GI disorders

Question 1

Ulcerative Colitis

Answer 1

inflammed colon, causes continuous lesions (LLQ pain, fever, 15-20 liquid stools/day, mucus/blood/pus in stools)

Question 2

Crohn’s Disease

Answer 2

inflammation/ulceration of small intestine, causes sporadic lesions; risk of fistulas (RLQ pain, fever, 5 loose stools/day, mucus/pus in stools, steatorrhea)

Question 3

Diverticulitis

Answer 3

inflammation of diverticula (small pouches in colon); can perforate & cause peritonitis (LLQ pain, n/v, fever, chills)

Question 4

Ulcerative Colitis & Crohn’s Disease

Answer 4

LABS: Decreased Hct/Hbg & albumin; Increased ESR, CRP, WBC
Risk Factors: genetics, stress, autoimmune disorders
Meds: 5-aminosalicylic acis (sulfasalazine); corticosteroids (prednisone); immunosuppresants (cyclosporine); antidiarrheals (loperamide)
Care: monitor for s/s of peritonitis (n/v, rigid/board-like abdomen, rebound tenderness, fever, tachycardia); monitor I&O, electrolytes (risk for hypokalemia); DIET= NPO then progress to high-protein/calories, low-fiber diet; avoid caffeine, alcohol; eat small, frequent meals

Question 5

Pancreatitis

Answer 5

autodigestion; enzymes activated before reaching intestines; Risk Factors: Bile tract disease, alcohol abuse, GI surgery, trauma, med toxicity
S/S: LUQ or epigastric pain radiating to back or left shoulder, n/v, Turner’s sign (ecchymoses), Cullen’s sign (blue/grey discoloration at umbilicus), jaundice, ascites, tetany
LABS: increased amylase, lipase, WBC, bilirubin, glucose; Decreased calcium, magnesium, platelets

Question 6

Pancreatitis

Answer 6

Care: NPO, NG tube, antiemetics, insulin, IV f&e, opioid analgesics, pancreatic enzymes with meals/snacks; progress to bland/low-fat diet
Teaching: no alcohol, no smoking, reduce stress
complications: chronic pancreatitis, pancreatic pseudocyst, type 1 diabetes

Question 7

Esophageal Varices

Answer 7

swollen/fragile blood vessels in esophagus that can hemorrhage (life-threatening)
Risk factors: portal hypertension (increased BP to liver) due to cirrhosis, hepatits
S/S: elevated liver enzymes (AST, ALT), w/ bleeding- hypotension, tachycardia, decreased Hct/Hgb
Meds: nonselective beta blockers (propanolol), vasoconstrictors (vasopressin)
Procedures: sclerotherapy

Question 8

Hepatitis

Answer 8

Hep A: fecal/oral
Hep B & C: blood/bodily fluids
Risk Factors: IV drugs, piercings/tattoos, unprotected sex, travel, crowded living
S/S: flu-like, fever, jaundice, dark urine, clay-colored stools
LABS: increased ALT, AST, bilirubin

Question 9

Cirrhosis

Answer 9

normal liver tissue replaced with fibrotic scar tissue (3 types)
postnecrotic: due to viral hepatits, toxins, meds
Leannec’s: chronic alcoholism
Biliary: biliary obstruction
S/S: jaundice, ascities, petechiae, spider angiomas, palmar erthyema, confusion, fatigue, GI bleeding, asterixis, fetor hepaticus (fruity breath), peripheral edema
LABS: increased AST, ALT, bilirubin, ammonia;
decreased serum protein, albumin, RBC, Hbg, Hct, platelets

Question 10

Cirrhosis

Answer 10

Meds: lactulose to remove excess ammonia through stool (monitor for hypokalemia); diuretics
procedures: Paracentesis- void prior to, supine w/ HOB elevated; assess extracted fluid (color/amt); liver transplant
Complications: encephalotpathy (reduce ammonia levels w/ lactulose), esophageal varices

Question 11

Cirrhosis

Answer 11

Diagnosis: liver biopsy, ultrasound, CT, MRI
Care: restrict fluids/sodium; elevate HOB; diet- high-carb, moderate fat, high protein, low sodium; measure abdominal girth daily; wash skin with cold water and apply lotion to reduce itching; encourage alcohol recovery program

Question 12

Intestinal Obstruction

Answer 12

mechanical causes: adhesions from surgery, tumor, diverticulitis, fecal impaction
nonmechanical: neurogenic or vascular disorder, electrolyte imbalance, inflammation
S/S: both small/large: high pitched sounds above obstruction and hypoactive sounds below obstruction
small bowel only: projectile vomiting w/ fecal odor, severe f&e imbalance, metabolic alkalosis
large bowel only: diarrhea or ribbon-like stools
care: NPO, NG tube, IV fluids/electrolytes
surgery: colon resection, colostomy, lysis of adhesions

Question 13

GERD

Answer 13

gastric contents backflow into esophagus causing pain and mucosal damage (esophagitis, Barrett’s epithelium)
Risk Factors: obesity, smoking, alcohol, older age, pregnancy, stress, ascites, hiatal hernia, supine position, caffeine, citrus fruits
S/S: dyspepsia, throat irritation, bitter taste, chronic cough

Question 14

GERD

Answer 14

antacids, h2 receptors (ranitidine), PPIs (pantoprazole), prokinetics (metoclopramide to accelerate emptying)
surgery: fundoplication
pt ed: avoid fried/fatty/spicy foods, eat small meals, remain upright after eating, avoid tight clothes, lose weight, elevate HOB 6-8 in, sleep on right side

Question 15

Irritable Bowel Syndrome

Answer 15

intestinal disorder causing abdominal pain, gas, diarrhea, and constipation
pt ed: avoid dairy, eggs, wheat, alcohol, caffeine; increase fiber (30-40g/day) and fluids (2-3L/day); keep diary of intake and bowel patterns
Meds: Alosetron for IBS w/ diarrhea
Lubiprostone for IBS w/ constipation

Question 16

Peptic Ulcer Disease

Answer 16

erosin in stomach, esophagus, or duodenum mucosa
risk factors: H. pylor, NSAID use, stress
s/s: n/v, heartburn, bloating, bloody emesis/stool
gastric ulcer- pain 30-60 mins after meal, worse in daytime, worse w/ eating
duodenal- pain 1.5-3 hr. after meal, worse at night, better w/ eating or antacids
Diagnosis: EGD

Question 17

Peptic Ulcer Disease

Answer 17

meds: multiple antibiotics (metronidazole, amoxicillin, clarithromycin, tetracyline), H2 receptor (ranitidine), PPI (pantoprazole), antacids, mucosal protectant (sucralfate- give 1 hr before meals and at bedtime)
pt teaching: avoid milk, caffiene, spicy foods; avoid NSAIDs
complications: perforation (results in hemorrhage)- s/s include severe epigatric pain, rigid boardlike abdomen, rebound tenderness, hypotension, tachycardia

Question 18

Cholecystits

Answer 18

inflammed gallbladder; gallstones block cystic or common bile duct
risk factors: female, high-fat diet, obesity, genetics, older age
s/s: RUQ pain and radiates to right shoulder, jaundice, clay colored stools, steatorhea, dark urine, pruritis, dyspepsia, gas
LABS: increased WBC, bilirubin (if bile duct is blocked), amylase & lipase (if pancreas involved), AST and ALP (if common bile duct is blocked
interventions: lithotripsy to breath up gallstones, choleycystectomy to remove gallbladder

Question 19

Normal GI ranges

Answer 19

AST= 0-35 & ALT= 3-36
Amylase= 30-220 &amp; Lipase= < 160
Bilirubin= < 1.0
Albumin= 3.5-5.0
Ammonia= 10-80