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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
C-diff
most common HAI induced by prolonged/high dosage of abx use- promoting abnormal growth of dangerous microbe
26
C-diff prioritization
stop the spread by instilling precautions, skin care on bottom,
27
C-diff mgmt
contact + precautions, bleach wipes to clean, vancomycin or flatly, fecal transplant
28
malabsorption manifestations
hallmark: diarrhea or frequent loose or bulky foul smelling stools -steatorrhea: fatty stools -weight loss, anemia, fatigue, anorexia, vitamin deficiency
29
common malabsorption diseases
celiac (AI), crohn's, lactose intolerance
30
peritonitis
inflammation of the peritoneum- serous membrane lining abdominal cavity and covering the viscera
31
Primary peritonitis
spontaneous
32
Secondary peritonitis
trauma, ulcer perforates - most common
33
Tertiary peritonitis
opportunistic infection (HIV, TB) - most rare
34
peritonitis causes
-bacterial or secondary to fungal infection -organisms from GI or female reproductive organs -trauma, surgery, inflammation of surrounding organs (ex: kidneys from dialysis)
35
peritonitis manifestations
severe abdominal pain, n/v, anorexia, elevated temp, tachycardia, abdomen distended/rigid/rebound tenderness, aggravated by mvmt, decreased bowel tones
36
peritonitis mgmt
- IV fluids, colloids, e- replacement (several liters of isotonic fluids - abx - surgery depending on cause - NG tube for decompression - antiemetics - pain mgmt
37
appendicitis
appendix becomes inflamed and edematous and obstructs orifice and bloodflow - becomes ischemic - bacterial overgrowth occurs - gangrene and perforation occurs
38
appendicitis manifestations
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
appendicitis complications
- gangrene - perforation- occurs 6-24 horus after pain begins, leads to peritonitis these require immediate surgery, IV fluids and abx
40
diverticulosis diagnosis
multiple diverticula without inflammation
41
Diverticular disease cause
high intra-luminal pressure, low volume, and decreased muscle strength
42
diverticulum
saclike herniation of lignin of the bowle that extends through a defect in the muscle layer
43
diverticululitis
infection and inflammation of diverticula manifestions: acute onset of mild to severe cramping in LLQ - change in bowel habits, bloating, nausea, fever, leukocytosis
44
Diverticular disease complications
abscess formation, bleeding, peritonitis, rectal bleeding, fistula formation, scarring
45
Obstruction prioritization
46
mechanical obstruction
caused from pressure on the intestinal wall preventing normal flow of intestinal contents
47
Functional/paralytic obstruction
(paralytic ileus)- the intestinal musculature can't propel the contents along
48
s/s of obstruction
crampy, colicky wavelike abd. pain, n/v, bloating, inability to pass gas, abdominal distention, loss of appetite, maybe diarrhea
49
Obstruction mgmt
decompression of bowel (NG), fluid replacement, NPO, serial X-rays, surgery
50
Ulcerative Colitis
mucosa of the colon becomes diffusely ulcerated and inflamed (exacerbations and remissions are common)
51
Ulcerative Colitis manifestations
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
Crohn's disease
regional enteritis- chronic inflammation in separate portions of bowel lining
53
Crohn's disease manifestations
*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
Crohn's diagnosis
endoscopy, abdominal CT and/or MRI - cbc, ESR, albumin/protein levels
55
Crohn's complications
obstruction or stricture, fistulas, fluid and e- imbalance, malnutrition
56
UC diagnosis
colonoscopy is definitive, and X-ray - stool blood studies, CBC, CMP, albumin, CRP
57
UC complications
cancer, toxic megacolon, perforation, bleeding
58
Surgical mgmt of IBD
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
Ostomy Care
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 (9 decks)

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