GI clinical pearles leik

Question 1

Barrets esophagusis a a

Answer 1

precancerous (esophagus cancer)

Question 2

how do you dx barrets esophagus

Answer 2

upper endoscopy and biopsy

Question 3

what life style factors do you teach to prevent GERD

Answer 3

dont eat mints, chocolate , spicy fluids, fatty foods, caffeine, alcohol

Meds avoid
calcium channel blockers
nasiads
nitrates
iron supplents
bisphosphonates

Question 4

cullen sign is

Answer 4

edema and burinsg of the subcutaineous tissue around the umbilicus

Question 5

turners signs is

Answer 5

brusing/bluish discoloration of the flank area that may indicate retroperitoneal hemorrhage

Question 6

classic pain of acute pancreatitsi is

Answer 6

severe midepigastric pain that radiates the midback

Question 7

rovsings sign

Answer 7

Deep plpation of the LLQ of the abdomen results in referred pain the the RLQ which is a positive sign of appendicitis

Question 8

Positive finding if RLQ abdominal pain occurs during maneuver. Indicates irritation to the iliopsoas group of hip flexors in the abdomen. A positive finding suggests peritoneal irritation. With patient in supine position, have patient raise right leg against the pressure of the professional’s hand resistance (Figure 1). With patient on left side, extend the right leg from the hip.

Answer 8

Psoas/ipiopsoas

Question 9

Positive if inward rotation of the hip causes RLQ abdominal pain. Rotate right hip through full range of motion. Positive sign is pain with movement or flexion of the hip.

Answer 9

obturator sign

Question 10

Instruct patient to raise heels and then drop them suddenly. An alternative is to ask the patient to jump in place. Positive if pain is elicited or if patient refuses to perform because of pain.

Answer 10

merkle sign

Question 11

If worrisome symptoms in GERD—e.g., odynophagia (pain with swallowing), dysphagia (difficulty swallowing), early satiety, weight loss, iron-deficiency anemia (blood loss), weight loss, or male >50 years—

Answer 11

refer to GI

Question 12

Any patient with at least a decade or more history of chronic heartburn should be referred to

Answer 12

GI for endoscopy to r/o barretts esophagus

Question 13

Patients with Barrett’s esophagus have up to

Answer 13

30 times higher risk of cancer of the esophagus

Question 14

Patient who is a young adult complains of acute onset of periumbilical pain that is steadily getting worse. Over a period of 12 to 24 hours, the pain starts to localize at McBurney’s point. The patient has no appetite (anorexia). Classic exam findings include low-grade fever and right lower quadrant (RLQ) pain (McBurney’s point) with rebound and guarding. The psoas and obturator signs are positive.

Answer 14

acute appendicitis

Question 15

Worrisome symptoms for esophageal cancer include

Answer 15

pain, swallowing, early satiety, and wt loss

Question 16

if pt needs tx for GERD start with what

Answer 16

H2 antagonists

Question 17

if pt has poor relief of GERD or who has erosive esophaitis step up to a

Answer 17

PPI

Question 18

Do not give antidiarrheal medications if patient has acute onset of

Answer 18

bloody diarrhea, fever, abdominal pain, or pain that worsens with defecation because it may be caused by E. coli O157:H7, shiga toxin–producing E. coli (STEC), amebiasis, Salmonella, Shigella, or other pathogens. May need to go to ED.

Question 19

H2 antagonists:

Answer 19

Ranitidine (Zantac) 150 mg twice a day or 300 mg at bedtime
Nizatidine (Axid) 150 mg twice a day or 300 mg at bedtime
Famotidine (Pepcid) 40 mg at bedtime

Question 20

PPIs:

Answer 20

Omeprazole (Prilosec) 20 mg daily
Esomeprazole (Nexium) 40 mg daily
Lansoprazole (Prevacid) 15–30 mg daily

Question 21

most common cause of peptic ulcer disease (PUD).

Answer 21

H pylori gram neg

Question 22

H. pylori–positive ulcers require

Answer 22

abx for 14 days plus PPI orally twice a day

Question 23

Worrisome symptoms for esophageal cancer include

Answer 23

anorexia, early satiety, anemia, recurrent vomiting, hematemesis, and weight loss.

Question 24

PPIs cure ulcers faster

Answer 24

than H2 antagonists.

Question 25

reatment for H. pylori–Positive Ulcers

Answer 25

Triple therapy:
Clarithromycin (Biaxin) 500 mg twice a day plus amoxicillin 1 g twice a day or metronidazole (Flagyl) 500 mg twice a day if allergic to amoxicillin × 14 days plus
Standard-dose PPI orally twice a day × 14 days
Quadruple therapy:
Bismuth subsalicylate tab 600 mg four times a day plus
Metronidazole tab 250 mg four times a day plus
Tetracycline cap 500 mg four times a day × 2 weeks plus
Standard-dose PPI orally twice a day × 14 days

Question 26

avoid using clarithromyocin for if high what

Answer 26

resistance in your area

Question 27

GERD physiological

Answer 27

occurs after eating , short lived, rarely wakes you up at night

Question 28

pathologic reflux

Answer 28

nocturnal symptoms , injury to esophageal mucosa, sx