Exam 1 Flashcards
Digestion
begins with the act of chewing, in which food is broken down into small particles that can be swallowed and mixed with digestive enzymes
Absorption
Absorption is the major function of the small intestine. Vitamins and minerals absorbed are essentially unchanged. Absorption begins in the jejunum and is accomplished by active transport and diffusion across the intestinal wall into the circulation
Elimination
phase of the digestive process that occurs after digestion and absorption when waste products are eliminated from the body
Chyme
mixture of food with saliva, salivary enzymes, and gastric secretions that is produced as food passes through the mouth, esophagus, and stomach
Amalase
an enzyme that aids in the digestion of starch
dyspepsia
indigestion; upper abdominal discomfort associated with eating
hydrochloric Acid
acid secreted by the glands in the stomach; mixes with chyme to break it down into absorbable molecules and to aid in the destruction of bacteria
intrinsic Factor
a gastric secretion that combines with vitamin B12 so that the vitamin can be absorbed
Lipase
an enzyme that aids in the digestion of fats
Pepsin
a gastric enzyme that is important in protein digestion
trypsin
enzyme that aids in the digestion of protein
microbiota
the complement of microbes in the GI tract
gingivitis
inflammation of the gums
Periapical abscess
abscessed tooth. Acute infection or chronic slow progressive infection.
Presence of pus in the apical dental periosteum and tissue surrounding the apex
Clinical manifestations: pain, cellulitis, facial edema, fever, malaise
Managing a peripheral abscess
Medical
Needle aspiration
Drill opening to relieve pressure, pain, and promote drainage
After acute phase tooth may be extracted
Antibiotics
Nursing
Assess for bleeding
Instruct to use warm saline/water rinse
Take antibiotic and analgesic
Keep follow up appointment
Parotitis
inflammation of the parotid gland
sialadenitis
inflammation of the salivary glands
sialolithiasis
salivary stones
Neoplasms
Leukoplakia
white patches in the buccal mucosa
- may become malignant
Oral hairy Leukoplakia: potentially viral, typically found on the tongue
Lichen Planus
Radiating white striations on the tongue and buccal mucosa
Erythroplakia
red patch on the oral mucosa
kaposi sarcoma
Appears first on the oral mucosa as red, purple or blue lesions
stomatitis
Erythema and edema of the oral mucosa
manifestations of oral cancer
Early Stage
Few or no symptoms in early stage
Painless sore or mass that does not heal; indurated ulcer with raised edges
Lesions that do not heal within 2 weeks should be reported
May bleed easily and present with red or white patch
Later manifestations include:
Complaints of tenderness
Difficulty in chewing, swallowing, or speaking
Coughing up blood-tinged sputum
Enlarged cervical lymph nodes
3 main types of oral cancer
Squamous cell carcinoma
Most common
May be present on lips, tongue, buccal mucosa and oropharynx
Basal Cell
Affects the lips and skin around the mouth
Kaposi’s sarcoma
Can be found on the hard palate, gums, tongue or tonsils
xerostomia
dry mouth
radical neck dissection surgery
A radical neck dissection involves removal of all cervical lymph nodes from the mandible to the clavicle and removal of the sternocleidomastoid muscle, internal jugular vein, and spinal accessory muscle on one side of the neck
The associated complications include shoulder drop and poor cosmesis (visible neck depression)
Modified radical neck dissection used more often
Leaves sternocleidomastoid intact
chyle fistula
Milk like drainage from the thoracic lymphatic duct into the thoracic cavity
achalasia
Absent or ineffective peristalsis of the distal esophagus by failure of the esophageal sphincter to relax in response to swallowing
Treatment
Pneumatic Dilation
Diverticula
Out-pouching of mucosa and submucosa that protrudes through a weak portion of the esophagus
Most common type: Zenker Diverticulum
May need to be surgically removed
( things can go into then and that can increase the risk for infection)
Barrett’s Esophagus
Lining of the esophageal mucosa to resemble the intestinal mucosa
Occurs in association with GERD
Only precursor to Esophageal Adenocarcinoma
( just because you have barrett’s does not mean you are going to get the cancer. )
Hiatal Hernia
located in the opening of the diaphragm
dysphagia
difficulty swallowing
odynophagia
pain on swallowing
GERD Gastroesophageal reflux disease
Common disorder marked by backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus
Excessive reflux may occur because of an incompetent lower esophageal sphincter, pyloric stenosis, hiatal hernia, or a motility disorder
Antacids
Calcium antacids (TUMS) may lead to the development of kidney stones and increased gastric acid secretion.
Antacids containing magnesium must be avoided in patients with renal failure.
Sodium bicarbonate is a highly soluble antacid form with a quick onset but short duration of action. (contraindicated for patients with hypertension or heart issues)
H2 Receptor Antagonists
Cimetidine
Ranitidine
Famotidine
Inhibits action of histamine on H2 receptor sites of parietal cells decreasing gastric acid secretion
* can cause confusion in elderly*
Adverse Reactions: CNS: Dizziness, confusion
GI: Constipation, diarrhea
Indications:GERD (gastroesophageal reflux disease)
-Erosive Esophagitis
-Peptic ulcer disease
-Adjunct therapy in the control of upper GI bleeding
Proton Pump Inhibitors
Omeprazole
Pantoprazole
Lansoprazole
Inhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphate, located at secretory surface of gastric parietal cells, to suppress gastric acid secretion
* take 30 min to an hour before 1st meal.*
Adverse Reactions: GI: Diarrhea, abdominal pain, possible predisposition to C. Diff
Musculoskeletal: Long term use potentially linked to osteoporosis
Indications: - H. Pylori
-NSAID induced ulcers
-Erosive esophagitis
-Symptomatic GERD that is unresponsive to H2 Receptor Antagonists
Gastritis
Inflammation of the stomach
Acute: rapid onset of symptoms usually caused by dietary indiscretion. Other causes include medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications
Chronic: prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori. May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile
Peptic Ulcer Disease
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum (most common), or esophagus
Manifestations include a dull gnawing pain or burning in the midepigastrium; heartburn and vomiting may occur
Treatment includes medications, lifestyle changes, and occasionally surgery
H. Pylori infection is most common cause. (antibiotics needed)
NSAIDs
Contraindicated in GI issues
Misoprostol
Prevention of ulcers related to NSAID (taking nsaids for a long time)
Gastric Ulcer
pain 30-60 mins after meal. less pain at night. malnourished, weight loss. Hematemesis: vomiting blood (looks like coffee grounds).
Duodenal ulcer
Pain 1.5-3 hours after meals. wakes up with pain during the night. pain relieved by ingestion of food or antacid. well nourished. Melena (blood in the stool).
The most common site for peptic ulcer formation is
the pylorus
Perforation
board-like ridged abdomen. this can be fatal. GI contents are going everywhere in the body
Penetration
erosion into the surrounding structures. most common site is the pancreas.
Pyloric obstruction
gastric outlet obstruction
- feels full easily, nauseous, vomiting profusely.
NG tube can be used.
Meds given for ulcers
H2 end in dine (elderly can become confused
PPI end in zole. (can cause osteoporosis long-term use)
Zollinger-Ellison syndrom (ZES)
Rare condition
Benign or malignant tumors of the pancreas and duodenum that secrete high levels of the hormone gastrin (promotes the release of hydrochloric acid)
Suspected when a patient has several peptic ulcers, or ulcers that are resistant to medications
Treatment includes
Medication (Acid-controlling medications)
Potential Chemotherapy
Surgical removal of gastrinomas
Any condition that causes the body to reproduce cells and heal rapidly can cause
CANCER
Patient coming in with GI issues are
NPO
Steatorrhea
Fatty Stools, decrease fat intake
If patient has diarrhea why are they given a CBC
Checks their WBC for infection, electrolyte imbalance (potassium: heart)
Fecal Management System
catheter for the rectum, poop goes into a bag to prevent skin irritation.
IBS irritable bowel syndrome
Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both
15% of adults in the United States report symptoms of IBS; More common in women than men
Triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis, and some foods
malabsorption
The inability of the digestive system to absorb one or more of the major vitamins, minerals, or nutrients
Conditions:
Mucosal (transport) disorders
Infectious disease
Luminal disorders
Postoperative malabsorption
Disorders that cause malabsorption of specific nutrients
Celiac Disease
disorder of malabsorption caused by an autoimmune response to the consumption of products that contain the protein gluten
gluten free diet
Appendicitis
Appendicitis is the most frequent cause of acute abdomen in the United States, most common reason for emergency abdominal surgery
Appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith or lymphoid hyperplasia
The inflammatory process increases intraluminal pressure, causing edema and obstruction of the orifice
Once obstructed, the appendix becomes ischemic, bacterial overgrowth occurs, and eventually gangrene or perforation occurs
Rovsing’s sign
Appendicitis assessment
Pain felt in the right lower quadrant with palpation of the left lower quadrant
McBurney’s Point
Appendicitis assessment
Pain in the right lower quadrant associated with appendicitis
Psoas Sign
Appendicitis assessment
pain when leg is lifted against resistance while lying supine
Obturator Sign
Appendicitis assessment
pain with slow internal movement of the hip joint while the knee is flexed
Diverticular Disease
Diverticulum: sac-like herniation of the lining of the bowel that extends through a defect in the muscle layer
May occur anywhere in the intestine but most common in the sigmoid colon
Diverticulosis: multiple diverticula without inflammation
Diverticulitis: infection and inflammation of diverticula
Diverticular disease increases with age and is associated with a low-fiber diet
Diagnosis is usually by colonoscopy
(antibiotics will be given)
Intestinal Obstruction
Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents through the intestinal tract
Mechanical obstruction:
Intraluminal obstruction or mural obstruction from pressure on the intestinal wall (can be Fecal Matter)
Functional or paralytic obstruction:
The intestinal musculature cannot propel the contents along the bowel
The blockage also can be temporary and the result of the manipulation of the bowel during surgery
(patient will be NPO or have an NG tube)
Inflammatory Bowel Disease
Crohn’s disease (regional enteritis). Colectomy can be used to treat
Ulcerative colitis: more localized. bleeding is more common
(corticosteroids used to help with inflammation. they can increase sugar so watch diabetics)
Indications for parenteral nutrition
Intake is insufficient to maintain anabolic state
Ability to ingest food orally or by tube is impaired
Patient is not interested or is unwilling to ingest adequate nutrients
The underlying medical condition precludes oral or tube feeding
Preoperative and postoperative nutritional needs are prolonged
If TPN fluid runs out what must you have on hand to give patient?
Dextrose solution 10%
Anorectal Conditions
Proctitis: inflammation of the rectum
Anorectal abscess
Anal fistula: Small tunnel between the end of the bowel and the skin near the anus
Anal fissure: Small tear in the lining of the anus
Hemorrhoids
Pilonidal sinus or cyst: Abnormal growth at the tailbone that contains skin and hair
cheilitis
chapped lips
80ml-120ml ?
jp drain
BMI
Height and weight to determine BMI
Overweight = BMI 25 to 29.9
Obese = BMI exceeding 30
Severe/extreme obese = BMI exceeding 40
HA1c Lab test
shows how glucose is from the last 3 months
Sympathomimetic Amines
Approved by the FDA for short term use-no more than 12 weeks
Phentermine & Benzphetaminefor obesity
Stimulates sympathetic system (flight or flight)
Adverse Reactions
Palpitations and tachycardia
Tremors
Hypertension
Dizziness, insomnia, restlessness
Diarrhea or constipation
Naltrexone/Bupropion
for obesity
Inhibits central opioid receptors and inhibits reuptake of dopamine and norepinephrine, resulting in diminished appetite and cravings
Vagal Blocking for obesity
Blocking of vagus nerve via implanted device
Slows gastric contraction and emptying
Few side effects
Intragastric balloon therapy
Endoscopic placement of saline-filled balloon
Remains in place for 3 to 6 months
Adverse effects: N and V, balloon rupture causing obstruction
Bariatric Surgery
Results in weight loss of 10% to 35% body weight within 2 to 3 years
Improvement in comorbid conditions
Selection by multidisciplinary team
Selection criteria has changed to include BMI of 30 for patients with comorbid conditions
Surgery is performed only after nonsurgical methods have failed
Bariatric Procedures
- Roux-en-Y gastric bypass (RYGB): most common, small top pouch of stomach (20-30ml capacity) attached to the small intestine.
- Gastric banding: it is reversible. 15-20ml capacity
- Sleeve gastrectomy: most common, smaller stomach
- Biliopancreatic diversion with duodenal switch
- Performed by laparoscopy or by an open surgical technique
Metabolic Functions of the liver
Glucose metabolism: stores as glycogen
Ammonia conversion
Protein metabolism
Fat metabolism: fat broken down by bile
Vitamin and iron storage
Bile formation
Bilirubin excretion
Drug metabolism
Liver Function Tests
ALT: liver test. elevated is liver issues/failure
AST: elevated can be liver or something else in the system
GST: grandma got trashed. elevated for related to alcohol.
Alanine aminotransferase (ALT) 8-40 U/mL: levels increase primarily in liver disorders; used to monitor the course of hepatitis, cirrhosis, the effects of treatments that may be toxic to the liver
Aspartate aminotransferase (AST)10-40 U/mL: not specific to liver diseases however levels of AST may be increased in cirrhosis, hepatitis, and liver cancer
Gamma-glutamyl transferase (GGT) 10-30 U/L: levels are associated with cholestasis; alcoholic liver disease
Serum aminotransferases: indicators of injury to the liver cells; useful in detecting hepatitis
More Lab tests for the liver
Serum Bilirubin (pigment derived from the breakdown of hemoglobin), total 0.3 to 1 mg/dL: Measure the livers ability to conjugate and excrete bilirubin. High in biliary tract disease. Associated with jaundice clinically
Serum Albumin 3.5 to 5.5 g/dL: Proteins are manufactured in the liver. Levels decreased in a variety of hepatic impairments
Prothrombin time 12-16 seconds: May be prolonged in liver disease. It will not return to normal with Vit K in severe liver cell damage
Ammonia 15-45 mcg/dL: Liver converts ammonia to urea. Ammonia level rises in liver failure
Hepatocellular Jaundice
Mild or severely ill
Lack of appetite, nausea or vomiting, weight loss
Malaise, fatigue, weakness
Headache, chills, fever, infection
Obstructive Jaundice
Dark orange-brown urine, clay-colored stools
Dyspepsia and intolerance of fats, impaired digestion
Pruritus
Ascites
condition in which fluid collects in spaces within your abdomen
Treatment:
spironolactone is the diuretic of choice.
Paracentesis
salt-poor albumin
transjugular intrahepatic portosystemic shunt (TIPS)
peritoneovenous-ascites
Portal Hypertension
Obstructed blood flow through the liver results in increased pressure throughout the portal venous system
Results in:
Ascites
Esophageal varices: varicose veins
Hepatic Encephalopathy
Ammonia (should be 15-45) building up, gets into the blood stream and can cause swelling of the brain.
Two major alterations underlie its development in acute and chronic liver disease
Hepatic insufficiency: the inability of the liver to detoxify toxic by-products of metabolism
Portosystemic shunting: collateral vessels develop allowing elements of the portal blood (laden with potentially toxic substances usually extracted by the liver) to enter the systemic circulation
Early signs: mental changes and motor disturbances
Asterixis
Inability to hold the hand in a flexed position
Apraxia
Inability to reproduce a simple figure in two or three dimensions is referred to as constructional apraxia
Spironolactone (aldactone)
patients with ascites from cirrhosis. It is potassium sparing.
Oral diuretics such as furosemide (Lasix) may be added but should be used cautiously. Ammonium chloride and acetazolamide (Diamox) are contraindicated because of the possibility of precipitating hepatic coma
Esophageal Varices
enlarged veins in the esophagus
Occurs in about one third of patients with cirrhosis and varices
First bleeding episode has a mortality rate of 10% to 30% depending on severity
Manifestations include hematemesis, melena, general deterioration, and shock
Patients with cirrhosis should undergo screening endoscopy every 2 to 3 years
Treatment of bleeding Varices
- Treat for shock; administer oxygen
- IV fluids, electrolytes, volume expanders, blood and blood products
- Vasopressin (ADH), somatostatin (growth hormone), octreotide to decrease bleeding
- Vasopressin (antidiuretic hormone) in combination with nitroglycerin to reduce coronary vasoconstriction
- Propranolol and nadolol to decrease portal pressure; used in combination with other treatment
- Balloon tamponade
Hepatitis
Viral hepatitis: a systemic viral infection that causes necrosis and inflammation of liver cells with characteristic symptoms and cellular and biochemical changes
A and E: fecal–oral route
B and C: bloodborne
D: only people with hepatitis B are at risk
Hepatitis G and GB virus-C
Nonviral hepatitis: toxic and drug induced
Fulminant Liver Failure
The liver just shuts down. Transplant is what you need.
Cirrhosis
Scarring of the liver and hypertension on the hepatic portal vein.
Lactulose
reduce serum ammonia levels
May lead to diarrhea (dehydration), hypokalemia and GI bleeding
Amalayse
breaks down carbs
Lipase
Breaks down fats
Cholecystitis
inflammation of the gallbladder
cholelithiasis
calculi in the gallbladder
Medical treatment of Cholelithiasis
ERCP: Endoscopic retrograde cholangiopancreatography
- Gallstone removal can be done during this procedure
Dietary management: Low fat diet, avoid gas forming foods
Laparoscopic cholecystectomy: Open approach- JP drain or T-tube may be placed
Nonsurgical removal
- By instrumentation
- Intracorporeal (within the body) or extracorporeal lithotripsy (outside the body)
Pancreatitis
Acute: pancreatic duct becomes obstructed (like from a moving gallstone), and enzymes back up, causing autodigestion and inflammation of the pancreas
Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
Pancreatitis
Acute: pancreatic duct becomes obstructed (like from a moving gallstone), and enzymes back up, causing autodigestion and inflammation of the pancreas
Chronic: progressive inflammatory disorder with destruction of the pancreas; cells are replaced by fibrous tissue; pressure within the pancreas increases, obstructing the pancreatic and common bile ducts. (common with alcohol)
Turner’s Sign in pancreatitis
Ecchymosis on flank
Cullen’s sign in pancreatitis
Bluish-gray periumbilical discoloration
Chvosteks’s Sign in pancreatitis
facial twitching when facial nerve is tapped
Trousseau’s Sign in pancreatitis
hand spasm when blood pressure cuff is inflated
Lab tests for pancreatitis
Serum Amylase (Digestion of carbohydrates)
Normal range 25-150 U/L
Increase within 12 to 24 hours and remains elevated for 2 to 3 days
Serum Lipase (Breaks down fats)
Normal range 10-140 U/L
Increases slowly, but remains elevated for up to 2 weeks
Cholesterol stones can be given medications to be broken up.
Ursodiol link (Actigall) and chenodiol link (Chenix)
monitor liver when taking the drugs.
Pigment stones
can be broken up inside or outside of the body or use ERCP
