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Medical Surgical > Gastrointestinal Disorders Chapt 45 > Flashcards

Gastrointestinal Disorders Chapt 45 Flashcards

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USMLE® Step 1 flashcards
1
Q

What is Parotitis

A

inflammation of the parotid gland. It is the most common inflammatory condition of the salivary glands

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2
Q

Inflammation to the Parotid may be due to

A

Mumps (epidemic parotitis)

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3
Q

Who is at high risk for bacterial parotitis

A

people who are older, acutely ill, or debilitated with decreased salivary flow from general dehyration or medications are at high risk

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4
Q

What organism causes bacterial parotitis

A

Staphylococcus Aureus (travels from the mouth through the salivary ducts)

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5
Q

What are the symptoms of Parotitis

A

fever, chills, and other systemic signs associated with infection. The glands swell and become tense and tender. The patient feels pain in the ear and swollen glands interfere with swallowing. Swelling increases rapidly and skin becomes red and shiny

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6
Q

What is the medical management for parotitis

A

adequate nutritional and fluid intake, good oral hygiene, and discontinuing medications (ex. tranquilizers, diuretic agents) that can diminish salivation.

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7
Q

Pharmacological treatment for parotitis

A

antibiotics are necessary for bacterial parotitis, and analgesics may be prescribed for pain.

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8
Q

Other treatments parotitis

A

the gland may need to be drained by a surgical procedure known as parotidectomy. This procedure may be necessary to treat chronic parotitis.

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9
Q

Sialadenitis

A

Inflammation of the salivary glands

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10
Q

What causes Sialadenitis?

A

dehydration, radiation therapy, stress, malnutrition, salivary gland calculi, or improper oral hygiene.

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11
Q

What bacteria causes Sialadenitis?

A

the inflammation is caused by S. Aureus. In hospitalized patients, the infecting organism may be methicillin-resistant S. Aureus (MRSA)

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12
Q

Symptoms of Sialadenitis

A

pain, swelling, and purulent discharge

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13
Q

Treatment for Sialadenitis

A

antibiotics, massage, warm compresses, and sialagogues (substances that trigger saliva flow like hard candy or lemon juice)

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14
Q

what causes chronic sialadenitis

A

decreased salivary flow

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15
Q

Treatment for recurrent sialadenitis

A

surgical drainage or excision of the gland and its duct

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16
Q

where does Salivary Calculus (Sialolithiasis) usually occur?

A

in the submandibular gland

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17
Q

What tests are needed to confirm the diagnosis of salivary calculus

A

salivary gland ultrasonography or sialography may be required to demonstrate obstruction of the duct

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18
Q

What forms salivary calculi

A

calcium phosphate

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19
Q

Symptoms of Sialolithiasis

A

calculi within the salivary gland may cause no symptoms
a calculus that obstructs the gland’s duct causes swelling and sudden, local, and often colicky pain, which is abruptly relieved by a gush of saliva

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20
Q

Treatment of Sialolithiasis

A

the calculus can be extracted. Sometimes enlargement of the ductal orifice permits the stone to pass spontaneously. Occasionally lithotripsy (a procedure that uses shockwaves to disintegrate the stone may be used.

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21
Q

Lithotripsy preparation and side effects

A

Requires no anesthesia, sedation, or analgesia

May cause local hemorrhage and swelling

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22
Q

Neoplasms (tumors or growths) risk factors

A

exposure to radiation to the head and neck, older age, and specific carcinogens introduced in specific work environments.

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23
Q

Symptoms for a benign tumor (Neoplasm)

A

most patients with a benign growth present with painless swelling of the glands

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24
Q

Symptoms for a malignant tumor (Neoplasm)

A

patients tend to have neurologic symptoms (weakness or numbness) and persistent facial pain.

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25
Q

How is diagnosis made (Neoplasm)

A

diagnosis is based on the health history, physical exam, and the results of fine-needle aspiration biopsy.

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26
Q

early stage salivary gland tumors treatment

A

usually curable with surgery alone.

27
Q

complications from surgery of salivary gland tumors

A

facial nerve dysfunction, and Frey syndrome

28
Q

What is Frey syndrome

A

involves facial sweating and flushing in the general location of the removed parotid gland that occurs while eating.

29
Q

Treatment for Frey Syndrome

A

Botulinum toxin type A injections

30
Q

treatment for a malignant tumor (Neoplasm)

A

Radiation may be needed following surgery, chemotherapy may be considered in late stages. Recurrent tumors are more aggressive than initial tumors.

31
Q

What is Achalasia

A

absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing

32
Q

When does achalasia occur?

A

progresses slowly most common in people 40 or older

33
Q

Clinical manifestations of achalasia

A

dysphagia of solids and liquids

34
Q

Symptoms of achalasia as it progresses

A

food is commonly regurgitated spontaneously or intentionally by the patient to relieve discomfort
the patient may report non-cardiac chest pain or epigastric pain and pyrosis (heartburn)

35
Q

How is Achalasia diagnosed?

A

x-ray, CT scan, barium swallow, and endoscopy

36
Q

what confirms the diagnosis of achalasia?

A

manometry- peristalsis, contraction amplitudes, and esophageal pressure is measured

37
Q

Management of Achalasia

A

pt is instructed to eat slowly and to drink fluids with meals
oral calcium channel blockers and nitrates have been used to decrease esophageal pressure and improve swallowing
injections of botulinum toxin into quadrants of the esophagus via endoscopy has been helpful b/c it inhibits the contraction of smooth muscle

38
Q

What is Hiatal Hernia?

A

the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax.

39
Q

Does hiatal hernia occur most often in women or men?

A

women

40
Q

What are the two types of hiatal hernias

A

sliding (type I) or paraesophageal

41
Q

What is a paraesophageal hernia?

A

when all or part of the stomach pushes through the diaphragm beside the esophagus

42
Q

How are paraesophageal hernias classified?

A

Type II, III, or IV
Type IV has the greatest herniation, with other intra-abdominal viscera such as the colon spleen, or small bowel evidencing displacement into the chest along with the stomach

43
Q

What type of hernia is most common? paraesophageal or sliding?

A

95% of patients with esophageal hiatal hernia have sliding hernias

44
Q

clinical manifestations of sliding hernia

A

pyrosis, regurgitation, and dysphagia, but many patients are asymptomatic.
The patient may present with vague symptoms of intermittent epigastric pain or fullness after eating.
commonly associated with GERD
hemorrhage, obstruction and strangulation can occur with any type of hernia

45
Q

Assessment and diagnostic findings of hiatal hernias

A

confirmed by x-ray, barium swallow, esophagogastroduodenoscopy (EGD), esophageal manometry, or chest CT scan

46
Q

Management of hiatal hernia

A

frequent small feedings that can pass easily through the esophagus, sit up for 1 hour after eating,

47
Q

When is surgery indicated for patients with a hiatal hernia?

A

when patients are symptomatic

48
Q

postoperative care for a hiatal hernia

A

the patient will slowly move from a liquid diet to solids, the nurse will monitor nausea and vomiting, nutritional intake, and weight.

49
Q

What is Gastroesophageal Reflux Disease (GERD)

A

backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and or mucosal injury to the esophagus.

50
Q

Clinical Manifestations of GERD

A

pyrosis, dyspepsia, regurgitation, dysphagia, or odynophagia, hypersalivation, and esophagitis. The symptoms may mimic those of a heart attack

51
Q

how do you diagnose GERD

A

endoscopy or barium swallow.

Ambulatory 12-36 hour esophageal pH monitoring to evaluate the degree of acid reflux

52
Q

Management of GERD

A

a low-fat diet, avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages: avoid eating or drinking 2 hours before bedtime; maintain normal body weight
avoid tight-fitting clothes
elevate the head of the bed at least 30 degrees
surgical intervention may be necessary

53
Q

what is Barrett Esophagus (BE)?

A

A condition in which the lining of the esophageal mucosa is altered.

54
Q

Clinical Manifestations of BE

A

pt complains of symptoms of GERD, frequent heartburn. Pt may also complain of symptoms related to peptic ulcers or esophageal stricture or both.

55
Q

How do you diagnose BE?

A

EGD and Biopsies are performed

56
Q

Management of BE

A 
Tx is individualized for each patient
surveillance with biopsies
use of proton pump inhibitors
endoscopic resection
radiofrequency ablation
and consideration of metal stents
57
Q

Cancer of the esophagus pathophysiology

A

Esophageal cancer can be of two cell types: adenocarcinoma, and squamous cell carcinoma. Risk factors for esophageal cancer include chronic esophageal irritation or GERD

58
Q

Cancer of the esophagus has been associated with ingestion of ___ and the use of ___

A

alcohol, tobacco

59
Q

What are the risk factors for squamous cell carcinoma

A

chronic ingestion of hot liquids or foods, nutritional deficiencies, poor oral hygiene, exposure to nitrosamines in the environment or food, cigarette smoking, or chronic alcohol exposure, and some esophageal medical conditions such as caustic injury

60
Q

Clinical Manifestations for cancer of the esophagus

A

many patients have an advanced ulcerated lesion of the esophagus before symptoms are manifested. Symptoms include dysphagia, sensation of a mass in the throat, painful swallowing, substernal pain or fullness, regurgitation of undigested food with halitosis, and hiccups.

61
Q

How is esophageal cancer diagnosed?

A

EGD with biopsy and brushings. PET scan can help detect metastasis

62
Q

Medical management of esophageal cancer

A

If detected at an early state treatment goals may be directed toward a cure
If detected in late stages relief of symptoms is the only tx
treatments include surgical resection of the esophagus, radiation, and chemotherapy

63
Q

Preoperative Nursing Management (esophageal cancer)

A

directed towards improving the patients nutritional and physical status in preparation for surgery, radiation, or chemotherapy

Medical Surgical (10 decks)

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