NR576/NR 576 FINAL EXAM
QUESTIONS AND DETAILED
ANSWERS
/. Assessing for prior antibiotic use is a critical part of the history in patients with
presenting with _______________ due to_________________ - Answer-
✅Diarrhea/CDiff
/.Irritable bowel syndrome - Answer-✅disorder of the bowel function not from anatomic
abnormality--constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large
bowel
NOT associated with serious medical conditions, IBD, CA
/.Inflammatory bowel disorder - Answer-✅chronic immunologic disease that manifests
in intestinal inflammation
Ulcerative colitis
crohn's disease
/.Two common inflammatory bowel diseases - Answer-✅Ulcerative colitis-mucosal
surface of the colon is inflamed and ultimately results in frability, erosions, and bleeding-
-most common in recto-sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall and can involve all
or any layer of the bowel wall and any portion of the GI tract from the mouth to the anus-
-skipped lesions, pain in LLQ
/.Diverticulitis - Answer-✅Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free air=perforation;
patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
/.Identify the significance of Barrett's esophagus - Answer-✅After repeated exposure to
gastric contents, inflammation of the esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar
epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
,/.Diagnosis of GERD - Answer-✅made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
/.Risks of GERD - Answer-✅Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
/.Treatments of GERD - Answer-✅Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of the bed
elevated.
/.Medications for GERD - Answer-✅antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole
40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
/.Differential diagnosis of acute abd pain - Answer-✅Acute appendicitis
Acute pancreatitis
Acute cholecystitis
/.Acute appendicitis - Answer-✅Inflammation of the vermiform appendix; due to
obstruction or infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
/.Acute pancreatitis - Answer-✅Sudden inflammation and hemorrhaging of the
pancreas due to destruction by its own digestive enzymes
1. Autodigestion
Most of the time mild, but can be severe
, Pancreas
Long skinny gland, length of dollar bill
Located in upper abdomen
Behind the stomach
Endocrine
Alpha/beta cells produce insulin & glucagon that are secreted into the blood stream
Exocrine
Leading causes:
ETOH abuse
Gallstones
Other Causes of acute pancreatitis
1. I Get Smashed
I - idoipathic
G- gallstones
E- ETOH abuse
T - trauma
S - steroids
M - mumps virus
A - autoimmune diseases
S - scorpion stings
H - hypertriglyceridemia & hypercalcemia
E - ERCP
D - drugs
Symptoms
Nausea
Vomiting
Hypocalcemia
Cullen's sign - bruising around umbilicus
Grey-Turner's Sign - Bruising along flank
Necrosis induced hemorrhaging spreads
/.Acute cholecystitis - Answer-✅Inflammation of gallbladder (GB)
Usually due to gallstone in cystic duct
1. Cystic duct - leaves gall bladder & connects to common bile duct
Symptoms
Patient will have mid-epigastric pain
Because GB is still squeezing, increasing pressure w/ nowhere for bile to go
Can lead to nausea/vomting
Stone can get more stuck w/ more squeezing
Bile starts to irritate mucosa
Mucosa starts to produce mucous and inflamm enzymes
Leads to inflammation, distention, pressure build up
Bacterial growth (E. coli, enterococci, bacteroides fragilis, colstriduim)
As GB "balloons", pain shifts to RUQ, R scapula/shoulder
Bacteria invades in & through GB wall, into peritoneum, causing peritonitis
Rebound tenderness
QUESTIONS AND DETAILED
ANSWERS
/. Assessing for prior antibiotic use is a critical part of the history in patients with
presenting with _______________ due to_________________ - Answer-
✅Diarrhea/CDiff
/.Irritable bowel syndrome - Answer-✅disorder of the bowel function not from anatomic
abnormality--constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large
bowel
NOT associated with serious medical conditions, IBD, CA
/.Inflammatory bowel disorder - Answer-✅chronic immunologic disease that manifests
in intestinal inflammation
Ulcerative colitis
crohn's disease
/.Two common inflammatory bowel diseases - Answer-✅Ulcerative colitis-mucosal
surface of the colon is inflamed and ultimately results in frability, erosions, and bleeding-
-most common in recto-sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall and can involve all
or any layer of the bowel wall and any portion of the GI tract from the mouth to the anus-
-skipped lesions, pain in LLQ
/.Diverticulitis - Answer-✅Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free air=perforation;
patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
/.Identify the significance of Barrett's esophagus - Answer-✅After repeated exposure to
gastric contents, inflammation of the esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar
epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
,/.Diagnosis of GERD - Answer-✅made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
/.Risks of GERD - Answer-✅Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
/.Treatments of GERD - Answer-✅Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of the bed
elevated.
/.Medications for GERD - Answer-✅antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI (pantoprazole
40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
/.Differential diagnosis of acute abd pain - Answer-✅Acute appendicitis
Acute pancreatitis
Acute cholecystitis
/.Acute appendicitis - Answer-✅Inflammation of the vermiform appendix; due to
obstruction or infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
/.Acute pancreatitis - Answer-✅Sudden inflammation and hemorrhaging of the
pancreas due to destruction by its own digestive enzymes
1. Autodigestion
Most of the time mild, but can be severe
, Pancreas
Long skinny gland, length of dollar bill
Located in upper abdomen
Behind the stomach
Endocrine
Alpha/beta cells produce insulin & glucagon that are secreted into the blood stream
Exocrine
Leading causes:
ETOH abuse
Gallstones
Other Causes of acute pancreatitis
1. I Get Smashed
I - idoipathic
G- gallstones
E- ETOH abuse
T - trauma
S - steroids
M - mumps virus
A - autoimmune diseases
S - scorpion stings
H - hypertriglyceridemia & hypercalcemia
E - ERCP
D - drugs
Symptoms
Nausea
Vomiting
Hypocalcemia
Cullen's sign - bruising around umbilicus
Grey-Turner's Sign - Bruising along flank
Necrosis induced hemorrhaging spreads
/.Acute cholecystitis - Answer-✅Inflammation of gallbladder (GB)
Usually due to gallstone in cystic duct
1. Cystic duct - leaves gall bladder & connects to common bile duct
Symptoms
Patient will have mid-epigastric pain
Because GB is still squeezing, increasing pressure w/ nowhere for bile to go
Can lead to nausea/vomting
Stone can get more stuck w/ more squeezing
Bile starts to irritate mucosa
Mucosa starts to produce mucous and inflamm enzymes
Leads to inflammation, distention, pressure build up
Bacterial growth (E. coli, enterococci, bacteroides fragilis, colstriduim)
As GB "balloons", pain shifts to RUQ, R scapula/shoulder
Bacteria invades in & through GB wall, into peritoneum, causing peritonitis
Rebound tenderness
