Dx and Management
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| Most common cause of Peptic Ulcer Dz... | H. pylori
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| Duodenal ulcers usually occur between what ages | 30-55
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| Gastric ulcers usually occur between what ages | 55-65
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| T/F: H. pylori occurs in >90% or duodenal ulcers and >75% of gastric ulcers | True
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| Sx's of PUD | gnawing epigastric pain that is well localized
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| In duodenal ulcers does pain get better or worse with eating | better
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| In gastric ulcers does pain get better or worse with eating | worse; feed it = worse
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| T/F: a rigid abdomen = peritonitis, acute abdomen | True
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| PUD labs/diagnostics | ~all should be evaluated 8-12 wks after tx; serology or urea breath test for H. pylori
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| 1st line Rx management of PUD | H2 Receptor Antagonists
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| Examples of H2 Receptor Antagonists are: | ~"dine": Cimetidine (Tagament), Rantidine (Zantac), Famotidine (Pepcid), Nizatidine
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| How soon before meals should PPI's be taken | 30
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| Examples of PPI's are: | ~"razole": Lansoprazole (Prevacid), Omeprazole (Prilosec), Rabeprazole (Aciphex), Pantoprazole (injectable)
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| Sucralfate (Carafate), Bismuth subsalicylate (Pepto-Bismal), Misoprostol (Cytotec) & Antacids (Mylanta, Maalox, MOM, etc) are what type of agents? | Mucosal Protective
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| What does Sucralfate (Carafate) require in order to work and what should be avoided | an acidic environment needs to be present; avoid antacids and H@ blockers
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| What are the actions of Bismuth subsalicylate (Pepto Bismal) | ~direct antibacterial action against H. pylori ~promotes prostaglandin production/stimulates gastric bicarb
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| T/F: Misoprostol (Cytotec) should be taken with food | True
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| What are the actions of Misoprostol (Cytotec)... | ~used as prophylaxis against NSAID-induced ulcers ~stimulates mucous and bicarb production ~may stimulate uterine contractions and induce abortion
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| Do antacids reduce the amount of gastric acidity? | NO
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| What is the combo option therapy for H. pylori | 2 antibx + either a PPI or Bismuth
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| "MOC" PPI regimen... | Metronidazole (Flagyl) with meals + Omeprazole (Prilosec) BID before meals + Clarithromycin (Biaxin) w/ meals x7 days
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| "AOC" PPI regimen... | Amoxicillin (Amoxil) with meals + Omeprazole (Prilosec) before meals + Clarithromycin (Biaxin) BID w/ meals x7 days
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| "MOA" PPI regimen... | Metronidazole (Flagyl) with meals + Omeprazole (Prilosec) before meals + Amoxicillin (Amoxil) BID w/ meals x7-14 days
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| What sx's must be present (5) to be dx'd with "gastroenteritis" | ~N/V ~watery diarrhea ~anorexia ~abdominal cramping ~general "sick" feeling
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| Common causes of gastroenteritis... | ~viruses (more common during the winter) ~bacterial ~parasitic ~emotional distress
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| PE signs that may be seen with gastroenteritis... | ~hyperactive BS ~abdominal distention ~fever ~tachycardia ~hypotension
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| When are diagnostics for gastroenteritis indicated & what should be ordered... | if sx's persist >72 hours...stool for cx, WBC's, O
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| Management of gastritis may consist of... | ~supportive care ~rehydration ~antibx
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| When are antibx indicated for gastroenteritis... | ~organism (except Salmonella) is isolated and sx's not resolved ~leukocytes or dysentery present ~Shigella present ~>8-10 stools/day ~the pt is immunocompromised
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| s/sx's of "Pre-icteric" | fatigue, malaise, anorexia, N/V, H/A, aversion to smoking and alcohol
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| s/sx's of "Icteric" | wt loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine ~low-grade fever may be present ~hepatosplenomegaly may be present
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| General Hepatitis labs/results may consist of... | ~WBC low to normal ~UA: proteinuria, bili ~*elevated AST & ALT (500-2000 IU/L...normal <35-40
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| Active Hep A will show... | Anti-HAV, IgM (immediate)
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| Recovered Hep A will show... | Anti-HAV, IgG (gone)
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| Anti-HAV, IgM will peak at about... | the first week of clinical illness
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| Anti-HAV, IgM will disappear in about... | 3-6 months
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| T/F: Anti-HAV will be either active or recovered | True
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| What surface antigen is the 1st evidence of HBV infection | Hepatitis B surface antigen (HBsAg)
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| HBsAg remains (+) in ______________ carriers and ____________ Hep B patients | "asymptomatic" "chronic"
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| Shortly after HBsAg disappears, which antibody appears | Anti-HBc
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| Active Hep B will show what lab results... | HBsAg, HBeAg, Anti-HBc, IgM
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| Chronic Hep B will show what lab results... | HBsAg, Anti-HBc, Anti-HBe, IgM, IgG
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| Recovered Hep B will show what lab results... | Anti-HBc, Anti-HBsAg
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| HBeAg indicates... | circulating & highly infectious HBV
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| Anti-HBe often appears... | after HBeAg disappears = decreased infectivity
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| What labs indicate Acute and Chronic Hep C | Anti-HCV, HCV RNA
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| What differentiates Acute from Chronic Hep C | PCR will differentiate prior exposure (+) from current exposure
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| Management of Hep C may consist of... | ~supportive ~increase fluids ~avoid ETOH, drugs detoxified by the liver ~no protein diet ~Vit K for prolonged PT (>15 sec) ~Lactulose for ^ ammonia level
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| S/Sx's of Diverticulitis | ~mild to moderate aching pain in LLQ ~constipation or loose stools ~N/V
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| Diverticulitits PE findings... | ~low grade fever ~LLQ tenderness to palp
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| Management of diverticulitis.. | ~IV fluids ~IV antibx ~NPO dependent on condition
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| IBS is characterized by... | lower abdominal pain and alternating diarrhea and/or constipation
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| Usual onset of IBS is generally.... | late teens to early twenties
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| Common sx's of IBS are... | ~abd cramping ~abd pain relieved with defication ~changes in stoll consistency/pattern ~dyspepsia ~fatigue ~c/o anxiety/depression
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| Recommended diet for IBS... | high fiber
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| Cholecystitis is... | inflammation of the gallbladder, associated with gallstones >90% of cases
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| Sx's of cholecystitis are... | ~often precipitated by a large or fatty meal ~sudden, steady, severe pain in epigastrium or R hypochondrium ~vomiting in many clients results in relief
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| PE findings of cholecystitis... | ~(+) Murphy's sign ~RUQ tenderness to palp ~muscle guarding and rebound pain ~fever
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| Cholecystitis lab/diagnostic findings... | ~WBC 12-15K ~serum billi may be ^ ~serum ALT, AST, LDH, & alk pho are ^ ~amylase may be ^ ~poss radiopque gallstones ~U/S scan
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| Management of cholecystitis... | ~pain ~NGT for gastric decomp ~NPO ~IV broad spectrum abx ~surgical consult for lap
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| Ulcerative Colitis is... | an idiopathic inflammatory condition characterized by diffuse mucosal inflammation of the colon; involves the rectum and may extend upward involving the whole colon
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| Hallmark sx of ulcerative colitis.. | bloody diarrhea
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| Diagnostic test of ulcerative colitis... | sigmoid
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| Management of ulcerative colitis.. | ~Mesalamine (Canasa) supp or enema ~Hctz supp or enema
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| Sx's of Colon CA... | ~may be asymptomatic until complications ~changes in bowel habits ~thin stools (goes around obstruction) ~anorexia/wt loss
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| Poss PE findings of Colon CA... | ~abd or rectal mass ~occult fecal blood may be present
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| Diagnostic results of Colon CA may show... | ~guaiac (+) stool ~colonscopy @50 the q 10yrs/sigmoid q 5yrs ~CBC ~CEA elevated
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| Apendicitis PE findings that may be present... | ~Psoas sign: pain w/ R thigh extension ~Obturator sign: pain with internal rotation of flexed R thigh ~(+) Rosvig's: RLQ pain when pressure applied to LLQ ~low fever
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