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NURS 502 > Exam 2 - GI problems (need to know) > Flashcards

Exam 2 - GI problems (need to know) Flashcards

1
Q

Gallbladder disease risk factors

A
  • Native American
  • Over age 40
  • Female
  • Family history
  • Diet
  • Medications (estrogen, OCP, thiazide)
  • Obesity
  • Rapid weight loss
  • History of gastric bypass surgery
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2
Q

Acute versus chronic cholecystitis

A

Acute: less than 1 month

Chronic: longer than 3 months

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3
Q

Symptomatic cholelithiasis symptoms

A

Presents as biliary colic

  • Intermittent or steady RUQ abdominal pain
  • Radiates to right posterior shoulder within one hour of eating a large meal with high fat content
  • Pain lasts 1-6 hours
  • Nausea and vomiting
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4
Q

Charcot triad for cholelithiasis

A
  • RUQ pain
  • Fever
  • Jaundice
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5
Q

Cholecystitis patient presentation

A
  • Recurrent, mild to moderate RUQ and epigastric abdominal pain
  • Nausea and vomiting
  • Pain may radiate to right shoulder; worse after eating fatty foods
  • Fever
  • Loss of appetite
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6
Q

Cholecystitis physical exam findings

A
  • Positive Murphy’s sign (inability to take a deep breath because of discomfort during palpation beneath right costal margin)
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7
Q

Cholangitis patient presentation

A

Same as cholecystitis plus

  • Jaundice
  • Altered mental status
  • Shock/sepsis
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8
Q

Diagnostic labs for cholecystitis and cholangitis

A
  • CBC with diff
  • Urinalysis
  • LFT
  • Pancreatic enzymes
  • BUN and creatinine (renal function and electrolyte balance)
  • CMP
  • hCG if childbearing age
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9
Q

Gold standard imaging for gallstones

A

Abdominal ultrasound

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10
Q

Pharmacologic treatment of symptomatic gallbladder disease

A

Isotonic IV rehydration and correction of electrolyte imbalances

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11
Q

Pharmacologic treatment for uncomplicated cholelithiasis

A
  • Antispasmodic
  • Antiemetic
  • NG tube for stomach decompression with protracted vomiting
  • NSAIDs, narcotics for pain control
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12
Q

When are ursodeoxycholic acid and/or chenodeoxycholic acid indicated for gallstone dissolution?

A
  • Patients with mild symptoms
  • Stone size <0.5-1 cm
  • Normal gallbladder function
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13
Q

What is the gold standard treatment for symptomatic gallbladder disease?

A

Laparoscopic cholecystectomy

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14
Q

Gallbladder disease patient education

A
  • Lifestyle and diet modifications (especially if obese)
  • Complications include blockage of common bile duct → symptomatic gallbladder disease requires surgery
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15
Q

Volume repletion rate for mild dehydration (pediatrics)

A

50 mL/kg over 4 hours

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16
Q

Volume repletion rate for moderate dehydration (pediatrics)

A

100 mL/kg over 4 hours

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17
Q

Volume repletion rate for severe dehydration (pediatrics)

A

NS or LR IV 20 mL/kg bolus

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18
Q

Pyloric stenosis risk factors

A
  • Preterm
  • Male
  • Caucasian first born male
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19
Q

Pyloric stenosis - HPI

A
  • Regurgitation and non projectile vomiting during first few weeks of life
  • Projectile, non bilious vomiting at 2-3 weeks of life
  • Insatiable appetite with weight loss, dehydration, constipation
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20
Q

Pyloric stenosis - physical exam findings

A
  • Weight loss
  • Non bilious vomiting immediately after feeding
  • “Olive” shaped mass in epigastrium to right of midline
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21
Q

Imaging indicated for pyloric stenosis

A

Ultrasound

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22
Q

Pyloric stenosis management

A

Surgical intervention (pyloromyotomy) indicated after correcting fluid and electrolyte imbalances

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23
Q

GI specialist referrals are indicated when…

A
  • Suspected GI bleed
  • Bowel obstruction
  • Orthostatic vital sign changes
  • Jaundice
  • Positive pregnancy test
  • Severe localized or unilateral lower abdominal pain
  • Any indication of peritoneal irritation
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24
Q

Appendicitis HPI

A
  • Epigastric or periumbilical pain
  • Pain migration to RLQ
  • Abdominal rigidity
  • N/V, anorexia
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25
Q

Appendicitis physical exam findings

A
  • Abdominal tenderness with cough
  • Signs of peritoneal irritation (guarding, rebound tenderness, obturator sign, psoas sign)
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26
Q

Abnormal presentations of appendicitis

A
  • Pain better when lying down
  • “Bump” sign - pain when driving over speed bump while driving
  • Markle sign - pain with jumping
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27
Q

What is McBurney’s point?

A

Sign of appendicitis

  • Tenderness in RLQ between the umbilicus and anterosuperior iliac spine
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28
Q

What is Rovsings sign?

A

Sign of appendicitis

  • RLQ pain with palpation of LLQ
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29
Q

Appendicitis diagnostic testing

A
  • History and physical exam findings
  • Elevated WBC count
  • hCG (females)
  • Serum amylase and lipase
  • CRP
  • Urinalysis
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30
Q

First line imaging for appendicitis (when diagnosis of abdominal pain is unclear)

A

CT abdomen/pelvis with contrast

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31
Q

Is pharmacologic therapy indicated for appendicitis?

A
  • Perioperative
  • Perforated appendix
  • Suspected septicemia
  • Scheduled laparoscopic surgery
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32
Q

True/false: Immediate surgical referral or transfer to the ER is indicated for suspected appendicitis

A
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33
Q

Appendicitis treatment

A
  • Appendectomy within 24 hours of symptom onset
    • NPO, IV fluid, electrolyte repletion
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34
Q

Small bowel obstruction clinical manifestations

A
  • Intermittent and crampy abdominal pain
  • Vomiting, constipation
  • Abdominal distention
  • Hyperactive bowel sounds
  • Fever
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35
Q

What relieves abdominal pain related to small bowel obstructions?

A
  • Vomiting
  • Intestinal tube decompression
  • Passage of intestinal contents through a partial obstruction
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36
Q

Concerning signs that warrant urgent referral to surgery (small bowel obstruction)

A
  • Pain that progresses in severity, localizes, becomes constant
  • Localized tenderness
  • Abdominal guarding
  • Rebound tenderness
  • Rigidity
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37
Q

Imaging for small bowel obstruction

A

Abdominal CT scan with contrast if abdominal infection or mechanical obstruction suspected

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38
Q

Small bowel obstruction labs

A
  • Elevated WBC
  • Electrolyte abnormalities
  • Elevated hematocrit, creatinine, BUN (dehydration)
  • hCG
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39
Q

Non pharmacologic management of small bowel obstruction

A
  • Restriction of oral intake
  • IV fluid therapy
  • Electrolyte and acid-base correction
  • NG tube for gastric decompression
40
Q

Pharmacologic management of small bowel obstruction

A

Antiemetics for systemic relief

41
Q

Are antibiotics indicated for small bowel obstructions?

A

Not indicated, but IV broad spectrum antibiotics can be used for strangulated bowel or adjunct to surgery

42
Q

Is a small bowel obstruction a medical emergency?

A

Yes - urgent laparotomy required if patient does not respond to supportive care, advanced illness, ischemia, or perforation

43
Q

Signs of ischemic bowel

A
  • Fever
  • Severe and continuous pain
  • Hematemesis
  • Peritoneal signs
  • Hypotension
  • Gas in bowel wall or portal vein
  • Abdominal free air
  • Acidosis
44
Q

Do peptic ulcer perforations occur more often with duodenal or gastric ulcers?

A

Duodenal ulcers

45
Q

Causes of peptic ulcers

A
  • H. pylori infection
  • Medications (aspirin, bisphosphonates, NSAIDs, potassium chloride)
  • Gastric malignancy
  • Tobacco abuse
46
Q

Peptic ulcer clinical manifestation

A
  • Abrupt onset of severe abdominal pain followed by peritoneal signs
  • Pain begins in epigastrium and spreads throughout the abdomen with radiation to scapular areas
  • Coffee-ground emesis
  • Hematemesis or melena
  • Hematochezia
  • Decreased perception of pain within 6-12 hours after perforation
47
Q

Peptic ulcer physical exam findings

A
  • Board-like abdominal rigidity
  • Gastric ulcer: pain after eating
  • Duodenal ulcer: pain between meals
48
Q

Imaging to diagnose peptic ulcers

A

Chest x-ray → pneumoperitoneum

Confirmed with endoscopy

49
Q

Peptic ulcer labs

A
  • CBC with diff
  • Serum electrolytes - BUN, creatinine, amylase
  • H. pylori
  • Stool for occult blood
  • hCG
50
Q

Non pharmacologic management of peptic ulcer disease

A
  • IV fluid resuscitation
  • Correct electrolyte abnormalities
  • Continuous NG suction for decompression
51
Q

Pharmacologic management for peptic ulcer disease

A
  • IV PPI and broad spectrum antibiotics
  • Transfusion if hemorrhage
52
Q

Indications for referral and hospitalization for peptic ulcer disease

A
  • Uncontrolled bleeding
  • Hemodynamically unstable
  • Signs of peritonitis
  • Free extravasation of contrast material on upper GI studies
53
Q

Peptic ulcer disease patient education

A
  • Older adults at higher risk due to increased use of NSAIDs, aspirin, warfarin, bisphosphonates
  • Long term tobacco and alcohol use increases risk
54
Q

Alarming symptoms that might suggest gastric cancer

A
  • Unintentional weight loss
  • Early satiety
  • Dysphagia or odynophagia
  • GI bleed
  • Iron deficiency anemia
  • Persistent vomiting
  • Palpable abdominal mass
  • Adenopathy
  • Consider EGD in patients >50 years or family history of GI malignancy
55
Q

True/false: An immediate hospital referral is indicated for suspected peritonitis

A

True

56
Q

What is the most common cause of primary spontaneous bacterial peritonitis in adults?

A

Cirrhosis complicated by variceal hemorrhage and ascites

57
Q

What is the most common cause of secondary peritonitis?

A

Spillage of GI or GU microorganisms into the peritoneal space

  • Most often the result of peritoneal dialysis, perforated viscus, penetrated wounds
58
Q

Peritonitis clinical manifestation

A
  • High fever, chills
  • Acute abdominal pain that is diffuse, localized, or referred
  • N/V/D/C
59
Q

Peritonitis physical exam findings

A
  • Abdominal distention and rigidity
  • Decreased bowel sounds
  • Diffuse abdominal tenderness
  • Rebound tenderness and guarding
  • Fever, tachycardia, tachypnea, hypotension
60
Q

What findings would make the provider suspect a diagnosis of peritonitis?

A
  • Fever
  • Abdominal pain
  • Tenderness
  • Leukocytosis
61
Q

What initial imaging and lab work could be collected in the primary care setting for suspected peritonitis?

A
  • Chest and abdominal x-ray
  • CBC w/ diff
  • Serum electrolyte with BUN and creatinine
62
Q

What diagnostic study is needed for confirmatory diagnosis of peritonitis?

A

Laparotomy

63
Q

On what basis should the provider diagnose spontaneous bacterial peritonitis if the patient has cirrhosis?

A
  • Clinical appearance
  • Presence of ascites
  • Ascitic fluid analysis

Requires paracentesis in hospital setting

64
Q

Non pharmacological management of peritonitis

A
  • Fluid resuscitation
  • Careful monitoring of VS and fluid balance
  • NG tube
65
Q

Pharmacologic management of primary bacterial peritonitis

A

Empiric antibiotic therapy until culture results available

  • 3rd or 4th generation cephalosporin
  • Quinolone
66
Q

Pharmacologic management of secondary bacterial peritonitis

A
  • May require surgical intervention
  • Metronidazole + carbapenem
67
Q

Abdominal aortic aneurysm risk factors

A
  • Male
  • Family history
  • Advanced age
  • Caucasian
  • Smoker
  • Hypertension
  • Atherosclerosis
68
Q

True/false: Most aortic aneurysms are asymptomatic until they rupture

A

True

69
Q

Abdominal aortic aneurysm clinical presentation

A

Rupture causes sudden onset severe abdominal pain that may be confined to the flank, low back, or groin with radiation to the back

70
Q

Abdominal aortic aneurysm physical exam findings

A
  • Abdominal distention
  • Pulsations (painful) felt directly over mass and displace examining fingers laterally - near xiphoid process and umbilicus
  • Aortic bruit
  • Diminished or absent peripheral pulses
71
Q

Screening recommendations for abdominal aortic aneurysms

A

Men ages 65-75 with positive history of smoking

72
Q

Are diagnostic tests indicated for the diagnosis of abdominal aortic aneurysms?

A

Additional diagnostics (other than screening) not required → immediate hospital referral for resuscitation and therapy in OR

73
Q

What imaging would be indicated if abdominal aortic aneurysm diagnosis is in doubt?

A

CT scan - determine extent of aneurysm

Angiography - preoperatively to demonstrate aortic and vascular anatomy and renal vessel involvement

74
Q

Abdominal aortic aneurysm symptom triad

A
  • Hypotension
  • Shooting back or abdominal pain
  • Pulsatile abdominal mass
75
Q

Diverticular disease risk factors

A
  • Low fiber diet
  • Aspirin and NSAID use
  • Lack of exercise
  • Obesity
  • Consumption of red or processed meats
  • Smoking
76
Q

Diverticulosis symptoms

A
  • Intermittent abdominal pain
  • Bloating
  • Excessive flatulence
  • Irregular defecation
  • Urinary dysfunction, anorexia, N/V, heartburn
77
Q

What imaging techniques can diagnose diverticulosis?

A

Colonoscopy, CT san

78
Q

Diverticulosis patient education

A
  • Goal of 30-35 g/day of fiber
79
Q

When is hospitalization indicated for diverticulitis?

A
  • Fever above 101.3
  • Signs of peritonitis
  • Suspected abscess
  • Intestinal obstruction
  • Sepsis
  • Hypovolemia
80
Q

Diverticulitis clinical presentation

A
  • LLQ abdominal pain
  • Fever
  • Leukocytosis
81
Q

Diverticulitis physical exam findings

A
  • LLQ tenderness + guarding and rigidity
  • Mild distention
82
Q

Diverticulitis diagnostic imaging

A

CT scan w/ contrast → bowel wall thickening, pericolic fat stranding, pericolic fluid

  • Colonoscopy (4-6 weeks after acute episode has resolved)
83
Q

Diverticulitis labs

A
  • CBC w/ diff
  • CRP
  • Urinalysis
  • BUN and creatinine in older patients and patients with renal insufficiency
84
Q

Are antibiotics indicated for uncomplicated diverticular disease?

A

No, but necessary to avoid sepsis in acute diverticulitis

85
Q

If antibiotics are used to treat uncomplicated diverticulitis, which should be prescribed?

A
  • Bactrim + metronidazole
  • Amoxicillin-clavulanate potassium
  • Ciprofloxacin + metronidazole
86
Q

Outpatient management of diverticulitis

A
  • Bowel rest (clear liquids and follow up in 48-72 hours)
  • Increased fluid intake
  • Oral antibiotics to cover colonic flora
87
Q

External versus internal hemorrhoids

A

External → distal to dentate line, sensitive to touch, temperature, stretch

Internal → proximal to dentate line, painless

88
Q

Hemorrhoid patient education

A
  • Increase dietary intake of fiber
  • Topical corticosteroids
  • Increase fluid intake
  • Avoid straining and prolonged time on the toilet
89
Q

Do most anal fissures occur in the posterior or anterior midline?

A

Posterior

90
Q

If an anal fissure is not in the posterior midline, what other causes does this indicate?

A
  • STD
  • TB
  • HIV
  • Ulcerative colitis
  • Crohn disease
  • Malignant neoplasm
91
Q

First line treatment of anal fissures

A
  • Increase dietary fiber
  • Stool softeners
  • Sitz baths
92
Q

Gold standard treatment of chronic anal fissures

A

Lateral internal sphincterotomy (LIS)

93
Q

What diarrheal findings would prompt immediate medical evaluation?

A
  • Fever
  • Significant abdominal pain
  • Bloody stool
  • Dehydration
  • Unintentional weight loss
  • Family history of colorectal cancer
94
Q

What is osmotic diarrhea?

A

Includes malabsorptive disorders and results from ingested, solute-rich molecules leaving the vascular space and entering the colon

95
Q

What is secretory diarrhea?

A

Most common → watery stool as the absorptive function of the gut is compromised

96
Q

What symptoms would prompt the provider to collect a stool sample for c. diff with consideration of IBD?

A
  • Temperature above 102
  • Blood diarrhea
  • Abdominal pain
  • 6+ unformed stools in 24 hour period
  • Profuse watery diarrhea
  • Dehydration
97
Q

If diarrhea continues for 2+ weeks and suspected cause is non infectious, what conditions would the provider suspect as the cause?

A
  • Colitis
  • Diverticulitis
  • Pancreatitis
  • IBS and IBD

NURS 502 (43 decks)

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