#6 Gastrointestinal System

Question 1

Tumours of the colon ?

Answer 1

1.) Ascending (right) colon tumours are generally large and bulky.
2.) Tumours of the descending (left) colon are small and button like masses

Question 2

What is a rectal carcinoma ?

Answer 2

generally located 15cm from the anus opening, spreads transmurally (passing through an anatomical wall) to the vagina in women or prostate in men.

Question 3

Clinical manifestations colon tumours

Answer 3

pain, bloody stool and bowel habit change

Question 4

colorectal cancer diagnosis tools/treatment ?

Answer 4

fecal occult blood test and colonoscopy. treatment is usually surgical removal, with chemotherapy and radiotherapy used.

Question 5

what is ulcerative colitis

Answer 5

inflammatory disease that causes ulceration, abscess formation and necrosis of the colonic and rectal mucosa

Question 6

symptoms of ulcerative colitis

Answer 6

cramping pain, bleeding, frequent diarrhoea, dehydration and weight loss

Question 7

what is crohn’s disease ?

Answer 7

similar to ulcerative colitis, however it affects both the large and small intestines and ulceration tends to involve all lumen layers.

Question 8

symptoms of crohns disease ?

Answer 8

‘skip lesion’ fissures and granulomas, abdominal tenderness, diarrhoea and weight loss.

Question 9

what is a peptic ulcer ?

Answer 9

an area of mucosal inflammation and ulceration caused by excessive secretion of gastric acid or disruption of the protective mucosal barrier, or both.

Question 10

3 types of peptic ulcers ?

Answer 10

gastric, duodenal and stress

Question 11

gastric ulcer ?

Answer 11

develop near parietal cells, generally in the antrum and become chronic. gastric secretions may be normal or decreased and may get pain after eating.

Question 12

duodenal ulcers ?

Answer 12

most common peptic ulcer, associated with increased numbers of parietal (acid-secreting) cells in the stomach, elevated gastrin levels and rapid gastric emptying.
Pain occurs when the stomach is empty and is relieved with food or antacids. Duodenal ulcers usually heal spontaneously and recur frequently.

Question 13

Stress Ulcers ?

Answer 13

acute form of peptic ulcer that accompany’s severe illness, systemic trauma or neural injury. Emotinal stress may cause stress ulcers. Usually occurs in multiple sites of the stomach and duodenum.

Question 14

what is malnutrition ?

Answer 14

lack of nourishment from inadequate amounts of kilojoules, protein, vitamins or minerals.

Question 15

starvation ?

Answer 15

extreme state of malnutrition

Question 16

what does short-term starvation result in ?

Answer 16

stimulates stored glucose to be produced from glucose stores and non-carbohydrate molecules

Question 17

Long-term starvation ?

Answer 17

Triggers the breakdown of ketone bodies and fatty acids, resulting in proteolysis (protein breakdown) which is advanced stage and death will ensue if nutrition is not restored

Question 18

What does a intestinal obstruction prevent ?

Answer 18

The normal movement of chyme through the intestinal tract. It can involve the SI or LI. Can be due to
1.) intussusception (part of intestine sliding into another part
2.) Volvulus (twisting or knotting of the intestinal tract)
3.) abdominal hernia (organ pushes through containing structure)
4.) paralytic ileus (motor activity of bowel impaired- not a physical block)

Question 19

Vomiting ?

Answer 19

forceful emptying of the stomach by gastrointestinal contraction and with the exception of projectile vomiting, which is directly associated with vomiting centre in the brain.

Question 20

Diarrhoea ?

Answer 20

can be caused by excessive fluid drawn into the intestinal lumen by osmosis (osmotic diarrhoea), excessive secretion of fluids by intestinal mucosa (secretory diarrhoea) or gastrointestinal motility.

Is a particular concern for young children, who are susceptible to changes in fluid balance. Severe dehydration from diarrhoea can be fatal. (childhood diarrhoea caused by rotavirus)

Question 21

Gastrointestinal bleeding ?

Answer 21

Manifestations include
1.) haematemesis (vomiting of blood)
2.) melaena (dark, tarry stools)
3.) maematochezia (frank bleeding from the rectum)

Occult bleeding can be detected only by testing stools or vomitus for the presence of blood.

Question 22

Abdominal distension ?

Answer 22

accompanies bowel hypermotility (high activity) and the accumulation of fluids in the peritoneal cavity. it may indicate underlying bowel disease.

Question 23

Diverticula Disease ?

Answer 23

• Outpouchings of colonic mucosa through the muscle layers of the colon wall
• Related to diets high in refined foods and a lack of fibre in a patient
• Defined as the inflammation of one or more diverticula. pathogenesis is unclear.

Question 24

Normal assessment for suspected diverticulitis ?

Answer 24

history, physical examination and investigation for inflammatory disease (fever, nausea, vomiting, pain and haemorrhagic disease)`

Question 25

Routine investigations for diverticulitis ?

Answer 25

Urinalysis, Hb, white cell count, blood cultures, urea and electrolytes, x-ray if suspected bowel obstruction or perforation and CT scan

Question 26

Routine nursing care for diverticulitis ?

Answer 26

Nil by mouth, administer IV fluids, administer antibiotics, monitor all fluid intake and output on FBC, administer analgesia, frequent vital sign obs, O2 therapy as prescribed, record and report bowel actions

Question 27

common complications of acute diverticulitis

Answer 27

intestinal bleeding, fistulas, abscess, colonic obstruction and bowel perforation with peritonitis.

Question 28

key clinical management strategy for diverticulitis

Answer 28

appropriate antibiotics, combination of amoxycillin+clavulanate and metronidazole and a hartman’s procedure

Question 29

Metoclopramide

Answer 29

Brand name: maxalon
IFU: Nausea + vomiting
DC: Antiemetic
MOA: Dopamine antagonists
PE: empty by the stomach + increase intestinal motility
ROA: Oral, IM or IV
CSE: Restlessness, drowsiness and fatigue

Question 30

Prochlorperazine

Answer 30

Brand Name: Stemetil
IFU: Nausea + Vomiting
Drug Class: Anti-emetic
MOA: Dopamine antagonists
PE: Phenothiazine antiemetic
ROA: Oral + IV
CSE: Constipation, dry mouth + drowsiness

Question 31

Ondansetron

Answer 31

Brand name: Ondaz
IFU: Nausea +Vomiting
DC: Antiemetic
MOA: 5-HT3 Receptor antagonists
PE: Antagonism of 5HT3 receptors on neurons located in CNS and peripheral
ROA: Oral + IV
CSE: Headache, Local IV site injection reactions.

Question 32

Hyoscine Butylbromide

Answer 32

Brand name: Buscopan
IFU: Spasm of the GI tract
DC: Antispasmodic
MOA: Muscarinic receptor antagonists
PE: Reduces the tone and peristalsis of smooth muscle
ROA: Oral + IV
CSI: Rash, tachycardia and dry mouth

Question 33

Amoxil

Answer 33

Brand name: Amoxicillin
IFU: Infections due to susceptible organisms incl skin, repiratory etc
DC: Penicillin antibiotic
MOA: Aminopenicillin, broad spectrum
PE: Bactericidal action against gram positive and gram negative susceptible organisms
ROA: Oral and IV

Question 34

Gentamicin

Answer 34

Brand Name: Gentamicin
IFU: Infections due to susceptible organisms, bacteraemia, RTI and periontitis
DC: Aminoglycoside, antibiotic
MOA: Bactericidal aminoglycoside
PE: inhibiting protein synthesis in susceptible bacteria
ROA: IV
CSE: Dizziness, vertigo, tinnitus, roaring in the ears and hearing loss which may be irreversible

Question 35

Metronidazole

Answer 35

Brand name: Flagyl
IFU: Severe anaerobic infection
DC: Nitroimidazole antibiotic
MOA: bactericidal action
ROA: Oral + IV
CSE: Nausea + vomiting

Question 36

Cefotaxime

Answer 36

Brand Name: Cefotaxime
IFU: intra-abdominal infection and other infections
DC: Cephalosporins antibiotic
MOA: Bactericidal action
PE: Bactericidal effect is due to cell wall synthesis
ROA: IV
CSE: Hypersensitivity reactions, angioedema, bronchospasm and malaise