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Med Surg II > Exam 1: Lower GI > Flashcards

Exam 1: Lower GI Flashcards

1
Q

The lower GI consist of what ?

A
  • Large intestine
  • Small intestine
  • Rectum
  • Anus
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2
Q

Diarrhea is defined as ?

A

Loose or liquid stools - 3 or more a day

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3
Q

True or False: All diarrhea is considered infectious until tested ?

A

True

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4
Q

Causes of Diarrhea ?

A
  • Infections (viral, bacterial, parasitic)
  • medications
    - anything w/ magnesium in it
    - Antibiotics can interrupt the flora of the GI tract
  • immunocompromised
  • etc,.
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5
Q

How is Diarrhea managed ?

A
  • Tx the cause

- Replace fluid & electrolytes

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6
Q

What is a complication of Diarrhea ?

A

Dehydration

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7
Q

True or False: Immunocomprimised pt’s are at risk for C-Diff ?

A

True

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8
Q

Constipation is defined as what ?

A

Difficult or infrequent stools - < 3 per week)

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9
Q

What are some causes of Constipation ?

A
  • Diet
  • Lifestyle
  • Medications
    • Narcotics*** (OIC = opioid induced constipation)
  • Not enough daily fluid intake
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10
Q

What are some pt. education points about constipation ?

A
  • utilize Fiber !!
    • Miralax
    • Prunes
    • 2L of non-carinated liquid a day
  • Avoid chronic use of laxatives and enemas
    (can exacerbate constipation)
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11
Q

What is a complication of constipation ?

A

Hemorrhoids

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12
Q

Acute abdominal pain can be caused by what kinds of things ?

A
  • Inflammation
    • Appendicitis
    • Diverticulitis
    • Gastroenteritis
  • Peritonitis
    - Perforation or rupture
  • Obstruction
  • Internal bleeding
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13
Q

Acute abdominal pain caused by inflammation can be caused by what types of things ?

A
  • Appendicitis
  • Diverticulitis
  • Gastroenteritis
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14
Q

What can Peritonitis lead to ?

A

Septic shock

because abdominal contents are leaving the cavity they are meant for

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15
Q

True or False: Surgery may be needed for acute abdominal pain ?

A

True

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16
Q

Chronic abdominal pain can be caused by what types of things ?

A
  • IBS
  • Inflammation
    • IBD
  • Chronic pancreatitis
  • Hepatits
  • Adhesions
  • Vascular insufficiencies
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17
Q

Adhesions are caused by what ?

A

Previous abdominal surgeries

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18
Q

What is Hepatitis ?

A

Inflammation of the Liver

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19
Q

Vascular insufficiencies are common with the ______________ artery ?

A

Mesinteric artery

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20
Q

What is the Pathophysiology of Chronic Pancreatitis ?

A

Pancreatic enzymes can’t exit the pancreas, so they are sort of chewing up the pancreas. (aka: Autodigesting)

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21
Q

What are Manifestations of Appendicitis ?

A
  • RLQ pain (McBurney’s point)
  • Rebound tenderness (classic sign)
  • N & V
  • Fever (aka: febrile)
  • Leukocytosis (elevated WBCs)
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22
Q

What is Rebound Tenderness ?

A

When you press slowly and firmly, and then remove your hand/pressure quickly, and the pt. experiences more pain as you move your hand away

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23
Q

Where is McBurney’s point ?

A

Between the belly button and the right illiac crest

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24
Q

True or False: The surgery for the management of Appendicitis, is often done Laparscopically, especially if caught early or it didn’t rupture ?

A

True

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25
Q

What are we worried about If Appendicitis ruptures ?

A

periotonitis

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26
Q

True or False: people with laparoscopic appendectomies typically will not stay over night, but if they do its typically just one night ?

A

True

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27
Q

True or False: Pt’s with appendectomies can advance their diet as tolerated ?

A

True

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28
Q

How soon after an appendectomy can pt’s ambulate ?

A

A few hours after surgery

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29
Q

How soon after an appendectomy can pt’s resume normal activities ?

A

Within a few weeks (depending on doctor)

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30
Q

What is the main contributing factor for Diverticulitis ?

A

Diets without enough Fiber

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31
Q

Diverticulitis is more common with what type of diets ?

A

Western diets b/c we have more refined carbohydrates

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32
Q

What is Diverticulitis ?

A

Inflammation of the Diverticula

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33
Q

Where is Diverticulitis common in ?

A

Descending & Sigmoid colon

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34
Q

What are complications of Diverticulitis ?

A

perforation –> peritonitis or stricture –> Obstruction

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35
Q

Acute Diverticulitis problems are usually managed how ? and include things such as ?

A

managed outpatient

  • Colon rest
  • Clear liquids
  • If hospitalized NPO/NG
    - may or may not, it depends on if there having a lot of N&V
  • PO antibiotics
  • If hospitalized, IV antibiotics & fluids
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36
Q

What is the management/teaching focused on for Diverticulitis ?

A
  • High fiber diets** (fresh fruits, vegetables, low fat diet)
  • Fluids* (2-3L per day/ 8-10 glasses per day)
  • Stool softners* (to help w/ passage of stool through the lower colon)
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37
Q

Diverticulitis pain will present where ?

A

LLQ (descending part of colon)

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38
Q

True or False: If the Diverticulitis becomes to much of a problem, then it will need to be resected ?

A

True

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39
Q

What are the Manifestations of Periotonitis ?

A
  • Abdominal pain
  • Abdominal rigidity
  • N & V
  • Malaise
  • Fever
  • Increases WBC
  • Tachycardia
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40
Q

What is the Management of Periotonitis ?

A
  • NPO
  • IV fluids
  • Possible NG to low intermittent suction
  • IV antibiotics
    • If theres been a little bit of leakage into the abdomen
  • Pain management
  • Surgery –> drain
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41
Q

What is an intenstinal blockage ?

A

Bowel contents cannot pass through the GI tract

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42
Q

What is a MECHANICAL Intestional Obstruction also known as ?

A

Physical obstruction

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43
Q

Where does a mechanical obstruction usually occur ?

A

Small intestine (Because its skinnier)

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44
Q

What are causes of Physical Intestional Obstructions ?

A
  • Adhesions
  • Hernia
  • Strictures
  • Cancer
  • Volvulus (the bowel actually twists on itself and causes an obstruction)
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45
Q

What are Examples of Physical (Mechanical) obstruction ?

A
  • Tumor
  • Stool
  • Fibroid
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46
Q

What is a Non-mechanical Intestional Obstruction also known as ?

A

Peristalsis absence

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47
Q

What are causes of Non-mechanical Intestional Obstructions ?

A

Neuromuscular or Vascular disorders

Neuromuscular

  • Drugs
  • Nerves being turned off during surgery

Vascular disorders

  • Embolus
  • Atherosclerosis (maybe in the mesenteric artery)
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48
Q

What does a paralytic ileus = ?

A

No Peristalsis

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49
Q

What is Irritable Bowel Syndrome (IBS) defined as ?

A

Chronic intermittent abdominal pain

50
Q

True or False: IBS tends to be diagnosed on symptoms alone ?

A

True

51
Q

True or False: IBS comes and goes, and theres no known organic cause ?

A

True

52
Q

What are the 3 categories of IBS based on still patterns ?

A
  • IBS w/ diarrhea
  • IBS w/ constipation
  • IBS mixed
53
Q

IBS with Diarrhea is more common in which sex ?

A

Men

54
Q

IBS with Constipation tends to be more common in which sex ?

A

Women

55
Q

What is the goal of IBS ?

A

Treat symptoms & Avoid triggers

-Pt’s really have to try and identify what the triggers are and avoid them

56
Q

What are some triggers for IBS ?

A
  • Stress
  • Anxiety
  • Some foods
57
Q

True or False: With Inflammatory Bowel Disease, pt’s will have exacerbations & remissions ?

A

True

58
Q

True or False: With IBD theres often a…

  • Family history
  • Genetic predisposition
  • There may be an autoimmune component
A

True

59
Q

True or False: With IBD we often see widespread tissue destruction ?

A

True

60
Q

True or False: Environment can play a role in IBD ?

A

True

61
Q

True or False: You should never smoke with IBD, as it exacerbates the issue ?

A

True !

62
Q

What is the biggest thing were trying to encourage pt’s to do who have a bowel obstruction to try and get it resolved ?

A

Walk, Walk, Walk, Walk !!!!

Get them up and moving, and try to get the nerves to wake up!

63
Q

What is Tx for a Partial Bowel Obstruction ?

A
  • Usually put an NG in
  • Decompress
  • Let the abdomen rest
  • IV fluids
  • Wait for the obstruction to clear
    - Sometimes even the physical obstructions will back off after a while. SAME thing with the Non-mechanical, where we have the nerves that have gone to sleep and were waiting for them to wake up
64
Q

What is the Tx for a complete bowel obstruction ?

A

The pt. may need surgery

- they may need to resect that part of the intestine.

65
Q

What is a Malignant Bowel Obstruction ?

A

Part of the intestine is narrowed, b/c theres cancer pushing on it.;

66
Q

What is the Tx for a Malignant Bowel Obstruction ?

A

They can try and go in and place a stent in the small intestine to try and keep that part of the intestine open.

67
Q

True or False: Crohn’s disease can occur throughout any part of the small or large intestine (aka: Anywhere) ?

A

True!

68
Q

Crohn’s disease most commonly affects what ?

A

The small intestine

69
Q

Ulcerative colitis involves what ?

A

The colon ONLY (Left side of the abdomen)

  • descending colon & Sigmoid colon
70
Q

Ulcerative Colitis is a disease of what ?

A

The Large intestine (colon) & Rectum

71
Q

____________________ is Chronic inflammation of the intestinal tract ?

A

Ulcerative Colitis

72
Q

What disease has an increased risk of colon cancer ?

A

Ulcerative Colitis

  • Because of the continuous ulceration, inflammation, & irritation of the colon. Whenever tissue is injured repeatedly, the cell structure changes and then theres more of a chance for a change to malignant or cancerous tissues.
73
Q

True or False: With Ulcerative Colitis there is…

  • bleeding & shallow ulcers of the colon ?
  • Abscess formation ?
  • Colon becomes thin and fragile ?
A

True

74
Q

What are Manifestations of Ulcerative Colitis ?

A
  • Bloody Diarrhea (w/large amounts of fluid & electrolyte loss)
  • Abdominal pain
  • Fever
  • Weight loss
  • Rectal bleeding (more common with UC)
75
Q

What are some intestinal complications with Ulcerative Colitis ?

A
  • Hemorrhage
  • Strictures
  • Perforation
  • Toxic Megacolon
  • Colonic dilation
76
Q

What is Toxic Megacolon ?

A

A shift of fluid into the Lumen of the Large intestine

77
Q

What is Colon dilation ?

A

The colon will be stretched as the bowel contents are trying to pass through

78
Q

What diagnostics are used to manage Ulcerative Colitis ?

A
  • Colonoscopy (can see entire colon)

- Sigmoidoscopy (can only visualize lower colon)

79
Q

What are the goals of treatment for the management of Ulcerative Colitis ?

A
  • Bowel rest (may involve NPO, clear liquids - depends on situation)
  • Control inflammation (may use steroids, immunosuppressants, etc.) (example of a medication = Sulfasalazine (anti-inflammatory))
  • Combat infection (w/antibiotics/antimicrobials)
  • Correct malnutrition (Can be done w/ TPN - depending on how long the pt. is unable to eat)
  • Alleviate stress
  • Symptomatic relief with drug therapy
    - pain meds & anti-anxiety meds can be used
80
Q

What is the Management of Mild to Moderate Ulcerative Colitis ?

A
  • Low-roughage diet - no milk or milk products
  • Antimicrobials (to prevent or treat secondary infections
  • Sulfasalazine (anti-inflammatory effects)
  • Anti-inflammatory (corticosteroids)
  • Anticholinergics
    • Decrease gastric motility, relief of smooth muscle spasm (Ex: Dycyclomine)
81
Q

There should be caution not to use Anticholinergics with what ?

A

Toxic megacolon or Severe disease

82
Q

What is the Tx for Severe Ulcerative Colitis ?

A
  • IV fluids & electrolytes
  • Blood transfusions
    • b/c they have bleeding or hemorrhage with the UC
  • NPO (may have TPN to meet their nutritional needs
  • NG tube to LES
  • Antimicrobials
  • Steroids
  • TPN (if needed)
  • Surgery if no improvement with the above interventions
    - Colon resection with ileostomy
83
Q

What type o Surgery is done if there is no improvement with UC interventions ?

A

Colon resection with Ileostomy

84
Q

True or False: Crohn’s disease can really occur anywhere in the GI tract (mouth to anus) ?

A

True

85
Q

What is Crohn’s disease ?

A

Chronic Nonspecific inflammatory bowel disease

86
Q

Where is Crohn’s disease frequently seen in ?

A

Terminal Ileum (small intestine)

87
Q

What is the internal appearance of Crohn’s disease ?

A

Cobble stone formation

88
Q

True or False: With Crohn’s disease there can be Malabsorption & nutritional deficiencies ?

A

True

89
Q

What are concerns with Crohn’s disease ?

A
  • Fissures
  • Strictures
  • Abscesses
  • Perforation
90
Q

__________: Are sort of like irritations, scratches, abrasions of the intestional tissues ?

A

Fissures

91
Q

__________: Are narrowing due to inflammatin ?

A

Strictures

92
Q

__________: Are pus filled pockets ?

A

Abscesses

93
Q

Whats the main thing to keep in mind about the manifestations of Crohn’s disease ?

A

Depends on which area is involved

94
Q

True or False: Crohn’s disease is insidious and nonspecific, making it hard to pin down ?

A

True

95
Q

What are the Manifestations of Crohn’s disease ?

A
  • Diarrhea (usually not bloody)
    • could be up to 20 to 25 per day
  • Fatigue
  • Abdominal pain
  • Weight loss
  • Fever
96
Q

What does the collaborative management do Crohn’s disease involve ?

A
  • High calorie, High protein, High vitamin, Low residue, milk free diet! (NO LACTOSE!)
  • Antimicrobials
    • If we think theres a risk for infection
  • Corticosteroids
    • To reduce inflammation of the intestine
  • TPN if necessary
  • Physical & Emotional rest
  • Possible surgery
97
Q

When managing Crohn’s, what does a Low residue diet mean ?

A

NO fruits or vegetables ! when somebody is having a flair

98
Q

When managing Crohn’s why do we want pt. to have a milk free diet (No lactose) ?

A

B/c we don’t want things to move any faster through the GI tract than it already is !

  • we want things to slow down :)
99
Q

What are type of Malobsorption Syndromes ?

A
  • Celiac Disease
  • Lactase deficiency
  • Short bowel syndrome
100
Q

True or False: Celiac disease is an Autoimmune disease ?

A

True

101
Q

What is Celiac disease related to ?

A

Gluten !!

102
Q

What is Celiac disease ?

A

Damage to the small intestine that occurs from wheat, barley, and rye

*it ends up causing a protein, fat, carbohydrate metabolism

103
Q

To manage the disease, many people with Celiac disease do what ?

A

go Gluten Free !!

people will instead tuen to corn, rice, etc

104
Q

True or False: Gluten is a substance in wheat, barley, and rye that causes a problem ?

A

True

105
Q

Individuals with a lactase deficiency will typically experience what types of symptoms ?

A
  • Bloating
  • Gas
  • Cramping
  • Diarrhea
  • etc,.
106
Q

True or False: Lactase is typically present and needed for the breakdown of Lactose ?

A

True

107
Q

With what syndrome is there not enough surface area in the small intestine to absorb the nutrients that are required for adequate nutrition ?

A

Short Bowel Syndrome

  • generally we say that 2/3 of the bowel has been resected…
108
Q

What is the Tx for Lactase deficiency aimed at ?

A

Generally aimed at avoiding lactose, and also taking a Lactase supplement

109
Q

What are the Manifestations of Short Bowel Syndrome ?

A
  • Chronic Diarrhea

- Vitamin & Mineral deficiencies

110
Q

What is the Tx for Short Bowel Syndrome ?

A

Small frequent meals

  • some people may require tube feedings at night to get all the nutrients that they are not getting during the day
111
Q

__________ are defined as, a protrusion of an internal organ such as the intestines through an opening or weakness in the abdominal wall ?

A

Hernia(s)

112
Q

What are types of Lower GI Hernias ?

A
  • Inguinal
  • Umbilical
  • Femoral
  • Ventral or Incisional
113
Q

What type of Hernia is the Most common ?

A

Inguinal

114
Q

Where is an Inguinal Hernia typically located ?

A

Down in the groin area

115
Q

With Inguinal Hernia’s the intestine is either slipping through the ___________________ in men or the __________________ in females ?

A 
Men = Spirmadic cord
Women = Round Ligament
116
Q

__________ Hernia, is where the rectus muscle gets muscle gets weakened in the abdomen & you see a protrusion of the intestine, right around the belly button area ?

A

Umbilical Hernia

117
Q

________ Hernia, occurs when the intestines sort of slips through the femoral vein ?

A

Femoral Hernia

118
Q

_________ or _________ Hernias are weakened areas due to the site of a previous surgical incision (ex: C-section scar)

A

Ventral or Incisional Hernia

119
Q

What is the Management/Treatment of Hernia’s ?

A
  • Generally includes surgery
    • Very often Laproscopically
    • surgeon typically goes in and reinforces the weakened area with mesh
  • Lifting restrictions (< 10lbs for 6-8 weeks)
120
Q

A ___________ Hernia, mean that the bowel has been pinched and lost circulation ?

A

Strangulated Hernia

  • In this case part of the bowel may need to be resected (the dead part)

Med Surg II (13 decks)

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