Exam 5 - GI Flashcards
Chrons disease is aka
regional enteritis
what part of the GI tract can be affected by Chrons
from the mouth to the anus
usually affects terminal ileum and ascending colon
2 types of chrons
subacute
chronic
chrons will have what type of appearance
cobblestone
Chrons s/sx
persistent diarrhea
liquid, soft stools
intestinal obstruction
RLQ pains, spasms
palpable RLQ mass
weight loss, malnutrition
anemia
T or F. Blood in stools r/t chrons is usually mild
True
Chrons complications
abscess
fistula to other organs
repeated bowel resection
F/E imbalance
malnutrition
malabsorption
chronic inflammatory bowel disorder
ulcerative colitis
what parts of the GI tract are affected with UC
mucosa, submucosa of colon and rectum ONLY
2 types of UC
chronic intermittent colitis (recurrent UC)
fulminant colitis (entire colon)
s/sx of UC
diarrhea
blood + mucous in stools
nocturnal diarrhea
rectal inflammation
LLQ cramping relieved by defecation
fatigue, anorexia, weakness
pallor, fever
anemia
tachycardia
complications r/t UC
hemorrhage
mega colon
dehydration
color perforation (board like abdomen)
increase colorectal cancer
inflammation extends inhibiting ability for contraction (colonic distention)
mega colon
s/sx of mega colon
fever
abdominal pain
distention
fatigue
vomiting
what will an MD want you to do if the pt is vomiting and has mega colon
NGT
when would surgery be performed with mega colon if decompression has not yet occured
after 72 hour
IBD diet
low residue
eliminate milk, milk products
< 2G fiber daily
avoid raw veggies
review Chrons and UC meds - slide 20-22
review Chrons and UC - slide 20-22
leading cause of surgery in Chrons
bowel obstruction
normal output first 24 hours after colostomy
1500-1800 mL
ileostomy postop care/education
drainage will be clear
Kegel exercises
perianal skin care
is the pancreas an endocrine or exocrine gland
both
pancreas endocrine function
insulin production
pancreas exocrine function
digestion; amylase, lipase, trypsin
2 types of pancreatitis
acute
chronic
acute pancreatitis can be ___ or ___
mild; severe
mild pancreatitis
self-limiting (acutely ill)
edema, inflammation of pancreas only
minimal organ dysfunction
return to normal in 6 months
severe pancreatitis
widespread damage, hemorrhage
necroisis/abscess
organ failure
death
pancreatitis risk factors
alcohol*
gallstones*
thiazides*
smoking
trauma
PUD
hypertriglyceridemia
*most common
what can cause acute pancreatitis turn into chronic
alcohol abuse
Turner’s sign
bruising in flank
Cullen’s sign
bruising around umilicus
acute pancreatitis s/sx
acute, continuous abdominal pain
–can radiate to back
N/V
abdominal distention, rigid
decrease bowel sounds, crackles
tachycardia
hypotension
mild confusion
fever, cold, clammy skin
mild jaundice (within 24 hours)
Turner’s sign (3-6 days after onset)
Cullen’s sign (3-6 days after onset)
severe acute pancreatitis s/sx
rigid, board like abdomen
ecchymosis
hypotension
tetany
shock
___ is shifted from the blood into the ___ space during pancreatitis
calcium; intracellular
normal amylase level
30-170
how soon will amylase rise and fall with acute pancreatitis
rise: 2-12 hours
fall: 3-4 days
normal lipase levels
14-280
how long will lipase levels remain elevated with acute pancreatitis
7-14 days
will WBC be elevated or depleted with acute pancreatitis
elevated
with calcium be elevated or depleted with acute pancreatitis
depleted
only method to remove gallstone
ERCP
how long can a person be NPO
no longer than 3-5 days
acute pancreatitis treatment
aggressive hydration
assess pain (morphine, dilaudid)
IV abx
antiemetics
H2 blockers
antipyretics
cholecystectomy (after acute phase is over)
acute pancreatitis nursing care
NPO
NGT
IVF/TPN
low fat diet
no alcohol, smoking
oral care
health promotion
bedrest, quiet environment
no food in room
daily weight
I&O
O2 SAT
positioning
PANCREAS re: nursing interventions
P ain (morphine, dilaudid)
A ntispasmodic drugs (decrease motility)
N PO, NGT
C alcium replacement
R eplace F/E
E ndocrine and enzymes
A bx with fever
S terioids for acute attack
acute pancreatitis PO diet
low fat
high carb
small frequent meals
no caffeine, alcohol, smoking
when measuring abdominal girth, where to do you mark the measuring tape
upper and lower part
causes of chronic pancreatitis
alcoholism
gallstones
trauma
smoking
autoimmune disease (lupus, cystic fibrosis)
chronic pancreatitis pain characteristics
severe pain in upper abdominal, back
reoccurring bouts
sometimes unrelieved by pain meds
nagging discomfort between bouts
can have decreased pain as destruction occurs
steatorrhea
fatty stools
foul smelling
frothy, loose
how to Dx chronic pancreatitis
ERCP
MRI, CT, US
GTT
amylase
steatorrhea
chronic pancreatitis management
prevent, manage attacks
pain control
manage exocrine, endocrine insufficiency
nonpharm pain management for chronic pancreatitis
yoga
antioxidants
avoid alcohol, heavy meals, irritating foods
meds for pancreatic enzyme replacement
pancrease
zenpep
creon
viokace
fat soluble vitamins to be replaced
A, D, E, K
pancreatic enzyme replacement education
take with food
do not crush or open capsule
dosing for meals, snacks
monitor BM for effectiveness
6 types of hepatitis
A, B, C, D, E, G
which race has the highest incidence of hepatitis C
African Americans
Hepatitis A is transmitted via which route
fecal-oral
poor sanitation
contaminated water
uncooked seafood
how soon is hepatitis A seen in feces before symptoms
2 weeks+
T or F. You have immunity after having hepatitis A
True
How is hepatitis B transmitted
blood
saliva
vaginal secretions
percutaneously
hepatitis is a ___ virus
DNA
how long can hepatitis B live on a dry surface
7 days
populations at risk for hepatitis B
healthcare workers
hemodialysis pts
blood transfusions
male homosexual, bisexual
heterosexual with many partners
IV drug users
close contact with a Hep B carrier
where is hepatitis B an endemic
Artic
Africa
China
SE Asia
Amazon
how many antigens does the hepatitis B structure have
3
surface (HBsAg)
core (HBcAg)
E (HBeAg)
where does hepatitis B replicate
the liver
how long does it take to see hepatitis B antigens in serum
6 months
this is a chronic disease
hepatitis C is a ___ virus
RNA
how is hepatitis C commonly transmitted in the US
IV drug use
hepatitis C risk factors
high risk sexual behavior
hemodialysis
occupational exposure
perinatal transmission
is there a vaccine against hepatitis C
No
those with the highest incidence of hepatitis D
Mediterranean
Middle Eastern
South America
Hepatitis D has a high risk for developing what other form of hepatitis
hepatitis C
T or F. Hepatitis D has a sudden, severe onset.
True
Where is hepatitis E most common?
India
Africa
Asia
Central America
hepatitis E route of transmission
fecal-oral
drinking contaminated water
what is present with hepatitis E
jaundice
how is hepatitis G transmitted
through blood
only found in those who have received contaminated blood transfusions
hepatitis G is what kind of virus
RNA
T or F. liver cells can regenerate with time if no complications occur.
True
the liver will resume normal appearance and function
antigen-antibody complexes have a ___ effect
systemic
antigen-antibody complex s/sx
rash
angioedema
arthritis
malaise
fever
glomerulonephritis
vasculitis
cryoglobulinemia (proteins in the blood clump together)
what can trigger antigen-antibody complex effects
cold weather - can lead to organ damage
how long does the acute phase last?
1-4 months
s/sx during the acute phase
malaise
anorexia
fatigue
N/V
abdominal discomfort
HA
low-grade fever
flu like s/sx
convalescent phase s/sx
jaundice beings to disappear
major complaints
malaise
easily fatigued
how long does the convalescent phase last
weeks to months
can be reinfected during this time
results in severe impairment or necrosis of liver cells and potential liver failure
fulminant hepatitis
fulminant hepatitis occurs bc of complications with hepatitis ___
hepatitis B
higher risk when hepatitis D is present
what to avoid with hepatitis infection
alcohol
drug therapy for hepatitis A
none, only supportive therapy (antiemetics)
acute hepatitis B virus is treated if ___ ___ is present
liver failure
review slide 33, 35 - drugs for hepatitis B
review slide 33, 35 - drugs for hepatitis B
review slide 34 - drugs for hepatitis C
review slide 34 - drugs for hepatitis C
hepatitis management
bed rest
small frequent meals
sit up to eat
increase calories, decrease fat
watch protein intake
vitamin K
3.5 - 5 L/daily
avoid alcohol
antiemetics
will immunoglobulins be present with chemical induced hepatitis?
No
drugs that can induce hepatitis
isoniazid
statins
acetaminophen
sulfonamides
antimetabolites
causes of bacterial liver abscess
secondary to trauma or bx
E. Coli is the most common
cause of protozoan liver abscess
poor hygiene
unsafe sex
contaminated drinking water
acute s/sx of liver abscess
fever
malaise
vomiting
anorexia
hyperbilirubinemia
RUQ pain
what are the 3 clotting factors
19
7
2
liver trauma treatment/management
blood/blood products (FFP, plasma, clotting factors)
IVF
monitor for hemorrhage
monitor for shock
may require sx to stop bleeding
