GI Disorders Flashcards
What are some skin related changes that could indicate a GI disorder?
- discolorations
- rashes
- jaundice
- increased bruising
- increased tendency to bleed
What are important lab tests to diagnose for GI disorders?
- CBC
- clotting factors (PT)
- electrolytes (Na+, K+)
- liver enzyme assay – will be elevated with liver disease
- aspartate (AST)
- alanine aminotransferase (ALT)
- serum amylase – elevated with pancreatic disorders
- serum lipase – elevated with pancreatic disorders
- bilirubin – elevated with impaired liver secretions
- produced during RBC breakdown
- ammonia – elevated can cause brain problems
- hepatic encephalopathy
- altered LOC
- oncofetal antigens – cancer markers
- urine tests
- amylase
- urine urobilinogen – only present in urine if there is a hepatic or biliary obstruction
- stool tests
- fecal occult blood test
- ova parasites
- C. diff infection
What 3 values are evaluated in a bilirubin panel?
- total bilirubin
- indicates
- hemolysis
- biliary obstruction
- liver damage
- indicates
- conjugated bilirubin
- indicates
- biliary obstruction
- indicates
- unconjugated bilirubin
- indicates
- hepatic damage
- hemolysis
- indicates
What is GERD? What population does GERD mostly affect?
– GERD: backward flow of gastrointesetinal contents into the esophagus
- often caused by
- relaxed lower esophageal spincter tone
- elevated gastric volume
- elevated intra-abdominal pressure
– mostly affects middle-aged to older adults
What are the major symptoms of GERD?
- heartburn
- dyspepsia
- regurgitation
- hypersalivation
- dysphagia (chronic GERD)
What are some interventions for GERD?
- diet changes
- limit consuming large meals
- eat meals slowly
- don’t eat 3H before bed
- lifestyle changes
- elevate HOB for sleep
- sleep in left lateral decubitus position
- reduce weight
- wear nonbinding clothing
- stop smoking and drinking alcohol
- drugs
- antacids – neutralize gastric acid
- H2 antagonists – decrease gastric acid secretion
- PPIs – long-acting inhbition of gastric acid secretion
- prokinetic GI stimulants – increase gastric emptying and improve peristalsis
What is a hiatal hernia? What is the difference between a sliding hiatal hernia and a rolling hiatal hernia?
– hiatal hernia: protrusion of the stomach through the esophageal hiatus of the diaphragm into the thorax
– sliding hiatal hernia: esophagogastric junction and a portion of the fundus of the stomach slide upward through the esophageal hiatus into the thorax
- most common type of hiatal hernia
– rolling hiatal hernia: fundus rolls into the thorax beside the esophagus
- decreases lung capacity
- increases risk of volvulus
What are the signs and symptoms of hiatal hernias?
– sliding hiatal:
- heartburn
- regurgitation
- dysphagia
- belching
– rolling hiatal:
- fullness/breathlessness after eating
- chest pain
- worsening symptoms in recumbent position
How are hiatal hernia diagnosed?
- barium swallow/esophagogram with contrast
- endoscopy
- shows protrusion of stomach through diaphragm
What are some interventions for hiatal hernias?
- usually resolved surgically
- laprascopic fundoplication
- drugs
- antacids
- H2 antagonists
- diet therapy
- avoid eating late at night
- avoid foods that cause reflux
- weight management
- elevate HOB for sleep
- remain upright for several hours after eating
- avoid straining and vigorous exercise
- avoid nonbinding clothing
What is the main priority with fundoplication surgery?
prevention of respiratory complications
What is gastritis? Differentiate between acute and chronic.
– gastritis: inflammation of the gastric mucosa
- acute: caused by bacterial infection, onset of H. pylori, or long-term use of NSAIDs (inhibit prostaglandin production)
-
chronic: antibodies cause an autoimmune response
- type A gastritis
How is gastritis diagnosed?
endoscope with biopsy to detect H. pylori = gold standard
What are the main signs and symptoms of gastritis?
- epigastric pain
- acute – rapid onset
- chronic – relieved with food
- anorexia
- N/V
– acute:
- hematemesis
- dyspepsia
- gastric hemorrhage
– chronic:
- intolerance to fatty/spicy foods
- pernicious anemia (B12 anemia)
- neuro issues – caused by lack of B12
What are some interventions for gastritis?
- treat etiology
- main tx
- drugs
- H2 antagonists
- antacids
- mucosal barrier fortifiers
- PPIs
- PPI triple – treats H. pylori infection
- 2 types of antibiotics
- 1 type of PPI
- diet changes
- limit foods that cause distress
- limit smoking and alcohol
- reduce stress
What is peptic ulcer disease (PUD)?
mucosal lesion of the stomach or duodenum – gastric mucus is no longer able to protect epithelium from HCl, pepsin, and H. pylori
What is the most common cause of gastric ulcers? What causes stress ulcers?
– cause = delayed gastric emptying
– stress ulcers caused by:
- acute medical crisis
- trauma
- head injury
- sepsis
- NPO
What are the signs and symptoms of PUD?
- epigastric tenderness midline b/w umbilicus and xiphoid process
- dyspepsia
- sharp, burning, gnawing pain
Where is the most common location of duodenal ulcers?
first portion of the duodenum
What are the 4 main goals of gastric drug therapy?
- pain relief
- eradication of H. pylori
- heal ulcers
- prevent ulcer recurrence
What are some complications of ulcers?
- hemorrhage – hematemesis
- perforation – surgical emergency
- pyloric obstruction – manifested by vomiting
- intractable disease – pt no longer responds to management despite interventions
What is important to note about upper GI bleeds?
emergency treatment is required
What is irritable bowel syndrome? What population most often experiences IBS?
– chronic or recurrent diarrhea, constipation, abdominal pain, and bloating
- AKA spastic colon
- likely due to altered peristalsis
– 2x more likely in women
- pts often have concurrent mental health disorder
What are interventions for IBS?
- avoid stimulants and upsetting foods
- drugs
- bulk-forming laxatives
- antidiarrheals
- anticholinergics
- tricyclic antidepressants
What are herniations? What are the 9 different types of hernias?
– herniation: weakness in the abdominal muscle wall causing a protrusion of the abdominal structure or portion of the bowel
- inguinal hernias are the most common – most often repaired by surgery
– 9 types:
- direct inguinal: hernia passes through a weak point in abdominal wall
- indirect inguinal: sac pushes into inguinal canal and into scrotum
- femoral: goes through femoral ring
-
umbilical: goes through umbilicus
- congenital or acquired
- incisional: at site of surgery
- ventral: at linea alba of the abdomen
- reducible: hernia can be pushed back into abdomen with gentle pressure
- irreducible/incarcerated: cannot be pushed back into abdomen; requires surgery
- strangulated: blood supply cut off by pressure from muscles in that area; can result in ischemia or necrosis
What are some interventions for hernias? What are some important things to note about postop care for hernia repair?
– surgical
- minimally invasive inguinal hernia repair (MIIHR)
- herniorrhaphy
– postop care:
- elevate scrotum to prevent/control swelling
- assess for voiding difficulties
What are the 3 types of intestinal obstructions?
- mechanical
- non-mechanical – paralytic ileus
- strangulated
What are some signs and symptoms of mechanical obstruction?
- midabdominal pain/cramping
- vomiting
- obstipation (no passage of stool) or changes in bowel patterns
- diarrhea
- abdominal distention
- borborygmi (high pitched bowel sounds)
- abdominal tenderness
What are some signs and symptoms of non-mechanical obstructions?
- constant, diffuse discomfort
- abdominal distention
- hypoactive or absent bowel sounds
- vomiting
- obstipation
- low-grade fever
What is appendicitis? What are some signs and symptoms?
– appendicitis: acute inflammation of vermiform appendix
– s/s:
- abdominal pain – epigastric, periumbilical, McBurney’s point
- initial symptom
- N/V
- rebound tenderness
- increased pain with cough or movement
- low-grade fever
What is peritonitis? What are some signs and symptoms?
– peritonitis: acute inflammation of peritoneum
- life-threatening
- can occur if appendix ruptures
– s/s:
- rigid board-like abdomen
- abdominal pain
- distention
- fever
- tachycardia
- dehydration
- low urine output
- hiccups
- compromised respirations
- N/V
What is gastroenteritis?
infectious disease of intestines causing an increase in frequency and water content of stools or vomit (inflammation of mucous membranes in stomach and intestines)
What are some interventions for gastroenteritis?
- fluid balance – main intervention
- N/V control – main intervention
- electrolyte balance
- pain control
- drug therapy to stop and clear infection
- NOT immodium – want to continue to have stools and vomit
What is inflammatory bowel disease (IBD)? What are the 2 diseases classified under IBD?
– IBD: disorders of GI tract with unknown etiology
- ulcerative colitis: widespread inflammation of rectum/sigmoid colon
- Crohn’s disease: inflammatory disease of small intestine, colon, or both
What are some signs and symptoms of UC?
- remissions and exacerbations
- 10 - 20 loose stools/day with blood and mucous
- multiple abscesses
- anorexia
- perforation
- poor absorption of nutrients
What are some signs and symptoms of Crohn’s disease?
- affects GI tract from mouth to anus
- terminal ileum is most common
- skip lesions
- cobblestone
- toxic megacolon
- bowel fistulas
- poor absorption of vitamines and nutrients
- cancer of small bowel and colon – rare
- 5 - 6 loose stools/day – rarely bloody
What are the major ways to diagnose Crohn’s and UC?
- colonoscopy
- CBC, ESR
- barium contrast
- endoscopy
What are some drugs that can be used for Crohn’s and UC?
- salicylate compounds (5-ASAs) – anti-inflammatories
- sulfasalazine
- corticosteroids – during exacerbations
- prednisone
- immunosuppressants
- remicade
- humira
- antidiarrheal
- lomotil
- immodium
What are some interventions (not drugs) for UC?
- surgical
- proctocolectomy
- colectomy
- nutritional therapy
- NPO during acute phase
- parental feeding
- iron supplements
- post-op nutrition
What are some interventions (not drugs) for Crohn’s disease?
- surgical
- intestinal resection
- ostomy if disease spreads
- nutritional
- parenteral nutrition
- low residue
- vitamin supplements
- post-op diet
What are some important things to keep in mind for nutritional therapy for IBD?
- for oral diets, low fiber is recommended to reduce bowel stimulation
- high protein and high calorie diets help healing
How do diverticula develop? How does diverticulitis result? How do pts usually present?
– develops due to increased pressure in intestinal lumen
– diverticulitis occurs when diverticula becomes inflamed
– pts are usually asymptomatic
What are some signs and symptoms of diverticulitis?
- cramping in LLQ
- periods of diarrhea and constipation
- flatus
- distention
- low-grade fever
What are some complications that could result from diverticulitis?
- iron-deficiency anemia due to occult blood loss and rectal bleeding
- peritonitis from abscesses and bowel perforation
- fistula formation can cause bowel obstruction
- malabsorption of fat and B12 due to bacterial overgrowth
What are some interventions for diverticulitis?
- nutrition
- high fiber – improves symptoms and prevents diverticulitis
- avoid nuts, seeds, popcorn
- NPO until bleeding and diarrhea subside
