GI MY favorite Flashcards
What are some meds that can cause dyspepsia?
You want to make sure ask pt if they take these meds
Aspirin
Antibiotics
DM drugs such as metformin
steroid meds
thyroid meds
psych meds
anti-hypertensives
oral contraceptives/estrogen replacement
Parkinson’s meds
painkillers
iron
What would be a key question to ask when taking history who comes with dyspepsia?
Do you go camping? Do you go hiking?
Here you thinking about causative agent of dyspepsia like Giardia
What kind of questions do you want you make sure to ask when taking social history of someone coming with dyspepsia?
Domestic violence
anxiety
home/school problems
prior psych problems?
Pt comes to you and states “ I have upper abdominal pain occurs with an empty stomach , but when I eat symptoms go away”
What is your one diagnosis?
PUD….. for definitive diagnosis you need to send this pt for EGD
What is one test you do not forget to order for a female of reproductive age coming with abdominal pain?
Urine HCG……… NO EXCUSE FOR NOT ORDERING IT…. definitely test question
What are some tests you will order for someone with dyspepsia?
H Pylori testing
Fecal occult blood
CBC
CT or US or gastric emptying studies if pt has recurrent vomiting
What is the treatment for H Pylori?
Clarithromycin 500 mg PO BID
Amoxicillin 1 gm PO BID
PPI PO BID 14 DAYS
What are the medications that constitute Prevpac( is prescribed for H.Pylori)
Lansoprazole
Clarithromycin
Amoxicillin
If allergic to penicillin what are your options for abx for H. pylori?
Flagyl
Tetracycline
What is the black box warning for Reglan if used over 3 months ?
Tardive dyskinesia especially with elderly
What physical exam ( tests) will you perform on pt presenting with sudden localized abd pain? think of physical exam not CT
Iliopsoas test
Obturator sign
What teaching would you give to someone with diverticulitis?
Avoid laxatives
enemas
opiates
What is the treatment plan for diverticulitis?
Flagyl with levaquin or ciprofloxacin
or alternative Augmentine 875/125 po TID 7-10 days or Septra DS along with Flagyl
What questions would you ask to get more history or ROS for someone with RLQ pain?
Is your pain aggravated by cough and walking?
Do you have n/v?
Do you have indigestion, flatulence, irregular BMs?
Fatigue /malaise?
Any dysuria?
Any rectal pain or pressure?
Pt may feel rectal pain and pressure if appendix located lower in the pelvis
What physical exam test will you perform for someone with RLQ pain or in general abd pain?
Deep palpation—— if appendicitis will be rebound tenderness
Abd pain gets worse with release of palpation
List all the possible tests you will perform for physical exam for someone suspecting appendicitis?
Positive psoas test— pain while extending psoas muscle
Positive obturator sign. pain on passive internal rotation of right thigh
positive McBurney’s tenderness 1.5-2 inches from anterior iliac spine aka rebound tenderness
Positive Rovsing’s test— pain elcited in RLQ with palpation pressure in the LLQ
Positive Markle test— pain in RLQ when dropping from standing on toes to heels with jarring landing
Positive Dunphy test—– a sharp pain in the RLQ elicited by cough
Positive Blumberg test— abd palpation reveals rebound tenderness
What are some differential diagnosis for a male patient with lower abd pain ?
Cecal diverticulitis
Meckel’s diverticulitis
Acute ileitis
Crohn’s disease
Renal colic
Testicular torsion—- big one
What are some differential diagnosis for a female patient coming to your clinic with lower abd pain?
Pelvic Inflammatory disease
Ectopic pregnancy—-big one
Ruptured ovarian cyst
Renal colic
Cecal diverticulitis
Meckel’s diverticulitis
Acute ileitis
Crohn’s disease
Tuboovarian abcess
What are some differential diagnosis for pt coming with epigastric pain?
GERD
Dyspepsia
AMI
Pancreatitis
Hiatal hernia
What are your differential diagnosis for someone coming with RUQ pain?
Hepatitis
Portal Vein Rupture
Splenic abcess/ rupture LUQ
What is a MUrphy’s sign and what is the condition associated with it?
Murphy’s sign—-pain on deep palpation of gallbladder in RUQ —- ask patient to take deep breath and pain causes them to stop breathing
Cholecystitis
What are your differential diagnosis for generalized abdominal pain?
Mesenteric ischemia
Bowel perforation
Bowel obstruction
Malignancy
Abdominal aortic aneurism
An infant presents with forceful vomiting after feeding and persistent hunger.. What is the diagnosis?
Pyloric Stenosis —-classic sign olive shaped mass
Who is at risk for intussusception?
MosT common abd medical emergency in first 2 years of life
Males> females
5-10 months most common’
What are signs and symptoms of intussusception?
intense abd pain
intermittent extremely sharp pain
loud cry is writhing in pain
child is inconsolable
child draws knees up
Current jelly stool
fever
bile colored vomit
bloody BM, n/v
How is Hemolytic Uremic Syndrome (HUS) defined in children?
Microangiopathic hemolytic anemia
Thrombocytopenia
Acute kidneyinjury
