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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
Q

PUD treatment

A

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

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26
Q

PUD complications

A 
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
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27
Q

GERD complications

A

Reflux related pulmonary disease
Persistent ulcerative esophagitis
Recurrent esophageal strictures
Large hiatal hernia

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28
Q

GERD Treatment

A 
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
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29
Q

Antibiotic therapy for H. Pylori eradication…

A
  1. Metrondiazole, clarithromycin, Amoxicillin
  2. PPI
  3. Bismuth
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30
Q

Radiographic findings for mesenteric ischemia

A

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

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31
Q

Radiography findings for perforated bowel

A

Free air under the diaphragm on an upright chest film suggests the presence of a bowel perforation

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32
Q

S/S of mesenteric ischemia

A 
Abdominal pain- severe, diffuse, non localized, constant
N/V
Distention
Hypotension
Hematochezia
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33
Q

Causes of mesenteric ischemia

A

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

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34
Q

How to diagnose mesenteric ischemia

A

Gold standard for diagnosis is the Digital subtraction angiography (DSA)

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35
Q

Treatment of occlusive mesenteric ischemia

A 
Embolectomy
Bowel resection
Stent placement
Thrombolytics during an angiogram
TPN- if large portion of bowel removed
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36
Q

Treatment of non occlusive mesenteric ischemia

A

Correct problem
Hypovolemia
Heart failure
Dig toxicity

37
Q

Treatment of chronic MI

A

Nitrate therapy
Anticoagulation- coumadin
Stent placement

38
Q

Labs to monitor for hepatic failure

A 
Bilirubin- elevated
Albumin- decreased
PT, ptt- prolonged
ALT- elevated (greater specificity for liver disease)
AST-  elevated
Ammonia- elevated
CMP with albumin
39
Q

Findings of diverticulitis

A

LLQ pain
Fever
Alternating constipation/diarrhea
Elevated ESR, CRP, Procal

40
Q

Treatment of diverticulitis

A

IV antibiotics
bowel rest
NGT for ileum
Surgery for free air or abscess

41
Q

Interventions to decrease complications of hepatic dysfunction

A

Acetaminophen is the most common cause of acute liver failure in the US
Administration of N-Acetylcysteine promptly helps to decreases mortality.

42
Q

Causes of pancreatitis

A 
ETOH
Gallstones
Hypertriglyceridemia
Hypercalcemia
ERCP post
43
Q

Tests to screen for hepatocellular carcinoma

A

US every 6 months for high risk patients (patients with cirrhosis or chronic hepatitis B)

44
Q

What HD parameters to maintain with esophageal varices

A

SBP < 110
CVP < 10
PAWP < 8

45
Q

GERD presentation

A 
Heartburn
regurgitation
hyper salivation
dysphagia
odynophagia
hemorrhage
belching
46
Q

Most likely cause of acute liver failure…

A

Acetaminophen

47
Q

Risk factors for gall stones

A 
Female
Fourty
Fertile
Fat
Rapid weight loss
high cholesterol diet
Certain meds: thiazide diuretics, birth control pills, lipid lowering agents
48
Q

Murphys sign and what it indicates

A

Deep pain on inspiration while fingers are placed under the right rib cage
Cholecystitis

49
Q

Labs to order for suspected gallstones

A

Elevated bilirubin, ALT, AST, LDH, Alk phos
Elevated Amylase
US of gall bladder

50
Q

S/S of pancreatitis

A 
Epigastric abdominal pain
Abrupt onset
steady and severe
N/V
Hypoactive BS
Tachycardia
Fever
Tachypnea
51
Q

What is greys turner sign

A

flank discoloration

Can be seen with hemorrhagic pancreatitis

52
Q

What is cullens sign

A

Periumbilical discoloration

Can be seen in hemorrhagic pancreatitis

53
Q

Lab findings in pancreatitis

A 
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
Q

Treatment for pancreatitis

A 
IV hydration
Pain control
Antibiotics- not used prophylactically
NPO
NGT
Monitor calcium
Monitor pulmonary function
Insulin
Surgery if indicated
55
Q

Ransons Criteria mortality risk

A

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
Q

Ranson criteria risk factors

A 
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
Q

IV antibiotics for diverticulitis

A

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
Q

McBurneys point

A

RLQ pain

indicative of appendicitis

59
Q

Rovsings sign

A

RLQ pain with palpation of LLQ

indicative of appendicitis

60
Q

Psoas sign

A

pain with active extension of the right hip

indicative of appendicitis

61
Q

Obturators sign

A

pain with internal rotation of the right hip

62
Q

Findings in appendicitis

A 
RLQ pain
Nausea with or without vomiting
Constipation
fever
guarding
UA with elevated specific gravity, hematuria, pyuria, albuminuria
US to diagnose
63
Q

Causes of SBO

A 
Adhesions are most common
Hernias
Volvulus
Strictures (Crohns, Radiation, Ischemia)
Hematomas
Intussusception
Feces
Tumors
Foreign bodies
64
Q

PE findings of SBO

A

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
Q

Labs of SBO

A 
Possibly leukocytosis
Hemoconcentration
Electrolyte imbalances
Hypokalemia
BUN/Cr elevated
66
Q

Treatment of SBO

A 
NPO
IV fluids
NGT
Labs
ABX if suspect perforation
Surgical consult for complete obstruction
67
Q

Facts about esophageal varices

A 
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
Q

Facts about hematochezia

A

Indicates a lower GI bleed or a massive upper GI bleed of more than a liter

69
Q

Information regarding balloon tamponade

A

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
Q

VS findings r/t severity of blood loss

A

40% blood loss- signs of hypovolemic shock (hypotension, tachycardia, pallor)
20% blood loss- orthostatic changes

71
Q

ABX for mild diverticulitis

A

Acute uncomplicated: oral ABX for 7-10 days. Cipro, Bactrim or Levo plus flagyl or Amoxicillin and clavulanate

72
Q

Treatments for upper GI bleed

A 
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
Q

Interventions to decrease complications of hepatic dysfunction in hepatitis include:

A

Supportive care

Symptom management

74
Q

Treatment of Lower GI bleed

A 
place NGT to rule out UGI bleed
IV PPI
T/C
Colonoscopy
Angiography
Surgery
75
Q

Courvoisers sign

A

enlarged gallbladder that is palpable but not tender

76
Q

Charcots triad

A

Jaundice, fever, RUQ pain

77
Q

C-reactive peptide elevated
Over 50
LLQ pain
No vomitting think

A

Diverticulitis

78
Q

ABX for appendicitis

A

Prior to surgery- cefoxitin, cefotan
Gangrenous or perforation- single or combination therapy with flagyl
Immunocompromised or elderly- carbapenem plus flagyl

79
Q

ABX for cholecystitis

A

Third generation cephalosporins (Cefazolin, cefuroxime, ceftriaxone) and metronidazole

For severe cases:
Fluoroquinolones (ciprofloxacin) plus metronidazole

80
Q

ABX will be necessary for pancreatitis in

A

Septicemia
Abscess
Pseudocyst

81
Q

ABX for pancreatitis

A

Imipenem

Cefuroxime

82
Q

Treatment of Peritonitis

A

IVF

ABX- 10 day therapy

83
Q

ABX for peritonitis

A

3rd generation cephalosporin

Ampicillin for enterococcus

84
Q

Colonic obstruction Meds

A

Broad spectrum ABX early; Clindamycin, flagyl

85
Q

Labs for UGI bleed

A 
T/C for 4 units PRBC
H/H
pt, ptt, plt, electrolyte, BUN/Cr, Liver enzymes
EKG (ischemia related to blood loss)
Endoscopy
86
Q

Labs for LGI bleed

A

R/O UGIB with NGT
CBC
Iron, TIBC, Ferritin
Fecal Occult blood

87
Q

The main cause of inflammation of liver cells and liver damage in hepatitis is because of…

A

Cell apoptosis

88
Q

Which liver test will be higher and stay elevated longer in viral hepatitis?

A

ALT

89
Q

True of false, the resolution of jaundice in hepatitis means resolution of infection?

A

false

AHN 568 Unit #5 (14 decks)

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