Gastrointestinal Flashcards
what is foodborne illness
food poisoning
common infective agents: staph aureus norovirus C. perfringens Salmonella botulism E. coli
foodborne management
food safety and preparation
good hand hygiene
prevent transmission
monitor fluid volume deficit
discourage use of antidiarrheals
with e. coli infection
- monitor kidney function
with botulism poisoning
- monitor neuro status
what is pernicious anemia
deficiency in production of RBCs because of lack of intrinsice factor
due to lack of intrinsic factor, vit B12 cant be absorbed
more frequently in Northern European descent and African Americans
pernicious anemia manifestations
fatigue
weakness
dyspnea
pallor and palpitations
beefy red tongue
nausea
vomiting
anorexia
diarrhea
abdominal pain
paresthesia in hands and feet
- burning or prickling sensation
impaired coordination and balance
pernicious anemia diagnostic studies
CBC
bone-marrow biopsy
low levels of gastric hydrochloric acid
Schilling test
- vit B12 absorption test
pernicious anemia care
lifelong vit b12 therapy adeuqate dietary sources of vit B12 - clams - sardines - meat - fish - milk - cheese - eggs - fortified breakfast cereals
pernicious anemia management
manage fatigue and activity intolerance
educat eclients
montitor for complications
will receive B12 injections weekly then monthly as maintenance
what is peptic ulcer disease
occurs as the resut of erosion of GI mucosa by hydrochloric acid and pepsin
risk factors of peptic ulcer disease
stress
H pylori
fam hx
use of aspirin
NSAIDs
steroids
caffeine
high alcohol intake
NSAIDs are responsible for majority of non H pylori peptic ulcers
peptic ulcer disease manifestations
pain near epigastrum nausea vomiting bloody emesis - blood vomiting tarry stools - bloody stools
peptic ulcer disease complications
hemorrhage
perforation
gastric outlet obstruction
peptic ulcer disease diagnostic studies
upper endoscopy = most accurate diagnostic procedure
stool for occult blood may be evaluated, as well as complete blood count
peptic ulcer disease care
NPO
NG tube
if acute GI bleeding, endoscopic therapy/hemostasis
srugery - if urgent
peptic ulcer disease pharmacologic interventions
proton pump inhibitors:
- pantoprazole
- omeprazole
- lansoprazole
antiinfectives if H pylori
- clarithromycin
- metronidazole
H2 receptor antagonists
- cimetidine
- ranitidne
- famotidine
anticholinergics
- dicyclomine
antacids
- aluminum hydroxide
- aluminum magnesium combinations
- calcium carbonate
metoclopramide
cytoprotective
- sucralfate
- misoprostol
peptic ulcer disease complementary health
licorice root cats claw goldenseal - little exvidence exists that support their efficacy
acupuncture
therapeutic massage
guided imagery
progressive relaxation
surgically severing vagus nerve (vagotomy) can help with gastric acid secretion
- for clients who do not respond to medical management
what is GERD
syndrome, not a disease
GERD manifestations
based on symptoms
increased by bending, stooping, lying down, or eating
usually relieved by antacids
nausea after eating is common
GERD diagnostic studies
endoscopy
manometry studies
- to evaluate LES and esophageal mobility
scintigraphy
- assess gastric emptying
- used with radioactive tracer to obtain an image of a bodily organ or a record of its functioning
GERD care
pharamacological interventions:
proton pump inhibitors:
- omeprazole
- lantoprazole
H2 receptor antagonists
- cimetidine
- ranitidine
- famotidine
OTC antacids
- pepto bismol
GERD management
HOb elevated, esp after meals
avoid alte night eating
administration of PPI before first meal of the day
monitor aspiration and other complications
maintain fluid and electrolyte balances
avoid foods that acidic or gas-forming
incidence of GERD increases with age
what is appendicitis
inflammation of the appendix
most common reason for emergency abdominal surgery
appendicitiy manifestations
anorexia
nausea and vomiting
right lower quadrant pain
low grade fever
localized and rebound tenderness
appendicitis diagnostic studies
physical exam
differential WBC count
urinalysis
- to rule out urinary conditions that mimic appendicitis
KUB
- kidneys, urter and bladder x ray
ultrasound of the abdomen
CT
appendicitis care
immediate appendectomy
- any delay can lead to rupture and peritonitis
what is ulcerative colitis
begins in the rectum and extends to the distal colong
causes swelling, ulcerations and loss of function of the large intestine - colon
scarring produces narrowing, thickening and shortening of the colon
ulcerative colitis manifestations
bloody diarrhea ranging from 2-3 times/day to 10-20 times/day
stools may contain pus and mucus
left-sided abdominal pain
fever
weight loss
anemia
tachycardia
dehydration
impaired abrotpion of fat soluble, vitamins such as E and K
inflammation of the eyes
liver disease
ulcerative colitis diagnostic studies
CBC
stool for occult blood
stool culture
sigmoidoscopy or colonoscopy
ulcerative colitis care
goal of treatment:
- decreased diarrhea
- formed stool
- control of bowel movement
ulcerative colitis pharmacological interventions
prednisone
infliximab
dicyclomine
drug of choice = sulfasalazine
metronidazole
diphenoxylate
methotrexate
cyclosporine
loperamide
ulcerative colitis dietary restrictions
adhere to high calorie and high protein diet
low roughage
- whole grains
- nuts
- seeds
- legumes
- fruits
- veggies
NO milk products
ulcerative colitis surgical management
proctocolectomy
colectomy
ileostomy creation
ulcerativie colitis complications
increased risk of colon cancer
fluid and electrolytes imbalances
toxic megacolon
- extreme inflammation and distention of the colon
perforation
bleeding
hemorrhage
ulcerative colitis management
manage pain
maintain optimal fluid and nutritional intake
prevent fluid and/or electrolytes imbalances
support coping mechanisms
recognize complications
ileum = most distal part of the small intestine ileus = obstruction in intestine
ilium = part of hipbone
what is crohns disease
results in swelling and dysfunction of intestinal tract
especially the small intesting
most frequent site if the distal ileum
inflammation involves all layers of the bowel wall
crohns disease manifestations
diarrhea with steatorrhea
no obvious blood or mucus in blood
abdominal pain located in right lower quadrant
fatigue
weight loss
dehydration
fever
extraintestinal manifestations: arhtiritis skin inflammations kidney gallstones
crohns disease diagnostic studies
stool for occult blood
stool culture
sigmoidoscopy
colonscopy
barium enema
crohns disease complications
obstructions from strictures
fistula formations
- abnormal made passage between organs
bowel perforation
infection
crohns disease care
rest
remaining NPO during exacerbation
TPN
diet high in calories and protein
low in roughage and fat
crohns disease pharmacological interventions
prednisone hydrocortisone azathioprine methotrexate cyclosporine infliximumab
same as ulcerative colitis
surgery will not cure crohns disease but it may limit the damage
what is diverticular disease
inflammation of one or more diverticula
colon wall thicken and increases pressure in the bowel
stool and bacteria retained in the diverticula become
inflamed and small perforations begin to occur
- surrounding tissue becomes inflamed –> diverticulitis
contributing factors for diverticular disease
smoking excessive alcohol consumption constipation obesity diet low in fiber
Diverticular disease manifestations
frequently asymptomatic
crampy lower left abdominal pain
alternating constipation and diarrhea
low grade fever chills anorexia nausea leukocytosis
diverticular disease diagnostic studies
barium enema
CBC
urinalysis
stool for occult blood
flexible sigmoidoscopy
colonscopy
diverticular disease care
high fiber, high residue diet
pharmacologic interventions:
- bulk laxatives
- stool softeners
- anticholinergics
client with be NPO for 24-48 hours
low fiber diet will be implemented after 48 hours
bowel resection with temporary colostomy
majority of clients with diverticulosis have no symptoms
- typically during a routine colonoscopy
diverticular disease complications
abscess formation
perforation with peritonitis
- progressive pain in other quadrants of the abdomen
fistula
bowel obstruction or hemorrhage
diverticular disease management
weight reduction for obese clients
high fiber diet
fluit intake at least 2L/day
use of stool softeners
avoid intra-abodminal pressure
- straining during defecation
- vomiting
- ending
- heavy lifting
what is intestinal obstruction
partial or complete blockage of bowel that preents the contents of the intestine from passing through
abdomen becomes distended from accumulation of fluid, gas, and intestinal contents
intestinal obstruction manifestations
abdominal pain
distention
nausea and vomiting
- vomiting will be bile stained - (yellowish brown)
hypoxia
metabolic acidosis
bowel necrosis from impaired circulation
low fluid volume increases WBC, hgb, hct, BUN
intestinal obstruction diagnostic studies
upper GI and lowe GI series
abdominal X-ray: for air in the bowel
intestinal obstruction care
abdomen will be decompressed via NG tube
surgical bowel resection may also be necessary
intestinal obstruction complications
perforation
peritonitis
shock
strangulation of the bowel
intestinal obstruction management
manage pain, but avoid using morphine or codeine
measure abdominal girth
provide good oral care if client has NG tube
maintain fluid and electrolyte balance
risk factor for colorectal cancer
clear risk factor is age
- ulcerative colitis
- crohns
- genetic abnormalities
- colorectal polyps
- high fat/low fiber diet
- smoking
- alcohol consumptions
- sedentary lfiestyles
colorectal cancer manifestations
early stages: no symptoms
advance cases:
- rectal bleeding
- blood in stool
- changes in bowel habits
- lower abdominal pain/cramping
screening for early detection is critical for survival
colorectal cancer diagnostic studies
DRE
fecal occult blood test
proctoscopy/sigmoidoscopy
colonscopy
CT scan
colorectal cancer care
goal of surgical intervention:
- removing tumor
finding out if cancer has spread
- removing lymph node near the cancer
chemotherapy and targeted therapy often follow
colorectal cancer management
clients over age of 50 to have screning
- bowel cleansing will be necessary in order for client to be screened properly
NG tube
- monitor for bleeding or coffee ground aspirate
nausea and vomiting are common
- antiemetics can be administered as ordered
monitor fluid and electrolyte
monitor wound incision and drainage after surgery
some might feel phantom rectal pain
- normal and ubsides quickly
progress to a regular diet as tolerated
if no ostomy, teach how to manage bowel movement changes
what is hepatitis
liver becomes inflamed and Kupffer cells become enlarged
stages of hepatitis
pre-icteric (pre jaundice) or prodromal stage
- general flu like symptoms occur
iceteric stage
jaundice occurs
- although not all clients with hepatitis develop jaundice
post icteric stage or recovery stage
- client continues to have fatigue and malaise
hepatitis can lead to :
- swelling
- scarring of the liver (cirrhosis)
- cancer
non viral hepatitis
drug- induced= reaction to a drug due to hypersensitivity
toxic hepatitis caused by;
- ingestion
- inhalation
- inspection of certain chemicals that have a poisonous effect on liver
like carbon tetrachloride, chloroform, poisonous mushrooms
viral hepatitis
5 different viruses to cause viral hepatitis
Hep A: infectious heaptitis
b: serum hepatitis
c: most common form of viral hepatitis
d: found in IV drugs and carriers of hep B
E: similar to hep A
- found in people who live in countries with poor sanitation
diagnosed as either acute or chronic
hepatitis diagnostic studies
decreased serum albumin
increased ALP, ALT, AST
- initially elevated and may rise 1-2 weeks before jaundice is apparent and then decline
bilirubin above 2.5 mg
bromsulphalein excretion test elevated
decreased RBC
antigen tests
abnormal liver enzymes
Pt may be prolonged
clay colored stool, steatorrhea
liver biopsy
liver scan
hepatitis interventions
rest
bedrest during acute phase
encourage client to eat
administer antacids afte r meals
- do not give antacids at the same time as H2 receptor antagonists
- maintain gastric pH greater than 3.5
smokers may report distaste for/aversion to cigarettes
avoid OTc meds that contain aspirin or NSAIDs
aceptance
infection control
what is cirrhosis
irreversible, chronic progressive degeneration of teh liver
types of cirrhosis
laennecs (alcoholic): related to alcohol abuse
post necrotic cirrhosis:
- associated with viral hep or exposure to hepatotoxin
biliary: inflammation or obstruction of the gallbladder or bile duct
cardiac icrrhosis:
- associated with heart failure
cirrhosis manifestations
weakness fatigue weight loss hepatomegaly right upper quadrant
jaundice
pruritus
steatorrhea
clay colored stools
increased bilirubin in urine - dark colored urine
impaired aldosterone metabolism - edema
hypoglycemia
impaired strogen matbolism
- spider angiomas
- palmar erythema
impaired metabolism of protein, carb and fat
- absorbs less Vit K s o prolonged bleeding
- less proteins needed for clotting
- less plasma proteins leads to edema and ascites
cirrhosis diagnostic studies
increased ALT, AST, alkaline phosphatase
Pt
CBC
decreased cholesterol
serum bilirubin and urine bilirubin
ERCP to examine bile ducts
CT scan of liver
liver biopsy
cirrhosis care
steroids for post-necrotic cirrhosis
replace vitamins B and fat soluble vitamins
increased carbs
protein may be restricted
possible sodium restriction
2,000-3,000 calories daily
no alcohol
cirrhosis complications
portal hypertension
ascites
hepatomegaly
cirrhosis management
monitor for bleeding
promote adequate or optimal nutrition
avoid alcohol and other hepatotoxic agents
manage itching and maintain skin integrity
rest
assess for changes in LOC monitor for fluid balance - measure abdominal girth daily - weigh daily - measure intake and output
acetaminophen is safe when taken in recommended amounts
- should take no more than 3,900 mg total in a 24 hour period
what is ascites
accumulation of fluid in the peritoneum
ascites manifestations
abdominal distention
protruding umbilicus
dull sound on percussion of abdomen
bulging flank
dyspnea
ascites diagnostic studies
abdominal x-ray
CT scan
ultrasound
ascites care
pharamcological interventions: - diuretics (spironolactone) - Iv albumin - paracentesis - low sodium diet - peritoneal venous shunt this allows the drainage of fluid from peritoneum to superior vena cava
ascites management
monitor fluid balance
intake and output
daily weight
abdominal girth
skin turgor
restric fluids
monitor ineffective breathing patterns
semi-fowlers position
impaired skin integrtiy
administration of lactulose to reduce ammonia levels in the body is often titrated
what is hepatic encephalopathy
syndrome observed in clietns with late-stage cirrhosis
impaired ammonia metabolism leads to neurotoxins in blood and cerebral edema
ammonia is produced in the bowel by the action of bacteria on protein
- as a result, nitrogenous waste and neurotoxins increase
hepatic encephalopathy amnifestations
changes from level of consciousness from confusion to coma
changes in sleep pattern
memory loss
asterixis - flapping tremor
impaired handwriting
hyperventilation with respiratory alkalosis
fetor hepaticus - musty, sweet breath to client
hepatic encphalopathy diagnostic studies
serum ammonia level
liver enzymes
hepatic encephalopathy care
antibiotics
- rifaximin
lactulose
- converts ammonia to ammonium
low protein diet
hepatic encephalopathy management
safety because treats can lead to falls and injury
uninterrupted rest periods
assess fluid and electrolyte balances andbody weight
monitor bowel changes
hepatic encephalopathy is a neuropsychiatric manifesation of late-stage liver disease
- caused by neurotoxis effects of elevated ammonia levels
what is acute pancreatitis
inflammation of the pancreas
acute pancreatitis manifesations
upper abdominal pain that radiates to the back
nausea
vomiting
tachycardia
slow and shallow respirations
swollen and tender abdomen
fever
complications
atelectasis
hypovolemia and shock
abscess
hemorrhage into retroperitoneal space
- produce bluish discoloration around umbilicus
risk factor of acute pancreatitis
heavy aclhol use gallstones drug ingestion viral infection trauma
acute pancreatitis diagnostic studies
labs serum amylase serum lipase increase urinary amylase CBC - increased WBC, decreased Hgb and Hct
increased LDH and AST
hyperglycemia
hypocalcemica chest x-ray CT scan ultrasound ERCP
acute pancreatitis care
pharamcological intervention:
- meperidine
- morphine
- insulin
- calcium replacement
- anticholinergics
- H2 receptor antagonists
fluid maintenance to repvent shock
calcium replacement and decreasing stimulation to pancreas
NG tube
eat high in protein and carbs
low in fat if eating is allowed
acute pancreatitis management
manage pain
monitor fluid and electrolyte balance
alcohol is STRICTLY prohibited
monitor breathing patterns
monitor nutritional status
oral care when NPO
what is cholecystitis
inflammation of the gallbladder
usually due to gallstones
happens because common bile duct is obstructed by gallstone and bile cannot be excreted
- remaining bile distends and inflames the gall bladder
2 types:
- cholesterol (most common)
- pigment (unconjugated bilirubin)
risk factors of cholecystitis
age 40 or older
birth control pills
being 6-9 months postpartum
cholecystitis manifestations
colicky pain in right upper quadrant
possible radiation to right shoulder and back
indigestion after eating fatty foods
nausea
vomiting
jaundice
low grade fever
cholecystitis diagnostic studies
ERCP
ERCG
CBC
amylase lipase
serum bilirubin
ultrasound
cholecystitis care
rest
low fat diet
removal of stone in common duct by endoscopy
pharmacological interventions
- chenodiol
- urosdiol
side effects are diarrhea and hepatotoxicity
- analgesics
- replace vit K if bleeding is prolonged
extracorporeal shockwave lithotripsy
- may have heamturia after procedure, but not longer than 24 hours
choledocholithotomy
- remove or break up stones and place a T-tube in common bile duct
laparascopic laser cholescystectomy
cholescystectomy
cholecystitis management
vitals
restrict fatty foods in their diet
remember 6 F’s of gallbladder disease:
- female
- fertile
- fat
- forty
- flatulent
- fair skin and hair
hemorrhoids care
- pain relief
- NSAIDs and/or acetaminophen
- opioids can be prescribed initially but may worsen constipation
1-2 days post op
warm stiz baths - preventing constipation
- high fiber diet
- adequate fluid intake at least 50 ml/day
-stool softener like Docusate
oil retention enema may be used if constipation persists for 2-3 days
Pain is priority
Colostomy and ileostomy irrigation procedure
- Fill with 500-1000mL of lukewarm water
- Flush irrigation tubing and red lamp
- Hang container on a hook or IV pole
- Sit on toilet
- Place irrigation sleeve over stoma
- Extend sleeve into toilet
- Place irrigation container approx 18-24 inches above stoma
- Lubricate done tipped irrigator
- Insert cone
- Attach catheter gently into stoma and hold in place
- Slowly open roller clamp, allow irrigation to flow for 5-10 min
- Clamp if cramping occurs, until it subsides
- Once desired amount is distilled, cone is removed and feces is allowed to drain through sleeve into toilet
Paracentesis procedure
Prior to a paracentesis,
- verify client received necessary information to give consent and witness informed consent
- instruct client to void to prevent puncturing bladder
- assess abdominal girth, weight and vitals
- place high Fowler’s or as upright as possible
NPO status is not required for paracentesis
Often performed at bedside
*remember, nurses cannot give informed consent. So just choose the answer that has verify that client got informed consent.
Don’t choose the one that says give informed consent
