NR 511 Midterm Exam 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. 1 / 4
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. 2 / 4
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 3 / 4
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 symptoms of IBS? (ANS- Changes in bowel habits such as diarrhea (IBS-D), constipation (IBS-C), abdominal pain, bloating, rectal urgency with diarrhea.What are some extra-intestinal (outside the intestines) symptoms of IBS? (ANS- Sexual dysfunction, loss of libido, dyspareunia, muscle aches and pains, fatigue, fibromyalgia, headaches, back pain, urinary urgency, urinary hesitation, or bladder spasms.
T or F: IBS results in serious medical consequences (ANS- False, prognosis for
IBS is excellent.
T or F: IBS is a risk factor for IBD (Crohn's and UC) and colon cancer. (ANS-
False What are the two most common types of bowel disorders under the Inflammatory Bowel Disease (IBD) umbrella? (ANS- Ulcerative Colitis (UC) and Crohn's Disease In which part of the bowel is UC most commonly manifested? (ANS- Rectosigmoid T or F: UC extends into the small intestine. (ANS- False, UC is not present outside of the colon.T or F: Crohn's Disease can be present anywhere from mouth to anus. (ANS- True
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