What are common causes of N/V associated with gastritis? - ANSWER Alcohol, NSAIDs, ASA, ABX, and illicit substances
What is the most common cause of nausea and vomiting? - ANSWER Acute Gastroenteritis (AGE)
What ar
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What are common causes of N/V associated with gastritis? - ANSWER Alcohol, NSAIDs, ASA, ABX, and illicit substances
What is the most common cause of nausea and vomiting? - ANSWER Acute Gastroenteritis (AGE)
What are some manifestations of AGE? - ANSWER Nausea, vomiting, and diarrhea, fever, abdominal pain. May also include fatigue, malaise, anorexia, tenesmus and borborygmus.
How is the severity of AGE gauged? - ANSWER 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? - ANSWER Travel, dining locations, ABX history..
What happens to the pH of the stomach when antacids are taken and how does this affect bacteria? - ANSWER High pH can make it easier for bacteria to survive and cause and infection.
How does motility of the GI tract affect bacteria colonization? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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/ - ANSWER Mucosal damage and inflammatory process secondary to invasive pathogens.
What do frothy stools and flatus suggest? - ANSWER Malabsorption problem.
Patients with prolonged AGE illness who are malnourished may present with edema. What is the reason? - ANSWER Hypoalbuminemia
T or F: Chronic diarrhea usually has a noninfectious etiology. - ANSWER True
T or F: Acute diarrhea usually is caused by infectious agents or toxins - ANSWER True
What is the most common viral pathogen causing AGE in adults? - ANSWER Norovirus
What is the most common viral pathogen causing AGE in pediatrics? - ANSWER 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 - ANSWER False
T or F: A CBC will help distinguish between viral and bacterial AGE - ANSWER False
When are stool studies warranted? - ANSWER 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? - ANSWER Shigella, Campylobacter, and E. coli.
What should the clinician do if the patient develops diarrhea after initiation of completion of antibiotic therapy? - ANSWER Test for C. diff.
What are some DDx of AGE, particularly in patients with persistent or chronic diarrhea and severe abdominal pain? - ANSWER IBS, IBD, ischemic bowel disease, partial bowel obstruction, small bowel diverticulosis.
What are some red flag symptoms that may indicate the need for hospitalization? - ANSWER 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? - ANSWER 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? - ANSWER 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? - ANSWER 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. - ANSWER True. Bactrim, Ciprofloxacin, Norfloxacin, Floxacin.
T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is appropriate. - ANSWER True
How effective is antibiotic prophylaxis for patients traveling to high-risk areas? - ANSWER 90% effective
What does antibiotic prophylaxis treatment consist of? - ANSWER 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? - ANSWER Two-day course of Loperamide (Imodium)
What is an appropriate symptomatic treatment for patients < 65 years or age with significant vomiting? - ANSWER Two-day course of Zofran or Phenergan.
What is the best way to prevent AGE? - ANSWER Hand washing.
T or F: Kids can attend daycare with infectious diarrhea as long as they're separated from other children. - ANSWER 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? - ANSWER IBD, IBS, Infectious Colitis, and Constipation
If pain is present in the left lower quadrant, what might be the etiology related to bowel disorders? - ANSWER 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? - ANSWER Stomach ulcers, pancreatitis, and gastritis.
If pain is present in the right upper quadrant, what might be the etiology related to bowel disorders? - ANSWER Gall bladder, hepatitis, and pancreatitis.
T or F: IBS is a disorder of bowel function in the absence of an atomic abnormality. - ANSWER True
What are common symptoms of IBS? - ANSWER 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? - ANSWER Sexual dysfunction, loss of libido, dyspareunia, muscle aches and pains, fatigue, fibromyalgia, headaches, back pain, urinary urgency, urinary hesitation, or bladder spasms.
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