NR511 Midterm- Chamberlain
What are common causes of N/V associated with gastritis? ANS: Alcohol, NSAIDs, ASA, ABX, and illicit
substances
What is the most common cause of nausea and vomiting? ANS: Acute Gastroenteritis (AGE)
What are some manifestations of AGE? ANS: Nausea, vomiting, and diarrhea, fever, abdominal pain.
May also include fatigue, malaise, anorexia, tenesmus and borborygmus.
How is the severity of AGE gauged? ANS: Dehydration secondary to profuse watery diarrhea, fever
greater than 101ºF (38.3ºC), vomiting, or dysentery.
What are important parts of a patient's history when AGE is suspected? ANS: Travel, dining locations,
ABX history..
What happens to the pH of the stomach when antacids are taken and how does this affect bacteria?
ANS: High pH can make it easier for bacteria to survive and cause and infection.
How does motility of the GI tract affect bacteria colonization? ANS: Small bowel stasis as a result of
obstruction, diverticulitis, or blind loop syndrome frequently develop an overgrowth of bacteria within
the stagnant segment.
Which immunoglobulin may protect the GI tract against invading organisms? ANS: IgA...may also help
protect against a future attack by the same pathogen.
Onset of N/V begin within 6 hours after exposure. Is this bacterial or viral? ANS: Bacterial: time frame
suggests food poisoning resulting from the ingestion of a preformed toxin such as that of Bacillus cereus.
,What two indications are highly suggestive of viral AGE? ANS: Incubation periods greater than 14 hours
and the initial symptom of vomiting.
If a patient presents with AGE and reports bloody stools, what can be understood about the reason for
blood in the stool/ ANS: Mucosal damage and inflammatory process secondary to invasive pathogens.
What do frothy stools and flatus suggest? ANS: Malabsorption problem.
Patients with prolonged AGE illness who are malnourished may present with edema. What is the
reason? ANS: Hypoalbuminemia
T or F: Chronic diarrhea usually has a noninfectious etiology. ANS: True
T or F: Acute diarrhea usually is caused by infectious agents or toxins ANS: True
What is the most common viral pathogen causing AGE in adults? ANS: Norovirus
What is the most common viral pathogen causing AGE in pediatrics? ANS: Rotavirus. This has been
greatly reduced since the introduction of the rotavirus vaccine.
T or F: Stool studies are indicated in the absence of bloody diarrhea or systemic disease ANS: False
T or F: A CBC will help distinguish between viral and bacterial AGE ANS: False
When are stool studies warranted? ANS: Severe or prolonged diarrhea, a fever > 38.5ºC, bloody stools
or stools that test positive for leukocytes or occult blood.
,What are common pathogens involved in Traveler's Diarrhea? ANS: Shigella, Campylobacter, and E. coli.
What should the clinician do if the patient develops diarrhea after initiation of completion of antibiotic
therapy? ANS: Test for C. diff.
What are some DDx of AGE, particularly in patients with persistent or chronic diarrhea and severe
abdominal pain? ANS: IBS, IBD, ischemic bowel disease, partial bowel obstruction, small bowel
diverticulosis.
What are some red flag symptoms that may indicate the need for hospitalization? ANS: Hypovolemia,
dehydration, abnormal electrolytes, decreased renal function, bloody stool/rectal bleeding, weight loss,
severe abdominal pain, prolonged symptoms greater than 1 week, pregnancy, advanced age, history of
hospitalization or antibiotic use in the last 3-6 months.
What is the usual course of treatment for AGE? ANS: Only supportive treatment is initiated since AGE is
usually self-limiting and resolves within 1 week after onset of symptoms.
How such patients with evidence of dehydration be treated initially? ANS: Fluid repletion and nutrition.
Sports drinks aren't as effective as specific electrolyte replenishing drinks.
At what point should a patient be referred to the hospital for dehydration? ANS: Signs of hypovolemia
such as hypotension, tachycardia, pallor, and poor skin turgor.
T of F: Empiric antimicrobial therapy is recommended for patients with severe diarrhea suspected form
traveling. ANS: True. Bactrim, Ciprofloxacin, Norfloxacin, Floxacin.
T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is appropriate. ANS: True
How effective is antibiotic prophylaxis for patients traveling to high-risk areas? ANS: 90% effective
, What does antibiotic prophylaxis treatment consist of? ANS: Bactrim, Ciprofloxacin, Norfloxacin, or
Floxacin given once daily until 2 days after returning home.
What is an appropriate symptomatic treatment for patients < 65 years or age with moderate to severe
diarrhea? ANS: Two-day course of Loperamide (Imodium)
What is an appropriate symptomatic treatment for patients < 65 years or age with significant vomiting?
ANS: Two-day course of Zofran or Phenergan.
What is the best way to prevent AGE? ANS: Hand washing.
T or F: Kids can attend daycare with infectious diarrhea as long as they're separated from other children.
ANS: False! Not until the diarrhea has stopped.
If pain is present in the right lower quadrant, what might be the etiology related to bowel disorders?
ANS: IBD, IBS, Infectious Colitis, and Constipation
If pain is present in the left lower quadrant, what might be the etiology related to bowel disorders? ANS:
Diverticulitis, IBS, IBD, Constipation, and Infectious Colitis.
If pain is present in the left upper quadrant, what might be the etiology related to bowel disorders?
ANS: Stomach ulcers, pancreatitis, and gastritis.
If pain is present in the right upper quadrant, what might be the etiology related to bowel disorders?
ANS: Gall bladder, hepatitis, and pancreatitis.
T or F: IBS is a disorder of bowel function in the absence of an atomic abnormality. ANS: True
What are common causes of N/V associated with gastritis? ANS: Alcohol, NSAIDs, ASA, ABX, and illicit
substances
What is the most common cause of nausea and vomiting? ANS: Acute Gastroenteritis (AGE)
What are some manifestations of AGE? ANS: Nausea, vomiting, and diarrhea, fever, abdominal pain.
May also include fatigue, malaise, anorexia, tenesmus and borborygmus.
How is the severity of AGE gauged? ANS: Dehydration secondary to profuse watery diarrhea, fever
greater than 101ºF (38.3ºC), vomiting, or dysentery.
What are important parts of a patient's history when AGE is suspected? ANS: Travel, dining locations,
ABX history..
What happens to the pH of the stomach when antacids are taken and how does this affect bacteria?
ANS: High pH can make it easier for bacteria to survive and cause and infection.
How does motility of the GI tract affect bacteria colonization? ANS: Small bowel stasis as a result of
obstruction, diverticulitis, or blind loop syndrome frequently develop an overgrowth of bacteria within
the stagnant segment.
Which immunoglobulin may protect the GI tract against invading organisms? ANS: IgA...may also help
protect against a future attack by the same pathogen.
Onset of N/V begin within 6 hours after exposure. Is this bacterial or viral? ANS: Bacterial: time frame
suggests food poisoning resulting from the ingestion of a preformed toxin such as that of Bacillus cereus.
,What two indications are highly suggestive of viral AGE? ANS: Incubation periods greater than 14 hours
and the initial symptom of vomiting.
If a patient presents with AGE and reports bloody stools, what can be understood about the reason for
blood in the stool/ ANS: Mucosal damage and inflammatory process secondary to invasive pathogens.
What do frothy stools and flatus suggest? ANS: Malabsorption problem.
Patients with prolonged AGE illness who are malnourished may present with edema. What is the
reason? ANS: Hypoalbuminemia
T or F: Chronic diarrhea usually has a noninfectious etiology. ANS: True
T or F: Acute diarrhea usually is caused by infectious agents or toxins ANS: True
What is the most common viral pathogen causing AGE in adults? ANS: Norovirus
What is the most common viral pathogen causing AGE in pediatrics? ANS: Rotavirus. This has been
greatly reduced since the introduction of the rotavirus vaccine.
T or F: Stool studies are indicated in the absence of bloody diarrhea or systemic disease ANS: False
T or F: A CBC will help distinguish between viral and bacterial AGE ANS: False
When are stool studies warranted? ANS: Severe or prolonged diarrhea, a fever > 38.5ºC, bloody stools
or stools that test positive for leukocytes or occult blood.
,What are common pathogens involved in Traveler's Diarrhea? ANS: Shigella, Campylobacter, and E. coli.
What should the clinician do if the patient develops diarrhea after initiation of completion of antibiotic
therapy? ANS: Test for C. diff.
What are some DDx of AGE, particularly in patients with persistent or chronic diarrhea and severe
abdominal pain? ANS: IBS, IBD, ischemic bowel disease, partial bowel obstruction, small bowel
diverticulosis.
What are some red flag symptoms that may indicate the need for hospitalization? ANS: Hypovolemia,
dehydration, abnormal electrolytes, decreased renal function, bloody stool/rectal bleeding, weight loss,
severe abdominal pain, prolonged symptoms greater than 1 week, pregnancy, advanced age, history of
hospitalization or antibiotic use in the last 3-6 months.
What is the usual course of treatment for AGE? ANS: Only supportive treatment is initiated since AGE is
usually self-limiting and resolves within 1 week after onset of symptoms.
How such patients with evidence of dehydration be treated initially? ANS: Fluid repletion and nutrition.
Sports drinks aren't as effective as specific electrolyte replenishing drinks.
At what point should a patient be referred to the hospital for dehydration? ANS: Signs of hypovolemia
such as hypotension, tachycardia, pallor, and poor skin turgor.
T of F: Empiric antimicrobial therapy is recommended for patients with severe diarrhea suspected form
traveling. ANS: True. Bactrim, Ciprofloxacin, Norfloxacin, Floxacin.
T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is appropriate. ANS: True
How effective is antibiotic prophylaxis for patients traveling to high-risk areas? ANS: 90% effective
, What does antibiotic prophylaxis treatment consist of? ANS: Bactrim, Ciprofloxacin, Norfloxacin, or
Floxacin given once daily until 2 days after returning home.
What is an appropriate symptomatic treatment for patients < 65 years or age with moderate to severe
diarrhea? ANS: Two-day course of Loperamide (Imodium)
What is an appropriate symptomatic treatment for patients < 65 years or age with significant vomiting?
ANS: Two-day course of Zofran or Phenergan.
What is the best way to prevent AGE? ANS: Hand washing.
T or F: Kids can attend daycare with infectious diarrhea as long as they're separated from other children.
ANS: False! Not until the diarrhea has stopped.
If pain is present in the right lower quadrant, what might be the etiology related to bowel disorders?
ANS: IBD, IBS, Infectious Colitis, and Constipation
If pain is present in the left lower quadrant, what might be the etiology related to bowel disorders? ANS:
Diverticulitis, IBS, IBD, Constipation, and Infectious Colitis.
If pain is present in the left upper quadrant, what might be the etiology related to bowel disorders?
ANS: Stomach ulcers, pancreatitis, and gastritis.
If pain is present in the right upper quadrant, what might be the etiology related to bowel disorders?
ANS: Gall bladder, hepatitis, and pancreatitis.
T or F: IBS is a disorder of bowel function in the absence of an atomic abnormality. ANS: True
