID, or acute Appendicitis

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8
Q

McBurney’s Point

A

the landing point of pain with a person with appendicits,

its is midway btw right anterior iliac crest and umbilicus

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9
Q

Presentation of Acute Cholecystitis / Biliary Dx

A

recurrent Colicky pain located in the RUQ
attacks come after a fatty meal
pain may radiate to Right shoulder or under scapula

+ murphy sign

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10
Q

what are gallstones called

A

cholelithiasis

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11
Q

For Acute Cholecystitis / Biliary Dx what is the imaging and labd

A

transabdominal US / Liver gallbladder US

elevated bili, and ALK phos

should refer to surgeon

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12
Q

who is in the high risk group for gallbladder dx

A 
Mexicans, Pima Tribe, NA
Ages 40-60
Females, Obese, 
Preg, DM,
OC
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13
Q

Presentation of Acute Pancreatitis and PE and signs

A

LUQ pain, hx of alcohol abuse, acute onset of mid-epigastric boring abdomial pain that radiates to the back

PE: tenderness to palpation, mid-epigastric w/ guarding and rigidity, decreased bowel sounds

+ cullen’s sign = periumbical brusing, discoloration
+ Grey-turner sign = bruising on flank

sensitive tests for pancreatisis:
- amylase and lipase

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14
Q

Acute Colonic Diverticulitis presentation, risks, labs

A

LLQ pain
older/adult w/ sudden onset of mild to moderate abdominal pain and a mass on LLQ. Will have fever and anorexia

Risks: Low fiber / age 40 or older / western society

Labs : elevated WBC, nuetrophils, and bands

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15
Q

Complication of diverticulalitis

A

infected - abscess - perforation and bleeding

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16
Q

what is diverticula?

A

sac-like herniations on the colonic wall ( not infected)

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17
Q

Management for diverticulsis

A

MILD cases only
Clear liquids only, close follow up 2-3 days

Mild = not toxic, no peritoneal signs

Cipro po BID + Metronidazole po BID x 7-10 days

Augmentin

Bactrim

moderate/severe - ED

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18
Q

Peptic Ulcer Duondenal ulcer DX presentation, TX, bacteria

A

recurrent episodes of gnawing and buring epigastic pain within 2-5 hours after meals

pain present when stomach is empty or hungry

feels better after eating and relief w/ antiacids

90% are positive for H.pylori ( most common type of ulcer)

TX: OTC antacids, H2 Blockers, or PPI’s

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19
Q

Gastic Ulcers presentation

A

epigastric pain with worsens with eating, postprandial belching, earlu saitety, nausea, pain may radiate to back

higher risk of cancer with these ulcers

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20
Q

Who can you tx in a PCP?

A

under 55 yrs old
no alarming symtpoms (no early satiety, dysphagia, anorexia, weight loss, anemia, blood in stools)

older people and high risk should go to GI for upper endosocopy

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21
Q

Who should be tested for H.pylori infections

A

Active PUD
Hx of PUD ( w/o hx of previous H.pylori )
On chronic ASA or NSAID therapy

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22
Q

Labs for PUD

A

H.plyori
CBC (iron deficiency anemia means bleeding)
Fecal Occult blood test

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23
Q

When to use H.pylori Titer test

A

For testing of dx
IgM and IgG will be + if active infection
IgG will stay + for years

Urea Breath Test or stool antigen test is very specific as well

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24
Q

How do you confirm eradication of H.pylori?

A

urea breath test 4 or more weeks post treatment

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25
Q

What is the gold standard for dx of H.pylori?

A

upper endoscopy w/ biopsies and H. pylori testing

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26
Q

what is the #1 tx for H.pyloir

A

Think “ BMT” + PPI “ QUAD THERAPY”

Bismuth (pepto-bismol) + Metronidazole (flagyl) + tetracyline QID + PPI 10-14 days

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27
Q

what is the #2 rx for H.pylori?

A

Clarithromycin , Amox + PPI x 14 days ( may have some resistance)

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28
Q

What are examples of PPI”s

A

Omeprazole Prilosec
Esomeprazole Nexium
Lansoprazole Prevacid

29
Q

Zollinger-Ellison Syndrome

A

TRAID: high level of gastric secretion, PUD and gastrinoma

can be benign or related to multiple endocrine neoplasia

symptom may be multiple ulcers

TX: PPI’s

Labs : fasting gastrin level increased ( hold PPI for 7 days prior to test)

30
Q

Ulcer Perforation

A

acute onset of mid-epigastric pain that radiates to the right shoulder

Vomits frank blood to cofee-ground emesis

tachy, clammy, shock

31
Q

What organs do NSAIDS effect?

A

GI tract, Kidneys, the CV system

32
Q

What is the effect on GI system?what NSAID highest problem rate?

A

Blocks prostaglandins which regulates flow of GI tract

most compliactions with indomethacin, then naproxen, then diclofenac

33
Q

Ways to decrease NSAID toxicity?

A

combine NSAID w/ PPI, Stop use of NSAID’s, can also combine with misoprostol

34
Q

What is the Key with toradol?

A

max number of days per “ episode” is 5 and you can give first dose IM or IV. Do not combine with other NSAID’s, anitcoagulants, ASA

35
Q

GERD presentation

A

middle-age adult c/o of daily episode of epigastic to mid-sternal pain( heartburn).

symptoms of sour taste, chronic sore throat, dry cough, esophageal erosion

36
Q

what is a red flag sign in GERD

A

Barett’s esophagus : precurser to esophageal cancer and it is dx by Biopsy

37
Q

when to refer people to GI specialist?

A

chronic (years) hx of GERD to r/o Barretts Esophagus

38
Q

GERD management first line

A
  1. lifestyle and dietary changes ( lose weight, stop eating 3-4 hours prior to bedtime, elevate HOB. Avoid aggrevating foods, alchol, smoking
39
Q

Food to avoid with GERD

A

mints/gum (relaxes esopheageal sphincter), alcohol, coffee

40
Q

GERD management medication

A
  1. Antacids PRN ( see effect in 30/60 min) Maalox, Roliads, Tums
  2. H2 recepter antagonists ( ranitidine, famitidine) if no releif stop and add
  3. PPI’s for up to 8 weeks omeprazole, esomeprazole, lansoprazole
41
Q

What are the averse effects of PPI’s

A

headache, diarrhea, abd pain

reduced absoption of mg, iron, vit b12

increased fractures ( reduced ca absoption)

c.diff

pneumonia

cv disease

renal disease ( stimulates immune response)

42
Q

IBS in adults

A

RLQ pain
functional disorder ( no change in colon)
Acute/recurrent abdominal pain w/ changes in stool and pain related to defecation
adult women
there are multiple types ( IBS w/ constipation, w/ diarrhea, w/ mixed)

does not increase colon cancer risk

43
Q

Alarm features of IBS

A 
older than 50
weight loss
abdominal mass, melana 
nocturnal adominal pain
iron-def anemia
fam hx of colon cancer
44
Q

what is the dx criteria for IBS

A 
recurrent abdominal pain
w/ 1 day/wk (previous 3 months) w at least two of following
- pain w/ defacation
- change in # of stools
- change in stool form / appearance
45
Q

IBS tx

A

life style

  • fiber supplementation - Psyllium can increase stool bulk
  • Food diary for triggers
  • Low FODMAP diet
  • Avoid high FODMAP: wheat, onion, garlic, fruits
  • stress reduction

pain - hypocyamine for spasms sublingual

5HT-3 antagonist - Lotronex for severe diarrhea IBS who have failed other tx. must have specific degree to tx

46
Q

Giardiasis presentation, labs and tx

A

sudden onset of foul-smelling fatty stools w/ explosive diarrhea w/ abdominal cramping, flatuence, and malaise. chronic infection may have malabsorption and weight loss

labs: c/s for parasites

tx; Tinidazole or Falgy

47
Q

what does low caliber stools indicate?

A

thin and narrow stools
may be caused by colon ca, diarrhea, ibs

refer to GI

48
Q

when can celiac dx erupt? presentation

A

any age or after a viral URI, preg

recurrent hc of abdominal pain, bloating/gas, fatigue, migraine, HA’s, anemia, joint pain weight loss

49
Q

What to avoid in celiac dx

A

gluten, wheat, barely, rye, kamut, spelt, titracale

50
Q

UC keys

A

colon and rectum only (always rectum), rectal bleeding and more common to see gross blood in feces **

DX : Colonoscopy

51
Q

Chrons keys

A

most common in ileum, strictures, fissues, skip lesions, not so much in rectum. May involve mouth , small intestine. If distal ileum is involved : crampy RLQ abdominal pain

Dx. colonosopy

52
Q

UC and Chrons sympts

A

fatigue, weight loss, prolonged diarrhea w/ abdominal pain, fever, gross bleeding

non GI sympt : arthtitis, anklyosing spondilitis (back pain), (eye)uveitis, (skin)erythema nodosum, (lung) chronic bronchitis

53
Q

Hemmoriods presentation and tx

A

recurrent right red blood from anal area. Hx of constipation, may have anal itching or pain during flare

will see soft bulging ble verins in anal area

OTC remedies, sitz bath, increase fiber, dont sit on toilet too long

54
Q

AST

A

liver function test, elevated after acute MI

will see it in lever, cardiac, skeletal muscle, kidney and lung

55
Q

ALT

A

most specific for liver dx

present in heart and liver

56
Q

AlK Phos

A

bone - growing children, teens, healing fractures

liver, gallbladder, kidneys, placenta

57
Q

GGT

A

lone elevation in alcoholic

if elevated w/ alk phos helps determine if it from lever or bone

58
Q

Alcoholic Hepatitis

A

will see elevated GGT and a 2:1 ration with AST to ALT = alochol abuse

59
Q

when do you see acute hepatitis s/s, labs , avoid

A

2-6 weeks after exposure.
fever, fatigue, loss of apetit
jaundice, dark urine, clay-colored stools

labs
ALT and AST will be normal ( if high it is indicative of viral hep)
Bili= normal to high

Avoid heptaotoxic things: statins, tylenol, alcohol

60
Q

Hepatitis A

A

Spread: fecal - oral route
post exposure prop - admin vaccine

screening test: IgM anti HAV

61
Q

Havrix

A

hep A vaccine
dose : two ( 0-6 months after)
give to MSM, international travel (mexico, central and south america, middle east, africa, SE asia

62
Q

Hep B

A

spread: semen, vaginal secretions, saliva, blood products

LFT’s will be elevated

63
Q

HBsAG

A

surface antigen = infected or infectious, acute or chronic

if + = they have it

64
Q

Anti-HBs

A

surface antibody = indicates immunity ( either recovered from infection or hep B vaccine)

65
Q

IgM anti-HBc

A

Hep B core antigen = recent infection ( is pt infectious)

66
Q

HbeAg

A

hep B envelop antigen = virus replication and high levels of hep B virus

67
Q

Where is Hep B most endemic?

A

Africa, southeast asia, western pacific, central and south america and carribean

68
Q

Hep C

A

spread: IVDU, blood products to baby boomers ( 1945-1965).

screening : anti- HCV if + = order a HCV RNA by PCR

if both + then pt has dx

Antiviral tx is - 96-99% effective

69
Q

Hep D

A

must be infected B to get D

AGNP AANC Boards (27 decks)

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