Week 8 Chronic GI Problems Flashcards
Common side effects of proton pump inhibitors (PPI) include all of the following except:
A Abdominal pain
B Diarrhea
C Vitamin B12 deficiency
D Melena
D Melena
Common side effects include abdominal pain, diarrhea and vitamin B12 deficiency (with long term use). Melena is not a side effect and warrants investigation for an upper GI bleed.
When examining the liver, which of the following is correct?
A The normal liver often extends down just below the right costal margin
B The liver edge should not be palpable
C The liver span is 6 cm to 15 cm in the right midclavicular line
D Dullness indicates that the patient likely has a hepatic mass
A The normal liver often extends down just below the right costal margin
The normal liver often extends down just below the right costal margin and can be felt easier during inspiration. The liver span is 6-12 cm. The liver is a solid organ so is dull when percussed. Percussion can estimate the size of the liver
How can the nurse practitioner assess for possible ascites on exam? (Select all that apply)
A Test for shifting dullness
B Test for a fluid wave
C Test for Murphy’s sign
D Measure the abdominal girth
A Test for shifting dullness
B Test for a fluid wave
A protuberant abdomen with bulging flanks suggests possible ascites. Testing for shifting dullness and for a fluid wave are techniques to confirm the presence of ascites although both signs may be misleading.
When percussing the abdomen, the nurse practitioner would expect a normal finding of
A predominantly tympany, with possible scattered areas of dullness
B dullness in both flanks.
C a large area of dullness throughout the lower abdomen
D tenderness in the right lower quadrant.
A predominantly tympany, with possible scattered areas of dullness
A normal finding to percussion of the abdomen is predominantly tympany, with possible scattered areas of dullness due to fluid and stool. Dullness of the flanks may indicate ascites. A large dull area may indicate a possible mass or enlarged organ. The abdomen should be non-tender to light palpation/percussion.
A patient reports a decrease in the frequency of stools and asks about treatment for constipation. Which findings are part of the Rome IV criteria for diagnosing constipation? (Select all that apply.)
A Feeling of incomplete evacuation
B Fewer than five stools per week
C Hard or lumpy stools
D Abdominal cramps relieved with defecation
E Symptoms present for three months
A Feeling of incomplete evacuation
C Hard or lumpy stools
E Symptoms present for three months
According to the Rome IV criteria, symptoms must have begun 6 months prior and persisted for at least 3 months and include a feeling of incomplete evacuation, lumpy or hard stools, fewer than 3 stools per week, and not meeting criteria for irritable bowel syndrome.
Which are characteristics of Crohn’s disease (CD)? (Select all that apply.)
A Fistulous tracts may occur as disease complications
B The disease does not have extraintestinal manifestations
C Inflammation affects all layers of the intestinal tract wall
D The disease may be limited to the small intestine
E The inflammation is diffuse and continuous
A Fistulous tracts may occur as disease complications
C Inflammation affects all layers of the intestinal tract wall
D The disease may be limited to the small intestine
CD may be complicated by fistulous tracts. Inflammation affects all layers of the intestinal wall tract. The disease may be limited to the small intestine. UC causes inflammation that is diffuse and continuous. CD is associated with uveitis, psoriasis, and arthritis.
A 22-year-old male reports lower abdominal cramping and occasional blood in stools. The provider suspects inflammatory bowel disease. Which test will the provider order to determine whether the patient has ulcerative colitis (UC) or Crohn’s disease (CD)?
A Barium enema
B Colonoscopy
C Genetic testing
D Small bowel series
B Colonoscopy
Colonoscopy is useful in differentiating UC from CD. Barium enema has limited use in diagnosis, but is used to detect distension, strictures, tumors, fistulas, or obstructions. Genetic testing may be helpful in the future with further advances. Small bowel series are used infrequently to determine small bowel involvement.
A school-age child has recurrent diarrhea with foul-smelling stools, excessive flatus, abdominal distension, and failure-to-thrive. A two-week lactose-free trial failed to reduce symptoms. What is the next step in diagnosing this condition?
A Lactose hydrogen breath test
B Sweat chloride test for cystic fibrosis
C Stool for ova and parasites
D Serologic testing for celiac disease
D Serologic testing for celiac disease
This child has symptoms consistent with celiac disease, especially FTT and foul-smelling stools. Since the lactose-free trial did not reduce symptoms, the likelihood of lactose intolerance is less and thus testing is not likely to be helpful. The symptoms are recurrent, so giardiasis is less likely. CF is still possible, but most children with CF are diagnosed as infants and have accompanying respiratory symptoms of some type.
What is the probable underlying pathology of irritable bowel syndrome (IBS)?
A Alteration in processing of sensory information
B Changes in intestinal secretory mucosa
C Intestinal tissue disease
D Malabsorption of specific nutrients
A Alteration in processing of sensory information
Recent research has yielded information about alterations in sensory processing that are different in persons with IBS. Changes in intestinal mucosa, intestinal tissue disease, and malabsorption syndromes are structural disorders and this is a functional disease.
A patient is diagnosed with mild to moderate ulcerative colitis. Which medication will be prescribed initially to establish remission?
A Azathioprine
B Budesonide
C Infliximab
D Sulfasalazine
D Sulfasalazine
Sulfasalazine is a 5-aminosalicyclic acid used to induce remission in UC and is a first-line medication. Budesonide is a synthetic corticosteroid used for moderate to severe disease, but not as a first-line agent. Azathioprine is an immunomodulator used to minimize the need for corticosteroids. Infliximab is a biologic medication and is more useful for treating Crohn’s disease.
The parent of a 3-month-old reports that the infant arches and gags while feeding and spits up undigested formula frequently. The infant’s weight gain has dropped to the fifth percentile from the 12th percentile. There are no red flags. What is the best course of treatment for this infant?
A Reassure the parent that these symptoms will likely resolve by 12 to 24 months
B Perform esophageal pH monitoring to determine the degree of reflux
C Begin a trial of extensively hydrolyzed protein formula for two to four weeks
D Institute an empiric trial of acid suppression with a proton pump inhibitor (PPI)
C Begin a trial of extensively hydrolyzed protein formula for two to four weeks
Formula-fed infants may be given a trial of a hydrolyzed protein formula to see if improvement occurs to determine if there is a cows milk allergy. An empiric trial of a PPI may be used in children and adolescents. PPI use less than age 1 is not FDA approved. However, a PPI or H2 Blocker may be appropriate for infants with clear diagnosis of GERD. Esophageal pH monitoring may be performed in consultation with a specialist but not as first-line evaluation. The infant has warning signs of GERD that require further investigation and not just reassurance.
The nurse practitioner diagnoses an adult patient with GERD and educates the patient to do which of the following?
A Eat larger, less frequent meals
B Sleep in a flat position, without the use of pillows
C Dietary changes are not necessary if taking a PPI
D Exercise regularly and wear loose, comfortable clothes
D Exercise regularly and wear loose, comfortable clothes
Patients with GERD should eat smaller, more frequent meals, elevate the head of the bed when sleeping, avoid common triggers in the diet, and exercise regularly to maintain or lose weight and avoid tight clothes.
A patient with a history of chronic alcoholism reports weight loss, pruritis, and fatigue. The patient’s urine and stools appear normal. What do these findings indicate?
A Early liver cirrhosis
B Late liver cirrhosis
C Liver failure and ascites
D Acute viral hepatitis
A Early liver cirrhosis
Early symptoms of cirrhosis are characterized by this patient’s symptoms. As the condition worsens, stools and urine change color and the patient develops anorexia, nausea, and vomiting. Liver failure and ascites are late and will include abdominal pain. Acute viral hepatitis is a less likely diagnosis in this patient based on his history of alcoholism and reported symptoms.
Which of the following statements about non-alcoholic fatty liver disease (NAFLD) is correct?
A It is an uncommon cause of elevated liver transaminase
B The risk of developing NAFLD is higher in patients who are pre-diabetic or diabetic
C Children are not affected by the disease
D It produces symptoms of fatigue, jaundice, and right upper quadrant pain early in the disease
B The risk of developing NAFLD is higher in patients who are pre-diabetic or diabetic
Fatty liver affects up to 20% of Americans including adults and children. Risk factors include obesity, hypercholesterolemia and DM. It most often asymptomatic early in the disease, and jaundice may appear once the disease has progressed.
A patient is diagnosed with cancer of the colon and is scheduled for surgical resection. A carcinoembryonic antigen (CEA) test prior to surgery is not elevated. What is the significance of this finding?
A A negative CEA indicates a reduced need for surgery
B The CEA should be repeated every 3 months
C The test is not informative and will not be repeated
D This result indicates a better prognosis for cure
C The test is not informative and will not be repeated
A negative CEA indicates that this test is not informative and will not be useful postoperatively. A positive CEA indicates the usefulness of this test and the measurement should be repeated every 3 months after surgery to detect tumor recurrence. It does not indicate whether surgery should be performed and does not predict cure rates.
What is cirrhosis
end-stage consequence of progressive hepatic fibrosis affecting normal liver function
serious, irreversible dx
results from exposure to persistent toxins and results in liver failure and death
common causes of cirrhosis
chronic hepatitis B & C
alcoholic liver dx
nonalcoholic fatty liver dx (NAFLD)
nonalcoholic steatphepatitis (NASH)
Meds associated with cirrhosis
acetaminophen amiodarone methotrexate isoniazid varied abx carbon tetrachloride
advanced stages of cirrhosis results in
shunting of portal and arterial blood supply causes: -portal HTN -obstructive biliary channels -destruction of liver cells -hepatocellular carcinoma liver failure
micronodular cirrhosis
associated with alcoholic liver dx
occurs when repeated presence of an offending agent prevents the regeneration of normal tissue, results in small nodules that have limited functional abilities
as it progresses liver becomes smaller and nodules become larger with diffuse fat accumulation
macronodular cirrhosis
seen in chronic viral hepatitis and hepatocelluar carcinoma, with larger nodules that can contain their own blood supply
larger nodules resemble scar tissue and have limited functional abilities
mixed cirrhosis
combination of both micronodular and macronodular cirrhosis, has mixed characteristics and liver functions are varied
how do we prioritize patients with cirrhosis as candidates for liver transplant
Model for end-stage liver dx (MELD) is a diagnostic tool based on underlying cause of cirrhosis and the Cr, bilirubin, and INR and is used as a prediction tool for liver transplantation
MELD is a 3-month predication of survival
cirrhosis prognosis
depends on cause and classification
if alcohol or drug related, the major factor that determines survival is the ability to STOP drinking or taking those drugs