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ACNP Gastrointestinal : Questions With A+ Solutions
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ACNP Gastrointestinal : Questions With A+ Solutions
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ACNP Gastrointestinal : Questions With A+ SolutionsH. Pylori Right Ans - Bacteria present in >90% of duodenal ulcers and
>75% of gastic cancers
Peptic Ulcer Disease Quick Facts Right Ans - Caused by meds like NSAIDS,
ASA, and glucocorticoids
More commen in men
More common in >1/2 ppd smokers
Alcohol and dietary factors do NOT appear to cause ulcer disease
The younger the patient, the more likely to be a duodenal ulcer (ages 30-55).
Gastric ulcers between ages 55-65.
S/S of PUD Right Ans - 1. Gnawing epigastric pain
2. Relief of pain with eating (duodenal ulcers)
3. Pain worsens with eating (gastric ulcers)
PE findings of PUD Right Ans - Mild epigastric tenderness
GI bleeding in 20%
Perforation in 5-10% of cases
Melena Right Ans - dark, tarry, cow-patty stools
Hematemesis Right Ans - Bright red, bloody vomit
Coffee-ground emesis Right Ans - Indicates bleed is beyond stomach,
duodenal bleed
Perforation Right Ans - Severe epigastric pain, "board-like" abdomen, quiet
bowel sounds, rigidity, and other signs of an acute abdomen
Labs and diagnostics of PUD Right Ans - 1. Normal, may not anemia on CBC
2. Consider endoscopy after 2-8 weeks of treatment
3. Consider H. pylori testing
3 Most Common Causes of Perforation/Peritonitis Right Ans - 1. PUD,
ruptured ulcer
2. Ruptured diverticulum
3. Rarely, appendicitis
, H2 Receptor Antagonists Right Ans - -"Dines"
- Should be the 1st drug used
- Least expensive
-Ex. Cimetidine (tagamet), Ranitide (zantac), Famotidine (pepcid), and
Nizatidine (axid)
-Begin QHS, then move to BID, then move to other drug class
Proton Pump Inhibitor Right Ans - - "Prazoles"
- Try after no relief from BID H2 antagonists
- Rebound GERD if you take off
- Ex. Lansoprazole (prevacid), Rabeprazole (achiphex), pantoprazole
(protonix), omeprazole (prilosec), dexlansoprazole (dexilant), esomeprazole
(nexium)
-If no relief after BID H2 and PPI, refer to GI for scope
- Blackbox warning: osteoporotic hip fx for elderly taking long term PPIs. Add
Vit D supplements 400-800 units
Mucosal Protective Agents Right Ans - Meds should be given 2 hours apart
from other drugs
Ex. Carafate, Bismuth subsalicylate, Misoprostol, and Antacids
Sucralfate (carafate) Right Ans - 1 gm QID
*Associated with decreases in noscomial PNA
Requires an acidic environment (avoid antacids and H2 blockers)
Bismuth subsalicylate (pepto-bismal) Right Ans - DOC for traveler's
diarrhea and gastroenteritis
Has direct antibacterial action against H. pylori
Promotes prostaglandin production/stimulates gastric bicarbonate
Misoprostol (cytotec) Right Ans - QID with food
*Used as prophylaxis against NSAID-induced ulcers (ex. patients with RA)
Stimulates mucous and bicarb production
*May stimulate uterine contraction and induce abortion
D/C offending agent if possible
PPI in patients who cannot D/C NSAID
H2 blockers, Sucralfate and antacids do NOT prevent NSAID-induced ulcers
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