INFLAMMATORY DISORDERS Flashcards
inflammation of mucosal lining of stomach
gastritis
inflammation and erosion of mucosal lining of the stomach, esophagus, and duodenum
peptic ulcer disease
what bacteria may cause PUD?`
helicobacter pylori
what drug can inc. production of HCl acid?
steroids
what drugs can decrease prostaglandin synthesis in the stomach?
aspirin and NSAIDS
protective barrier of stomach
prostaglandin and mucus
stress ulcer that occurs in burn patients
curling’s ulcer
stress ulcer that occurs in stroke patients
cushing’s ulcer
a tumor that may cause increase production of HCl acid leading to PUD or gastritis
gastrinoma/zollinger-ellison syndrome
what chemicals can cause chronic gastritis if you’re exposed to it?
nickel and lead
which condition does gastritis have in common in regards to their clinical manifestation related to pain?
gastric ulcer
pain occurs after meals
gastritis/gastric ulcer
pain occurs 2 hours after meals
duodenal ulcer
this condition is relieved by vomiting
gastritis/gastric ulcer
this condition is relieved by eating
duodenal ulcer
what manifestation related to weight do you see in patients with duodenal ulcer?
weight gain
what manifestation related to weight do you see in patients with gastritis and gastric ulcer?
weight loss
why does the pain of gastritis and gastric ulcer happens after meals?
because food increases release of HCl acid in the stomach
why does the pain of duodenal ulcer happens 2 hrs after meals?
because pyloric sphincter opens 2 hrs after meals due to gastric emptying time = acid goes into duodenum
patients with this type of ulcer has pain at night due to continuous gastric emptying time
duodenal ulcer
most common complication of gastritis and PUD
bleeding
this is a complication of PUD when ulcer completely erodes the mucosa of the stomach
perforation
this can happen due to perforation caused by PUD
peritonitis
s/sx of peritonitis
rigid, board-like abdomen, (-) bowel sound
most definitive dx test for gastritis/PUD
endoscopy
this can be a diagnostic test for PUD where you will test for blood in the stool
guaiac test/FOBT
a drug that can help to coat the ulcer called cytoprotective drugs
sucralfate
when should you administer sucralfate?
before meals
removal of vagus nerve supply of stomach
vagotomy
a procedure where pylorus is being widened
pyloroplasty
complication of pyloroplasty
rapid gastric emptying time
a procedure where the stomach and small intestine is being bypassed
gastroenterectomy
this procedure directly connects the remaining of the stomach into duodenum
billroth I or gastroduodenostomy
this procedure have the distal stomach removed, but instead of reconnecting to the duodenum, it is attached to the jejunum (second part of the small intestine)
billroth II or gastrojejunostomy
why is pernicious anemia a complication of stomach surgery?
because stomach produces intrinsic factor that absorbs vit. B12 in the small intestine
another complication of stomach cancer wherein food moves too quickly from the stomach into the small intestine, causing a shift in fluid and triggering various symptoms
dumping syndrome
why is consuming moderate fat advisable to prevent dumping syndrome?
because fat slows down gastric motility
anti-spasmodic drug that dec. motility
buscopan
this condition make the intestines to have a cobblestone appearance
Crohn’s disease
another term for crohn’s disease
regional enteritis
which part of the intestines does ulcerative colitis affect?
large intestine
which part of the intestines does crohn’s disease affect?
small intestines
a non-inflammatory disease that is a risk factor for developing ulcerative colitis
IBS
common risk factor of IBD
autoimmune
where does the inflammation starts at crohn’s disease?
terminal ileum
where does the inflammation starts at ulcerative colitis?
rectum
stool characteristic and frequency in crohn’s
5 to 6 soft stools per day, rarely bloody
stool characteristic and frequency in ulcerative colitis
10 to 20 bloody stools/day
where is the pain located in crohn’s disease?
RLQ
where is the pain located in ulcerative colitis?
LLQ
persistent feeling that you need to have a bowel movement, even though your bowels are empty
tenesmus
what can you see in the imaging tests in ulcerative colitis?
ulcers in the intestine
drug used to relieve the pain in IBD
salicylates
this is used in IBD to reduce inflammation
steroids
surgery for crohn’s disease where ileum is removed
ileal resection
surgery for ulcerative colitis when colon is resected
colostomy
where is the appendix located?
ileocecal junction; between ileum and cecum
etiology of appendicitis
fecalith
inflammation of the vermiform appendix
appendicitis
how does fecalith causes appendicits?
fecalith compromises blood flow to the appendix which may cause ischemia and injury leading to inflammation of the appendix
where is the most common site of pain of appendicitis?
RLQ and epigastric
what do you call an abdominal assessment where deep palpation causes pain in RLQ and sudden withdrawal of the palpation causes more pain in the RLQ?
+ blumberg’s sign/rebound tenderness
what is an abdominal assessment where pain in the RLQ is caused by deep palpation in the LLQ?
+ rovsing’s sign
what is an abdominal assessment where you place the patient in a supine position and flexing the right hip and knee and rotating it will cause pain in the RLQ?
+ obturator sign
what is an abdominal assessment where you place the patient in a supine position and flexing the right hip with knee extended will cause pain in the RLQ?
+ psoas sign
most definitive dx test for appendicitis
CT scan
non-pharmaceutical intervention that we can do to alleviate the pain in appendicitis
cold compress over abdomen
why do we avoid placing hot compress over abdomen when a patient is suspected of appendicits?
because the appendix may rupture
what drug should we avoid to administer to prevent rupture of the appendix?
laxative
what procedure is being avoided to prevent rupture of appendix?
enema
in what position can we instruct the patient with appendicitis to relieve the pain?
side lying knee chest position
inflammation of diverticulum/diverticula
diverticulitis
outpouching, sac-like formation in wall of colon
diverticulum
presence of several diverticula
diverticulosis
common risk factor of diverticulosis
constipation
may cause increase pressure in the colon causing diverticula to form
why do elderly is most at risk in having diverticulosis?
they have weakened muscle in colon causing distention
s/sx of diverticulosis
asymptomatic
how are diverticulosis diagnosed?
incidental findings
most common etiology of diverticulitis
infection
why is infection common cause of diverticulitis?
colon are full of bacteria that may proliferate in the outpouching
where is the pain of diverticulitis?
LLQ
most definitive test for diverticulitis
CT scan
what diet is best for patients with diverticulitis?
high fiber diet
when is surgery considered in managing diverticulitis?
when there is already an obstruction and abscess formation
inflammation of the gallbladder
cholecystitis
other term for gallstones
cholelithiasis
most common cause of cholecystitis
gallstones
what color is pigment stone?
green
what color is cholesterol stone?
yellow
risk factors of cholecystitis
4Fs: fat, female, forty y/o and above, fertile
where is bile being stored and concentrated?
gallbladder
what can be formed due to supersaturation of bile?
stone
formed due to supersaturation of cholesterol
cholesterol stone
formed due to supersaturation of bile
pigment stone
location of pain in cholecystitis
RUQ
patient supine -> palpate on RUQ -> stop inspiration due to pain
+ murphy’s sign
how does gallstone cause inflammation of the gallbladder?
stone causes irritation of the wall which may cause injury every time the gallbladder contracts when a person eats fatty food
what do you call a stone in the common bile duct?
choledocholithiasis
complications of cholecystitis
ascending cholangitis and septic shock
how does ascending cholangitis happens?
bacteria in duodenum ascend in the common bile duct making it infected
what s/sx does the charcot’s triad have?
fever, RUQ pain, jaundice
what s/sx does the reynold’s pentad have?
fever, jaundice, RUQ pain, hypotension, altered LOC: confusion
you may suspect choledocholithiasis if a patient’s stool is:
gray-colored
what do you call the gray-colored stool in a patient who has choledocholithiasis?
acholic stool
how long will be the drug therapy to remove gallstones?
6 to 12 months
what are the drugs that is used in dissolving cholelithiasis?
chenodeoxycholic acid and ursodeoxycholic acid
what do you call the procedure where you can pulverize gallstone?
lithothripsy
removal of the gallbladder
cholecystectomy
in open chole, where is the incision?
subcostal area
nursing consideration regarding respiratory function post-open cholecystectomy
splint while breathing
how many ml of bile should be draining in the t-tube drain on the first 24 hrs?
500-750 ml
this is done to prevent pressure on the sutures after cholecystectomy
t-tube drain
if there is no bile in the t-tube drain on the first 24 hrs, what should you do?
assess for jaundice and refer
complication that may happen if you do not insert t-tube drain after cholecystectomy
peritonitis
inflammation of the pancreas
pancreatitis
why does patients with pancreatitis at most risk for FVD?
they are put on NPO to prevent/manage an attack
most common cause of pancreatitis
gallstone obstruction in pancreatic duct
choledocholithiasis may enter the pancreatic duct as these two ducts meet the ampulla of vater to enter the duodenum
risk factors for pancreatitis
alcohol, fatty meal, obesity
how does pancreatitis develops?
autodigestion
if there is an obstruction in the pancreatic duct, enzymes will backflow to the pancreas that can digest the pancreatic tissue causing injury
pain location of pancreatitis
LUQ
other books - pain radiating to back, left flank, left shoulder area
most definitive dx test for pancreatitis
elevated serum levels of lipases and amylases
lipase and amylase leak into bloodstream due to pancreatic cell damage
primary management in pancreatitis
NPO
pain reliever DOC in acute pancreatitis
meperidine demerol - morphine can cause spasm of sphincter of oddi
morphine - less adverse effect; meperidine is neurotoxic
hematoma in umbilical area that happens in pancreatitis when BV bursts
cullen’s sign
hematoma in flank area that happens in pancreatitis when BV bursts
grey turner’s sign
TPN can be given to patients with pancreatitis whose on NPO, what are the possible complications?
fluid overload, hypernatremia, hyperglycemia, infection
what electrolyte imbalance does pancreatitis cause?
hypocalcemia
how would you know that acute pancreatitis is resolving?
serum levels of enzymes are decreasing
goals in managing chronic pancreatitis
prevent an attack, manage an attack, manage complications
why is DM a complication of chronic pancreatitis?
beta cells are also destroyed
management of steatorrhea as complication of chronic pancreatitis
pancrealipase w/ meals
fat in stool
steatorrhea
pain reliever of choice for chronic pancreatitis
non-narcotics
diet for pancreatitis
low fat, high carb, high protein
