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Adult Health > Gastrointestinal Disorders > Flashcards

Gastrointestinal Disorders Flashcards

1
Q

RUQ Organs

A
  1. Liver
  2. Gallbladder
  3. Hepatic flexure
  4. Kidney
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2
Q

RLQ Organs

A
  1. Appendix
  2. Ureter
  3. Ovary
  4. Fallopian tube
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3
Q

LUQ Organs

A
  1. Spleen
  2. Stomach fundus
  3. Kidney
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4
Q

LLQ Organs

A
  1. Left colon
  2. Ureter
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5
Q

Lower Abdominal Segment Organs

A
  1. Uterus
  2. Bladder
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6
Q

Epigastrium Organs

A
  1. Heart
  2. Lung
  3. Esophagus
  4. Pancreas
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7
Q

Acute Gastroenteritis: What is it?

A

Acute infection or irritation of the digestive tract, particularly the stomach and intestine, that results in vomiting, diarrhea, and abdominal cramps.
** Some patients also experience fever

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8
Q

Acute Gastroenteritis: Etiology

A
  1. Fecal-oral route (usually by food or water contamination) or person-to-person contact
  2. Viruses
  3. Bacterial
  4. Parasites
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9
Q

Acute Gastroenteritis: Viral Causes

A
  • Most infections in healthy U.S. hosts are viral
    1. Rotavirus (more common in children less than 1 yo)
    2. Norovirus
    3. Enteric adenovirus
    4. Astrovirus
    ** Most commonly transmitted in winter and spring
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10
Q

Acute Gastroenteritis: Bacterial Causes

A
  • Less common than viral, but is more severe
    1. Campylobacter jejuni (most common in children)
    2. Salmonella (most common foodborne illness in US)
    3. Staph aureus
    4. Shigella
    5. E. coli
    6. C. diff
    7. Clostridium perfringens
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11
Q

Acute Gastroenteritis: Parasitic Causes

A
  1. Giardia lamblia
  2. Cryptosporidium
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12
Q

Acute Gastroenteritis: Risk Factors

A
  1. Improper handwashing and food preparation
  2. Daycare attendance
  3. Recent use of antibiotics
  4. Recent hospitalization
  5. Poor sanitation
  6. Immunocompromised status
  7. Recent travel to developing countries
    ** Pregnancy and age over 65 can have more severe complications
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13
Q

Acute Gastroenteritis: Assessment Findings

A
  1. Hyperactive bowel sounds
  2. Acute diarrhea (3 or more loose stools within 24 hours; lasts no longer than 2 weeks)
  3. Blood in stool (RED flag)
  4. Abd pain upon palpation; guarding
  5. WBC in stool
  6. N/V precede diarrhea
  7. Anorexia
  8. Weight loss (RED flag)
  9. Fever
  10. Fecal incontinence
  11. Dehydration
  12. Lethargy
  13. Pale skin color
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14
Q

Acute Gastroenteritis: Signs of Dehydration

A
  1. Poor skin turgor
  2. Dry mucous membranes
  3. Flattened or sunken fontanels
  4. Tachycardia, tachypnea
  5. Hypotension
  6. AMS
  7. HA
  8. Oliguria
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15
Q

Acute Gastroenteritis: Diagnostic Studies

A
  1. Usually none unless symptoms are severe and last longer than 48 hours
  2. Stool for WBC
  3. Stool cultures
  4. Stool for ova and parasites
  5. Occult stool
  6. UA
  7. Dehydration: BUN, specific gravity, electrolytes
  8. More severe cases may require blood cultures to ensure absence of systemic infection
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16
Q

Acute Gastroenteritis: Nonpharmacologic Treatment

A
  1. Correct dehydration, orally if possible
  2. Rehydrating with soft drinks, gelatin, or apple juice not advised due to high carbohydrate, low electrolyte composition
  3. Age-appropriate diet as soon as possible
  4. Reintroduce solid foods within 24 hours of diarrhea onset
  5. BRAT diet no longer recommended (inadequate protein, fat, and calories)
  6. Monitor oral intake, urine output, and bowel movements; count wet diapers
  7. Use of sitz baths, hydrocortisone cream, zinc oxide cream, and/or witch hazel hemorrhoidal pads can provide pain relief from perineal irritation
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17
Q

Acute Gastroenteritis: Pharmacologic Treatment Staph aureus

A

Antibiotics not recommended

18
Q

Acute Gastroenteritis: Pharmacologic Treatment Salmonella

A
  • Antibiotics not recommended
    ** Cipro or Bactrim for patients with valvular heart disease or immunocompromise
19
Q

Acute Gastroenteritis: Pharmacologic Treatment Shigella or E. coli

A

Bactrim BID x 3-5 days
** If shigella acquired outside of U.S., use cipro x 10 days

20
Q

Acute Gastroenteritis: Pharmacologic Treatment Campylobacter

A
  1. Erythromycin QID x 5 days
    OR
  2. Cipro BID x 7 days
21
Q

Acute Gastroenteritis: Pharmacologic Treatment Giardia

A

Metronidazole 250 mg TID x 5-7 days

22
Q

Acute Gastroenteritis: Pharmacologic Treatment C. diff

A
  1. Metronidazole 500 mg TID or 250 mg QID x 10-14 days
    OR
  2. Vancomycin 125 mg QID
23
Q

Acute Gastroenteritis: General Pharmacologic Treatments

A
  1. Antiemetics
  2. Probiotics
    ** Antidiarrheals can worsen symptoms
24
Q

Acute Gastroenteritis: When to refer?

A
  1. Patients with red flags may need hospitalization
  2. Parenteral rehydration for intractable symtpoms
  3. Neurologic symptoms
  4. Severe abdominal pain
25
Q

Appendicitis: What is it?

A

Inflammation of the vermiform appendix, a projection from the apex of the cecum. Appendicitis is a medical emergency; the organ must be removed before it ruptures.

26
Q

Appendicitis: Etiology

A

Obstruction of the appendix secondary to stool, inflammation, stricture, foreign body, or neoplasm. The obstructed lumen prevents drainage. The resultant increased pressure decreases mucosal blood flow, and the appendix becomes hypoxic.

27
Q

Appendicitis: Risk Factors

A
  1. Family history
  2. Abdominal neoplasm
28
Q

Appendicitis: Assessment Findings

A
  1. Abd pain, usually severe; initially presents throughout abdomen or periumbilical area and later becomes localized to the RLQ
  2. Most common symptoms: anorexia, abd pain, N/V (typically present in this order)
  3. Constipation and diarrhea occur after the pain
  4. Maximum abd tenderness and rigidity occurs over the right rectus muscle (McBurney’s point)
  5. Psoas sign: pain with right thigh extension
  6. Obturator sign: pain with internal rotation of flexed right thigh
  7. Fever
  8. Decreased bowel sounds
  9. Older adults may present with weakness, anorexia, tachycardia, and abd distention
29
Q

Appendicitis: Assessment Considerations

A
  • A rectal exam is no longer best practice
  • A pelvic exam should be performed on all women with lower abd pain to rule out pelvic inflammatory disease, adnexal mass, ectopic pregnancy, or uterine pathology.
30
Q

Appendicitis: Diagnostic Studies

A
  1. UA: may be positive for RBCs and leukocytes
  2. CBC: higher leukocytosis associated with bowel perforation
  3. Urine pregnancy test: negative
  4. KUB xray: may show gas-filled appendix
  5. Abd and pelvic CT with and without contrast
  6. Ultrasound: imaging study of choice in children and pregnancy
  7. Pediatric appendicitis score for children
  8. Alvarado score for acute appendicitis
31
Q

Appendicitis: Non-Pharmacologic Management

A
  1. Keep NPO
  2. Instruct to refrain from laxatives, enemas, or heat application to the abdomen
  3. Prompt surgery is treatment of choice
32
Q

Appendicitis: Pharmacologic Management

A
  • Preoperative antibiotics may be prescribed by surgeon
33
Q

Appendicitis: Follow-Up

A
  1. Routine postoperative assessment at 2 weeks and 6 weeks
  2. May require postoperative antibiotics if perforation has occurred.
34
Q

Appendicitis: Expected Course

A
  • Quick recovery usually follows surgical removal of intact appendix
  • Activity should be restricted for 2-6 weeks
35
Q

Cholecystitis: What is it?

A

Inflammation of the gallbladder usually associated with gallstone disease; can be acute or chronic.

36
Q

Cholecystitis: Etiology

A
  1. Gallstone obstructs the gallbladder-cystic duct junction, resulting in inflammation (90-95% of cases) and acute pain
  2. In small number of cases, gallbladder inflammation occurs without stone formation
  3. Obstruction of common bile duct can cause jaundice, light-colored stools, and biliary colic
  4. Obstruction of pancreatic duct can produce pancreatitis; pain over upper abdomen; nausea and vomiting
  5. Gallbladder sludge
37
Q

Cholecystitis: Risk Factors

A
  1. Pregnancy
  2. Rapid weight loss (ex: bariatric surgery)
  3. Obesity
  4. Gallstones or bile duct blockage
  5. Infection
  6. Tumor
  7. Surgery or trauma
  8. Sickle cell anemia
  9. Age greater than 40
  10. Female sex
  11. Sedentary lifestyle
  12. Use of OCP
  13. Family history of gallstones
  14. Crohn’s disease
  15. Medications such as clofibrate, ceftriaxone, and octreotide
38
Q

Cholecystitis: Assessment Findings

A
  1. Patients are usually ill-appearing, febrile, and tachycardic
  2. Murphy’s sign
  3. RUQ pain: may be unremitting with or without rebound pain; may radiate to right shoulder or right subscapular area
  4. Nausea and vomiting/anorexia
  5. Attack follows meal (especially high in fat) by 1-6 hours
  6. Low grade fever
  7. Palpable RUQ mass
    ** A patient with acute cholecystitis usually avoids movement because peritoneal inflammation is present and discomfort worsens with movement
39
Q

What is Murphy’s Sign?

A
  • Occurs with cholecystitis
  • Inspiratory arrest with deep palpation of the RUQ
40
Q
A

Adult Health (14 decks)

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