GI and gallbladder

Question 1

cholelithiasis

Answer 1

calculi in the gallbladder
gallstones composition (pigment: 25%, cholesterol: 75%)
biliary colic with obstruction of cystic duct
stone may retreat or pass

Question 2

cholelithiasis diagnosis

Answer 2

ultrasonography, cholecystography, endoscopic retrograde cholangiopancreatography, PCT, MRI, blood test, X-ray

Question 3

cholelithiasis treatment

Answer 3

ERCP and PTC (removal of stones) and extracorporeal lithotripsy to dissolve stones
NG tube
nutrition: low fat
avoid alcohol, gas forming foods, fried foods
drug therapy: antibiotics, lipid/cholesterol lowering drugs, antispasmodics, analgesics

Question 4

cholecystectomy

Answer 4

surgical procedure to remove the gallbladder

Question 5

cholelithiasis post procedure care

Answer 5

assess, monitor vitals, O2 sat, skin care, biliary drainage, t-tub or NG tube, pain control, I&O, encourage activity
low fat diet, ideal weight, limit pregnancies
report fever, jaundice, pruritus, dark urine, pale stools

Question 6

dumping syndrome

Answer 6

food rapidly enters jejunum, vasomotor disturbances within 10-30 minutes after eating
vertigo, tachycardia, syncope, sweating pallor, palpitation, d/n, weak

Question 7

dumping syndrome patient teaching

Answer 7

small frequent meals, avoid drinking with meals
HIGH PROTEIN, HIGH FAT, LOW CARB, LOW FIBER (dry diet)
antispasmodics
lying down after meals

Question 8

GERD

Answer 8

Backflow of gastric contents into the esophagus
incompetent LES and inflamed esophageal mucosa
mucus and saliva are protective factors

Question 9

GERD risk factors

Answer 9

unknown cause
pressure zones, weight gain, obesity, pregnancy, lying flat, spicy food, high fat foods, caffeine, carbonation, chocolate, chewing tobacco, elderly
NSAIDs and stress increase gastric acid

Question 10

clinical manifestations of GERD

Answer 10

dyspepsia
pain after activities/meals, supine position, radiates to the back of neck or jaw (confused with angina), walking
esophageal spasm/odynophagia
intermittent dysphagia
acid regurgitation
water brash
eructation
distended abdomen

Question 11

GERD diagnosis

Answer 11

barium swallow, esophagoscopy, esophageal biopsy, cytology, gastric secretions, acid tests

Question 12

medical management of GERD

Answer 12

mild- antacids, work in 30 minutes to increase gastric pH, avoid mg antacids
persistent- histamine receptor antagonists, reduce gastric secretions, take 1 hr before or after antacid
severe- cholinergic drugs (reglan) increases LES pressure and gastric emptying, taken before meals
PPIs (nexium) suppress gastric secretions

Question 13

Gerd nursing interventions

Answer 13

eat small frequent meals slowly
chew to create saliva
avoid extremely hot or cold foods
don’t drink 2-3 hours before bed
elevate HOB 30º
avoid tobacco, fatty foods, chocolate, caffeine
no strenuous activities after meals

Question 14

bowel obstruction

Answer 14

impairment of forward flow of intestinal contents
high mortality rate if not treated within 24 hours
partial or complete
mechanical (blockage) or nonmechanical (paralytic ileus)

Question 15

etiology of bowel obstruction

Answer 15

adhesions (most common), tumors, hernias, fecal impaction, strictures, narrowed blood vessels, intussusception, volvulus, ileus

Question 16

bowel obstruction assessment

Answer 16

hiccups, last BM, fever, ribbon like stools, tachycardia, bowel sounds may be absent or decreased or increased, a mass

Question 17

bowel obstruction clinical manifestations

Answer 17

abdominal cramps, fever, nausea with vomiting (may be orange or brown with fecal odor), hiccups, obstipation, partial obstruction, fluid and electrolyte imbalance

Question 18

diagnosis for bowel obstruction

Answer 18

CBC, BUN and electrolytes, elevated amylase if pancreas affected, ABG abnormal, abdominal X-rays, CT scan, colonoscopy

Question 19

bowel obstruction treatment

Answer 19

nonmechanical obstruction (NG tube)
mechanical obstruction (NG tube and removal of obstruction)
fluid and electrolyte replacement
pain management (avoid opioids)
antibiotics
surgery

Question 20

surgical options for bowel obstructions

Answer 20

laparotomy if the cause is unknown (to find cause), adhesions removed, bowel resection

Question 21

ulcerative colitis

Answer 21

starts at rectum and works way up, continuous, not deep, just first layer
inflamed mucosal lining of colon or rectum
unknown etiology
tobacco protects against development of UC (risk for Crohn’s)
LOW FIBER, LOW RESIDUE, LOW FAT DIET, high protein and calories

Question 22

ulcerative colitis signs and symptoms

Answer 22

many loose stools with pus, blood, or mucous (10-20 liquid stools per day)
dehydration
intermittent tenesmus (straining)
metabolic acidosis or alkalosis
fistulas from exertion
toxic megacolon

Question 23

crohn’s disease

Answer 23

deeper, not continuous, some lesions
inflammatory disease of the small intestine or beginning of colon
flares and remissions
healthy tissue interspersed with diseased tissue

Question 24

crohn’s signs and symptoms

Answer 24

steatorrhea from malabsorption (frequent fatty stools, 5-6 per day)
loss of appetite
periumbilical pain
low grade fever
increased WBC
urgency, straining

Question 25

ileostomy preoperative

Answer 25

psychological prep
bowel prep (neomycin)
cleaning enema
discuss post op incentive spirometry and breathing exercises
refer counseling

Question 26

permanent ileostomy

Answer 26

terminal ileum brought out through the abdominal wall
brought into intra-abdominal pouch
drained with catheter
emptied every 2 hrs in the first 2 weeks

Question 27

ileoanal anastomosis

Answer 27

colon and rectum removed

Question 28

J pouch

Answer 28

colon removed leaving rectal sphincter

Question 29

billroth 1

Answer 29

a gastroduodenostomy and involves resection of the lower portion of the stomach. offers a lower cure rate than the billroth 2