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NUNP 547 - Older Adult > GI - brit > Flashcards

GI - brit Flashcards

1
Q

Laxatives to avoid or use with caution in elderly

A 
Docusate
Magnesium (renal impairment)
Mineral oil
Soap sud
PEG (if impaired gag reflex)
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2
Q

Alarm symptoms of upper GI cancer

A 
weight loss
dysphagia
persistence of symptoms despite optimal treatment (4-6 weeks) on PPI
Odonyphagia
IDA
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3
Q 
All of the following are risk factors for what type of cancer:
>/= 50 years
Chronic GERD
smoking
EtOH
increased BMI
A

Esophageal cancer

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4
Q 
All of the following are risk factors for what type of cancer:
Family history
Gastric polyp
H. pylori
Previous partial gastrectomy
A

Stomach cancer

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5
Q

If age > 55 with persistent progression of heartburn or persistent progression of abdominal pain, what is your next step?

A

Referral

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6
Q

Referral is indicated if < 55 years with absence of alarm symptoms
T/F?

A

False

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7
Q

What diagnostic tests should be ordered to rule out stomach/esophageal cancer?

A

CEA serum

CT chest/abd/pelvis

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8
Q

GI tract is frequent site of involvement for ______ it usually involves the stomach

A

Lymphoma

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9
Q

There is a strong association with _____ and gastric lymphoma

A

H. pylori

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10
Q

Interpret the following HBV serology
HBsAG -
anti-HBs +
anti-HBC total -

A

Immune due to vaccination

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11
Q

Interpret the following HBV serology
HBsAG -
anti-HBs -
anti-HBC total -

A

No evidence of infection, offer vaccine

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12
Q

Interpret the following HBV serology
HBsAG -
anti-HBs +
anti-HBC total +

A

past HBV infection, immune

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13
Q 
Interpret the following HBV serology
HBsAG +
anti-HBs - 
anti-HBC total +
anti HBc IgM +
A

acute or chronic hep B infection

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14
Q

T/F?

ALP and GGT may take up to 24 hours to increase?

A

True

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15
Q

What serum results would lead you to suspect cholestasis and what is the next diagnostic test you would order?

A

elevated ALP and GGT

Perform abdominal ultrasound to assess biliary tree

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16
Q

If GGT not elevated and ALP elevated, what can you suspect?

A

May be of bone or placental origin

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17
Q

What to suspect if ALT > 1000U/L

A

Acute viral hepatitis, hepatotoxin, acute liver injury

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18
Q

What transaminase is most sensitive and specific for hepatitis? Acute increase in this marker can be seen within the first _____ .

A

ALT

within first 24 hours

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19
Q

AST is produced from: (3)

A

liver, cardiac, skeletal muscle

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20
Q

If GGT is elevated suspect:

A

cholestasis or EtOH

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21
Q

If serum LFTs abnormal when to repeat BW or isolated minor abnormality (<1.5 times upper limit of normal)

A

1-3 months

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22
Q

Diagnostic tests to consider in RUQ pain

A

AST
ALT
ALP
GGT

If suspect, then abdominal US
If fever –> refer

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23
Q

Define constipation

A

< 3 stools per week, for > 6 months

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24
Q

Primary causes of constipation (3)

A

Normal transit
Slow transit
Defecatory dyssynergia

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25
Q

T/F?

Most patients with fecal incontinence do not warrant extensive diagnostic evaluation

A

True

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26
Q

Early marker of sarcopenia

A

Decreased grip strength, should be assessed with dysphagia

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27
Q

Stomach acid production in elderly and consequences

A

Decreased –> decreased empyting, less Ca+ absorption, and changes in med absorption

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28
Q

S&S of constipation

A

Incomplete emptying
Straining
Lumpy hard stools
Digital maneouvers to relieve symptoms

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29
Q

What two screeners are useful when assessing patient for constipation?

A

Bristol stool chart
Norgine risk assessment tool for constipation
- https://www.movicol.com.au/files/Constipation-Risk-Assessment-Tool.pdf

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30
Q

List 5 secondary causes of constipation

A 
hypothyroidism
hypercalcemia
hypokalemia
neurologic disorders
malignancy
rheumatic disease
medications
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31
Q

Give an example of a medication that slows transit time for stool

A 
Narcotics
Anabolic steroids
Anticonvulsants
Anticholinergics
Antihypertensives
TCA
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32
Q

Give an example of a medication that increases transit time and produces hard stools

A 
NSAIDs
antidiarrheals
antacids
Calcium and iron supplements
antihistamines
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33
Q

Red flag S&S for constipation

A 
Acute changes in bowels (caliber)
Age > 50 
IDA
Fever
Absence of flatus
Blood in stool/hematochezia
Unexpected wt loss (>/= 10 lbs)
Severe abdominal pain, N/V
34
Q

What examination should be included if patient is experincing abdominal pain, outside of GI/GU and GYNE exam

A

CVS

35
Q

BW and diagnostics to consider if presence of alarm symptoms

A

CBC, serum Ca, TSH, fecal occult testing
Abdominal X ray
Colonoscopy

36
Q

Fiber dietary intake reccomendations

A

25-30 g day, increase fiber 5g/day every week (slowly)

37
Q

Fibre is not recommended in confirmed ______ or ______ constipation

A

slow transit

pelvic floor dyssynergia

38
Q

Bulk forming laxative example and how to take

A

Psyllium, take 1 hour before and 2 hours after other medications, increase intake of fluid

39
Q

Stool softener/emollient example

NOT advised for patients taking ______

A

Docusate or mineral oil (increased risk of aspiration)

Not advised for patients on narcotics

40
Q

Osmotic laxatives examples

A

Lactulose
Sorbitol
PEG
Mag hydroxide

41
Q

Caution ___ and ______ in CHF or CKD for treatment of constipation due to electrolyte imbalances

A

PEG and Mag hydroxide

42
Q

T/F?

Suppositories should be used as first line agents for dyssynergic defecation

A

False, used when oral agents are ineffective

43
Q

Example of stimulant medications for constipation

A

Senna

Bisacodyl

44
Q

What hormonal change in gut is responsible for decreased appetite in older adults?

A

Altered ghrelin secretion

45
Q

Two screening tools for malnutrition and feeding problems in elderly

A 
Mini-nutritional assessment ( 6 question, 89% sensitive, 82% specific)
DETERMINE Checklist:
Disease
Eating Poorly
Tooth Loss/Mouth Pain
Economic Hardship
Reduced Social Contact
Multiple Medicines
Involuntary Weight Loss/Gain
Needs Assistance in Self- Care
Elder Years Above Age 80
46
Q

Differentiate esophageal vs oropharyngeal dysphagia based on symptoms

A

Esophageal - difficulty swallowing several seconds after initiating swallow, feeling food is stuck
Oropharyngeal - difficulty initiating swallow, regurgitation, aspiration, coughing/choking

47
Q

All of the following are possible diagnosis of what symptom profile (solids/liquids, progressive/intermittent):
Esophageal stricture
Peptic stricture
Cancer

A

Solids ONLY + progressive symptoms

48
Q

All of the following are possible diagnosis of what symptom profile (solids/liquids, progressive/intermittent):
Esinophilic esophagitis
Esophageal webs/rings
Vascular abnormality

A

Solids ONLY + intermittent symptoms

49
Q

All of the following are possible diagnosis of what symptom profile (solids/liquids):
Achalasia
Esophageal spasm or contractile disorder
Functional disorder

A

Liquid and/or solid dysphagia

50
Q

All of the following are possible diagnosis of what symptom profile:
Infectious esophagitis - HSV/candida
Medication induced - doxy, biphosphonates

A

Odynophagia + dysphagia

51
Q

Name that condition:
Loss of normal peristalsis in distal esophagus and failure of LES relation with swallow
Progressive dysphagia with solids and liquids
Regurgitation of bland, undigested food or saliva
+/- chest pain, heart burn and difficulty burping

A

Achalasia

52
Q

Functional dysphagia must have duration of ______ with symptom onset at least _____ prior to diagnosis and frequency of at least once weekly

A

Functional dysphagia must have duration of 3 months with symptom onset at least 6 months prior to diagnosis and frequency of at least once weekly

53
Q

Diagnostic tests to consider for esophageal dysphagia

A

Barium swallow
Upper endoscopy/biospy
Esophageal manometry

54
Q

Diagnostic tests to consider for oropharyngeal dysphagia

A

nasalendoscopy

videofluroscopy + manometry

55
Q

Clinically significant weight loss

A 
>/= 2 % in baseline body weight in 1 month
>/= 5% decrease in 3 months
>/= 10 % decrease in 6 months
56
Q

T/F?

Elderly patients have ambiguous presentations for abdominal pain and should be imaged liberally.

A

True

57
Q

Which of the following mesenteric ischemias (SMA embolus, SMA thrombosis, SMV thrombosis, or NOMI ischemia) have the following risk factors:
a.fib
valvular heart disease
dilated cardiomyopathy

A

SMA emobolus

58
Q

Which of the following mesenteric ischemias (SMA embolus, SMA thrombosis, SMV thrombosis, or NOMI ischemia) have the following risk factors:
Atherosclerosis
Smoking

A

SMA thrombosis

59
Q

Which of the following mesenteric ischemias (SMA embolus, SMA thrombosis, SMV thrombosis, or NOMI ischemia) have the following risk factors:
hypercoagulable
OC use

A

SMV thrombosis

60
Q

What S&S would make you suspect mesenteric ischemia

A

out of proportion pain, N/V/D, postrprandial pain

61
Q

Diagnosis of mesenteric ischemia

A

CT/angio

BW - acidosis

62
Q

T/F?

Blood in urine can be a sign of AAA

A

True

63
Q

What diagnostic test has the highest sensitivity for bowel obstruction?

A

CT abdo

64
Q

All of the following are sequelae of what condition:

abscess, fistula, obstruction, perforation, sepsis, GI bleed

A

Diverticular disease

65
Q

What is the most common cause of lower GI bleeding in older adults?

A

DIverticular disease

66
Q

Conoloscopy or sigmoidoscopy is indicated ____ after resolution of diverticular symptoms to rule out _____

A

4-6 weeks

Carcinoma

67
Q

True/False

PUD in elderly may present with the ABSENCE of abdominal pain

A

True

68
Q

T/F?

Melena is the most common sign of PUD in the elderly?

A

True

69
Q

What is the #1 cause of abdominal surgery in the elderly?

A

Acute cholecystitis

70
Q

Posterior infarct is the most common location of MI that may present as abdominal pain. T/F?

A

False, inferior infarct is most common

71
Q

T/F?

Normal BW can rule out AMI in elderly

A

False

72
Q

T/F?

Abdominal rigidity is a reliable sign of visceral perforation in elderly

A

False

73
Q

T/F?

Hyperplastic polyps have malignant potential on colorectal cancer screening

A

False, no malignant potential

74
Q

What stool test is performed for bloody infectious diarrhea?

A

Ecoli

75
Q

Severe diarrhea is classified according to 5 criteria for ANY duration. List the criteria.

A 
Fever > 38.5
Bloody stool
Systemic illness
Hemodynamic instability
>6 diarrhea/day for 5 days
76
Q

What tests are indicated for severe diarrhea?

A

c. diff
O&P
culture

77
Q

Moderate - mild diarrhea duration is ______ when no testing is reccomended

A

< 5 days

78
Q

Earlier testing for infectious diarrhea is warrants if > 70 years, severe abdominal pain or querying c. diff. T/F?

A

True

79
Q

Testing is reccomended if mild-moderate diarrhea is ongoing for ______

A

> 5 days

80
Q

BW to consider for malnutrition

A 
CBC
protein/albumin
CRP
lipids
electrolytes
BUN/Cr
81
Q

Why is it important to order CRP with albulim/prealbumin for malnourished individuals

A

Low albumin and prealbumin can occur with illness/inflammation. If CRP - then likely malnutrition

82
Q

If pancreatitis is diagnosed in primary care or suspected, what is the next step?

A

Refer

NUNP 547 - Older Adult (19 decks)

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