GI Flashcards
Oral cavity probs
stomatitis
candidiasis
leukoplakia
oral cancer
Stomatitis
causes: chronic disease, nutritional deficiences (albumin and vitamin c), allergic responses
CM: oral lesions, pain, weight loss
Interventions: antimicrobials, oral hygiene, analgesics, cool liquids
Candidiasis
causes: long term antibiotic use
CM: painful white patches
Interventions: nastatin, analgesics, cool liquids, gentle mouth care
Leukoplakia
causes: long term irritation
cm: thickened raised white patches on mucous membranes
Interventions: biopsy, monitor it, excision (partial glossectomy)
Oral cancer
CM: oral lesion, lump in cheek, dysphagia, voice change, foul odor, weight loss
interventions: maintain patent airway, aspiration precautions, respiratory status, radiation, chemo, surgical excision
Esophageal probs
GERD
hiatal hernia
esophageal tumors
GERD
causes: weak esophageal sphincter
dx: endoscopy
cm: heartburn, throat clearing, esophageal ulcers, cough, nausea, difficulty swallowing bc throat is inflamed
complication: barretts esophagus
interventions: PPI, histamine blockers, bed blocks, dietary restrictions (avoid spicy food), smoking cessation
Hiatal hernia
Causes: Heredity, weak spot in diaphragm, trauma, diaphragmatic injuries
Dx: Ba swallow, endoscopy
Clinical Manifestations: heartburn, dysphagia, feel full with little food
Complications: GERD, esophagitis, erosion, bleeding
Interventions: lifestyle modifications (sitting up after eating, bed blocks), surgery, small meals
Histamine blockers, PPIs, antacids
Esophageal tumor
Causes: Smoking/alcohol, untreated GERD, malnutrition, genetics
Dx: Cat scans, endoscopy, X-ray, biopsies, MRI
Clinical Manifestations: difficulty swallowing, weight loss, malnutrition, odynophagia, hoarseness, halitosis (bad breath)
Complications: Aspiration, closed airway
Interventions: Shrink size of tumor with radiation and chemo, excision, photodynamic therapy- assess for chest pain frequently and NPO until gag reflex comes back
Gastritis
Causes: food poisoning, spicy foods, food intolerance
Dx: Clinical manifestations, labs would have elevated WBC, electrolytes are off
Clinical Manifestations: Diarrhea, N/V, dehydration, increased hr, abdominal pain,
Complications: dehydration
Interventions: fluids, antiemetic (zofran), antibiotics
Peptic ulcer disease
Causes: Stress, diet
Diagnostics: Endoscopy, Ba contrast, H. pylori (will have low hct and hgb and + for h pylori)
Clinical Manifestations: epigastric pain
Complications: Perforation, hemorrhage
Interventions: Diet, medication, cessation of smoking and alcohol, vagotomy, gastrectomy, sit up right for 60 mins after meals
Vagotomy - reduce the acidity of the stomach, by denervating the parietal cells that produce acid.
2 antibiotics + PPI
Gastric ulcer pain
High in epigastrium
1 to 2 hours after meals
Burning or gaseous
Normal to low secretion of gastric acid
Duodenal ulcer pain
Midepigastric region beneath xiphoid process
Back pain—if located in posterior aspect
2 to 4 hours after meals
Tendency to occur, then disappear, then occur again
Associated with increased HCl acid secretion
Gastric cancer
often times there aren’t any symptoms
Nonsurgical: chemo and radiation–> mostly surgical solution (gastrectomy), not much you can do non surgically
Want to prevent dumping syndrome after a gastrectomy
Dumping syndrome
Early: 30 mins after eating. Symptoms– abdominal discomfort, N/V, diarrhea, vertigo, dizziness, syncope, diaphoretic, palpitations, tachycardia
Late (1-3 hours after eating): hunger, fatigue, diaphoretic, dizziness, lightheadedness, tachycardia, can cause low blood sugar
Can cause distention bc lots of fluid goes directly into small intestine, antidiarrheal, limit high sugar, small frequent meals
Noninflammatory intestinal disorders
Irritable Bowel Syndrome Colorectal Cancer Intestinal Obstruction Lower GI Bleeding Malabsorption
IBS
Causes: females, genetics
Dx: symptoms
CM: alternating constipation/diarrhea, LLQ pain
Complications: dehydration, electrolyte disturbances, constipation causing increased hemorrhoids & bowel obstruction
Tx: fiber, anti-diarrhea, probiotics, caffeine alcohol fruit and dairy make it worse
Colorectal
refers to colon and rectum, which together make up large intestine
Colorectal cancer
Intermittent painless rectal bleeding most common symptom also Change in Bowel Habits
Other Symptoms: anemia, weak, fatigue, pale, low o2 sats, melena (black tarry stools), Hematochezia (bright red blood in stools)
Intestinal obstruction
Causes: Paralytic ileus, age, severe constipation, hernia, tumors, scar tissue
Diagnostics: x-ray can show abdominal distention, CAT scans
Clinical Manifestations: Vomiting, pain, reflux, absent bowel sounds, obstipation=no BM, large intestine- abdominal distention, once small intestine and large intestine are full you start vomiting fecal matter. Hyperactive above obstuction and hypoactive bowel sounds below
Complications: rupture –> infection (prognosis is very poor), electrolyte imbalances so lab work is good, peritonitis, necrotic bowel bc not getting blood due to the pressure, death
Interventions: NG tube for continuous suction of gastric secretions and decompression, NPO so you need IV fluids, pain management, may do a bowel resection
Small intestine obstruction
sporadic, colicky pain
visible peristaltic waves
profuse projective vomitus with fecal odor, which relieves pain
Causes symptoms shortly after onset: abdominal cramps centered around the umbilicus or in the epigastrium, vomiting, and—in patients with complete obstruction—obstipation
With infarction, the abdomen becomes tender and auscultation reveals a silent abdomen or minimal peristalsis. Shock and oliguria are serious signs that indicate either late simple obstruction or strangulation.
Large intestine obstruction
diffuse and constant pain
significant abdominal distention
infrequent vomiting, leakage of fecal fluid around impaction
Usually causes milder symptoms that develop more gradually than those caused by small-bowel obstruction. Increasing constipation leads to obstipation and abdominal distention.
Lower abdominal cramps unproductive of feces
istended abdomen with loud borborygmi.
There is no tenderness, and the rectum is usually empty. Systemic symptoms are relatively mild, and fluid and electrolyte deficits are uncommon.
Volvulus
twisting of bowel
Intussusception
telescoping of bowel
Common causes of lower GI bleeding
ulcerative colitis, polyps, colon cancer, diverticulosis/diverticulitis, rectal cancer, hemorrhoids
Inflammatory intestinal disorders
Appendicitis Peritonitis Gastroenteritis Ulcerative Colitis Crohn’s Disease Diverticulitis
Inflammatory Bowel Disease
A group of immunologically related inflammatory conditions of the colon and small intestine. body mistakes food for foreign objects and sends white blood cells which causes inflammation
Crohn’s disease and ulcerative colitis are major types
Main difference between Crohn’s disease and UC is the location and nature of the inflammatory changes
Crohn’s Disease
End of small intestine / beginning of large intestine
RLQ pain
20-40 yrs old
Severe diarrhea, crampy abdominal pain, occasional bleeding, fever, fatigue
Food avoidance due to pain –> weight loss
Goal is to rest the bowel, let inflammation subside, prevent infection, give relieve of pain and severe diarrhea
tx: Aminosalicylates Antibiotics Steroids Immunosuppressant
Ulcerative colitis
Colon and Rectum
LLQ pain
Bloody loose stools, crampy abdominal pain, urgent bowel (tenesmus), fatigue, anorexia, possible anemia due to blood loss
Complications: hemorrhage, perforation which leads to peritonitis or toxic megacolon (massive dilatation of colon causes gangrene and perforation)
**Risk for Cancer (10-20X)**
Tx:
Aminosalicylates
Antibiotics
Corticosteroids
Immunosuppressant
Appendicitis
RLQ, rebound tenderness
McBurney’s point
Diverticula
Out-pouching’s– food gets stuck, causing infection and inflammation (diverticulitis)
Form near the end of the large intestine
Diverticulosis is associated with constipation, low fiber diet and straining with bm -> increases pressure inside colon-> forming diverticulum
Diverticulitis occurs when diverticulum become inflamed -> LLQ pain fever, constipation and decreased appetite
Diverticulosis Tx
Fiber rich diet
Diverticulitis Tx
clear liquid diet and oral antibiotics, no fiber at this phase
alternating diarrhea and constipation, chills or fever, LLQ pain
Flagyl, cipro
Peritonitis
Hallmark signs- abdominal distention, pain & nausea, rebound tenderness, abdominal rigidity (board like)
Tx: Pain increase bp and hr
Bowel sounds may decrease
Want to decompress stomach and bowel using ng tube, give fluids, antibiotics, pain meds, supplemental electrolytes, monitor bowel sounds
Acute hepatitis
N/V/D, Anorexia, Fever, Light (clay) colored stools, Dark urine, Jaundice
Tx:
A – no specific drug therapy, wait for liver to heal itself
B – a-Interferon, Ribavirin
C – Pegasys
Prevention
A – Hepatitis A vaccine, immune globulin
B – HBV (series of 3)
C – no vaccine available
Nutritional Therapy
Important for hepatocyte regeneration
Sufficient calories to prevent weight loss
Vitamin Supplements
Cholecystitis
RUQ pain (gallbladder is below liver)
Murphy’s sign
Increased pain with deep breath
N/V, Feeling full, abdominal distention, jaundice, fever
ESWL- break up stones so it can travel easier
Acute episode focus on: Pain control, antibiotics, fluids and electrolytes
Tx: Anticholinergics, Analgesics, Fat-soluble vitamins, Bile salts, Cholestyramine (Questran)
Albumin
3.5-5.0 g/dl
Pre-Albumin
20 mg/dl
Transferrin
215-380mg/dl or 2.15-3.8g/L
Ammonia
15-110 mg/dL
Phosphorus, Potassium, Albumin
all about 3.5-5
NG tube feeding
semi folwers or higher
180 ml residual –> do not refeed, contact PCP
