Everything for TEST 1! Flashcards
Similarities of Crohn’s and Ulcerative Colitis
Both a form of IBD (inflammatory bowel disease)
Both cause inflammation & ulcer formation
Cause is UNKNOWN- suggested due to a faulty immune system in overdrive…may be triggered by environment and genetics
Flare ups are common followed by remission
Increased risk of colon cancer
Cirrhosis complications
jaundice
ascites
portal hypertension
neurologic changes (buildup in ammonia that crosses blood brain barrier- delirium)
Medication used to decrease bilirubin levels
lactulose therapy
Leading cause of liver cancer:
cirrhosis
Major cause of cirrhosis
hepatitis c (major)
fatty liver can also induce cirrhosis
prolonged and excessive use of alcohol (alcohol subjects liver to stress)
clinical manifestations
Elevated liver enzymes (CBC, pro-thrombin)
distended abdomen
firm abdomen
weight loss, fatigue
dry skin, rashes, ecchymosis
vascular lesions with red center
tendency to bleed
spider angioma
clinical manifestations
Elevated liver enzymes (CBC, pro-thrombin)
distended abdomen
firm abdomen
weight loss, fatigue
diagnosis for liver cirrhosis
MRI
CT scan
Nonsurgical Interventions for cirrhosis
pain management
nutritional therapy
low sodium diet, fluid and electrolyte
Drugs to be given to cirrhosis patients
diuretics
antibiotics sometimes given
Hepatitis can occur during a
secondary infection
infection from another virus
Hepatitis can occur during a
secondary infection
infection from another virus
Hep A transmission
fecal-oral route
Hep B transmission
through sexual intercourse with affected parter
through contact with blood or other body fluids
symptoms of hep B
anorexia
nausea
fatigue
fever
right upper quadrant pain
joint pain
jaundice
light stool?
which hepatitis is waterborne
Hep E!
India, africa, Middle East, countries that don’t have source of clean water
which hepatitis is waterborne
Hep E!
major difference between chronic and acute hepatitis
chronic is reoccurring (chronic more specific to B and C)
acute: first attack, may progress to chronic
clinical manifestations of liver cancer
ascites
edema
Transplant complications
rejection!
infection
2 types of cholecystitis
acute
chronic
2 types of cholecystitis
acute
chronic
Goal of drug therapy for GI disorders is to treat:
peptic ulcers
nausea
constipation
diarrhea
IBS
IBD
Histamine2- Receptor Antagonists purpose:
Gastric and duodenal ulcers
heartburn, dyspepsia
Erosive esophagitis
Gastrointestinal reflux disease (GERD)
Aspiration pneumonitis
Hypersecretory disorders (Zollinger-Ellison syndrome [gastrin]), systemic mastocytosis [histamine])
Histamine2-Receptor Antagonist drugs:
Prototype drug: ranitidine hydrochloride (ZANTAC)
Cimetidine (TAGAMET)
Famotidine (PEPCID)
Physiologic change in compartment syndrome:
increased compartment pressure
increased capillary permeability
release of histamine
increased blood flow to area
pressure on nerve endings
increased tissue pressure
decreased oxygen to tissues
increased production of LACTIC ACID
muscle ischemia
tissue necrosis
Clinical findings of compartment syndrome:
edema
pulses present
pink tissue
pain
cyanosis
allow
unequal pulses
tense muscle swelling
tingling
numbness
severe pain unrelieved by drugs
paralysis
What is a fat embolism?
fat globules are released from the yellow bone marrow into the bloodstream within 12 - 48 hours after an injury or other illness
these globules clog small blood vessels that supply vital organs- most commonly the lungs, and impair organ perfusion
Fat embolism syndrome (FES) usually results from
fractures or fracture repair but occasionally is seen in patients who have total joint replacement
Early manifestations of FES:
hypoxemia
dyspnea
tachypnea
headache
lethargy
agitation
confusion
decreased level of consciousness
PETECHIA (a macular, measles-like rash may appear over the neck, upper arms and chest- NOT PRESENT IN DVT)
Factors that make patients with fractures most likely to develop venous thromboembolism
cancer/ chemotherapy
surgical procedure lasting longer than 30 minutes
history of smoking
obesity
heart disease
prolonged immobility
oral contraceptives
older adults (especially with hip fractures)
What is included in a neuromuscular assessment?
CSM!!
assess skin color
temperature
sensation
mobility
pain
pulses distal to fracture site
Can check capillary refill but not as reliable
“6 P’s” for ACS (Acute compartment syndrome)
Pain
Pressure
Paralysis
Paresthesia
Pallor
Pulselessness (rare)
Biggest risk factor for hip fractures:
osteoporosis
Most common complications of amputations:
hemorrhage
infection
phantom limb pain
neuroma
flexion contractures
Parietal cells secrete:
hydrochloric acid
intrinsic factor (substance that aids in absorption of vitamin b12)
chief cells secrete:
pepsinogen (precursor to pepsin, a digestive enzyme)
Liver stores:
many minerals and vitamins
iron
magnesium
fat soluble vitamins (ADEK)
Sequence for abdomen assessment (IAPP)
inspect
auscultate
percuss
palpate
Endoscopy is used to evaluate
bleeding
ulceration
inflammation
tumors
cancer of esophagus
stomach
biliary system or bowel
EGD is used for
a visual examination of the esophagus, stomach, duodenum
EGD preparation:
NPO 6-8 hours
Usual drug therapy for hypertension or other diseases may be taken morning of test (diabetics consult!)
avoid anticoagulants, aspirin, or other NSAIDS for several days before the test unless its absolutely necessary
Normally used drugs for sedation:
Midazolam hydrochloride (versed)
fentanyl (fentanyl, sublimaze)
propofol (deprivan)
ERCP is
visual and radiographic examination of the liver, gallbladder, bile ducts and pancreas to identify the cause and location of obstruction
Stomatitis:
inflammation within the oral cavity that may present in many different ways
canker sores
Primary stomatitis:
most common type
noninfectious stomatitis
herpes simplex stomatitis
traumatic ulcers
Secondary stomatitis:
generally results from infection by opportunistic viruses, fungi or bacteria in patients who are immunocompromised
can result from chemotherapy drugs
Drug therapy used for stomatitis:
antimicrobials
immune modulators
symptomatic topical agents
Foods that can trigger aphthous (noninfectious) ulcers:
coffee
potatoes
cheese
nuts
citrus fruits
gluten
Leukoplasia presents as
slowly developing changes in the oral mucous membranes causing
thickened, white, firmly attached patches that can’t be easily scanned off
slightly raised and sharply rounded
MOST COMMON LESION AMONG ADULT
Oral hairy leukoplakia is associated with
Epstein-Barr virus (EBV) and can be an early manifestation of HIV infection.
Erythroplakia appears as
red, velvety mucosal lesions on the surface and there are MORE malignant changes in this than in leukoplakia
often considered “precancerous”
Possible preparation for patient undergoing are surgical resection
placement of temporary tracheostomy, oxygen therapy and suctioning
temporary loss of speech because of tracheostomy
frequent monitoring of post op vital signs
NPO stays until intraoral suture lines are healed
Need to have IV lines in place for drug therapy
Most common upper GI disorder:
GERD!
Most common cause of GERD is:
Excessive relaxation of the LES, which allows the reflux of gastric contents into the esophagus and exposure of the esophageal mucosa to acidic gastric contents
Patients who are overweight or obese are at highest risk for development of GERD because
increased weight increases intra-abdominal pressure which contributes to reflux of stomach contents into the esophagus
Factors contributing to decreased lower esophageal sphincter pressure:
caffeinated beverages, such as coffee, tea, and cola
chocolate
citrus fruits
tomatoes and tomato products
smoking and use of tobacco products
calcium channel blockers
nitrates
peppermint, spearmint
alcohol
anticholinergic drugs
high levels of estrogen and progesterone
NG tube
Most accurate method of diagnosing GERD:
pH monitoring examination is most accurate
Foods to avoid with GERD
peppermint
chocolate
alcohol
fatty foods (especially fried)
caffeine
carbonated beverages
spicy and acidic foods (OJ, tomatoes)
Drugs that lower LES pressure and CAUSE reflex:
oral contraceptives
anticholinergic agents
sedatives
NAIDS (ibuprofen)
calcium channel blockers
3 MAJOR Drug therapy groups to manage GERD:
antacids
histamine blockers
proton pump inhibitors
these drugs also used for peptic ulcer disease
functions:
- inhibit gastric acid secretion
- accelerate gastric emptying
- protect gastric mucosa
Main drug therapy for GERD
Proton pump inhibitors (PPI’s) (given once a day)
omeprazole (prilosec)
rabeprazole (AcipHex)
pantoprazole (proton)
esomeprazole (nexium)
standard surgical approach for treatment of severe GERD
Laparoscopic Nissen fundoplication
2 major types of hiatal hernias
sliding hernia (most common)
paraesophageal (rolling) hernia
Type A chronic gastritis
refers to an inflammation of the glands as well as the fungus and body of the stomach
Type B chronic gastritis
usually affects the glands of the antrum but may involve the entire stomach
Atrophic chronic gastritis:
diffuse inflammation and destruction of deeply located glands accompany the condition
affects all layers of stomach
muscle thickens and inflammation is present
total loss of fundal glands`
Risks for gastritis
long term NSAID use
local irritation from radiation therapy
alcohol, coffee, caffeine, corticosteroids
accidental or intentional ingestion of corrosive substances
Most common form of chronic gastritis
type B gastritis caused by H. Pylori infection
Early pathologic manifestation of gastritis is
thickened, reddened mucous membrane with prominent rug (foldS)
Acute gastritis features:
rapid onset of epigastric pain or discomfort
N/V
Hematemesis
gastric hemorrhage
dyspepsia (heartburn)
anorexia
Chronic gastritis features:
vague report of epigastric pain relieved by food
anorexia
n/v
intolerance of fatty, spicy foods
Standard for diagnosing gastritis
Esophagogastroduodenoscopy (EGD)
Drugs to avoid with gastritis
corticosteroids
erythromycin
aspirin
saids
ibuprofen
