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Med/Surg > Ch 40 (ulcers) & Ch 41 (intestine/rectal disorders) > Flashcards

Ch 40 (ulcers) & Ch 41 (intestine/rectal disorders) Flashcards

1
Q

Pt education for gastritis

A

modify diet: refrain from alcohol and irritating foods, avoid NSAIDs
recommend pharm. therapy: PPI (omeprazole), antacid (tums) etc.
chronic: promote rest, reduce stress

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2
Q

Gastritis

A

inflammation of the stomach mucosa (common)
- acute: erosive vs. non erosive
- chronic

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3
Q

Erosive gastritis

A

form of acute gastritis usually caused by local irritants (ex: aspirin, NSAIDS, alcohol)

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4
Q

Non-erosive gastritis

A

Acute form of gastritis that is caused by infection from H. Pylori

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5
Q

Chronic gastritis

A

prolonged inflammation due to irritants or H. Pylori
-may be associated with some AI diseases, diet, medications, substance (alcohol, smoking), or chronic reflux of pancreatic secretions

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6
Q

Chronic gastritis manifestations

A

fatigue, heartburn (pyrosis), belching, sour taste, halitosis, food intolerance (caffeine, spicy or fatty foods)
-may have vitamin deficiency due to malabsorption of B12

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7
Q

Acute gastritis manifestations

A
  • rapid onset of abdominal pain/discomfort, indigestion (dyspepsia), anorexia, nausea, vomiting, hiccups
    -may cause bleeding: vomit, stool (melena- black/tarry stools, or hematochezia- bright red, bloody stools)
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8
Q

H. Pylori mgmt

A

If untreated, could lead to PUD and cancer.
- combo of drugs: PPI, abx, and sometimes bismuth salts

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9
Q

Peptic Ulcer Disease

A

Erosion of mucous membrane forms excavation in the stomach, pylorus, duodenum or esophagus
causes: NSAIDS, H. Pylori

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10
Q

PUD manifestations

A

dull, gnawing pain or burning in the mid-epigastrium or back, sometimes heartburn (pyrosis), bleeding, sour burps

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11
Q

Gastric ulcer pain

A

pain occurs immediately after eating, 30-40% awake with pain at night

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12
Q

Duodenal ulcer pain

A

pain relieved by eating but reoccurs 2-3 hours after; 50-80% awake with pain at night

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13
Q

PUD complications

A

Gastric outlet syndrome
hemorrhage: if large (2000-300mL) usually vomited, if small its usually passed in the stool

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14
Q

Gastric outlet obstruction syndrome

A

any condition that mechanically impeded normal gastric emptying

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15
Q

Gastric outlet syndrome symptoms

A

n/v, constipation, epigastric fullness, anorexia and later weight loss

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16
Q

Gastric outlet syndrome mgmt

A

NG tube to decompress the stomach (output >400 mL indicates obstruction), IV fluids and e-, balloon dilation or surgery

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17
Q

GI bleed manifestation

A

vomit, pain, stool (melena or hematochezia)

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18
Q

Perforation manifestations

A

sudden/severe upper abdominal pain that may be referred to the right shoulder, vomiting and collapse, tender board-like abdomen, symptoms of shock or impending doom

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19
Q

Perforation

A

erosion of ulcer through gastric serosa into peritoneal cavity

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20
Q

penetration

A

erosion of ulcer through gastric serosa into adjacent structures (back and epigastric pain not relieved by medication)

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21
Q

Abdominal emergency perforation/penetration mgmt

A

monitor NG tube, I/O, electrolytes, infection, peritonitis, abdominal pain, bowel tones, distention

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22
Q

Pharmacology for constipation

A
  • Softeners: pull water into colon (ex: docusate- colace)
  • osmotic agent: cleanses colon rapidly (ex: goLYTELY, or polyethylene glycol- PEG)
  • Stimulants: increase peristalsis (ex: senekot or bisacodyl- dulcolax)
  • Bulk forming/fiber: diarrhea and constipation (citrucel- methylcellulose, metamucil- psyllium)
  • saline agent: milk of magnesia
  • Enemas/lubricant (glycerin suppository)
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23
Q

constipation complications

A

<3 BM/week
- decreased cardiac output, fecal impaction, hemorrhoids, fissures, rectal prolapse, megacolon

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24
Q

fecal incontinence mgmt

A

fiber supplementation, loperamide prior to meals, bowel training, pelvic floor training, surgical repair of anal sphincter, skin care

25
Q

C-diff

A

most common HAI induced by prolonged/high dosage of abx use- promoting abnormal growth of dangerous microbe

26
Q

C-diff prioritization

A

stop the spread by instilling precautions, skin care on bottom,

27
Q

C-diff mgmt

A

contact + precautions, bleach wipes to clean, vancomycin or flatly, fecal transplant

28
Q

malabsorption manifestations

A

hallmark: diarrhea or frequent loose or bulky foul smelling stools
-steatorrhea: fatty stools
-weight loss, anemia, fatigue, anorexia, vitamin deficiency

29
Q

common malabsorption diseases

A

celiac (AI), crohn’s, lactose intolerance

30
Q

peritonitis

A

inflammation of the peritoneum- serous membrane lining abdominal cavity and covering the viscera

31
Q

Primary peritonitis

A

spontaneous

32
Q

Secondary peritonitis

A

trauma, ulcer perforates
- most common

33
Q

Tertiary peritonitis

A

opportunistic infection (HIV, TB)
- most rare

34
Q

peritonitis causes

A

-bacterial or secondary to fungal infection
-organisms from GI or female reproductive organs
-trauma, surgery, inflammation of surrounding organs (ex: kidneys from dialysis)

35
Q

peritonitis manifestations

A

severe abdominal pain, n/v, anorexia, elevated temp, tachycardia, abdomen distended/rigid/rebound tenderness, aggravated by mvmt, decreased bowel tones

36
Q

peritonitis mgmt

A
  • IV fluids, colloids, e- replacement (several liters of isotonic fluids
  • abx
  • surgery depending on cause
  • NG tube for decompression
  • antiemetics
  • pain mgmt
37
Q

appendicitis

A

appendix becomes inflamed and edematous and obstructs orifice and bloodflow
- becomes ischemic
- bacterial overgrowth occurs
- gangrene and perforation occurs

38
Q

appendicitis manifestations

A

vague pre-umbilical pain (dull, poorly localized), eventually progressed to sharp RLQ pain
- anorexia and nausea
- low grade fever
- tenderness (at McBurrey’s point)
- abdominal distention may occur
-PAIN MAY DISAPPEAR IF RUPTURED

39
Q

appendicitis complications

A
  • gangrene
  • perforation- occurs 6-24 horus after pain begins, leads to peritonitis

these require immediate surgery, IV fluids and abx

40
Q

diverticulosis diagnosis

A

multiple diverticula without inflammation

41
Q

Diverticular disease cause

A

high intra-luminal pressure, low volume, and decreased muscle strength

42
Q

diverticulum

A

saclike herniation of lignin of the bowle that extends through a defect in the muscle layer

43
Q

diverticululitis

A

infection and inflammation of diverticula
manifestions: acute onset of mild to severe cramping in LLQ
- change in bowel habits, bloating, nausea, fever, leukocytosis

44
Q

Diverticular disease complications

A

abscess formation, bleeding, peritonitis, rectal bleeding, fistula formation, scarring

45
Q

Obstruction prioritization

A
46
Q

mechanical obstruction

A

caused from pressure on the intestinal wall preventing normal flow of intestinal contents

47
Q

Functional/paralytic obstruction

A

(paralytic ileus)- the intestinal musculature can’t propel the contents along

48
Q

s/s of obstruction

A

crampy, colicky wavelike abd. pain, n/v, bloating, inability to pass gas, abdominal distention, loss of appetite, maybe diarrhea

49
Q

Obstruction mgmt

A

decompression of bowel (NG), fluid replacement, NPO, serial X-rays, surgery

50
Q

Ulcerative Colitis

A

mucosa of the colon becomes diffusely ulcerated and inflamed
(exacerbations and remissions are common)

51
Q

Ulcerative Colitis manifestations

A

bleeding is common, diarrhea with mucus and blood, LLQ pain (starts from anus and progresses up the descending colon), fatigue, anorexia, weight loss, fever, vomiting, dehydration, >6 BM/day

52
Q

Crohn’s disease

A

regional enteritis- chronic inflammation in separate portions of bowel lining

53
Q

Crohn’s disease manifestations

A

cobblestone appearance and skip lesions, chronic diarrhea, RLQ pain unrelieved by defecation, and tenderness, cramping after meals
- gradual onset of symptoms, progressive, relentless and often debilitating
- late: weight loss, malnutrition, secondary anemia

54
Q

Crohn’s diagnosis

A

endoscopy, abdominal CT and/or MRI
- cbc, ESR, albumin/protein levels

55
Q

Crohn’s complications

A

obstruction or stricture, fistulas, fluid and e- imbalance, malnutrition

56
Q

UC diagnosis

A

colonoscopy is definitive, and X-ray
- stool blood studies, CBC, CMP, albumin, CRP

57
Q

UC complications

A

cancer, toxic megacolon, perforation, bleeding

58
Q

Surgical mgmt of IBD

A

one-stage resection: inflamed area removed, primary end to end is anastomoses
multiple stage: diseased colon resected, no anastomosis, healthy end brought out of abdomen to set up a stoma for a colostomy

59
Q

Ostomy Care

A

early ambulation, pain mgmt, stoma should be pink to bright red, shiny. shouldn’t be swelling or drainage
- strict I/O
- may need NG suction and irrigation
- progress diet
- assess for nausea and distention

Med/Surg (6 decks)

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