Exam 4: GI dysfunction Flashcards
What substances are present in cirrhosis that suggest the onset of fibrosis?
a. Mallory bodies b. Fatty infiltration in liver cells c. Varices d. Acetylaldehydes
A
Which one of the following organisms may be a causative agent for peptic ulcer disease in many individuals?
a. E. coli b. H. pylori c. Staph aureus d. H. influenza
B
The manifestations of a bowel obstruction are primarily related to which of the following?
a. Decreased absorption of nutrients
b. Accumulation of fluid and gas distal to the obstruction
c. Accumulation of fluid and gas proximal to the obstruction
d. Edema impairing biliary secretion
C
Which of the following are signs of Crohn’s disease? Select all that may apply.
a. __ ___ Steatorrhea
b. __ ___ Increased risk for cancer
c. __ ___ Only mucosal layer affected
d. _ ____ Skip lesions present
e. _ ____ Frequent, non-bloody stools common
A,D,E
Which one of the following is a characteristic of a gastric ulcer? Select all that may apply.
a. \_\_\_\_\_ Affects males more than females b. \_\_\_\_\_ Onset is usually between 50 and 70 years of age c. \_\_\_\_\_ Gastritis is also a common occurrence d. \_\_\_\_\_ An affected person has a positive family history for PUD e. \_\_\_\_\_ An increased risk for cancer f. \_\_\_\_\_ Pain relief with food
B,C,E
Which of the following people are in need for immunization against Hepatitis B? Select all that apply.
a. _____ People who have unprotected sex with more than one partner
b. _____ Men who have sex with men
c. _¬____ Police officers
d. _____ Health care workers
ALL
A characteristic manifestation of malabsorption syndrome is the inability to reabsorb fats from the intestines. What is this sign called?
a. Ecchymosis b. Melena c. Borborygmi d. Steatorrhea
D
What is the condition called when the pyloric valve is bypassed and food is emptied directly into the jejunum without mixing first in the duodenum?
a. Malabsorption syndrome
b. Intestinal obstruction
c. Dumping syndrome
d. Intestinal fistula formation
C
Which of the following is the leading cause of acute liver failure in the United States?
a. Alcohol consumption
b. Acetaminophen toxicity
c. Hepatitis B
d. Hepatotoxic antibiotics
B
Increased ammonia levels leading to hepatic encephalopathy is called which of the following terms?
a. Ascites
b. Melena
c. Azotemia
d. Varices
C
The type of gastritis that predisposes a person to pernicious anemia and stomach cancer is Acute / Chronic gastritis and the transient type that affects persons using alcohol or certain drugs is Acute / Chronic gastritis.
Chronic, Acute
The bacteria associated with gastritis and peptic ulcer disease is ___________________.
H.Pylori
TRUE – FALSE Duodenal ulcers are more common than gastric ulcers
T
A person presents to your clinic complaining of heartburn and gnawing-type pain that is worse after eating a meal. Based on this information you suspect that this person is suffering from a Gastric / Duodenal ulcer.
Gastric
A lower GI disease that may affect the large or small bowel is Crohn’s Disease / Ulcerative Colitis and is characterized by continuous inflammation / skip lesions of the intestine.
Crohn’s Disease……skip lesions
Frequent bloody, loose stools is a manifestation of Ulcerative colitis / Crohn’s disease and steatorrhea and malabsorption are common signs of Ulcerative colitis / Crohn’s disease.
colitis, crohn’s
Sudden abdominal pain, emesis containing bits of fecal matter, frequent watery stools are signs/symptoms of Dumping syndrome / peritonitis / malabsorption syndrome / intestinal obstruction.
intestinal obstruction
TRUE – FALSE A life-threatening complication of PUD is peritonitis
True
TRUE – FALSE A common complication of Crohn’s disease is toxic megacolon
False
The type of cirrhosis of the liver that could be caused by viral hepatitis is Portal / Biliary / Postnecrotic cirrhosis.
Postnecrotic
The stage of alcoholic cirrhosis that shows the presence of Mallory bodies is Alcoholic steatosis / hepatitis / cirrhosis.
hepatitis
Circle the two types of viral hepatitis transmitted via the oral – fecal route.
Hepatitis: A B C D E F G
A,E
what are the primary manifestations of any GI disorder?
pain, bleeding, anorexia, dysphagia, altered elimination, jaundice.
What is gastritis?
inflammatory disorder of the gastric mucosa. acute and chronic.
differentiate between acute and chronic gastritis?
acute-caused by local irritants or bacterial toxins
chronic- progressive disease causing thinning and degeneration of stomach wall
what are the three types of chronic gastritis?
Helicobacter pylori: most common cause is developing countries
Chronic autoimmune:
what is PUD? what are the risk factors for PUD?
peptic ulcer disease: break in mucosal lining of the lower esophagus, stomach, or upper small intestine. duodenal ulcers more commons than gastric ulcers.
risk factors: smoking, alcohol use, aspirin use, emotional stress
How does the assessment of pain assist in determining gastric vs duodenal ulcers?
- Duodenal – upper abdomen, intermittent, pain-antacid or food relief, nocturnal pain
- Gastric- upper abdomen, intermittent, pain-antacid relief, food pain pattern
Define ulcerative colitis and Crohn’s disease. Compare the two conditions: incidence, etiology, pathophysiology and manifestations.
• Ulcerative colitis – inflammatory disease of the colon
o Incidence
Common between 20 and 25 but can affect any age group
Females and males affected equally
May be associated with family history
Has increased risk for cancer
o Etiology – unknown; may have autoimmune component
o Pathophysiology
Continuous inflammatory process in rectum and left colon
Ulcers and denuded areas cause bleeding and bloody diarrhea
Characteristic lesion
o Manifestations
Mild to severe abdominal pain
Bloody stools and diarrhea common
Rare abdominal mass, malabsorption, and steatorrhea (fat secretion in feces)
• Crohn’s Disease – inflammatory disease of large or small intestine
o Incidence
10 to 30 most common but affects any age group
Males and females equally
Family history more common
Cancer risk not increased
o Etiology – unknown; may have genetic component
o Pathophysiology
Progressive granulomatous inflammatory response frequent in ileocecal area
All bowel layers affected
Skip lesions present
o Manifestations
Mild to severe abdominal pain
Frequent stools and diarrhea common
Abdominal masses common
Malabsorption common
Steatorrhea common
Fever possible
What are mechanical vs nonmechanical intestinal obstructions?
- Mechanical – anything that encroaches on the lumen of the bowel
- Non-mechanical – paralytic ileus (non-contractibility of intestine)
Define: volvulus
obstruction due to knotting or twisting of gastrointestinal tract
Define:• Intussusception
condition in which part of intestine slides into adjacent part of intestine
• Peritonitis –
inflammation of membrane lining abdominal wall and covering abdominal organs
inability of intestine to contract normally
• Paralytic ileus –
Why is peritonitis and/or paralytic ileus a dangerous complication in a client?
- Prevents elimination of waste leading to Fluid imbalances
* Pt. develops s/sx. Common to heart failure
Define intrahepatic disorders. Types?
- Disrupt flow of bile through liver, causing cholestasis and biliary cirrhosis
- Primary Biliary Cholangitis (PBS): autoimmune destruction of small intrahepatic bile ducts and cholestasis
- Secondary Biliary Cholangitis (SBS): prolonged obstruction of extrabiliary tree; most common cause: cholelithiasis
Define cirrhosis
- Scarring of the liver
* End stage of chronic liver disease
What are the manifestations of liver failure? . . . complications?
• Weakness, weight loss, anorexia, fatigue • N/V, change in bowel habits • Pruritus • GI bleeding • Jaundice • Ascites • Ecchymosis, Petechiae, spider angioma • Palmer erythema • Hepatomegaly (liver shrinks) Complications: • Portal hypertension • Varices • Ascites • Encephalopathy • Bleeding and DIC • Hepatorenal syndrome
What are esophageal varices and why are they a serious complication?
- Distended thin-walled and fragile collateral veins in esophagus
- Rupture of varices due to erosion by gastric acid causes serious hemorrhage
- Can lead to hypovolemic shock
Define hepatic encephalopathy: etiology,
• Coma
• Etiology:
o Unknown but associated with increased ammonia level
o Blood shunted around liver due to failure and collateral vessels
Describe/define the various types of hepatitis according to:
• Inflammation of liver
Cause/etiology:
: toxins, reactions to drugs, infectious agents
• Describe/define the various types of hepatitis according to:
Route of infection:
o Hep. A- fecal-oral route o Hep. B- contaminated blood and body fluids o Hep C- blood and body fluids o Hep D- blood and body fluids o Hep E- oral fecal route o Hep F and G- unknown
• Describe/define the various types of hepatitis according to:
Available vaccine
o Hep A – vaccine available
o Hep B- vaccine available
o Hep C- no vaccine
o Hep D- prevention of HBV prevents HDV
Describe the clinical manifestations according to each phase of illness.
• Prodromal (Preicteric) o Flu-like symptoms: Anorexia, fatigue, N/V, malaise, headache, hyperalgia, low-grade fever o RUQ pain and tenderness o Weight loss • Icteric Phase o Characterized by jaundice o Clay colored stools, dark urine o Hepatomegaly o Splenomegaly o Abdominal pain/tenderness • Recovery (Posticteric) o Decreases in symptoms
What is chronic active hepatitis? Autoimmune hepatitis?
- Chronic- persistence of signs and symptoms and liver inflammation after Hep B,C and/or D
- Autoimmune- severe type of chronic hepatitis of unknown origin with high levels of serum immunoglobulins
