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exam 3 GI system > everything > Flashcards

everything Flashcards

1
Q

condition where gastric content and enzymes backflow into the esophagus

A

GERD

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2
Q

primary treatment of GERD

A

diet and lifestyle changes

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3
Q

medication treatment of GERD

A

antacids
H2 receptor antagonists
proton pump inhibitors

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4
Q

untreated GERD leads to

A

inflammation
breakdown
long term complications (barretts esophagus)
adenocarcinoma of esophagus

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5
Q

condition where lining of esophagus gets damaged by acid reflux

A

barretts esophagus

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6
Q

GERD prevention includes

A

BMI below 30
smoking cessation
limit alcohol/tobacco use
low fat diet
no eating 2 hrs before bed
no tight fitting clothes
elevate head of bed 6-8 inches

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7
Q

risk factors of GERD

A

obesity
old age
sleep apnea
nasogastric tube

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8
Q

what type of foods relax LES and cause GERD

A

fatty fried foods
chocolate
caffenated beverages
peppermint
spicy foods
tomatoes
citrus fruits
alcohol

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9
Q

burning sensation in the esophagus is called

A

pyrosis

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10
Q

pain when swallowing is called

A

odynophagia

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11
Q

what color will esophageal lining be in GERD pt

A

red

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12
Q

allows visualization of esophogus and can reveal barretts epithelium or esophagitis

A

EGD

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13
Q

diagnostic procedure done under moderate sedation to observe for tissue damage

A

EGD

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14
Q

what should you verify has returned before giving a pt oral fluids or food after a EGD

A

gag reflex

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15
Q

manifestations of esophageal perforation

A

fever
pain
dyspnea
bleeding

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16
Q

most accurate method of diagnosing GERD

A

esophageal pH monitoring

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17
Q

diagnostic procedure where small catheter is placed through nose into esophagus to get pH readings for 24-48 hrs

A

esophageal pH monitoring

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18
Q

nursing action for esophageal pH monitoring

A

have pt log food/beverages consumed, manifestations and activity during 24 hr test period

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19
Q

records lower esophageal sphinter pressure & peristaltic activity of esophagus

A

esophageal manometry

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20
Q

identifies hiatal hernia, strictures or structural abnormalities that contribute to GERD

A

barium swallow

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21
Q

not eliminating barium places pt at risk for what?

A

fecal impaction

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22
Q

proton pump inhibitors

A

pantaprazole
omeprazole
esomeprazole
rabeprazole
lansoprazole

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23
Q

what do proton pump inhibitors do?

A

stop stomach cells from pumping acid into the stomach

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24
Q

what to watch for in diabetic pts taking PPIs

A

electrolyte imbalances
hypoglycemia

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25
Q

signs of C.diff diarrhea secondary to PPI use

A

abdominal cramping
fever
diarrhea

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26
Q

long term PPI use can increase the risk for what especially in older pts

A

fractures

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27
Q

types of antacids

A

aluminum hydroxide
magnesium hydroxide
calcium carbonate
sodium bicarbonate

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28
Q

what do antacids do?

A

neutralize acid in stomach to make it less abrasive

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29
Q

what med cant be taken w antacids

A

levothyroxine

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30
Q

what function should you check for pts taking magnesium hydroxide (antacid)

A

kidney function

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31
Q

when is acid secretion highest

A

1-3 hrs after eating
bedtime

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32
Q

when should acacia be taken

A

when acid secretion is high

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33
Q

how long should you wait to take other meds before/after antacids

A

1 hr

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34
Q

h2 receptor antagonists

A

ranitidine
famotidine
cimetidine
nizatidine

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35
Q

what do h2 receptor antagonists do

A

reduce stomach acid secretion

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36
Q

difference between antacids & h2 receptor

A

h2 takes longer to kick in but lasts longer

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37
Q

use h2 receptor antagonists carefully in pts with

A

kidney disease

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38
Q

pt education for h2 receptor antagonists

A

take w meals and at bedtime
take 1 hr apart from antacids

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39
Q

med that increases motility of esophagus and stomach

A

metoclopramide

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40
Q

what should you monitor in pt taking metoclopramide

A

extrapyramidal adverse effects (involuntary movement)

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41
Q

procedure that uses radio frequency energy from an endoscope to decrease vagus nerve activity

A

stretta

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42
Q

post op stretta pt education

A

clear liquids for first 24 hrs
no NSAIDS for 10 days after
report CP, abd pain, bleeding, difficulty swallowing, dyspnea, nausea/vomiting

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43
Q

what is used to treat bleeding esophageal varices

A

vassopressin

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44
Q

what does peppermint do to indigestion

A

increases indigestion (bad for hiatal hernias)

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45
Q

most common area for peptic ulcer

A

duodenum

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46
Q

what infection causes peptic ulcers

A

H. pylori

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47
Q

how do you get H pylori

A

food, water, or exposure to body fluids

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48
Q

curlings ulcer is found in patients

A

with burns

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49
Q

cushings ulcers are found in patients with

A

head/brain trauma

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50
Q

what is used prophylactically to prevent stress ulcers

A

PPIs

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51
Q

gastric ulcer pain usually occurs

A

30-60 mins after a meal

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52
Q

gastric ulcer pain is exacerbated by

A

ingestion of food

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53
Q

does gastric ulcer pain usually occur at night

A

no

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54
Q

what kind of ulcer pain is found in malnourished patients

A

gastric ulcer

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55
Q

what ulcer pain has hematemesis as a symptom

A

gastric ulcer

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56
Q

patient with what kind of ulcer would be throwing up blood

A

gastric ulcer

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57
Q

what ulcer pain has melena as a symptom

A

duodenal (peptic) ulcer pain

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58
Q

patient with dark stool would have what kind of ulcer

A

peptic (duodenal) ulcer

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59
Q

when would pt with duodenal (peptic) ulcer feel pain

A

1.5-3hrs after a meal

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60
Q

which ulcer will wake patient up at night

A

peptic (duodenal) ulcer

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61
Q

which ulcer would occur in a well nourished patient

A

peptic (duodenal) ulcer

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62
Q

which ulcer is relieved by food or an antacid

A

peptic (duodenal) ulcer

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63
Q

physical signs of peptic ulcer

A

epigastric pain or tenderness
vomiting blood
poo-ing blood
losing weight

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64
Q

how is H pylori tested for

A

endoscopy
urea breath test
stool sample test
hemoglobin and hematocrit
stool sample

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65
Q

how does a urea breath test find H.pylori

A

pt drinks carbon rich urea solution
blows into collection container

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66
Q

positive urea breath test

A

carbon dioxide will be released if h pylori is present

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67
Q

foods to avoid w/ ulcer

A

coffee
tea
carbonated beverages

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68
Q

meds for ulcers

A

antibiotics
H2 receptor antagonists
PPIs
antacids
mucosal protectants

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69
Q

what to do before EGD procedure

A

start 2 large bore IV catheters

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70
Q

what to do after EGD procedure

A

monitor vitals
NPO until gag reflex returns

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71
Q

surgerys if ulcers dont heal

A

gastrectomy
vagotomy
pyloroplasty

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72
Q

procedure that part or whole stomach is removed

A

gastrectomy

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73
Q

procedure that vagus nerve is cut to decrease gastric acid production

A

vagotomy

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74
Q

how is vagotomy done to prevent post op complications

A

laparoscopically

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75
Q

procedure where opening between stomach opening and small intestine is enlarged to increase gastric emptying rate

A

pyloroplasty

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76
Q

what happens to pts HR w peptic ulcer

A

tachycardia

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77
Q

abdominal signs of peptic ulcer

A

rigid abdomen
rebound tenderness

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78
Q

what happens to peptic ulcer pt BP

A

hypotension because of GI bleed

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79
Q

what is dumping syndrome

A

high sugar food moves from stomach to small intestine too quick

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80
Q

gastritis caused by h pylori infection

A

nonerosive

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81
Q

gastritis caused by NSAIDS, alcohol use, recent radiation

A

erosive gastritis

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82
Q

gastritis w sudden/short onset and results in gastric bleeding if severe

A

acute gastritis

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83
Q

chronic gastritis can be caused by

A

autoimmune disease
bacterial infection

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84
Q

lab tests for gastritis

A

CBC (anemia)
blood/stool antibody test (h. pylori)
urea breath test (h pylori measurement)

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85
Q

pernicious anemia is treated with

A

monthly vitamin b12 injections

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86
Q

what does famotidine do

A

antacid (stops acid production)

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87
Q

ulcerative colitis is characterized by

A

frequent stools
cramping/abdominal pain
exacerbations/remissions

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88
Q

edema & inflammation in the rectum and rectosigmoid colon is called

A

ulcerative colitis

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89
Q

Inflammation and ulceration of GI tract at distal ileum is called

A

crohns disease

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90
Q

cultures w high risk get ulcerative colitis

A

caucasian
jewish

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91
Q

culture w high risk for crohns disease

A

jewish

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92
Q

crohns disease requires what monthly

A

vitamin b12 injections

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93
Q

part of abdomen that ulcerative colitis is felt

A

LLQ

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94
Q

part of abdomen crohns disease is felt

A

RLQ

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95
Q

hematocrit & hemoglobin lvls with ulcerative colitis

A

decreased

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96
Q

ESR lvls with ulcerative colitis

A

increased

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97
Q

WBC with ulcerative colitis

A

increased

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98
Q

CRP w/ ulcerative colitis

A

increased

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99
Q

albumin w/ ulcerative colitis

A

decreased

100
Q

electrolytes w/ ulcerative colitis

A

decreased

101
Q

hematocrit & hemoglobin in crohn’s disease

A

decreased

102
Q

ESR in crohns disease

A

increased

103
Q

WBC in crohns disease

A

increased

104
Q

CRP in crohns disease

A

increased

105
Q

albumin in crohns disease

A

decreased

106
Q

folic acid and b12 in crohns disease

A

decreased

107
Q

urynalisis in crohns disease will show

A

WBC

108
Q

electrolytes in crohns disease will be

A

decreased

109
Q

diagnostic procedures for ulcerative colitis

A

colonoscopy
sigmoidoscopy
barium enema
CT scan/MRI
stool exam

110
Q

crohns disease diagnostic procedure

A

endoscopy
proctosigmoidoscopy
colonoscopy
abd US
barium enema

111
Q

life threatening inflammation of peritoneum and abdominal cavity lining

A

peritonitis

112
Q

cause of peritonitis

A

bacteria in peritoneal cavity

113
Q

nursing actions for peritonitis

A

place pt in fowlers (drain fluid)
monitor for hypovolemia
adminitser hypertonic IVF & antibiotics

114
Q

crohns disease diet

A

high protein diet

115
Q

ulcerative colitis diet

A

low fiber diet

116
Q

inflammation of gallbladder wall

A

cholecystitis

117
Q

cholelithiasis is

A

gallstones

118
Q

where is bile stored

A

the gallbladder

119
Q

cholecystitis risk factors

A

females
oral contraceptives
obesity
older pts
type 2 DM (high triglycerides)
crohns disease
rapid weight loss
native/mexican american

120
Q

cholecystitis would be felt where

A

RUQ radiating to right shoulder

121
Q

physical assessment test for cholecystits

A

murphys sign

122
Q

positive murphys sign

A

pain w/ deep inspiration during palpation of R subcostal

123
Q

food that causes pain in pt w cholecystitis

A

high fat food caused by biliary colic

124
Q

physical findings in cholecystitis pts

A

jaundice
icterus
clay colored stool
steatorrhea
dark urine

125
Q

cholecystitis WBC labs will be

A

increased (inflammation)

126
Q

cholecystitis blood bilirubin will be

A

increased

127
Q

cholecystitis amylase and lipase will be

A

increased

128
Q

AST, LDH & ALP can indicate what in cholecystitis

A

common bile duct is obstructed

129
Q

cholecystitis diagnosis exams

A

US
abd CT
hepatobiliary scan (HIDA)
endoscopic retrograde cholangiopancreatography
magnetic resonance cholangiopancreatography

130
Q

bile duct obstruction can cause

A

ischemia
gangrene
rupture of gallbladder wall

131
Q

a ruptured gallbladder can cause

A

bile peritonitis

132
Q

when can a pt eat a normal diet of choice after a cholecystectomy

A

upon discharge

133
Q

what pain would a pt s/p laparascopic cholecystectomy experience

A

shoulder pain (from free air introduced into the abdomen during surgery)

134
Q

what does chenodiol do?

A

dissolves gallstones over 2 years

135
Q

what does the pancreas secrete

A

insulin
glucagon

136
Q

autodigestion of pancreas by enzymes that activate early before reaching stomach

A

pancreatitits

137
Q

pancreatitis is felt where in the abdomen

A

LUQ, midepigastric and radiates to the back

138
Q

pancreatitis pain is worse when

A

lying down

139
Q

pancreatitis pain is relieved by what position

A

fetal position
sitting upright
bending forward

140
Q

what does insulin do to glucose

A

decreases it

141
Q

what does glucagon do to glucose

A

increases it

142
Q

lipase breaks down

A

lipids

143
Q

amylase breaks down

A

carbohydrates

144
Q

what worsend cholecystitis pain

A

movement and eating

145
Q

referred pain is

A

pain felt in different area than problem area

146
Q

nerves that elevate the diapraghm

A

frenic nerves

147
Q

pancreatitis risk factors

A

gallbladder stones
alcoholism
diet (high fat meal)

148
Q

pancreatitis meds

A

antibiotics
h2 receptor antagonists
PPIs
pancreatic enzymes

149
Q

hypercalcemia will cause pt to be

A

fatigued
bradycardia
hyperactive muscles

150
Q

what will pancreatitis do to blood glucose

A

increase

151
Q

pancrelipase should be given with what

A

every meal or snack

152
Q

what should pt do after taking pacrelipase

A

drink full glass of water

153
Q

what can you sprinkle pancrelipase on

A

non protein food

154
Q

severe, boring epigastric pain that radiates to back, left flank, or left shoulder is a sign of

A

pancreatitis

155
Q

gray-blue discoloration in periumbillical area is a manifestation of

A

pancreatitis

156
Q

inflammation of liver cells

A

hepatitis

157
Q

permanent scarring of liver that is caused by chronic inflammation

A

cirrhosis

158
Q

most common type of hepatitis

A

viral hepatitis

159
Q

can hepatitis be asymptomatic

A

yes

160
Q

hepatitis A is transmitted through

A

food/water contaminated w feces

161
Q

hepatitis B is transmitted through

A

blood

162
Q

you get hepatitis B from

A

unprotected sex w infected person
contact w infected blood
substance use disorder

163
Q

hepatitis C is transmitted through

A

blood

164
Q

hepatitis D is transmitted through

A

co-infection with hepatitis B

165
Q

hepatitis E is transmitted through

A

contaminated food/water

166
Q

physical manifestations of hepatitis

A

fever
vomiting
dark color urine
clay colored stool
jaundice

167
Q

HBV lab tests

A

ALT (elevated)
AST (elevated)
ALP (elevated)
total bilirubin (elevated)
HBV antibodies (will be present)

168
Q

normal ALT level

A

4-36 units/L

169
Q

normal AST

A

0-35 units/L

170
Q

normal ALP

A

30-120 units/L

171
Q

total bilirubin

A

0.3-1.0 mg/dL

172
Q

HCV labs

A

AST
ALP
ALT
total bilirubin
HCV antibodies
EIA
HCV PCR

173
Q

HDV labs

A

intrahepatic delta antigen identification
HDV antibodies

174
Q

hepatitis diagnostic procedures

A

liver biopsy

175
Q

what to do during liver biopsy

A

put pt in supine position w RUQ exposed
exhale and hold for 10 secs while needle inserted

175
Q

what to do during liver biopsy

A

put pt in supine position w RUQ exposed
exhale and hold for 10 secs while needle inserted

176
Q

post op liver biopsy

A

put pt in right side lying position
assess for pneumothorax

177
Q

medication for chronic HCV

A

antiviral medication

178
Q

HCV treatment

A

combination of peginterferon alfa-2a & ribavirin (antivirals)

179
Q

are there meds for HBV & HEV?

A

no only supportive care

180
Q

chronic hepatitis results from

A

HBV
HCV
HDV

181
Q

chronic hepatitis increases risk for

A

liver cancer

182
Q

post necrotic cirrhosis is caused by

A

viral hepatitis

183
Q

laennecs cirrhosis is caused by

A

chronic alcohol use

184
Q

biliary cirrhosis is caused by

A

chronic biliary obstruction or autoimmune disease

185
Q

s/s of cirrhosis

A

cognitive changes
GI bleeding
splenomegaly
ascites
jaundice
petechiae
red palms
spider angionomas

186
Q

cirrhosis labs

A

ALT (elevate)
AST (elevated)
ALP (elevated)
blood bilirubin (elevated)
blood protein (decreased)
blood albumin (decreased)
PT/INR (prolonged)
ammonia (increase)
creatine levels (increase)

187
Q

cirrhosis diagnostic procedures

A

US
CT
MRI
liver biopsy
EGD
ESRC

188
Q

monitor what for cirrhosis

A

resp status
skin integrity
fluid balance
vital signs
neurologic status
GI status
pain status

189
Q

meds for cirrhosis

A

diuretics
beta blocking agent
lactulose
nonabsorbable antibiotic

190
Q

procedures for cirrhosis

A

paracentesis
endoscopic sclerotherapy
transjugular intrahepatic portosystemic shunt
surgical bypass shunting procedures
liver transplant

191
Q

pre op for paracentesis procedure

A

assis pt to bathroom to void

192
Q

during paracentesis procedure

A

put pt supine with elevated bed head
apply dressing over puncture

193
Q

post op paracentesis procedure

A

measure fluids and document amount/color
send to lab
asses puncture site for drainage
weigh pt

194
Q

diet for pt with cirrhosis

A

high calorie mod fat
low sodium (ascites)
lowprotein (encephalopathy)
small frequent well balanced meals

195
Q

cirrhosis complications

A

hepatic encephalopathy
esophageal varices
acute graft rejection post liver transplantation

196
Q

medication for hepatic encepholopathy

A

lactulose (reduces ammonia)

197
Q

signs hepatic encepholopathy is worsening

A

asterixis (hand flapping)
fetor hepaticus (bad breath)

198
Q

HBV diet

A

high calorie high carbs

199
Q

inappropriate amounts of T3 and T4 indicate

A

hypo or hyperthyroidism

200
Q

what gland secretes TSH

A

anterior pituitary gland

201
Q

T3 normal range

A

70-205 in adults
40-180 in old ppl

202
Q

T4 normal range

A

4-12 mcg/dl up to 60 yrs old
5-11 mcg/dL over 60 y/o

203
Q

increased TSH indicates

A

hypothyroidism

204
Q

decreased TSH indicates

A

hyperthyroidism

205
Q

TSH normal range

A

0.3-0.5 mU/L

206
Q

hbA1c measures blood glucose for the past

A

120 days

207
Q

lab values of pt with SIADH

A

low sodium
increased urine osmolarity
high urine sodium
increased urine specific gravity

208
Q

excess growth hormone in adults w increased body part size but not height

A

acromegaly

209
Q

untreated acromegaly can cause

A

HTN
DM
cardiac issues

210
Q

acromegaly risk factors

A

age
benign tumors

211
Q

s/s of acromegaly

A

headaches
visual disturbance
joint pain
hyperglycemia
barrel chest

212
Q

types of diabetes insipidus

A

primary neurogenic
secondary neurogenic
nephrogenic

213
Q

defects in pituitary gland cause lack of ADH

A

primary neurogenic

214
Q

lack of ADH caused by infetions or tumors near pituitary gland

A

secondary neurogenic

215
Q

renal tubules that dont react to ADH

A

nephrogenic

216
Q

diabetes insipipidus urine labs will all be

A

decreased

217
Q

diabetes insipidus blood labs will be

A

increased

218
Q

meds for diabetes insipidus

A

desmopressin
chkorpramide
thiazide

219
Q

hyperthyroidism risk factors

A

graves disease
thyroiditis
toxic adenoma
toxic goiter

220
Q

synthroid hormone replacement

A

levothyroxine

221
Q

levothyroxine increases the effects of what drugs

A

warfarin

222
Q

levothyroxine is increased how often

A

every 2-3 weeks

223
Q

levothyroxine should be taken on

A

an empty stomach before breakfast

224
Q

how long is levothyroxine treatment

A

lifelong

225
Q

abnormal menstrual periods (mennorrhia)
dry skin
hoarseness are manifestations of

A

hypothyroidism

226
Q

methimazole treats

A

graves disease

227
Q

disease caused by long term gluccocorticoid use

A

cushings syndrome

228
Q

result of tumor in pituiatary gland resulting in release of ACTH hormone

A

cushing disease

229
Q

cushings disease risk factor

A

females 20-40

230
Q

cushings disease labs

A

cortisol levels (elevated)
urine (elevated free cortisol)
ACTH levels (elevated)
salivary cortisol (elevated)
blood potassium and calcium lvls (decreased)
blood glucose level (increased)
blood sodium level (increased)
lymphocytes (decreased)

231
Q

pt with cushings disease increased risk for

A

infection
gastric ulcer
bone fractures

232
Q

pt s/p transsphenoidal hyposectomy nasal drainage should be testes for

A

glucose

233
Q

primary addisons disease causes

A

autoimmune dysfunction
TB
histopasmosis
adrenalectomy
cancer w metastasis
abd radiation therapy

234
Q

secondary addissons disease causes

A

steroid withdrawal
hypophysectomy
pituitary neoplasm
high dose radiation of pituitary gland

235
Q

s/s of addissons disease

A

weight loss
salt craving
hyperpigmentation
weakness/fatigue
nausea/vomiting
abdominal pain
constipation/diarrhea

236
Q

addisons disease labs

A

blood electrolytes (increased)
BUN/Creatine (increased)
blood glucose (decreased)
blood/salivary cortisol (decreased)

237
Q

unable to produce insulin

A

type 1 DM

238
Q

diabetes screening `

A

BP greater than 140/90
HgA1c over 5.7%
HDL less than 35
triglycerides greater than 250 mg/dL

239
Q

rapid acting insulin is given

A

before meals

240
Q

rapid acting insulin onset

A

10-30 mins

241
Q

give rapid acting insulin with

A

intermediate or long acting insulin

242
Q

regular insulin (short acting) should be given

A

30-60 mins before meals

243
Q

NPH insulin (intermediate acting insulin) should be given

A

given between meals

244
Q

long acting insulin should be given

A

anytime but at the same time daily

exam 3 GI system (2 decks)

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