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GI and Hepatic disorders Flashcards

1
Q

Dx of GERD

A

established when typical symptoms of heartburn and regurgitation
don’t test for H.pylori initially
upper EGD not needed either for dx

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2
Q

When is endoscopy recommended with GERD pts

A

if there are findings such as dysphagia, odynophagia, wt loss, hematemesis, bloody stools, chest pain.

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3
Q

What monitoring can be done to assess reflux pts

A

ambulatory esophageal reflux monitoring b/c it can show reflux symptoms association

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4
Q

Medical management of GERD

A

tx with PPI
8 week tx max
once a days dosing with first meal of the day

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5
Q

Those needing long term therapy for GERD

A

H2 receptor atagonist in those without erosive disease

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6
Q

Other recommendations for tx in GERD

A

wt loss
avoid laying down 2-3 hours following meals
head of bed elevation
avoid foods that can cause the symptoms

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7
Q

Omeprazole for GERD administration

A

should give 30-60 min before meals

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8
Q

Symptoms of GERD

A

hoarseness
recurrent cough
chronic pharyngitis

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9
Q

What pharmacologic tx is used to prevent a duodenal ulcer caused by H.pylori

A

antimicrobial therapy

give this in conjunction with meds that tx symptoms such as PPI, H2 blocker and antacid

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10
Q

Classic presentation of appendicitis

A

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

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11
Q

What would you not expect with appendicitis

A

sudden onset of vomiting and generalized abdominal pain with a fever
= gastroenteritis

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12
Q

This sign is elicited by gently palpating an area of abd tenderness, then rapidly releasing the pressure.

A

Blumberg sign
indicates inflammation
aka rebound tenderness

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13
Q

This sign is elicited by having pt stand on tip toes then letting the body weight fall to heels causing abdominal pain

A

Markle

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14
Q

This sign is elicited with painful arrest of inspiration triggered by palpating the edge of inflamed gallbladder

A

Murphy’s

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15
Q

This sign is positive when slight later pressure on the skin results in epidermal exfoliation

A

Nikolsky’s sign

Derm emergency

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16
Q

Gallbladder issues typically seen in

A 
really old
younger
fertile
fair
fat
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17
Q

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

A

acute pancreatitis

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18
Q

Objective with pancreatitis

A

epigastric tenderness
hypoactive bowel
abd distenstion and hypertympanic
elevated amylase and lipase

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19
Q

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

A

Diverticulitis

20
Q

Objective with diverticulitis

A

soft abd
active bowel sounds
tenderness without rebound
leukocytosis and neutrophilia

21
Q

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

A

Duodenal ulcer

22
Q

Objective of duodenal ulcer

A

tender at epigastrium and LUQ

hyperactive bowl sounds

23
Q

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

A

erosive gastritis

24
Q

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

A

inflammatory bowel disease

25
Q

Objective inflammatory bowel disease

A 
pale conjunctiva
tachy
hyperactive bowel
diffuse abd tenderness
normocytic normochromic anemia
leukocytosis and neutorphillia
26
Q

Risk factors for pancreatic cancer

A

history of chronic pancreatitis
tobacco use
DM

27
Q

How is Hep B virus spread

A

bodily fluids

28
Q

How is Hep C spread

A

blood

29
Q

What is vertical transmission of Hep C

A

means mom passes it to baby in utero

30
Q

How is Hep A spread

A

fecal-oral

31
Q

Immunization for hep A

A

is available

post exposure prophylaxis with immunoglubulin (IG)

32
Q

Acute disease marker for hep A

A 
HAV IgM (you are miserable)
hepatic enzymes 10x normal
33
Q

Chronic disease marker for hep A

A

none

chronic hep A does not exist

34
Q

Marker that would show Hep A in the past or immunization

A

Anti- HAV
this is the total of IgM and IgG (gone)
hepatic enzymes normal

35
Q

This would should that person still susceptible to hep A

A

Anti HAV negative

neg = never had

36
Q

Immunization for Hep B

A

available

post-exposure prophylaxis with HBIG

37
Q

Acute disease marker for Hep B

A

HBsAg = always growing
HBeAG = time when extra contagious
IgM = earliest marker to be pos post exposure
hepatic enzymes 10x normal

38
Q

Chronic disease marker for Hep B

A

Pt without symptoms
Normal or slightly elevated hepatic enzymes
HBsAg (always growing) if HBV on board

39
Q

Marker for Hep B in past or immunization

A

HBsAb
no HBV on board
unable to get in future

40
Q

Marker to show still susceptible to Hep B

A

HBsAB neg
Anti HBc neg
HBsAb negative

41
Q

Immunization for Hep C

A

not available

42
Q

Acute disease marker for Hep C

A

Anti HCV present
HCV viral RNA
elevated hepatic enzympes

43
Q

Chronic disease marker for Hep C

A

Anti HCV
HCV viral RNA
normal or slightly elevated hepatic enzymes

44
Q

Disease in the past marker for Hep C

A

Anti HCV present
HCV RNA absent
normal hepatic enzymes

45
Q

Immunization for Hep D

A

not available

prevent hep B you can prevent hep D

46
Q

markers of hep D

A

HBsAg maker plus Hep D IgM with elevated hepatic enzymes

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