GASTROINTESTINAL TRACT Flashcards
1
Q
-Incompetent Lower esophageal sphincter
-Pyloric Stenosis
-Delayed emptying
-Lead to: Backflow
A
GERD
2
Q
Dx of GERD
A
24- hour ambulating ph monitoring
Endoscopy
3
Q
Interventions: GERD
A
Non surgical
Avoid acids
No meal before bedtime
Surgical:
Laparoscopic Nissen Fundoplication
4
Q
Life Modifications: Drug Therapy (GERD)
A
Antacids
H2 Receptor
Chloride Ion Channel
5
Q
Poor man’s laborer
A
Gastric Ulcer
6
Q
Executive ulcer
A
Duodenal Ulcer
7
Q
50 Above ulcer
A
Gastric Ulcer
8
Q
25-50 yrs old ulcer
A
Duodenal Ulcer
9
Q
Malnourished ulcer
A
Gastric Ulcer
10
Q
Well-nourished ulcer
A
Duodenal Ulcer
11
Q
Pain is felt when eating ulcer
A
Gastric Ulcer
12
Q
Pain is relieved by eating ulcer
A
Duodenal Ulcer
13
Q
Pain on the left ulcer
A
Gastric Ulcer
14
Q
pain on right ulcer
A
Duodenal Ulcer
15
Q
hematemesis ulcer
A
Gastric Ulcer
16
Q
Melena ulcer
A
duodenal ulcer
17
Q
(+) h-pylori
A
gastric & duodenal ulcer
18
Q
dx ulcer
A
Hemoccult test /Guac Test
EGD- Esophagogastroduodenoscopy
19
Q
Interventions: DIET for Ulcer
A
Bland diet (walang lasa)
20
Q
Interventions: ulcer surgical
A
Gastrectomy
Vagotomy: removal branch of stomach
Bilroth Procedure
Billroth 1: Gastroduodenostomy: Stomach joined to duodenum
Billroth 2: Gastrojejunostomy: jejunum and stomach is attacthed at opening hole next to small intestine.
Pyloroplasty:allows gastric drainaige
21
Q
-Rapid emptying of stomach contents into the small intestines
A
dumping syndrome
22
Q
s/sx of dumping syndrome
A
Hyposmolar jejunal chyme–> Intraluminal fluid sequestration
Decrease blood volume
Hypotension
Tachycardia
Bloating
Abdominal pain
Diarrhea
Rapid Glucose absorption
Inappropriate insulin release
Late hypoglycemia
23
Q
Interventions: dumping syndrome
A
Avoid sugar
High protein (CHON), high fat, & low CHO
-Protein & fat= digest slower
-Carbohydrate=digest faster
Small meals
Avoid fluids (high fluid hasten digestion)
lie down after meals
24
Q
-Weakness in the abdominal muscle wall in which a segment of the bowel protrudes.
A
herniation
25
Intervention for hernia: non-surgical
truss
26
Intervention for hernia: surgical
Herniorrhaphy
27
Common type of hernia in male
Inguinal
28
common type of hernia in female
Umbilical hernia???
29
-idiopathic inflammatory disease of the small/large intestine, or both
CHRONIC INFLAMMATORY BOWEL DISEASE (IBD)
30
-Inflammatory disease of the large intestines that begins in the rectum-upward.
Ulcerative Colitis:
31
Regional enteritis
Environmental
Diarrhea
no bleeding
5-6 stools (soft)
Anorexia
Dehydration/Weight loss
abd pain
Chron’s Disease
32
Large intestine
Rectum
Emotional
With bleeding
20-30 wattery stool
Severe form of anorexia
DHN/weight loss
abd pain
ulcerative colitis
33
Intervention for IBD: NON-SURGICAL
NPO
IV fluids
34
Intervention for IBD: DRUG THERAPY
Salicylate compound (Sulfasalazine)
Prednisone
SE:immunosupression
Cyclosporine
Anti-diarrheals
35
Intervention for IBD: Surgical
Total proctocolectomy with permanent ileostomy
Ileoanal anastomosis
36
frequent urge to defecate. Sensation of incomplete evacuation.
Tenesmus:
37
pouchlike herniations of the small intestines or colon
Diverticula
38
Presence of many pouchlike herniations
Diverticulosis:
39
Inflammation of one or more diverticula
Diverticulitis
40
Interventions:
Non-surgical: DIVERTICULAR DISEASE
Bedrest
NPO, or clear liquids
Fiber rich food
Avoid gas formers/ seeds/ Nuts
41
Drug therapy:DIVERTICULAR DISEASE
Antibiotics: Metroni/ Ciproflox
Analgesics
Laxatives
42
Surgical: DIVERTICULAR DISEASE
Total proctocolectomy with permanent ileostomy
Ileoanal anastomosis
Colon resection
43
cause: appendicitis
Fecalith-small fecal material
44
Assessment: appendicitis
-Pain in the McBurney’s point: 2/3 distance from navel to Right Anterior superior iliac spine.
Rovsing’s obturator: referred pain in the RLQ when LLQ is palpated.
Psoas sign :lie on side and right thigh is flexed backward.
Fever/elevated WBC
Anorexia
N/V
45
pt lies on the left side and extension of the right thigh
Psoas sign
46
flexion of the obturator muscle.
Obturator sign
47
referred pain in the RLQ when LLQ is palpated
Rovsing’s sign
48
intervention of appendicitis
Non-surgical
NPO
IV therapy
Proper positioning
Surgical
Appendectomy
49
-Unnaturally swollen or distended vein in the anorectal region
HEMORRHOIDS
50
Pathophysiology:HEMORRHOIDS
Activities that increases intra-abdominal pressure leading to proplapse of the hemmorhoidal vessels.
51
Interventions: hemorrhoids
Cold packs followed by sitz bath
Witch hazel soaks
High fiber diet
Avoid straining
Hemorrhoidectomy
52
-A progressive liver disease with diffused degeneration & destruction of hepatocytes.
CIRRHOSIS
53
Laënnec's cirrhosis
primarily caused by excessive alcohol consumption
54
breath of the dead; fecal in nature.
Fetor hepaticus:
55
Ammonia that reaches the brain; inability to maintain posture, flappy/tremor hands.
Asterixis
56
assessment: cirrhosis
Spider angioma
Caput medusae: swollen cluster vein in abd
Esophageal varices
Fetor hepaticus: breath of the dead; fecal in nature.
Asterixis: Ammonia that reaches the brain; inability to maintain posture, flappy/tremor hands.
Jaundice: cannot excrete bilirubin thru stool
Ascites: vein problem co2 tha liver cant accpet.
Hepatic Encephalopathy
57
interventions: cirrhosis
Diet: CHO (Carbohydrates)
Surgical:
Paracentesis: Removal of fluid in peritoneal area
58
Drug Therapy: cirrhosis
Diuretics
Lactulose
Neomycin Sulfate
-Metronidazole
59
Assessment: cholecystitis
RUQ pain going to the scapula hours post eating fatty foods.
Mass palpated in the RUQ
Biliary obstruction
Jaundice
Dark orange & foamy urine
Streatorrhea
Clay-colored stool: No Bilirubin
60
Interventions: DIET CHOLECYSTITIS
NPO
Low-fat meals
Eat in small amount
61
Interventions: Surgery; CHOLECYSTITIS
Cholecystectomy
Choledoclithotomy
Cholecystostomy
62
-Inflammation of the pancreas with escape of pancreatic enzymes into surrounding tissues.
Pancreatitis
63
Cause: PANCREATITIS
-Alcohol -gallstones
-idiopathic -others: drugs
-hyperlipidemia
-hypercalcemia
-Trauma -Ductal Obstruction
64
Ecchymosis in the side of abdomen
Grey Turner Sign:
65
(+) cullen sign & (+) grey turners sign
pancreatitis
66
DOC: Pancreatitis
1st : Mild-NSAIDS
2nd :Moderate- Codeine/Meperidone demerol
3rd:Severe: Morphine
SE: spasm in sphincter of ODDI
67
Deficiency of one or more AP hormones
HIPOPITUITARISM
68
Hypersecretion of pituitary hormones
-GH, ACTH, & Prolactin are commonlu oversecreted
-caused by tumor in pituitary gland (PG)
HYPERPITUITARISM
69
DOC: acromegaly/gigantism
Bromocriptine Mesylate (Parlodel)
SE: orthostatic hypotension
70
SURGERY: acromegaly/gigantism
Transphenoidal Hypophysectomy
71
POST-OP MANAGEMENT:Transphenoidal Hypophysectomy
HOB elevated 2 weeks
Nasal packing
No blowing
Nasal drainage
Halo test/sign: CSF is formed around blood when drop to cloth sheet.
72
Hypersecretion of ADH
-excessive retention of water.
SIADH/ SCHWARTZ-BATTER SYNDROME
73
MANAGEMENT:SIADH
Diuretics
Hypertonic IV
Fluid restriction
Provide safe environment
74
ADH deficiency or kidney ignoring the ADH
-Excessive release of water
-Inability to retain water
DIABETES INSIPIDUS
75
MANAGEMENT:DIABETES INSIPIDUS
Administer ADH:
-Desmopressin
-Vasopressin
Sit up when spraying
SE: Stomatitis, Allergy, Chest Tightness
Alternative: when experiencing SE
SUBQ VASOPRESSIN
76
Thyroid Hormones:
T3 (Triiodothyronine)
T4 (Thyroxine)
Thyrocalcitonin: Normalizes calcium when too high.
77
hormone that Normalizes calcium when too high.
Thyrocalcitonin:
78
-Has too much ADH retention of fluid
-Concentrated urine
-Low sodium
SIADH
79
-Has too little ADH secretion of fluid
-Diluted urine
-High Sodium
DI
80
Deficiency of thyroid hormones
Cause: Thyroidectomy; Antithyroid Drugs
HYPOTHYROIDISM
81
MANAGEMENT: HYPOTHYROIDISM
VS
Diet: Low calories, Low fat, High Fiber
Administer thyroid replacement drug
82
Medication:HYPOTHYROIDISM
Synthoid
Levothroid
Cytomel
Thyrolar
Thycar
83
Excessive thyroid hormone secretion
Cause: Emotional stress, Autoimmune
HYPERTHYROIDISM
84
S/SX : All symptoms are high except weight & Irregular Menstruation.
Hyperthyroidism
85
MANAGEMENT:HYPERTHYROIDISM
Rest
Non-stimulating event
Diet: High calories
Safety
Artificial tears
Avoid stimulants
86
Medications:Hyperthyroidism
Beta-blockers
Calcium channel blockers
Oral radioactive iodine
-Destroys thyroid hormone
-i 131:destruction of follicular cells
Takes effect in 6-8 weeks
87
Medication alternative for pregnant hyperthyroidism pt?
TAPAZOLE
88
-Adrenal insufficiency
-hyposecretion of adrenal cortex
-decrease S-S-S :Sugar, Sodium, Sex
ADDISON’S DISEASE
89
Diet for Addison's disease:
High protein, High Carbohydrate, High Sodium, Low Potassium
90
Hypercorticolism
Cause: could be Steroid Medications
CUSHING’S DISEASE
91
Manifestations of cushing
Obese trunk
Moon face
Buffalo hump
Reddich-Purple striae on trunk
Hypertension
Hyperglycemia
Hypokalemia
Hirsutism, acne
Low immunity
92
MANAGEMENT: Cushing Syndrome
Monitor Weights/ VS
Monitor: Serum Na, Serum K
-If adrenal tumor is the caused
Two/Bi: Lifelong hormone replacement
Uni/one: 2 years of HR & stop
93
DOC: Cushing syndrome
MITOTANE
- Reduces Cortisol
94
Surgery: cushing syndrome
Hypophysectomy
Adrenalectomy
95
Catecholamine: Producing Tumor
Cause: Unknown
Pheochromocytoma
96
Hallmark sign of pheochromocytoma
Hypertension
97
Manifestation: of pheochromocytoma
Hypertension: Hallmark sign
Headache
Hyperhidrosis
Hypermetabolism
Hyperglycemia
98
Management: pheochromocytoma
Monitor VS/ Blood glucose
Position: Elevate HOB
Do not palpate the abdomen
Surgery:
Adrenalectomy
99
-AKA juvenile DM as it happens 10-16 years old.
-Diabetes of infancy: Hyperglycemia onset before 6 months
-Absolute deficiency of insulin
DIABETES MELLITUS TYPE 1 DM
100
Determine the compliance to regimines/therapy of DM for the past 3-4 months.
HBA1C or glycosylated hgb
101
results of HBA1C:
Normal: 5.7 % Below
Prediabetes: 5-7-6.4 %
Diabetes: 6.5 % Higher
102
Order of 3P'S
1st: Polyphagia
2nd: Polyuria
3rd: Polydipsia
4th: weight loss (4th sign)
103
MANIFESTATION: DM1
Polyuria
Polydipsia
Polyphagia
Weight loss
Weakness
Hyperviscosity
Hemoconcentration
Hypoperfusion
104
TYPES OF INSULIN
-quick acting/ very rapid acting
-short-acting
-intermediate acting
-long-acting
-very long acting
105
Quick acting: Onset & Peak
L-A-G
Lispro
Aspart (Novolog)
Glulisine (apidra)
Onset:
5-15 mnutes (effect)
Peak:
30 minutess to 1 hour
106
Short acting: Onset & Peak
Regular (humulin R)
Onset: 30 minutes -1 hour
Peak: 2-4 hours
107
Intermediate acting: Peak and hour
NPH (Humulin N)
Onset: 1-2 hrs
Peak: 6-12 hrs
108
Long acting: onset and Peak
Ultralente (Humulin U)
Onset: 2-4 hours
Peak: 16-24 hours
109
Very long acting: onset & peak
Lanthus (Glargine)
Onset:3-5 hours
*No peak time*: basal insulin
110
CLEAR INSULIN
=L-A-G (quick acting)
=Regular
=Lanthus (glargine)
111
OHA: 1
Sulfonylureas Agents : (ask help on pancreas)
Chlorpropamide (Diabenase)
Glimepiride (Amaryl)
Glipizide (Glucotrol)
Tolazamide (Tolinase)
112
OHA 2:
BIGUANIDES: ask help on liver
-appetite suppresant
METFORMIN
-Metformin: Decrease liver glucose release
-30 minutes before meals
-do not give for: 48 hours for contrast dye procedures
***Metformin + contrast dye = Lactic Acid result to Spasm in muscle
113
OHA 3
Alpha-Glucosidase inhibitors
-Slows intestine
-Take with first bite
Acarbose (Precose)
Miglitol (Glyset)
SE:
Flatulence
Abdominal discomfort
Diarrhea
114
OHA 4:
insulin; 20 glucose (kumpras)
-Thiazolidinedione (anti-diabetic agents)
-Increase insulin Sensitivity, improving glucose absorption
-with or without food
-Rosiglitazone (Avandia)
-Pioglitazone (Actos)
115
Causes: HHNKS
Causes:
-from DM2
-Underdose or missed dose of OHA
-Illness or infection
-Overeating
-Stress,Surgery
116
MANAGEMENT: HHNKS
Administer oxygen
Nacl or 0.45 % NaCl
Regular insulin IV
117
CAUSE:DKA
CAUSE:
-from DM 1
-Under dose or missed dose of insulin
-Illness or infection
-Overeating
-Stress, Surgery
118
CHRONIC COMPLICATONS OF DM:
Neuropathy 1st
Retinopathy 2nd
Nephropathy 3rd
119
