GI and Hepatic disorders Flashcards
Dx of GERD
established when typical symptoms of heartburn and regurgitation
don’t test for H.pylori initially
upper EGD not needed either for dx
When is endoscopy recommended with GERD pts
if there are findings such as dysphagia, odynophagia, wt loss, hematemesis, bloody stools, chest pain.
What monitoring can be done to assess reflux pts
ambulatory esophageal reflux monitoring b/c it can show reflux symptoms association
Medical management of GERD
tx with PPI
8 week tx max
once a days dosing with first meal of the day
Those needing long term therapy for GERD
H2 receptor atagonist in those without erosive disease
Other recommendations for tx in GERD
wt loss
avoid laying down 2-3 hours following meals
head of bed elevation
avoid foods that can cause the symptoms
Omeprazole for GERD administration
should give 30-60 min before meals
Symptoms of GERD
hoarseness
recurrent cough
chronic pharyngitis
What pharmacologic tx is used to prevent a duodenal ulcer caused by H.pylori
antimicrobial therapy
give this in conjunction with meds that tx symptoms such as PPI, H2 blocker and antacid
Classic presentation of appendicitis
12 hour hx of abdominal pain that begins at the epigastrium and shifts to localized right lower quadrant abdominal pain.
positive obturator and psoas sign
leukocytosis with neutrophilia and bandemia
What would you not expect with appendicitis
sudden onset of vomiting and generalized abdominal pain with a fever
= gastroenteritis
This sign is elicited by gently palpating an area of abd tenderness, then rapidly releasing the pressure.
Blumberg sign
indicates inflammation
aka rebound tenderness
This sign is elicited by having pt stand on tip toes then letting the body weight fall to heels causing abdominal pain
Markle
This sign is elicited with painful arrest of inspiration triggered by palpating the edge of inflamed gallbladder
Murphy’s
This sign is positive when slight later pressure on the skin results in epidermal exfoliation
Nikolsky’s sign
Derm emergency
Gallbladder issues typically seen in
really old younger fertile fair fat
Clinical presentation of a man who drinks 8-10 beers/day with a 12 hour acute onset of epigastric pian radiating to the back with bloating, n/v could suggest
acute pancreatitis
Objective with pancreatitis
epigastric tenderness
hypoactive bowel
abd distenstion and hypertympanic
elevated amylase and lipase
Clinical presentation of at 64 year old woman with a 3 day hx of intermittent LLQ pain with fever, cramping, n/v and loose stools could suggest
Diverticulitis
Objective with diverticulitis
soft abd
active bowel sounds
tenderness without rebound
leukocytosis and neutrophilia
Clinical presentation of a 34 year old man with 3 month hx of intermittent upper abdominal pain of burning and gnawing 2-3 after meals. Wakes up during the night with symptoms and releif with foods and antacids
Duodenal ulcer
Objective of duodenal ulcer
tender at epigastrium and LUQ
hyperactive bowl sounds
Clinical presentation of 52 year old woman who got laid off from her job and is taking 3-4 doses of ibuprofen a day for the past 2-3 months and now intermittent nausea, burning and pain limited to the upper abdomen and worse with eating could suggest
erosive gastritis
Clinical presentation of 21 year old woman with 2 month hx of crampy abdomen, diarrhea, weight loss and fatigue who now has a 3 day history or increasing discomfort, fever and tenesmus could suggest
inflammatory bowel disease
