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50 Cards in this Set
- Front
- Back
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Causes of Peptic Ulcer Disease |
H.pylori >90% duodenal ulcers >75% gastric
Meds such as NSAIDS, ASA, glucocorticoids more common in men more common in >1/2 PPD smokers Type A personalities?
Duodenal ulcers: 30-35 Gastric ulcers: 55-65 |
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S/S Peptic ulcers |
gnawing epigastric pain relief with eating (duodenal) pain worse with eating (gastric) |
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PE Peptic ulcers |
may have some mild epigastric tenderness GI bleeding Perforation (board like abdomen) quiet bowel sounds ridgidity |
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Lab/Dignostics Peptic Ulcers |
may have some anemia on CBC consider endoscopy after 8-12 weeks treatment consider H.pylori testing |
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Management of Peptic ulcers |
H2 Receptor Antagonists
Proton Pump Inhibitors |
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H2 Receptor Antagonists |
Tagament (Cimetidine) Ranitidine (Zantac) Famotidine (Pepcid) Nizatindine (Axid)
"INES" |
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Proton Pump Inhibitors |
Take 30 minutes before meals
"ZOLES"
Lansoprazole (prevacid) Rabeprazole (aciphex) Pantoprazole (protonix) Omeprazole (prilosec) Dexlansoprazole (Dexilant Esomeprazole (Nexium) |
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Mucosal Protective Agents |
Give 2 hours apart from other meds
Pepto-bismol: has direct antibacterial action against H.pylori
Cytotec: used as prophylaxis agains NSAID induced ulcers May be used for abortion
Antacids (mylanta, maalox, MOM) |
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H.Pylori Combo therapies |
2 antibiotics + PPI or bismuth
MOC: Flagyl, Biaxin, and Prilosec
AOC: Amoxicillin, Prilosec, and Biaxin
MOA: Flagyl, Priolsec, and Amoxicillin
Bismuth regimens require QID dosing BMT: bismuth, flagyl, and tetracycline
BMT + Prilosec
Antiulcer for 3-7 weeks to ensure proper healing of ulcer and symptom relief
Duodenal: prilosec H2 blockers
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Urgent Care/ Emergent Management of PUD |
CBC PT/PTT BMP
O2 Endoscopy Urinary catheter NG tube NPO IV H2 blockers GI/surgery eval |
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GERD |
back flow (reflux) of gastric contents into the esophagus
Incompetent lower esophageal sphincter
delayed gastric emptying |
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S/S GERD |
retrosternal "burning" bitter taste in mouth belching hiccoughs dysphagia excessive salivation frequently occurs at night and/or recumbent position may be relieved by sitting up, water, food, antacids |
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Diagnostics for GERD |
EGD referral rule out cancer Barrett's esophagus PUD |
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Management for GERD |
elevate head of bed avoid caffeine, alcohol, spices, peppermint stop smoking weight reduction if needed
Antacids PRN
H2 blockers (INES) PPI (ZOLES) if H2 ineffective
GI surgical consult PRN |
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Gastroenteritis |
n/v diarrhea cramping
no need for antibiotic unless bacteria present
bowel sounds hyperactive
supportive care fluids, rehydration clear liquids progressively no anti motility drugs so the bug can get out
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Traveler's diarrhea prophylaxis |
Pepto-Bismol |
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Diverticulitis |
inflammation or localized perforation of the diverticula with abscess formation
more common in women
higher incidence in those with low dietary fiber |
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S/S Diverticulitis |
mild to moderate aching abdominal pain in LLQ
constipation or loose stools
n/v |
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PE Diverticulitis |
low grade fever LLQ tenderness to palpation perforation may present with more dramatic and peritoneal signs |
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Lab/Diagnostics for Diverticulitis |
mild/mod leukocytosis elevated ESR stool + heme in 25% of cases sigmoidoscopy may show inflamed mucosa might consider CT to evaluate abscess
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Management for Diverticulitis |
NPO dependent upon condition
Refer for IV fluids for hydration GI/surgery consult |
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IBS |
Lower abdominal pain and alternating diarrhea and/or constipation
greater incidence among women |
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S/S IBS |
abdominal cramping abdominal pain relieved by defecation may be preoccupied with bowel symptoms changes in stool consistency and/or pattern dyspepsia fatigue anxiety and/or depression are common |
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Diganostics of IBS |
sigmoidoscopy barium studies rectal exam |
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Management of IBS |
emotional support recommend high fiber SSRIs for patients who are depressed antidiarrheals antidepressant |
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Choleycystitis |
inflammation of the gallbladder
>90% of cases gallstones present |
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S/S Choleycystitis |
often precipitated by a large or fatty meal sudden appearance of steady, severe pain in epigastrium or right hypochondrium vomiting my bring relief |
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PE Choleycystitis |
Murphy's sign: deep pain on inspiration while fingers are placed under right rib cage
RUQ tenderness to palpation muscle guarding and rebound pain fever |
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What is gold standard for diagnosing cholycystitis? |
Ultrasound |
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Management of choleycystitis |
pain management
Acute: refer for NGT IV antibiotics GI/surgery consult |
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Bowel Obstruction |
blockage of intestinal lumen impeding passage of bowel contents |
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Causes of Bowel obstruction |
hernia adhesions volvulus tumors fecal impaction heus (functional obstruction) |
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S/S Bowel obstruction |
cramping periumbilical pain intitally pain becomes constant and diffuse vomiting within minutes of pain (proximal block) vomiting within hours of pain (distal block) unable to pass stool/gas |
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Management of bowel obstruction |
refer for fluid resucitation and NGT suction broad spectrum abx GI/surgery consult |
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Ulcerative colitis |
diffuse mucosal inflammation of the colon
Involves the rectum and my extend upward involving the whole colon |
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S/S Ulcerative colitis |
bloody diarrhea
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Lab/Diagnostics for Ulcerative colitis |
negative stool studies sigmoidoscopy to establish diagnosis |
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Management for Ulcerative colitis |
Mesalamine (Canasa) suppositories or enemas Hydrocortisone suppositories or enema |
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Colon cancer |
Increased incidence: family history other adenocarcinomas high fat or refined carb diets polyps IBS |
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S/S colon cancer |
often asymptomatic until complications
change in bowel habits thin stools weight loss |
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Diagnostics for colon cancer |
possible + guiac colonoscopy CBC |
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Management of colon cancer |
surgical consult subsequent oncology consult supportive care |
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Appendicitis |
inflammation of appendix
if untreated, gangrene and perforation may develop in 36 hours
18-36 years of age |
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S/S Appendicitis |
vague colicky umbilicus pain after several hours pain goes to RLQ nausea with 1-2 episodes vomiting pain worse and localized with coughing |
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PE Appendicitis |
RLQ guarding with rebound tenderness Psoa's sign Obturator sign Positive Rovsing's sign low grade fever |
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Psoa's sign |
pain with right thigh extension
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Obturator's sign |
pain with internal rotation of the flexed right thigh |
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Rovsing's sign |
RLQ pain when pressure is applied to the LLQ |
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Lab/Diagnostic for Appendicitis |
CT |
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Management for Appendicitis |
refer for surgery and pain management |
