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AHN 568 Unit #5 > GI Study Guide > Flashcards

GI Study Guide Flashcards

1
Q

How do diagnose hepatitis based on presenting symptoms

A

A- mild flu like illness, or acute hepatitis with jaundice.
Fatigue, Malaise, HA, RUQ pain, Nausea, Loss of appetitie, Weight loss, Jaundice dark urine, clay stools. High fevers more common in HAV
B- anorexia, fatigue, N/V, jaundice, malaise, Diarrhea, Low grade temp, Tender hepatomegaly. Aversion to smoking, skin rashes, arthritis, more common in early HBV
C- Asymptomatic in acute illness, Chronic- liver failure, cirrhosis, fatigue

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2
Q

What tests should be ordered to confirm hepatitis?

A

A- anti HAV-IgM
B- HBsAg in acute infection, first to show
C- Anti HCV suggests infection until proven otherwise, RIBA-2, 2/4 present confirms infection
D- Anti-HDV

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3
Q

What are the serological tests for severity of hepatitis?

A

HBV-DNA - if you have either acute or chronic this is a quantitative test that will let you know the extent of the viral load
HCV-RNA- quantitative, tests level of actual virus

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4
Q

What is the appropriate intervention for a patient with a mallory-weirs tear who fails endoscopic therapy?

A

Angiographic arterial embolization

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5
Q

What is the most specific and sensitive test for diagnosis of GERD?

A

24 hour ambulatory pH monitoring

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6
Q

What are the genotypes for hepatitis?

A

Six different genotypes in hepatitis C
type 1 is the most common and most difficult to treat
Type 2 and 3 are more sensitive to treatment.
Types 1, 4, 5, 6- 48 weeks treatment
Types 2, 3- 24 weeks treatment

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7
Q

What is the treatment for hepatitis?

A

Acute HAV:
No specific treatment for
rest the body and assist the liver with regeneration
Nutrition and rest
Avoid alcohol and drugs detoxified in liver
Chronic:
B- Interferon, nucleoside and nucleotide analogs if severe (Intron A for 5 months or Epivir for 1 year)
C- Pegylated interferon (best within 12-24 weeks of infection to prevent chronic), protease inhibitors, ribavarin
Intron for 24-48 weeks
Ribavirin for 24 weeks

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8
Q

How do you determine if the hepatitis is acute or chronic?

A

IgM AntiHBc- is for acute infections
IgG AntiHBc- shows chronicity
HBeAg- if this is detectable after 3 months probably chronic

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9
Q

Pseudomembraneous colitis

A 
C. Diff is responsible for virtually all cases
Clindamycin
Ampicillin, amoxicillin, Cephalosporins
Risk factors:
Severe illness
> 2 days in hospital
GI surgery
PPI
Enteral tube feedings
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10
Q

What is the most specific and sensitive test for diagnosis of GERD?

A

24 hour ambulatory pH monitoring

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11
Q

Type of Pseudomembraneous Colitis

A 
Type 1- mild
Inflammatory changes, lesions present
Type 2- More severe disruption of glands
Marked mucin secretion
intense inflammation
Type 3- Severe, intense necrosis of the fully thickness
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12
Q

symptoms of PMC

A

Profuse diarrhea
Nausea/anorexia
dehydration
Abdominal tenderness and distention

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13
Q

Findings of Ulcerative colitis

A

Affects only the large intestine extending form the rectum upwards
Inflammation is limited to the mucous membrane
Pyoderma gangrenosum occurs frequently with UC
Liver disease

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14
Q

Treatment of Ulcerative colitis

A

Can give 5-aminocalicyclic acid derivatives (salazopyrin, asacol, pentasa, salofalk, dipentum, colazide)- if disease is confined to rectum
Corticosteroids for severe attacks
Immunosuppressive agents sometimes to reduce the use of steroids
can use antidiarrheal and antispasmodic medications

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15
Q

Know PUD presentation

A

Duodenal ulcers are the most common
More common in men
Presentation:
Epigastric tenderness 1 inch or more to the right of midline

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16
Q

Know GERD presentation

A 
heart burn- described as substernal sensation of warmth, or burning that may radiate to the neck, throat and or back
regurgitation
dysphagia
odynophagia
belching
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17
Q

Know ulcers presentation

A 
DU: epigastric pain, gnawing, aching
1-3 hours after eating
nocturnal pain
Relieved by antacid of food ingestion
GU: Epigastric pain, not relieved by food
Food may precipitate symptoms
nausea and anorexia
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18
Q

How long would you continue omeprazole therapy?

A

DU 4 weeks

GU 8 weeks

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19
Q

Gastric ulcers most common cause…

A

NSAIDs

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20
Q

Duodenal ulcers most common cause…

A

H. Pylori

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21
Q

PUD risk factors…

A 
NSAIDS
Smoking
Zollinger-Ellison syndrome
Stress
Corticosteroid use
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22
Q

Findings with Chronic lower GI bleed

A

anemia

orthostatic hypotension

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23
Q

Diagnostics for H. Pylori

A

Biopsy from endoscopy is the gold standard
Urea breath test- PPI gives false negative, withhold PPI 7-14 days before
Serum antibody test- not current infection, past infection
Fecal antigen- active infection, PPI false negative

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24
Q

Would you obtain a barium study to confirm perforated ulcer?

A

No this is contraindicated

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25
PUD treatment
PPI (suppresses acid secretion)- administered at least 30 minutes before meals 4 weeks for DU 8 weeks for GU Serum gastrin level checked after 6 months of therapy- terminated or decreased if rise > 500 pg/ml H2 Blocker- decreases acid secretion 8 weeks of therapy for both Sucralfate- enhance mucosal defense Bismuth- (promotes healing through stimulation of mucosal Bicarb and prostaglandin production. Has direct antibacterial action against H. Pylori) Follow up endoscopy
26
PUD complications
``` GI bleed (Elevated BUN, not creatinine) Perforations (Severe epigastric pain radiates to the back, hypoactive, very ill, board like abdomen, rebound tenderness) Leukocytosis Gastric outlet obstruction ```
27
GERD complications
Reflux related pulmonary disease Persistent ulcerative esophagitis Recurrent esophageal strictures Large hiatal hernia
28
GERD Treatment
``` phase 1: lifestyle modification elevate bed avoid exercise and large meals before bed avoid aggravating foods Weight reducation Stop smoking Antacids PRN- Mylanta, maalox Over the counter H2 blockers Phase 3: PPI Phase 4: surgical intervention ```
29
Antibiotic therapy for H. Pylori eradication...
1. Metrondiazole, clarithromycin, Amoxicillin 2. PPI 3. Bismuth
30
Radiographic findings for mesenteric ischemia
Digital subtraction angiography (DSA) is the gold standard to diagnose Upright abdominal films will be normal in AMI- rules out other causes of pain Pneumatosis may be seen which is a late sign CT with contrast- may reveal "thumb printing, pneumatosis" Ultrasound can be used MRI/MRA- similar to CT but expensive
31
Radiography findings for perforated bowel
Free air under the diaphragm on an upright chest film suggests the presence of a bowel perforation
32
S/S of mesenteric ischemia
``` Abdominal pain- severe, diffuse, non localized, constant N/V Distention Hypotension Hematochezia ```
33
Causes of mesenteric ischemia
Arterial Clot Embolism: Most commonly from cardiac source: MI, mitral stenosis, Afib, Endocarditis, Septic emboli Thrombotic: Atherosclerotic disease, aortic aneurysm, dissection, spontaneous thrombus TTP, DIC, SLE Low flow conditions: Hypotension, Arrhythmias, Shock, Vasoconstricting drugs Venous: Tumors, hypercoagulubility, infection, congestion
34
How to diagnose mesenteric ischemia
Gold standard for diagnosis is the Digital subtraction angiography (DSA)
35
Treatment of occlusive mesenteric ischemia
``` Embolectomy Bowel resection Stent placement Thrombolytics during an angiogram TPN- if large portion of bowel removed ```
36
Treatment of non occlusive mesenteric ischemia
Correct problem Hypovolemia Heart failure Dig toxicity
37
Treatment of chronic MI
Nitrate therapy Anticoagulation- coumadin Stent placement
38
Labs to monitor for hepatic failure
``` Bilirubin- elevated Albumin- decreased PT, ptt- prolonged ALT- elevated (greater specificity for liver disease) AST- elevated Ammonia- elevated CMP with albumin ```
39
Findings of diverticulitis
LLQ pain Fever Alternating constipation/diarrhea Elevated ESR, CRP, Procal
40
Treatment of diverticulitis
IV antibiotics bowel rest NGT for ileum Surgery for free air or abscess
41
Interventions to decrease complications of hepatic dysfunction
Acetaminophen is the most common cause of acute liver failure in the US Administration of N-Acetylcysteine promptly helps to decreases mortality.
42
Causes of pancreatitis
``` ETOH Gallstones Hypertriglyceridemia Hypercalcemia ERCP post ```
43
Tests to screen for hepatocellular carcinoma
US every 6 months for high risk patients (patients with cirrhosis or chronic hepatitis B)
44
What HD parameters to maintain with esophageal varices
SBP < 110 CVP < 10 PAWP < 8
45
GERD presentation
``` Heartburn regurgitation hyper salivation dysphagia odynophagia hemorrhage belching ```
46
Most likely cause of acute liver failure...
Acetaminophen
47
Risk factors for gall stones
``` Female Fourty Fertile Fat Rapid weight loss high cholesterol diet Certain meds: thiazide diuretics, birth control pills, lipid lowering agents ```
48
Murphys sign and what it indicates
Deep pain on inspiration while fingers are placed under the right rib cage Cholecystitis
49
Labs to order for suspected gallstones
Elevated bilirubin, ALT, AST, LDH, Alk phos Elevated Amylase US of gall bladder
50
S/S of pancreatitis
``` Epigastric abdominal pain Abrupt onset steady and severe N/V Hypoactive BS Tachycardia Fever Tachypnea ```
51
What is greys turner sign
flank discoloration | Can be seen with hemorrhagic pancreatitis
52
What is cullens sign
Periumbilical discoloration | Can be seen in hemorrhagic pancreatitis
53
Lab findings in pancreatitis
``` Elevated amylase and lipase Lipase elevates higher and remains elevated longer Elevated trypsin level Leukocytosis elevated H/H Hyperglycemia AST and LDH Hypocalcemia Low albumin ```
54
Treatment for pancreatitis
``` IV hydration Pain control Antibiotics- not used prophylactically NPO NGT Monitor calcium Monitor pulmonary function Insulin Surgery if indicated ```
55
Ransons Criteria mortality risk
0-3 risk factors- < 1% mortality 3-4 risk factors- 16% mortality 5-6 risk factors- 40% mortality more than 7 risk factors- close to 100% mortality
56
Ranson criteria risk factors
``` on admission: older than 55 WBC > 16000 Glucose > 200 LDH > 350 AST > 250 In initial 48 hours; H/H drop > 10% BUN increases > 5 Calcium below 8 SaO2 below 60 Base deficit > 4 fluid sequestration > 6000 ```
57
IV antibiotics for diverticulitis
Inpatient: (7-10 days of IV ABX but can switch to oral if improved after 5 days). 1. Ciprofloxacin or levofloxacin (Flouroquinolone) and metronidazole 2. Cefotaxime or ceftriaxone or cefepime (3-4 gen. cephalosporin) and metronidazole 3. Zosyn 4. Timentin 5. Imipenem- immunocompromised patients
58
McBurneys point
RLQ pain | indicative of appendicitis
59
Rovsings sign
RLQ pain with palpation of LLQ | indicative of appendicitis
60
Psoas sign
pain with active extension of the right hip | indicative of appendicitis
61
Obturators sign
pain with internal rotation of the right hip
62
Findings in appendicitis
``` RLQ pain Nausea with or without vomiting Constipation fever guarding UA with elevated specific gravity, hematuria, pyuria, albuminuria US to diagnose ```
63
Causes of SBO
``` Adhesions are most common Hernias Volvulus Strictures (Crohns, Radiation, Ischemia) Hematomas Intussusception Feces Tumors Foreign bodies ```
64
PE findings of SBO
Cramping periumbilical pain- sporadic Proximal: profuse vomiting, upper abdominal pain Distal: periumbilical pain, distention, episodic vomitting the more distal the more NGT output, more feculent emesis Obstipation water diarrhea for incomplete high pitched tinkling bowel sounds s/s dehydration
65
Labs of SBO
``` Possibly leukocytosis Hemoconcentration Electrolyte imbalances Hypokalemia BUN/Cr elevated ```
66
Treatment of SBO
``` NPO IV fluids NGT Labs ABX if suspect perforation Surgical consult for complete obstruction ```
67
Facts about esophageal varices
``` EGD is gold standard for diagnosis Stabilize patient Blood products Octreotide Propranolol to prevent rebleed Needs emergent banding TIPS with stent Can cause hepatic encephalopathy due to digestion of blood- give lactulose ```
68
Facts about hematochezia
Indicates a lower GI bleed or a massive upper GI bleed of more than a liter
69
Information regarding balloon tamponade
Can be used short term to control bleeding sengstaken-blakemore (3) or minnesota (4) Inflate to 20-45 mmHg Monitor continuously Deflate every 8-12 hours Scissors at bedside always deflate esophageal balloon first Complications include airway occlusion, esophageal rupture, ulceration
70
VS findings r/t severity of blood loss
40% blood loss- signs of hypovolemic shock (hypotension, tachycardia, pallor) 20% blood loss- orthostatic changes
71
ABX for mild diverticulitis
Acute uncomplicated: oral ABX for 7-10 days. Cipro, Bactrim or Levo plus flagyl or Amoxicillin and clavulanate
72
Treatments for upper GI bleed
``` T/C for 4 units resuscitation blood transfusions to keep hat > 20 in young patient, >30 in everyone else FFP NGT Endoscopy PPI Surgery Arteriography ```
73
Interventions to decrease complications of hepatic dysfunction in hepatitis include:
Supportive care | Symptom management
74
Treatment of Lower GI bleed
``` place NGT to rule out UGI bleed IV PPI T/C Colonoscopy Angiography Surgery ```
75
Courvoisers sign
enlarged gallbladder that is palpable but not tender
76
Charcots triad
Jaundice, fever, RUQ pain
77
C-reactive peptide elevated Over 50 LLQ pain No vomitting think
Diverticulitis
78
ABX for appendicitis
Prior to surgery- cefoxitin, cefotan Gangrenous or perforation- single or combination therapy with flagyl Immunocompromised or elderly- carbapenem plus flagyl
79
ABX for cholecystitis
Third generation cephalosporins (Cefazolin, cefuroxime, ceftriaxone) and metronidazole For severe cases: Fluoroquinolones (ciprofloxacin) plus metronidazole
80
ABX will be necessary for pancreatitis in
Septicemia Abscess Pseudocyst
81
ABX for pancreatitis
Imipenem | Cefuroxime
82
Treatment of Peritonitis
IVF | ABX- 10 day therapy
83
ABX for peritonitis
3rd generation cephalosporin | Ampicillin for enterococcus
84
Colonic obstruction Meds
Broad spectrum ABX early; Clindamycin, flagyl
85
Labs for UGI bleed
``` T/C for 4 units PRBC H/H pt, ptt, plt, electrolyte, BUN/Cr, Liver enzymes EKG (ischemia related to blood loss) Endoscopy ```
86
Labs for LGI bleed
R/O UGIB with NGT CBC Iron, TIBC, Ferritin Fecal Occult blood
87
The main cause of inflammation of liver cells and liver damage in hepatitis is because of...
Cell apoptosis
88
Which liver test will be higher and stay elevated longer in viral hepatitis?
ALT
89
True of false, the resolution of jaundice in hepatitis means resolution of infection?
false

AHN 568 Unit #5 (14 decks)

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