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Clinical Nursing May Exam > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

define dysphagia

A

difficulty swallowing

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2
Q

define odynophagia

A

painful swallowing

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3
Q

define regurgitation

A

passive return of food

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4
Q

define halitosis

A

bad breath

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5
Q

what are clinical signs of oropharyngeal disease?

A 
drooling
ptyalism
pseudoptyalism
halitosis
dysphagia
odynophagia
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6
Q

define ptyalism

A

over production of saliva due to pain or disease in mouth

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7
Q

define pseudoptyalism

A

normal amount of saliva but leaves mouth not swallowed

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8
Q

how is oropharyngeal disease investigated?

A 
physical exam
radiographs
minimum database
FNA
biopsy
special tests
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9
Q

what can cause oropharyngeal disease?

A 
foreign body
ulcers
burns
inflammatory disease
neoplasia
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10
Q

what are nursing considerations for oropharyngeal disease?

A 
diagnose and treat underlying disease
analgesia 
oral feeding of warm soft food
may need tube feeding
barrier nursing if infectious cause
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11
Q

why are anorexic patients prone to oral infections?

A

lack of saliva produced so low immune defence

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12
Q

define vomiting

A

acute forceful reflex ejection of gastric contents following stimulation of neural reflex

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13
Q

when can regurgitation happen after food intake?

A

immediate or delayed

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14
Q

what makes regurgitation different to vomiting?

A

passive

neutral pH as not reached stomach acid

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15
Q

what are secondary problems of regurgitation?

A 
malnutrition
dehydration
anorexia
polyphagia
aspiration pneumonia
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16
Q

how is regurgitation investigated?

A 
physical exam
chest x-rays
haematology
biochemistry
oesophagoscopy
oesophageal fluoroscopy
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17
Q

what can be causes of regurgitation?

A

megaoesophagus
oesophagitis
oesophageal obstruction

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18
Q

what are the different types of oesophageal obstruction?

A

complete or partial
intraluminal
intramural
extraluminal

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19
Q

what are the types of megaoesophagus?

A

generalised

focal dilation

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20
Q

what causes generalised megaoesophagus?

A

idiopathic

myasthenia gravis

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21
Q

what causes focal dilation of oesophagus?

A

vascular ring abnormality

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22
Q

how is generalised megaoesophagus treated?

A

idiopathic- no cure

myasthenia gravis- pyridostigmine, neostigmine

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23
Q

how is focal dilation oesophagus treated?

A

surgery

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24
Q

what is nursing care for megaoesophagus?

A

postural feeding as no oesophageal contraction to move food

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25
what are complications associated with megaoesophagus?
aspiration pneumonia | changes to body weight
26
what causes oesophagitis?
ingesting hot liquids, caustics, hot food, foreign body, irritants gastro-oesophageal reflux causing inflammation persistent vomiting
27
what are signs of oesophagitis?
``` regurgitation hypersalivation anorexia pain weightloss ```
28
how is oesophagitis managed?
``` oesophageal rest by gastrotomy tube analgesia antacid gels or coating agents for food acid blockers- omeprazole drugs to reduce reflux ```
29
how can oesophageal foreign bodies be removed?
endoscopy | surgery
30
how do oesophageal strictures form?
fibrosis after severe ulceration of mucosa
31
define emetic
substance that stimulates vomiting
32
define -itis
inflammation
33
what questions should be asked in phone triage for patients with acute vomiting and diarrhoea?
``` productive or non-productive vomiting frequency foreign materials present haematemesis melaena other conditions worming history demeaner appetite and drinking systemic signs ```
34
define haematemesis
vomiting blood
35
define melaena
faecal passage of digested blood
36
when are consults advised for acute vomiting and diarrhoea?
``` unproductive vomiting lots of fluid lost haematemesis melaena suspicion of FB ingestion inappetant hypodipsic systemic signs young animal ```
37
define emesis
vomiting
38
what is vomiting?
complex coordinated reflex reaction, not involving gastric contraction
39
list the stages of vomiting
prodromal retching expulsion relaxation
40
what are signs of the prodromal stage of vomiting?
``` nausea restlessness hypersalivation gulping lip licking ```
41
what happens in the retching stage of vomiting?
inhibition of saliva simultaneous uncoordinated spasmodic contraction of respiratory muscles, duodenal retroperistalsis and mixing of gastric contents
42
what happens in the expulsion stage of vomiting?
pyloric contraction fundic relaxation relaxation of proximal stomach and lower oesophageal sphincter airway protected by closure of glottis and nasopharynx abdominal contraction and lowering of diaphragm to force up vomitus oesophageal retroperistalsis reduced upper oesophageal sphincter tone
43
what happens in the relaxation phase of vomiting?
abdominal, diaphragmatic and respiratory muscles, glottis and nasopharynx relax breathing returns
44
define diarrhoea
high faecal water content
45
what are characteristics of SI diarrhoea?
large volume watery normal frequency normal colour or melaena
46
what are characteristics of LI diarrhoea?
``` small volume increased urgency and frequency tenesmus dyschezia mucus or blood present ```
47
define tenesmus
straining to pass faeces
48
define dyschezia
difficulty passing faeces
49
what can cause non-fatal acute vomiting and diarrhoea?
diet parasites enteric infection adverse drug event
50
what can cause severe acute vomiting and diarrhoea?
``` pathogenic enteric infections acute haemorrhagic diarrhoea syndrome acute pancreatitis surgical disease intoxications ```
51
what are examples of causes of surgical acute vomiting and diarrhoea?
``` intussusception GDV incarceration stricture obstruction FB ```
52
define intussusception
intestine slides inside itself
53
list consequences of acute vomiting and diarrhoea
dehydration hypovolaemia acid base imbalance aspiration
54
how is acute gastroenteritis diagnosed?
``` history physical exam electrolytes haematology biochemistry faecal sample testing imaging response to treatment ```
55
how is hydration maintained for patients with gastroenteritis?
hartmanns with KCl water oral rehydration solutions
56
what is dietary advice for acute vomiting?
rest gut but free access to water re introduce bland diet in small quantities transition to normal diet over 2-5 days
57
state dietary advice for diarrhoea
feed through to help repair intestinal cells and reduce sepsis risk
58
define anti-emetic
substance that inhibits vomiting
59
what is supportive management for gastroenteritis?
``` anti-emetics if no obstruction- metoclopramide, maropitant antispasmodics- buscopan barrier nurse until diagnosis of cause keep patient clean keep environment clean ```
60
how is gastroenteritis treated?
anthelmintics for young or unwormed adults antibiotics if pyrexic or haemorrhagic diarrhoea pro-biotics may be effective
61
why are NSAIDs contraindicated in treatment of gastroenteritis?
prostaglandins needed for maintenance of GI mucosa and renal blood flow
62
how are non-obstructive small gastric FB treated?
induce emesis dogs- apomorphine cats- xylazine
63
how are non-obstructive intestinal FB treated?
monitor passage with radiographs
64
how are non-obstructive gastric FB treated?
endoscopic retrieval | surgery
65
how are obstructive GI FB treated?
surgery
66
what is the consequence of GDV?
impaired venous return compromised gastric mucosa shock death
67
what are potential causes for GDV?
``` deep chested, older dogs diet aerophagia delayed emptying exercise timing ```
68
how is GDV treated?
aggressive IVFT decompression by stomach tube or needle paracentesis IV antibiotics surgical derotation and gastropexy
69
what is common after GDV?
cardiac arrhythmia
70
what is gastropexy?
tying stomach to wall of abdomen to reduce future risk of recurring GDV
71
what are some parasitic causes of acute vomiting and diarrhoea?
round worms hook worms whip worms cestodes
72
what are some protozoal causes of acute vomiting and diarrhoea?
coccidia spp. | giardia spp.
73
who does tritrichomonas foetus effect and how is it spread?
young cats | faeco-orally
74
what is the effects of tritrichomonas foetus infection?
intractable diarrhoea perianal oedema faecal incontinence
75
how is tritrichomonas foetus diagnosed?
colonic wash | PCR
76
how is tritrichomonas foetus treated?
maturity provides immune response otherwise poor response to treatment manage environment to prevent spread
77
what are causes of acute pancreatitis?
idiopathic | predisposing factors
78
what are predisposing factors for acute pancreatitis?
``` dietary indiscretion high fat diet hyperlipidaemia impaired perfusion truama obesity ```
79
how does acute pancreatitis effect the body?
local release of pancreatic enzymes causing pancreatic autodigestion severe local inflammation and cell necrosis can have systemic inflammation and death
80
what are signs of acute pancreatitis?
``` inappetence lethargy abdominal pain vomiting and diarrhoea jaundice if bile duct obstruction ```
81
how is acute pancreatitis diagnosed?
``` history physical exam imaging haematology biochemistry pancreatic lipase immunoreactivity sensitive test ```
82
what is treatment for acute pancreatitis?
``` supportive management IVFT keep up nutrition analgesia antiemetics gastroprotectants ```
83
what is prognosis for acute pancreatitis?
guarded | death and recurrence possible
84
what diet should be given to acute pancreatitis patients?
highly digestible complex carbs low fat
85
what causes chronic pancreatitis?
repeated acute pancreatitis | low grade chronic pancreatitis
86
what are signs of chronic pancreatitis?
inappetence lethargy vomiting diarrhoea
87
what is management for chronic pancreatitis?
modify diet manage nausea and appetite analgesia
88
define hyporexia
reduced appetite
89
define polyphagia
excessive appetite
90
define pica
appetite for non-nutritional substances
91
define ileus
reduced GI motility
92
define anorexia
loss of desire to eat
93
what are consequences of anorexia?
``` weight loss impaired immune function increased risk of sepsis poor wound healing slow recovery ```
94
list signs of chronic GI disease
``` altered appetite dehydration vomiting BW or condition loss borborygmi flatus abdominal discomfort ascites or oedema ```
95
define borborygmi
gurgling
96
what causes chronic vomiting and diarrhoea?
``` gastric ulceration dietary sensitivity neoplasia liver disease kidney disease pancreatitis endocrine disease ```
97
how is chronic vomiting and diarrhoea diagnosed?
``` history clinical exam haematology biochemistry faecal analysis absorption tests imaging gastroscopy laparotomy biopsy ```
98
how is chronic vomiting and diarrhoea treated?
``` treat underlying cause exclude parasites modify diet vitamin B12 steroids anti-emetics appetite stimulants ```
99
what are causes of inappetance?
``` pain stress dehydration hypokalaemia nausea delayed gastric emptying ```
100
how can you encourage inappetent patients to eat?
``` wet, warm, smelly food preferred food and method keep euhydrated and electrolyte balanced anti-emetics appetite stimulants ```
101
how can you provide nutritional support to inappetant patients?
feeding tubes | cobalamin supplements
102
define chronic enteropathies
chronic disease of SI
103
what is part of IBD complex?
food responsive diarrhoea antibiotic responsive diarrhoea idiopathic IBD
104
what is protein losing enteropathy?
severe SI disease resulting in severe malabsorption and loss of albumin and globulin form of chronic enteropathy
105
what is the consequences of protein losing enteropathy?
weight loss oedema ascites thromboembolism
106
what causes protein losing enteropathy?
IBD lymphangiectasia alimentary lymphoma or lymphosarcoma
107
how is protein losing enteropathy diagnosed?
endoscopy
108
what are dietary considerations for chronic enteropathies?
``` avoid allergens highly digestible food restrict fat supplement fibre feed little and often ```
109
what is EPI?
failure of normal exocrine secretions
110
what is the effects of EPI?
maldigestion | malabsorption
111
what causes EPI?
pancreatic acinar atrophy common in GSD recurrent pancreatitis
112
what are signs of EPI?
ravenous appetite diarrhoea fatty faeces as limited fat digestion weight loss
113
how is EPI diagnosed?
trypsin like immunoreactivity serum test
114
how is EPI treated and what are downsides?
oral pancreatic extract | expensive and lifelong
115
describe diet for EPI
``` 2-3 meals enzyme at every meal highly digestible good quality protein non-complex carbs cobalamin supplement ```
116
define colitis
colonic inflammation
117
how is colitis treated?
anti-inflammatory sulfasalazine
118
what can be a side effect to colitis treatment?
keratoconjunctivitis sicca
119
what are signs of IBS?
LI diarrhoea | occasional vomiting
120
what is signalment for IBS?
anxious small breed dogs
121
how is IBS diagnosed?
exclusion of other causes
122
how is IBS treated?
long term diet modification anti-spasmodics anti-cholinergics
123
list causes of GI bleeding
coagulopathy | swallowed blood
124
what is seen from gastric or SI bleeding?
haematemesis | melaena
125
what is seen from LI bleeding?
haematochezia
126
define haematochezia
fresh blood in faeces
127
what are causes of GI ulceration?
``` NSAIDs steroids FB gastric carcinoma hypoadrenocorticism kidney or liver disease ```
128
how is GI ulceration treated?
treat underlying cause | surgery if perforates
129
what is constipation?
impaction of colon or rectum with faecal matter, usually excessive hard or dry
130
what is consequence of prolonged constipation?
irreversible changes | obstipation
131
define obstipation
excess faeces accumulation that cant be passed
132
what are signs of constipation?
``` infrequent defecation dyschezia pain with defecation vomiting anorexia lethargy ```
133
what causes constipation?
``` ingestion of FB dehydration drugs stress lack of toileting opportunity pain preventing posturing CNS disease ```
134
how is constipation and megacolon treated?
``` correct underlying cause IVFT correct electrolytes oral laxatives enema surgery if needed ```
135
how can you manage and prevent constipation?
``` good water intake control underlying disease add fibre to diet increase exercise laxatives as needed ```
136
what causes megacolon?
idiopathic neuromuscular dysfunction | chronic underlying disease
137
state normal liver function
synthesis of proteins, glucose, cholesterol | clearance and detoxification of ammonia, bilirubin, bile acids, drugs
138
what are signs of hepatic dysfunction?
``` inappetence lethargy vomiting diarrhoea jaundice ascites synthesis failure persistent drug activity ```
139
what causes jaundice?
failure of clearance of bilirubin causing yellow discolouration from hyperbilirubinemia and bile pigment deposition in tissues
140
what are the types of jaundice?
pre-hepatic- too much bilirubin to be cleared hepatic- failure of hepatic uptake, coagulation and transport of bilirubin post-hepatic- failure of bile excretion
141
what are causes of ascites?
hypoalbuminemia portal hypertension sodium and water retention
142
what causes failure of hepatic detoxification?
hepatic dysfunction | abnormal blood supply
143
what is the effect of failure of conversion of ammonia to urea?
hyperammonaemia | hepatic encphalopathy
144
what is the impact of build up of encephalopathic toxins?
``` fore brain dysfunction lethargy pacing head pressing seizures coma ```
145
what precipitates hepatic encephalopathy?
high protein meal vomiting diarrhoea diuretics
146
how is hepatic dysfunction diagnosed?
``` liver enzymes bilirubin bile acids blood glucose blood clotting imaging liver cytology liver biopsy ```
147
what can cause acute liver disease?
hepatotoxins infection medication side effects
148
what are nursing considerations for acute liver disease?
``` manage hepatic encephalopathy lactulose to reduce ammonia absorption seizure management monitor hydration and electrolytes anti-emetics manage hypoglycaemia leg veins used as may be coagulopathic antioxidants antibiotics barrier nursing ```
149
how is nutrition managed for acute liver disease patients?
restrict animal protein hepatic prescription diet restrict copper antioxidant supplements
150
what are causes of chronic inflammatory liver disease?
``` chronic hepatitis lymphocytic cholangitis infectious cholangitis leptospirosis chronic FIP ```
151
how is chronic inflammatory liver disease treated?
``` de-coppering therapy antibiotics if indicated modify diet anti-oxidants steroids hepatic encephalopathy therapy manage ascites ```
152
what is gall bladder mucocoeles?
gall bladder full of insipidated bile and mucus
153
what are signs of gall bladder mucocoeles?
asymptomatic obstructed bile flow rupture
154
how is gall bladder mucocoeles treated?
medication | gall bladder removal
155
what is feline hepatic lipidosis?
hepatocyte triglyceride deposition | when anorexic fat stores mobilise for energy then accumulate in liver
156
what predisposes to feline hepatic lipidosis?
obesity high fat or carb diet systemic illness diabetes mellitus
157
what are the effects of feline hepatic lipidosis?
``` intracellular fat accumulation liver failure encephalopathy coagulopathy death ```
158
how is feline hepatic lipidosis treated?
``` treat underlying diseases nutritional support enough protein antioxidants often 6-8 weeks tube feeding ```
159
state the types of portosystemic shunt
single | acquired/multiple
160
list signs of portosystemic shunt
dullness lethargy inappetance history of GI signs
161
how are portosystemic shunts diagnosed?
``` abnormal liver function low albumin low cholerterol high bile acids high ammonia ```
162
what is the effects of portovascular abnormalities?
blood from GIT bypasses liver to systemic circulation so lack of nutrients delivered to liver causing dysfunction blood from GIT not filtered by liver so accumulation of toxins cause hepatic encephalopathy and brain dysfunction
163
how are portosystemic shunts treated?
``` hydrated and normal blood potassium restrict protein lactulose to trap ammonia in colon antibiotics to minimise ammonia produced by gut flora close surgically ```
164
what are signs of hepatic neoplasia?
asymptomatic hepatic or obstructive signs rupture causing haemoabdomen
165
what are types of hepatic neoplasia and how are they treated?
primary- surgery infiltrive, lymphomas- chemo metastatic, carcinomas- none
166
why are dry food diets reccomended?
balanced nutrients convenient good for dental hygiene
167
state the most important nutrient
water
168
how much water is needed a day?
50ml/kg/day | affected by factors such as exercise, weather
169
list fat soluble vitamins
A D E K
170
why is it important not to have too many fat soluble vitamins in the diet?
they get stored in fat reserves and not excrete
171
state the water soluble vitamins
B | C
172
are water soluble vitamins stored in the body?
no
173
why is it important to get the right amount of vitamins?
energy metabolism biochemical reactions deficiency syndromes
174
list macrominerals
``` calcium phosphorus magnesium sodium potassium chloride sulphur ```
175
list microminerals
``` iron copper zinc manganese iodine selenium ```
176
which type of minerals are most important?
microminerals
177
what is an essential amino acid?
amino acid not synthesised by the body
178
why are cats obligate carnivores?
need to take in taurine through diet as cant synthesise it
179
how many amino acids are there?
23
180
state the function of protein
regulate metabolism cell and muscle fibre structure tissue growth and repair energy
181
define biological value
amount of protein utilisable
182
how is biological value assessed?
acceptable digestible utilisable bioavailability
183
what is the consequence of excess protein?
liver and kidney issues
184
list effects of protein deficiency
``` poor growth muscle loss weight loss dull hair reduced immunity oedema death ```
185
what is the function of fats?
energy absorption of fat soluble vitamins enhance palatability source of EFA
186
what is the effect of lack of fat in diet?
energy deficiency impaired reproduction impaired wound healing dry coat and skin
187
what are the types of carbohydrates and examples of each?
monosaccharide- glucose, fructose disaccharides- maltose, lactose, sucrose polysaccharides- starch, glycogen, fibre
188
what is the function of carbohydrates?
energy fat stores precursor for AA and glycerol
189
what is dietary fibre and examples?
indigestible polysaccharides | cellulose, lignin, pectin
190
what is the function of fibre?
bulk faeces prevent constipation and diarrhoea keep full for longer blood glucose regulation in diabetes
191
what is meant by metabolizable energy?
kcal/100g food
192
what is gross energy of food?
all energy of the food by not all available to the animal
193
define BER
amount exerted in sleep 12-18 hours after feeding in thermoneutral environment
194
define RER
includes energy for recovery from activity and feeding
195
define MER
energy required by moderately active animal not including growth, lactation, work
196
what needs considering when calculating MER?
life stage factors
197
state the calculation of RER
70 x BW^0.75 if less than 2kg or over 45kg | otherwise (30 x BW) + 70
198
how do you calculate how much to feed an animal?
calculate energy requirement choose suitable diet divide energy content of diet by energy requirement for amount of feed needed daily divide by times wanting to feed
199
which energy requirements are used for sick and healthy animals?
sick- RER | healthy- MER
200
how is MER calculated?
RER x appropriate life stage factor
201
define obesity
excess accumulation of body fat
202
what predisposes to obesity?
neutering overfeeding poor owner knowledge
203
list consequences of obesity
``` hepatic lipidosis joint disease exercise intolerance diabetes mellitus skin disease cardiorespiratory disease risk in surgery FLUTD ```
204
what is ideal amount of weight to lose a week?
1-2% BW
205
describe how to implement weight loss for patients
change diet gradually build up exercise base MER of ideal weight individually tailored
206
what is the effect of starvation when trying to lose weight?
excess loss of muscle mass body function problems hepatic lipidosis
207
what are features of obesity diet?
nutritionally balanced high protein to keep satiated and preserve lean body mass joint diet in some cases L-carnitine to encourage fat for energy rather than storage
208
what problems GI diets be used to treat?
``` diarrhoea gastritis enteritis IBD maldigestion EPI ```
209
what are features of GI diets?
highly digestible protein and starch MOS and FOS prebiotics EPA/DHA highly digestible unsaturated fatty acids and omega 3 psyllium to aid removal from GI tract
210
what are hypoallergenic diets used for?
manage food allergy food elimination trials EPI IBD
211
what are features of hypoallergenic diets?
hypoallergenic and highly digestible hydrolysed or novel proteins nutrients support skin, GI mucosa and healthy intestinal environment
212
what are the effects of pancreatitis if not treated?
``` renal failure acute lung injury chronic pancreatitis EPI death ```
213
what is the feature of convalescent diets?
protein provides 30-50% total energy source
214
state consideration for use of convalescent diets
due to high protein care with renal failure or hepatic encephalopathy as reduced ability to deal with protein
215
why do critical care patients have high risk of malnutrition?
catabolism and rapid breakdown of protein and energy stores
216
what nutrition should be given to critical care nutrition?
oral nutrition as early as possible enough energy sources EFAs micronutrients
217
how do dental diets help dental health?
mechanically remove plaque if hard food phosphate salts reduce mineralisation of plaque chews reduce plaque
218
what nutrients are needed for skeletal development and maintenance?
calcium phosphorus vitamin D
219
what are examples of conditions that can be helped by orthopaedic diets?
osteoarthritis joint dysplasia CCLR luxating patella
220
how do orthopaedic diets help?
manage weight omega 3s to manage inflammation help cartilage repair or slow degeneration
221
how can diets help diabetes mellitus?
achieve and maintain normal serum glucose levels decrease peaks of glucose post feeding help normal metabolism normalise body weight
222
what are features of diabetes diets?
high protein low fat low soluble carbs fibre
223
describe diet for hyperthyroidism
0.2ppm iodine dry matter base hills y/d exclusive feeding
224
what are feeding considerations for cardiac diets?
mild sodium restriction maintain ideal BCS monitor for cachexia
225
define cachexia
muscle loss in presence of disease
226
what are features of cardiac diets?
taurine as deficiency linked to DCM L-carnitine for myocardial energy requirement arginine for vascular tone omega 3s
227
define -otomy
cutting open tissue which is then repaired to allow normal healing
228
define -ostomy
creation of opening to outside of skin | if device removed keeping open wound either heals closed or as permanent stoma
229
define -oscopy
device to visualise inside cavity
230
define -ectomy
removal of part or all of structure
231
list roles of vet nurse in GI surgery
``` pre op care of animal surgical prep of animal equipment prep assistance in surgery anaesthetic monitoring post op care ```
232
what are pre op considerations for GI surgery?
usually emergency and unwell | stabilise fluids and electrolytes before anaesthesia
233
how are GI patients prepared for surgery?
starve for 12 hours ideally but not always possible if emergency specific condition management flush mouth with sterile saline if oral surgery
234
what are other considerations for GI surgery?
antibiotics during and post op keep warm as lose lots of heat from abdomen seal ETT as high risk of regurgitation
235
list equipment used in GI surgery
``` laparotomy swabs suction histopathology swabs retractors bowel clamps 2 surgical kits to prevent contamination pre-warmed saline stomach tube endoscope ```
236
state role of vet nurses in GI surgery
clamp bowels keep GI contents moist with saline separate contaminated instruments suction
237
what type of suture materials are used for GI surgery and why?
short duration absorbable as quick healing | synthetic monofilament to prevent wicking in infection
238
what needles are used for GI surgery suturing and why?
round body | least traumatic
239
why are antibiotics used in GI surgery?
considered clean contaminated procedure | contaminated if questionable tissue viability or contamination occurs
240
what is oral surgery used for?
``` oral tumours oronasal fistula cleft palette foreign body penetrating injuries ```
241
what are pre-op considerations for oral surgery?
saline flush to remove debris positioning anaesthesia
242
what are post op considerations for oral surgery?
ensure can eat and drink soft food feeding tube as needed
243
what conditions is oesophageal surgery used for?
FB by endoscope or surgical removal from stomach | stricture
244
what are pre-op considerations for oesophageal surgery?
manage dehydration and hypovolaemia | IVFT
245
state post op considerations for oesophageal surgery
feeding tubes to allow oesophagus to heal | liquid diet
246
what are reasons for gastric surgery?
``` FB pyloric obstruction neoplasia GDV tube gastrotomy ```
247
what are pre-op and intra-op considerations for gastric surgery?
IVFT for dehydration and hypovolaemia prepare surgical site monitor heat loss
248
what are post op considerations for gastric surgery?
low fat bland diet liquid diet if obstruction IVFT monitor for arrhythmia if GDV
249
describe treatment plan for GDV
``` treat shock with rapid IVFT IV antibiotics decompress stomach with stomach tube radiographs to confirm ECG to check for dysrhythmia surgical decompression and derotation gastropexy ```
250
what are types of SI surgery?
biopsy enterotomy for FB removal enterectomy to removed section intussusception repair or resection
251
what are pre- and intra-op considerations for SI surgery?
``` IVFT keep abdomen moist during surgery prepare wide surgical site monitor temperature surgical assistant ```
252
what are post-op considerations for LI surgery?
manage biopsy samples encourage eating low fat diet encourage drinking
253
why does LI surgery have more risk than SI surgery?
increased bacterial load | slower healing
254
what are examples of LI surgery?
biopsy | colectomy
255
list intra-op considerations for LI surgery
avoid enemas as slurry more likely to spill | antibiotics
256
what are post op considerations for LI surgery?
manage biopsy samples | nutrition to support healing
257
when is anal and rectal surgery performed?
``` polyps or tumours prolapse imperforate anus anal sac removal anal furcunculosis ```
258
what is imperforate anus?
congential condition where anus doesnt join rectum
259
why is anal sac removal performed?
chronic sacculitis, impaction and abscessation
260
what are signs of rectal polyps or tumours?
tenesmus bleeding discomfort
261
what is anal furcunculosis?
inflammatory disease almost exclusively in GSD
262
what are pre-op considerations for anal surgery?
positioning keep prolapses moist and lubricated purse string placement
263
state post op considerations for anal surgery
nutritional support to aid healing
264
how does peritonitis happen?
irritation or contamination to peritoneum causing inflammatory response
265
why is peritonitis life threatening?
infection develops and rapidly causes severe illness, sepsis, shock, CV collapse
266
list signs of peritonitis
``` pyrexia anorexia depression tachycardia vomiting ascites abdominal pain ```
267
how is peritonitis treated?
``` exploration to find source of contamination lavage abdomen provide open peritoneal drainage IVFT monitor blood albumin and electrolytes ```
268
what are common complications following GI surgery?
``` hypothermia hypovolaemia hypotension hypoglycaemia nausea dehydration ```
269
what is post op care for GI surgery?
wound care analgesia monitor for dysphoria
270
list some immediate post op complications following GI surgery
``` physiological abnormalities worsening pain haemorrhage drug reaction vomiting and regurgitation wound breakdown ```
271
what are longer term post op complications for GI surgery?
``` pain haemorrhage aspiration pneumonia ileus infection ```
272
what are features of GI post op care plans?
tailored to individual 3-5 careful observation in or out of hospital monitor for abnormalities manage hydration with IVFT until eating and drinking normlly
273
describe nutrition plans for post GI surgery
lower GIT surgical patients encouraged to eat straight away to prevent ileus and help intestine function upper GIT patients start water after 2 hours, food after 12 hours aid gut motility by keeping ambulatory consider feeding tubes
274
what are signs of nausea?
salivation swallowing lip-licking
275
what drugs can help prevent nausea?
maropitant metoclopramide ranitidine omeprazole
276
what types of medications can be used post GI surgery?
``` prokinetics probiotics appetite stimulants analgesia anti-emetics ```
277
why are NSAIDs not recommended post GI surgery?
cause GI ulceration and upset
278
define dehiscence
disruption of wound edges
279
when is dehiscence mostly seen?
3-5 days post op
280
list most common areas affected by dehiscence
skin abdominal wall intestines
281
what are clinical signs of dehiscence?
serosanguinous or purulent discharge from suture line swelling necrosis of edges
282
what is the effect of abdominal wall dehiscence?
hernia
283
what are clinical signs of abdominal wall dehiscence?
oedema inflammation serosanguinous drainage painless swelling
284
what is the effect of intestinal dehiscence?
septic peritonitis
285
list clinical signs of intestinal wall dehiscence?
``` depression anorexia vomiting abdominal pain acute collapse ```
286
list risk factors for dehiscence
``` wound tension suture choice self trauma underlying neoplasia closing non-viable skin endocrine disease obesity immunocompromise hypovolemia ```
287
how can dehiscence be prevented?
bandaging to immobilise collar to prevent trauma confined and exercise restricted
288
what is primary cause of peritonitis?
cats with FIP
289
what are secondary types of peritonitis?
aseptic | septic
290
what are causes of peritonitis?
dehiscence ischaemic necrosis infection
291
list complications associated with oesophageal surgery
regurgitation oesophagitis strictures swallowing affecting healing
292
list complications associated with gastric surgery
``` vomiting anorexia ulceration gastric obstruction pancreatitis ```
293
list common gastric surgery performed in first opinion
gastrotomy for FB | gastropexy
294
list complications associated with SI surgery
``` adhesions from excess handling ileus perforation stenosis intestinal strictures diarrhoea anorexia ```
295
define stenosis
constriction of lumen
296
what are common SI surgery performed in first opinion?
enterotomy for FB | enterectomy for intussucception
297
list complications associated with LI surgery
``` haemorrhage faecal contamination leakage stricture stenosis incontinence ```
298
list complications associated with perineum, rectal and anal surgery
``` tenesmus rectal prolapse incontinence anal stricture urethral obstruction stenosis ```
299
define colic
abdominal pain of any origin
300
what is significant about colic?
clinical signs of many GI conditions | most die of colic
301
list signs of colic
rolling pawing flank watching lip curling
302
what is the purpose of clinical exam for colic patients?
determine if needs emergency surgery
303
list what is assessed in clinical exam for colic
``` CV status HR RR temperature haematocrit TP lactate abdominal exam rectal exam ultrasound abdominoparacentesis oral exam gastroscopy radiography ```
304
why is assessment of CV status important in colic patients?
acute GI conditions can lead to endotoxemia, dehydration, shock, coagulation disorders
305
describe how abdominal exam in horses is done
auscultate 4 quadrants | observe for distension
306
what can be identified from rectal exam of horses?
distension impaction displacement limited one part of abdomen
307
why are stomach tubes lifesaving in horses?
they cant vomit so prevents stomach rupture if outflow is obstructed
308
what is a risk of stomach tubing in horses?
nose bleed
309
what is the disadvantage of ultrasounding horses abdomens?
can only see 15cm deep so doesnt prove no issues
310
what is an abdominoparacentesis?
belly tap of peritoneal fluid
311
what can abdominoparacentesis in horses show?
``` intestinal damage hamoperitoneum rupture inflammatory cells neoplasia ```
312
what are gastroscopy in horses used for?
look for ulceration look for outflow obstruction and impactions biopsies
313
list tests that are done on horses with colic
``` bloods peritoneal fluid cytology and appearance FEC faecal culture glucose absorption test laparoscopy ```
314
why do horse teeth need rasping once a year?
less grinding than wild horses so can form sharp edges | if not corrected can cause dysphagia and impaction
315
list examples of dental disease in horses
``` eruption disorders dental decay peritoneal disease fractured tooth diastema ```
316
how are equine dental diseases examined?
watch eating palpate sedate and wash out mouth to examine
317
list some treatment options for dental disease in horses
filling or widening to prevent things getting stuck | removal of teeth
318
what are downsides of tooth extraction in horses?
opposite tooth wont be ground down | hard to remove
319
define oesphageal choke
obstruction
320
list causes of oesophageal choke in horses
``` eating to fast dry concentrate poor dentition oesophageal damage from previous choke mass ```
321
state clinical signs of oesophageal choke in horses
``` neck extended food coming from food gag cough dehydration weight loss acid base imbalance aspiration pneumonia ```
322
what are problems associated with oesophageal choke in horses?
damaged oesophagus acute oesophageal rupture strictures
323
how is oesophageal choke diagnosed in horses?
``` auscultation CV parameters bloods gastroscopy imaging stomach tube to determine site of blockage ```
324
how is oesophageal choke treated in horses?
relieve obstruction stomach tube to lavage obstruction buscopan and oxytocin to relax oesophagus check obstruction cleared with gastroscope or stomach tube check no mucosal damage check for underlying issues rest from feeding
325
what are stages of gastroduodenal ulceration in horses?
inflammation erosion ulceration perforation
326
how are gastroduodenal ulcers graded in horses?
0-4 | none to bleeding
327
what causes gastroduodenal ulcers in horses?
imbalance between inciting and protective factors
328
list inciting factors in equine stomach
HCl bile acids pepsin
329
list protective factors in equine stomach
``` mucus-bicarbonate layer mucosal blood flow mucosal prostaglandin E epidermal growth factor production gastroduodenal motility ```
330
state risk factors for gastroduodenal ulcers in horses
``` empty stomach exercise diet stress NSAIDs hospitalisation ```
331
list clinical signs of gastroduodenal ulcers in horses
``` poor appetite colic tooth grinding diarrhoea poor performance ```
332
how is gastroduodenal ulcers diagnosed in horses?
gastroscopy | interpretation as presence doesn't mean significance
333
how are gastroduodenal ulcers in horses treated?
dependent on cause general management omeprazole for adults sucralfate for foals
334
list causes of primary gastric dilation and rupture in horses
``` gastric impaction grain engorgement colic unknown cause idiopathic ```
335
list secondary causes of gastric dilation and rupture in horses
SI or LI obstruction ileus functional obstruction
336
list clinical signs of gastric dilation and rupture in horses
``` over filling of stomach acute colic tachycardia fluid from nose just before rupture dehydration ```
337
how is gastric dilation and rupture in horses diagnosed?
clinical signs reflux colic work up gastroscopy
338
how do you treat gastric over filling and rupture in horses?
stomach tubing treat underlying cause IVFT IV nutrition if needed
339
what is anterior enteritis in horses?
inflammatory condition affecting proximal SI
340
what is a risk factor for anterior enteritis in horses?
diet change to high concentrate
341
list clinical signs of anterior enteritis in horses
hypersecretion functional ileus secondary to inflammation distended SI and stomach pyrexia
342
how is anterior enteritis diagnosed in horses?
colic investigation peritoneal fluid with raised protein culture reflux ex-lap
343
how is anterior enteritis treated in horses?
``` repeated stomach tubing antibiotics IVFT no feeding by mouth analgesia ex-lap SI decompression ```
344
what is prognosis for anterior enteritis in horses?
varies survival as treatment expensive and long but those that do have it is good prognosis
345
what can cause malabsorption and maldigestion in horses?
inflammatory type diseases | lymphosarcoma
346
what is the clinical sign of malabsorption and maldigestion in horses?
weight loss
347
how is malabsorption and maldigestion in horses diagnosed?
abdominoparacentesis ultrasound oral glucose tolerance test laparoscopic biposy
348
how is malabsorption and maldigestion in horses treated?
depends on diagnosis resection corticosteroids no treatment
349
what is a simple obstruction in horses?
obstruction of intestinal lumen without obstruction to blood flow
350
what can cause simple SI obstructions in horses?
food ileal hypertrophy adhesions
351
what is strangulation of intestines in horses?
occlusion of lumen and blood supply so intestine dies
352
what are causes of strangulation in horses?
``` lipoma SI volvulus mesenteric rent inguinal diaphragmatic hernia intussucception ```
353
list effects of SI obstruction in horses
``` gastric overfilling deterioration of intestinal mucosa intestinal death sepsis endotoxemia ```
354
what are signs of SI obstruction in horses?
``` colic, eases when gut dead reflux tachycardia hypovolaemia distended SI serosanguinous, protein and lactate in peritoneal fluid ```
355
how are SI obstructions in horses treated?
surgery with 3-4 months rest | euthanasia
356
what is prognosis for SI obstructions in horses?
80% short term survival | 60-70% long term survival depending on severity of presentation
357
what are causes of caecal impaction in horses?
underlying motility disorder | after ortho procedures in young horses
358
list clinical signs of caecal impaction in horses
colic rupture severe shock death
359
how is caecal impaction in horses diagnosed?
clinical signs history rectal exam abdominoparacentesis
360
how are ceacal impactions in horses treated?
medical surgery IVFT
361
what is prognosis for caecal impactions in horses?
90% success as most caught early
362
what are the types of caecal intussusception in horses?
ileo-caecal | caeco-ceacal
363
what is signalment for caecal intusucception in horses?
young horses tapeworms causing inflammation reduced motility
364
list clinical signs of caecal intussusception in horses
varies colic can be chronic
365
how is caecal intussusception diagnosed in horses?
rectal exam | ultrasound
366
how is caecal intussusception in horses treated?
surgery | treat tapeworms
367
what are causes of simple LI obstructions in horses?
impaction | displacement
368
what are causes of LI strangulation in horses?
torsion
369
where are LI obstructions in horses normally?
pelvic flexure
370
what are causes of LI obstruction in horses?
poor teeth ingesting long fibre motility disorder box rest
371
list clinical signs of LI obstruction in horses
mild colic | reduced faecal output
372
how are LI obstructions in horses diagnosed?
rectal exam | abdominoparacentesis
373
how are horses with LI obstruction treated?
IVFT cathartics to move water to gut analgesia surgery
374
why does Li displacement happen in horses?
lots of space for intestines to move around
375
state types of LI displacement in horses
right dorsal left dorsal nephrosplenic entrapment
376
how are LI displacements managed and treated?
``` may resolve medication starve to empty and deflate gut so returns to normal IVFT analgesia surgery ```
377
how are LI displacements diagnosed in horses?
rectal exam ultrasound abdominoparacentesis surgery
378
when do LI torsions tend to happen in horses?
spontaneously | following displacement
379
list signs of LI torsion in horses
extreme pain abdomen distension respiratory compromise
380
how is LI torsion in horses diagnosed?
rectal exam
381
how is LI torsion in horses treated?
surgery | may need resection
382
what is prognosis for LI torsion in horses?
depends on damage to LI | can recur
383
what are causes of acute diarrhoea in horses?
``` salmonella colitis neoplasia food hypersensitivity toxicity ```
384
what causes chronic diarrhoea in horses?
``` dental disease dietary sensitivity parasites IBD neoplasia ```
385
how is diarrhoea diagnosed in horses?
``` CV parameters rectal exam ultrasound abdominoparacentesis rectal biopsy FEC and culture ```
386
how is diarrhoea in horses treated?
``` hydration electrolytes laminitis prevention treat underlying cause give antibiotics keep feeding nursing care ```
387
what are causes of small colon impaction in horses?
foreign bodies | salmonella
388
what are signs of small colon impaction in horses?
intermittent diarrhoea | colic
389
how is small colon impaction in horses treated?
medication | surgery
390
what are signs of peritonitis in horses?
mild colic | pyrexia
391
how is peritonitis in horses diagnosed?
abdominoparacentesis showing high WBCs
392
how is peritonitis in horses treated?
antibiotics laparoscopy laparotomy
393
what can be causes of secondary peritonitis in horses?
colic surgery
394
what are reasons for equine GI surgery?
normally colic related | occasionally due to laparotomy or laparoscopy
395
what tests influence the decision to perform emergency colic surgery decided?
``` pain clinical exam rectal exam peritoneal fluid analysis bloods ultrasound findings ```
396
what are colic finding indicating possible surgery?
``` signs of colic despite analgesia lack of faeces HR over 60bpm poor MM colour reduced gut sounds distention or displacement of intestines high PCV, lactate, protein reflux with NG tubing over 5L discoloured peritoneal fluid ```
397
what practicalities need considering for colic surgery?
expensive, unsuccessful cases often most transport to hospital prognosis complications
398
list preparations for colic surgery
``` jugular IV placement NG tube to decompress stomach analgesia antibiotics IVFT clip abdomen remove shoes and tape feet wash out mouth ```
399
describe how NG stomach tubes are placed for stomach decompression in horses
tube passed through ventral meatus with head flexed to encourage passage to oesophagus confirm placement by observing left side of neck
400
what preparations are needed for horses laparotomy?
``` dorsal recumbency for dorsal midline incision urinary catheter clip and prep abdomen cover legs and feet drape ```
401
what are principles of colic surgery?
``` exploration of abdomen and intestines identifying lesions correct displacements decompression of distended viscera resection of devitalised tissue ```
402
what is functional intestinal obstruction?
peristalsis fails to propel ingesta causing distention
403
what are the consequences of strangulation of intestines in horses?
``` death of section of intestine oedematous thickening of gut wall endotoxin release shock laminitis ```
404
how does strangulated small intestines in horses cause issues?
strangulated section dies | mucosa becomes permeable to endotoxins which leak into peritoneal cavity and circulation
405
how are SI resections done in horses?
isolate segment with bowel clamps ligate blood vessels supplying segment resect segment
406
how are simple or functional SI obstructions treated in horses?
decompression | removal of obstruction by enterotomy
407
what is prognosis for intestinal obstructions in horses?
simples- good when resolved | strangulating is worse
408
what are risks for strangulation resection in horses?
``` contamination peritonitis endotoxic shock ileus adhesions ```
409
how are LI displacements in horses treated?
decompression of bowel evacuation of colon via pelvic flexure enterotomy correct displacement coloplexy to prevent recurrence
410
what are causes of large colon volvulus in horses?
unknown but usually larger horses or brood mares 90 days post foaling
411
what are signs of equine large colon volvulus?
``` sudden onset abdominal pain enlarged colon on rectal exam abdominal distension endotoxemia high HR poor peripheral perfusion ```
412
how is large colon volvulus treated in horses?
surgery to correct | removal of ischemic colon
413
what effects the prognosis for large colon volvulus in horses?
time from onset of condition to surgery
414
what are post op care for horses after GI surgery?
``` exam every 2-4 hours analgesia antibiotics IVFT monitoring for complications bloods NG tubing as needed ```
415
list possible complications following GI surgery in horses
``` endotoxemia ileus jugular thrombophlebitis obstruction anastomosis leakage peritonitis adhesions laminitis colitis infection ```
416
what needs monitoring in horses following GI surgery?
``` pain pyrexia faecal output gut sounds reflux through NG tube incision catheter feet respiratory system ```
417
describe how horses are fed after GI surgery
nil by mouth if significant reflux through NG tube when no reflux small amounts of water start with grass then gradually introduce hay normal volume return over 3 days
418
what are exercise requirements post GI surgery in horses?
6 weeks box rest small walks to allow grazing and promote gut motility turn out after 6 weeks to small paddock ridden exercise after 3 months if no incisional issues
419
how is endotoxemia in horses treated?
IVFT flunixin polymyxin hyperimmune plasma
420
what are signs of endotoxemia in horses?
``` pyrexia tachycardia tachypnoea hyperaemic MM colic ```
421
how is ileus treated in horses?
IVFT stomach tube decompression prokinetics

Clinical Nursing May Exam (22 decks)

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