GI Flashcards

1
Q

Scarrrosis/ fibrosis of liver—liver hard like rock

A

CIRRHOSIS

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2
Q

CIRRHOSIS cause

A
  • Alcohol
  • Cystic fibrosis
  • Hepa B C
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3
Q

CIRRHOSIS types
1. mc due to alcohol
2. dt hepa B C
3. dt gall stone obstruction
4. dt to RSHF

A
  1. LAENNEC’s
  2. POST NECROTIC
  3. BILIARY
  4. CARDIAC
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4
Q

LIVER 4 RESPONSIBILITIES

A
  1. produce Albumin, Bile, coagulation factors
  2. Detoxify AMMONIA
  3. Drugs metabolism
  4. Store GLYCOGEN
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5
Q

Liver is like __ bus that scoops ___ and bilirubin

A

Bile bus
Cholesterol

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6
Q

Fx ni albumin

A

Attracts water, drugs, binds with Ca

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7
Q

CIRRHOSIS hepa-j sx and ano sx under nila.

A

Hepatic Encepalopathy (ammonia)
* Asterixis
* LOC
* Constructional apraxia
Esophageal varices
Portal HPN
* Pre renal failure
* Hepatomegaly
* hemorrhoids
* Caput Medusae
* SPIDER ANGIOMA
Ascites
Jaundice
* Pruritus

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8
Q

CIRRHOSIS other sx

A
  • Dec Ca and Platelet dt to albumin (trousseau and chvostek, bleeding)
  • > 20 BUN
  • Inc AST & ALT
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9
Q

CIRRHOSIS interventions for:
- Hepatic Encepalopathy (ammonia):
- Esophageal varices:
- Portal HPN:
- Ascites:
- Jaundice:
- Dec Ca and Platelet dt to albumin:

A
  • Hepatic Encepalopathy (ammonia): LIMIT PROTEIN, no SEDATIVES, ✅NEOMYCIN & LACTULOSE
  • Esophageal varices: no NGT/ STRAINING and coughing , and no NGT, ✅Balloon Tamponade
  • Portal HPN: BETA BLOCKERS, TIPS/ transjugularhepatic portosystemic shunt
  • Ascites: PARACENTESIS, low NA, ✅reverse trendelenburg, ALDACTONE
  • Jaundice: cool moist skin, moisturizing cream, long sleeved cotton gloves, trim nails
  • Dec Ca and Platelet dt to albumin: iron rich foods, Vitamin ADEK, bleeding prec, Spirinolactone, ALBUMIN IV (egg white)
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10
Q

CIRRHOSIS considerations of paracentesis

A
  • Empty bladder
  • Measure abd circumference/ wt
  • High fowlers
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11
Q

CIRRHOSIS giving albumin effective if?

A

⬆️BP and pulse

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12
Q

CIRRHOSIS dx and considerations

A

Liver biopsy
- Before and during: supine c pillow sa head and R side
- After procedure: R side lying to prevent bleeding

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13
Q

CIRRHOSIS y insert balloon tamponade? What kind of tube? Ano prio at ilalagay sa bedside

A
  • to apply pressure kasi nag rupture na, compress stomach dt bleeding, and decompress gastric/air
  • Sengstaken Blakemore Tube (triple lumen)
  • Airway. Scissor
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14
Q

CIRRHOSIS neomycin and lactulose is effective?

A

⬆️LOC

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15
Q

CIRRHOSIS lactulose’s stool na masasabi effective eto? Monitor for?

A

Soft stools c 2-3 bowel movt
HYPOKALEMIA

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16
Q

CIRRHOSIS Hepatic Encephalopathy stages

A
  1. Stage 1: confused
  2. Stage 2: lethargy
  3. Stage 3: stupor
  4. Stage 4: coma
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17
Q

CIRRHOSIS 3 complications

A
  1. Primary peritonitis: ANTIBIOTICS
  2. HEPATORENAL SYNDROME: dialysis
  3. HEPATIC ENCEPALOPATHY
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18
Q

Inflammatory cond of liver caused by viral or non viral (alcohol autoimmune)

A

HEPATITIS

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19
Q

HEPATITIS types

A

hepa TAE
BC- blood and body fluids
D- co-infection c B

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20
Q

HEPATITIS ABA sx

A

⬆️bilirubin
- Jaundice & pruritus
- Clay colored/ pale stools
- Dark or tea-colored urine
⬆️aPTT and PT
- bruising
⬇️Albumin
- edema

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21
Q

HEPATITIS mngt and DIET

A
  • low PROTEIN (all liver dse)
  • low FAT (kc my nausea)
  • ❌acetaminophen (tylenol), alcohol
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22
Q

HEPATITIS pruritus mngt

A
  • Moisturizer
  • Cool compress
  • Avoid sun
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23
Q

Enzymes begin to digest the pancreas (autodigestion)

A

PANCREATITIS

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24
Q

PANCREAS fxns

A
  • Exocrine: produce digestive enzymes
  • Endocrine: insulin & glucagon
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25
Q

3 digestive enzymes

A
  1. Trypsin/ protease: protein
  2. Lipase: fat (most destructive)
  3. Amylase: carbs
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26
Q

PANCREATITIS sx specially hallmark

A
  • Turner’s sign- flank
  • Cullen’s sign- umbiliCULL
  • LUQ epigastric pain radiates to back aggravated by Flat position
  • ⬆️bilirubin (jaundice)
  • internal bleeding, Ascites (Internal Bleeding dito may lead to DHN, Hypotension)
  • HypoCa
  • NV indigestion
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27
Q

PANCREATITIS dx kung san lahat ⬆️

A
  • Enzymes (best parameter)
  • Glucose (hyperglycemia)
  • WBC (fever)
  • PT and aPTT
  • Bilirubin, Alkaline Phosphatase
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28
Q

PANCREATITIS mngt

A
  • LUQ epigastric pain radiates to back aggravated by Flat position: ❌MORPHINE/ HYDROMORPHONE/ DEMEROL or any NARCOTICS
  • ⬆️bilirubin (jaundice): ✅pruritus care
  • internal bleeding, Ascites (Internal Bleeding dito may lead to DHN, Hypotension)- ✅BLEEDING PREC
  • Prio: REST THE GI/ NPO or ✅NGT
  • hypergly: INSULIN
  • ⬆️enzymes: PPI, H2 BLOCKERS, ANTACIDS
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29
Q

PANCREATITIS diet

A

Enzymes c meals

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30
Q

PANCREATITIS compli

A
  • Steatorrhea
  • HYPOCALCEMIA
  • DM
  • ARDS
  • PERITONITIS
  • HYPOVOLEMIC/HEMORRHAGIC SHOCK
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31
Q

Inflammation of gallbladder caused by gallstones (CHOLELITHIASIS) resulting to backup ng bile

A

CHOLECYSTITIS

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32
Q

CHOLECYSTITIS supersaturation of bile types

A
  1. Cholesterol (mc)- yellow color
  2. Bile/Pigment stone (hemolysis, dark green color)
  3. Calculous- gall stone (mc din)
  4. Acalculous- injury/surgery➡️infxn
  5. Water
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33
Q

CHOLECYSTITIS signs

A
  • Murphy’s sign: hepatic subcoastal margin/last rib palpation while on supine gall bladder contrac/mamaga then pain + Rebound Tenderness
  • Boas sign: pain after intake of fat, pain sa SCAPULA
  • RUQ colic pain radiates to RIGHT shoulders
  • Fever c chills
  • ⬆️bilirubin (jaundice, pruritus, steatorrhea, dark tea colored urine)
  • ⬇️Vit K (bleeding)
  • Belching/indigestion of fats
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34
Q

CHOLECYSTITIS prio mngt

A

NPO/ REST THE GI

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35
Q

CHOLECYSTITIS
1. diet
2. meds
3. treatment/surgery

A

❌gas forming foods

  1. ursoDEOXYCHOLIC acid or chenoDEOXYCHOLIC acid
  2. PANTOLINE/ATROPINE (anti spasmodic/anticholinergic)
  3. NSAIDS for pain
  4. PPI & H2 blocker (⬇️secretion—⬇️contraction)
  5. Lithotripsy
  6. Laparoscopic cholecystectomy(stone lang tanggal)
  7. cholecystectomy (gall bladder)
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36
Q

cholecystectomy may bile parin?

A

Yes kasi may liver pa

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37
Q

Triad/peritad na naga septick shock na

A

CHARCOT’s triad or REYNOLD’s Peritad
1. RUQ pain
2. Jaundice
3. Fever
4. Confusion
5. Hypotension

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38
Q

CHOLECYSTITIS compli wherein gallstone bumababa sa common bile duct

A

CholeDOCHOlithiasis

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39
Q

CHOLECYSTITIS dx

A

UTZ

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40
Q

CHOLECYSTITIS heath educ

A
  • ❌fatty fried foods
  • Lose wt
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41
Q

cholecystectomy post op instruction

A
  1. early ambulation
  2. Prevent pneumonia (deep breath and cough)
  3. Prevent infection (❌baths✅shower, report redness/swelling sa incision site)
  4. 1 wk bago balik sa work
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42
Q

Dt fecalith causing inflammation in RLQ

A

APPENDICITIS

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43
Q

APPENDICITIS signs
1. pain upon release/ rebound tenderness
2. pain in umbilicus hanggang iliac crest
3. Rolling/paradoxical pain (sa LLQ nag palpate pero pain sa RLQ)
4. Pain triggered by coughing
5. Pain when R knee flexed 90 degrees tas inikot ikot or external rotaion
6. R leg flexed backward tas naga L lateral position pt

A
  1. BLUMBERG
  2. MCBURNEY
  3. ROVSING
  4. DUNPHY’S
  5. OBTURATOR
  6. PSOAS
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44
Q

APPENDICITIS other sx

A
  • Low grade fever
  • ⬇️bowel sound
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45
Q

APPENDICITIS mga bawal ❌

A
  • Heat pads or blanket
  • Laxative
  • Enemas
  • Colonoscopy
46
Q

APPENDICITIS mngt

A
  1. IV MORPHINE/HYDROMORPHONE
  2. IV NS or LR
  3. ✅cold compress
  4. Appendectomy or Ex Lap (❌lifting obj, prevent pneumonia, prevent infxn)
47
Q

PERITONITIS (nag rupture/perforate) vs and signs

A
  • ⬆️HR, RR, Temp
  • Rebound tenderness
  • Rigid board like abd
48
Q

Immune reaction to eating gluten dt absence og intestinal villi resulting to malabsorption

A

CELIAC DSE

49
Q

CELIAC DSE foods na bawal

A

Lahat ng may GLUTEN (BROW)—barley, rye, oats, wheat) example is dinner roll, spag, beer, breaded meat

50
Q

CELIAC DSE sx (SADEK)

A
  • Steatorrhea
  • Abd pain
  • Diarrhea
  • Vit ADEK (fat soluble) di absorbed
51
Q

Grains like rice corn potatoes soy quinoa pede?

A

YES

52
Q
  1. Little pOuches of stress bubbles leading to CONSTIPATION
  2. Dangerous Inflammation of diverticula
A
  1. DIVERTICULOSIS
  2. DIVERTICULITIS
53
Q

DIVERTICULA DISORDERS cause and age affected

A
  • LOW FIBER, popcorn, seeds, nuts
  • ELDERLY
54
Q

DIVERTICULA DISORDERS sx

A
  • LLQ pain
  • Fever, ⬆️WBC
  • ⬇️Hct
  • Abd sx c blood stool
55
Q

DIVERTICULA DISORDERS prio during acute phase and dx

A

REST THE bowel/ NPO
CT scan

56
Q

DIVERTICULITIS mngt

A
  • NPO
  • clear liquid diet (jello broth juices)
  • LOW fiber
57
Q

DIVERTICULOSIS mngt

A
  • Avoid consti & STRAINING (HIGH fiber)
  • ❌ popcorn, seeds, nuts (⬇️fiber mga to)
58
Q

Other mngt na pang either sa dalawa

A
  • MORPHINE/HYDROMORPHONE
  • PANTOLINE/ ATROPINE
  • ✅NGT decompression kasi naka NPO
  • TPN lang if (+) malnutrition
  • Antibiotics, antipyretics
  • Diverticulectomy
59
Q

Impending sign ng rupture (peritonitis)

A

Paralytic ileus (ABSENT BOWEL SOUND)

60
Q

aka Dietary Compli, Resulting to massive fluid shift dt Stomach empties too quickly into duodenum (SI) 30 mins after eating seen any bariatric surgery

A

DUMPING SYNDROME

61
Q

DUMPING SYNDROME goal

A

Delay gastric emptying

62
Q

DUMPING SYNDROME sx is like __

A

Hypovolemic shock
- Hypotachytachy
- POST PRANDIAL HYPOGLY (rebound hypogly dt ⬆️insulin)
- SWEATING dizziness
- SEVERE ABD PAIN 30 mins after eating
- Diarrhea NV

63
Q

DUMPING SYNDROME mngt

A
  1. L SIDE LYING after eating
  2. Recumbent DURING eating
  3. Liquid IN BETWEEN meals (before and after kain)
  4. ⬆️CHON for oncotic
  5. ⬇️Carbs, ❌simple sugar milk caffeine salt
  6. Atropine Pantoline (antispasmodic/ anticholinergic)
64
Q

GI SURGERY post op mngt

A
  • NPO until bowel sounds return
  • ✅sequential compression devices or any Splinting specially during coughing
  • Prevent infxn (shower), prevent pneumonia (coughing and DBE/incentive spirometer q hr), early ambulation
65
Q

DEHISCENCE/EVISCERATION
1. Una gagawin
2. Position
3. Ilalagay

A
  1. STAY c the client and CALL for help
  2. LOW FOWLERS C KNEES BENT
  3. Sterile gauze c saline
66
Q

DEHISCENCE/EVISCERATION educ

A
  • CARBS lang ⬇️ sa diet
  • L SIDE LYING agad after eating
  • Foods in bet meals
  • SFF
  • (**Dumping syndrome mngt din diba)
67
Q

anong Vit imeasure after GI surgery to prevent compli

A

Serum VIT B12

68
Q

Diff ng sx ng UPPER sa LOWER GI bleed

A

Upper (DARK)
- Hematemesis (coffee ground emesis)
- Melena (black tarry stool)
Lower (BRIGHT red bleeding)

69
Q

GI BLEED common rx

A

Upper
- gastritis gerd PUD
- Esophageal varices
Lower
- Colorectal Cancer
- Hemorrhoids
- Diverticulosis
- Ulcerative colitis

70
Q

GI BLEED dx

A

Guiac FOBT

71
Q

how to perform Guiac FOBT

A
  1. Nonsterile gloves
  2. Lagay stool sa boxes
  3. Sa likod, put 2 drops ng solution
  4. Wait 1 min
  5. Document
72
Q

GI BLEED Compli

A
  • HYPOVOLEMIC SHOCK
  • hemorrhagic shock (Hgb <7 pt goes to Heaven)
73
Q

GI BLEED Mngt
1. position
2. what IV sol to stabilize Bp
3. to increase Hgb
4. For upper GI bleed ano mngt
5. consideration if may esophageal varices

A
  1. Low HOB
  2. NS
  3. BT
  4. NGT lavage
  5. ❌ NGT
74
Q

surgery ng upper GI? low GI? post op mngt?

A

Upper GI: ENDOSCOPY
lower GI: COLONOSCOPY

Clear liquids like juice broth jello unsweetened tea

75
Q

GERD cause

A

Anything nagpapa weaken/wide ng LES (lower esophageal sphincter) na nagpapa backflow ng hydrochloric acid and pepsin

76
Q

GERD sx

A
  • DYSPEPSIA “heartburn” aka PYROSIS after meal or lying down
  • Globus (fullness in throat)
  • Laryngitis (dry cough, hoarseness)
  • Odynophagia (painful swallowing)
77
Q

GERD rx

A
  • Pyloric stenosis
  • ⭐️Hiatal hernia
  • ⬆️abd pressure
  • Stress and obesity
  • Slow motility
78
Q

GERD mga ❌kainin

A
  • Fried fatty
  • Citrus/acidic like tomato spag ++ spicy
  • Dairy (milk cheese)
  • Chocolates
  • Peppermint/spearmint
  • Caffeine
  • Tobacco and alcohol
79
Q

GERD mngt

A
  • ✅3 hr after meal saka pede humiga
  • Fowlers sa gabi.. or L SIDE LYING
  • SFF (6-10 meals)
  • ❌inc ng abd pressure like compression
80
Q

GERD meds

A
  • antacid pang NEUTRALIZE (Al/Mg hydroxide, —carbonates)
  • H2 blockers
  • PPI
  • DOMPERIDONE & METOCLOPROMIDE (prokinetics ⬆️motility)
81
Q

GERD meds na bawal (ANAC)

A
  • Aspirin
  • NSAIDS
  • anticholinergic/antispasmodic (atropine pantoline)
  • Ca Channel Blockers

AN- ⬆️HCl
AC-⬇️motility

82
Q

2 tests to determine LES competence

GERD 2 surgeries pampasikip ng LES

A

UPPER GASTROINTESTINAL ENDOSCOPY
ESOPHAGOGASTRODUODENOSCOPY (EGD)

STRETTA PROCEDURE (radio frequency waves)
FUNDOPLICATION

83
Q

Happens when gastric acids erodes gastric lining creating holes/sores in stomach or duodenum

A

PUD

84
Q

PUD gastric vs duodenal ulcer

A

Gastric
- sa STOMACH
- Poor man/ laborer’s ulcer
- ⬆️50 y.o
- pain after eating—wt loss
- HEMATEMESIS
- (ako to)😂
Duodenal (mas common)
- sa duodenum
- Executive ulcer
- 25-50 y.o
- nawawala lang sakit pag kumakain kaya worse sa gabi —wt gain
- MELENA
BOTH
- Dyspepsia/indigestion/Epigastric/Burning/Pain

85
Q

PUD causes

A
  • H. Pylori (raw meat)
  • NSAIDs (Naproxen, Aspirin, Indomethacin, Ibuprofen)
  • Stress and Vices
  • Coffee
86
Q

PUD dx

A

GUIAC FOBT
UPPER GI SERIES c BARIUM CONTRAST
- NPO 8h before
- expect abd cramping & chalky white stool
- OFI & laxatives
BIOPSY (tignan H pylori)
Gastric acid analysis

87
Q

PUD
1. Diet
2. Avoid __
3. Report__
4. Tyoe of diet during active phase/painful
5. Educ

A
  1. ❌spicy, fatty fried, acidic/citrus, caffeine, alcohol and cigars, peppermint/spearmint
  2. NSAIDS and large amount milk (1 c per day lang or maga rebound hyperacidity), and stress
  3. Black tarry stools
  4. Bland diet
  5. Chew slowly
88
Q

PUD meds and med’s WOF

A

Antacids (neutralize, chewable 1-2 AFTER meal the 1 full glass water..eto lang after meal, the rest before)
1. Al Hydroxide (ala tae/consti, ⬇️phosphate/phosphorus)
2. Mg hydroxide (mag tae, ⬆️mg)
3. Ca carbonate (⬆️Ca)
4. Na bicarbonate (metabolic alkalosis)
5. Combined dalawang hydroxide—MgALOH (Maalox)

H2 blockers, PPI (before breakfast)— mga nagpapa ⬇️HCl

Sucralfate/Misoprostol
(Misoprostol is anti prostaglandin so ❌preg pang abort

Bismuth, Tetracycline, Metronidazole, Amoxicillin, Clarithromycin, Quinolones (H. Pylori)

89
Q

3 types ng Histamine and their fxn

A
  1. H1: allergy
  2. H2: HCl
  3. H3: drowsy
90
Q

2 disease ng Inflammatory Bowel Dse (IBS) and difference

A

Ulcerative COLitis
- Colon
- LLQ
- 10-20 bloody stools
- ⬇️Hgb & Hct
- Rx: Colorectal Ca
- 16-25 and 55-65 y.o
CRohn’s Dse
- SI
- RLQ
- aka regional enteritis
- Rx: Irritable bowel Syndrome
- 5 soft loose stools/steatorrhea/mucus/pus (❌bleed)
- 35-55 y.o
BOTH
- tenesmus (urge to defecate but isn’t relieved by defecation)

91
Q

IBS cause & triggers

A

AUTOIMMUNE
3 S- stress smoking sepsis

92
Q

IBS dx and seen, surgery

A

UC- laceration inflammation
Crohns- cubble stone/ crown

Colostomy or Ileostomg

93
Q

IBS mngt
1. Diet
2. Electrolytes
3. Avoid___
4. Meds (lodips)

A
  1. ⬇️FIBER/ residue ⬆️CHON & Cal
  2. 2 L water + more w diarrhea, ⬆️K, ⬆️ Ca vit, ✅oresol
  3. Stress, alcohol, caffeine
  4. Loperamide, Dicyclomine, Prednisone, Sulfasalazine
94
Q

blockage in SI w rapid onset sx

A

SMALL BOWEL OBSTRUCTION

95
Q

SBO sx

A
  • COLICKY “intermittent” abd pain
  • abd distention, NV
  • HYPERactive bowel sounds (ABOVE obstruction)
  • hypo (below)
96
Q

SBO non mechanical & mechanical causes

A

Non mechanical: PARALYTIC ILEUS
Mechanical: anything nagpapa obstruct
- ADHESION From surgery
- Intussusception
- Hernia
- Volvulus (twisting ng bowel)
- Tumor

97
Q

SBO mngt

A
  1. NPO, ✅NGT
  2. Semi FOWLER
  3. NON OPOIDS
  4. ❌ opoids (morphine, hydromorphone, hydrocodone)
  5. Bowel resection
98
Q

SBO mngt

A
  1. NPO, ✅NGT
  2. Semi FOWLER
  3. NON OPOIDS
  4. ❌ opoids (morphine, hydromorphone, hydrocodone)
  5. Bowel resection
99
Q

IRRITABLE BOWEL SYNDROME (IBS)

A

Affects LARGE INTESTINES either diarrhea or consti

100
Q

IBS
1. type of stool
2. Cause
3. Rx factor

A
  1. mucoid ❌bloody
  2. Idiopathic
  3. Stress, women, neuroendo dysfxn
101
Q

IBS mngt
1. Diet
2. Dx
3. Position
4. Meds
5. Tell to avoid __

A
  1. ⬆️FIBER ⬆️CHON❌gas forming (legumes/beans, eggs, dairy, FRUITS). If consti= low fat/low residue like rice ++lactulose (laxative)
  2. Colonoscopy, Barium Enema
  3. S LYING KNEES FLEXED
  4. Loperamide
  5. Stress
102
Q

Potrusion ng part ng stomach thru diaphragm and now is stuck sa esophagus (SLIDING) or to the side ng esophagus (ROLLING) or MIXED

A

HIATAL HERNIA

103
Q

HH cause & dx

A
  • ⬆️abd pressure
  • Obesity stress female
  • Congenital
    Endoscopy & Barium Swallow
104
Q

HH sx & mngt

A

GERD sx + esophagitis
- ❌nagpapa⬆️abd pressure including tight clothing and girdle
- GERD mngt
- PPI (Pantoprazole)
- Fundoplication

105
Q

ESOPHAGEAL CA rx factors (TOGA)

A

Tobacco
Obesity
Gerd
Alcohol

106
Q

Cancer of large intestine + rectum

A

Colon Cancer

107
Q

Colon & Colorectal Cancer
1. rx factor
2. dx
3. Educ

A
  1. TOGA + DIVERTICULITIS + Ulcerative Colitis
  2. Colonoscopy
  3. Lose wt, no alcohol & tobacco, iwasan magka GERD, ⬆️FIBER
108
Q

COLONOSCOPY before and after things to do

A

Before
- Clear liquid diet Laxatives
- NPO midnight
- Polyethylene Glycol
After
- WOF: peritonitis

109
Q

Colostomy vs Ileostomy location

A

Colostomy- colon
Ileostomy- ileum (SI)

110
Q

Colostomy & Ileostomy tell if ✅ or ❌
1. Red beefy after surgery then pink long term
2. Moist shiny
3. Pale grey dusky purple
4. Cold
5. Post op ⬆️fiber
6. Fluid electrolytes imbalance as compli
7. No gassy foods
8. No hard to digest like popcorn seeds nuts

A
  1. ✅Red beefy after surgery then pink long term
  2. ✅Moist shiny
  3. ❌Pale grey dusky purple
  4. ❌Cold
  5. ❌Post op ⬆️fiber
  6. ✅Fluid electrolytes imbalance as compli
  7. ✅No gassy foods
  8. ✅No hard to digest like popcorn seeds nuts
111
Q

Colostomy & Ileostomy
1. How many ml fluid intake
2. Irrigation how many ml
3. warm or tap water?
4. place bag above__ (__height)
5. Cramping:
6. Empty pouch when __
7. Skin breakdown:
8. Nsg dx:

A
  1. 3,000 ml
  2. 500-1000
  3. Warm
  4. Ostomy, shoulder
  5. STOP FLUID
  6. 1/3–1/2 full
  7. Clean periostomal skin meticulously
  8. Disturbed body image
112
Q

DOC diuretics of Ascites in Cirrhosis

A

Aldactone