Gastrointestinal Disorders: Diagnosis and Management, Exams of Nursing

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AG-ACNP - GI AG-ACNP - GI

What bacteria is associated with >90% duodenal ulcers and >75% gastric ulcers? - correct answer H. pylori Which medications cause peptic ulcer disease? - correct answer NSAIDS ASA Glucocorticoids At what age do duodenal ulcers typically present? - correct answer 30-55 yo. At what age do gastric ulcers typically present? - correct answer 55-65 years old What are the signs and symptoms associated with a duodenal ulcer? - correct answer Gnawing, epigastric pain Relief of pain WITH eating What are the signs and symptoms associated with a gastric ulcer? - correct answer Gnawing, epigastric pain Pain WORSENS with eating What are the expected physical findings associated with PUD? - correct answer Physical exam unremarkable GI bleeding - melena, hematemesis or coffee-ground emesis (duodenum) In a patient presenting with coffee-ground emesis, where does the ACNP suspect the ulcer is located? - correct answer In the duodenum

What are the signs and symptoms of a perforated peptic ulcer? - correct answer Severe epigastric pain BOARD LIKE abdomen QUIET BOWEL SOUNDS Acute abdomen What is the first-line treatment in PUD? - correct answer H2 Blocker - Ranitidine (Zantac) 300 mg/hr at SLEEP Famotidine (Pepcid) 40 mg/hrs at SLEEP When should you educate patients on administration of a Proton Pump Inhibitor? - correct answer Patient should take PPI 30 minutes before meals What is the BBW associated with PPIs? - correct answer HIP FRACTURE What is the dosing for PPIs in PUD? - correct answer Pantoprazole (Protonix) 40 mg/day Omeprazole (Prilosec) 20 mg/day What patient education is needed when prescribing Mucosal Protective Agents? - correct answer Sucralfate (Carafate) 1 gm PO QID Requires acidic environment - avoid ANTACIDS and H2 Blockers What medication used in treatment of PUD is also associated with decreases in nosocomial PNA? - correct answer sucralfate (Carafate) - mucosal protective agent What medication indicated in the management of PUD has antimicrobial action against H.Pylori? - correct answer bismuth subsalicylate (Pepto-Bismol) Which medication is used as ppx against NSAID-induced peptic ulcers? - correct answer misoprostol (Cytotec)

What are examples of antacids? - correct answer Mylanta Maalox Milk of Magnesia What medications are used in combination therapy MOC indicated for H.Pylori treatment? - correct answer Metrondiazole (Flagyl) omeprazole (Prilosec) clarithryomycin (Biaxin) BID x 7 days What medications are used in combination therapy AOC for H. Pylori? - correct answer Amoxicillin omeprazole (Prilosec) clarithromycin (Biaxin) What two medications does H. Pylori develop the least resistance to? - correct answer amoxicillin tetracycline What is the duration of antiulcer therapy? - correct answer 3-7 weeks to ensure symptom relief and ulcer healing What is the common CXR finding associated with inpatient hospital PUD/GI bleed/Perforation management? - correct answer CXR - upright, decubitus films show free air = PNEUMOPERITONEUM What diagnostic is standard for inpatient PUD management? - correct answer Endoscopy - GI angiography What medication is standard in in patient PUD management? - correct answer IV H2 Blockers What medications do NOT prevent NSAID-induced ulcers? - correct answer Antacids

H2 Blockers sucralfate (Carafate) 42 yo. M presents to your clinic with complaints of epigastric pain that increased intensity over past two weeks. He describes the pain as decreasing after he eats. This finding mostly suggests what? - correct answer Duodenal ulcer Define GERD. - correct answer The backflow of acidic gastric contents into the esophagus What are the two main causes of GERD? - correct answer Incompetent lower esophageal sphincter Delayed gastric emptying A 65 yo. M complains of dysphagia and epigastric pain. He reports hx of ETOH use and smoking for 25 years. What is the most likely diagnosis? - correct answer GERD What is are the hallmark signs and symptoms associated with GERD? - correct answer Occurs at night and/or in recumbent position Retrosternal burning sensation Bitter taste in mouth In the elderly, what is a classic sign of GERD? - correct answer Dysphagia What diagnostic procedure is used in GERD? - correct answer EGD - r/o cancer, Barrett's esophagus, PUD What is the medical management of GERD? - correct answer Antacids PRN H2 blockers - at hour or sleep or BID PPI GI/Surgical consult PRN

What pharmacological agent was initially marketed for and used most commonly in the treatment of GERD? - correct answer omeprazole (Prilosec) Define Hepatitis. - correct answer Inflammation of the liver, with resultant liver dysfunction. Define Hep. A. - correct answer ANAL Enteral virus, transmitted via ORAL-FECAL route. How long is the blood and stool of an individual with Hep A infective? - correct answer 2-6 week incubation period What are the common sources of Hep. A? - correct answer contaminated food and water intimate sexual body contact - body secretion exchange What is the mode of transmission for Hep. B? - correct answer Blood Sexual activity mother-fetus Define Hep. B. - correct answer Blood borne DNA virus found in serum, semen, saliva and vaginal secretions Define Hep. C - correct answer Blood borne RNA virus. What is the mode of transmission of Hep. C virus? - correct answer Blood

• transfusions
• IVDU What signs and symptoms are characteristic of the pre-icteric phase of Hepatitis? - correct answer Aversion to smoking and ETOH Fever

Nausea HA Malaise Anorexia What signs and symptoms are characteristic of the icteric phase of Hepatitis? - correct answer Clay colored stool RUQ pain Jaundice Dark urine Pruritus Weight loss What is hallmark lab values suggestive of Hepatitis? - correct answer Elevated AST/ALT (n: 500-2000)

35- What serology tests are associated with active Hep. A? - correct answer Anti-HAV IgM What serology marker is indicative of Hep A noninfectivity? - correct answer Anti-HAV IgG What is the serology tests associated with active Hep B.? - correct answer HBsAg HBeAg Anti-HBc IgM What are the serology markers characteristic of immunity to Hep B? - correct answer Anti-HBsAg, Anti- HBc

True or False: There is a chronic form of Hep. A. - correct answer False. There is NO chronic form of Hep. A. Hep A peaks at one week and disappears in 3-6 months What is the first evidence of Hep B infection? - correct answer Hep B surface antigens - HBsAg What indicates cirulating HBV and highly infectious serum in Hep. B patient? - correct answer HBeAg - protein derived from HBV core What is the serology test associated with active Hep. C? - correct answer Anti-HCV, HCV RNA What diagnostic is used to determine the presence of antibodies in Hep C? - correct answer Enzyme immunoassay What diagnostic test is used to distinguish prior exposure from current viremia in Hep C? - correct answer Polymerase Chain Reaction (PCR) What is the management for Hepatitis? - correct answer Supportive, increase rest FLUIDS 3-4L/day NO protein diet No ETOH What drug is indicated for elevated ammonia levels causing hepatic encephalopathy? - correct answer Lactulose 30 mL PO or PR What is indicated in the management of a prolonged PT interval (>15 seconds) in a hepatic patient? - correct answer Vitamin K - clotting Define diverticulitis. - correct answer Inflammation or localized PERFORATION of one or more diverticula WITH ABSCESS formation

Inflammation Perforation Abscess formation What type of pain is associated with diverticulitis? - correct answer Cramping LLQ pain What is a significant cause of diverticulitis? - correct answer Low fiber diet 45 yo. M presents to your office with complaints of colicky, cramping abdominal pain in the left lower quadrant, and recent history of constipation. Patient now complains of nausea and vomiting x 2 days. You suspect: - correct answer Diverticulitis - inflammation, perforation, abscess formation What diagnostic is obtained on all patients presenting with diverticulitis? - correct answer CXR - assess for free air in abdomen; pneumoperitoneum A positive stool heme test is suggestive of what GI disorder? - correct answer Diverticulitis - positive stool heme in 25% patients What is standard diagnostics used in diverticulitis? - correct answer Stool heme test (+) Sigmoidoscopy - inflamed mucosa CT scan - abscess evaluation CXR - pneumoperitoneum What is the inpatient management of diverticulitis? - correct answer NPO IVF - hydration IV Abx metronidazole (Flagyl) ciprofloxacin (Cipro) clindamycin (Cleocin)

ampicillin GI surgical consult Define cholecystitis. - correct answer Inflammation of the gallbladder What is the most common cause of cholecystitis? - correct answer Gallstones - >90% of cases What are the hallmark signs and symptoms associated with cholecystitis? - correct answer Precipitated by large, fatty meal Sudden onset steady, severe epigastric pain or R hypochondrium Vomiting - relief What classic physical examination finding is suggestive of cholecysititis? - correct answer Murphy's Sign - deep pain on inspiration while fingers are placed under right ribcage Guarding Rebound tenderness RUQ finger placement under ribs = PAIN on inspiration True or False: A patient will experience relief of pain with vomiting in the presence of cholecystitis. - correct answer True. Vomiting provides relief in these patients. What is the gold standard in diagnosing cholecystitis? - correct answer Ultrasound What is the treatment of cholecystitis? - correct answer PAIN meds IVF NPO - Gastric lavage IV abx - piperacillin Lap cholecystectomy

What are the two most important interventions in the management of cholecystitis? - correct answer NPO IV broad spectrum abx - piperacillin What is the pathology of pancreatitis? - correct answer Acute inflammation of the pancreas due to escape of pancreatic enzymes into the surrounding tissue, causing autodigestion of the pancreas. What is the number one cause of acute pancreatitis? - correct answer Gallbladder disease Others: ETOH use, Hypercalcemia, hyperlipidemia, trauma, drugs (sulfonamides, furosemide, thiazides, estrogen) What is a classic presentation of a patient with acute pancreatitis? - correct answer SUDDEN severe epigastric pain worsened with movement/walking and supine Pain improved with sitting and leaning forward Grey and Turner's signs are indicative of what GI disease? - correct answer Acute hemorrhagic pancreatitis Greys - flank ecchymosis Turners - umbilical eccymosis What are the classic physical findings in acute pancreatitis? - correct answer Distended abdomen Absent bowel sounds (paralytic ileus) What lab findings are elevated in 90% of patients with acute pancreatitis? - correct answer Amylase (50-

Lipase (14-280) What lab value is suggestive of pancreatic necrosis? - correct answer Elevated C-reactive protein

What electrolyte abnormality is commonly seen with acute pancreatitis? - correct answer Hypocalcemia What is the gold standard diagnostic for acute pancreatitis? - correct answer CT scan more useful than ultrasound What is the medical management of acute pancreatitis? - correct answer Bed rest NPO NGT LWS IVF - hydration Pain meds In the management of acute pancreatitis, when is it indicated to advance from NPO to clear liquid diet? - correct answer Once patient is PAIN FREE and BOWEL SOUNDS RETURN Define bowel obstruction. - correct answer Blockage of the lumen of the bowel that impedes movement of gas and contents through bowel What are the causes of a bowel obstruction? - correct answer Adhesions Tumors Volvus Hernias Fecal impaction Ileus What sign is indicative of a proximal bowel obstruction? - correct answer Vomiting within MINUTES of pain. What sign is indicative of a distal bowel obstruction? - correct answer Vomiting within hours of pain Pronounced abdominal distention

Cramping, periumbilical pain that become constant and diffuse is suggestive of? - correct answer Bowel obstruction What bowel sounds are associated with a bowel obstruction? - correct answer High pitched, tinkling bowel sounds What is the diagnostic standard for bowel obstruction and what are the findings? - correct answer Plain abdominal films - dilated loops of bowel and air-fluid levels Horizontal pattern - SBO Frame pattern - LBO What is the management of a bowel obstruction? - correct answer IVF NGT LWS Broad spectrum abx Define ulcerative colitis. - correct answer Idiopathic inflammation of the colon and rectum. DIFFUSE inflammation What is a defining characteristic of Chron's Disease? - correct answer Entire span of GI tract. Diffuse, transluminal mucosal irritation. What is a classic characteristic of ulcerative colitis? - correct answer Symptomatic episodes and remission What is the hallmark sign of ulcerative colitis? - correct answer Bloody diarrhea. What establishes diagnosis of ulcerative colitis? - correct answer Sigmoidoscopy Stool studies negative

What is the medical management of ulcerative colitis? - correct answer mesalamine (Canasa) suppositories or enemas x 3-12 weeks Hydrocortisone suppositories and enemas Define mesenteric infarct. - correct answer Inadequate blood flow through the mesenteric circulation leading to ischemia and gangrene of the bowel What is the number one cause of mesenteric infarct? - correct answer Arterial or venous thrombosis/emobolism. What is the classic symptom of a mesenteric infarct? - correct answer Pain out of proportion to physical exam findings Sudden onset or cramping, colicky abdominal pain (usually after eating) What is the diagnostic for mesenteric infarct? - correct answer Abdominal films CT scan What lab value is elevated in mesenteric infart? - correct answer Amylase What is the medical management of mesenteric infarct? - correct answer Emergency surgical intervention Define appendicitis. - correct answer Inflammation of the appendix caused by obstruction of the appendiceal lumen. Surgical emergency - untreated, will develop gangrene within 36 hrs. Pain associated with appendicitis is: - correct answer RLQ pain Worse sitting still, and coughing What is Psoas sign? - correct answer Pain with right thigh extention What is Obturator's Sign? - correct answer Pain with internal rotation of flexed right thigh

What is a positive Rovsing's Sign? - correct answer RLQ pain when LLQ is pushed on McBurney's Point is associated with what GI disorder? - correct answer Appendicitis. Pain illicited with one finger on right lower quadrant What is the standard diagnostic for appendicitis? - correct answer CT scan` What is the medical management of appendicitis? - correct answer Stat surgical consult IV broad spectrum abx IVF Pain management What is the most critical assessment finding in the differential diagnosis of the acute abdomen with peritonitis, such as in a patient with a bowel perforation? - correct answer Rigidity 50 yo. M presents with complaints of decreased stool caliber, constipation, and black tarry stool. You would: a. consult general surgery for colon cancer resection b. consult oncology c. order more tests d. 2 units PRBC stat - correct answer C. Order more tests What is the classic xray finding associated with mesenteric infarct? - correct answer thumbprinting on abdominal film What two antibiotics are associated with C. difficile? - correct answer Clindamycin Ampicillin What is the drug of choice for treatment of C. diff? - correct answer metrondiazole (Flagyl)

Projectile vomiting is a hallmark symptoms of what GI disease? - correct answer Acute pancreatitis 25 yo. F with PMH significant for Chron's disease presents with abdominal pain, fever and nausea. An abdominal xray reveals air under the diaphragm. What is your next plan of care? - correct answer Obtain stat surgical consult and start broad spectrum antibiotics due to suspected bowel perforation and ARF peritonitis Pneumoperitoneum is clinically significant for what potential problem? - correct answer Bowel perforation resulting in peritonitis 35 yo. F health care worker has sustained a needle stick from a patient known to have hep B. What should the plan of care be for the health care worker? - correct answer Give HIBG immunoglobulin and hepatitis B vaccine immediately

AG-ACNP - GI