GI exam #2 Flashcards
1
Q
What is the most common GI problem?
A
N&V
2
Q
What are the 3 types of N&V
A
- pathogenic- R/T disease process
- iatrogenic- R/T disease Tx
- psychogenic- R/T psychological state (stress)
3
Q
Patho of vomiting:
A
stimulation of chemo-receptor trigger zone (CTZ) which then stimulates the vomiting center (VC) in the medulla
4
Q
Objective data of emesis:
A
color, consistency and amount
5
Q
Tx for N&V:
A
NPO until able to tolerate oral intake
HOB elevated to prevent aspiration
replace fluid and electrolytes
6
Q
Acid-base balance
vomiting leads to _______?
diarrhea leads to _______?
A
vomiting = alkalosis diarrhea = acidosis
7
Q
What is gastritis?
A
Inflammation of the gastric mucosa
8
Q
What causes gastritis?
A
long-term NSAID use
H. Pylori or other bacteria
9
Q
Chronic gastritis is closely associated with development of _______.
A
Gastric CA
10
Q
Chronic Gastritis
What is chronic duodenal reflux?
A
When the pyloric sphincter allows alkaline juices to leak into stomach
11
Q
Chronic Gastritis
Introduction of alkaline juices into stomach destroy which 2 kinds of cells in the stomach?
A
Parietal and chief cells
12
Q
Chronic Gastritis
What will develop if there is no intrinsic factor produced?
A
pernicious anemia b/c B12 cannot be absorbed
13
Q
Chronic Gastritis
Why do antacids not relieve pain associated with chronic gastritis?
A
b/c problem is alkaline not acidotic.
14
Q
melena?
A
dark and tarry stool
15
Q
hematochezia?
A
bright red blood in stool
16
Q
What are the 2 origins of upper GI bleeding?
A
arterial and venous
17
Q
which type of upper GI bleeding is more severe?
A
arterial
18
Q
Hematoemesis?
A
bloody vomit
19
Q
What kind of bleeding does melena indicate?
A
slow, oozing bleed in upper GI tract
20
Q
What kind of bleeding does hematochezia indicate?
A
bleeding in lower GI tract
21
Q
What is the most important intervention for upper GI bleed?
A
maintain airway
22
Q
What is a mallory-weiss tear?
A
tear in esophagus caused by severe, violent vomiting
23
Q
Peptic Ulcer Disease
Are gastric secretions increased, normal or decreased with gastric ulcer?
A
normal to decreased
24
Q
Peptic Ulcer Disease
Are gastric secretions increased, normal or decreased with duodenal ulcer?
A
increased
25
what is Peptic Ulcer Disease?
erosion of GI mucosa from digestive action of HCl & Pepsin
26
Peptic Ulcer Disease
| Acute vs. Chronic
Acute- superficial erosion
| Chronic- long duration, erosion though muscular layer
27
#1 cause of Peptic Ulcers:
H. Pylori
28
Peptic Ulcer Disease
| S/Sx:
Burning, gnawing pain that is worse on empty stomach. Relieved by food, but recurs when stomach empties again.
29
Peptic Ulcer Disease
| Tx:
relieve pain, avoid stressors
| physical & emotional REST
30
Peptic Ulcer Disease
| Drug Therapy:
```
Antacids
H2 receptor agonists
Proton pump inhibitors (PPI's)
anticholenergics
reglan (increase gastric motility)
sucralfate (coats ulcer, protects from erosion)
```
31
Peptic Ulcer Disease
| action of antacids & when to admin?
antacids neutralize gastric acid. give 1-3 hours after meals & at bedtime
32
Peptic Ulcer Disease
| action of H2 blockers?
reduce HCl acid secretions (Tagamet, Zantac, Pepcid)
33
Peptic Ulcer Disease
| action of PPI's?
stop secretion of HCl acid to raise pH of stomach (Protonix, Prilosec, Prevacid)
34
Peptic Ulcer Disease
| action of Anticholinergics?
block SNS- so they slow everything down. inhibit gastric secretions, decrease gastric motility. high incidence of s/e: dry mouth, urinary retention
35
What is the most common complication of Peptic Ulcer Disease?
hemorrhage.
36
What is the most serious complication of Peptic Ulcer Disease?
perforation (high mortality)
37
Peptic Ulcer Disease Complications:
| What happens when perforation occurs?
gastroduodenal contents spill into peritoneal cavity= peritonitis & septicemia
38
Peptic Ulcer Disease Complications:
| S/sx of perforation?
sudden onset sever upper abd pain, rigid, boardlike abd, absent bowel sounds, rapid & shallow resp
39
Peptic Ulcer Disease Complications:
| What is gastric outlet obstruction?
occurs when inflammation & edema around ulcer (primarily duodenal) result in narrowing of pyloric sphincter = food can't escape stomach
40
Peptic Ulcer Disease
| S/sx of gastric outlet obstruction:
long Hx of pain, belching, vomiting of undigested food, weight loss
41
Peptic Ulcer Disease
| Tx of gastric outlet obstruction:
gastric decompression by large lumen NG tube, then surgery.
42
Gastric Surgery
| gastrectomy?
partial removal of stomach (70-80%), anastomosis to either duodenum (Bilroth I) or jejunum (Bilroth II)
43
Gastric Surgery
| Vagotomy?
severe vagus nerve to decrease gastric secretions
44
Gastric Surgery
| Pyloroplasty?
enlargement of the pyloric sphincter
45
Gastric Surgery
| Post-op drainage will be bright ___ for first __ hours. Then return to normal _____ color in __ hours.
bright red 1st 12 hours. yellow-green after 36 hours.
46
Gastric Surgery Complications
| What is dumping syndrome?
rapid emptying of gastric contents into sm intestines.
47
Gastric Surgery Complications
| dumping syndrome S/sx:
weakness, syncope, dizziness b/c of increased blood flow to GI tract to facilitate digestion
48
Gastric Surgery Complications
| dumping syndrome interventions:
small, frequent meals
no fluids with meals
avoid concentrated sweets
REST after meals
49
Gastric Surgery Complications
| why pernicious anemia with complete gastrectomy?
b/c IF can no longer be produced= no B12 absorption, will need B12 injections for life
50
What are features of Zollinger-Ellison syndrome?
Pancreatic islet cell tumors
severe upper GI ulcers
excessive gastric acid secretions
diarrhea
51
What is steatorrhea?
fatty, greasy, foul-smelling stools
52
Tx of Zollinger-Ellison Syndrome:
Surgery- total or partial gastrectomy
| Pancreatectomy- to remove tumors
53
S/sx of gastric CA:
indigestion, feeling of fullness, gastric discomfort, weight loss, dysphagia, anemia, weakness, pale
54
Enteral Nutrition
| Percutaneous Endoscopic Gastrostomy? PEG
feeding tube inserted directly into stomach
55
Enteral Nutrition
| Duodenostomy?
feeding tube inserted directly into duodenum
56
Enteral Nutrition
| Jejunostomy? PEJ
feeding tube inserted directly into jejunum
57
Enteral Nutrition
| indications:
Physiologic- Inability to swallow
Psychologic- Mental disorders that prevent intake of nutrition
Pathophysiologic- Diseases that affect nutrition
58
Enteral Nutrition
| who can NOT have enteral feedings?
post op for gastric surgery
| people who need bowel rest
59
Enteral Nutrition
| Orogastric?
through mouth into stomach
60
Enteral Nutrition
| Nasogastric?
through nose into stomach
61
Enteral Nutrition
| Nasoenteric?
through nose into small bowel
62
Enteral Nutrition
| After placement, when can feedings begin?
When bowel sounds are present
63
Enteral Nutrition
| What is an incomplete supplement?
do not provide all nutritional needs. for pt who still eats, but not enough calories
64
Enteral Nutrition
| Optimental formulas?
partially broken down, for pt unable to digest foods and/or absorb nutrients
65
Enteral Nutrition
| What does SOB indicate?
aspiration
66
How do you measure an NG tube for insertion?
from ear lobe to tip of nose to xiphoid process
67
2 types of diarrhea?
```
Large Volume (excess fecal water)
Small volume (without excess fecal water)
can also be acute or chronic
```
68
What is ABX related diarrhea?
when ingestion of ABX leads to destruction of bowels normal flora, permits overgrowth of C. diff
69
S/sx of C. diff
severe diarrhea, fever/chills, abd distention, crampy pain
70
Dx of C. diff
stool culture
71
Tx of C. diff
D/C ABX which caused, take diff ABX designed to kill C. diff (Vancomycin)
72
What is fecal incontinence?
relaxation, loss of control of, external sphincter = involuntary passage of stools
73
Laxatives:
| action of bulk-forming agents:
absorbs water, stimulates peristalsis (increase fluids)
74
Laxatives:
| action of stimulants:
irritates colon wall to increase peristalsis
75
Laxatives:
| action of stool softeners:
lubricates intestinal tract & softens stool
76
what is Appendicitis?
acute inflammation of the vermiform appendix
77
Most common cause of appendicitis?
fecalith
78
Appendicitis
| S/sx
abd pain RLQ
low grade fever
rebound tenderness
McBurney's Point
79
Appendicitis
| Tx
NO HEAT to abd
| appendectomy
80
What is the major complication of a ruptured appendix?
peritonitis
81
What is peritonitis?
inflammation of all or part of parietal & visceral surfaces of abd cavity
82
S/sx Periotonitis:
pain = most consistent symptom
rigid, board-like abd
N/V, absent bowel sounds
rapid, shallow respirations
83
Tx Peritonitis:
IV ABX & Fluids
| semi-fowlers
84
What is gastroenteritis?
inflammation of the stomach AND intestinal tract
85
Causes of gastroenteritis?
bacteria, virus, parasite, food poisoning
86
How is gastroenteritis transmitted?
fecal-oral route
87
S/sx of gastroenteritis:
N/V, Cramping, Diarrhea, Dehydration, fever
88
Tx of gastroenteritis:
determine cause
fluid/electrolyte balance
NPO until vomiting stops
ABX if bacterial
89
What is dysentery?
gastroenteritis of the large bowel
90
What is IBS?
Irritable Bowel Syndrome, chronic, NON-infectious irritation caused by spasms of colon
91
How do you diagnose IBS?
H&P- weight loss, abd pain
| "Manning's criteria"
92
S/sx IBS:
intermittent crampy lower abd pain, diarrhea alternating with constipation
93
What is ulcerative colitis?
progressive & continuous inflammation & ulceration of lg bowel. intestinal mucosa- hyperemic, edematous, ulcerated, bleeds
94
Who does UC usually affect?
young females
95
S/sx of UC:
```
PROFUSE BLOODY, MUCOUSY DIARRHEA
LLQ abd pain
fever
tenesmus
weight loss
anorexia
anemia
```
96
Tx of UC:
bowel rest, ABX, I&O, daily weights, alleviate stress, fluid & electrolytes. Surgery = Proctolectom (remove colon & rectum with permanent ileostomy)
97
Tx of UC meds:
steroids, ABX, vitamins & iron
98
Dx UC:
Colonoscopy
99
What is Crohn's disease?
chronic inflammation of the small & or large bowel
100
Describe pattern of UC:
Starts distally and spreads in a continuous pattern up the colon
101
Describe pattern of Crohn's:
Occurs anywhere along the GI tract in skip lesions. segmental
102
Depth of involvement Crohn's vs UC:
Crohn's: entire thickness of bowel
| UC: mucosa and submucosa
103
Bowel lumen size: Crohn's vs UC:
Crohn's narrow
| UC: normal
104
Malabsorption: Crohn's vs UC:
Crohn's common
| UC rare
105
Weightloss: Crohn's vs UC:
Crohn's: severe
| UC: common
106
Rectal bleeding: Crohn's vs UC
Crohn's: rare
| UC: common
107
Tenesmus: Crohn's vs UC
crohns: rare
UC: severe
108
steatorrhea: Crohn's vs UC
Crohn's common
| UC: rare
109
Carcinoma risk: Crohn's vs UC
crohn's: only slightly greater than general pop
| UC: increased incidence
110
What are polyps?
projection of mucosal surface of the bowel lumen can be benign or malignant
111
What is familial polyposis?
genetic condition, entire bowel covered in polyps. Leads to colon CA always... will have entire bowel removed
112
3 types of intestinal obstruction:
1. Mechanical
2. Neurogenic
3. Vascular
113
What is the most common form of small bowel obstruction?
adhesions
114
What kind of intestinal obstruction is a hernia?
mechanical
115
What is volvulus?
the twisting of bowel on itself, twisted loop becomes strangulated. mechanical
116
what kind of bowel obstruction is paralytic ileus?
neurogenic
117
what causes vascular obstruction?
blood supply to bowel is disrupted (emboli, athersclerosis)
118
S/Sx intestinal obstruction:
abd distention, liquid stools if partial obstr.
no stools if complete obstr.
abd pain, increased bowel sounds proximal to obstruction
119
What is borborygmi?
High pitched, screaming bowel sounds
