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NURS 322 > GI Disorders > Flashcards

GI Disorders Flashcards

1
Q

What are some skin related changes that could indicate a GI disorder?

A
  • discolorations
  • rashes
  • jaundice
  • increased bruising
  • increased tendency to bleed
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2
Q

What are important lab tests to diagnose for GI disorders?

A
  • 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
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3
Q

What 3 values are evaluated in a bilirubin panel?

A
  1. total bilirubin
    • indicates
      • hemolysis
      • biliary obstruction
      • liver damage
  2. conjugated bilirubin
    • indicates
      • biliary obstruction
  3. unconjugated bilirubin
    • indicates
      • hepatic damage
      • hemolysis
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4
Q

What is GERD? What population does GERD mostly affect?

A

– 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

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5
Q

What are the major symptoms of GERD?

A
  • heartburn
  • dyspepsia
  • regurgitation
  • hypersalivation
  • dysphagia (chronic GERD)
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6
Q

What are some interventions for GERD?

A
  • 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
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7
Q

What is a hiatal hernia? What is the difference between a sliding hiatal hernia and a rolling hiatal hernia?

A

– 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
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8
Q

What are the signs and symptoms of hiatal hernias?

A

– sliding hiatal:

  • heartburn
  • regurgitation
  • dysphagia
  • belching

– rolling hiatal:

  • fullness/breathlessness after eating
  • chest pain
  • worsening symptoms in recumbent position
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9
Q

How are hiatal hernia diagnosed?

A
  • barium swallow/esophagogram with contrast
  • endoscopy
    • shows protrusion of stomach through diaphragm
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10
Q

What are some interventions for hiatal hernias?

A
  • 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
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11
Q

What is the main priority with fundoplication surgery?

A

prevention of respiratory complications

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12
Q

What is gastritis? Differentiate between acute and chronic.

A

– 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
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13
Q

How is gastritis diagnosed?

A

endoscope with biopsy to detect H. pylori = gold standard

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14
Q

What are the main signs and symptoms of gastritis?

A
  • 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
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15
Q

What are some interventions for gastritis?

A
  • 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
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16
Q

What is peptic ulcer disease (PUD)?

A

mucosal lesion of the stomach or duodenum – gastric mucus is no longer able to protect epithelium from HCl, pepsin, and H. pylori

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17
Q

What is the most common cause of gastric ulcers? What causes stress ulcers?

A

– cause = delayed gastric emptying

– stress ulcers caused by:

  • acute medical crisis
  • trauma
  • head injury
  • sepsis
  • NPO
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18
Q

What are the signs and symptoms of PUD?

A
  • epigastric tenderness midline b/w umbilicus and xiphoid process
  • dyspepsia
  • sharp, burning, gnawing pain
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19
Q

Where is the most common location of duodenal ulcers?

A

first portion of the duodenum

20
Q

What are the 4 main goals of gastric drug therapy?

A
  1. pain relief
  2. eradication of H. pylori
  3. heal ulcers
  4. prevent ulcer recurrence
21
Q

What are some complications of ulcers?

A
  1. hemorrhage – hematemesis
  2. perforation – surgical emergency
  3. pyloric obstruction – manifested by vomiting
  4. intractable disease – pt no longer responds to management despite interventions
22
Q

What is important to note about upper GI bleeds?

A

emergency treatment is required

23
Q

What is irritable bowel syndrome? What population most often experiences IBS?

A

– 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
24
Q

What are interventions for IBS?

A
  • avoid stimulants and upsetting foods
  • drugs
    • bulk-forming laxatives
    • antidiarrheals
    • anticholinergics
    • tricyclic antidepressants
25
Q

What are herniations? What are the 9 different types of hernias?

A

– 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:

  1. direct inguinal: hernia passes through a weak point in abdominal wall
  2. indirect inguinal: sac pushes into inguinal canal and into scrotum
  3. femoral: goes through femoral ring
  4. umbilical: goes through umbilicus
    • congenital or acquired
  5. incisional: at site of surgery
  6. ventral: at linea alba of the abdomen
  7. reducible: hernia can be pushed back into abdomen with gentle pressure
  8. irreducible/incarcerated: cannot be pushed back into abdomen; requires surgery
  9. strangulated: blood supply cut off by pressure from muscles in that area; can result in ischemia or necrosis
26
Q

What are some interventions for hernias? What are some important things to note about postop care for hernia repair?

A

– surgical

  • minimally invasive inguinal hernia repair (MIIHR)
  • herniorrhaphy

– postop care:

  • elevate scrotum to prevent/control swelling
  • assess for voiding difficulties
27
Q

What are the 3 types of intestinal obstructions?

A
  1. mechanical
  2. non-mechanical – paralytic ileus
  3. strangulated
28
Q

What are some signs and symptoms of mechanical obstruction?

A
  • midabdominal pain/cramping
  • vomiting
  • obstipation (no passage of stool) or changes in bowel patterns
  • diarrhea
  • abdominal distention
  • borborygmi (high pitched bowel sounds)
  • abdominal tenderness
29
Q

What are some signs and symptoms of non-mechanical obstructions?

A
  • constant, diffuse discomfort
  • abdominal distention
  • hypoactive or absent bowel sounds
  • vomiting
  • obstipation
  • low-grade fever
30
Q

What is appendicitis? What are some signs and symptoms?

A

– 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
31
Q

What is peritonitis? What are some signs and symptoms?

A

– 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
32
Q

What is gastroenteritis?

A

infectious disease of intestines causing an increase in frequency and water content of stools or vomit (inflammation of mucous membranes in stomach and intestines)

33
Q

What are some interventions for gastroenteritis?

A
  • 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
34
Q

What is inflammatory bowel disease (IBD)? What are the 2 diseases classified under IBD?

A

– 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
35
Q

What are some signs and symptoms of UC?

A
  • remissions and exacerbations
  • 10 - 20 loose stools/day with blood and mucous
  • multiple abscesses
  • anorexia
  • perforation
  • poor absorption of nutrients
36
Q

What are some signs and symptoms of Crohn’s disease?

A
  • 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
37
Q

What are the major ways to diagnose Crohn’s and UC?

A
  • colonoscopy
  • CBC, ESR
  • barium contrast
  • endoscopy
38
Q

What are some drugs that can be used for Crohn’s and UC?

A
  • salicylate compounds (5-ASAs) – anti-inflammatories
    • sulfasalazine
  • corticosteroids – during exacerbations
    • prednisone
  • immunosuppressants
    • remicade
    • humira
  • antidiarrheal
    • lomotil
    • immodium
39
Q

What are some interventions (not drugs) for UC?

A
  • surgical
    • proctocolectomy
    • colectomy
  • nutritional therapy
    • NPO during acute phase
    • parental feeding
    • iron supplements
    • post-op nutrition
40
Q

What are some interventions (not drugs) for Crohn’s disease?

A
  • surgical
    • intestinal resection
    • ostomy if disease spreads
  • nutritional
    • parenteral nutrition
    • low residue
    • vitamin supplements
    • post-op diet
41
Q

What are some important things to keep in mind for nutritional therapy for IBD?

A
  • for oral diets, low fiber is recommended to reduce bowel stimulation
  • high protein and high calorie diets help healing
42
Q

How do diverticula develop? How does diverticulitis result? How do pts usually present?

A

– develops due to increased pressure in intestinal lumen

– diverticulitis occurs when diverticula becomes inflamed

– pts are usually asymptomatic

43
Q

What are some signs and symptoms of diverticulitis?

A
  • cramping in LLQ
  • periods of diarrhea and constipation
  • flatus
  • distention
  • low-grade fever
44
Q

What are some complications that could result from diverticulitis?

A
  • 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
45
Q

What are some interventions for diverticulitis?

A
  • nutrition
    • high fiber – improves symptoms and prevents diverticulitis
    • avoid nuts, seeds, popcorn
    • NPO until bleeding and diarrhea subside

NURS 322 (19 decks)

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