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6030 Primary Care Test 3 COMPLETE ☑️ > Module 7: GI > Flashcards

Module 7: GI Flashcards

1
Q

GI Complaints

-Assessments

A
  1. Recent Surgery?
  2. Woman of childbearing age (Ectopic pregnancy r/o)
  3. Age, lifestyle, exercise, risk factors
  4. Chronic Illness
  5. Meds
  6. General appearance — Do they look ill??
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2
Q

Abdominal Pain

-Clues of an emergent patient?

A
  1. Fever
  2. Unstable VS’s
  3. Appearance
  4. Tender or rigid abdomen
  5. Referred pain, guarding, or rebound tenderness
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3
Q

Rigid Abdomen Tests?

-Psoas Sign?

A
  1. Lying on back, have patient raise leg against resistance on thigh
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4
Q

Rigid Abdomen Tests?

-Obturator Sign?

A
  1. Pelvic abscess, ruptured appendix Test

—Lying supine, flex right leg 90 degrees at hip and knee

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5
Q

Rigid Abdomen Tests?

-Rovsing’s Sign

A
  1. Test for peritoneal irritation & appendicitis

—Palpate LLQ Abdomen and increased pain on the RLQ

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6
Q

Rigid Abdomen Tests?

-Murphy’s sign

A
  1. Test for Cholecystitis

—Palpate RUQ w/ patient breathing in deeply

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7
Q

Rigid Abdomen Tests?

-Markle Sign?

A
  1. Heel jar test

—Test for appendicitis & Peritoneal irritation

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8
Q

Common GI Disorders

-Acute/Surgical Abdomen

A
  1. Appendicitis
  2. Pancreatitis
  3. Cholecystitis
  4. Small bowel obstruction/Ischemia

REFER to ER/Surgery

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9
Q

Surgical Abdomen

-Appendicitis Exam Findings

A
  1. WBC’s — normal to moderate elevated WBC’s w/ LEFT shift**
  2. +Psoas sign and abdominal rigidity
  3. Anorexia
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10
Q

Surgical Abdomen

-Appendicitis Differentials?

A
  1. Nephrolithiasis
  2. AAA
  3. MI
  4. Ectopic pregnancy
  5. PID
  6. Cholecystitis; pancreatitis
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11
Q

Surgical Abdomen

-Acute Pancreatitis Hx?

A
  1. Common causes — ETOH abuse
    - Also caused by: Gallstones, trauma, hypertriglyceridemia
    - ACE-I, statins, sulfonamides, metronidazole, acetaminophen, diuretics
  2. Common differentials?
    - Gallbladder disorder, Ulcer, PID, ectopic, AAA (Pg 707)
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12
Q

Surgical Abdomen

-Acute Pancreatitis Clinical Picture

A
  1. Sudden onset pain, N/V
  2. Epigastric tenderness, guarding, fever, jaundice, hemodynamic instability
  3. Bruising of periumbilicus or flank
  4. Elevated lipase, amylase, WBC’s and ALT.
  5. Imagine — US/CT scan — pancreatic protocol
    - REFER to ER/Surgery
    - High mortality —pancreatic necrosis
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13
Q

Chronic Pancreatitis

-Presentation & info

A
  1. Epigastric pain that radiates to back of the chest or flank
    - N/V as well
  2. Caused by ETOH or Lipid disorders — Gallstones
  3. PE reveals — pain, weight loss, steatorrhea, & brittle diabetes
  4. Order Labs & studies
    —CBC, CMP, lipase & amylase
    —Abdominal imagine —US or CT or MRI

REFER to GI.

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14
Q

Chronic Pancreatitis

-Patient Education

A
  1. Low fat diet
  2. NO ETOH
  3. Hydration w/ water
  4. Guidance on when to seek ER care
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15
Q

Cholecystitis & Cholelithiasis

A
  1. Female, Fat, Fertile, Forty, Fat-intolerant, Flatulent
  2. Obstruction of cystic duct by gallstones/inflammation of gallbladder
  3. Progression of Dz
    - Asymptomatic, sludge to stones — cholelithiasis (stones) — Impaction/obstruction
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16
Q

Cholecystitis & Cholelithiasis

-Differentials

A
  1. MI
  2. Liver Dx
  3. Pancreatitis
  4. PUD
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17
Q

Common Episodic GI Complaints

-Gastroenteritis

A
  1. Acute N/V/D
  2. 2nd most common cause for missed work — bacterial, viral or parasitic
  3. Fever/diarrhea >2 days or travel — Stool cultures / Labs
  4. R/O Pregnancy, Med reactions, GI OBSTRUCTION**
  5. Differentials:
    - Infectious diarrhea, IBS, IBD
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18
Q

Common Episodic GI Complaints

-Gastroenteritis Clinical Encounter

A
  1. Define Diarrhea
  2. 7 elements of HPI
  3. Recent antibiotics? Hospitalization?
    - Food borne illness?
  4. Most common infection — E Coli, Shigella, Salmonella
  5. Concerning when:
    —Fever, dehydration, presence of blood >2-3 weeks
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19
Q

Common Sources of Food-borne illness?

A
  1. Seafood — viruses & parasites
  2. Dairy — Listeria
  3. Beef — E. coli
  4. Pork — Trichonella
  5. Poultry and eggs — Salmonella
  6. Produce — E. coli, cyclospora
  7. Water — Typhoid, cholera, Giardia, Amoebiasis
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20
Q

Common Episodic GI Complaints

-Gastroenteritis Management?

A
  1. Self-limiting
  2. NPO x 24 hrs after last episode — Progress to clear fluids and advance as tolerated
    —Hydration and electroLYTE balance is KEY
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21
Q

Gastroenteritis

-Travelers & Travel Hx

A
  1. 3-4 unformed stools in 24 hrs
  2. E Coli, viruses, parasites
  3. Prevention/Pre-travel education is key

TREATMENT
-Cipro or Levaquin **

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22
Q

Gastroenteritis

-Pseudomembranous Colitis: C. Diff

A
  1. Abx use in past 3 months (PCN, Ceph), Acid suppressants*
  2. STOP causative ABX, order stool culture
    - Hydration & hand washing
  3. Admit if:
    - Dehydration, fever, peritonitis, sudden cessation of diarrhea
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23
Q

Gastroenteritis

-Treatment of C. Diff

A
  1. Flagyl
  2. Vancomycin
  3. Probiotics
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24
Q

Common Episodic GI Complaints

-Constipation Causes?

A
  1. Medications — Ca-channel blockers, opiates, Anticholinergics, Iron supplements
  2. Pregnancy
  3. Inactivity
  4. Pain
  5. Diet, dehydration
  6. Endocrine/CNS disorders (DM, Hypothyroidism, MS)
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25
Q

Common Episodic GI Complaints

-Constipation Management

A
  1. Lifestyle is #1 — Increase fiber intake (30g/day), Water, & Exercise
    - Avoid skipping meals
  2. Change causative meds (Opioids, Iron)
  3. Acute signs — consider imaging
    - Consider colonoscopy/GI referral based on risk
    - Consider Ultrasound based on presentation
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26
Q

Common Episodic GI Complaints

-GI Bleed Differentials

A
  1. Upper GI (Hematemesis)—Ulcers, varices, esophagitis, CA
  2. Stomach — Ulcers
  3. Lower GI — Hematochezia & Melena
    —Causes: Diverticulitis, CA, Polyps, IBD
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27
Q

Common Episodic GI Complaints

-GI Bleed: Emergent Vs. Outpatient?

A
  1. PE, labs and stability
  2. Determine cause to treat outpatient
  3. Imaging
    —Colonoscopy, EGD, CT
  4. Labs
    —CBC, Coags, ABO, CMP (LFT’s and serum creatinine)

Fetal occult test for Rectal bleeding

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28
Q

Common Episodic GI Complaints

-Rectal Bleeding Hx and PE

A
  1. Location, quality, color of blood (fetal occult test FOBT)
  2. Causes:
    - Anal fissure, hemorrhoid, abscess
  3. Rectal Exam w/ FOBT
  4. Imaging, Scope
  5. Differentials:
    - Diverticulosis or Diverticulitis, IBD
29
Q

Common Episodic GI Complaints

-Rectal Bleeding Management?

A
  1. Manage constipation — Diet and hydration
  2. Stool softeners
  3. Sitz baths, topical preparations
  4. Bowel retraining
  5. Referral/Surgical Management if needed
30
Q

Chronic GI

-Conditions?

A
  1. GERD
  2. PUD
  3. Celiac
  4. IBS, IBD, Crohn’s
  5. Diverticulitis
  6. Chronic cholecystitis/pancreatitis
  7. Hepatitis
  8. GI cancers
  9. Non-alcohol fatty liver disease (NAFLD)
31
Q

Chronic GI

-GERD Overview

A
  1. Heartburn, Coughing, HOARSENESS, CHEST PAIN, HICCUPS, DENTAL EROSION
  2. PE: HEENT, Abdomen — R/O hernia, CV causes
  3. Responsive to PPI’s?
  4. Endoscopy for serious Sxs
32
Q

Chronic GI

-GERD — Endoscopy for?

A
  1. Dysphagia, odynophagia, early satiety, weight loss, bleeding
  2. Non responsive to PPI’s
  3. Esophageal ulcer/stricture
  4. Laryngitis & Throat CA
  5. Barrette’s Esophagus (5 yrs )
33
Q

Chronic GI

-GERD management?

A
  1. Small Frequent meals w/ meal timing
  2. Elevate HOB — Don’t lay down w/in 2-3 hrs of eating
  3. Medications
    - Antacids, H2 blockers, PPI’s
  4. Alcohol and smoking cessation
  5. Refer to GI
34
Q

Chronic GI

-PUD overview

A
  1. Epigastric pain
    - Weight loss, early satiety, bleeding, anemia
  2. NSAID, ASA, Corticosteroid use
  3. H. Pylori = 80%
    —Tobacco Doubles risk
    —Serum H. Pylori antibody testing (+18 months after eradication)
    —Stool H. Pylori antigen
  4. CBC
  5. Diagnosis:: ENDOSCOPY**
35
Q

Chronic GI

-PUD & H. Pylori

A
  1. > 50% global human population colonized
  2. > 80% + in developing nations
  3. Inversely proportional to socioeconomic status
36
Q

Chronic GI

-PUD Treatment

A
  1. PPI or H2 blocker, sucralfate 8-12 wks (for ulcers)
  2. H. Pylori Eradication — 3-4 drug regimen x 2 weeks
    —PPI, 2x antibiotics
  3. EGD after 8 wks — after treatment optional
  4. REFER when:
    —weight loss, no resolution, Dysphagia, hematemesis, melena, anemia, vomiting
37
Q

Chronic GI

-H. Pylori Treatment (Triple)

A
  1. PPI
  2. Clarithromycin
  3. Amoxicillin
  4. Metronidazole
38
Q

Chronic GI

-Celiac Sprue

A
  1. Autoimmune disorder of GI tract
    —Gluten sensitivity —Wheat, barley, rye
  2. Causes bloating, abdominal pain, decreased appetite & weight loss
  3. Inflammation causes malabsorption
  4. Labs — transglutaminase antibodies
  5. DX — endoscopy & biopsy (RARE)
39
Q

Chronic GI

-Celiac Sprue Management

A
  1. Gluten-free diet
  2. Supplements
  3. Steroids (Once on steroids, GI Referral

Order test before gluten restriction to avoid FALSE NEGATIVE

40
Q

Chronic GI

-IBS DIagnosis

A
  1. Recurrent abdominal pain or discomfort at least 3 days/month x 3 months + two or more of the following
    —Improvement w/ defecation
    —Onset associate w/ change in frequency of stool
    —Onset associate w/ change in form (appearance) of stool
41
Q

Chronic GI

-IBS ABCDEs

A
  1. Abdominal pain
  2. Bloating
  3. Constipation
  4. Diarrhea
  5. Extra-Bowel sxs — HA, fatigue, sleep disturbance, back pain
42
Q

Chronic GI

-IBS Diagnosis

A
  1. Endoscopy & Referral for — weight loss, bleeding, anemia, early satiety
  2. H. Pylori testing if ulcer present
  3. Education
    —Diet, exercise, stress management
    —Fiber, limit caffeine & fat
43
Q

Chronic GI

-Constipation ROME Criteria

A

Diagnostic criteria for functional Constipation
1. Must include 2 of the following;
—Straining at defecation
—lumpy/hard stools
—sensation of incomplete evacuation
—sensation of anorectal obstruction/blockage
—Manual maneuvers to facilitate defecation
—Fewer than 3 defecations/wk

  1. Loose stools rarely present w/out laxatives
  2. Insufficient criteria for IBS
44
Q

Chronic GI

-IBD (UC and Crohn’s)

A
  1. Diarrhea, weight loss, abdominal pain

Ulcerative Colitis
—Chronic inflammation of colon/rectum
—Bloody diarrhea

Crohn’s Disease
—Transmural inflammation of gut wall
—Any part of GI tract — mouth to anus
—Fístulas, strictures, abscesses, obstructions

REFER to GI specialist

45
Q

Chronic GI

-PCP Role w/ IBD?

A
  1. Diagnosis and supportive management — Education
  2. REFER to GI
  3. Cancer surveillance
46
Q

Chronic GI

-Diverticulosis

A
  1. Incidental finding on colonoscopy
  2. Out pockets in colonic mucosa
  3. Diverticulosis — Asymptomatic
    —Manage w/ diet and increased fiber
47
Q

Chronic GI

-Diverticulitis

A
  1. Micro-perforation/infection of diverticulum
    —LLQ pain, fever, chills, altered bowel habits
    —Elevated WBC’s and Left shift
  2. Diagnose w/ CT SCAN*
  3. NO COLONOSCOPY 4-6 weeks after exacerbation
  4. Low residue diet
  5. Inpatient in moderate to severe cases
48
Q

Chronic GI

-Diverticulitis Treatment

A
  1. Cipro + metronidazole 10-14 days

2. Low residue diet

49
Q

Chronic Cholelithiasis Management

A
  1. Ultrasound — Dx, visualize stones, obstructions
    —Cholecystectomy for obstructing stones**
  2. Non-Emergency Treatment
    —Hydration - Water
    —Diet and lifestyle modifications
    —GI referral — elective surgery
50
Q

Chronic GI

-Hepatitis A, B, C

A
  1. Prevention**
    - Vaccination for A & B
    - Sexual education - prevention
  2. Screening and detection
  3. Coordination of care
    - refer to GI, hepatology and/or infectious dz specialist
    - coordinate primary care and optimize general health and maintenance
51
Q

Chronic GI

-Hepatitis A info

A
  1. Food-borne illness — rates ⬇️ w/ vaccination
  2. Acute and self-limiting — 3 months to resolution (85%)
  3. Supportive care
  4. Consult ID/GI
52
Q

Chronic GI

-Hepatitis A presentation and Tests?

A
  1. Abrupt onset fatigue, malaise, N/V, anorexia, fever
  2. RUQ pain
  3. Dark urine & light-colored stools
  4. Pruritus
  5. Jaundice and hepatomegaly

LABS
-LFT’s and IGM HAV

53
Q

Chronic GI

-Hepatitis B Hx?

A
  1. Surgery — known infection or exposure

2. Meds, ETOH use — substances metabolized by liver

54
Q

Chronic GI

-Hepatitis B Presentation

A
  1. Jaundice & Weight loss
  2. N/V &/or abdominal pain
  3. Arthralgias and myalgias
  4. Pruritis/rash
  5. Anorexia
  6. Fever
  7. Changes in urine and stool
55
Q

Chronic GI

-Testing for Hepatitis B

A
  1. Hepatitis B surface antigen and surface antibody
  2. Hepatitis B core antibody
  3. Test all forms — A, B, and C
  4. Consider other possible exposures
    —STI & blood borne illness **
56
Q

Chronic GI

-Hepatitis B Screening Guidelines

A
  1. Persons from endemic areas
  2. Household/sexual contact acts of Hep B + patients
  3. Hx IV drug use
  4. Hx STI or multiple partners
  5. Men who have sex with men
  6. Inmates of correctional facilities
  7. Chronically elevated ALT or AST
  8. Infection w/ HCV or HIV
  9. Dialysis &
  10. All pregnant women
  11. Immunosuppressive therapy recipients (Diabetes)
57
Q

Chronic GI

-Care of Hep B?

A
  1. Baseline Labs — Electrolytes, CBC, PLT, LFT’s PT
    —Hep B panel — Hep A, C, D, E, if high risk
  2. Iron and TIBC to R/O hemochromatosis
  3. Vaccine for Hep A
  4. Screen for HIV infection for pt’s with risk factors**
  5. Screening for hepatocellular carcinoma **
  6. Refer to GI/Hepatology/ID*
58
Q

Chronic GI

-Hepatitis C

A
  1. Blood transfusions
  2. IV drug use or Cocaine use
  3. Occupational exposure (NURSES)**
  4. Tattoos, body piercing
  5. High risk sexual behavior

Screen all adults 18-79 yrs old

HEP C is COMMON

59
Q

Chronic GI

-Hepatitis C Treatment

A
  1. Monitor progression to hepatocellular cancer
  2. Refer: GI/Hepatology/ID
  3. Counsel on prevention and transmission
  4. Monitor Liver US Q6 months + AFP level
60
Q

Chronic GI

-Hepatitis Role of PCP

A
  1. Prevention — Education, vaccines (A & B), Prevention
  2. Screening —STI panel; CMP when LFT’s are elevated
  3. Detection — Type (A,B,C), Labs (Elevated LFT’s)
    —Monitor pt’s on STATINS d/t LFT elevation
61
Q

Non-Alcoholic Fatty Liver Dz (NAFLD)

-Definition

A
  1. Fatty infiltration of liver in absence of excessive alcohol intake
62
Q

Non-Alcoholic Fatty Liver Dz (NAFLD)

-Stats and RIsk

A
  1. Increases risk for CVD, malignancy, and overall morbidity and mortality
  2. NAFLD can progress to NASH (Nonalcoholic steatohepatitis) which can progress to Cirrhosis
  3. Most COMMON cause of elevated LFT’s in adults

RISK FACTORS:

  • Obesity, DM, HTN, Elevated TG & Low HDL (Dyslipidemia)
  • Identify and treat early
63
Q

Non-Alcoholic Fatty Liver Dz (NAFLD)

-Clinical Presentation

A
  1. Asymptomatic **
  2. Fatigue, vague RUQ pain
  3. Elevated LFT’s or abnormal US
  4. Obese w/ hepatomegaly
  5. Spider Nevi; palmer erythema
  6. Jaundice, anorexia, pruritis, ascites
64
Q

Non-Alcoholic Fatty Liver Dz (NAFLD)

-Concerning Hx

A
  1. ETOH use
  2. High dose acetaminophen
  3. Autoimmune Dz
  4. Diet and exercise habits
  5. Biliary tract dz
65
Q

Non-Alcoholic Fatty Liver Dz (NAFLD)

-Objective data

A
  1. BMI, Obesity
  2. Hepatomegaly
  3. LFT’s (CMP); PT, albumin, serum bilirubin
  4. Glucose, HbA1C & lipids
  5. CBC, ANA, ESR
  6. US liver, GB, spleen
66
Q

Non-Alcoholic Fatty Liver Dz (NAFLD)

-KEY diagnostics?

A
  1. Abnormal hepatic histology
  2. Minimal consumption of ETOH
  3. Absence of viral hepatitis
  4. Noted fatty infiltration on imaging
67
Q

GI Cancers

-Types (7)

A
  1. Esophageal
  2. Stomach
  3. Liver
  4. Pancreatic
  5. Gallbladder
  6. Colorectal
  7. Anal/rectal
68
Q

GI Cancers

-Risk factors

A
  1. Uncontrolled chronic dz & inflammation
  2. H. Pylori
  3. HPV
  4. Smoking
  5. Obesity
  6. Sodium
  7. Nitrosamines
  8. Low fruit/veg/fiber intake
  9. Immunosuppression
69
Q

GI Cancers

-Screening & Health Promotion

A
  1. HPV vaccine and STI education for risk reduction
  2. Hepatitis vaccines
  3. Colonoscopy — q10 yrs at age 45-75 — consider risk and fam hx
  4. Diet
    —healthy diet, exercise and low ETOH use
    —Tobacco cessation
  5. Manage chronic diseases
    —PUD & H. Pylori, GERD, IBD

6030 Primary Care Test 3 COMPLETE ☑️ (7 decks)

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