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NPTE > Immune and GI systems > Flashcards

Immune and GI systems Flashcards

1
Q

What are the proteins to “tag” antigens?

A
  1. antibodies
  2. immunoglobulins
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2
Q

What are the primary cells of the immune system?

A

Lymphocytes

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3
Q

What are the type of lymphocytes?

A

T and B

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4
Q

What does the thymus produce?

A

produces mature T lymphocytes

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5
Q

What is the primary central gland of the immune system?

A

thymus

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6
Q

(true/false) The thymus is not fully developed until puberty.

A

FALSE - thymus is fully developed at birth and then reaches maximal size at puberty

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7
Q

What happens to the thymus as a person ages?

A

Decreases in size and is slowly replaced by adipose tissue.

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8
Q

What do the lymph nodes produce?

A
  1. lymphocytes
  2. monocytes
  3. plasma cells
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9
Q

What is the function of the spleen?

A
  1. Filters antigens from the blood
  2. produces leukocytes, monocytes, lymphocytes, and plasma cells in response to infection
  3. Produces RBC and WBC while in embryo

Only produces lymphocytes after birth unless severe anemia exists

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10
Q

During an adaptive immune response, slower acting defences are mediated by what?

A

lymphocytes

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11
Q

Definition

Classification of diseases characterized by depressed or absent immune responses.

A

immunodeficiency diseases

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12
Q

What causes primary immunodeficiency disorders?

A

Defect in T cells, B cells, or lymphoid tissue

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13
Q

definition

Classification of diagnoses characterized by immune system responses directed against the body’s normal tissues; self-destructive processes impair the body functioning

A

autoimmune diseases

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14
Q

What is HIV?

A

A virus that weakens the immune system and destroys cells that fight disease and infection

  • CD4+ helper cells, resulting in CD4+ T lymphocytopenia (major immune system defect)
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15
Q

What are the stages of HIV?

A

Stage 1: flu-like illness within 2-4 wks after exposure/infection

stage 2 (clinical latency): asymptomatic HIV infection or chronic HIV infection that can last a decade or longer

Stage 3 (AIDS): most severe phase; mass destruction of cells resulting in the immune system not being able to fight off disease or illness

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16
Q

How is HIV spread?

A

Body fluids

Rare: during pregnancy, birth, or breastfeeding

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17
Q

(true/false) HIV can be transmitted through saliva, tears or sweat.

A

FALSE (unless blood is present)

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18
Q

(true/false) AIDS can be contracted through respiratory inhalation, skin contact, or human waste

A

FALSE

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19
Q

What is the regular range of CD4?

A

500-1200 cells/mm

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20
Q

What is used to diagnose AIDS?

A
  1. CD4 cell count < 200 cells/mm or if they develop opportunistic illnesses - have a high viral load and are very infectious
  2. presence of acute symptoms secondary to immune system deficiency (AIDS-Related Complex (ARC))
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21
Q

What is AIDS-related complex (ARC)?

A

presence of acute symptoms secondary to immune system deficiency

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22
Q

What are the s/s of HIV?

A
  • flu-like symptoms that resolve within a few weeks
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23
Q

(true/false) Getting tested is the only way to diagnose HIV.

A

true

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24
Q

What are the s/s of AIDS?

A
  • presence of opportunistic infections
  • malignancies
  • neural conditions
  • deconditioning
  • anxiety and depression
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25
Q

What opportunistic infections that are considered as AIDS-defining conditions?

A
  • PNA
  • candidiasis
  • cytomegalovirus
  • toxoplasmosis
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26
Q

What is the most common malignancy caused by AIDS?

A

Kaposki’s sarcoma and non-hodgkins lymphoma

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27
Q

What neuro conditions can be seen with AIDS?

A
  • AIDS dementia complex
  • focal encephalitis
  • meningitis
  • herpes zoster
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28
Q

(true/false) Some patients with AIDS may exhibit a brief, early, nonspecific viral HIV infection and then remain asymptomatic for years.

A

True

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29
Q

(true/false) antibiotics cure HIV infections

A

FALSE (no cure for HIV)

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30
Q

Those with HIV will progress to having ____ if not treated.

A

AIDS

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31
Q

What medication does not cure HIV but does keep those with HIV healthy for many years if taken consistently and correctly?

A

Antiretroviral therapies (ARTs)

Antiviral drugs reduce the amount of virus (viral load) in the system

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32
Q

What does a retrovirus do?

A

Replicates in reverse fashion (RNA code is transcribed into DNA)

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33
Q

What are common side affects of ARTs?

A
  • N/V
  • diarrhea
  • HA
  • dizziness
  • fatigue
  • pain
  • rash
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34
Q

(True/false) a person experiencing an acute episode of HIV can participate in exercise testing.

A

FALSE - no exercise testing during acute infections

Avoid intense exercise with symptomatic individuals due to possible immune suppression occurring

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35
Q

What does staphylococcus aureus commonly begin as?

A

localized infection through skin portal

Bacterial invasion and spread is through the bloodstream or lymphatic system to almost any body location

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36
Q

What do staphylococcus aureus infections produce on the skin?

A

Pus formation and abscess

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37
Q

Diagnosis

  • swollen, painful red bumps that can quickly progress to an abscess with pus/drainage inside
  • area around abscess is warm to the touch
  • fever
  • possibility to produce life-threatening infections in the body
A

MRSA

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38
Q

(true/false) MRSA can be treated and reappear in the same individual

A

true

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39
Q

(true/false) Vancomycin-resistanct staphylococcus aureus (VRSA) can be a life-threatening infection

A

true

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40
Q

The following are examples of what type of infection:

  • pharyngitis
  • rheumatic fever
  • scarlet fever
  • impetigo
  • necrotizing fasciitis (gangrene)
  • cellulitis
  • myositis
A

Group A streptococcus (S. pyogenes)

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41
Q

What population commonly experiences Group BB streptococcal infections (S. agalactiae)?

A

Neonatal and adults

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42
Q

The following are examples of what type infection:
- PNA
- otitis media
- meningitis
- endocarditis

A

Group 3 streptococcus (S. pneumoniae)

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43
Q

What are the early symptoms of lyme disease?

Within 3-30 days of tick bite

A
  • fever
  • chills
  • swollen lymph nodes
  • HA
  • muscle and joint aching
  • fatigue
  • bulls-eye rash
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44
Q

What are the symptoms of lyme disease if left untreated?

Days to months after tick bite

A
  • severe HA and neck stiffness
  • arthritis is joint pain and swelling
  • palpitations and/or irregular heartbeat (lyme endocarditis)
  • inflammation of brain and spinal cord
  • nerve pain
  • shooting pain
  • N/T in hands and feet
  • palsy
  • issues with short-term memory
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45
Q

What is it called when symptoms of lyme disease linger for months or years after treatment of an acute infection?

10% of cases

A

Post-lyme disease syndrome (PLDS)

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46
Q

What is the cause of PLDS?

A

unknown- individuals are asymptomatic in the absence of clinically detectable infection

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47
Q

What are symptoms of PLDS?

A
  • MSK pain
  • fatigue
  • impaired cognition
  • difficulty sleeping
  • unexplained numbness
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48
Q

(true/false) An extended course of antibiotics has been proven beneficial for treatment of PLDS.

A

false

treatment is symptomatic-based (analgesics, antidepressants, and psychotherapy) and most patients recover with time

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49
Q

Diagnosis

  • rash with the site of bite being black or crusted
  • caused by a tick
  • fever and chills
  • muscle aches
  • confusion
  • N/V
  • neuro changes
A

Rocky mountain spotted fever

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50
Q

What are possible complications of rocky mountain spotted fever?

A
  • encephalitis
  • inflammation of heart and lungs
  • heart failure
  • kidney failure
  • serious infection in fingers in toes (possible amputation)
  • death (if untreated)
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51
Q

Complications of rocky mountain spotted fever can be avoided if treatment is started within ___ days of developing symptoms

A

5 days

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52
Q

(true/false) MRSA can be contracted via indirect and direct contact to infected person

A

true

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53
Q

Plasma makes up ___% of of total blood volume

A

55%

91% water, 7% protein, 2-3% other small molecules

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54
Q

What are the plasma proteins?

A
  1. albumin
  2. globulins
  3. fibrinogen
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55
Q

What is plasma without the clotting factors?

A

serum

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56
Q

RBCs make up ___% of the total blood volume

A

45%

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57
Q

What is the function of erythropoietin?

A

hormone that regulates RBC production

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58
Q

How long do most RBCs last?

A

120 days

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59
Q

(true/false) RBC count varies with age, activity, and environmental conditions

A

true

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60
Q

Leukocytes make up __% of total blood volume

A

1%

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61
Q

What is the function of leukocytes (WBCs)?

A

function in immune responses as phagocytes of bacteria, fungi, toxic proteins, and viruses

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62
Q

Where are leukocytes produced?

A

bone marrow

Along with RBCs

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63
Q

What are the 5 types of leukocytes?

A
  1. lymphocytes
  2. monocytes (agranulocytes)
  3. neutrophils
  4. basophils
  5. eosinophils (granulocytes)
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64
Q

definition

The normal function and generation of blood cells in bone marrow

A

hematopoiesis

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65
Q

What regulates production, differentiation, and function of blood cells?

A

Cytokines and growth factors acting on blood-forming cells

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66
Q

What is ESR?

A

Rate of RBCs to clot

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67
Q

What is indicated when ESR is elevated?

A

presence of inflammation

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68
Q

What are the normal values of ESR?

A

Male: <15 mm/hr
Female: <20 mm/hr

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69
Q

What is hemostasis?

A

Termination of blood flow by mechanical or chemical processes

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70
Q

What are examples of hemostasis?

A
  • vasospasm
  • platelet aggregation
  • thrombin and fibrin synthesis
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71
Q

What does blood clotting require?

A
  1. platelets (produced in bone marrow)
  2. Von Willebbrand’s factor (produced by endothelium of BVs)
  3. clotting factors from the liver using vitamin K
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72
Q

What is fibrinolysis?

A

clot dissolution that prevents excess clot formation

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73
Q

Atherosclerosis, DM, elevated blood lipids, and cholestrol have a (decreased/increased) platelet function.

A

increased platelet function

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74
Q

(true/false) A person with a hypocoagulopathy disorder has no limitations for exercise.

A

FALSE: strenuous exercise contraindicated due to risk of increased hemorrhage

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75
Q

Diagnosis

Condition of inadequate blood flow to the body tissues that is associated with hypotension, inadequate cardiac output, and changes in peripheral blood flow resistance

A

shock

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76
Q

What causes hypovolemic shock?

A

Hemorrhage, vomiting, or diarrhea

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77
Q

What is progressive shock associated with?

A
  • restlessness and anxiety
  • weakness
  • lethargy
  • pallor with cool and moist skin
  • decreased body temperature
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78
Q

diagnosis

  • fatigue and weakness with minimal exertion
  • DOE
  • pallor or yellow skin of the face, hands, nails, or lips
  • tachycardia
  • bleeding gums, mucus membranes, or skin w/o trauma
  • possible hypoxic damage to the liver and kidney
  • possible heart failure
A

anemia

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79
Q

(true/false) patients with anemia have a normal exercise tolerance.

A

FALSE- decreased tolerance

Use RPE scale and closely monitor vital signs

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80
Q

diagnosis

Group of inherited, autosomal recessive RBC disorders; Hgb and the size and shape of RBCs are abnormal

A

sickle cell disease

Types: HbSS, HbSC, HbS, beta thalassemia, HgSD, HbSE, HbSO

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81
Q

What shape are the RBCs when sickle-cell disease is present?

A

crescent

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82
Q

diagnosis

Hgb is released from the abnormal RBCs into the plasma resulting in decreased oxygen delivery into the tissues

  • results from bone marrow aplasia, hemolysis, folate deficiency, splenic involvement
A

Chronic hemolyic anemia (sickle cell anemia)

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83
Q

What are the s/s of sickle cell crisis?

A
  • pain caused by clots in joints, organs, and/or bone
  • acute abdominal pain from visceral hypoxia
  • swelling in the hands and feet
  • persistent HA
  • dizziness
  • convulsions
  • coma
  • nystagmus
  • chest pain
  • dyspnea
  • coughing
  • tachypnea
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84
Q

definition

rapid drop in hemoglobin levels

A

anemic crisis

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85
Q

definition

characterized by severe anemia associated with acute viral, bacterial, or fungal infection. Results in an increased risk of infection

A

aplastic crisis

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86
Q

What is the MOI of hydrooxyurea?

A

stimulates Hgb production

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87
Q

(heat/cold) therapy is contraindicated with sickle cell anemia.

A

Cold therapy is contraindicated due to vasoconstriction and sickling

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88
Q

What intensity of exercise is most appropriate for a person with sickle cell disease?

A

low to moderate level exercise

High intensity exercise leads to dehydration and may increase the risk of sickle cell crisis

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89
Q

What is hemophilia?

A

bleeding disorders inherited as a sex-linked recessive disorder

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90
Q

Who is commonly diagnosed with hemophilia?

A

affects males

females are carriers

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91
Q

What is the most common clotting factor deficiency?

A

Clotting factor VIII eficiency (hemophilia A)

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92
Q

What is another name for hemophilia B?

A

Christmas disease/clotting factor ix deficiency

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93
Q

What determines the level of severity and rate of spontaneous bleeding in a person with hemophilia?

A

percentage of clotting factor in the blood

94
Q

Where is hemiarthrosis most common?

A

synovial joints

bleeding in the joint

95
Q

What is observed at a joint with hemiarthrosis?

A
  • swelling
  • pain
  • decreased ROM
  • warmth

long-term results:
- chronic synovitis and arthropathy leading to bone and cartilage destruction

96
Q

What are possible complications of hemophilia?

A
  • scoliosis
  • equinus gait
  • lack of knee EXT torque
  • decreased aerobic capacity
  • ADL deficiency
  • LLD
  • muscle weakness
  • contractures (FLX and PF)
97
Q

What are clinical s/s of acute bleeding episodes?

A
  • decreased ROM
  • stiffness
  • pain
  • swelling
  • tenderness
  • heat
  • tingling
98
Q

What PT interventions should be used during the acute stage of hemophilia?

A
  1. RICE (rest, ice, compression, elevation)
  2. prevent deformities
99
Q

Why is passive stretching rarely used in those with hemophilia?

A

Increased risk of myositis ossificans

100
Q

What are the early warning signs of cancer?

A
  • unusual bleeding or discharge
  • lumps
  • sore throat that does not go away
  • B/B disturbance
  • hoarseness/persistent cough
  • ingestion or dysphagia
  • change in size of a wart or mole
  • unexplained weight loss
101
Q

What is the 2nd leading cause of death in the US?

A

cancer

102
Q

definition

Abnormal growth of new tissue that is not functional and competes for vital blood supply and nutrients

A

tumor/neoplasm

103
Q

Where do carcinomas originate?

A

epithelial tissues

Carcinoma in situ is a premalignant neoplasm that has not invaded the basement membrane

104
Q

What do leukemia and myeloma affect?

A

blood (unrestrained growth of WBCs) and blood-forming organs (bone marrow)

105
Q

How does a metastasis spread in the body?

A

lymphatic system or bloodstream

106
Q

What factors are considered when staging cancer?

A

Primary tumor (T)
Regional lymph node involvement (N)
Metastasis (M)

107
Q

What are the stages of cancer?

A

0: carcinoma in situ

1: localized tumor <2 cm; no lymph node involvement

2: locally advanced tumor that is 2-5 cm with or without lymph node involvement

3: Advanced local tumor that has spread to the lymph nodes

4: metastasized tumor

108
Q

What are the cancer grades?

A

1 (Low grade): cells resemble normal cells and are gradually growing

2 (intermediate): cells look abnormal and are faster growing (moderate differentiation)

3 (high grade): cells are abnormal with aggressive growth and spreading (poorly differentiated)

4 (high grade): cancer cells are abnormal (undifferentiated)

109
Q

Cancer can be considered cured if what happens?

A

If the patient does not have a reoccurrence within 5 years after treatment

110
Q

What are local and systemic effects of radiation therapy?

A
  • pain
  • fatigue
  • radiation sickness
  • immunosuppression
  • fibrosis
  • burns
  • delayed wound healing
  • edema
  • hair loss
  • radiation encephalopathy
  • rapid motor weakness (occurs years after therapy)
111
Q

What are the local and systemic effects of chemotherapy?

A
  • fatigue
  • GI disturbance
  • bone marrow suppression
  • rash
  • neuropathy
  • phlebitis
  • hair loss
112
Q

What are the local and systemic effects of immunotherapy?

A
  • fatigue
  • weight loss
  • flu-like symptoms
  • N/V
  • anorexia
  • fluid retention
113
Q

What are the local and systemic effects of hormone therapy?

A
  • GI symptoms
  • HTN
  • steroid-induced diabetes
  • myopathy
  • weight gain
  • hot flashes and sweating
  • altered mental status
  • impotence
114
Q

When examining tumors, pain distal to the tumor may suggest what?

A

metastasis

115
Q

What are the side effects of cancer treatments?

A
  • intense fatigue
  • atrophy and weakness
  • ROM deficit
  • WBC suppression (leukopenia)
  • platelet suppression and increased bleeding (thrombocytopenia)
  • anemia
116
Q

What treatments are appropriate to perform with patients who have significant bony matastases, osteoporosis, or low platelet count?

A
  • AROM
  • ADLs
117
Q

What are contraindications with exercise in patients those who have cancer?

A
  • severe reaction to radiation therapy
  • acute infection or fever
  • severe N/T/D within 24-36 hours after treatment
  • extreme fatigue, muscular weakness, or bone pain
  • chest pain, altered HR, elevated BP
  • swelling in the ankles
  • severe dyspnea, pain with deep breathing, coughing/wheezing
  • dizziness
  • disorientation
  • confusion
  • blurred vision
  • ataxia
118
Q

Those receiving chemotherapy should NOT exercise for how long?

A

At least 24 hours after treatment

119
Q

Cancer patients with low platelets of < _______/mm may experience spontaneous bleeding

A

<10,000

120
Q

Exercise is contraindicated in patients with platelet counts < _____.

A

< 20,000

Use caution with counts between 20,000-50,000

121
Q

(true/false) thermal agents are contraindicated for those with cancer.

A

true

122
Q

(true/false) hydrotherapy is appropriate for a patient with cancer

A

false

123
Q

Do not use (cold/heat) therapy in those who have delayed wound healing

A

cold therapy

124
Q

diagnosis

Individual has a long-term pattern of manipulating, exploiting, or violating the rights of others

often criminal

A

antisocial personality disorder

125
Q

diagnosis

individual has varying moods, impulsive actions, and problems with relationships; may experience intense episodes of anger, depression, and anxiety that can last hours to days

A

borderline personality disorder

126
Q

diagnosis

individual has an inflated sense of their own importance, troubled relationships, a deep need for excessive admiration, and a lack of empathy for others

A

narcissistic personality disorders

127
Q

diagnosis

Individual has feelings of extreme social inhibition and sensitivity to negative criticism and rejection

A

avoidant personality disorder

128
Q

(true/false) onset of PTSD symptoms can be delayed

A

true

129
Q

definition

A type of schizophrenic disorder characterized by mutism or stupor; unresponsiveness; catatonic posturing (unable to move or talk for periods of time; fixed position)

A

catatonia

130
Q

diagnosis

Patient experiences neurological symptoms without evidence of specific neurological disease or other medical condition
- significant loss of function and emotional distress

A

functional neurologic symptom disorder

conversion disorder/functional neurologic syndrome

131
Q

What are the stages of death and dying?

A
  1. denial
  2. anger
  3. bargaining
  4. depression
  5. acceptance and preparation for death
132
Q

What are the stages of grief?

A
  1. shock/disbelief
  2. increased awareness and anguish
  3. mourning
  4. resolution of loss
  5. idealization of lost person or function
133
Q

What does the upper GI tract consist of?

A
  1. mouth
  2. esophagus
  3. stomach

ingestion and intial digestion of food

134
Q

What does the middle GI tract consist of?

A

small intestine (duodenum, jejunum, and ileum)

digestion and absorption of nutrients

135
Q

What does the lower GI tract consist of?

A

Large intestine (cecum, colon, rectum)

absorption of water and electrolytes, storage, and elimination of waste

136
Q

What are the major GI hormones?

A
  1. cholecystokinin
  2. gastrin
  3. secretin
137
Q

What is achalasia?

A

lower esophageal sphincter fails to relax leading to food being trapped in the esophagus

138
Q

What does nausea stimulate?

A

Medullary vomiting center

139
Q

What is obstipation?

A

intractable constipation with resulting fecal impaction or inability to pass gas and retention of hard, dry stools in the rectum and colon.

can cause partial or complete bowel obstruction

140
Q

Where can constipation pain refer to?

A
  • abdomen
  • anterior hip, groin, or thigh
141
Q

Visceral pain from the esophagus can refer to the ______.

A

midback

142
Q

Midthoracic spine pain (nerve root pain) can appear as _______ pain.

A

esophageal pain

143
Q

What organs can have visceral pain referral to the shoulder?

A
  1. liver
  2. diaphragm
  3. pericardium
144
Q

What organs can have visceral pain referral to the midback and scapular regions?

A
  1. gallbladder
  2. stomach
  3. pancreas
  4. small intestine
145
Q

What organs can have visceral pain referral to the pelvis, low back, and/or sacrum?

A
  1. colon
  2. appendix
  3. pelvic viscera
146
Q

What is hepatitis?

A

Inflammation of the liver

can be caused by bacteria or a virus

147
Q

How is hepatitis A transmitted?

A

fecal-oral route

148
Q

(true/false) all forms of hepatitis can be acute or chronic.

A

False-
Hepatitis A is only acute

149
Q

How is hepatitis B transmitted?

A
  1. blood
  2. body fluids
  3. body tissues

through blood transfusion, oral or sexual contact, contaminated needles

150
Q

How is hepatitis C transmitted?

A
  1. blood
  2. body fluids
  3. body tissues

Through blood transfusion, oral or sexual contact, contaminated needles

151
Q

How is hepatitis D transmitted?

A

Dependent upon having hepatitis B
- prognosis is poor and those often have liver failure

152
Q

What are the s/s of the preicteric phase of hepatitis?

Initial stage

A
  • fever
  • anorexia
  • N/V
  • diarrhea
  • fatigue
  • malaise
  • HA
  • abdominal tenderness
  • myalgia
  • arthralgia
153
Q

What are the s/s of the jaundice (icteric) phase of hepatitis in addition to the s/s of the preicteric phase?

A
  • fever
  • jaundice
  • enlarged liver with tenderness
  • amber-colored or dark urine
154
Q

What can chronic hepatitis B and hepatitis C lead to?

A

chronic liver infection

necrosis, cirrhosis, liver failure

155
Q

What is the leading cause of liver cancer and common reason for liver transplants?

A

viral hepatitis

156
Q

diagnosis

Irreversible chronic injury of the hepatic parenchyma as a result of chronic hepatitis

A

cirrhosis

157
Q

diagnosis

  • jaundice
  • peripheral edema
  • dupuytren’s contracture
  • palmar erythema
  • angiomas
  • hepatomegaly
  • splenomegaly
  • ascites
A

cirrhosis

158
Q

What is a late complication of cirrhosis?

A

Hepatic encephalopathy

159
Q

What is asterixis?

A

myoclonus of the hand with the wrist in EXT

“liver flap”

160
Q

What is asterixis a sign of?

A

liver cirrhosis

Why? liver is unable to convert ammonia to urea

161
Q

____ can be used to increase bowel movement and excrete ammonia in the stool

A

lactulose

162
Q

What is cholelithiasis?

A

gallstones

163
Q

What is the treatment for gallstones?

A

often asymptomatic- no treatment needed

164
Q

What can happen if a gallstone blocks the common bile duct?

A

biliary colic

obstruction of biliary tract

165
Q

Where does pain refer to when a gallstone is present?

A

RUQ and right scapula

can worsen after a fatty meal

166
Q

what is cholecystitis?

A

partial or complete obstruction of the common bile duct resulting in inflammation of the gallbladder

167
Q

Where does pain from cholecystitis refer to?

A

Severe pain in the RUQ and radiating to the right scapula

168
Q

Describe the Murphy’s sign.

A

Palpate near right subcostal margin while the patient takes a deep breath

(+) pain elicited

169
Q

A positive murphy’s sign is indicative of what?

A

cholecystitis

170
Q

What pain pattern is formed with acute pancreatitis?

A

Bandlike pain that can radiate to the back

171
Q

What position can aggravate pain caused by acute appendicitis?

A

supine

172
Q

Diagnosis

  • bandlike pain radiating to the back
  • pain aggravated in supine position
  • hypotension
  • tachycardia
  • N/V
A

acute pancreatitis

173
Q

What interventions are used to treat acute pancreatitis?

A
  • IV fluid
  • pain medication
  • NPO order
  • surgery
174
Q

What pain pattern is caused by chronic pancreatitis?

A

epigastic and LUQ pain

175
Q

What are the s/s of chronic pancreatitis?

A
  • anorexia
  • N/V
  • constipation
  • flatulence
  • weight loss
  • greasy stools (steatorrhea)
176
Q

When do symptoms of pancreatic cancer arise? What are they?

A

Once the cancer is more advanced

  • abdominal pain radiating to the back
  • unexplained weight loss
  • jaundice
  • dark urine
  • light-colored stool
  • fatigue
177
Q

What causes GERD?

A

Failure of the lower esophageal sphincter to regulate flow of food from the esophagus into the stomach with an increased gastric pressure

diaphragm and esophageal muscles also contrinute to anti-reflux function

178
Q

Over time, a pH <___ damages the esophagus and causes reflux esophagitis

A

< 4

179
Q

Heartburn caused by GERD commonly occurs when?

A
  1. 30-60 minutes after eating
  2. at night when laying down (nocturnal reflux)
180
Q

What can esophageal pain present as?

A

head, neck, or chest pain

181
Q

What is esophageal pain commonly mistaken as?

A

heart attack

182
Q

What is Barret’s esophagus?

A

damage to lower portion of esophagus

183
Q

What should you avoid during activity when a patient has barret’s esophagus/GERD?

A
  1. supine/declined position
  2. jogging
  3. jumping
  4. any exercise that exacerbates symptoms
184
Q

What medications are used for treatment of GERD?

A
  1. acid-suppressing proton pump inhibitor (PPI) (prilosec)
  2. H2 blockers (famotidine/pepcid)
  3. cimetidine (tagamet)
  4. antacids
185
Q

A rolling hiatal hernia is a protrusion of the stomach through the ______ .

A

diaphragm

186
Q

definition

displacement of both the stomach and gastroesophageal junction into the thorax

A

sliding hiatal hernia

187
Q

Those who have a hiatal hernia can have symptoms of ____.

A

GERD

188
Q

What are s/s of esophageal cancer?

A
  • dysphagia
  • unexplained weight loss
  • chest pain
  • worsening indigestion
  • coughing/hoarseness
189
Q

What is gastritis?

A

inflammation of the stomach mucosa

190
Q

What causes acute gastritis?

A
  • severe burns
  • aspirin/NSAIDS
  • corticosteroids
  • food allergies
  • viral/bacterial infections
191
Q

What are the s/s of acute gastritis?

A
  • N/V
  • anorexia
  • pain
192
Q

What needs to be monitored in patients who are long-term users of NSAIDS?

A
  • stomach pain
  • bleeding
  • n/v
193
Q

What medications are used for treatment of gastritis?

A

Symptom-based
- acid-suppressing PPIs
- H2 blockers
- antacids

194
Q

What is peptic ulcer disease?

A

Ulcerative lesions that occur in the upper GI tract in areas exposed to acid-peptin secretions

Can affect 1 or more layers of the duodenum or stomach

195
Q

diagnosis s/s

  • epigastric pain described as gnawing, burning, or cramping
  • pain aggravated by change in position and absence of food within the stomach
  • relieved with use of antacids or food
A

peptic ulcer disease

196
Q

Where is pain caused by peptic ulcer disease found?

A

presents as radiating back pain that can radiate to the right shoulder

peptic ulcers are found on the posterior wall of the stomach

197
Q

definition

A complex of disorders characterized by problems with intestinal absorption of nutrients

A

malabsorption syndrome

198
Q

What are the possible s/s of malabsorption syndrome?

A
  • anorexia
  • weight loss
  • abdominal bloating
  • pain/cramps
  • indigestion
  • steatorrhea (fatty feces)
  • chronic/excessive diarrhea
199
Q

Malabsorption syndromes can cause iron-deficiency anemia with easy bruising and bleeding due to lack of _______.

A

vitamin K

200
Q

Malabsorption syndromes can cause muscle weakness and fatigue due to lack of what?

A
  1. protein
  2. folic acid
  3. vitamin B
201
Q

Malabsorption syndromes cause bone loss, pain, and increased risk of fractures due to lack of what?

A
  1. vitamin D
  2. calcium
  3. phosphate
202
Q

Malabsorption syndrome can cause neuropathy due to lack of what?

includes tetany, parasthesia, and N/T

A
  1. magnesium
  2. calcium
  3. vitamin B
  4. vitamin D
  5. potassium
203
Q

What are the types of inflammatory bowel disease (IBD)?

A
  1. crohn’s disease
  2. ulcerative colitis
204
Q

What are the symptoms of ulcerative colitis and chron’s disease?

Inflammatory bowel diseases

A
  • abdominal pain
  • frequent diarrhea/fecal urgency
  • weight loss
  • stunted growth in pediatric patients
205
Q

(true/false) Ulcerative colitis and chron’s disease are characterized by remission and exacerbation of bowel inflammation.

A

true

206
Q

Where is pain from UC and CD found?

A

Lower back

207
Q

What are the complications of UC and CD?

A
  • intestinal obstruction
  • corticosteroid toxicity (low bone density, increased Fx risk)
  • nutritional deficiencies
  • Chronic IBD can cause anxiety and depression
208
Q

What are the differences between UC and CD?

A

CD:
- granulomas inflammation that can occur anywhere in the GI tract
- Skip lesions are present (areas of adjacent normal tissue)

UC:
- ulcerative and exudative inflammation of the large intestine and rectum
- Bloody diarrhea, mucus, and pus
- no skip lesions are present

209
Q

What is diverticulosis? What are the symptoms?

A

pouchlike herniations of the colon (especially the sigmoid colon)

  • minimal but can include rectal bleeding
210
Q

What can diverticulosis progress to?

A

diverticulitis

211
Q

What is diverticulitis? What are the symptoms?

A

inflammation of one or more diverticula (pouchlike herniations) of the colon’s mucosal layer – fecal matter penetrates the diverticula and causes inflammation and an abscess

  • pain and cramping in LLQ
  • N/V
  • slight fever
  • elevated WBCs
212
Q

What is noted as appendicitis progresses?

A

becomes swollen, gangrenous, and possibly perforated

213
Q

What happens if the appendix is perforated?

A

Life-threatening and can lead to the development of peritonitis

214
Q

Where is pain located if caused by appendicitis?

A
  • abrupt onset
  • localized in the epigastric or periumbilical areas
  • intensity progresses over time
215
Q

What 6 signs are used for additional testing for appendicitis?

A
  1. Blumberg’s sign (rebound tenderness)
  2. McBurney’s point (point tenderness)
  3. Rozsing’s sign
  4. psoas sign
  5. obturator sign
  6. markle’s sign

Immediate medical attention is needed if any are positive

216
Q

Describe blumberg’s sign

A

Rebound tenderness in response to depression of the abdominal at a site distal to the painful area

217
Q

Describe McBurney’s point.

A

Point tenderness 1/3 of the distance from the ASIS and umbilicus

218
Q

Describe Rovsing’s sign

A

Pain in the RLQ with pressure administered to the LLQ

219
Q

Describe the psoas sign.

A

Pain elicited in the RLQ when the patient is passively put into right hip EXT

220
Q

Describe the obturator sign.

A

RLQ pain with right hip ER and FLX (90 degrees) in addition to knee FLX (90 degrees)

221
Q

What is a (+) psoas sign indicative of?

A

inflammation of peritoneum over the psoas muscle

222
Q

What is a (+) obturator sign indicative of?

A

inflammation of the obturator nerve sheath

223
Q

What is Markle’s sign?

A

Elicited RLQ pain when a patient drops from toes –> heel with an abrupt landing

224
Q

An elevation of WBC count > _______ are indicative of appendix perforation and surgery is indicated

A

> 20,000

225
Q

What is peritonitis?

A

Inflammation of the peritoneum (serous membrane in the abdominal cavity wall)

226
Q
A
227
Q

What causes peritonitis?

A

bacterial invasion and infection of the peritoneum

228
Q

Diagnosis s/s

  • abdominal distention
  • severe abdominal pain
  • rigidity from reflex guarding
  • rebound tenderness
  • decreased or absent bowel sounds
  • N/V
  • tachycardia
  • fever
  • elevated WBCs
  • electrolyte imbalance
  • hypotension
A

peritonitis

229
Q

What can peritonitis lead to?

A
  1. toxemia and shock
  2. circulatory failure
  3. respiratory distress
230
Q

diagnosis

Internal and/or external varicosities in the lower rectum or anus caused by congestion of the veins in the hemorrhoidal plexus

A

hemorrhoids

231
Q

s/s

local pain, irritation, and rectal itching

pain is increased with defecation, constipation, and prolonged sitting

A

hemorrhoids

232
Q

(true/false) Pregnancy increases the risk of hemorrhoids

A

true

NPTE (20 decks)

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