ANP Certification GI Flash Cards.txt
Card Set Information
ANP Certification GI Flash Cards.txt
ANP Certification GI Flash Cards
ANP Certification GI Flash Cards
What is the chance of cirrhosis when Hepatitis B chronic infection gets Hep D?
How does aging affect fat soluble vitamins?
See decreased absorption of fat soluble vitamins
What happens to liver with again?
Decreased size of liver, and number of hepatic cells.
What happens with there is decrease in liver enzymes?
Unable to detoxify drugs
What happens to pancreatic ducts with age?
Calcify, distend, dilate and also see decrease production of lipase
What are the pancreatic enzymes?
Amylase, lipase, trypsin
What are the risk factors for pancreatitis?
Gall stones 45%, excessive ETOH use 35%, elevated triglycerides over 800, idiopathic. Binge drinking. Viral infection. Blunt trauma. Opioids, corticosteroids, thiazide diuretics.
What laboratory results will be seen in acute pancreatitis?
Elevated amylase and lipase. But amylase can also be elevated in perforated duodenal ulcer and other abdominal emergencies
Signs of pancreatic cancer?
Abdominal pain, n/v, weight loss, anorexia, jaundice, pain
Signs of pancreatitis?
Pain radiating to mid back, fever, elevated heart rate, shock, ileus, jaundice
What is the name of the criteria used for classifying severity of pancreatitis?
Signs positive for hemorrhagic pancreatitis?
Turner's and Cullen's signs
What are the risk factors for pancreatic cancer?
Tobacco use, history of pancreatitis, DM
What is a positive obturator sign?
Positive in appendicitis. When raise leg with knee flexed and internally rotate leg, will have pain in RLQ
What is McBruney's point positive in?
What does positive psoas sign mean?
What meds can make GERD worse?
Calcium channel blockers, theophylline, nitrates. Those in the smooth muscle relaxant category. And Hormone therapy. Nicotine
What H2 blocker is not recommended due to many drug-drug interactions?
Prevention of return of duodenal ulcer?
H. Pylori antibiotic treatment keeps it from coming back
Acute Appendicitis nausea and vomiting has onset when?
Vomiting and fever will occur 12-24 after pain. If pain and vomiting occurs simultaneously, it indicates more a GI infection
Duodenal ulcer pain noted when?
Worse when hungry, better when eats. Due to food buffering the gastric acid when it enters the duodenum
Gastric ulcer pain noted when?
Disease of 'Too much' Pain worse when eating. Food activates acid production.
What is a better benzo to give for acute ETOH withdrawal treatment?
Ativan is shorter half life and better in presence of liver dysfunction.
What is given in ETOH withdraw to help with DT?
Direct-acting Alpha 2 adrenergic agonist Clonidine and Beta adrenergic antagonist Propranolol
What nutritional supplements need to be added for ETOH abuse?
High dose Vitamin Bs, Vitamin C, Magnesium
Where is AST found?
Liver, but also heart, brain, kidney and skeletal muscle
Where is ALT found?
More liver specific L= liver
What would cause an elevated AST?
Alcohol, Statins, Tylenol
What would cause elevated ALT?
Hepatitis due to Toxins or Infection
What is AST ALT ratio used for?
Gain insight into reason for LFT elevation
Where is ALP found?
Alkaline Phosphatase if found in rapidly dividing or metabolically active tissue in liver, bone, intestine, placenta.
What does an elevation in ALP indicate?
Damage to liver and also biliary obstruction, cholestasis
GGT is found where?
Liver and kidney.
Will LFTs return to normal after ETOH abuse resolved?
Yes, in 2-3 months they will go back to baseline
Appendicitis progression of symptoms?
Pain first, nausea and vomiting are later symptoms AFTER pain onset.
Appendicitis assessment signs?
+ psoas (iliopsoas) sign. Pain with hip extension. + obturator sign. Pain with hip flexion and internal rotation. Pain is indicative of location of appendix, not always RLQ.
What scan would you order for appendicitis?
US if no signs of rupture. If suspect rupture, do CT to check for abscess
Signs of an appendix perforation?
Fever, marked leukocytosis, positive peritoneal signs, RLQ mass, symptoms greater than 24 hours
What is Zollinger-Ellison Syndrome?
A Gastrinoma located in pancreas or stomach that produces gastrin with increased acid production causing multiple severe gastric and duodenal ulcers.
What test is done for Zollinger-Ellison syndrome?
Serum fasting gastrin level
Which IBD has skip lesions?
Crohn's has skip lesions, areas of involvement scattered among healthy intestine.
What is secreted by Stomach for digestion?
Hydrochloric acid and intrinsic factor
What is secreted by duodenum for digestion?
Bile acids, amylase, lipase
Which ulcer is worse after eating?
Duodenal is worse about 2 hours after eating
Testing for H. Pylori includes?
Stool antigen testing. Urea breath test. Immunoglobulin levels not as sensitive/specific
What does the gastric parietal cell secrete?
Hydrochloric acid, mediated by the H2 receptor site
What drugs does cimetidine interfere with?
Theophylline, Warfarin, seizure meds,
How long should antacids and FQs be separated?
Antacid 2-4 hours before FQ dose or antacid 4-6 hours after FQ dose
Barrett's esophagus is precancerous for what type of esophageal cell cancer?
Adenocarcinoma (columnar epithelial metaplasia), Squamous cell carcinoma
What is Carafate's MOA?
Gel forms on mucosa and into ulcer sulcus, inactivates pepsin and stimulates prostaglandins
What is a side effect of Reglan?
What follow-up is indicated with diagnosis of Barrett's esophagus?
EGD every 6 months and then once negative twice, can move to every 3 years
What medication regimen is recommended for H. Pylori infection?
Each 10-14 day duration treatment option includes a PPI plus Flagyl and Bismuth, or PPI plus Amoxicillin and Clarithromycin
Hepatitis acute illnesses typical last how long?
HAV and HBV acute illness usually lasts 2-3 weeks
Symptoms of hepatitis infection?
Malaise, fatigue, nausea, anorexia, fever, hepatomegaly, mild RUQ tenderness without rebound, splenomegaly.
When does jaundice occur in hepatitis infection?
1 week after onset of symptoms
What characteristics are noted on CBC with Hepatitis infection?
Leukopenia with lymphocytosis and atypical lymphocytes
Urine finding with hepatitis?
What does the ratio of AST to ALT note in alcohol use?
AST will be greater than ALT two to one
What is GGT sensitive for?
ETOH abuse, may be a lone elevation. Also elevated in acute pancreatitis
Alkaline phosphatase is noted in?
Bone, liver, gallbladder, kidney. Can be normally elevated in teen growth spurts
What degree of elevation is noted on AST and ALT during acute Hepatitis?
Can see up to a 10 fold increase in values
What symptoms are noted in the incubation period of viral hepatitis?
No subjective signs and symptoms are noted.
What is noted in the icteric phase of viral hepatitis?
Jaundice, dark urine, light stools, plus prodrome symptoms continue
What is bilirubin a byproduct of?
Degradation of heme molecule
What kind of bilirubin gives urine the yellow color?
What is the treatment in acute viral hepatitis?
Supportive care, anti virals, interferon, corticosteroids
What test is most diagnostic for acute cholecystitis and to assess duct?
What sign is positive in acute cholecystitis?
Murphy's sign (respiratory arrest with RUQ palpation)
Symptoms of acute cholecystitis?
RUQ pain, Vomiting, occasional jaundice and fever
What lab values are noted in acute cholecystitis?
Leukocytosis, Elevated LFT, GGT, Alk phos, bilirubin, amylase
What does ALP elevation indicate in cholelithiasis?
Increases with obstruction of biliary system, sensitive indicator of intra and extrahepatic cholelithiasis
If ALP is elevated and GGT is normal?
Consider bone problem, and can r/o liver as source
Colorectal colonoscopy cancer screenings should occur?
Every 10 years at age 50.
Colonoscopy should be performed how frequently in a person with risks?
Every 5 years
What medications have been show to decrease colon cancer risks?
Low dose ASA, calcium supplements, antioxidants
What antibiotics are given for intestinal perforation?
Ciprofloxacin and Flagyl
What GI symptom is associated with Giardia?
What is a major risk factor for Hep A?
What are the common symptoms of Hep B?
Clinical presentation is variable, may are asymptomatic
What do you suspect if patient has gall bladder pain with fever?
Acute complicated cholecystitis
What is the AST ALT ratio for an alcoholic?
AST is twice the ALT. Both will be elevated
What if ALT is greatly elevated?
Suspect hepatitis infection
What is the most common causes of acute pancreatitis?
Alcoholism and gall stones
What causes grayish tan stool?
What causes pale yellow greasy stool?
Steatorrhea, due to malabsorption cystic fibrosis, celiac disease