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568 > Unit 4- GI/GU > Flashcards

Unit 4- GI/GU Flashcards

1
Q

Ask about during medical HX with GI

A

Hx problems- IBD, IBS, GERD, constipation, change in bowels

ABD surgery

Gyn hx in women- LMP, method of contraception, STD risk

Medications

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2
Q

Order of abd assessment

A

Look- distension, surgical scars, peristalsis, pulsations, veins, tugor, hernias
listen- bowels, renal or aortic bruits
feel- painful area last, spleen/liver, rigidity, masses, pulsations, rebound tenderness
percuss- ascites, CVA tenderness, hepatosplenomegaly

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3
Q

Murphys sign

A

RUQ pain on deep innspiration, inflamed gallbladder

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4
Q

Rovsing sign

A

palpation of LLQ and pain in the RLQ = appendicitis

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5
Q

Obturator test

A

pain in RLQ on internal rotation of right hip= appendicitis

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6
Q

psoas sign

A

extension of right hip, and pain in the RLQ appendicitis

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7
Q

Causes of diffuse abd pain

A

IBD, IBS, gasatroenteritis, AAA, bowel obstruction, ischemic bowel

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8
Q

Causes of epigastric pain

A

MI, PUD, biliary disease, pancreatitis

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9
Q

Causes of LUQ pain

A

spleen, renal disease

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10
Q

Causes of periumbilical pain

A

early appendicitis, small bowel disease

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11
Q

Causes of LLQ pain

A

diverticulitis, PID, ovarian cyst, ectopic prego

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12
Q

Causes of RLQ pain

A

appendicitis, PID, ovarian cyst, ectopic prego

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13
Q

voluntary guarding

A

usually symmetric, muscles
more tense on inspiration,
usually doesn’t hurt to rise from supine to sitting position (using abdominal muscles),
lessens with distraction.

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14
Q

involuntary guarding

A

asymmetrical,
rigidity present on inspiration and expiration,
rising to sitting position greatly increases pain, doesn’t change with distraction

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15
Q

Appendicitis sx

A

anorexia
periumbilical pain that migrates to RLQ
N/V

+mcburneys point, rebound tenderness
+obturator, Rovsing and psoas sign

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16
Q

Cholelithiasis sx

A

colicky pain, located in epigastrium or RUQ and flank, occasionally R shoulder

Pain occurs within 1 hr after eating large meal, last several hours, residual aching can last for days

anorexia
N/V
Fever
\+murphys sign
guarding and rebound
increase WBC, total bili, ALT, Alk phosp, and amylase
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17
Q

Pancreatitis sx

A

abrupt onset of severe epigastric pain that radiates to the back
pain increase with movement or lying supine (pt prefer to sit up and lean forward)

N/V
sweating
anxiety 
abd tenderness without guarding
rigidity or rebound
distension
Absent bowel sounds
fever
tachycardic
pallor 
hypotension

Increase amylase and lipase, WBC, ALT

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18
Q

Tx for appy

A

CT scan

surgery

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19
Q

Tx for choliliathisis

A

bowel rest (NPO)
pain management
IV abx
lap choly

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20
Q

Tx for pancreatitis

A

refer

KUB, CT

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21
Q

What is gastroenteritis

A

acute infectious diarrhea

usually self limiting

very young or elderly more at risk

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22
Q

causes of gastroenteritis

A

virus (70-80%)- rotavirus, adenovirus, water or person-to-person
Bacterial (10-20%)- s. aureus, c. diff
Parasites (<10%)- giardia

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23
Q

sx of gastroenteritis

A

viral- large volume watery stool
last 1-2 days
N/V, crampy, fever, malaise, dehydration

bacterial- may have bloody diarrhea, c. diff can occur 8 weeks after abx,

parasitic- watery diarrhea prolonger, cramps

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24
Q

get stool culture in gastroenteritis if

A

more than 3 days, <3mo old
>70 years
at risk (food service, day care worker)

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25
Q

tx for gasteroenteritis

A

supportive, assess for dehydration,

adults should avoid dairy, caffeien and alcohol

Eat rice, potatoes, wheat, banana, yogurt, soup, crackers

Imodium, Kaopectate
DO NOT use in severe or bloody diarrhea, high fever or systemic toxicity

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26
Q

diverticulitis define

A

inflammation of a diverticulum that ranges from icro perforation with localized inflammation, macro perforation with abscess or peritonitis

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27
Q

diverticulitis sx

A

aching abd pain usually LLQ, constipation or loose stools
N/V, low-grade fever, LLQ tenderness, palpable mass

+occult blood in stool, mild-moderate increase in WBC

pt dont seek attention until several days after onset

pt with perforation will have more severe sx

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28
Q

Tx of diverticulitis with mild sx

A

empiric abx without imaging, colonoscopy, CT colo, or barium enema

Clear liquid diet
usually improve in 3 days
high fiber diet

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29
Q

Tx of diverticulitis with severe sx

A

may need CT of abd in acute stage to eval severity

REFER for inpt, IV abx, possible surgery

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30
Q

GERD sx

A

heartburn usually 30-60 miin after meal with reclining, burning CP and regurgitation

Non-gi- asthma, chronic cough, laryngitis, sore throat, sleep disturbances

Alarm sx- >55yo, anemia, melena, hematemsis, dysphagia, weight loss, difficult/painful swallowing

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31
Q

tx for mild gerd

A

smaller meals, eliminate spicy or acidic foods, elevate HOB, dont lay down 3 hr post eat, weight loss

PRN antacids or H2 receptor antagonist- pepcid, zantac, tagament

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32
Q

tx of mod-severe gerd

A

empiric therapy PPI
PPI- once daily for 4-8 weeks

if no response=refer
+ response= keep taking PPI for 8-12 weeks

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33
Q

Causes of PUD

A

NSAIDS, h. pylori

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34
Q

sx of PUD

A

Dyspepsia

hunger-like burning pain in epigastrcic area, pain may awaken, sx wax and wane

up to 60% NSAID induced have no sx

normal or sightly tender epigastric, new onset guaiac stools

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35
Q

dx of PUD

A

upper endoscopy with biopsy

h pylori- upper breath test or fecal antigen

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36
Q

medications for PUD

A

acid antisecretory agents: PPI have replaced H2

abx-eradicate h pylori

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37
Q

What is colic

A

healthy, well fed infant that cries for more than 3 hours/day, more than 3 days a week and more than 3 weeks

severe and paroxysmal crying that occurs mainly in late afternoon

knees drawn up and fists clenched- begins at 2-3 months

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38
Q

intussusception

A

most common in first 2 years of life

thriving infant 3-12 mo with paroxysmal, colicky pain, draws up knees and screams

use barium or air enema

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39
Q

intussusception s/sx

A

vomiting, diarrhea, 90% bloody BM with mucus within 12 hours

prostration and fever, tender distended abd, sausage shaped mass may be palpated in upper mid abd

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40
Q

umbilical hernias affect what population

A

full-term african american within 1st year of life

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41
Q

T or F: umbilical hernias need repaired in adults due to high risk of incarceration and strangulation

A

True

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42
Q

Inguinal hernias

A

75% of abd hernias

congenital in children but can be d/t obesity, chronic cough, ascites, chronic constipations with straining and lifting heavy objects

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43
Q

Management of hernias

A

DO NOT reduce strangulated- can cause gangrenous bowel to enter peritoneal cavity

REFER

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44
Q

alarm markers for referral of hernais

A

acute onset of colicky abd pain, N/V, edema

discoloration at the site

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45
Q

intestinal malroation

A

healthy infant suddenly refusing to eat, vomits bile, becomes inconsalable- usually develops distention, occurs during first 3 weeks of life

use upper GI to and barium enema to confirm

surgery to fix

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46
Q

T or F: Pyloric stenosis is most common in females

A

FALSE, males

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47
Q

signs of pyloric stenosis

A

usually begins at 2-4 weeks old, projectile vomiting, rapidly becomes projectile after every feeding

appears hungry, eats frequently, constipation, dehydration, weight loss and fretful, olive size mass can be felt on deep palpation in RUQ

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48
Q

what does pyloric stenosis show on US?

A

hypoechoic ring with thickness >4mm

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49
Q

Tx of pyloric stenosis

A

hydration, correct electrolyte abnormality prior to surgical repair

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50
Q

Lactose intolerance

A

sx usually 4-6yo, intestinal dilation, bloating, increase flatulence, pain and diarrhea

onset of sx 2hr after ingestion of milk

tx- lactase supplement to dairy products

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51
Q

cows milk intolerance

A

occurs in infance, blood in stool, often manifestation of allergies

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52
Q

ectopic pregnancy

A

unilateral lower quad pain, continuous and crampy, vag bleeding and low-grade fever

EMERGENT referal to OB

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53
Q

Mittelschmerz

A

spillage of fluid from ruptured follicular cystic-irritates peritoneum-mid cycle pain

sx-sudden onset localized lower quad pain-persist for few minutes to as long as 8 hr

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54
Q

anovulatory cycles

A

lead to normal follicular cyst growing large over several cycles- considerable pain on rupture reveal intrauterine rego

EMERGENT referral

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55
Q

Tx of acute cystitis in women

A

cephalexin, nitrofurantoin, bactrim

Fluoroquinolone for uncomplicated UTI

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56
Q

most common cause of acute cystitis

A

e. coli

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57
Q

Labs for acute pyelo

A

leukocytosis and a left shift

UA-pyuria, bacteriuria, hematuria, white cell casts

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58
Q

tx for acute pyelo

A

empiric therapy-ampicillin, cipro, levofloxacin, bactrim,

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59
Q

when to refer for acute pyelo

A

complications
urolithiasis
obstruction

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60
Q

5 types of stones

A 
calcium oxalate
calcium phosphate
struvite
uric acid
cystine
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61
Q

contributing to the stones

A

high humidity and elevated temps

sedentary lifestyle: HTN, carotid calcification, cardiovascular disease, high protein and salt intake, inadequate hydration

*keep sodium <150/day

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62
Q

Urge incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients

A

a.

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63
Q

Transient incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients

A

c.

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64
Q

Functional incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients

A

E.

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65
Q

Stress incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients

A

b.

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66
Q

Overflow incontinence is?
a. most common cause of persistent
(INVOLUNTARY) incontinence in the elderly
b. present when involuntary leakage
occurs from effort or exertion or from sneezing or coughing
c.incontinence less than 6 weeks
spontaneously resolves with tx of underlying condition
d.prevalence of prostate disorders,
incontinence in older men due to obstruction of urinary
outflow; symptoms = dribbling
e.inability or unwillingness to
toilet because of physical, cognitive, psychological, or
environmental factors. Common in hospital and nursing
home patients

A

d.

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67
Q

Dyspepsia is

A

predominant epigastric pain for at least 1 mo, epigastric fullness, N/V, heartburn,

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68
Q

everyone older than ___ get endoscopy with dyspepsia

A

60,
or selected younger with alarm features

In all others test for h. pylori

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69
Q

T or F: prescribe empiric PI in those with h. pylori who dont improve after eradication

A

True

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70
Q

pancreatic disease

A

pancreatic carcinoma and chronic pancreatitis=chronic epigastric pain

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71
Q

what is functional dyspepsia

A

most common cause of dyspepsia

increased visceral afferent sensitivity, gastric delated emptying or impaired accommodation to food or stressors

often younger, signs of anxiety or depression

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72
Q

What is biliary tract dysfunction

A

abrupt onset of epigastric or RUQ pain r/t cholelithiasis, elithiasis, or choledocholithiasis

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73
Q

tx of dyspepsia

A

initial empiric in all younger than 60 with no alarm feature (PPI)

all others get upper endoscopy with subsequent tx and cause

obtain gastric bisy- during endoscopy to test for h. pylori

If positive for h. pylori give abx

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74
Q

diagnostic studies for dyspepsia

A

upper endo- choice for GI ulcer, erosive esophagitis, increased GI malignancy

abd CT scan

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75
Q

sx of N/V w/out abd pain causes

A

food poisoning, infectious gastroenteritis, drugs, systemic illness

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76
Q

sx of N/V w/ severe pain and vomiting

A

peritoneal irritation, acute gastroparesis, intestinal dysmotility, psychogenic disorders, CNS or systemic disorder

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77
Q

Causes of vomiting in the morning before breakfast

A

prego, uremia, ETOH, increased ICP

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78
Q

Causes of vomiting immediately after meals

A

bulimia and psychogenic

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79
Q

causes of vomiting of undigested food one to several hr post meal

A

gastroparesis or gastric outlet syndrome

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80
Q

special exam for severe or protracted vomiting

A

electrolytes for assess hypokalemia, azotemia, or metabolic alkalosis (due to gastric contents)

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81
Q

special exam for flat and upright abd xray or CT

A

severe pain or suspicion of obstruction to look for intraperitoneal air or dilated loops of small bowel

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82
Q

What does upper endo determine?

A

gastric outlet obstruction

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83
Q

What does an abd CT imaging determine?

A

cause of small intestinal obstruction

84
Q

What does a nuclear scintigraph study or c-octanoic acid breath test determine?

A

gastroparesis, shows delayed emptying and no evidence of gastric outlet obstruction

85
Q

example of a serotonin 5-ht-receptor antagonist

A

ondansetron- effective in preventing chemo and radiation induced emesis and pstop when given prior to treatment

efficacy is enhanced by combined therapy with a steroid

86
Q

corticosteroids

A

enhance efficacy of serotonin antagonist for preventing acute and delayed N/V in pt receiving emetogenic chemo

87
Q

dopamine antagonists

A

promethazine

work by blocking dopaminergic and have sedative effects

se:extrapyramidal reactions and depression

88
Q

antihistamines and anticholinergics for n/V

A

meclizine, dimenhydrinate, scopolamine

work by stimulating labyrinth. give with oral vitamin B6 and doxylamine given FIRST LINE during PREGO

se: drowsiness

89
Q

Cannabinoids for N/V

A

stimulate appetite and antiemetic

dronabinol- good for chemo and CNS pt

90
Q

T or F: Hiccups can cause metabolic acidosis

A

FALSE- can cause respiratory alkalosis

91
Q

causes of hiccups

A

gastric distention, sudden temp change, ETOH, heightened emotion

recurrent: GI, CNS, CV, and thoracic disorders

92
Q

Assessment of hiccups include looking at what body systems?

A

Neuro
serum creatinine
liver chem test
CXR

Unclear cause= CT/MRI or head, chest, and abd, EKG, upper endo

93
Q

Drug given for hiccups

A

Chlorpromazine

94
Q

What is primary constipation?

A

unattributed to any structural abnormality or systemic disease - most common

95
Q

What is normal colonic time?

A

approx. 35 hr, anything >72=ABNORMAL

96
Q

What is secondary constipation?

A

cauesd by systemic disorders, medications, or obstructing colonic lesions

neoro gut dysfunction, myopathies, endocrine disorders, or electrolyte abnormalities

97
Q

What is fecal impaction

A

sever impaction in the rectal vault that may lead to obstruction either partial or complete large bowel

causes-meds, pyshiatric disease, bed rest, neuro/spinal disorders

98
Q

fiber will exacerbate sx in these disorders

A

colonic inertia
defecatory disorders
opioid-induced
IBS

99
Q

When to give laxatives

A

in intermittent or chronic bases for constipation that does not respond to dietary or lifestyle changes

100
Q

osmotic laxatives

A

daily
increase secretions of water into lumen
Miralax

101
Q

Purgative laxative

A

rapid tx
mag citrate

may cause hypermagnesemia

102
Q

stimulant laxatives

A

pt with no response to osmotic agents

stimulate fluid secretion and colonic contraction
bisacodyl, senna, cascara

103
Q

Chronic excessive belching

A

supragastric belching or true air swallowing= behavioral seen in psychiatric pt

104
Q

etiology of flatus

A

increased ingestion of lactose, polyols, and fructants or disorder of malabsorption

105
Q

Avoid what in flatus

A

gum chewing or carbonated beverages, assess lactose intolerance

106
Q

bloating cause

A

production of excess gas or impaired gas propulsion

107
Q

treatment of bloating

A

reduce fermentable sugars with restricted diet, reduce intake of dietary fat

Rifaximin

108
Q

Acute diarrhea

A

<2 weeks, most commonly caused by invasive or noninvasive pathogrens

109
Q

what is acute inflammatory diarrhea?

A

fever and bloody diarrhea

colonic tissue damage r/t invasion or a toxin

110
Q

acute inflammatory diarrhea s/sx

A

small volume diarrhea, LLQ cramps, urgency and tenesmus

fecal leukocytes or lactoferrin

111
Q

causes of infectious dysentery

A

e coli

CMV

112
Q

when should a stool sample be sent with diarrhea

A

7-14 days fr analysis for viral, protozoan, and bacterial pathogens

113
Q

when to seek medical evaluation in diarrhea

A 
6+ unformed stools in 24hr
profuse watery diarrhea and dehydration
frail older pt or nursing home 
immunocompromised
exposure to abx
hospital-acquired diarrhea
systemic illness
114
Q

tx for diarrhea

A

PO fluids
rest bowel
frequent feedings of tea, flat carbonated beverages and soft easily digested foods

antidiarrhea safe in pt with ild-mod diarrheal illness
loperaide
bismuth

abx- empiric tx, fluoroquinolones, bactrim

DONT GIVE macrolides

115
Q

Chronic diarrhea last longer than

116
Q

causes of chronic diarrhea

A

carbohydrate malabsorption*
laxative abuse
malabsorption syndromes

117
Q

secretory conditions for chronic diarrhea

A

increased intestinal secretions or decreased absorption=high vlm watery diarrhea w/ normal osmotic gap

caused by endocrine tumors and micro colitis

118
Q

inflammatory conditions for chronic diarrhea

A

IBS, UC, chrons

abd pain, fever, weight loss, hematochezia

119
Q

malabsorptive conditions for chronic diarrhea

A

small mucosal intestinal disease, intestinal resections, lymphatic obstruction, small intestinal bacterial overgrowth, pancreatic insufficiency

weight loss, osmotic diarrhea, steatorrhea, and nutritional deficiencies

120
Q

motility conditions for chronic diarrhea

A

IBS

lower abd pain+altered bowel habits w/out evidence of serious organic disease

121
Q

chronic infections conditions for chronic diarrhea

A

protozoans, intestinal nematodes, c.diff

122
Q

systemic conditions conditions for chronic diarrhea

A

thyroid disease, DM, collagen vascular disorders

123
Q

Which produces greasy or malodorous diarrhea

a. inflammatory
b. secretory process
c. malabsorption

124
Q

Which produces pus or bloody diarrhea

a. inflammatory
b. secretory process
c. malabsorption

125
Q

Which produces watery diarrhea

a. inflammatory
b. secretory process
c. malabsorption

126
Q

T or F: presence of nocturnal diarrhea, weight loss, anemia, positive FOBT warrant further eval

127
Q

labs for malabsoprtion

A

anemia

  • folate
  • iron deficiency
  • vit b12

hypoalbuminemia

128
Q

labs for and inflammatory conditions

A

anemia

  • folate
  • iron deficiency
  • vit b12

hypoalbuminemia

increased ESR/ C-reactive protein

129
Q

labs for secretory diarrhea

A

hyponatremia

nonanion gap metabolic acidosis

130
Q

T or F: Hct is a good early indicator of blood loss

131
Q

causes of upper GI bleed

A 
PUD
portal HTN
mallory-weiss tear
vascular anomalies
gastric neoplasms
erosive gastritis
erosive esophagitis
trauma
132
Q

T or F: All pt with upper GI bleed should undergo endo within 48 hr of ED arrival

A

FALSE

within 24 hr

133
Q

Gerd is exacerbated by

A

meals
bending
recumbency

134
Q

Dysfunction of the gastroesophageal sphincter

A

transient relaxations of the LES- triggered by gastric distention by a vasovagal reflex

135
Q

T or F: treatment is NOT warranted for pt with typical GERD suggesting uncomplicated reflux

136
Q

Heartburn and regurgitation should be treated with?

A

daily H2-receptor antagonists or

PPI for 4-8 weeks

137
Q

alarm features with GERD

A

troublesome dysphagia
odynophagia
weight loss
iron deficiency anemia

138
Q

T or F: Barium esophagography should be done to diagnose gerd

139
Q

tx for mild GERD

A

lifestyle modificiations and medical interventions

eat smaller meals and eliminate acidic foods/fatty foods/chocolate/peppermint/alcohol/ cigarettes

weight loss
avoid laying down 3 hr post meal

antacids take before meals

140
Q

Tx for GERD

A

once daily PPI (omeprazole, lansoprazole, pantoprazole)

141
Q

gastritis is put into what 3 categories

A

erosive and hemorrhagic

nonerosive, nonspecific

specific types

142
Q

erosive/hemorrhagic gastritis causes

A

alcoholics, critically ill, taking NSAIDS

often asymptomatic, may cause epigastric pain, N/V, anorexia , upper GI bleed

143
Q

major risk factors for erosive/hemorrhagic gastritis

A

vents, coagulopathy, trauma, burns, shock, sepsis, CNS injury, liver/kidney disease, MODS

144
Q

tests for erosive/hemorrhagic gastritis

A

upper endo, labs (low Hct)

145
Q

stress gastritis

A

mucosal erosions and subepithelial hemorrhages may develop w/in 72hr critically ill pt.

tx-continuous PPI

146
Q

NSAID gastritis

A

less incidence of endoscopically visible ulcers

increase risk of MI, CVA, death

upper endo if- severe pain, weight loss, vomiting, GI bleed, anemia

tx- po PPI

147
Q

alcoholic gastritis

A

excessive consumption=dyspepsia, N/V, minor hematamesis

tx- H2 receptor, PPI

148
Q

portal hypertensive gastropathy

A

gastric mucosal and submucosal congestion of capillaries and venules

asymptomatic, can cause chronic GI bleed

tx- propranolol

149
Q

non-erosive types

A

h. pylori
pernicious anemia
eosinophilic gastritis

150
Q

h. pylori gastritis

A

inflammation w PMNs and lymphocytes

higher in non-whites and immigrants

transmission- person to person

tx- abx

151
Q

fecal antigen immunoassay and urea breath test

A

d/c PPI 7-14d and abx for at least 28 days

152
Q

Pernicious anermia gastritis

A

rare autoimmune, involves fundic glands w/ resultant achlorhydria, decreased intrinsic factor secretion, vit B12 malabsorption

153
Q

T or F: most NSAIDS induced ulcers are asymptomatic

154
Q

What are the 2 causes of PUD

A

NSAIDs and chronic H pylori infection

Alcohol, dietary factors, stress DO NOT cause ulcer disease

155
Q

Duodenal ulcers are caused by___

156
Q

Tx of Uncomplicated H pylori–associated

ulcers:

157
Q

T or F: must confirm h pylori eradication for all pt more than 4 week after completion of abx therapy and 2 weeks after d/s of PPI

158
Q

Hallmark sign of PUD

A

epigastric pain- dyspepsia

159
Q

dyspepsia is relieved with what

A

food or antacids

160
Q

sign of gastric outlet syndrome

A

significant vomiting and weight loss

161
Q

nonhealing ulcers are suspicious for what?

A

malignancy

162
Q

When should H2 receptor antagonist be given in uncomplicated peptic ulcers?

A

daily at bedtime

163
Q

What is zollinger-ellison syndrome?

A

very rare
PUD severe and atypical gastric acid hypersecretion

gastrin-secreting gut tumors-excessive acid production by GI tract- mostly arise in gastrinoma triangle

164
Q

what is the gastrinoma triangle?

A

portal hepatitis, neck of pancreas, 3rd portion of duodenum

165
Q

T or F: ZES is very similar to PUD so will go undetected for many years

166
Q

ZES signs

A

diarrhea, GERD, steatorrhea, weight loss

NG aspirationof stomach acid stops diarrhea

167
Q

ulcer patient with _____ or family hx of ulcers should be screened for ZES

A

hypercalcemia

168
Q

What is the most sensitive and specific method for identifying ZES?

A

increased fasting gastric concentration >150

obtain when NOT taking H2 for 24hr or PPI for 6days

169
Q

What is celiacs disease?

A

permanent dietary disorder to gluten due to immunologic

most present in childhood or adulthood

170
Q

sign of celiacs

A

weight loss, chronic diarrhea, abd distention, growth retardation, dyspepsia, muscle wasting, hyperactive bowel sounds

dematitis, herpetiformis, IDA, osteoporosis

40% dont have symptoms

171
Q

Dx celiac

A

abnormal serologic test+small bowel biopsy

IgA tissue transglutaminase antibody***

172
Q

dietary supplements for celiacs disease

A 
folate
iron
zinc
calcium
vit a, b6, b12, d, and e
173
Q

sx of lactase deficiency

A

diarrhea
bloating
gas
abd pain post dairy

174
Q

dx of lactase deficiency

A

hydrogen breath test

175
Q

lactase deficiency

A

can arise from GI disorders that affect proximal small intestinal mucosa

chrons, celiac, viral gastroenteritis

176
Q

What supplements do pt with lactase deficiency need?

A

calcium d/t risk for osteoporosis

177
Q

sx of appendicitis

A 
RLQ pain, +mcburneys point
low grade fever
leukocytosis 
colicky pain
feel constipated
178
Q

What can happen if appy left untreated?

179
Q

Gold standard screen for appy

180
Q

IBS

A

chronic functional disorder >6mo

characterized by abd pain w/ alterations in bowel habits

more common in women

181
Q

T or F: IBS will interfere with sleep

182
Q

What to avoid in IBS

A

fatty foods, alcohol, caffeien, spicy foods, grains

183
Q

T or F: drug therpay should be given to all IBS pt

A

FALSE

only given to mod-severe cases that dont respond to conservative measures

184
Q

MEds for IBS

A 
antispasmodic
antidiarrheal
anticonstipation
psychotropic agents
serotonin receptor antagonist
185
Q

UC or Crohns has bloody diarrhea, fecal urgency, anemia, and low albumin?

186
Q

UC or Crohns is dx with sigmoidoscopy?

187
Q

UC or Crohns should have a colonoscopy?

188
Q

UC or Crohns is tx w/ steroids

189
Q

UC or Crohns should not have antidiarrhealth agents

190
Q

UC or Crohns affects rectum to large bowel

191
Q

UC or Crohns affects anywhere from the mouth to anus?

192
Q

UC or Crohns has continuous diffse inflammation

193
Q

UC or Crohns has patch inflammation

194
Q

UC or Crohns has hematochezia

195
Q

UC or Crohns has mucus/pus

196
Q

UC or Crohns hassmall bowel disease

197
Q

UC or Crohns has abd mass and where

A

chrons, RLQ

198
Q

UC or Crohns has extra intestinal

199
Q

UC or Crohns has SBO

200
Q

UC or Crohns has colonic obstruction

201
Q

UC or Crohns has strictures and fistulas

202
Q

UC or Crohns has thin and which one has thick bowel wall

A

thin=uc

thick=crohns

203
Q

UC or Crohns has insidious onset with intermittent low grade fevers, RLQ pain

204
Q

UC or Crohns is associated with smoking

205
Q

UC or Crohns is acommon with chronic inflammatory disease

206
Q

UC or Crohns has arthralgia, arthritis, iritis

207
Q

UC or Crohns will have at least one surgery

568 (8 decks)

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