AGACNP AACN BOARD REVIEW - GASTROINTESTINAL
DISORDERS EXAM QUESTIONS AND VERIFIED
ANSWERS WITH COMPLETE SOLUTIONS
Peptic Ulcer disease causes and incidence - ANSWER - h. pylori
men 3:1
smokers
NSAIDs, ASA, glucocorticoids
alcohol and dietary factors don't seem to contribute
zollinger ellison syndrome which is a gastric secreting tumor
What is Zollinger-Ellison syndrome? - ANSWER - rare condition characterized by
gastrin-producing tumors in the duodenum and/or pancreas that lead to
oversecretion of gastrin, which lead to gastric and duodenal ulcers that result in
gastric bleeding. treatment is same as PUD +/- tumor resection
PUD s/s - ANSWER - gnawing epigastric pain
relief of pain with eating (duodenal)
if pain worsens with eating then (epigastric)
duodenal ulcer - ANSWER - age 30-55
pain relief with EATING
gastric ulcer - ANSWER - ages 55-65
,pain worse with EATING
physical findings of PUD - ANSWER - often unremarkable but might have
epigastric tenderness
GI bleeding 20% of causes- melena, hematemesis or coffee ground emesis
perforation s/s - ANSWER - board like abdomen
quiet bowel sounds
RIGIDITY - peritonitis - hole in lumina of GI tract- requires immediate surgery
(washout with abx)
other acute abdomen causes - ANSWER - crohn's disease
ruptured diverticulum
ruptured appendix
labs/diagnostics for ulcer - ANSWER - can show anemia
endoscopy after 8-12 weeks of treatment
h. pylori testing
PPI vs H2RA - ANSWER - PPI indicated for acute ulceration
Medical management - H2 receptor antagonist - start with dyspepsia
"tidine" - ANSWER - cimetidine (tagamet) - 800mg/HS
Famotidine (pepcid) - 40mg/HS
, nizatidine (axid) - 300mg/HS
start at HS, then BID, then add PPI
medical management - PPI - start if pepcid ulcer disease suspected
"prazole" - ANSWER - lansoprazole (pravacid) - 15mg/day
pantoprazole (protonix) - 20mg/day
omeprazole (prilosec) - 40mg/day
esomeprazole (nexium) - 20mg/day
rebound GERD
BLACK BOX WARNING - hip fracture with long-term use
mucosal protective agents - ANSWER - sucralfate (carafate) 1 gm QID
- decreases nosocomial PNA
- avoid antacids and H2 blockers
bismuth subsalicylate (pepto-bismol)
- helps against h. pylori
- prostaglandin production/gastric bicarb
antacids
H. pylori eradication therapy - ANSWER - EBP - combination
2 antibiotics + PPI with or without bismuth for 10 - 14 days
DISORDERS EXAM QUESTIONS AND VERIFIED
ANSWERS WITH COMPLETE SOLUTIONS
Peptic Ulcer disease causes and incidence - ANSWER - h. pylori
men 3:1
smokers
NSAIDs, ASA, glucocorticoids
alcohol and dietary factors don't seem to contribute
zollinger ellison syndrome which is a gastric secreting tumor
What is Zollinger-Ellison syndrome? - ANSWER - rare condition characterized by
gastrin-producing tumors in the duodenum and/or pancreas that lead to
oversecretion of gastrin, which lead to gastric and duodenal ulcers that result in
gastric bleeding. treatment is same as PUD +/- tumor resection
PUD s/s - ANSWER - gnawing epigastric pain
relief of pain with eating (duodenal)
if pain worsens with eating then (epigastric)
duodenal ulcer - ANSWER - age 30-55
pain relief with EATING
gastric ulcer - ANSWER - ages 55-65
,pain worse with EATING
physical findings of PUD - ANSWER - often unremarkable but might have
epigastric tenderness
GI bleeding 20% of causes- melena, hematemesis or coffee ground emesis
perforation s/s - ANSWER - board like abdomen
quiet bowel sounds
RIGIDITY - peritonitis - hole in lumina of GI tract- requires immediate surgery
(washout with abx)
other acute abdomen causes - ANSWER - crohn's disease
ruptured diverticulum
ruptured appendix
labs/diagnostics for ulcer - ANSWER - can show anemia
endoscopy after 8-12 weeks of treatment
h. pylori testing
PPI vs H2RA - ANSWER - PPI indicated for acute ulceration
Medical management - H2 receptor antagonist - start with dyspepsia
"tidine" - ANSWER - cimetidine (tagamet) - 800mg/HS
Famotidine (pepcid) - 40mg/HS
, nizatidine (axid) - 300mg/HS
start at HS, then BID, then add PPI
medical management - PPI - start if pepcid ulcer disease suspected
"prazole" - ANSWER - lansoprazole (pravacid) - 15mg/day
pantoprazole (protonix) - 20mg/day
omeprazole (prilosec) - 40mg/day
esomeprazole (nexium) - 20mg/day
rebound GERD
BLACK BOX WARNING - hip fracture with long-term use
mucosal protective agents - ANSWER - sucralfate (carafate) 1 gm QID
- decreases nosocomial PNA
- avoid antacids and H2 blockers
bismuth subsalicylate (pepto-bismol)
- helps against h. pylori
- prostaglandin production/gastric bicarb
antacids
H. pylori eradication therapy - ANSWER - EBP - combination
2 antibiotics + PPI with or without bismuth for 10 - 14 days
