D118 Unit 5 Study Guide
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Western Governors University
D118 Adult Primary Care for the Advanced Practice Nurse
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Date
D118 Unit 5 Study Guide
Managing Chronic Pulmonary Disorders and Diseases
What is Asthma and How Does It Present Clinically?
Asthma is a long-term inflammatory condition affecting the airways, characterized by increased airway sensitivity to various environmental and internal triggers. This hypersensitivity results in episodic, reversible narrowing and inflammation of the bronchial tubes. Common clinical manifestations include recurrent episodes of coughing, wheezing, chest tightness, and shortness of breath. The intensity of symptoms varies widely, ranging from mild discomfort to life-threatening exacerbations (Global Initiative for Asthma, 2024). Early recognition and management are crucial for preventing severe attacks and maintaining quality of life.
What Does the Physical Examination of a Patient with Asthma Include?
The physical assessment of a patient suspected to have asthma serves four main goals: confirming the diagnosis while excluding alternative conditions, evaluating the severity of the disease, identifying any negative effects related to asthma medications, and detecting coexisting illnesses that could impact asthma control. Typical findings during examination often include wheezing on auscultation and signs of airway obstruction such as prolonged expiration (GINA, 2024).
How is Asthma Managed Immediately?
Initial management of acute asthma symptoms involves administering short-acting beta-agonists (SABA) via inhalation. Treatment typically includes up to two doses spaced 20 minutes apart, with 2 to 6 puffs delivered through a metered-dose inhaler or nebulizer. Prompt relief of bronchospasm reduces airway resistance and improves ventilation (GINA, 2024).
What Are the Diagnostic Criteria for Asthma Using Spirometry or Pulmonary Function Tests?
Spirometry is essential in diagnosing asthma by demonstrating reversible airflow obstruction. A post-bronchodilator increase in forced expiratory volume in one second (FEV1) by at least 12% and 200 mL from baseline confirms airway reversibility characteristic of asthma (American Thoracic Society, 2023). This objective measurement helps differentiate asthma from other obstructive lung diseases.
What Are the Risk Factors for Poor Asthma Outcomes?
Risk factors for unfavorable asthma progression should be evaluated at diagnosis and regularly every 1 to 2 years. These factors include uncontrolled symptoms, history of exacerbations, poor adherence to inhaled corticosteroids (ICS), incorrect inhaler technique, excessive reliance on SABAs, low baseline lung function (FEV1 <60%), psychological or socioeconomic challenges, exposure to allergens or smoking, previous ICU admission, comorbid conditions such as obesity, and elevated markers of allergic inflammation like eosinophils and fractional exhaled nitric oxide (FENO). Pregnant women are also at higher risk for poor control.
Table 1: Risk Factors for Poor Asthma Outcomes
| Risk Factor | Description/Impact |
|---|---|
| Uncontrolled symptoms | Increase exacerbation likelihood |
| ≥1 exacerbation/year | Predictor of future severe attacks |
| Poor ICS adherence | Leads to insufficient asthma control |
| Incorrect inhaler technique | Decreases medication efficacy |
| High SABA use (>1 canister/month) | Linked to higher mortality risk |
| Low baseline FEV1 (<60% predicted) | Indicates severe obstruction |
| Psychological/socioeconomic issues | Raise risk of exacerbations |
| Smoking/allergen exposure | Triggers inflammation and airway hyperresponsiveness |
| ICU admission history | Suggests severe disease |
| Comorbidities (obesity, rhinosinusitis) | Worsen asthma control |
| Elevated eosinophils and FENO | Reflect allergic inflammation |
| Pregnancy | Increases risk of poor control |
What Are the Five Steps for Pharmacologic Management of Asthma?
Asthma pharmacotherapy follows a stepwise approach, escalating treatment intensity based on symptom control and exacerbation risk. Early initiation of low-dose ICS is critical for preventing lung function decline and severe attacks.
Table 2: Pharmacologic Steps in Asthma Management
| Step | Reliever Medication | Preferred Controller Medication | Other Controller Options |
|---|---|---|---|
| 1 | As-needed SABA | Consider early low-dose ICS | None |
| 2 | As-needed SABA | Low-dose ICS | Leukotriene receptor antagonists (LTRA) |
| 3 | As-needed SABA or ICS/formoterol | Low-dose ICS + LABA | Medium/high-dose ICS + LTRA or theophylline |
| 4 | As-needed SABA or ICS/formoterol | Medium/high-dose ICS + LABA | Tiotropium (≥12 years), high-dose ICS/LABA, slow-release theophylline |
| 5 | Specialist consultation | Tailored therapy per specialist | Additional immunomodulators |
When Should Patients with Asthma Be Referred or Hospitalized?
Referral to an asthma specialist is advised in cases of severe asthma marked by hospitalizations, poorly controlled symptoms interfering with daily life, frequent emergency visits, failure to respond to standard treatment, or when detailed assessment for allergies, therapy adjustment, or disease classification is needed (GINA, 2024).
Chronic Cough
What Are the Clinical Features and Management of Chronic Cough?
Chronic cough, defined as lasting more than eight weeks, is often accompanied by throat clearing and thick mucus production, particularly in the morning. Physical exam may reveal signs suggestive of underlying causes, such as pharyngeal redness indicating sinusitis or allergies, crackles linked to pulmonary edema or fibrosis, and wheezes consistent with asthma or COPD. Ear canal irritation can also provoke cough reflexes. Treatment targets the underlying cause—whether asthma, COPD, or sinus disease—and emphasizes trigger avoidance. When pulmonary function tests are normal but asthma is still suspected, a methacholine challenge test can be diagnostic (Irwin et al., 2023).
What Are the Most Common Causes of Chronic Cough with Normal Chest Radiography?
Common etiologies of chronic cough with normal chest imaging include corticosteroid-responsive eosinophilic airway diseases (e.g., asthma, eosinophilic bronchitis), upper airway cough syndrome (postnasal drip), and gastroesophageal reflux disease (GERD).
Chronic Obstructive Pulmonary Disease (COPD)
How Does COPD Present Clinically, and What Are Key Physical Findings?
COPD typically presents with progressive dyspnea, chronic cough, and sputum production. Physical signs of advanced disease include lung hyperinflation, clubbing of the nails, tobacco staining of fingers, increased anterior-posterior chest diameter, and use of accessory respiratory muscles. Patients may adopt a forward-leaning posture and employ pursed-lip breathing to enhance ventilation efficiency (GOLD, 2024).
What Are the Management Strategies for COPD?
Key management strategies involve smoking cessation, pulmonary rehabilitation, regular physical activity, and pharmacological therapies including bronchodilators (both beta-agonists and anticholinergics), inhaled corticosteroids, and surgical options such as lung volume reduction in select patients (GOLD, 2024).
What Are the Four Severity Classifications of COPD?
COPD severity is classified by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) based on airflow limitation measured by FEV1:
Table 3: COPD Severity Classification
| Stage | Description |
|---|---|
| GOLD 1 | Mild airflow limitation (FEV1 ≥ 80%) |
| GOLD 2 | Moderate airflow limitation (FEV1 50–79%) |
| GOLD 3 | Severe airflow limitation (FEV1 30–49%) |
| GOLD 4 | Very severe airflow limitation (FEV1 <30%) |
When Should Patients with COPD Be Referred to the Hospital?
Hospital referral is necessary for patients experiencing severe symptoms interfering with daily life, recurrent exacerbations, need for oxygen therapy assessment, preoperative evaluations, acute exacerbations unresponsive to outpatient care, persistent infiltrates, sleep disturbances, respiratory failure, or cor pulmonale with right heart failure (GOLD, 2024).
Diagnostic Studies for Pulmonary Diseases
Table 4: Common Diagnostic Tests in Pulmonary Medicine
| Diagnostic Test | Purpose/Use |
|---|---|
| Pulmonary Function Tests (PFTs) | Measure airflow limitation and lung volumes |
| Chest Radiography (X-ray, CT, MRI) | Identify structural abnormalities or masses |
| Positron Emission Tomography (PET) | Assess metabolic activity of lesions |
| Bronchoscopy | Direct visualization and biopsy of airways |
| Electrocardiogram (EKG) | Evaluate cardiac involvement or pulmonary hypertension |
| Blood Tests (D-dimer, ABG, Alpha-1 antitrypsin) | Assess clot presence, gas exchange, and enzyme deficiencies |
Lung Cancer
How Does Lung Cancer Present, and What Are Its Physical Exam Findings?
Lung cancer presents variably but commonly includes symptoms such as persistent cough, unexplained weight loss, chest pain, and hemoptysis. Physical examination may reveal signs of metastasis including lymphadenopathy, bone tenderness, hepatomegaly, neurological deficits, and features of superior vena cava syndrome (facial swelling, dilated neck veins). Additionally, patients may develop deep vein thrombosis due to a malignancy-induced hypercoagulable state (Molina et al., 2023).
What Diagnostic Studies Are Used for Lung Cancer?
Diagnostic evaluation involves laboratory tests like complete blood count and tumor markers, imaging including chest X-ray, CT scan (gold standard), PET, and MRI, and invasive procedures such as bronchoscopy and biopsy. Molecular profiling guides targeted therapy decisions (Molina et al., 2023).
Pneumothorax
What Are the Clinical Features and Management of Pneumothorax?
Pneumothorax typically presents with sudden onset breathlessness and unilateral pleuritic chest pain. Large or tension pneumothoraces may cause respiratory distress, tachycardia, tracheal deviation, and cyanosis, constituting a medical emergency. Management varies from observation for small pneumothoraces to needle aspiration, chest tube insertion, or surgery for more severe cases (Light, 2024).
How to Differentiate Types of Pneumothorax?
Table 5: Types of Pneumothorax and Management
| Type | Characteristics | Management |
|---|---|---|
| Primary Spontaneous Pneumothorax (PSP) | Occurs without trauma in healthy individuals | Needle aspiration or chest tube |
| Secondary Spontaneous Pneumothorax | Occurs with underlying lung disease | Chest tube, possibly surgery |
| Traumatic Pneumothorax | Results from blunt or penetrating chest trauma | Tube thoracostomy |
| Iatrogenic Pneumothorax | Caused by medical interventions | Tube placement as needed |
Pulmonary Embolism
What Are the Clinical Presentation, Examination, and Management of Pulmonary Embolism?
Pulmonary embolism (PE) often presents acutely with sudden dyspnea, tachypnea, pleuritic chest pain, leg pain or swelling, hemoptysis, tachycardia, and jugular venous distension. Symptoms can be nonspecific, including syncope or malaise. Physical findings vary with embolus size and may include signs of respiratory distress and hypoxemia. Management focuses on stabilization, oxygen supplementation to maintain saturation above 92%, and anticoagulation with agents such as heparin or direct oral anticoagulants. Severe cases may require thrombolytic therapy or mechanical support (Kearon et al., 2023).
What Are the Risk Factors for Pulmonary Embolism?
Risk factors for PE include recent surgery or trauma, immobilization, malignancy, stroke, heart failure, smoking, pregnancy, estrogen therapy, and a prior history of PE.
How Is Pulmonary Embolism Diagnosed?
Diagnostic workup includes EKG to exclude cardiac causes, chest X-ray to rule out other lung pathology, ventilation/perfusion scanning, and computed tomography angiography (CTA), the latter being the diagnostic gold standard (Kearon et al., 2023).
Sarcoidosis
What Are the Clinical Features, Physical Examination Findings, and Management of Sarcoidosis?
Sarcoidosis is a granulomatous disease frequently involving the lungs but can affect multiple organs. Patients may experience fatigue, cough, chest pain, arthritis, skin lesions, and eye inflammation. Auscultation is often normal, though wheezing can occur in advanced disease stages. Neurological involvement is rare. Treatment focuses on symptom control, often using corticosteroids for significant or progressive disease. Asymptomatic patients may require only observation and supportive care such as pulmonary rehabilitation (Iannuzzi et al., 2023).
How Is Sarcoidosis Diagnosed and Monitored?
Diagnosis relies on high-resolution computed tomography (HRCT) to distinguish between inflammatory and fibrotic changes in lung tissue. Laboratory markers include elevated serum angiotensin-converting enzyme (ACE) levels, hypergammaglobulinemia, and sometimes hypercalcemia. Skin testing may show anergy. Ongoing monitoring involves clinical assessment and periodic imaging (Iannuzzi et al., 2023).
Sleep Disorders
Table 6: Sleep Disorders – Symptoms and Management
| Disorder | Symptoms & Signs | Management Options |
|---|---|---|
| Insomnia and Non-Restorative Sleep | Difficulty initiating or maintaining sleep | Pharmacotherapy (zolpidem, eszopiclone, etc.), sleep hygiene |
| Sleep-Related Breathing Disorders | Loud snoring, witnessed apneas, excessive daytime sleepiness (EDS) | CPAP, oral appliances, surgery |
| Central Nervous System Hypersomnias | Excessive daytime sleepiness without other causes | Stimulant medications (dextroamphetamine, methylphenidate) |
| Sleep-Related Movement Disorders | Urge to move legs, worse at rest or night | Lifestyle changes, gabapentin enacarbil, dopamine agonists |
| Parasomnias | Sleepwalking, night terrors, REM sleep behavior disorder | Environmental modifications, benzodiazepines, antidepressants |
Abdominal Aortic Aneurysm (AAA)
Clinical Presentation and Management of AAA
An abdominal aortic aneurysm is defined as a permanent dilation of the abdominal aorta measuring 3.0 cm or more in diameter or at least 50% larger than the normal vessel size. Patients may present with hypotension, a pulsatile abdominal mass, and abdominal or back pain. Clinical diagnosis includes palpation and auscultation for bruits. Management strategies depend on aneurysm size and rupture risk, ranging from medical surveillance to open surgical repair or endovascular aneurysm repair (EVAR) (Johnston et al., 2024).
Carotid Artery Disease
Presentation, Examination, and Treatment
Carotid artery disease commonly presents with transient ischemic attacks or strokes, characterized by contralateral weakness, sensory deficits, or transient vision loss known as amaurosis fugax. Auscultation may reveal carotid bruits. Treatment includes statins, antihypertensive medications, antiplatelet therapy, and, in severe cases, carotid endarterectomy (Goldstein et al., 2024).
Coronary Artery Disease and Angina
How Does Coronary Artery Disease Present and How Is It Managed?
Symptoms of coronary artery disease (CAD) typically include chest pain described as pressure or squeezing, sometimes accompanied by nausea, sweating, or dyspnea. Management of stable angina involves aspirin, beta blockers, lipid-lowering agents, and nitrates. Unstable angina necessitates urgent ECG evaluation and risk stratification to exclude acute coronary syndromes (Amsterdam et al., 2024).
Heart Failure
Clinical Features and Physical Examination of Heart Failure
Heart failure presents with symptoms such as dyspnea, fatigue, peripheral edema, pulmonary congestion, and abdominal discomfort. Physical findings include jugular venous distention and leg swelling. Diagnosis integrates clinical assessment with imaging and laboratory tests to guide therapy (Yancy et al., 2023).
Abdominal Fullness, Bloating, and Appetite Loss
Symptoms like abdominal fullness, bloating, and poor appetite often accompany heart failure. Lifestyle modifications—smoking cessation, dietary salt reduction, limiting alcohol and illicit drugs, and regular exercise—are essential. Screening with B-type natriuretic peptide (BNP) and echocardiography is recommended for at-risk patients. Pharmacological treatment commonly involves ACE inhibitors, ARBs, beta blockers, and mineralocorticoid receptor antagonists (Yancy et al., 2017).
New York Heart Association Classifications of Heart Failure
Table 7: NYHA Functional Classification
| Class | Description |
|---|---|
| I | No physical activity limitation; ordinary activity does not cause symptoms |
| II | Slight limitation; comfortable at rest, symptoms with ordinary activity |
| III | Marked limitation; comfortable at rest, symptoms with less than ordinary activity |
| IV | Unable to carry out any physical activity without discomfort; symptoms at rest |
Diagnosis of Congestive Heart Failure (CHF)
CHF diagnosis relies on clinical evaluation, imaging, and invasive procedures such as left-sided heart catheterization for coronary assessment. Echocardiography is vital for evaluating ventricular function, valve disease, and ejection fraction. BNP serves as a sensitive biomarker for cardiac stress and heart failure presence (McMurray et al., 2014).
Infective Endocarditis and Myocarditis
Infective Endocarditis
Typical features include low-grade fever, chills, weight loss, and heart murmurs, with additional signs such as joint pains, petechiae, kidney infection, and Roth spots (retinal hemorrhages). Treatment necessitates prolonged intravenous antibiotics and sometimes valve surgery (Baddour et al., 2015).
Myocarditis
Myocarditis symptoms range from fever and atypical chest pain to severe cardiogenic shock. Management includes rest, avoidance of stimulants, and treatment similar to heart failure, using ACE inhibitors, diuretics, and beta blockers. BNP levels assist diagnosis (Cooper, 2009).
Hypertension: Clinical Presentation and Management
Hypertension is often asymptomatic but may present with tinnitus, headache, or dizziness. Accurate blood pressure measurement requires proper technique with multiple readings in different positions. Management emphasizes lifestyle modification and pharmacologic treatment using ACE inhibitors, ARBs, thiazides, and calcium channel blockers. Nondihydropyridine calcium channel blockers are contraindicated in heart failure with reduced ejection fraction (Whelton et al., 2018).
Hypertensive Emergency Criteria
A hypertensive emergency is defined by severe blood pressure elevation (usually >180/120 mmHg) accompanied by acute target organ damage such as encephalopathy or pulmonary edema (Whelton et al., 2018).
Question: What are the clinical features, examination findings, and treatment approaches for peripheral arterial disease (PAD) and venous insufficiency?
Patients with peripheral arterial disease (PAD) commonly present with symptoms such as intermittent claudication, ischemic rest pain, leg fatigue, and poor wound healing. On physical examination, important assessments include palpation of peripheral pulses, checking capillary refill time, and evaluating for the presence of swelling or ulcers.
Treatment strategies focus first on lifestyle modifications such as cessation of tobacco use and aggressive control of comorbid conditions like hypertension, diabetes, and hyperlipidemia. Compression stockings may be used when the ankle-brachial index (ABI) is greater than 0.8 to manage venous insufficiency. Pharmacological management includes antiplatelet agents such as aspirin or clopidogrel, as well as statins to improve cardiovascular outcomes. Cilostazol has demonstrated efficacy in increasing walking distance in patients experiencing claudication. In advanced cases, surgical options such as angioplasty or bypass grafting may be necessary (Gerhard-Herman et al., 2017).
Valvular Heart Disease and Murmurs
Question: How do valvular heart diseases present, and what are their examination and management strategies?
Patients with valvular heart disease often report symptoms including chest pain, palpitations, dizziness, syncope, fatigue, and shortness of breath (dyspnea). The clinical examination begins with inspection and palpation of the chest to identify the point of maximum impulse (PMI), followed by auscultation to detect abnormal heart sounds or murmurs.
Management of valvular diseases depends on severity and symptomatology. For severe aortic stenosis, non-pharmacologic strategies include activity restrictions to prevent adverse outcomes. Medical therapy primarily targets modification of cardiovascular risk factors and symptom relief. Surgical interventions, such as transcatheter aortic valve replacement (TAVR), are reserved for patients deemed high risk for conventional surgery (Nishimura et al., 2017).
Valvular Heart Murmurs: Characteristics and Treatment
| Valvular Disease | Murmur Characteristics | Clinical Features | Management |
|---|---|---|---|
| Aortic Stenosis | Loud, harsh crescendo-decrescendo murmur at 2nd right ICS, radiates to neck; thrill often present | Fatigue, dizziness, syncope, angina, diminished pulse pressure | Echocardiography, cardiology referral, TAVR if high risk |
| Mitral Regurgitation | Holosystolic, blowing murmur at apex, radiates to left axilla | Fatigue, dyspnea on exertion (DOE), palpitations, left atrial enlargement | Echocardiography, medical therapy, surgery if severe |
| Mitral Valve Prolapse | Midsystolic click with possible murmur at apex, accentuated sitting or with Valsalva maneuver | Dysrhythmias, chest pain, anxiety | Usually benign; diagnosis via echocardiography |
| Aortic Regurgitation | High-pitched decrescendo diastolic murmur at left 3rd ICS, radiates downward | Wide pulse pressure, head bobbing, DOE | Early cardiology referral for surgical repair |
| Mitral Stenosis | Diastolic rumble with opening snap, loud S1 at apex | DOE, poor pregnancy tolerance | Echocardiography, surgical intervention as needed |
Diverticular Disease: Presentation and Management
Question: What differentiates diverticulitis from diverticulosis, and how are these conditions managed?
Diverticulosis is characterized by the presence of multiple colonic diverticula, usually asymptomatic or associated with intermittent abdominal discomfort such as bloating and irregular bowel movements. Conversely, diverticulitis occurs when one or more diverticula become inflamed, presenting clinically with left lower quadrant pain, fever, leukocytosis, nausea, and vomiting.
Physical examination in diverticulitis may reveal localized tenderness, guarding, or a palpable abdominal mass, whereas diverticulosis typically does not cause notable physical findings. Management involves stool testing and colonoscopy to evaluate colonic health. Acute diverticulitis requires antibiotic therapy, while dietary fiber supplementation is the mainstay for diverticulosis to prevent complications (Strate & Morris, 2019).
Gastroesophageal Reflux Disease (GERD)
Question: How does GERD present, and what are the key examination and treatment principles?
GERD often manifests as heartburn and chest discomfort that can mimic cardiac angina. Oral examination may reveal dental erosions, halitosis, or signs suggestive of scleroderma. Respiratory manifestations, including cough and wheezing, may also occur secondary to reflux-related airway irritation.
Treatment focuses on acid suppression through the use of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). Promotility agents like metoclopramide may be beneficial in patients with delayed gastric emptying (Katz et al., 2022).
Gastrointestinal Hemorrhage
Question: What are the clinical features, examination findings, and management strategies for gastrointestinal bleeding?
Gastrointestinal bleeding may present with hematemesis (vomiting blood), melena (black tarry stools), or hematochezia (bright red blood per rectum). Early evaluation includes monitoring vital signs, mental status, and skin for signs such as telangiectasia or stigmata of chronic liver disease like cirrhosis.
Management strategies vary but can include balloon tamponade for esophageal variceal bleeding, surgical shunting, or placement of a transjugular intrahepatic portosystemic shunt (TIPS) to control portal hypertension-related bleeding (Strate & Gralnek, 2016).
Hepatitis and Liver Disease
Question: What are the typical symptoms, examination features, and treatments of hepatitis?
Patients with hepatitis often present with systemic symptoms including anorexia, fatigue, muscle aches, nausea, fever, and abdominal pain. Physical examination focuses on vital signs and screening for complications such as jaundice or signs of liver failure.
Treatment depends on the underlying cause. For viral hepatitis, antiviral therapies such as nucleoside analogues may be required. In some cases, liver biopsy is necessary for disease staging and management decisions (European Association for the Study of the Liver, 2017).
Inflammatory Bowel Disease (IBD)
Question: What are the clinical presentation and management of ulcerative colitis (UC) and Crohn’s disease (CD)?
IBD commonly presents with abdominal pain, diarrhea, fatigue, weight loss, fever, and extraintestinal manifestations such as joint pain. Physical examination may reveal oral ulcers, hyperactive bowel sounds, abdominal tenderness, and perianal lesions, which are more suggestive of Crohn’s disease.
Treatment involves medications such as 5-aminosalicylates, immunomodulators like azathioprine, corticosteroids for acute flares, and biologic agents including infliximab to control inflammation and maintain remission (Torres et al., 2020).
Irritable Bowel Syndrome (IBS)
Question: How is IBS diagnosed and managed?
IBS is characterized by abdominal pain accompanied by altered bowel habits but lacks alarming features like weight loss or gastrointestinal bleeding. Physical examination is usually normal, although mild tenderness may be noted.
Management focuses on symptom control, which includes dietary fiber supplementation, antispasmodic drugs, antidiarrheal agents, and psychotropic medications when anxiety or depression coexists (Ford et al., 2018).
Chronic Pancreatitis
Question: What is the clinical presentation and treatment approach for chronic pancreatitis?
Patients with chronic pancreatitis typically report recurrent episodes of epigastric pain radiating to the back, nausea, steatorrhea (fatty stools), and unintentional weight loss. Examination may reveal abdominal tenderness and signs of malnutrition.
Treatment emphasizes abstinence from alcohol and tobacco, pain management through analgesics, pancreatic enzyme replacement therapy to improve digestion, vitamin supplementation, and in some cases, surgical intervention to address complications (Yadav & Lowenfels, 2013).
Gastrointestinal Tumors: Symptoms, Physical Findings, and Management
| Tumor Type | Symptoms | Physical Exam Findings | Management |
|---|---|---|---|
| Esophageal Tumors | Dysphagia, weight loss, odynophagia | Often unremarkable; possible lymphadenopathy | Surgery for localized disease; chemotherapy/radiotherapy as adjunct |
| Gastric Tumors | Weight loss, upper abdominal pain, nausea | Palpable abdominal mass; metastatic lymph nodes such as Virchow’s or Sister Mary Joseph’s nodes | Endoscopic resection for early disease; surgery and chemotherapy for advanced cases |
References
Baddour, L. M., et al. (2015). Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications. Circulation, 132(15), 1435–1486.
Cooper, L. T. Jr. (2009). Myocarditis. New England Journal of Medicine, 360(15), 1526–1538.
European Association for the Study of the Liver. (2017). EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. Journal of Hepatology, 67(2), 370–398.
Ford, A. C., et al. (2018). Irritable bowel syndrome. Lancet, 391(10114), 1814–1825.
Gerhard-Herman, M. D., et al. (2017). 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease. Circulation, 135(12), e726–e779.
Katz, P. O., et al. (2022). Guidelines for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 117(1), 27–56.
McMurray, J. J., et al. (2014). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 35(27), 1787–1847.
Nishimura, R. A., et al. (2017). 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. Circulation, 135(25), e1159–e1195.
Strate, L. L., & Gralnek, I. M. (2016). Management of acute lower gastrointestinal bleeding. Gastroenterology, 150(7), 1683–1691.
D118 Unit 5 Study Guide
Strate, L. L., & Morris, A. M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 156(5), 1282–1298.
Torres, J., et al. (2020). Crohn’s disease. Lancet, 395(10221), 1246–1260.
Whelton, P. K., et al. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Journal of the American College of Cardiology, 71(19), e127–e248.
Yadav, D., & Lowenfels, A. B. (2013). The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology, 144(6), 1252–1261.
Yancy, C. W., et al. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Journal of the American College of Cardiology, 70(6), 776–803.