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NURS526 > GI/Renal > Flashcards

GI/Renal Flashcards

1
Q

When GFR is at what level should you refer to nephrology

A

> 30

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2
Q

how is AKI differentiated from AKI

A

decreased in renal function for more than 3 months

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3
Q

what are the main causes of kidney disease

A

HTN
DM (diabetic nephropathy)
glomerulonephritis (inflammatory conditions and infection)
Polycystic kidney disease
NSAIDs

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4
Q

what would you expect to see in electrolytes with kidney damage

A

increase potassium
increased phosphate
decreased calcium
increased sodium (when very severe)

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5
Q

what are common signs and symptoms of kidney disease caused by increased fluid retention

A

pulmonary edema
HTN
peripheral edema

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6
Q

albuminuria signifies what

A

damage to the kidneys

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7
Q

what is azotemia

A

increased urea from kidney damage

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8
Q

what are some possible neuro complications of kidney disease

A

encephalopathy
asteristix
seizures
coma

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9
Q

what are some cardiac complications of kidney disease

A

uremic pericarditis
pericardial effusions

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10
Q

what is uremic frost

A

urea crystals on the skin from uremia caused by chronic kidney disease

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11
Q

true or false: chronic kidney disease increases your bleeding risk

A

true

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12
Q

what would you expect to see on CBC for CKD

A

decreased RBCs

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13
Q

what antihypertensive is renal protective

A

ACE-I

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14
Q

CKD may cause increased or decreased parathyroid hormone

A

increased
(hyperparathyroidism secondary to hypocalcemia)

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15
Q

how does CKD affect the bones

A

increased breakdown of bone = increased risk of #

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16
Q

would you expect a metabolic acidosis or alkalosis from CKD

A

acidosis

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17
Q

true or false: CKD will not affect the level of lipids in the blood stream

A

false, can cause hyperlipidemia with increased TG and increased LDL

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18
Q

how is CKD staged

A

Based on GFR

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19
Q

what are the hallmark findings of CKD and AKI

A

decreased GFR
increased Cr
albumin in the urine

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20
Q

at what GFR level would you start to see overt symptoms of CKD

A

not until <35, so important to know risks and when to screen

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21
Q

what nonpharmacological treatments are used for kidney disease

A

protein and sodium restriction
strict fluid monitoring
avoiding nephrotoxic medications

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22
Q

whats the BP goal in CKD

A

<130/80

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23
Q

what antihypertensives might you consider for CKD

A

ACE-I
ARBs
Potassium sparing diuretics

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24
Q

what is the goal HBA1C for DM with CKD

A

<6.5%

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25
Q

what part of the bowel does chrons affect

A

any part of the GI tract

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26
Q

what disease causes skip lesions and where are they most often seen

A

crohns disease, usually seen in ileum

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27
Q

what is the main symptoms of crohns

A

watery, non bloody diarrhea
RLQ pain

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28
Q

which IBD has transmural inflammation

A

Crohns disease

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29
Q

which IBD has continous inflammation and which one is patchy

A

continous = UC
patchy = CD

30
Q

what are some presumed causes of CD

A

autoimmune
western diet
smoking

31
Q

which IBD spares the rectum

A

CD

32
Q

which IBD starts at the rectum

A

UC

33
Q

which IBD causes blood stool

A

UC

34
Q

where is the pain usually in UC

A

LLQ

35
Q

tenesmus, blood diarrhea, and LLQ is indicative of what

A

UC

36
Q

true or false: tensmus is seen in crohns disease

A

false, cronhs spares the rectum. It is seen in UC

37
Q

which cytokine is implicated in both CD and UC

A

TNF alpha

38
Q

how does smoking impact UC

A

smoking has been shown to decrease UC flares

39
Q

what are the main signs and complications of CD

A

malabsorption
fistulas/abcess
strictures

40
Q

what results might you see with a CBC, CRP and ESR in IBD

A

anemia
increased platelet
increased CRP and ESR

41
Q

what testing should be done for all initial presentations of diarrhea

A

stool for O&P, C-diff, cultures

42
Q

what skin conditions can be seen in patients with IBD

A

erythema nodosum (tender red nodules on shins)
pyoderma gangrenosum
aphthous stomatitis (oral ulcers)
psoriasis
skin tags

43
Q

what ocular complications may occur in patients with IBD

A

uveitis
episcleritis
keratitis
conjunctivitis

44
Q

what liver complications can occur with IBD

A

primary sclerosing cholangitis
autoimmune hepatitis
NAFLD
gall bladder disease

45
Q

true or false: both IBD and IBS may awaken a patient at night with symptoms

A

false, IBS does not awaken patients from sleep

46
Q

what are treatment options for IBS

A

antidepressants
antispasmodics
antidiarrheals
counselling

47
Q

what should be rule out with diarrhea

A

thyroid dysfunction
IBD
celiac
intestinal infection
H pylori

48
Q

dermatitis herpetiforms (itchy bilstering skin rash symmetrically on elbows, knees buttocks and scalp) is often associated with what GI disorder

A

celiac

49
Q

the majority of acute and persistent cases of diarhere are caused by ____

A

infectious causes

50
Q

what is steatorrhea and what does it usually indicate

A

fatty diarrhea
associated with malabsorption

51
Q

do asymptomatic diverticula found incidentally require further investigation?

A

no

52
Q

what are s&s of diverticulitis when it is symptomatic

A

abdo pain
bloating/gas
irregular stools

53
Q

how is diverticulosis diagnosed

A

colonoscopy or sigmoidoscopy

54
Q

the hallmark of diverticulosis is

A

colicky abdo pain without an inflammatory process

55
Q

what are nonpharmacological managements for diverticular diseas

A

increased fibre intake
increased exercise

56
Q

what pharmacological treatmemts are used for diverticular disease

A

anticholinergics
antispasmodics

57
Q

What is a Barrett’s esophagus?

A

changes in cells of lower esophagus resulting in GERD symptoms, precancerous

58
Q

what are atypical symptoms of GERD

A

epigastric fullness
epigastric pressure
epigastric pain
dyspepsia
nausea
bloating
belching

59
Q

what are some extra esophageal symptoms of GERD

A

sore throat
laryngitis
hoarseness
chronic cough
wheezing
asthma
bronchospasm

60
Q

what are the 2 types of GERD and which is more prevalent

A

non erosive (NERD) - is more prevalent
erosive (ERD)

61
Q

how do ERD and NERD respond differently to therapy

A

NERD - no changes seen on endoscopy and often no response to PPI
GERD - inflammatory changes on ednoscopy and usually responds well to PPI

62
Q

which foods may worsen GERD symptoms

A

sugar
peppermint
chocoalte
coffee
garlic
onions
citrus, tomato, spicy

63
Q

which medications may worsen GERD

A

ASA
NSAIDs
potassium
nitrates
TCAs
benzos and other sedatives
anticholinergics
bronchodilators
many cardiac meds

64
Q

why is dental examination important with GERD

A

may cause dental erosin with loss of enamel and exposed dentin

65
Q

when is diagnostic testing warranted for GERD

A

failed empiric therapy
red flag symptoms
first occurence age over 50
long symptom duration that increased risk for barrets esophagus

66
Q

what is the best test for patients with long standing or poorly controlled GERD

A

EGD

67
Q

true or false: a patient with symptoms suggestive of GERD including dysphagia should be started on empiric PPI

A

false, dysphagia is an alarm symptom and pt should have an EGD done

68
Q

what are the steps of treatment for presumed GERD with no red flags

A
  1. diet and lifestyle modification with antacids
  2. if ineffective, trail PPI for 8 weeks
  3. if still ineffective, endopscopy
69
Q

what are lifestyle modifications for GERD

A

elevating head while sleeping
sleep on right side
lower fat intake
stop smoking
dont wear tight clothing
reduce trigger food and meds

70
Q

can PPIs and H2RAs be used together

A

yes but they should be taken at different times of the day

71
Q

what deficiencies may be seen with long term PPI use

A

vit B12
Mg
Ca
Iron

72
Q
A

NURS526 (13 decks)

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