GI System

Question 1

physcial exam

Answer 1

inspect, auscultate, percuss, palpate

Question 2

absent/dec bowel sounds

Answer 2

inflamm, late bowel obstruction

Question 3

hyperactive bowel sounds

Answer 3

gastroenteritis, early bowel obstruction,

NG can mimic (shut off suction to auscultate)

Question 4

physical exam- monitor

Answer 4

severe abdom pain, prolonged vomiting, blood while vomiting, tarry stool, fever, htn, tachycardia

Question 5

CBC- Hbg

Answer 5

12-16 F and 14-18 males g/dL
reflects blood vol
dec= blood/Gi loss
inc+ dehydration, chronic respir distress

Question 6

CBC- Hct

Answer 6

37-47% F and 42-52%
reflects blood vol
dec= blood/Gi loss
inc+ dehydration, chronic respir distress

Question 7

CBC-WBC

Answer 7

5-10,000 mm^3
inc- infection, steroid meds, appendicitis
dec= immunocomp, cancer

Question 8

K+ and Na levels

Answer 8

k- 3.5-5.0

Na- 135-145 mEq/L

Question 9

Fecal occult blood test

Answer 9

suspect if Hbg or Hct low

false-positive- iron, lrg amnt red meat digestion, recent nose bleed, vigorous excercise

Question 10

CT scan considerations

Answer 10

radiographic, use contrast dye
check kidney function (creatinine lvl) if impaired= give extra fluid or dec dose
shell fish allergies- can pretreat or give more fluid

Question 11

MRI considerations

Answer 11

magnet
check metal- rods, pacemaker, aneurysm clip
NPO if abdomen concerns

Question 12

age r/t changes

Answer 12

min effects on Gi function
conspitation
heartburn- relaxation lwr es
tooth loss
slower perstalsis- loss sm musc tone

Question 13

stomatitis

Answer 13

ulceration mouth
upper gi tract more prone trauma *pt induced
risk factors- thrush, chem/radiation therapy, vitamin def, chronic dis (kidney/inflamm bowel)
epidemiology- inflamm condition affecting orla mucosa, dentition
occurs 40% chemo pati
patho- “oral mucositis”
painful inflamm/ulceration lining of mouth
management- assessment oral cavity b,d,a chemo and radiation, rinse mouth norm saline/ Na bicarb, lidocaine suspension, diet modif, chart I/O
complications- dysphagia/ odynophagia (painful swallowing), xerostomia

Question 14

GERD

Answer 14

Risk- girls, preg, obesity, lrg meals, tight clothing, ng tubes, excessive acid secretion
patho- pressure grad diff btw stomach and LES, irreg LES function
can aspirate Gi contents if not controlled
epidem- common western countries, 10-20%
management- pH monitoring, esophageal manometry/motility testing (most effective)
esophagogastrodudodenoscopy (EGD)
meds (PPI, H2 blocker, antacids)
head elevated > 30
cessation alcoh/smoking, weight loss, stress reduc, smllr meals, avoid dietary irritants

Question 15

peptic ulcer dis- types, cause, patho

Answer 15

types- duodenal 80%
chronic w/ periods exacerb
gastric- 20% common lesser curvature stomach
causes- h- pylori (secrete toxin destroys stomach mucous protection= infection)
Nsaids, exposure irritants
patho- gastroduodenal mucosa destroyed by gastric acid and pepsin

Question 16

peptic ulcer dis- manifestations/management, complications

Answer 16

manif- burning pain, worse when hungry/fasting (duodenal)
gastric- worse when eating, pain
management- diagnosed during upper endoscopy, lab,radiological tests
lab- h-pylor, stool antigen testing, CBC (elevated WBC, dec Hbg, Hct), positive fecal occult blood test
upper GI endoscopy preferred
meds- pain relief, ulcer healing, acid suppression, therapy for h-pylori
monitor I+O, smoking cessation, NG tube for decompression (eliminate caustic blood)
complications- fluid shift, dec Na and K

Question 17

NG tube placement

Answer 17

nose, ear, xiphoid process + 6 in
check placement w/ xray/imaging, ph paper test < 4, Co2 gas detection, WHOSH test(20 mL air into tube and listen) , visual assess of placement

Question 18

Sm/ Lrg intestine function

Answer 18

sm- dig/ absorp nutrients
protein, carbs, fat 
lrg- absorp water, fluid/electrolyte reaborb/elimin
*loss function 2-3 days after surgery
     use NG tube for decompression

Question 19

inflamm bowel dis- manif- epidem-patho

Answer 19

incl crohn’s, ulcerative colitis
manif- weight loss, fever, malnutrition, oral ulcerations
epidem- 1.4 million
patho- cause unknown
linked genetic predisposition (autoimm), environmental conditions, defects in immune regulation

Question 20

crohn’s dis

Answer 20

affect entire gi tract
inc risk- small bowel cancer, absess/fistual, peritonitis (inflamm abdom wall), adhesions/narrowing lead obstruction/impaired absorp, fluid/electrolyte imbal, abdom pain RLQ
common- terminal ileum and colon
transmural (across wall) can penetrate
diarr less severe
pain worse, blood less common stool
noted to skip lesions w/ normal appearing bowel btw lesions

Question 21

ulcerative colitis

Answer 21

affects Lrg intestine (mucosa and sub-muc)
inc risk colon
diarrh common
blood, mucus, pus common
abdom pain/ tenderness in LLQ
tenesmus- spasm anal sphincter (constant feeling need empty bowels)

Question 22

IBD management

Answer 22

periods remission/exacerbation
rest bowels (no lax) control inflamm
stress control
meds( immuno suppr, cortical steroids) surgery, correct nutritional deficits, fluid/electrolyte balance
total parenteral nutrition (TPN) via central line
complications- bg lvls, correct position line, electroly imbal
low ruffage diet- low residue (fiber)= dec effort digestion, avoid lactose
risk dec musc mass, immune system, poor wound healing

Question 23

IBD complications/ surgical management

Answer 23

comp- fistulas/abscess w/ crohns
short bowel syndrome- dec absorp
chronic abdom pain
surgical management- if meds don’t work or run into complications

Question 24

total parenteral nutrition

Answer 24

TPN
protein, CHO, fat, minerals, electrolytes, vitamins
bypasses normal digestion
nurse considerations- correct placement line, sterile dressing change, verify nutrient order, monitor bg levels

Question 25

Diverticulitis- epidem, patho, management, complications

Answer 25

epidem- small herniation in GI tract (often colon)
common western industrialized societies and older ppl
patho/manif- extraluminal “outpouching”
diverticulosis- NONinflammed diverticula
management- uncomplicated -antibio
lax and enemas avoided, pain meds, monitor I+Os, and CBC/ electrolytes
complications- perforation, fistula/ abscess formation, bowel obstruction, bleeding, inflamm (can result in fistula to o/organs)

Question 26

appendicitis- epidem-patho-manif- management

Answer 26

abdomin pain RLQ
epidemi- acute inflamm of vermiform appendix
common in 10-19yr olds
* if occur in adult more likely rupture
patho- result foreign body blocking the opening leads to inflamm/infection
manif- elevated WBC, fever, tachycardia, n/v, peritonitis (bowel contents in abdom) if rupture
management- scope or open, meds- antiemetics ,antipyretic (dec fever)
avoid lax/enemas

Question 27

mechanical v functional intestinal obstruction- care and manif

Answer 27

mech- tumor/food
functional- interrupts/ slower peristalsis
care- NG tube, I&Os, iv analgesics, iv fluid, bowel tones
manif- n/v, abdominal pain

Question 28

bowel surgery- after surgery care

Answer 28

create stoma
trtment chronic ulcer, obstructions, tumors
can be reversed
after surgery- low/ semi-fowlers position, TPN, or iv fluids, NG tube, daily weights, I&Os, bowel sounds, wrk from fluid- low residue diet (avoid raw fruit/veg and seeds)

Question 29

liver function

Answer 29

blood storage, blood filtration, production bilirubin, syn clotting factors, removal clotting factors
metab carbs, fat and protein
detoxify blood (Kuppfer cells)
storage vitam A,D,E,K and Fe

Question 30

cirrohsis- cause, patho, manif

Answer 30

cause- hep C, alcoholic liver dis and NASH non alcoholic fatty liver dis
patho- chronic dis causes cell destruction and fibrosis hepatic tissues
manif- dec liver function (inc AST/ALT released w/ cell death)
ascites= low albumin- leak fluid
portal htn w/ varices
hepatic encephalopathy- confusion, elevated ammonia, change motor fun, abnormal sleep cycle, coma
remove ammonia w/ lactulose
coagulopathy
hepatorenal syndrome (HRS)
spontaneous bacterial peritonitis
jaundice- excess bilirubin

Question 31

cirrohsis- management

Answer 31

lab/diag testing
withhold hepatoxic meds
Na restriction or diuretics use w caution (used trt edema/ascites but pull fluid frm vascular system and can cause hypovolemia (dec bp))
lactulose admin (titrate)
monitor I&O, nutr supp
TIPS trans jugular intrahepatic portosystemic shunt
(temporary bypass vascular system liver ex. hepatic/portal veins) used trt portal htn

Question 32

biliary disorders

Answer 32

inc gallbladder and bile ducts
bile breaks down fat
system transports bile frm liver to gallb and the sm intestine

Question 33

cholecystitis

Answer 33

gallbladder dis
inflamm frm obstruction bile flow
manif- none or RUQ pain, fever, tachycardia, cramping,
assoc w/ fatty meals, common females 45-50
management- antib, food avoidance
trtment- surgery (cholecystectomy)