🟣 Module 11 · Procedures: Scopes & Tubes
EGD · NG tube placement · Enteral feeding (G-tube, J-tube)
Esophagogastroduodenoscopy (EGD)
WhatScope through mouth to view esophagus, stomach, duodenum. Dx tool for GERD, PUD, Barrett, bleeding, cancer (biopsy).
BeforeNPO 8 hrs. Consent. Remove dentures. Sedation (midazolam/propofol) + throat spray.
AfterNPO until gag reflex returns — this is THE test answer. Then monitor for perforation.
NG Tube Placement & Care
UsesDecompression (suction), feeding, med administration, lavage.
- Insertion: High Fowler's, measure nose→earlobe→xiphoid (NEX), hyperextend neck to pass nares, then flex chin to chest and sip water as tube passes to esophagus.
- Verify placement: Gold standard = X-ray before first use. Ongoing: gastric pH ≤ 5, aspirate appearance. Auscultating air ("whoosh") is NOT acceptable.
- Coughing, choking, cyanosis during insertion = tube in airway → pull back immediately.
- Keep HOB ≥ 30° (feeding: 30–45° during and 30–60 min after).
- Check residuals and pH per policy; flush with 30 mL water before/after meds and feeds.
Enteral Feeding (G-tube / J-tube / NG)
WhoFunctional GI tract but can't swallow safely (stroke, head/neck cancer, ventilated). G-tube = stomach; J-tube = jejunum (use when stomach must be bypassed, ↓ aspiration risk).
- #1 priority = prevent aspiration: HOB 30–45°, check placement + residual before feeds, hold per policy for high residual.
- Flush 30 mL water q4h (continuous) and before/after everything.
- Change bag/tubing q24h; hang time for open-system formula ≤ 4–8 hrs (prevents bacterial growth).
- Diarrhea = most common complication (rate too fast, cold formula, contamination, hyperosmolar formula).
- Stoma care: clean, dry, assess for skin breakdown and buried bumper.
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🟣 Module 11 · Oral Cavity & Neck
Dental caries · Salivary disorders · Oropharyngeal cancer · Neck dissection
Dental Caries & Salivary Disorders
CariesTooth decay from bacterial plaque + sugar → acid erosion. Prevention teaching = brush/floss, fluoride, limit sugar, routine dental visits.
SialadenitisInflammation/infection of a salivary gland (often S. aureus), commonly parotid in dehydrated/older/post-op clients. S/s: painful swollen gland, ↑ with eating.
CareHydration, warm compresses, gland massage, sialagogues (lemon drops/sour candy to stimulate flow), good oral hygiene, antibiotics.
Oropharyngeal Cancer & Neck Dissection
RisksTobacco (all forms), alcohol, HPV, sun exposure (lip). Combined tobacco + alcohol is synergistic.
S/sNon-healing mouth sore, white/red patch (leukoplakia/erythroplakia), lump, sore throat, dysphagia, hoarseness, unilateral ear pain.
Post-op neck dissection
- Airway is the #1 priority — edema can obstruct; keep HOB up (semi-Fowler's) to reduce swelling and improve drainage.
- Monitor flaps/drains; assess for carotid rupture risk (a late emergency — if it ruptures, apply pressure and call for help).
- Communication plan (may not be able to speak), nutrition (often enteral), suction available.
🟣 Module 11 · Esophageal Disorders
Esophageal obstruction · Hiatal hernia · GERD · Barrett esophagus · Esophageal cancer
GERD & Hiatal Hernia
PathoWeak/incompetent lower esophageal sphincter (LES) lets acid reflux into esophagus. Hiatal hernia = stomach herniates up through the diaphragm, worsening reflux.
S/sHeartburn (pyrosis), regurgitation, dyspepsia, worse lying down/after meals; may mimic chest pain.
Teaching (huge on exams)
- Small frequent meals; stay upright 2–3 hrs after eating; elevate HOB on blocks for sleep.
- Avoid triggers: caffeine, chocolate, peppermint, fatty/fried/spicy foods, alcohol, tobacco.
- Avoid eating 3 hrs before bed; lose weight; avoid tight clothing.
- Meds: antacids, H2 blockers (famotidine), PPIs (omeprazole — take before meals).
Esophageal Cancer & Obstruction
RisksChronic GERD/Barrett, smoking, alcohol, obesity (adenocarcinoma); tobacco/alcohol (squamous cell).
Hallmark S/sProgressive dysphagia (solids → then liquids) + unintentional weight loss. Often late diagnosis.
CareNutrition support (soft/enteral), aspiration precautions, upright with meals, small bites, emotional support. Post-esophagectomy: HOB up, monitor for leak, respiratory care.
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🟣 Module 11 · Stomach Disorders
PUD (gastric vs duodenal) · Gastritis · Gastric cancer/gastrectomy · Pernicious anemia · Dumping syndrome
Peptic Ulcer Disease — Gastric vs Duodenal ⭐
CausesH. pylori and NSAIDs are the top two. Also smoking, alcohol, stress, steroids.
| Gastric ulcer | Duodenal ulcer | |
|---|---|---|
| Pain timing | WITH/soon after eating (food ↑ pain) | 2–3 hrs after meals / at night; food relieves pain |
| Weight | Weight loss (afraid to eat) | Weight stable/gain |
| Bleeding | Hematemesis more common | Melena more common |
Care/MedsPPIs, H2 blockers, antibiotics for H. pylori (triple therapy), avoid NSAIDs/irritants, stop smoking.
Gastritis, Gastric Cancer & Gastrectomy
GastritisInflammation of gastric mucosa (H. pylori, NSAIDs, alcohol, stress). Acute → pain, N/V; chronic → can cause B12 malabsorption.
Gastric cancerOften vague/late: early satiety, indigestion, weight loss, anemia. Risks: H. pylori, chronic gastritis, smoked/salted foods, smoking.
Post-gastrectomyMonitor for bleeding, ensure NG patency (do NOT reposition NG after gastric surgery without order), pain control, nutrition, and the two classic complications below.
Dumping Syndrome ⭐ (teaching-heavy)
PathoAfter gastric surgery, food dumps rapidly into small intestine → fluid shift. Early (15–30 min): dizziness, tachycardia, diaphoresis, cramping, diarrhea. Late (1–3 hr): rebound hypoglycemia.
Diet teaching (memorize)
- Small, frequent meals; high protein, high fat, low simple carbs.
- NO fluids WITH meals — drink between meals (30–60 min before/after).
- Lie down after eating (recumbent/left side) to slow gastric emptying.
- Avoid concentrated sweets.
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🔵 Module 12 · Colonoscopy & Parenteral Nutrition
Colonoscopy prep/after · TPN safety rules
Colonoscopy
WhatScope of the entire large intestine. Screening (CRC), evaluate bleeding/IBD/polyps, biopsy/remove polyps.
PrepClear liquids day before (no red/purple), bowel prep (PEG/GoLYTELY) until stool runs clear, NPO after midnight, consent, sedation.
AfterMonitor VS + return of gag/alertness, expect flatus/cramping (air insufflation — walking helps), check for rectal bleeding, resume diet when alert.
Parenteral Nutrition / TPN ⭐ (safety rules)
WhatIV nutrition when the gut can't be used. TPN = hypertonic (high dextrose) → needs a central line. PPN = lower concentration, peripheral, short-term.
- Dedicated line — nothing else infused with TPN; verify with 2 nurses per policy.
- Change bag and tubing q24h (high infection/glucose risk); use aseptic technique.
- Monitor blood glucose regularly (hyperglycemia common; sliding-scale insulin often ordered).
- Infuse via pump; never speed up or slow down to "catch up."
- Daily weights, I&O, electrolytes; monitor for refeeding syndrome (↓K, ↓phos, ↓Mg).
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🔵 Module 12 · Functional & Malabsorption + Bowel Habits
IBS · Celiac disease · Constipation · Diarrhea · Fecal incontinence
Irritable Bowel Syndrome (IBS)
PathoFunctional disorder — altered motility + visceral hypersensitivity, no structural/inflammatory damage. Triggers: stress, certain foods, hormones.
S/sChronic abdominal pain relieved by defecation, bloating, alternating diarrhea/constipation. No bleeding, no weight loss, no fever (those suggest something else).
TeachingIdentify/avoid trigger foods (food diary), low-FODMAP diet, adequate fiber + fluids, regular exercise, stress management. Meds target the dominant symptom (antispasmodics, antidiarrheals, laxatives).
Celiac Disease
PathoAutoimmune reaction to gluten (wheat, barley, rye) damages small-intestine villi → malabsorption.
S/sSteatorrhea (fatty, foul, floating stools), bloating, weight loss, fatigue, anemia, vitamin deficiencies; kids: failure to thrive. Dermatitis herpetiformis (itchy rash).
TeachingLifelong strict gluten-free diet is the only treatment. Read labels (hidden gluten), watch cross-contamination. Safe grains: rice, corn, quinoa, oats (certified GF).
Constipation, Diarrhea & Fecal Incontinence
Constipation↑ fiber (gradually), ↑ fluids, ↑ activity, respond to urge, scheduled toileting. Laxative overuse and chronic straining cause problems (hemorrhoids, Valsalva).
DiarrheaPriority = fluid/electrolyte balance (watch dehydration, hypokalemia), skin care, identify cause (infection, C. diff, meds, feeding). For C. diff: contact precautions + soap-and-water handwashing (alcohol gel doesn't kill spores).
Fecal incontinenceBowel training/scheduled toileting, skin protection/barrier cream, dignity + emotional support, treat underlying cause.
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🔵 Module 12 · Acute Inflammatory Abdomen
Appendicitis · Peritonitis · Diverticular disease
Appendicitis ⭐
S/sPeriumbilical pain that migrates to RLQ (McBurney's point), rebound tenderness, low-grade fever, N/V, anorexia. Rovsing/psoas signs.
CareNPO, IV fluids, prep for appendectomy. Position of comfort (often right side/knees flexed).
Peritonitis
PathoInflammation of the peritoneum from perforation/leak (ruptured appendix, diverticulum, ulcer, bowel). Life-threatening — can lead to sepsis + shock.
S/sRigid, board-like abdomen, severe diffuse pain, rebound tenderness, absent bowel sounds, fever, tachycardia, ↓BP, shallow breathing.
CareNPO, NG decompression, IV fluids + antibiotics, monitor for shock, prep for surgery. Semi-Fowler's to localize/pool drainage in pelvis.
Diverticulosis vs Diverticulitis ⭐ (opposite diets)
DiverticulosisOutpouchings in the colon wall, usually asymptomatic. Linked to low-fiber diet + chronic constipation/straining.
DiverticulitisThose pouches become inflamed/infected. S/s: LLQ pain, fever, ↑WBC, N/V, altered bowel habits.
| State | Diet |
|---|---|
| Diverticulosis (prevention) | HIGH fiber, high fluids to prevent flares |
| Acute diverticulitis | LOW fiber / clear liquids → bowel rest (NPO if severe), then advance |
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🔵 Module 12 · Inflammatory Bowel Disease (IBD) ⭐⭐
Crohn disease vs Ulcerative colitis — highest-yield compare
Crohn Disease vs Ulcerative Colitis — Compare Table
| Crohn Disease | Ulcerative Colitis | |
|---|---|---|
| Location | Mouth → anus, anywhere; often terminal ileum. Skip lesions | Colon & rectum only, continuous from rectum up |
| Depth | Full thickness (transmural) → "cobblestone" | Mucosa/submucosa only |
| Stool | Diarrhea, usually non-bloody, steatorrhea | Bloody diarrhea w/ mucus, many stools/day |
| Complications | Fistulas, strictures, abscess, malabsorption | Toxic megacolon, ↑ colon cancer risk, perforation |
| Cure | No surgical cure (can recur) | Colectomy can be curative |
Shared careMonitor fluid/electrolytes + nutrition (may need TPN in flares), skin/perianal care, meds: aminosalicylates (mesalamine), corticosteroids (flares), immunomodulators, biologics. Low-residue diet in flares; avoid triggers.
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🔵 Module 12 · Obstruction · Cancer · GI Bleed
Bowel obstruction (SBO vs LBO) · Colorectal cancer · GI bleed
Bowel Obstruction (SBO vs LBO)
PathoBlockage of intestinal contents. Mechanical (adhesions #1 for SBO, tumors, hernia, volvulus) or functional (paralytic ileus).
| Small bowel (SBO) | Large bowel (LBO) | |
|---|---|---|
| Vomiting | Early, profuse (may be bilious/fecal) | Late or absent |
| Distension | Less | Marked |
| Pain | Cramping, higher | Lower, more gradual |
| Bowel sounds | High-pitched then absent | Absent (later) |
CareNPO + NG decompression, IV fluids + electrolyte replacement, I&O, monitor for strangulation/perforation, prep for surgery if mechanical.
SBO (mechanical) vs Paralytic Ileus (functional) ⭐
PathoBoth stop intestinal contents from moving — the difference is why. SBO = a physical blockage. Ileus = peristalsis simply stops (no blockage).
| Mechanical SBO | Paralytic (adynamic) ileus | |
|---|---|---|
| Cause | Physical block: adhesions (#1), hernia, tumor, volvulus, intussusception | No block: post-op (most common), peritonitis, hypokalemia, opioids, sepsis, bowel handling during surgery |
| Bowel sounds | High-pitched / hyperactive above the block → later absent | Absent or ↓ throughout (no peristalsis) |
| Pain | Cramping, colicky — comes in waves | Diffuse, constant, milder discomfort |
| Distension | Yes | Yes (often marked) |
| Vomiting | Yes — may become bilious/fecal | Possible, usually less |
| Onset | Can be acute | Often after abdominal surgery (expected ~24–72h; concerning if longer) |
| Treatment | NPO + NG decompression, IV fluids/electrolytes; surgery if strangulation or complete block | Treat the cause: NPO + NG, IV fluids, correct K⁺, limit opioids, early ambulation; usually resolves without surgery |
NursingSBO → watch for strangulation (fever, ↑pain, ↑HR, ↓BP, rigid abdomen) = surgical emergency. Ileus → ambulate, monitor for return of bowel sounds & passing flatus (sign it’s resolving).
MemoryMechanical = hyperactive then silent + crampy. Ileus = silent + constant & dull. Hypokalemia and opioids are the classic ileus causes.
Colorectal Cancer (CRC)
RisksAge >50, family hx, IBD (esp. UC), high-fat/low-fiber diet, processed/red meat, smoking, obesity, polyps.
S/sChange in bowel habits, blood in stool (occult or visible), narrow/pencil stools (left-sided), anemia/fatigue (right-sided), unexplained weight loss.
Screening/DxColonoscopy (gold standard, removes polyps), FOBT/FIT, CEA tumor marker (trend, not screening).
CareSurgery ± chemo/radiation; may create colostomy; nutrition + emotional/ostomy support.
GI Bleed
Upper GI bleedHematemesis (bright red or coffee-ground) and/or melena (black tarry). Sources: PUD, varices, gastritis, Mallory-Weiss.
Lower GI bleedHematochezia (bright red rectal blood). Sources: diverticulosis, CRC, hemorrhoids, IBD, angiodysplasia.
Priorities (ABC)Assess for shock (↑HR, ↓BP, pallor, ↓LOC), 2 large-bore IVs + fluids/blood, O₂, NPO, type & cross, monitor H&H, prep for endoscopy/scope to locate + treat.
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🔵 Module 12 · Anorectal & Hernias
Hemorrhoids · Anal fistula · Pilonidal cyst · Abdominal hernia
Hemorrhoids, Anal Fistula & Pilonidal Cyst
HemorrhoidsDilated rectal veins (straining, pregnancy, constipation, prolonged sitting). S/s: bright-red bleeding with defecation, pain, itching. Care: high fiber + fluids, sitz baths, topical agents, don't strain; hemorrhoidectomy if severe.
Anal fistulaAbnormal tract between anal canal and skin (often after abscess/abscess in IBD). S/s: drainage, pain, irritation. Care: surgery (fistulotomy), sitz baths, wound/skin care.
Pilonidal cystCyst/abscess in the sacrococcygeal cleft (hair follicle). Care: I&D, packing, hygiene, keep area clean/dry, wound care teaching.
Shared post-opSitz baths for comfort/healing, high-fiber diet + stool softeners (avoid straining), pain control, monitor for bleeding/infection.
Abdominal Hernia
PathoProtrusion of organ/tissue through a weak abdominal wall (inguinal, umbilical, incisional). Reducible = pushes back in; incarcerated = stuck; strangulated = blood supply cut off (emergency).
CareAvoid heavy lifting/straining, treat constipation/cough; surgical repair (herniorrhaphy). Post-op: avoid lifting, support incision when coughing, monitor bowel function.
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🔵 Module 12 · Ostomies
Ileostomy vs Colostomy · Stoma care
Ileostomy vs Colostomy & Stoma Care
| Ileostomy | Colostomy | |
|---|---|---|
| Location | Small intestine (ileum), usually RLQ | Colon; more distal = more formed stool |
| Output | Liquid, constant, enzyme-rich (skin-damaging) | More formed/solid (esp. left colon) |
| Risks | Dehydration + electrolyte loss, skin breakdown | Fewer fluid issues |
Stoma assessmentHealthy stoma = pink/red, moist. Pale = poor perfusion; dark/purple/black = ischemia/necrosis → report immediately. Small amount of bleeding when cleaning is normal.
Care/teachingSkin barrier fits snugly (protect peristomal skin), empty pouch when ⅓–½ full, change appliance q3–7 days. Ileostomy: ↑ fluids + electrolytes, chew well, watch for blockage (avoid high-fiber/stringy foods early). Odor/gas control, emotional support + body image.
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🟡 Exam Tips & Highest-Yield Recall
Quick-fire answers most likely to show up
⚡ The 10 things most likely to be tested
- Crohn vs UC — location, stool, complications, cure (know the table cold).
- Gastric vs duodenal ulcer — pain timing vs meals; hematemesis vs melena.
- PUD complications — hemorrhage & perforation (rigid abdomen = surgical emergency).
- Dumping syndrome — lie down after meals, no fluids with meals, low simple carb/high protein.
- TPN rules — dedicated line, tubing/bag q24h, monitor glucose, hang D10 if bag is late, air-embolism response.
- Enteral feeding priorities — verify placement, HOB 30–45°, aspiration prevention, residuals.
- Appendicitis — RLQ/McBurney's; sudden pain relief = perforation. NO heat/enemas/laxatives.
- Bowel obstruction — SBO vs LBO; NPO + NG decompression; metabolic alkalosis from vomiting.
- Diverticulosis vs diverticulitis — opposite diets; NO colonoscopy/enema during acute flare.
- Post-gastrectomy — pernicious anemia (lifelong B12), dumping syndrome.
🧪 Acid-base & electrolyte quick map
- Vomiting / NG suction → lose acid → metabolic alkalosis + hypokalemia.
- Diarrhea / ileostomy → lose bicarb → metabolic acidosis + hypokalemia + dehydration.
- Prolonged obstruction → fluid shifts, hypovolemia; watch K⁺ and cardiac rhythm.
🚨 "Call the provider NOW" red flags
- Rigid, board-like abdomen + rebound tenderness = perforation/peritonitis.
- Sudden relief of appendicitis pain = rupture.
- Dusky/black stoma = ischemia.
- UC + distended abdomen/fever/tachycardia = toxic megacolon.
- Hematemesis/melena + ↓BP/↑HR = GI hemorrhage/shock.
- Neck-wound bright-red bleeding post-dissection = carotid rupture.
💊 Medications
High-yield GI drugs for Exam 5 (Modules 11 & 12), grouped by what they do — action, use, and the nursing/teaching points most tested
🔥 Reduce or Neutralize Acid & Protect the Ulcer
Use: GERD, PUD, gastritis, H. pylori, stress-ulcer prevention.
Key points: Blocks the gastric proton pump — the final step of acid production. Take 30–60 min before meals; don't crush delayed-release forms.
Watch: Long-term use: ↓ magnesium, ↓ B12, ↑ fracture & C. diff risk.
Use: GERD, PUD, heartburn.
Key points: Blocks histamine-2 receptors on parietal cells to reduce acid. Slower, gentler than PPIs; can be scheduled or PRN.
Use: Fast, short-term heartburn & dyspepsia relief.
Key points: Neutralize acid already in the stomach. Separate from other meds by 1–2 hr (they impair absorption).
Watch: Aluminum → constipation; magnesium → diarrhea; calcium → rebound acid.
Use: PUD — coats and protects the ulcer.
Key points: Forms a protective barrier over the ulcer base. Give on an empty stomach, 1 hr before meals and at bedtime.
Watch: Separate from antacids/other meds by ≈ 30 min; can cause constipation.
Use: Eradicate H. pylori in PUD/gastritis.
Key points: Two antibiotics kill the bacteria; the PPI lowers acid so they work. Bismuth + metronidazole may be added (quad therapy).
Watch: Finish the entire course even when feeling better, or it recurs.
🔄 Move the Gut & Stop Nausea (Motility & Antiemetics)
Use: Gastroparesis, GERD, nausea, dumping-related symptoms.
Key points: Speeds gastric emptying and raises LES tone. Give before meals and at bedtime.
Watch: Extrapyramidal symptoms / tardive dyskinesia — watch for tremor, restlessness, abnormal movements.
Use: Nausea and vomiting.
Key points: Blocks serotonin (5-HT3) receptors in the CTZ and gut. Common first-line antiemetic.
Watch: Can prolong the QT interval; watch for headache and constipation.
Use: Nausea and vomiting.
Key points: Blocks H1 and dopamine receptors. Very sedating.
Watch: IV extravasation causes severe tissue damage — give slowly, deep IM/central preferred; drowsiness.
🛑 Slow the Gut Down (Antidiarrheals & Antispasmodics)
Use: Acute and chronic diarrhea (non-infectious).
Key points: Slows intestinal motility so more water is reabsorbed. Not for the child or the patient with bloody stool/fever.
Watch: Avoid in C. diff or infectious diarrhea — trapping toxin can cause toxic megacolon.
Use: Diarrhea control.
Key points: Opioid-derived; slows motility. Atropine added to discourage misuse.
Watch: Anticholinergic effects; controlled substance; caution with IBD flares.
Use: IBS — cramping and abdominal pain.
Key points: Anticholinergic that relaxes GI smooth muscle to ease spasm.
Watch: Anticholinergic effects: dry mouth, blurred vision, urinary retention, constipation.
🌿 Get Things Moving (Laxatives & Bowel Prep)
Use: Constipation; safest for long-term/daily use; also IBS.
Key points: Absorbs water to add soft bulk and stimulate peristalsis. Take with a full glass of water.
Watch: Too little fluid can cause esophageal/bowel obstruction.
Use: Prevent straining (post-op, MI, hemorrhoids, opioids).
Key points: Draws water into stool to soften it. First-line prophylaxis with opioids.
Watch: Softener, not a strong stimulant — for prevention, not acute disimpaction.
Use: Constipation; bowel prep before colonoscopy.
Key points: Pulls water into the bowel. For prep, drink until stool runs clear yellow liquid.
Watch: Monitor fluid/electrolyte balance with large prep volumes.
Use: Constipation (and lowers ammonia in hepatic encephalopathy).
Key points: Osmotic draw of water into the colon; acidifies stool.
Watch: Titrate to 2–3 soft stools/day; causes bloating/flatus.
Use: Short-term constipation, bowel prep.
Key points: Directly stimulate peristalsis. Fast-acting but for short-term use.
Watch: Not for daily long-term use — dependence and cramping.
🛡️ Calm Inflammation (IBD Therapy)
Use: IBD — maintain remission in UC & Crohn.
Key points: Anti-inflammatory action on the bowel mucosa. Maintenance drug (not for acute rescue).
Watch: Sulfasalazine: give with food + fluids, may turn urine orange; sulfa allergy caution.
Use: IBD acute flares (short-term).
Key points: Powerful anti-inflammatory to calm a flare. Use the lowest dose for the shortest time; taper, never stop abruptly.
Watch: ↑ glucose, infection risk, mood changes, osteoporosis, GI irritation — take with food.
Use: IBD — steroid-sparing maintenance.
Key points: Suppresses the immune response to reduce inflammation. Slow onset (weeks–months).
Watch: Bone-marrow suppression & infection — monitor CBC; report fever/sore throat.
Use: Moderate–severe IBD.
Key points: Monoclonal antibody that blocks TNF-alpha. Given by IV infusion.
Watch: Screen for TB & hepatitis before starting; serious infection risk — hold if febrile/infected.
🦠 Fight Infection (Antibiotics)
Use: Diverticulitis, intra-abdominal infection, C. difficile.
Key points: Anti-anaerobic/antiprotozoal. Complete the full course.
Watch: No alcohol during and 3 days after — disulfiram-like reaction; metallic taste.
Use: C. difficile infection (oral route acts locally in the gut).
Key points: Oral form stays in the GI tract to treat C. diff. Pair with contact precautions + soap-and-water hygiene.
Watch: Oral vanco is for C. diff (not absorbed) — different purpose than IV vanco.
💉 Replace What's Missing (Supplements)
Use: Pernicious anemia; post-gastrectomy.
Key points: Replaces B12 that can't be absorbed without intrinsic factor. Given as lifelong IM injections.
Watch: Oral B12 won't work without intrinsic factor — must be parenteral.
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📌 Clinical Signs & Quick References
GI reference charts & screenshots, grouped. (Non-GI images like cardiac, respiratory, and general electrolyte physiology were left out.)
🩻 Abdominal Regions & Assessment
🔎 Acute-Abdomen & Pancreatitis Signs
🎥 Video lectures
🎯 Practice Quiz — 200 Questions
Multiple choice · select-all · matching · drop-down — every item has a rationale