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NRS 105 Exam #1 > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

________________ is a burning sensation in the stomach and esophagus that moves up to the mouth.

A

Pyrosis

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2
Q

TRUE or FALSE
The vast majority of gastric cancers are acquired and not inherited.

A

True

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3
Q

Tumors of the small intestine are uncommon, of these approximately 64% are __________________.

A

Malignant

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4
Q

TRUE or FALSE
The most common site for a peptic ulcer formation is in the pylorus.

A

False

It is the duodenum

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5
Q

TRUE or FALSE
Older adults tend to have increased gastric motility.

A

False

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6
Q

________________ syndrome may occur as a result of any surgical procedure that involves the removal of a significant portion of the stomach or includes resection or removal of the pylorus.

A

Dumping

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7
Q

TRUE or FALSE
Proton pump inhibitors may be administered for at least 1 year in patients with risk factors for peptic ulcer disease.

A

True

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8
Q

TRUE or FALSE
Most peptic ulcers result from infection with the gram-negative bacteria H. pylori, which may be acquired through ingestion of food and water.

A

True

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9
Q

Gastritis and ________________ from peptic ulcer disease are the two most common causes of upper GI tract bleeding.

A

hemorrhage

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10
Q

________________________ is indigestion, an upper abdominal discomfort associated with eating.

A

Dyspepsia

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11
Q

What does PQRST stand for?

A

P: What Provokes the pain and what makes it feel better?
Q: Quality - What does it feel like? Describe it in own words
R: Region or Radiation - Where is it? Is it radiating anywhere?
S: Severity - scale of 0-10
T: Timing - How long has it been going on? How long does it last? What time of day does it happen? Is it constant or intermittent?

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12
Q

GI History Assessment

A
  • Any pain? - PQRST
  • Is there any dyspepsia?
  • Intestinal gas?: From stomach or colon?
  • Nausea/Vomiting?: How long? How much? What does it look like? Color? How long after eating?
  • Stool/Bowel Habits?: What is normal? Texture/color/firmness
  • Oral Hygiene routine?
  • Any lesions in the mouth/throat/tongue?
  • Normal dietary intake?
  • Smoking/alcohol/tobacco use?
  • Dentures?
  • Medication use?
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13
Q

GI Physical Assessment

A
  • Inspect oral cavity for hydration, color, texture, symmetry, lesions
  • Tongue: thin white coat and large vallate papillae in V formation at distal end are normal findings
  • Use tongue depressor to visualize pharynx
  • Inspect abdomen: Pt lays supine, knees flexed
  • Inspect, auscultate, percuss, palpate
    Begin in RLQ
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14
Q

What does a hollow sound on abdominal percussion mean?

A

Air

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15
Q

What does a dull thud sound on abdominal percussion mean?

A

Fluid

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16
Q

What are normoactive bowel sounds?

A

5-34 gurgling sounds in 1 minute

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17
Q

What are hyperactive bowel sounds?

A

more than 35 gurgling/click sounds in 1 minute

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18
Q

What are hypoactive bowel sounds?

A

<5 gurgling/click sounds
Must listen in each quadrant for full 2 minutes
NO Bowel Sounds could be a medical emergency

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19
Q

Why is Intrinsic Factor important?

A

Combines with dietary Vitamin B12 so it can be absorbed in the ileum
No Intrinsic Factor? ➡️ B12 deficient ➡️ pernicious anemia

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20
Q

What are the functions of gastric secretions?

A
  1. Hydrochloric acid: Breaks down food and aids in the destruction of most ingested bacteria
  2. Pepsin: protein digestion
  3. Intrinsic Factor: aids in the absorption of Vitamin B12
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21
Q

What controls the rate of gastric secretions and influences gastric motility?

A
  1. Hormones
  2. Neuroregulators
  3. Local regulators
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22
Q

What are the functions of pancreatic enzymes?

A
  1. High concentration of bicarbonate - neutralizes stomach acid to protect the small intestine
  2. Digestive function: trypsin (proteins), amylase (starch), lipase (fats)
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23
Q

How long after eating does it take waste material to pass into the terminal ileum and then slowly into the proximal portion of the right colon through the ileocecal valve?

A

Within 4 hours

24
Q

How long after eating does it take waste materials to reach the rectum?

A

About 12 hours
(Could still be in the rectum 3 days after eating)

25
Q

Why is the composition of fecal matter relatively unaffected by alterations in diet?

A

A large portion of the fecal mass is derived from secretions of the GI tract - not from a dietary origin.

26
Q

When is the gut microbiome generally established?

A

By two years of age

(Begins shortly after birth)

27
Q

What are the general functions of the gut microbiome?

A
  1. Protection
  2. Defense
28
Q

What are some GI Diagnostic Studies?

A
  • Serum Lab Tests (CMP, CBC)
  • Stool tests (ova/parasite and guaiac)
  • Breath tests (checking for hydrogen gasses - may indicate H. pylori
  • Abdominal ultrasound
  • Genetic testing (checking for cancer risks)
  • Imaging: CT, PET, MRI, scintigraphy, virtual colonoscopy
29
Q

What are GI trace studies?

A

Test anatomic function
* Upper GI fluoroscopy tracing (swallow barium pill)
* Lower GI fluorosopy tracing (swallow barium pill or suppository)

30
Q

What are GI Endoscopic Studies?

A

Fiberoptic camera to visualize the anatomy
* Upper GI: Esophagogastroduodenoscopy (EGD) or Endoscopic Retrograde Cholangiopancreatography (ERCP)
* Lower GI: Fiberoptic colonoscopy

31
Q

Important things to remember for an EGD

A
  • NPO for 8 hours
  • Moderate sedation (midazolam or propofol) (no intubation)
  • Takes about 30 min.
  • Recovery 30-60 min.
32
Q

EGD: Post Procedure Complications

A

S/S of Esophageal perforation
* increased pain
* Bleeding
* BP ⬇️
* HR ⬆️
* Unusual difficulty swallowing
* Rapidly elevating temperature

33
Q

Important things to know for Colonoscopy

A
  • Must have a good colon prep! Output should be clear
  • Laxative solution or pills 24-48 hours prior
  • Clear liquid/ low residue diet for 2 days
  • Monitor older patient closely during bowel prep
  • Assess glucose levels due to dietary modifications
  • Pt. laying on left side
  • Moderately sedated (ex: midazolam/propofol)
  • Takes about an hour
  • Recovery 30-60 minutes
34
Q

Colonoscopy: Post Procedure Complications

A

S/S of Bowel perforation
* rectal bleeding
* vital signs
* severe abdominal pain
* fever
* localized peritoneal signs
* firm abdomen

35
Q

Manometry / Electrophysiologic Studies
Things to know

A
  • Manometry used to diagnose GERD, motility disorders of esophagus, upper and lower esophageal sphincters
  • NPO for 8-12 hours
  • Meds that affect motility withheld for 24-48 hrs (calcium channel blockers, anticholinergic agents, sedatives)
  • Pressure sensitive catheter inserted through the nose, patient swallows small amounts of water, pressure changes are recorded.
36
Q

What are some disorders of the esophagus?

A
  • Motility disorders (achalasia, esophageal spasm)
  • Hiatal hernias
  • Diverticula
  • Perforation
  • Foreign bodies
  • Chemical burns
  • GERD
  • Barrett Esophagus (from long term GERD - considered pre-cancerous)
  • Benign tumors
  • Carcinoma
37
Q

The etiology of cancer of the colon and rectum is predominantly ________________________, a malignancy arising from the epithelial lining of the intestine.

A

adenocarcinoma

38
Q

TRUE or FALSE
Diarrhea is defined as the increased frequency of more than three bowel movements per day.

A

True

39
Q

TRUE or FALSE
Celiac disease is a disorder of malabsorption caused by an autoimmune response to consumption of products that contain the protein gluten.

A

True

40
Q

Straining at stool initiates the ________________ maneuver that results in a potentially dangerous increase in BP.

A

valsalva

41
Q

In Crohn’s disease, the common clinical manifestations include abdominal pain and ________________.

A

diarrhea

42
Q

TRUE or FALSE
Decompression of the bowel through a nasogastric tube is necessary for all patients with small bowel obstruction.

A

True

43
Q

________________________, the most common cause of acute surgical abdomen in the United States, is the most common reason for emergency abdominal surgery.

A

Appendicitis

44
Q

________________________is a chronic functional disorder characterized by recurrent abdominal pain associated with diarrhea, constipation, or both.

A

Irritable Bowel Syndrome

45
Q

TRUE or FALSE
Diverticula may occur anywhere in the small intestine or colon, but most commonly occur in the ascending colon.

A

False

46
Q

TRUE or FALSE
The patient with irritable bowel syndrome (IBS) should select foods low in fiber in order to minimize intestinal irritation.

A

False

47
Q

What are the most common symptoms of esophageal disease?

A
  • Dysphagia - most common
  • Odynophagia - acute pain on swallowing
48
Q

Hiatal Hernias
Clinical Manifestations

A
  • Pyrosis (heartburn)
  • Regurgitation
  • Dysphagia
  • Vague symptoms of intermittent epigastric pain
  • Fullness after eating

(Many patients are asymptomatic)

49
Q

What are the two types of hiatal hernias?

A

Sliding (when the stomach bulges through the diaphragm opening into the esophagus, slides in and out of the esophagus, more common, less severe)

Paraesophageal (the herniated organ is stuck in the chest next to the esophagus… less common, more severe)

50
Q

Gastroesophageal Reflux Disease
Definition

A
  • Common disorder marked by backflow of gastric duodenal contents into the esophagus that causes troublesome symptoms and/or mucosal injury to the esophagus
51
Q

Gastroesophageal Reflux Disease
Causes

A
  • Incompetent lower esophageal sphincter
  • Pyloric stenosis
  • Hiatal hernia
  • Motility disorder
52
Q

Gastroesophageal Reflux Disease
Risk Factors

A
  • Increasing age
  • Irritable Bowel Syndrome
  • Obstructive airway disorders (asthma, COPD, cystic fibrosis)
  • Barrett esophagus
  • Peptic ulcer disease
  • angina
  • tobacco, coffee, or alcohol use
  • gastric infection with H. pylori
53
Q

Gastroesophageal Reflux Disease
Diagnostics

A
  • Esophageal Manometry
  • Upper Gastrointestinal Esophagogastroduodenoscopy (EGD)
54
Q

Gastroesophageal Reflux Disease
Clinical Manifestations

A
  • Most Common: Dyspepsia (Indigestion)
  • Heartburn
55
Q

Gastroesophageal Reflux Disease
Self-Treatment/Nursing Care

A

Avoid situations that decrease lower esophagus sphincter pressure or cause irritation of the esophagus:
* low fat diet
* avoid caffeine, tobacco, beer, milk, peppermint, spearmint, carbonated beverages, citrus, acidic foods
* Avoid eating or drinking 2 hours before bedtime
* Elevate the head of the bed by at least 30 degrees

56
Q

Gastroesophageal Reflux Disease
Medical Treatment

A
  • Surgical: Open or laparoscopic Nissen fundoplication
    Medications:
  • Proton Pump Inhibitors* (-prazole)
  • Antacids/Acid Neutralizing: Calcium Carbonate, Aluminum hydroxide, magnesium hydroxide, simethicone
  • Histamine-2 Blockers (famotadine, cimetidine)
  • Prokinetic agents: Metoclopramide
  • Surface agents: Sucralfate
  • Uncommon: Reflux inhibitors (bethanechol chloride), Muscle Relaxers (baclofen)
56
Q
A

NRS 105 Exam #1 (5 decks)

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