NR507 Final Exam Study Guide
Gastrointestinal (GI) System
Gastroesophageal Reflux Disease (GERD)
- Pathophysiology: Weakening of the Lower Esophageal Sphincter (LES) leads to gastric content reflux.
- Risk Factors: Hiatal hernia, obesity, smoking, pregnancy.
- Symptoms: Heartburn, regurgitation, bitter taste, dysphagia.
- Complications: chronic GERD can lead to esophageal stricture
- Management:
- Lifestyle modifications: 'HEAD'
- H: Head elevated during sleep.
- E: Eat smaller meals.
- A: Avoid trigger foods (spicy, fatty).
- D: Don’t lie down after eating.
- PPIs (Proton Pump Inhibitors): When symptoms persist despite lifestyle modifications; if breakthrough
symptoms are present, inquire about timing and adherence to medication
- Endoscopy: Indicated if PPIs fail or severe reflux causes complications like esophagitis.
Peptic Ulcer Disease (PUD)
- Pathophysiology: Mucosal damage caused by H. pylori (more often than gastric) or NSAIDs (which
contribute to gastric ulcers due to decreased prostaglandin synthesis).
- Symptoms:
- Gastric ulcers: Pain worsens after eating.
- Duodenal ulcers: Pain improves temporarily with food that is epigastric and occurs one hours after a
meal
- Risk Factors: NSAIDs, smoking, alcohol, bisphosphonates, taking potassium chloride
- Erosion vs. Ulcer:
- Erosion: Limited to mucosa.
- Ulcer: Extends to submucosa or deeper.
, Appendicitis
Pathophysiology:
• Inflammation of the appendix due to obstruction by fecalith, lymphoid hyperplasia, or foreign
bodies.
• Obstruction leads to increased intraluminal pressure, ischemia, and bacterial overgrowth,
resulting in inflammation and potential perforation.
Symptoms:
• Initial periumbilical or epigastric pain that migrates to the right lower quadrant (McBurney’s
point) and becomes persistent and severe.
• Associated with nausea, vomiting, fever and chills, and anorexia.
• Rebound tenderness and guarding on abdominal examination.
Complications:
• Perforation leading to peritonitis or abscess formation.
• Colon cancer post-appendectomy (age 50-74; follow-up with colonoscopy).
Diagnostics:
• Clinical history and physical exam (e.g., rebound tenderness).
• Imaging: Abdominal ultrasound or CT scan for confirmation.
• Lab Findings: Increased neutrophils and C-reactive protein.
Management:
• Urgent surgical intervention (appendectomy).
• IV antibiotics to address secondary infection or prevent complications in perforated cases.
Ulcerative Colitis (UC) vs. Crohn’s Disease
- UC: Continuous mucosal inflammation starting at the rectum and extending proximally. Refer for
colonoscopy with biopsy
- Crohn’s: Transmural inflammation with skip lesions. Treat with smoking cessation, steroids, anti-TNF-
alpha
- Key Difference: Cancer risk is higher in UC.
Gastrointestinal (GI) System
Gastroesophageal Reflux Disease (GERD)
- Pathophysiology: Weakening of the Lower Esophageal Sphincter (LES) leads to gastric content reflux.
- Risk Factors: Hiatal hernia, obesity, smoking, pregnancy.
- Symptoms: Heartburn, regurgitation, bitter taste, dysphagia.
- Complications: chronic GERD can lead to esophageal stricture
- Management:
- Lifestyle modifications: 'HEAD'
- H: Head elevated during sleep.
- E: Eat smaller meals.
- A: Avoid trigger foods (spicy, fatty).
- D: Don’t lie down after eating.
- PPIs (Proton Pump Inhibitors): When symptoms persist despite lifestyle modifications; if breakthrough
symptoms are present, inquire about timing and adherence to medication
- Endoscopy: Indicated if PPIs fail or severe reflux causes complications like esophagitis.
Peptic Ulcer Disease (PUD)
- Pathophysiology: Mucosal damage caused by H. pylori (more often than gastric) or NSAIDs (which
contribute to gastric ulcers due to decreased prostaglandin synthesis).
- Symptoms:
- Gastric ulcers: Pain worsens after eating.
- Duodenal ulcers: Pain improves temporarily with food that is epigastric and occurs one hours after a
meal
- Risk Factors: NSAIDs, smoking, alcohol, bisphosphonates, taking potassium chloride
- Erosion vs. Ulcer:
- Erosion: Limited to mucosa.
- Ulcer: Extends to submucosa or deeper.
, Appendicitis
Pathophysiology:
• Inflammation of the appendix due to obstruction by fecalith, lymphoid hyperplasia, or foreign
bodies.
• Obstruction leads to increased intraluminal pressure, ischemia, and bacterial overgrowth,
resulting in inflammation and potential perforation.
Symptoms:
• Initial periumbilical or epigastric pain that migrates to the right lower quadrant (McBurney’s
point) and becomes persistent and severe.
• Associated with nausea, vomiting, fever and chills, and anorexia.
• Rebound tenderness and guarding on abdominal examination.
Complications:
• Perforation leading to peritonitis or abscess formation.
• Colon cancer post-appendectomy (age 50-74; follow-up with colonoscopy).
Diagnostics:
• Clinical history and physical exam (e.g., rebound tenderness).
• Imaging: Abdominal ultrasound or CT scan for confirmation.
• Lab Findings: Increased neutrophils and C-reactive protein.
Management:
• Urgent surgical intervention (appendectomy).
• IV antibiotics to address secondary infection or prevent complications in perforated cases.
Ulcerative Colitis (UC) vs. Crohn’s Disease
- UC: Continuous mucosal inflammation starting at the rectum and extending proximally. Refer for
colonoscopy with biopsy
- Crohn’s: Transmural inflammation with skip lesions. Treat with smoking cessation, steroids, anti-TNF-
alpha
- Key Difference: Cancer risk is higher in UC.
