D118 Unit 5 Study Guide

D118 Unit 5 Study Guide

Managing Chronic Pulmonary Disorders and Diseases

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What is Asthma and How Does It Present Clinically?

Asthma is a chronic inflammatory disorder of the airways characterized by heightened airway reactivity to a variety of triggers, both environmental and internal. This increased sensitivity causes periodic and reversible narrowing and swelling of the bronchial tubes. Patients typically experience recurring symptoms such as coughing, wheezing, chest tightness, and difficulty breathing. The severity of these symptoms can range from mild to severe, potentially becoming life-threatening during acute exacerbations. Recognizing asthma early and initiating appropriate management is essential to prevent serious attacks and maintain patient well-being (Global Initiative for Asthma [GINA], 2024).

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What Does the Physical Examination of a Patient with Asthma Include?

A thorough physical exam in suspected asthma cases aims to achieve four key objectives: confirming the asthma diagnosis while ruling out other possible conditions, assessing the severity of the disease, identifying any adverse effects from asthma medications, and detecting coexisting illnesses that might affect disease control. Common physical signs include audible wheezing during lung auscultation and prolonged expiration, which indicate airflow obstruction (GINA, 2024).

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How is Asthma Managed Immediately?

The immediate treatment of acute asthma attacks primarily involves the use of short-acting beta-agonists (SABAs), administered via inhalers or nebulizers. The typical regimen includes up to two doses, spaced 20 minutes apart, with 2 to 6 puffs per dose. This rapid bronchodilation helps to relieve airway constriction, reduce airflow resistance, and improve ventilation (GINA, 2024).

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What Are the Diagnostic Criteria for Asthma Using Spirometry or Pulmonary Function Tests?

Spirometry is a vital diagnostic tool in asthma evaluation, demonstrating reversible airflow obstruction. A positive test is confirmed by an increase in forced expiratory volume in one second (FEV1) of at least 12% and 200 mL after bronchodilator administration. This reversibility is a hallmark of asthma and distinguishes it from other obstructive lung diseases (American Thoracic Society, 2023).

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What Are the Risk Factors for Poor Asthma Outcomes?

Evaluation of risk factors that predispose patients to poor asthma control and complications is essential at diagnosis and at routine follow-ups, ideally every 1 to 2 years. Factors increasing risk include uncontrolled symptoms, frequent exacerbations, non-adherence to inhaled corticosteroids (ICS), improper inhaler technique, overuse of SABAs, reduced baseline lung function (FEV1 < 60%), psychological or social challenges, exposure to allergens or smoking, previous ICU admission, comorbidities like obesity, and elevated inflammatory markers such as eosinophils and fractional exhaled nitric oxide (FENO). Pregnant patients also face increased risks for poor asthma control.

Table 1: Risk Factors for Poor Asthma Outcomes

Risk Factor	Description/Impact
Uncontrolled symptoms	Raises exacerbation risk
≥1 exacerbation/year	Predictor of future severe attacks
Poor ICS adherence	Results in inadequate asthma control
Incorrect inhaler technique	Reduces medication effectiveness
High SABA use (>1 canister/month)	Linked to increased mortality risk
Low baseline FEV1 (<60% predicted)	Reflects severe airflow obstruction
Psychological/socioeconomic issues	Increases exacerbation likelihood
Smoking/allergen exposure	Triggers airway inflammation and hyperresponsiveness
ICU admission history	Indicates severe disease
Comorbidities (obesity, rhinosinusitis)	Worsen asthma outcomes
Elevated eosinophils and FENO	Marker of allergic inflammation
Pregnancy	Increases risk of poor control

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What Are the Five Steps for Pharmacologic Management of Asthma?

Asthma treatment follows a progressive stepwise protocol based on symptom frequency and exacerbation risk. Starting treatment early with low-dose ICS is critical for lung protection and preventing severe attacks. Treatment intensification involves adding or adjusting medications according to control levels.

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

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When Should Patients with Asthma Be Referred or Hospitalized?

Referral to a specialist is warranted in cases of severe asthma characterized by recurrent hospital admissions, persistent symptoms disrupting daily activities, frequent emergency department visits, poor response to conventional treatment, or the need for advanced diagnostic assessment or therapy modification (GINA, 2024).

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Chronic Cough

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What Are the Clinical Features and Management of Chronic Cough?

Chronic cough is defined as a cough lasting over eight weeks and may be accompanied by frequent throat clearing and thick mucus production, especially in the mornings. Physical signs that suggest underlying causes include pharyngeal redness (indicative of sinusitis or allergic rhinitis), lung crackles (suggesting fibrosis or edema), wheezing (common in asthma or COPD), and ear canal irritation that can stimulate cough reflexes. Management involves treating the underlying disorder, whether asthma, COPD, or sinus disease, and avoiding triggers. When pulmonary function tests are normal but asthma remains suspected, methacholine challenge tests can help confirm diagnosis (Irwin et al., 2023).

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What Are the Most Common Causes of Chronic Cough with Normal Chest Radiography?

Common reasons for chronic cough despite normal chest imaging include eosinophilic airway diseases responsive to corticosteroids (such as asthma and eosinophilic bronchitis), upper airway cough syndrome (postnasal drip), and gastroesophageal reflux disease (GERD).

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Chronic Obstructive Pulmonary Disease (COPD)

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How Does COPD Present Clinically, and What Are Key Physical Findings?

COPD is characterized by a gradual onset of worsening breathlessness, chronic productive cough, and sputum production. Physical examination in advanced stages may reveal lung hyperinflation, clubbing of nails, discoloration of fingers from tobacco use, increased chest diameter (barrel chest), and use of accessory muscles for breathing. Patients often lean forward and use pursed-lip breathing to optimize airflow (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2024).

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What Are the Management Strategies for COPD?

Management focuses on smoking cessation, pulmonary rehabilitation, increased physical activity, and pharmacologic treatment involving bronchodilators (beta-agonists and anticholinergics) and inhaled corticosteroids. Surgical options like lung volume reduction surgery may be indicated in select cases (GOLD, 2024).

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What Are the Four Severity Classifications of COPD?

COPD severity is categorized by FEV1 percentage of predicted value:

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%)

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When Should Patients with COPD Be Referred to the Hospital?

Hospitalization is indicated for severe symptoms disrupting daily life, recurrent exacerbations, evaluation for oxygen therapy, preoperative assessments, acute exacerbations not responsive to outpatient treatment, persistent lung infiltrates, sleep-related breathing problems, respiratory failure, or cor pulmonale with right heart failure (GOLD, 2024).

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Diagnostic Studies for Pulmonary Diseases

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Table 4: Common Diagnostic Tests in Pulmonary Medicine

Diagnostic Test	Purpose/Use
Pulmonary Function Tests (PFTs)	Assess airflow limitation and lung volumes
Chest Radiography (X-ray, CT, MRI)	Detect structural abnormalities or masses
Positron Emission Tomography (PET)	Evaluate metabolic activity of lesions
Bronchoscopy	Direct airway visualization and biopsy
Electrocardiogram (EKG)	Evaluate cardiac function or pulmonary hypertension
Blood Tests (D-dimer, ABG, Alpha-1 antitrypsin)	Detect clots, assess gas exchange, enzyme deficiencies

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Lung Cancer

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How Does Lung Cancer Present, and What Are Its Physical Exam Findings?

Lung cancer may present with persistent cough, unexplained weight loss, chest discomfort, and hemoptysis. Examination may reveal signs of metastasis such as lymph node enlargement, bone tenderness, hepatomegaly, neurological deficits, and superior vena cava syndrome characterized by facial swelling and distended neck veins. Additionally, malignancy may lead to deep vein thrombosis due to a hypercoagulable state (Molina et al., 2023).

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What Diagnostic Studies Are Used for Lung Cancer?

Diagnosis involves laboratory tests including blood counts and tumor markers, imaging studies such as chest X-ray, CT scans (the gold standard), PET, MRI, and invasive procedures like bronchoscopy with biopsy. Molecular profiling informs targeted therapeutic approaches (Molina et al., 2023).

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Pneumothorax

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What Are the Clinical Features and Management of Pneumothorax?

Pneumothorax commonly presents with sudden shortness of breath and sharp unilateral chest pain. Large or tension pneumothorax can cause severe respiratory distress, tachycardia, tracheal deviation, and cyanosis, requiring urgent intervention. Treatment varies from observation for small pneumothoraces to needle decompression, chest tube insertion, or surgery for severe cases (Light, 2024).

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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 in patients with underlying lung disease	Chest tube, possible surgery
Traumatic Pneumothorax	Caused by blunt or penetrating chest trauma	Tube thoracostomy
Iatrogenic Pneumothorax	Due to medical procedures	Tube placement as required

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Pulmonary Embolism

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What Are the Clinical Presentation, Examination, and Management of Pulmonary Embolism?

Pulmonary embolism (PE) usually presents suddenly with shortness of breath, rapid breathing, chest pain that worsens with inspiration, leg swelling or pain, coughing blood, tachycardia, and jugular venous distension. Some patients may have nonspecific symptoms like fainting or malaise. Physical findings depend on the embolus size and include signs of respiratory distress and low oxygen levels. Management priorities include stabilization, oxygen therapy to maintain saturation above 92%, and anticoagulation with heparin or direct oral anticoagulants. Severe cases might require thrombolysis or mechanical circulatory support (Kearon et al., 2023).

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What Are the Risk Factors for Pulmonary Embolism?

Risk factors include recent surgery or trauma, prolonged immobilization, cancer, stroke, heart failure, smoking, pregnancy, estrogen use, and previous PE history.

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How Is Pulmonary Embolism Diagnosed?

Diagnostic evaluation includes EKG to exclude cardiac causes, chest X-ray to rule out other lung issues, ventilation/perfusion scanning, and CT angiography (CTA), which remains the gold standard (Kearon et al., 2023).

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Sarcoidosis

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What Are the Clinical Features, Physical Examination Findings, and Management of Sarcoidosis?

Sarcoidosis is a granulomatous multisystem disease commonly involving the lungs but may affect various organs. Patients might report fatigue, cough, chest discomfort, arthritis, skin rashes, and eye inflammation. Lung auscultation is often normal but may reveal wheezing in advanced disease. Neurological involvement is rare. Management involves symptom relief, primarily with corticosteroids for significant disease, while asymptomatic cases may only need monitoring and pulmonary rehabilitation (Iannuzzi et al., 2023).

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How Is Sarcoidosis Diagnosed and Monitored?

Diagnosis relies heavily on high-resolution CT scans to differentiate inflammatory from fibrotic lung changes. Blood tests reveal elevated serum angiotensin-converting enzyme (ACE), hypergammaglobulinemia, and sometimes increased calcium. Skin testing may show anergy. Ongoing monitoring involves clinical review and imaging (Iannuzzi et al., 2023).

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Sleep Disorders

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Table 6: Sleep Disorders – Symptoms and Management

Disorder	Symptoms & Signs	Management Options
Insomnia and Non-Restorative Sleep	Difficulty falling or staying asleep	Pharmacotherapy (zolpidem, eszopiclone), sleep hygiene education
Sleep-Related Breathing Disorders	Loud snoring, witnessed apneas, excessive daytime sleepiness	CPAP, oral devices, surgical interventions
Central Nervous System Hypersomnias	Excessive daytime sleepiness without other causes	Stimulants (dextroamphetamine, methylphenidate)
Sleep-Related Movement Disorders	Urge to move legs, worsening at rest/night	Lifestyle changes, gabapentin enacarbil, dopamine agonists
Parasomnias	Sleepwalking, night terrors, REM behavior disorder	Environmental safety, benzodiazepines, antidepressants

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Abdominal Aortic Aneurysm (AAA)

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Clinical Presentation and Management of AAA

An abdominal aortic aneurysm is defined as a permanent enlargement of the abdominal aorta exceeding 3.0 cm in diameter or increasing by at least 50% over normal size. Patients may present with low blood pressure, a pulsating mass in the abdomen, and abdominal or back pain. Physical diagnosis includes palpation and auscultation for bruits. Treatment depends on size and rupture risk, ranging from surveillance to surgical repair or endovascular stenting (Johnston et al., 2024).

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Carotid Artery Disease

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Presentation, Examination, and Treatment

Carotid artery disease often manifests with transient ischemic attacks or stroke symptoms, including weakness, sensory deficits, or transient vision loss (amaurosis fugax). Auscultation may detect carotid bruits. Management involves statins, blood pressure control, antiplatelet therapy, and possibly carotid endarterectomy in severe cases (Goldstein et al., 2024).

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Coronary Artery Disease and Angina

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How Does Coronary Artery Disease Present and How Is It Managed?

CAD typically causes chest discomfort described as pressure or squeezing, sometimes with nausea, sweating, or shortness of breath. Stable angina is managed with aspirin, beta blockers, lipid-lowering agents, and nitrates. Unstable angina requires immediate ECG evaluation to rule out acute coronary syndromes (Amsterdam et al., 2024).

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Heart Failure

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Clinical Features and Physical Examination of Heart Failure

Heart failure presents with symptoms such as shortness of breath, fatigue, swelling in legs, pulmonary congestion, and abdominal discomfort. Physical signs include jugular venous distention and peripheral edema. Diagnosis integrates clinical findings with imaging and lab tests to guide treatment (Yancy et al., 2023).

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Abdominal Fullness, Bloating, and Appetite Loss

These symptoms frequently occur with heart failure. Lifestyle changes such as smoking cessation, salt restriction, reduced alcohol intake, and regular exercise are important. Screening with B-type natriuretic peptide (BNP) and echocardiography is recommended. Medications include ACE inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and mineralocorticoid receptor antagonists (Yancy et al., 2017).

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New York Heart Association Classifications of Heart Failure

Table 7: NYHA Functional Classification

Class	Description
I	No symptoms with ordinary activity
II	Slight limitation; symptoms with ordinary activity
III	Marked limitation; symptoms with less than ordinary activity
IV	Symptoms at rest, unable to perform any activity

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Diagnosis of Congestive Heart Failure (CHF)

CHF diagnosis combines clinical evaluation, imaging studies like echocardiography, and invasive tests such as left heart catheterization. Echocardiography assesses ventricular function, valvular disease, and ejection fraction. BNP levels are sensitive markers of cardiac stress and heart failure (McMurray et al., 2014).

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Infective Endocarditis and Myocarditis

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Infective Endocarditis

This infection manifests with low-grade fever, chills, weight loss, heart murmurs, joint pain, petechiae, kidney infection, and Roth spots (retinal hemorrhages). Treatment involves prolonged intravenous antibiotics and sometimes surgical valve repair or replacement (Baddour et al., 2015).

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Myocarditis

Myocarditis presents with a wide range of symptoms, from mild manifestations such as fever and atypical chest pain to severe cases resulting in cardiogenic shock. The diagnosis is supported by elevated brain natriuretic peptide (BNP) levels, which help assess cardiac stress. Treatment primarily involves resting and avoiding stimulants that could exacerbate cardiac strain. Medical management aligns with standard heart failure protocols, including the use of angiotensin-converting enzyme (ACE) inhibitors, diuretics, and beta blockers to support cardiac function and reduce symptoms (Cooper, 2009).

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Hypertension: Clinical Presentation and Management

Hypertension is frequently asymptomatic, often detected only through routine screening. When symptoms occur, patients may report tinnitus, headaches, or dizziness. Accurate diagnosis requires precise blood pressure measurement techniques, including taking multiple readings across different positions to avoid false readings.

Management prioritizes lifestyle modifications such as diet, exercise, and weight control. Pharmacological therapy typically involves ACE inhibitors, angiotensin receptor blockers (ARBs), thiazide diuretics, and calcium channel blockers. It is important to note that nondihydropyridine calcium channel blockers should be avoided in patients with heart failure with reduced ejection fraction due to potential adverse effects (Whelton et al., 2018).

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Hypertensive Emergency Criteria

A hypertensive emergency is characterized by a critically elevated blood pressure, usually exceeding 180/120 mmHg, combined with acute damage to target organs. Clinical features may include encephalopathy, pulmonary edema, or acute coronary syndrome, which require immediate intervention to prevent irreversible organ damage (Whelton et al., 2018).

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What Are the Clinical Features, Examination Findings, and Treatment Approaches for Peripheral Arterial Disease (PAD) and Venous Insufficiency?

Patients with peripheral arterial disease often report intermittent claudication—pain and cramping in the legs during exertion that resolves with rest. More severe cases may present with ischemic rest pain, fatigue, and poor wound healing due to inadequate blood flow. Physical examination includes palpation of peripheral pulses, assessment of capillary refill, and inspection for swelling or ulcers indicative of venous insufficiency.

Management emphasizes lifestyle interventions such as smoking cessation and rigorous control of comorbidities like hypertension, diabetes, and hyperlipidemia. When the ankle-brachial index (ABI) exceeds 0.8, compression stockings may alleviate symptoms of venous insufficiency. Pharmacological treatments include antiplatelet agents such as aspirin or clopidogrel to reduce cardiovascular risk, and statins for lipid control. Cilostazol is specifically effective in improving walking distance in claudicant patients. Surgical options, including angioplasty or bypass grafting, are reserved for advanced disease stages (Gerhard-Herman et al., 2017).

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Valvular Heart Disease and Murmurs

How Do Valvular Heart Diseases Present, and What Are Their Examination and Management Strategies?

Patients with valvular heart disease frequently report symptoms such as chest pain, palpitations, dizziness, syncope, fatigue, and dyspnea. The physical exam includes inspection and palpation to identify the point of maximum impulse (PMI), followed by auscultation to detect abnormal heart sounds or murmurs characteristic of valvular pathology.

Management varies with disease severity. Severe aortic stenosis, for instance, may require activity restrictions to prevent complications. Medical therapy aims to control cardiovascular risk factors and provide symptomatic relief. Surgical interventions like transcatheter aortic valve replacement (TAVR) are considered for patients at high surgical risk (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 for high-risk patients
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 when 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

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Diverticular Disease: Presentation and Management

What Differentiates Diverticulitis from Diverticulosis, and How Are These Conditions Managed?

Diverticulosis refers to the presence of multiple diverticula in the colon, usually asymptomatic or causing mild intermittent abdominal discomfort such as bloating or irregular bowel habits. In contrast, diverticulitis is an inflammation of diverticula, manifesting clinically as left lower quadrant abdominal pain, fever, leukocytosis, nausea, and vomiting.

Physical examination in diverticulitis may show localized tenderness, guarding, or an abdominal mass, whereas diverticulosis generally lacks significant physical findings. Diagnostic evaluation includes stool tests and colonoscopy for colonic assessment. Treatment for diverticulitis involves antibiotics to control infection, while diverticulosis management focuses on dietary fiber to reduce the risk of complications (Strate & Morris, 2019).

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Gastroesophageal Reflux Disease (GERD)

How Does GERD Present, and What Are the Key Examination and Treatment Principles?

GERD typically presents as heartburn and chest discomfort, sometimes mimicking angina. Oral examination may reveal dental erosions or halitosis, and respiratory symptoms like chronic cough or wheezing may result from airway irritation due to reflux.

Treatment primarily involves acid suppression with histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). Prokinetic agents, such as metoclopramide, may be beneficial in patients with delayed gastric emptying to improve motility and reduce reflux episodes (Katz et al., 2022).

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Gastrointestinal Hemorrhage

What Are the Clinical Features, Examination Findings, and Management Strategies for Gastrointestinal Bleeding?

Gastrointestinal bleeding presents variably with hematemesis (vomiting blood), melena (black, tarry stools), or hematochezia (bright red blood per rectum). Early clinical evaluation focuses on assessing vital signs, neurological status, and skin changes such as telangiectasia or stigmata of chronic liver disease like cirrhosis.

Treatment depends on the bleeding source. For esophageal variceal bleeding, balloon tamponade can be a temporary measure, while definitive therapy may include surgical shunting or placement of a transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal hypertension and control hemorrhage (Strate & Gralnek, 2016).

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Hepatitis and Liver Disease

What Are the Typical Symptoms, Examination Features, and Treatments of Hepatitis?

Patients with hepatitis often experience systemic symptoms including anorexia, fatigue, myalgia, nausea, fever, and abdominal discomfort. Physical exam should assess vital signs and look for jaundice or signs of liver failure such as ascites or encephalopathy.

Treatment depends on etiology. Viral hepatitis often requires antiviral therapy with nucleoside analogues. Liver biopsy may be indicated for staging disease severity and guiding management decisions (European Association for the Study of the Liver, 2017).

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Inflammatory Bowel Disease (IBD)

What Are the Clinical Presentation and Management of Ulcerative Colitis (UC) and Crohn’s Disease (CD)?

IBD is characterized by abdominal pain, diarrhea, fatigue, weight loss, fever, and extraintestinal symptoms like arthritis. Physical examination may reveal oral ulcers, hyperactive bowel sounds, abdominal tenderness, and perianal disease, which is more typical of Crohn’s disease.

Therapy includes 5-aminosalicylates for mild disease, immunomodulators such as azathioprine, corticosteroids for flares, and biologics like infliximab for moderate to severe cases to maintain remission and prevent complications (Torres et al., 2020).

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Irritable Bowel Syndrome (IBS)

How Is IBS Diagnosed and Managed?

IBS diagnosis is clinical, characterized by abdominal pain associated with altered bowel habits, without alarming signs such as weight loss or bleeding. Physical exam is generally unremarkable, though mild abdominal tenderness may be present.

Management targets symptom relief through dietary fiber supplementation, antispasmodics, antidiarrheal agents, and psychotropic medications for patients with comorbid anxiety or depression (Ford et al., 2018).

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Chronic Pancreatitis

What Is the Clinical Presentation and Treatment Approach for Chronic Pancreatitis?

Patients with chronic pancreatitis typically present with recurrent epigastric pain radiating to the back, nausea, steatorrhea, and unintended weight loss. Examination may reveal abdominal tenderness and signs of malnutrition.

Treatment focuses on abstaining from alcohol and tobacco, pain management using analgesics, pancreatic enzyme replacement to aid digestion, vitamin supplementation, and surgical intervention when complications such as strictures or pseudocysts occur (Yadav & Lowenfels, 2013).

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Gastrointestinal Tumors: Symptoms, Physical Findings, and Management

Tumor Type	Symptoms	Physical Exam Findings	Management
Esophageal Tumors	Dysphagia, weight loss, odynophagia	Often normal; possible regional lymphadenopathy	Surgery for localized disease; chemo/radiotherapy adjunct
Gastric Tumors	Weight loss, upper abdominal pain, nausea	Palpable abdominal mass; metastatic lymph nodes (Virchow’s, Sister Mary Joseph’s nodes)	Endoscopic resection for early disease; surgery and chemotherapy for advanced cases

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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.

Strate, L. L., & Morris, A. M. (2019). Epidemiology, pathophysiology, and treatment of diverticulitis. Gastroenterology, 156(5), 1282–1298.

D118 Unit 5 Study Guide

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.