GI boards some GI in endocrine slides
Exam-Graded A
barrets and cancer - ANSWER-barretts is a precancer
barretts dx - ANSWER-upper endoscopy w biopsy
Classic pain of acute pancreatitis is - ANSWER-secere midepigastric pain that radiates
to midback
pan middle
Know how to perform Rovsing's and Markle maneuvers. Positive tests mean -
ANSWER-acute abdomen.
Know how to perform psoas maneuver. Psoas and obturator signs are positive for -
ANSWER-acute appendicitis
worrisome sx for esophageal cancer include - ANSWER-pain w swalling, early satiety,
weight loss
acute vs perisistent vs chronic bacteria - ANSWER-Acute diarrhea lasts 1 to 2 days;
persistent diarrhea lasts 2 to 4 weeks; chronic diarrhea lasts ≥4 weeks.
most common viral gastroenteritisi bathogens - ANSWER-norovirus
rotavirus
bacterial gastroenteritis sx - ANSWER-Acute onset of high fever, BLOODY diarrhea,
severe abdominal pain with at least six stools in a 24-hour period.
contaminated food bacteria - ANSWER-enterotoxin
antibiotcs for bacterial gastroenteritis - ANSWER-abx can prolong the length and
severity
Protozoal Gastroenteritis - ANSWER-Symptoms develop within 7 days of exposure and
typically last ≥7 days. It is usually watery diarrhea. Travelers' diarrhea starts within 3 to
7 days after exposure and usually resolves in 5 days. It is usually self-limited. Protozoal
pathogens include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
,IBS - ANSWER-hronic functional disorder of the colon (normal colonic tissue) marked
by exacerbations and remissions (spontaneous
alternate diarrhea constipation
relief from defecation
exam for IBS - ANSWER-Abdominal exam: Tenderness in lower quadrants during an
exacerbation. Otherwise the exam is normal.
Rectal exam: Stool is normal with no blood or pus.
Stools are heme negative.
treatment IBS - ANSWER-Increase dietary fiber. Supplement fiber with psyllium
(Metamucil or Konsyl), methylcellulose (Citrucel), wheat dextrin (Benefiber). Start at low
dose (causes gas).
abd pain treatment IBS - ANSWER-Antispasmodics for abdominal pain: Administer
dicyclomine (Bentyl) or hyoscyamine as needed
IBS w constipation treatment - ANSWER-: Begin a trial of fiber supplements,
polyethylene glycol (osmotic laxative).
If severe constipation: Prescribe lubiprostone or linaclotide (contraindicated in pediatric
patients <6 years, has caused death from dehydration).
IBS with diarrhea treament - ANSWER-Take loperamide (Imodium) before regularly
scheduled meals.
Severe diarrhea-predominant IBS: Administer alosetron (warning: ischemic colitis,
which can be fatal).
ibs check stool - ANSWER-Check stool for ova and parasites (especially diarrheal
stools) with culture.
organism common cause of ulcers - ANSWER-h. pylori
duodenal vs gastric ulcer - ANSWER-Duodenal ulcers are more common than gastric
ulcers. Most patients (up to 70%) are asymptomatic. Gastric ulcers have higher risk of
malignancy (up to 10%) compared with duodenal ulcers, which are mostly benign.
classic sx ulcer - ANSWER-Adult complains of recurrent epigastric pain,
burning/gnawing pain, or ache (80%). Pain relieved by food and/or antacids (50%) with
recurrence shortly after meals (gastric ulcer) and 2 to 4 hours after a meal (duodenal
ulcer).
Black or tarry stools (melena), red/maroon blood in stool (hematochezia), coffee-ground
emesis, or iron-deficiency anemia indicates GI bleeding.
, Urea breath test: - ANSWER-Indicative of active H. pylori infection and is commonly
used to document eradication of H. pylori after treatment. Use of PPIs within 2 weeks of
the test can interfere with results
Stool antigen - ANSWER-Can be used to confirm infection and posttreatment to
document eradication.
Urea breath test and stool/fecal antigen test are more sensitive for active infection than
serology/titers.
H pylori titerz - ANSWER-H. pylori immunoglobulin (IgG) levels elevated. Presence of
antibodies does not necessarily indicate current infection. H. pylori antibodies can be
elevated for months to years.
gold standard dx ulcers - ANSWER-Upper endoscopy and biopsy of gastric and/or
duodenal tissue.
how to r/o zollinger-ellison syndrome - ANSWER-Multiple severe ulcers or unresponsive
to treatment: Use fasting gastrin levels to rule out Zollinger-Ellison syndrome as
needed.
gastric ulcers and cancer - ANSWER-Requires an endoscopy to rule out gastric cancer
and document healing of ulcer.
treatment ulcers - ANSWER-H2 antagonists:
Ranitidine (Zantac) 150 mg twice a day or 300 mg at bedtime
Nizatidine (Axid) 150 mg twice a day or 300 mg at bedtime
Famotidine (Pepcid) 40 mg at bedtime
PPIs:
Omeprazole (Prilosec) 20 mg daily
Esomeprazole (Nexium) 40 mg daily
Lansoprazole (Prevacid) 15-30 mg daily
Treatment for H. pylori-Positive Ulcers - ANSWER-H. pylori-positive ulcers require
antibiotics for 14 days plus PPI orally twice a day.
Triple therapy:
Clarithromycin (Biaxin) 500 mg twice a day PLUS amoxicillin 1 g twice a day OR
metronidazole (Flagyl) 500 mg twice a day if allergic to amoxicillin × 14 days
PLUS
Standard-dose PPI orally twice a day × 14 days
its CLEAR e MOXley has h pylori or shes MET a good trainer.
Exam-Graded A
barrets and cancer - ANSWER-barretts is a precancer
barretts dx - ANSWER-upper endoscopy w biopsy
Classic pain of acute pancreatitis is - ANSWER-secere midepigastric pain that radiates
to midback
pan middle
Know how to perform Rovsing's and Markle maneuvers. Positive tests mean -
ANSWER-acute abdomen.
Know how to perform psoas maneuver. Psoas and obturator signs are positive for -
ANSWER-acute appendicitis
worrisome sx for esophageal cancer include - ANSWER-pain w swalling, early satiety,
weight loss
acute vs perisistent vs chronic bacteria - ANSWER-Acute diarrhea lasts 1 to 2 days;
persistent diarrhea lasts 2 to 4 weeks; chronic diarrhea lasts ≥4 weeks.
most common viral gastroenteritisi bathogens - ANSWER-norovirus
rotavirus
bacterial gastroenteritis sx - ANSWER-Acute onset of high fever, BLOODY diarrhea,
severe abdominal pain with at least six stools in a 24-hour period.
contaminated food bacteria - ANSWER-enterotoxin
antibiotcs for bacterial gastroenteritis - ANSWER-abx can prolong the length and
severity
Protozoal Gastroenteritis - ANSWER-Symptoms develop within 7 days of exposure and
typically last ≥7 days. It is usually watery diarrhea. Travelers' diarrhea starts within 3 to
7 days after exposure and usually resolves in 5 days. It is usually self-limited. Protozoal
pathogens include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
,IBS - ANSWER-hronic functional disorder of the colon (normal colonic tissue) marked
by exacerbations and remissions (spontaneous
alternate diarrhea constipation
relief from defecation
exam for IBS - ANSWER-Abdominal exam: Tenderness in lower quadrants during an
exacerbation. Otherwise the exam is normal.
Rectal exam: Stool is normal with no blood or pus.
Stools are heme negative.
treatment IBS - ANSWER-Increase dietary fiber. Supplement fiber with psyllium
(Metamucil or Konsyl), methylcellulose (Citrucel), wheat dextrin (Benefiber). Start at low
dose (causes gas).
abd pain treatment IBS - ANSWER-Antispasmodics for abdominal pain: Administer
dicyclomine (Bentyl) or hyoscyamine as needed
IBS w constipation treatment - ANSWER-: Begin a trial of fiber supplements,
polyethylene glycol (osmotic laxative).
If severe constipation: Prescribe lubiprostone or linaclotide (contraindicated in pediatric
patients <6 years, has caused death from dehydration).
IBS with diarrhea treament - ANSWER-Take loperamide (Imodium) before regularly
scheduled meals.
Severe diarrhea-predominant IBS: Administer alosetron (warning: ischemic colitis,
which can be fatal).
ibs check stool - ANSWER-Check stool for ova and parasites (especially diarrheal
stools) with culture.
organism common cause of ulcers - ANSWER-h. pylori
duodenal vs gastric ulcer - ANSWER-Duodenal ulcers are more common than gastric
ulcers. Most patients (up to 70%) are asymptomatic. Gastric ulcers have higher risk of
malignancy (up to 10%) compared with duodenal ulcers, which are mostly benign.
classic sx ulcer - ANSWER-Adult complains of recurrent epigastric pain,
burning/gnawing pain, or ache (80%). Pain relieved by food and/or antacids (50%) with
recurrence shortly after meals (gastric ulcer) and 2 to 4 hours after a meal (duodenal
ulcer).
Black or tarry stools (melena), red/maroon blood in stool (hematochezia), coffee-ground
emesis, or iron-deficiency anemia indicates GI bleeding.
, Urea breath test: - ANSWER-Indicative of active H. pylori infection and is commonly
used to document eradication of H. pylori after treatment. Use of PPIs within 2 weeks of
the test can interfere with results
Stool antigen - ANSWER-Can be used to confirm infection and posttreatment to
document eradication.
Urea breath test and stool/fecal antigen test are more sensitive for active infection than
serology/titers.
H pylori titerz - ANSWER-H. pylori immunoglobulin (IgG) levels elevated. Presence of
antibodies does not necessarily indicate current infection. H. pylori antibodies can be
elevated for months to years.
gold standard dx ulcers - ANSWER-Upper endoscopy and biopsy of gastric and/or
duodenal tissue.
how to r/o zollinger-ellison syndrome - ANSWER-Multiple severe ulcers or unresponsive
to treatment: Use fasting gastrin levels to rule out Zollinger-Ellison syndrome as
needed.
gastric ulcers and cancer - ANSWER-Requires an endoscopy to rule out gastric cancer
and document healing of ulcer.
treatment ulcers - ANSWER-H2 antagonists:
Ranitidine (Zantac) 150 mg twice a day or 300 mg at bedtime
Nizatidine (Axid) 150 mg twice a day or 300 mg at bedtime
Famotidine (Pepcid) 40 mg at bedtime
PPIs:
Omeprazole (Prilosec) 20 mg daily
Esomeprazole (Nexium) 40 mg daily
Lansoprazole (Prevacid) 15-30 mg daily
Treatment for H. pylori-Positive Ulcers - ANSWER-H. pylori-positive ulcers require
antibiotics for 14 days plus PPI orally twice a day.
Triple therapy:
Clarithromycin (Biaxin) 500 mg twice a day PLUS amoxicillin 1 g twice a day OR
metronidazole (Flagyl) 500 mg twice a day if allergic to amoxicillin × 14 days
PLUS
Standard-dose PPI orally twice a day × 14 days
its CLEAR e MOXley has h pylori or shes MET a good trainer.
