NR576 Final Exam Study Guide/NR576 Final Study Guide Worksheet

Viral Gastroenteritis

• Disease: Viral Gastroenteritis
• Risk: Contaminated food, poor hydration, crowded places (schools, daycare, nursing homes, hospitals, cruise ships), norovirus or rotavirus (seasonal, usually in winter)
• Subjective Findings: Nausea, vomiting, fever, cramps, abdominal pain
• Objective Findings: Hyperactive bowel sounds
• Diagnostics: Stool examination, clinical diagnosis
• Treatment: Increase fluid intake with electrolytes, Imodium or Pepto-Bismol, avoid NSAIDs
• Education: Practice good hand hygiene, avoid crowded places and contaminated food

Bacterial Gastroenteritis

• Disease: Bacterial Gastroenteritis
• Risk: Contaminated food or water (salmonella, E. coli, shigella, listeria), improper food handling, inadequate cooking, weak immune system
• Subjective Findings: Anorexia, nausea, vomiting, diarrhea, diffuse pain
• Objective Findings: Hyperactive bowel sounds
• Diagnostics: Stool culture, stool antigen testing
• Treatment: Fluid replacement, antibiotics, supportive care
• Education: Good hand hygiene, avoid daycare until diarrhea stops, consume safe food (unpeeled citrus fruits, steamed food)

Gastroesophageal Reflux Disease (GERD)

• Disease: GERD
• Risk: Lifestyle factors (reclining after eating, alcohol, spicy food, heavy lifting, nicotine, caffeine)
• Subjective Findings: Heartburn/reflux (lying down or after eating), epigastric pain, chest pain, sour taste in morning, belching, cough at night, hoarseness, difficulty swallowing, pharyngitis (worse with bending)
• Objective Findings: Occult blood in stool
• Diagnostics: History (80% sensitivity), ambulatory esophageal pH monitoring, barium swallow, upper endoscopy with biopsy
• Treatment: H2 blockers, PPIs (8-week course), maintenance therapy for severe erosive esophagitis
• Education: Stop using NSAIDs, avoid heavy lifting, weight loss, small frequent meals, avoid high-fat, spicy food, caffeine, onions, garlic, quit smoking, avoid tight garments, elevate head of bed

Heartburn

• Disease: Heartburn
• Risk: GERD, spicy/acidic/fried food, caffeine, alcohol, obesity, pregnancy, hiatal hernia, smoking
• Subjective Findings: Burning sensation, regurgitation, dysphagia, chest pain
• Diagnostics: Endoscopy, esophageal pH monitoring
• Treatment: Antacids (calcium carbonate), H2 receptor antagonists (ranitidine, famotidine), PPIs (omeprazole, lansoprazole)
• Education: Antacids may contain magnesium causing diarrhea

Peptic Ulcer Disease (PUD)

• Disease: PUD
• Risk: NSAIDs, aspirin, history of H. pylori, age 55-70, smoking, alcohol use
• Subjective Findings: Burning/gnawing pain in epigastrium (radiating to back, light shoulder or side), nausea (worse with empty stomach), duodenal ulcer pain (relieved by food), gastric ulcer pain (aggravated by food), episodic pattern, nocturnal pain
• Objective Findings: Pain relieved by food, epigastric abdominal tenderness, occult blood in stool (tarry stools), pallor, fatigue, weakness, pain 2-4 hours after meal
• Diagnostics: Upper endoscopy (gold standard), barium swallow, H. pylori testing (breath test, fasting gastrin levels)
• Treatment: PPI, Carafate, Pepto-Bismol, Misoprostol, H2 receptor antagonists, H. pylori treatment (combination of two antibiotics and PPI)
• Education: If no improvement in 2 weeks, refer to GI for endoscopy, if gastric vs. duodenal ulcer suspected, refer to endoscopy due to risk of gastric cancer

H. Pylori Infection

• Disease: H. Pylori Infection
• Risk: Poor sanitation, crowded living conditions, increasing age, close contact with infected person, higher prevalence in developing countries
• Subjective Findings: Burning/gnawing pain in upper abdomen between meals or during night, nausea, vomiting, loss of appetite, indigestion
• Objective Findings: Chronic H. pylori could lead to anemia (iron deficiency due to chronic bleeding from ulcer)
• Diagnostics: Urea breath test, stool antigen test, upper endoscopy with biopsy
• Treatment: Amoxicillin, clarithromycin, omeprazole (for 2 weeks)
• Education: Practice good hygiene, avoid contaminated food and water, medication adherence

Constipation

• Disease: Constipation
• Risk: Elderly, polypharmacy, lack of dietary fiber, habitual use of laxatives, IBS, sedentary lifestyle, hypothyroidism, diabetes, medications (codeine, morphine, calcium channel blockers)
• Subjective Findings: Ribbon-like stool
• Objective Findings: None specified
• Diagnostics: Stool for occult blood
• Treatment: Increase dietary fiber (25-35 mg/day), exercise, adequate hydration, medications (bulking agents like psyllium, stool softeners like docusate, saline laxatives like magnesium sulfate, stimulant laxatives, lubricants like mineral oil)
• Education: Increase fiber intake, stay hydrated, exercise regularly

Irritable Bowel Syndrome (IBS)

• Disease: IBS
• Risk: Female, age 35-50, family history, trauma, stress, emotional factors, small intestine bacterial overgrowth
• Subjective Findings: Chronic intermittent diarrhea, mucus in stool (worse with stress and eating, relieved with defecation), sense of incomplete evacuation, alteration in frequency and consistency of stool, bloating, abdominal distension
• Objective Findings: LLQ most common, RLQ intermittent, recurrent abdominal pain (on average >1 day per week in 3 months), colon tenderness on palpation
• Diagnostics: Abdominal imaging, lab tests (CBC, ESR, chemistry, urinalysis, stool for occult blood)
• Treatment: High fiber diet (20-30 grams per day), increase water intake (8 glasses per day), anti-diarrheal, stimulant laxatives (linaclotide), antispasmodics (Bentyl, Hycosamine), local GI tract medications (Linaclotide, Plecanatide)
• Education: Decrease stress, avoid triggers, follow a healthy diet, refer to GI if not responding to treatment

Crohn’s Disease (IBD)

• Disease: Crohn’s Disease (IBD)
• Risk: More common in females, smoking, age 15-40, location (distal ileum and cecum), discontinuous patchy gut inflammation with skip lesions, transmural inflammation
• Subjective Findings: Mass palpated on abdomen, weight loss, RLQ tenderness, steatorrhea (excessive fat in stool), dehydration, fistula formation, fever, soft and semiliquid stool, foul-smelling fatty stool
• Objective Findings: Affects cecum and ileum, small intestine has skip lesions
• Diagnostics: Colonoscopy
• Treatment: Corticosteroids, aminosalicylates (mesalamine), immunomodulators (azathioprine, methotrexate), antibiotics
• Education: Blood, mucus, or pus in stool, thin pencil-like stool due to obstructing lesion in sigmoid colon

Ulcerative Colitis (IBD)

• Disease: Ulcerative Colitis (IBD)
• Risk: Both genders, age 15-40, location (distal colon), continuous inflammatory lesions, superficial inflammation
• Subjective Findings: Bloody and purulent diarrhea, abdominal cramps (relieved with defecation), fever (with severe disease)
• Objective Findings: Inflammation of rectal and sigmoid colon (proctitis), inflammation can spread
• Diagnostics: None specified
• Treatment: Colectomy (not first-line treatment, but can completely resolve the problem)
• Education: None specified

Diverticulitis

• Disease: Diverticulitis
• Risk: Obesity, low fiber diet, chronic constipation, straining, high in Asian population
• Subjective Findings: LLQ pain and tenderness, anorexia, nausea, vomiting
• Objective Findings: Inflamed diverticula, fever, chills, tachycardia, firm fixed mass in area of diverticula, rebound tenderness with involuntary guarding and rigidity, bowel sounds initially hypoactive but hyperactive if obstructive process developed
• Diagnostics: Stool positive for occult blood, abdominal x-ray, barium enema, CBC, CT with oral contrast (most sensitive)
• Treatment: High fiber diet, daily fiber supplement (psyllium), mild symptoms (rest, oral antibiotics like metronidazole and levofloxacin, clear liquid diet), severe symptoms (IV antibiotics, analgesia, bowel rest, NG tube)
• Education: Colonoscopy follow-up, barium enema every 3 years, eat high-fiber foods (bran, fresh fruits, vegetables, whole grains)

Appendicitis

• Disease: Appendicitis
• Risk: Age 10-30, men twice as likely as women, low fiber diet, high fat and refined sugar/carbs diet
• Subjective Findings: Loss of appetite, nausea, vomiting, acute onset of mild to severe colicky epigastric or periumbilical pain (vague at first, localizes to RLQ within 24 hours), pain exacerbated by walking or coughing, pain may radiate to testicles in males, pain worse with movement or coughing, relieved by lying still
• Objective Findings: Mild elevated temperature, RLQ guarding and rebound tenderness, Rovsing’s sign, psoas sign, obturator sign, McBurney’s point tenderness
• Diagnostics: History and physical exam, CBC (mild leukocytosis), urinalysis (microscopic hematuria or WBC in urine), urine hCG (to rule out ectopic pregnancy), x-ray, CT scan abdomen
• Treatment: Surgery, preoperative management (fluid and electrolyte correction, bedrest, NPO, IV antibiotics)
• Education: Discharge usually same day as surgery

Benign Prostatic Hyperplasia (BPH)

• Disease: BPH
• Risk: Men older than 50, age 60-90, androgen role, lower cell turnover
• Subjective Findings: Difficulty initiating urinary stream, hesitancy, urgency, postvoid dribbling, urinary frequency, nocturia, urinary retention, sensation of full bladder immediately after voiding
• Objective Findings: Bladder and urethral pressure, chronic constipation, suprapubic and pelvic pain, difficulty having an erection, early signs (frequency, urgency, nocturia), bladder palpable over symphysis pubis, gross hematuria, weak urinary stream, bladder distention > 150ml by percussion
• Diagnostics: Digital rectal exam, PSA (not diagnostic alone)
• Treatment: Alpha-adrenergic blockers (terazosin, doxazosin), 5-alpha reductase inhibitors (finasteride), if untreated, risk of bladder tone loss and detrusor muscle damage
• Education: Avoid caffeine, alcohol, highly seasoned food

Erectile Dysfunction (ED)

• Disease: ED
• Risk: Age > 40, DM, heart disease, HTN, obesity, smoking, alcohol, stress, anxiety, depression, medications (anti-androgens, antihypertensives, central sympatholytics, antidepressants)
• Subjective Findings: Inability to maintain erection, reduced libido, anxiety, and stress related to sexual performance
• Objective Findings: Genital abnormalities (Peyronie’s disease), blood test for underlying conditions, assessment of depression and anxiety
• Diagnostics: Physical exam (genital exam, pulse palpation, check for gynecomastia), labs (CBC, CMP, fasting blood sugar, lipid panel, TSH, testosterone), ultrasound (blood flow to penis), nocturnal penile tumescence test (determine physical or psychological cause)
• Treatment: Quit smoking and alcohol, medication (sildenafil, tadalafil, vardenafil), psychotherapy, vacuum erection devices, penile implants, hormone therapy (testosterone replacement)
• Education: None specified