Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NURS 518 > 526 Gastro and Hepatic > Flashcards

526 Gastro and Hepatic Flashcards

1
Q

what are the three signs most predictive of appy

A

pain that starts in epigastrum or periumbilical
migration of pain to right lower quadrant
abdominal rigidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

true or false, appendictis most often results in a left shift

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what other blood tests should be ordered when diagnosing appendicitis

A

CBC and lytes, HCG, amylase, lipase, CRP, urinalysis, sickeldex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what differential should be considered for a possible appendicitis in african americans

A

sickle cell anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the most common causes of bowel obstructions

A

adhesions, hernias and tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

bowel obstruction type pain that increases in severity, localizes and becomes constant is indicative of what

A

strangulated obstruction - requires urgent surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how does the presention of a bowel obstruction differ from the presentation of an ileus

A

ileus - bowel sounds or usually decreased or absent and in obstruction they are usually hyperactive at the beginning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how do bowel sounds progress throughout the progression of a bowel obstruction

A

initially hyperactive with high pitched tinkling sounds but then absent with progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

true or false, it is possible to diagnose a small bowel obstruction with plain radiography

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the diagnostic of choice for bowel obstruction

A

CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what would an abdominal xray show for a bowel obstruction

A

free air (if there is perforation)
distended bowel proximal to the obstruction
air-fluid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how would xray results differ in a SUPINE radiograph for an ileus and an obstruction

A

ileus - distended bowel loops in large and small intestine
obstruction - distending bowel loops proximal to obstruction, and decreased bowel distal to obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

duodenal or gastric ulcers are more likely to perforate

A

duodenal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the most common presenting symptoms of perforated peptic ulcer

A

abrupt severe abdo pain in epigastrum and then throughout abdo followed by peritoneal signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

severe abdo pain with hematemesis that improves after 6-12 hours but then is followed by worsening illness if common of what condition

A

perforated peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

boardlike abdo rigidity, tachycardia, hypotension and fever or indicative of what condition

A

perforated peptic ulcer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is perforated peptic ulcer diagnosed

A

finding of pneumoperitoneum on an upright abdo xray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the most common cause of primary spontaneous bacterial peritonitis

A

cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is secondary peritonitis

A

spillage of gastro or GU contents into peritoneal speace

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the most common pathogen in primary peritonitis

A

E coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what should be suspected in a patient with fever, abdo pain and tenderness with rigidity and leukocytosis

A

peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

systemic symptoms with peritoneal signs in a patient with ascites or cirrhosis is likely from

A

peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what empiric antibiotics are chose for primary peritonitis

A

3rd or 4th gen cephalosporin or quinolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

why would a patient with cirrhotic ascites be prescribed low dose antibiotics for a prolonged time

A

to prevent a peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

a patient with cirrhosis would have an increased or decreased systemic response to a peritonitis

A

decreased, signs may only be subtle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what is the typical presentation of a AAA

A

severe abdo pain to the flank, low back or groin that radiates into the back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when is screening for AAA recommended

A

men 65-75 with history of smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if time allows, what is the standard for evaluation of a AAA

A

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the most common misdiagnosis for AAA

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

a nonpainful abdominal mass that englarged with increasing intra abdominal pressure or with standing if characteristic of what

A

aymptomatic hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the characteristics of an incarcerated hernia

A

painful enlargement of previous hernia
cannot be manipulated through fascial defect
n/v symptoms of bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are the characteristics of a strangulated hernia

A

symptoms of incarcerated
systemic toxicity
pain and tenderness persist after reduction of incarcerated hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

at what age would you consider sending a child for repair of an umbilical hernia

A

2-4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is an incarcerated hernia

A

unable to be reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how might the skin appear for a strangulated abdominal hernia

A

erythematous or dusky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

should you reduce an abdominal hernia with erythema or dusky skin

A

no, needs emergent surgical consult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what maneuver should be preformed when evaluating for a hernia

A

valsalva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what location of hernia have high risk for strangulation and should be surgically repaired

A

femoral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are the two common causes PUD

A

NSAID and H. pylori

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

sharp, aching, gnawing pain in the epigastrum occuring 2-5 hours after eating or waking from night is characteristic of what

A

PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

true or false: the pain of PUD is usually relieved with eating food

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

how long must a patient be off PPI before completing the stool antigen test for H pylori

A

14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is the pros and cons to a serologic H pylori test

A

pro: does not need to stop PPI
con: unable to determine if previous or active infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what diagnostic provides the most accurate diagnosis for PUD

A

endoscopy

45
Q

what condition should be considered for a patient with PUD that does not respond to lifestyle modification and pharmacotherapy

A

zollinger-ellison syndrome - excess acid production

46
Q

true or false: new onset dyspepsia in a patient older than 50 requires immediate physician consult

A

true

47
Q

cimetidine, famotidine, and nizatidine are all what class of medication and are used to treat what abdominal disorder

A

histamine 2 receptor antagonists (H2RAs) for PUD

48
Q

what is the course prescribed for H2RAs for PUD

A

4-6 weeks for healing then maintainence at bedtime for 1 year

49
Q

when might you consider prostaglandin therapy for PUD? what medication is used for prevention?

A

patients with PUD who cannot stop taking NSAIDs
misoprostol

50
Q

what is the recommended treatment for H pylori

A

PPI + clarithromycin +amox
OR
PPI + clarithromycin + metronidaxzole
for up to 14 days

51
Q

pain in the RUQ radiating into the scapula 1-2 hours after a fatty meal is indicative of what condition

A

gallbladder stones

52
Q

how can you treat an acute attack of cholelithiasis pain with no signs of infection

A

buscopan
gravol
toradol
if no resolution in 6-8 hours transfer to hospital

53
Q

what diagnostic imaging would you order for recurrent gallbalder colic

A

abdo ultrasound

54
Q

true or false: the number of gallbladder stones seen on an US will determine need for surgery

A

false, surgical treatment is determined by presentation, frequency of attack and other risk factors

55
Q

what medications may increase risk for gallbladder disease

A

estrogen, oral contraceptives, thiazides, diuretics

56
Q

what are the 3 types of gall stones

A

cholesterol, bilirubin (or pigmented), and mixed

57
Q

how do gallstones cause diarrhea and jaundice

A

bile cant be extreted which causes jaundice and lack of bile means fat cant be broken down so it pulls more water into the large intestines

58
Q

what is acalculous cholecystitis and when is it acute vs chronic

A

cholecystitis in the abscence of stones
acute <1 month
chronic >3 months

59
Q

what is the difference between cholelithiasis and cholecystitis

A

cholecystitis develops similar to cholelithiasis but lasts longer than 4-6 hours

Cholelithiasis= presence of stones
Cholecystitis = inflammation of gallbalder

60
Q

what is the charcot triad and what is it indicative of

A

right upper quadrant pain
fever
jaundice
seen when stone is lodged in common bile duct causing cholangitis

61
Q

true or false: patients with acute acalculous cholecystitis are usually sicker and require hospitalizaiton

A

true

62
Q

true or false: cholecystitis will not have muscle guarding or rigidity

A

false

63
Q

a patient with tender RUQ, (+) murphys, and jaundice may have what condition

A

cholecystitis

64
Q

what imaging is used to definitively diagnose cholecystitis

A

ultrasound

65
Q

true or false: oral hydration is preferred over IV for initial management of symptomatic gallbladder disease

A

false, oral hydration is contraindicated during this time

66
Q

what is ursodeoxycholic acid and when is it used

A

it is a treatment to decrease the pain with biliary disease and help with gallstone dissolution
for mild symptoms, with small stones and normal gallbladder function

67
Q

what is choledocholithiasis

A

presence of gallstones in the common bile duct

68
Q

if gallstones found incidentially on imaging are not symptomatic do they still require surgical intervention

A

no

69
Q

what is the most common cause of pancreatitis

A

gall stones

70
Q

what are the causes of pancreatitis (I GET SMASHED)

A

iatrogenic
gallstones
ETOG
trauma
steroids
mumps
autoimmune
scorpion bites
hypertriglycerides/hypercalcemia
ERCP
drugs

71
Q

a patient with constant epigastric pain that radiates to the back, worse with lying flat, with n/v and jaundice may have what

A

pancreatitis

72
Q

how is the epigastric pain from pancreatitis different from the epigastric pain of PUD

A

PUD is intermittent, pancreatitis is constant

73
Q

what GI disorder puts the patient at risk for developing DIC

A

pancreatitis

74
Q

what would you expect to see of the following labs for a pancreatitis:
CRP, BUN, GFR,

A

CRP increased
BUN increased
GFR decreased

75
Q

triglycerides 3x the upper limit is diagnostic of what condition

A

pancreatitis

76
Q

what would you expect to see with bili, AST and ALT in pancreatitis

A

all elevated

77
Q

what is initial treatment for pancreatitis? what is definitive treatment

A

initially fluids then ERCP or cholecystecomy

78
Q

true or false: pancreatitis is treated with anitbiotics

A

false, only if an abcess forms afterwards

79
Q

what is the difference between chlelithiasis and cholecystitis

A

cholelithiasis is formation of gall stones in gall bladder
cholecystitis is inflammation of the gallbladder

80
Q

what is the difference between cholelithiasis and choledocholithiasis

A

cholelithiasis is formation of stones in gallbladder
choledocholithiasis is formation of stones in the common bile duct

81
Q

what is cholangitis

A

a complication of bile stones where infection develops in the bile duct

82
Q

will biliary colic have fever, increased WCC, and jaundice

A

no

83
Q

how can you differentiate biliary colic, cholyecystitc and cholangitis based on symptomology

A

biliary colic = RUQ only
cholecystitis = RUQ and fever
Cholangitis = RUQ, fever and jaundice (charcots triad)

84
Q

which strands of viral hepatitis cause acute hepatitis

A

B, C, D

85
Q

when is hepatitis considered viral

A

presence of virus at least 6 months after initial exposure

86
Q

how many weeks after exposure would you expect to see symptoms of hepatitis

A

4 weeks

87
Q

true or false: patients with hepatitis are not conatgious when they are asymptomatic

A

false

88
Q

what liver disease is associated with metabolic disorder

A

NASH

89
Q

which viral strain of hepatitis is most likely to cause haundice

A

B

90
Q

what are symptoms of cirrhosis

A

jaundice
ascites
edema
easily bruised
fatigue
encephalopathy
upper GI bleeding

91
Q

spider telangiectasia, parotid enlargement, gynecomastia and palmar erythema is more common in what condition

A

alcoholic hepatitis

92
Q

which serum levels will you look for in the acute phase of hepatitis

A

increased AST and ALT, bili

93
Q

what condition would cause equal proportions of direct and indirect bili with bili in the urin

A

hepatitis

94
Q

what treatment suggestions might you make for NAFLD

A

diet, exercise, weight loss, Vit. E

95
Q

malabsorption causing soulte rich molecules to enter the colon is what kind of diarrhea

A

osmotic

96
Q

diarrhea that starts postprandial and ends with fasting is osmotic or secretory

A

osmotic

97
Q

secretory or osmotic diarrhea is most common

A

secretoy

98
Q

diarrhea caused by compromise of the absorptive fuction of the gut is what kind

A

secretory

99
Q

celiac and diabetes cause what kind of diarrhea

A

secretory

100
Q

what is the abx of choice to treat C diff

A

metronidazole or vanco for 10-14 days

101
Q

when should you suspect bacterial casues of diarrhea

A

when the presentation suggests inflammatory (fever, pain, tenesmus, large volume, blood or mucuos)

102
Q

how long does travellers diarrhea usually last

A

3-7 days

103
Q

although travellers diarrhea is usually self limiting, what bx may be prescibred

A

cipro or azithro

104
Q

when are diagnostics needed for travellers diarrhea

A

persists past 1 week or symptoms of inflammatory diarrhea

105
Q

when would you presscribe an abx for travellers diarrhea

A

symptoms last more than 2 days and assocaited with high fever

106
Q

osmotic or stimulant laxatives are first line treatment for constiptaion

A

osmotic

107
Q

PEG is an osmotic or stimulant laxative

A

osmotive

108
Q

Senna is an osmotic or stimulant laxative

A

stimulant

109
Q

what is the chain of advancing treatment for consitpation

A
  1. lifestyle
  2. bulk forming agents
  3. stool softeners
  4. osmotic laxatives
  5. stimulant laxatives
  6. secretagogues

NURS 518 (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions