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Acute Care > GI > Flashcards

GI Flashcards

1
Q

what is located in the RUQ?

A
  1. liver
  2. gallbladder
  3. colon
  4. kidney
  5. duodenum
  6. small intestine
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2
Q

What is located in the RLQ?

A
  1. ascending colon
  2. cecum
  3. appendix
  4. small intestine
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3
Q

what is in the LUQ?

A
  1. stomach
  2. spleen
  3. pancreas
  4. kidney
  5. colon
  6. jejunum
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4
Q

what is in the LLQ?

A
  1. descending colon
  2. colon
  3. sigmoid colon
  4. small intestine
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5
Q

when is it a good time to consider GI pain referrals?

A

when the pt’s pain pattern doesn’t match the mechanism of injury and you can’t find any mechanical reason for their pain

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6
Q

List common symptoms for GI dysfunction

A
  1. N/V/D
  2. hemoptysis
  3. Incontience/Diarrhea
  4. Heartburn (reflex)
  5. Abdominal pain
  6. Dysphagia/Odynophagia
  7. Jaundice
  8. Color changes in stool/urine
  9. Hematochezia
  10. Melena
  11. Medical hx (hernia, liver disease, etc.)
  12. substance use disorder
  13. food interolance
  14. thyroid dysfunction
  15. DM
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7
Q

list various types of diagnostic studies that may be conducted in the presence of GI dysfunction

A
  1. Laparoscopy
  2. Barium swallow
  3. Modified barium swallow study
  4. Endoscopy
  5. ERCP
  6. GI bleeding scans
  7. Upper GI scans
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8
Q

what is a laproscopy?

A

insertion of laparoscope into abdominal cavity

uses small incision and local anesthetic

can be diagnostic or therapeutic

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9
Q

what is the barium swallow study?

A

pt swallow barium liquid while x-ray anf fluoroscopic images examine swallowing and peristalsis of esophagus

used to ID pathologic conditions of the esophagus (propulsion of liquid through esophagus into stomach)

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10
Q

what is a modifed barium swallow study?

A

used to diagnose dysphagia (analyzes oral, pharyngeal, and upper esophagus)

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11
Q

what is an endoscopy?

A

insertion of endoscopic into digestive tract (esophagus, stomach, small intestine)

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12
Q

what is an ERCP?

A

endoscopic retrograde cholangiopancreatography

uses endoscopy and fluoroscopy to diagnose and treat gallbladder, biliary system, pancreas, and liver problems

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13
Q

what are GI bleeding scans?

A

(scintigraphy) used to determine the presence and/or source of GI bleeding

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14
Q

what are Upper GI series?

A

used to ID disorders of the esophagus, stomach, and duodenum (jejunum and ileum visualized for small bowel series)

passage of barium is visualized with imaging studies

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15
Q

List liver function/biliary tests

A
  1. ALT
  2. ALP
  3. AST
  4. albumin
  5. bilirubin
  6. ammonia
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16
Q

list pancreatic function tests

A
  1. lipase
  2. amylase
  3. sweat test
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17
Q

List some GI conditions

A
  1. Dysphagia
  2. GERD
  3. PUD
  4. Dumping Syndrome
  5. GI Hemorrhage
  6. Diverticular disease
  7. Hernias
  8. Irritable Bowel Syndrome (IBS)
  9. Crohn’s Disease (idiopathic inflammatory bowel disease → IBD)
  10. Ulcerative Colitis
  11. Morbid Obesity
  12. Encephalopathy
  13. Cholecystitis
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18
Q

describe the disorder Dysphagia

A

esophagel disoder

  1. difficulty swallowing; oropharyngeal or esophageal
  2. diagnosis:
    • MBSS
    • endoscopy
    • CT
    • MRI
  3. Causes
    • neuro conditions (stroke, TBI)
    • dementia
    • myasthenia gravis
  4. Treatment:
    • airway protection
    • nutritional support
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19
Q

describe the disorder GERD

A

esophagus/stomach disorder

  1. backflow of gastric acid into esophagus
  2. S/S:
    • heartburn
    • regurgitation
  3. Treatment:
    • diet modification
    • weight loss
    • PPIs, H2 blockers
    • Nissen fundoplication
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20
Q

describe the disorder PUD

A

esophageal/stomach disorder

  1. ulceration in the stomach or duodenum
  2. Causes → H.pylori infection or NSAIDs
  3. S/S:
    • hungerlike sensation
    • nocturnal pain
  4. Treatment:
    • lifestyle modifications
    • PPIs
    • antibiotics
    • no NSAIDs/aspirin
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21
Q

describe the disorder Dumping Syndrome

A
  1. enhanced gastric emptying interrupts normal digestive sequence
  2. can result from a number of GI surgeries
    • gastrectomy, gastric bypass, PUD surgery, Nissen fundoplication
  3. Can be early or late DS
  4. Treatment → dietary changes and meds
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22
Q

what is the difference between Early DS and Late DS?

A
  1. Early DS
    • occurs within 30 min of meal
    • palpitations, tachycardia, flushing, diaphoresis, syncope, abdominal symptoms (cramping, bloating)
  2. Late DS
    • occurs 1-3 hrs after meal
    • S/S consistent with hypoglycemia
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23
Q

describe the 2 types of GI hemorrahges that can occur

A
  1. UGIB → occurs in esophagus, stomach, or duodenum
    • caused by ulcers, gastric erosion, gastric/esophageal varices
  2. LGIB → occurs in colon and anorectum
    • caused by IBS (diverticulitis), ischemic colitis, anal and rectal lesions (hemorrhoids), ulcerative polyps and colorectal canacer
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24
Q

what are S/S and treatments for GI hemorrhages?

A
  1. S/S:
    • hematemesis
    • hematochezia
    • melena
  2. Treatment:
    • IV fluids
    • blood transfusions
    • management of causative factors
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25
Q

what is diverticular disease?

A

can be diverticulosis or diverticulitis

Diverticulosis → presence of out-pocketings which can be asymptomatic

Diverticulitis → inflammation of diverticuli (these are symptomatic)

26
Q

Describe S/S and treatment for Diverticular disease

A
  1. S/S:
    • LLQ pain
    • polyuria
    • fever and elevated WBCs
    • constipation
    • N/V
  2. Treatment:
    • diet modification
    • clear liquids
    • IV fluids
    • pain meds
    • anitbiotics
    • surgery (abscess drainage, colectomy)
27
Q

what is a hiatal hernia?

A

protrusion of abdominal structures upward through esophageal hiatus

28
Q

List S/S of a hiatal hernia

A
  1. heartburn-like pain
  2. dysphagia
  3. chest pain
  4. dyspnea
  5. hoarseness
29
Q

List treatments for hiatal hernais

A
  1. behavior modifications
  2. eating small/frequent meals
  3. bland foods w/high fiber content
  4. acid-reducing meds
  5. laparoscopic repair
30
Q

what is an abdominal hernia?

A

protrusion of bowel that is classified by location of protrusion

(epigastric, umbilical, inguinal, femoral)

31
Q

what is the difference between a reducible and strangulated hernia?

A

reducible → the contents can be replaced within the surrounding musculature

strangualted → compromised circulation, can be fatal

32
Q

list S/S of abdominal hernias

A
  1. abdominal distension
  2. N/V
  3. position changes with increased abdominal pressure (laughing, coughing)
  4. pain
  5. paresthesia
33
Q

how are abdominal hernias treated?

A
  1. monitor asymptomatic cases
  2. surgical repair for symptomatic
  3. possible temporay colostomy
34
Q

what symptoms characterize IBS?

A

abdominal pain and altered bowel movements

35
Q

in order to be classified as IBS how frequent must the symptoms be?

A

S/S have to persist for at least 3 days a month for the past 3 months

36
Q

what is Crohn’s disease?

A

idiopathic inflammatory bowel disease (IBD)

can occur anwhere in GI system (most common is terminal ileum, prox colon)

37
Q

list the S/S of IBD

A
  1. abdominal cramping
  2. RLQ pain/mass
  3. diarrhea
  4. weight loss
  5. fatigue
  6. low grade fever
38
Q

list some potential causes of IBD

A
  1. genetics
  2. immune dysregulation
  3. infectious agents
  4. psychological issues
  5. environmental factors
39
Q

how is IBD treated?

A
  1. corticosteroids
  2. antibiotics
  3. immunosuppresants
  4. nutritional support
40
Q

list some complications to IBD

A
  1. intestinal obstruction
  2. inflammation of membranes
  3. arthritis
  4. ankylosing spondylitis
  5. gallstones
  6. B12 deficiency
  7. thromboembolism
41
Q

what is ulcerative colitis?

A

idiopathic bowel disease (IBD)

occurs in mucosal layers of rectum and prox colon

cause is not well known but appears to be similar to Crohn’s disease

42
Q

list S/S of ulcerative colitis

A
  1. lower abdominal pain relieved by defecation
  2. bloody stools
  3. diarrhea
  4. incontinence
  5. nocturnal defecation
  6. fatigue
  7. wt loss
  8. dehydration
43
Q

how is ulcerative colitis treated?

A
  1. anti-inflammatory meds
  2. immunosuppresants
  3. biologics
  4. diet modification
  5. surgery
  6. monitoring for colon cancer
44
Q

how are Crohn’s disease and ulcerative colitis similar?

A
  1. both developed by teenagers and older adults
  2. symptoms are similar
  3. causes are both unknown
  4. similar contributing factors
45
Q

how are Crohn’s disease and Ulcerative Colitis different?

A
  1. Ulcerative colitis
    • inflammation is continous within colon
    • only affect innermost lining of colon
  2. Crohn’s disease
    • healty parts of intestine mixed in between inflammed areas
    • can affect all layers of bowel walls
46
Q

what is Morbid Obesity?

A
  1. chronic disease characterized by excessive body fat and BMI of 30 or higher
    • many comorbidities linked
47
Q

what are the 2 trx approaches for Morbid Obesity?

A
  1. Conservative
    • weight loss (goal: 10% reduction)
    • diet modification
    • meds
    • behavior mgmt
    • increased physical activity
  2. Surgical (BMI >40)
    • gastric bypass
    • gastric banding
    • gastroplasty
    • gastrectomy
48
Q

important considerations for Morbid Obesity

A
  1. better outcomes associated w/pts involved in exercise program
  2. closely monitor exercise tolerance with BP, HR, RR
  3. Skin inspection is key! (check fat folds)
  4. Be aware of weight limits for equipment
49
Q

what is encephalopathy?

A

Liver and Biliary disorder

  1. may be caused by acute or chronic liver disease (ie. cirrhosis)
  2. impaired mental status and neuromuscular dysfunction occurs over hours to days
  3. altered consciousness (mild to coma)
    • ammonia intoxication
    • changes in cerebral blood flow
50
Q

describe treatment for encephalopathy

A
  1. reduce ammonia levels
  2. correct electrolyte imbalance
  3. antibiotics
  4. nuritional support
  5. liver transplant
51
Q

what is cholecystitis?

A

acute or chronic inflammation of the gallbladder

52
Q

what is cholelithiasis?

A

gallstone formation

53
Q

List S/S and treatments for cholelithiasis and cholecystitis

A
  1. S/S
    • RUQ pain that may radiate to R shoulder
    • abdominal rebound tenderness (Murphy’s sign)
    • jaundice
    • N/V
    • fever
  2. Treatment
    • laparoscopic cholecystectomy (gallbladder removal)
54
Q

List methods of managing GI conditions

A
  1. Pharmacologic
  2. Abdominal surgeries
    1. “-ectomies”
    2. Colostomies
55
Q

what are the 2 main goals of pharmacologic management of GI conditions?

A
  1. control gastric acid secretion
  2. normalize GI motility
56
Q

List some abdominal surgical approaches

A
  1. laparotomy
  2. laparoscopic
  3. appendectomy
  4. cholecystectomy
  5. colectomy
  6. gastrectomy
  7. splenectomy
  8. colostomy
57
Q

what is a laparotomy?

A

open surgery of the abdomen to explore and/or repair issues; many different types of incisions, “midline” is the standard cut

used for situations involving multiple dense adhesions, grossly distended intestines, massive ascites, severe bleeding, blunt and penetrating trauma

58
Q

what is a colostomy?

A

procedure that reroutes stool from diseased colon to external bag

  1. end colostomy
  2. double-barreled colostomy
  3. loop colostomy
59
Q

things to keep in mind with colostomies

A
  1. make sure pouch is securely closed before pt interventions
  2. keep covered for pt dignity
  3. empty bag if full (nursing or pt self-care)
60
Q

General PT considerations for GI

A
  1. Pt position for comfort
    • sidelying to decrease tension on surgical site
    • flex knees while HOB lowered to decrease tension
    • supine can aggravate dysphagia and GERD
    • splinting during mobility/coughing
  2. increased fatigue likely
  3. be aware of dietary restrictions
  4. varices (dialted blood vessels)
    • may rupture w/increased intrabdominal pressure
    • avoid valsalva effects (coughing)
  5. ascites (fluid accumulation in abdomen)
    • hinders effective coughing
    • restricts adequate ventilation

Acute Care (11 decks)

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