GI

Question 1

absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing. Narrowing of the esophagus just above the stomach results in a gradually increasing dilation of the esophagus in the upper chest.

Answer 1

Achalasia

Question 2

Major complications of achalasia

Answer 2

Food is regurgitated either spontaneously or intentionally by the patient to relieve the discomfort produced by prolonged distention of the esophagus by food that will not pass into the stomach
Aspiration of gastric contents

Question 3

Radical neck dissection purpose

Answer 3

Remove cervical lymph nodes in neck to prevent death from metastasis of malignancy

Question 4

involves removal of all cervical lymph nodes from the mandible to the clavicle and removal of the sternocleidomastoid muscle, internal jugular vein, and spinal accessory muscle on one side of the neck.

Answer 4

Radical neck dissection

Question 5

Major complications of radical neck dissection

Answer 5

Shoulder drop
Poor cosmesis (visible neck depression)
Altered respiratory status
Regular stuff: infection, bleeding.. etc.

Question 6

peptic ulcer and ulcer disease causes

Answer 6

Most caused from bacteria H. pylori
Use of NSAIDs
Possibly smoking and alcohol
Genetic
Association with COPD, cirrhosis of liver, CKD and Zollinger-Ellison Syndrome (ZES)
Stress (cushings and curlings)

Question 7

peptic ulcer and ulcer disease symptoms

Answer 7

May last for a few days, weeks or months; may disappear and reappear.
Many have no s/s
Dull, gnawing pain or burning sensation at the mid-epigastrium or back
Vomiting
Constipation
Diarrhea
Bleeding
Gastric ulcers most commonly cause pain immediately after eating
Pain relieved immediately after eating or taking antacids in duodenal ulcers

Question 8

peptic ulcer and ulcer disease medications

Answer 8

combination of antibiotics (flagyl, amoxicillin, clarithromycin.. etc.), PPIs (prevacid, omeprazole or rabeprazole) and bismuth salts (pepto-bismol) that suppress or eradicate H. pylori [10-14 days]

Question 9

diagnostic tests for peptic ulcer and ulcer disease

Answer 9

physical examination may reveal pain, epigastric tenderness or abdominal distention
Upper endoscopy (allows visualization of inflammatory changes)
Histologic examination
Serologic testing for antibodies against H. pylori antigen
Urea breath test

Question 10

Surgical intervention for peptic ulcer and ulcer disease

Answer 10

Vagotomy (w/ or without pyloroplasty) and

Antrectomy

Question 11

Antrectomy

Answer 11

removal of the pyloric portion of the stomach with anastomosis to either the duodenum or the jejunum
Can be done traditionally or laparoscopically

Question 12

Vagotomy (w/ or without pyloroplasty)

Answer 12

transecting nerves that stimulate acid secretion and opening the pylorus

Question 13

H-Pylori causes

Answer 13

may be acquired by ingestion of food or water, person to person transmission through exposure to emesis

Question 14

H-pylori treatment

Answer 14

Antibiotics, PPIs and bismuth salts

Question 15

NGT purposes

Answer 15

Decompression: remove gas or fluid from upper GI tract
Nutrition/meds: to provide nutrition or meds under circumstances where patient who cannot adequately process food, fluids or medications by the gastric route (aspiration, surgery)

Question 16

NGT management

Answer 16

Monitoring patient and maintaining tube function
Providing oral and nasal hygiene
Monitoring for managing potential complications
Administering tube feedings

Question 17

what is the purpose of the appendix

Answer 17

The appendix is a small, vermiform (i.e., wormlike) appendage about 8 to 10 cm (3 to 4 inches) long that is attached to the cecum just below the ileocecal valve. The appendix fills with by-products of digestion and empties regularly into the cecum. Because it empties inefficiently and its lumen is small, the appendix is prone to obstruction and is particularly vulnerable to infection (i.e., appendicitis). Appendicitis, the most frequent cause of acute abdomen in the United States, is the most common reason for emergency abdominal surgery. Although it can occur at any age, it typically occurs between the ages of 10 and 30 years.

Question 18

causes of appendicitis

Answer 18

The appendix becomes inflamed and edematous as a result of becoming kinked or occluded by a fecalith (i.e., hardened mass of stool), lymphoid hyperplasia (secondary to inflammation or infection), or rarely, foreign bodies (e.g., fruit seeds) or tumors. The inflammatory process increased intraluminal pressure, causing edema and obstruction of the orifice. Once obstructed, the appendix becomes ischemic, bacterial overgrowth occurs, and eventually gangrene or perforation occurs

Question 19

complications of appendicitis

Answer 19

Perforation
Gangrene
→ can lead to peritonitis, abscess formation or portal pylephlebitis (septic thrombosis of the portal vein caused by vegetative emboli that arise from septic intestines)

Question 20

appendicitis treatment

Answer 20

Immediate surgery (unless it is uncomplicated) to reduce risk of perforation
Antibiotics postoperatively for 3-5 days
IV fluids

Question 21

Bariatric Surgery Post-op care

Answer 21

Ensuring dietary restrictions → clear liquids for 24-48hrs then a slow progression to soft solids then solid foods to prevent complications such as nausea, vomiting, bile reflux and diarrhea
Reducing anxiety → encourage joining a bariatric surgery support group
Relieving pain → analgesics, PCA, coughing and deep breathing, ambulation, low fowler’s position to promote comfort and gastric emptying
Ensuring fluid volume balance → IV fluids for first several hours, sugar free oral fluids in small volumes (30mL every 15 minutes) stopping if they feel full or nauseous
Preventing infection or anastomotic leak
Ensuring adequate nutritional status → after bowel sounds have returned and oral intake is resumed, six small feedings consisting of a total of 600 to 800 calories per day are provided, fluids between meals. Encourage the patient to eat slowly and stop eating if feeling full. Monitor for dietary deficiencies such as iron and vitamin B12.

Question 22

Bariatric Surgery complications

Answer 22

Hemorrhage
Venous thromboembolism
Bile reflux
Dumping syndrome
Dysphagia
Bowel or gastric outlet obstruction

Question 23

PPI

Answer 23

Decreases gastric acid secretion by slowing the H+, K+-ATPase pump on the surface of the parietal cells of the stomach

Question 24

H2 blocker

Answer 24

Decreases amount of HCl produced by stomach by blocking action of histamine-on-histamine receptors of parietal cells in the stomach

Question 25

bismuth salts

Answer 25

forms protective coating of the intestinal mucosa, possesses antisecretory and antimicrobial effects

Question 26

Sucralfate

Answer 26

Creates a viscous substance in the presence of gastric acid that forms a protective barrier, binding to the surface of the ulcer, and prevents digestion by pepsin

Question 27

Stool softeners

Answer 27

Promotes incorporation of water into stool, resulting in softer fecal mass. May also promote electrolyte and water secretion into the colon

Question 28

Bowel stimulants

Answer 28

causes the intestinal muscles to rhythmically contract and help push out, or “stimulate” a bowel movement.

Question 29

bulk laxatives

Answer 29

not digested but absorb liquid in the intestines and swell to form a soft, bulky stool. The bowel is then stimulated normally by the presence of the bulky mass.

Question 30

Antiemetics

Answer 30

Phenothiazines act on the chemoreceptor trigger zone to inhibit nausea and vomiting. Dimenhydrinate, scopolamine, and meclizine act as antiemetics mainly by diminishing motion sickness. Metoclopramide ↓ nausea and vomiting by its effects on gastric emptying. Dolasetron, granisetron, palonosetron, and ondansetron block the effects of serotonin at 5-HT3 receptor sites. Aprepitant, fosaprepitant, netupitant, and rolapitant act as selective antagonists at substance P/neurokinin 1 receptors in the brain.

Question 31

Hiatal Hernia causes/risk factors:

Answer 31

Increased pressure in abdominal cavity (coughing, vomiting, straining during BM, exercise / heavy lifting)
Gender (women)

Question 32

Hiatal Hernia symptoms

Answer 32

Pyrosis (heartburn)
Regurgitation 
Dysphagia 
Epigastric pain
Fullness after eating
Intolerance to food
Nausea/vomiting
Many are asymptomatic

Question 33

Hiatal Hernia treatment

Answer 33

Small frequent feedings
No reclining for 1 hour after eating
Elevate head of bed
Surgical hernia repair when symptomatic/ to relieve GERD symptoms

Question 34

gastritis

Answer 34

epigastric pain/discomfort, heartburn from stomach up to mouth, pain intolerant to spicy or fatty foods, might be relieved by eating

Question 35

GERD

Answer 35

burning sensation in the esophagus

Question 36

Peptic ulcer

Answer 36

Dull, gnawing pain or burning sensation at the midepigastrium or

Question 37

Bowel obstruction causes:

Answer 37

Mechanical → tumors, stenosis, strictures, adhesions, hernias, abscesses, forien objects
Functional → poop is stuck (fecal impaction)
Intussusception volvulus (twisting of bowel)
Diverticulitis
Inflammatory bowel disorders

Question 38

Bowel obstruction symptoms

Answer 38

Crampy pain that is wavelike an colicky due to persistent peristalsis above or below the blockage
Passing of blood and mucus but no fecal matter or flatuls
Vomiting
Signs of dehydration
Distended abdomen

Question 39

Care of patient with colostomy or ileostomy

Answer 39

skin and stoma care
Record I&O
Manage dietary and fluid needs
Wound therapy consult
Education on care of pouch
Emotional support

Question 40

Paralytic ileus causes

Answer 40

Constipation can occur after surgery as a minor or a serious complication. Decreased mobility, decreased oral intake, and opioid analgesic medications can contribute to difficulty having a bowel movement. In addition, irritation and trauma to the bowel during surgery may inhibit intestinal movement for several days

Question 41

Paralytic ileus treatment

Answer 41

The combined effect of early ambulation, improved dietary intake, and a stool softener (if prescribed) promotes bowel elimination. Research suggests that chewing gum, particularly following laprascopic surgery, can help restore bowel function and prevent paralytic ileus by promoting peristalsis

Question 42

peritonitis

Answer 42

Inflammation of the peritoneum, which is the serous membrane lining the abdominal cavity and covering the viscera. Usually, it is a result of bacterial infection but may occur secondary to a fungal or mycobacterial infection; the organisms come from diseases or disorders of the GI tract or, in women, from the internal reproductive organs (e.g., fallopian tube). The most common bacteria implicated are Escherichia coli and Klebsiella, Proteus, Pseudomonas, and Streptococcus species. Peritonitis can also result from external sources such as abdominal surgery or trauma (e.g., gunshot wound, stab wound) or an inflammation that extends from an organ outside the peritoneal area, such as the kidney, or from continuous ambulatory peritoneal dialysis (CAPD)

Question 43

Gastric outlet disorder

Answer 43

occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down. The patient may have nausea and vomiting, constipation, epigastric fullness, anorexia, and, later, weight loss.

Question 44

Perforation

Answer 44

Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning. It is an abdominal emergency and requires immediate surgery. Perforation of a peptic ulcer is associated with a 10% to 25% mortality rate, making it the most lethal of all complications.

Question 45

Symptoms of penetration

Answer 45

include back and epigastric pain not relieved by medications that were effective in the past. Like perforation, penetration usually requires surgical intervention.

Question 46

Penetration

Answer 46

Penetration is erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastrohepatic omentum (membranous fold of the peritoneum).

Question 47

Crohn’s

Answer 47

characterized by periods of remission and exacerbation. It is a subacute and chronic inflammation of the GI tract wall that extends through all layers. Begins with crypt inflammation and abscesses which develop into small, focal ulcers, separated by edematous patches that create a cobblestone appearance to the affected bowel. Fistulas, fissures, and abscesses form as the inflammation extends into the peritoneum. Granulomas can occur in lymph nodes, the peritoneum, and through the layers of the bowel in about half of patients. Diseased bowel segments are sharply demarcated by adjoining areas of normal bowel tissue. These are called skip lesions, from which the label regional enteritis is derived. As the disease advances, the bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows.

Question 48

UC

Answer 48

Chronic ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum that is characterized by unpredictable periods of remission and exacerbation with bouts of abdominal cramps and bloody or purulent diarrhea. Bleeding occurs as a result of the ulcerations. The mucosa becomes edematous and inflamed. The lesions are contiguous, occurring one after the other. Eventually, the bowel narrows, shortens, and thickens because of muscular hypertrophy and fat deposits.

Question 49

ERCP (endoscopic Retrograde Cholangiopancreatography)

Answer 49

uses the endoscope in combination with x-rays to view the bile ducts, pancreatic ducts, and gallbladder. The side-viewing flexible scopes are used to visualize the common bile duct and the pancreatic and hepatic ducts through the ampulla of Vater in the duodenum. ERCP is helpful in evaluating jaundice, pancreatitis, pancreatic tumors, common bile duct stones, and biliary tract disease. However, ERCP is associated with post procedure pancreatitis; therefore, alternative diagnostic studies such as magnetic resonance cholangiopancreatography or EUS are typically preferred for diagnosing obstructive biliary disease

Question 50

EGD-esophagogastroduodenoscopy

Answer 50

the gastroenterologist views the GI tract through a viewing lens and can obtain images through the scope to document findings. Electronic video endoscopes also are available that attach directly to a video processor, converting the electronic signals into pictures that are projected on a screen. This allows larger and continuous viewing capabilities, as well as the simultaneous recording of the procedure.

Question 51

Causes of blood in the stool

Answer 51

Rectal bleeding is a symptom of conditions like hemorrhoids, Diverticular disease, Colitis, esophogeal complications, anal fissures, inflammatory bowel disease (IBD), ulcers and colorectal cancer.

Question 52

Melena

Answer 52

(dark and tar-like stool) - bleeding in stomach, ulcers

Question 53

Care/causes of a patient with esophageal damage, toxic

Answer 53

intentional or unintentional swallowing of strong acid, base or undissolved medication that leads to chemical burns of the esophagus. An acute chemical burn of the esophagus may be accompanied by severe burns of the lips, mouth, and pharynx, with pain on swallowing. Breathing difficulties due to either edema of the throat or a collection of mucus in the pharynx may occur.

Question 54

Complications of a patient with esophageal damage, toxic

Answer 54

Shock
Respiratory distress
May require reconstruction or esophagectomy