Exam 3 Study Guide - Gastrointestinal

Question 1

GI Changes w/ Aging - Stomach

Answer 1

• Atrophy of gastric mucosa
• Dcr in hydrochloric acid lvls
  > dcrd absorp of iron & vit B12
  > proliferation (incr) of bacteria
  > atrophic gastritis occurs as a consequence of bacterial overgrowth
• Interventions
  > encourage bland foods high in vits & iron
  > assess for epigastric pain to detect gastritis

Question 2

GI Changes w/ Aging - Intestine

Answer 2

• Peristalsis dcrs
• Nerve impulses are dulled
• Dcrd sensation to defecate can result in postponement of BMs
  > leads to constipation & impaction
• Interventions
  > encourage a high-fiber diet & 1500mL of fluid intake daily
  > encourage as much activity as tolerated
  > these interventions incr the sensation of needing to defecate

Question 3

GI Changes w/ Aging - Pancreas

Answer 3

• Distension & dilation of pancreatic ducts
• Calcification of pancreatic vessels occurs w/ a dcr in lipase production
  > dcr lipase lvl results in dcrd fat absorp & digestion
  > excess fat in feces (steatorrhea) occurs bc of dcrd fat digestion
• Interventions
  > encourage small, frequent meals; helps prevent steatorrhea
  > assess for diarrhea & dehydration

Question 4

GI Changes w/ Aging - Liver

Answer 4

• Dcr in # & size of hepatic cells & inr in fibrous tissue
  > leads to dcrd protein synthesis & changes in liver enzymes
  > depresses drug metabolism; leads to accumulation of drugs - possibly to toxic lvls
• Interventions
  > assess for AEs of meds, specifically drug toxicity

Question 5

Basic Hx & Px Assessment

Answer 5

• Pt hx
• Nutrition hx
  > diet
  > food allergies
  > anorexia
  > N/V
  > changes in taste
  > pain or difficulty swallowing
  > abd pain or discomfort w/ eating
  > dyspepsia; indigestion or heartburn
  > unintentional weight loss
  > alcohol & caffeine consumption
• Family hx & genetic risk

Question 6

Hx & Px Assessment

current health probs
physical assessment
psychosocial assessment

Answer 6

• Current Health Problems
  > change in bowel habits
  > unintentional weight gain/loss
  > pain
  > changes in skin: discoloration, rashes, itching, jaundice, incr bruising, incrd tendency to bleed
• Physical Assessment of Abdomen
  > inspection, auscultation, light palpation, percussion
  > if appendicitis or an abdominal aneurysm is suspected, palpation is not done
• Psychosocial Assessment
  > stress can exacerbate some GI disorders

Question 7

Liver Function Tests (liver enzymes)

Answer 7

• Alanine Aminotransferase-ALT (4-36 units/L)
  > incrd values may indicate liver disease, hepatitis, cirrhosis
• Aspartate Aminotransferase-AST (0-35 units/L)
  > incrd values may indicate liver disease, hepatitis, cirrhosis
• Alkaline Phosphatase-ALK (30-120 units/L)
  > incrd values may indicate cirrhosis, biliary obstruction, liver tumor

Question 8

GI Labs

bilirubin
albumin
ammonia

Answer 8

• Bilirubin (0.3-1.0 mg/dL)
  > incrd values may indicate hemolysis, biliary obstruction, hepatic damage
• Albumin (3.5-5)
  > dcrd values may indicate hepatic disease
• Ammonia (10-80 mg/dL)
  > incrd values may indicate hepatic disease like cirrhosis

Question 9

GI Labs

Ca
serum amylase
serum lipase
prothrombin time

Answer 9

• Ca 19-9 & CEA
  > elevated to diagnosis cx & could be incrd in benign GI conditions
• Serum Amylase (30-220 units/L)
  > incrd values may indicate acute pancreatisis
• Serum Lipase (0-160 units/L)
  > incrd values may indicate acute pancreatitis
• Prothrombin Time (PT) (11-12.4 sec)
  > useful in evaluating clotting
  > if elevated could indicate hepatic issue

Question 10

GI Labs

electrolyts
CBC
stool

Answer 10

• Electrolytes
  > Calcium (9-10.5): dcrd values may indicate malabsorp kidney failure, acute pancreatitis
  > Potassium (3.5-5): dcrd values may indicate vomiting, gastric suctioning, diarrhea, drainage from intestinal fistulas
• CBC
  > low H/H could indicate anemia GI bleeding
  > elevated WBC vould indicate infection
• Stool
  > annual guaic heme fecal occult blood test (gFOBT) or fecal immunochemical tst (FIT) to detect colorectal cx
  > ova and parasites; acid in diagnosis of parasitic infection
  > fecal fats
  > cytotoxic assay or culture

Question 11

Diagnostic Tests - Imaging

abd x-ray
acute abd series
abd ct
abd mri

Answer 11

• Abdominal X-Ray
  > can identify tumors, strictures, & obstructions
• Acute Abdominal Series
  > includes chest x-ray, supine and upright abd x-ray
• Abdominal Computerized Tomography (CT)
• Abdominal Magnetic Resonance Imaging (MRI)

Question 12

Diagnostic Tests - Imaging

UGI series
smll bowel
barium enema
ptc
mrcp

Answer 12

• Upper GI Series (Barium Swallow)
  > x-ray from mouth to duodenojejunal junctions w/ use of barium
• Small Bowel Follow-Through
  > extension of UGI x-ray w/ use of barium
• Barium Enema
  > x-ray of large intestine w/ use of barium
• Percutaneous Transhepatic Cholangiography (PTC)
  > examines biliary duct system using iodine dye
• Magnetic Resonance Cholangiopancreatigraphy (MRCP)

Question 13

Esophagogastroduodenoscopy (EGD)

Answer 13

• Visual exam of esophagus, stomach, duodenum w/ use of fiberoptic scope
• Prep: NPO for 6-8hrs & avoid anticoags, Aspirin, & NSAIDs several days prior
• Procedure: moderate sedation & lasts abt 20-30mins
• Post Procedure
  > keep pt NPO until gag reflex returns
  > priority care includes preventing aspiration & assess for any bleeding or pain tht could indicate perforation

Question 14

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Answer 14

• Visual & radiographic exam of liver, gallbladder, bile ducts, & pancreas
• Use radiopaque dye
• used to diagnose obstruction as well as treat obstructions
• Prep: NPO for 6-8hrs & typically avoid anticoags as determined by provider
• Procedure: moderate sedation & lasts 30mins-2hrs
• Post Procedure
  > keep pt NPO until gag relfex returns
  > Priority care includes preventing aspiration & assess for any bleeding or pain tht could indicate perforation
  > assess for gallbladder inflamm & pancreatitis; severe abd pain, N/V, fevere & elevated lipase

Question 15

Small Bowel Endoscopy (enteroscopy)

Answer 15

• Provides a visual view of small intestine
• Used to evaluate & locate source of GI bleeding
• Prep: NPO except water for 8-10hrs then complete NPO for 2hrs b4 swallowing capsule
• Procedure
  > sensors are placed on abd & pt wears a data recorder
  > pt swallows capsule endoscope & can resume normal activity
  > pt may eat 4hrs after swallowing capsule
  > procedure lasts 8hrs
• Post Procedure
  > explain to pt tht capsule endoscope is excreted naturally & will be seen in stool

Question 16

Colonoscopy

Answer 16

• Endoscopic exam of entire large intestine
  > can be used to visually diagnose, biopsy, & treat
• Baseline test should be done at age 50 & every 10yrs
• Prep:
  > clear liqiuds day before
  > NPO 4-6hrs prioir
  > avoid aspitin, anticoags, & platelet drugs for several days before
  > adequate bowel cleansing is essential; follow provider orders for oral & rectal prep; pt should be passing clear liquid prior to procedure
• Procedure: moderate sedation & procedure lasts 30-60mins
• Post Procedure
  > observe for signs of perforation (severe pain) & hemorrhage
  > feelings of fullness & cramping are expected
  > fluids are permitted after pt passes flatus to indicate tht peristalsis has returned