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XIO > Lower GI > Flashcards

Lower GI Flashcards

1
Q

microbiome

A

vitamin K absorption

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2
Q

absorption and reabsorption - how many liters are produced in 24 hours?

A

Saliva, gastric, bile, pancreas, small bowel, all produce GI fluids
7 liters of fluids in 24/hours
All but 100 mL is reabsorbed terminal ileum

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3
Q

crohn’s disease - what side? (lee leans to the right)

A

right

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4
Q

diverticulitis - what side?

A

left

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5
Q

important labs (4, 3, 2)

A

K (at 4), Phos (at 3), mag (at 2)

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6
Q

lactic acid tells us if

A

someone is septic

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7
Q

pre-albumin is

A

recent nutrition

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8
Q

albumin is

A

nutrition over several months

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9
Q

pancreas enzymes

A

amalyse and lypase

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10
Q

ABG tests for

A

lactate

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11
Q

occult blood

A

blood you can’t see, the test is a guiac

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12
Q

barium enema (are clear liquids ok?)

A

pt needs to be able to swallow, but can be given via tube. clear liquids. may give laxatives, enema. if they can’t drink, give liquids IV. make sure barium comes out the other end.

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13
Q

gastroscopy - NPO for how long? And sedation?

A

NPO 6-8 hrs, bowel prep, conscious sedation, aspiration is a risk. ex. endoscopy, EGD. should be totally awake afterwards.

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14
Q

stool

A

FIT, FOBT, iFOBT, C and S, and O & P

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15
Q

constipation

A

Defined as fewer than three bowel movements weekly or bowel movements that are hard, dry, small, or difficult to pass

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16
Q

constipation causes

A

meds, chronic laxative use, immobility, fatigue, can’t increase abdomen pressure, diet, ignoring urge, lack of exercise

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17
Q

perceived constipation

A

subjective, when person’s elimination is not consistent w/ what is believed to be normal

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18
Q

constipation symptoms

A

less than 3 a week, distention and bloating, sensation of not evacuating, straining, small dry stools

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19
Q

cause of chronic constipation

A

usually idiopathic

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20
Q

diagnostics for constipation (constipation is defcon 1)

A

MRI, Defecography and colonic transit studies

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21
Q

constipation complications (constipation/mega)

A

decreased C/O, fecal impaction, hemorrhage, fissures, prolapse, megacolon (abnormal dilation)

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22
Q

types of diarrhea (diarrhea pac)

A

acute, persistent, or chronic

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23
Q

diarrhea causes

A

infections, medications, tube feeding formulas, metabolic and endocrine disorders, and various disease processes

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24
Q

manifestations of diarrhea

A

Increased frequency and fluid content of stools
Abdominal cramps
Distention
Borborygmus (grumbling)
Anorexia and thirst
Painful spasmodic contractions of the anus
Tenesmus (feeling like you need to have a bowel movement)

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25
Q

C.diff

A

About1 in 6 patientswho getC. diffwill get it again in the subsequent 2-8 weeks. One in 11 people over age 65diagnosed with a healthcare-associatedC. diffinfection die within one month.

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26
Q

fecal incontinence - causes

A

anal sphincter weakness, trauma, neuropathies, pelvic floor disorders, CNS disorders, diarrhea, behavioral disorders

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27
Q

gastroparesis (is it painful?)

A

Motor and nerve functions of digestive organs are impaired
Accompanied by pain

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28
Q

gastroparesis - Weakness of stomach

A

muscles cannot fully aid in the digestive process. Delayed stomach emptying.

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29
Q

gastroparesis - causes (paralyzed by diabetes and opioids)

A

DM, electrolyte imbalances (K+, Mg, Ca+), opioids, hypothyroid vagus nerve damage, pancreatitis, scleroderma

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30
Q

gastroparesis - S & Sx (think full)

A

bloating, abdominal distention, early satiety, abdominal pain, vomiting (large pieces undigested food), GERD, malnutrition

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31
Q

treatment for gastroparesis - how long to sit upright? and what type of diet? (slow needs low fiber and low fat)

A

Control N, V, abdominal pain
Nutrition/Diet –low fiber, low fat, soft or liquid with good hydration, MVI to prevent malnutrition, position upright after meals 4-5 hours, eat early in the day

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32
Q

gastroparesis - diagnostics

A

gastric emptying study, antro-duodenal motility study (measures strength of contractions); electrogastrogram (measures electrical voltage of contractions, endoscopy, CT

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33
Q

meds for gastroparesis

A

Promotility medications in liquid form –metoclopramide, domperidone, erythromycin, SQ octreotide

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34
Q

lowe GI bleed - causes - but esp which one?

A

Diverticula
IBD
Crohn’s (some with crohns). UC (especially UC), gastroenteritis
Perianal disorders
Hemorrhoids
Carcinoma
AV malformation

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35
Q

Hemorrhoids - does bleeding hurt?

A

can be internal or external, bleeding is usually painless.

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36
Q

external hemmoroids usually

A

itchy. bleeding is like a streak. some can prolapse during defacation and then back to normal.

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37
Q

hemmoroids treatment

A

cold baths, topicals to shrink, stool softeners, topical nitroglycerin.

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37
Q

hemmoroids treatment

A

cold baths, topicals to shrink, stool softeners, topical nitroglycerin.

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38
Q

Diverticula - type of bleeding (D for dieverticula, D for dark)

A

Diverticula - Sustained dark bleeding

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39
Q

IBD - type of bleeding (I for IBD, I for intermittent)

A

IBD -Intermittent bleeding & frequent BM’s

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40
Q

Perianal disorders - type of bleeding (perianal is bright)

A

BRB per rectum

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41
Q

Cancer - type of bleeding(cancer is the occult)

A

CA - Occult bleeding with intermittent melena

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42
Q

AV malformations - type of bleeding (AVs go either way)

A

AV malformations - Intermittent BRB (bright red blood), dark with clots from cecum

43
Q

perforation - symptoms

A

Symptoms include: severe abdominal pain, cramping, N/V, bleeding, tenderness to palpation, distention, rigidity, fever/chills, change in stool

44
Q

Stomach perforation pain is

A

sudden

45
Q

Colon perforation may come on (colon is slow)

A

more gradually

46
Q

perforation etiologies

A

PUD, forceful vomiting, UC, Crohn’s, diverticulitis, toxic megacolon, strangulated hernia, bowel ischemia, bowel obstruction, abdominal surgery (anastamotic leaks), trauma, foreign body, corrosive substance ingestion, appendicitis

47
Q

2nd most common cause of sepsis

A

peritonitis (#1 cause organ perforation)

48
Q

peritonitis (peri inflames sara)

A

inflammation of the serosal membrane that lines the abdominal cavity

49
Q

peritonitis - causes

A

perforation - bile from perforated gall bladder, liver laceration, gastric acid from perforated ulcer, surgical leak, foreign bodies, ectopic pregnancy, ruptured ovarian cyst or appendix, infected PD catheter or G-J Tube

50
Q

peritonitis - s & sx - early and then later (and what relieves it?) (peri hurts my shoulder)

A

Early vague, diffuse pain, may become sharp and radiate to shoulder; progresses with intensity & is worse with movement, might be slightly relieved with fetal position

51
Q

peritonitis - gold standard for diagnosis

A

CT scan

52
Q

one way to define peritonitis is (peri has a high WBC - what number)

A

WBCs >500 with peritoneal lavage

53
Q

peritonitis - interventions

A

Minimize complications-hypoxia, shock, AKI/ARF, sepsis, acidosis
Supplemental oxygen
Bowel rest
NPO, NGT suction (low to continous suction)
Maintain FEN/Acid-base balance
IV hydration
Electrolyte additives/replacements
Caloric supplementation (PPN, TPN)

54
Q

peritonitis surgeries

A

Exploratory lap, open lavage, I & D abscess, lysis of adhesions, resections of tumors or c=necrosis, temporary or permanent fecal diversions, drains

55
Q

peritonitis - post op

A

ABC
Prevent pulmonary complications, dehydration and malnutrition
Positioning, oxygen, pulmonary toilet, mobility
Identify infection early, antibiotics
Hydration
Acid-base/FEN
Wound drainage/management (tubes, drains, positioning)
Pain/anxiety management (motility compromise)
Maintain mobility

56
Q

sepsis - what is the mortality rate? (not quite 50)

A

distributive shock, 30% mortality. 50% of survivors have post-sepsis syndrom.

57
Q

sepsis shock

A

Inadequate vessel tone
Blood pressure is a function of cardiac output and systemic vascular resistance (SVR).
If SVR decreases from vasodilation, blood pressure decreases.
Massive vasodilation can occur from loss of sympathetic nervous system function or chemicals released within the body.
Bacteria and toxins in the blood lead to vasodilation and increased capillary permeability.
Treatment includes vasoconstriction and volume restoration.

58
Q

post sepsis syndrome - causes

A

Causes of PSS
DIC, decreased CO, amputations, ARDS, pulmonary edema, ATN/ARI, liver

59
Q

post sepsis syndrome - symptoms (like ptsd)

A

Both physical and psychological long-term effects
Sleep pattern disturbances, nightmares, hallucinations, panic attacks, PTSD
Disabling muscle or joint pain
Difficulty concentration, decreased cognitive ability
Loss of self esteem, depression
Hair loss
Chronic fatigue
High risk for viral respiratory infections

60
Q

IBS - more common in men or women?

A

2x more in women

61
Q

IBS triggers (not so much foods)

A

chronic stress, sleep deprivation, surgery, infections, diverticulitis, and some foods

62
Q

IBS manifestions (IB bloated)

A

Alteration in bowel patterns
Pain
Bloating
Abdominal distention

63
Q

IBS diagnostics

A

Stool studies
Contrast radiography studies
Proctoscopy
Barium enema
Colonoscopy
Manometry
Electromyography

64
Q

malabsorption - conditions

A

Mucosal (transport) disorders
Infectious disease
Luminal disorders
Postoperative malabsorption
Disorders that cause malabsorption of specific nutrients

65
Q

malabsorption manifestations

A

Symptoms similar to irritable bowel syndrome
Manifested by weight loss and vitamin and mineral deficiency

66
Q

gluten is found in

A

Gluten is most commonly found in wheat, barley, rye, and other grains malt, dextrin, and brewer’s yeast.

67
Q

celiac can lead to (Celia and hashi are friends)

A

hashimotos

68
Q

celiac disease - manifestations

A

Diarrhea
Steatorrhea
Abdominal pain
Abdominal distention
Flatulence
Weight loss

69
Q

inflammatory bowel disease - 2 types

A

UC and Crohns

70
Q

UC - where is it located? (U see it’s just large)

A

Ulcerative IBD that is just in the large intestines

71
Q

crohns - inflammation where? and where is it found? (Crohn’s hangs out w/ illeana)

A

Also called regional enteritis
Inflammation and erosion of the ileum
Can be found throughout the GI tract and anywhere

72
Q

S/Sx of IBD (IB rebound cheese w/ anemia)

A

N, V D
Weight loss
Cramping
Rectal bleeding
Dehydration
Hematochezia
Anemia
Fever
Rebound tenderness

73
Q

can UC be cured?

A

yes, removal of part of colon

74
Q

can Crohn’s be cured?

A

no

75
Q

more bleeding with UC or crohns?

A

UC

76
Q

IBD treatment (nothing really)

A

Hydration
Pain control
Diet
Correct anemia
Education
Support

77
Q

IBD meds

A

Antidiarrheals (Only given with mildly symptomatic UC)
Antibiotics
Sulfonamides (for Peritonitis)
Steroids (To decrease inflammation)
Immune system suppressors
Potentiate the effects of corticosteroids
6 mercaptopurine & azathioprine

78
Q

IBD - Immune system suppressors

A

Potentiate the effects of corticosteroids
6 mercaptopurine & azathioprine

79
Q

IBD meds (IB ending in mab)

A

Bind to TNF
Remicade (infliximab) & Humira (adalimab), Stelara (ustekinumab)

80
Q

Diverticular Disorders - what part of colon? (sigfried descends on his dive)

A

Major cause of lower GI bleed
Diverticula are small herniations in the bowel wall caused by weakness in sigmoid or descending colon

81
Q

dDiverticular Disorders - risk factors (just 2 things) (ol and constipated is the big d)

A

> 60 years, constipation

82
Q

Diverticular Disorders - complications

A

Diverticulitis
inflammation/infection
Obstruction, rupture
Bleeding, perforation
Intra-abdominal abscess
Adhesions, fistulas

83
Q

divertula - treatment (divers need fiber)

A

keep things moving, give fiber, exercise

84
Q

diverticulitis - what to eat? (dive softly w/ food)

A

soft diet, avoid inflammation

85
Q

diverticular disorders - pathos

A

herniation of colonic mucosa.. outpouchings form..fecal material trapped…microperforation…contamination of surrounding tissues…inflammatory response…abscess formation… may erode vessels… bleeding…perforation

86
Q

diverticular disorders - S/Sx - where is the pain? (Dive to the left, it’s worse after you eat)

A

flares/remissions; constipation, diarrhea, flatulence; pain is acute, LLQ, and worst after meals; relieved with BM; rectal bleeding; fever/chills

87
Q

diverticular disorders - diagnostics (dive cutie)

A

history/physical, CT, abdominal ultrasound, CBC with diff

88
Q

diverticular disorders - prevention - fiber good or bad?

A

Prevention
High fiber diet, increase bulk of stools with colloid laxative During “flare”: AVOID high fiber. Pain management (anticholenergics; minimize opiates
ABX
Bowel rest from clears for 48 hours to NPO and IV hydration

89
Q

diverticular disorders - surgeries (drain the pool before diving)

A

abscess drainage, resections, temporary fecal diversion, repair/manage fistulas, relieve obstructions

90
Q

Acute paralytic ileus (adynamic ileus)

A

results from loss of intestinal peristalsis

91
Q

Acute paralytic ileus (don’t touch a cute illeana)

A

Causes: handling of the bowel during surgery, trauma, electrolyte disturbances, intestinal ischemia, infections, peritonitis, sepsis, toxic metabolic conditions, pain, spinal cord trauma/lesions and medications that decrease gastric motility

92
Q

Ogilvie’s syndrome (olga is dilated)

A

Massive dilation
NO peristalsis

93
Q

illeus - s/sx

A

Pain, dehydration, vomiting (not prominent), abdominal distention & tenderness, hiccoughs, decreased/absent bowel sounds, no flatus/stool

94
Q

illeus - complications

A

Obstruction, delay/inability to ingest food/fluids, pain, delayed healing, peritonitis

95
Q

illeus - does it resolve on its own? (Illeana helps herself)

A

Usually self limiting (2-3 days)
Correct underlying cause
Bowel rest (NPO, NGT LC/I WS (wall suction) fluids
Increase mobility (ambulate)
Increase GI motility (warm, medications, guided imagery and other integrative approaches
Wean from opioids or oral naloxone

96
Q

intestinal bowel obstruction - what about the kidneys?

A

Partial or complete
Mechanical
Non-Mechanical
Vascular
If unresolved can lead to AKI d/t 3rd spacing, hypovolemia; bowel perforations, bowel ischemia/infarction, `peritonitis, sepsis, death

97
Q

most bowel obstructions occur in

A

the small intestines

98
Q

bowel obstruction

A

Distention of gas and fluid occurs proximal to the distention.Trapped fluid and electrolytes leak out into the peritoneal cavity. inflammation causes na to get stuck. strangulation, perforation or cardiovascular collapse are are worst case scenarios.

99
Q

bowel obstruction - fluid replacement

A

keep them euvolemic (equal fluids)

100
Q

bowel obstruction - risks

A

Motility problems
Elderly
Postoperative
Bedridden
Multisystem dysfunction
Multiple abdominal or bowel surgeries
adhesions

101
Q

bowel obstruction - treatments

A

FLUIDS
Isotonic
NPO
NGT
I & O
Antibiotics for strangulation
Surgical consultation
KUB
Abdominal CT

102
Q

gastroparesis - who is at risk?

A

Patient with diabetes, surgical anastamoses and certain viral conditionsp are at greatest risk for developing gastroparesis

103
Q

peritonitis - hypo or hypervolemia? any distention? (you’ve lost the fluid, so…)

A

Abdominal distention, A/N/V decreased bowel sounds
Dehydration/hypovolemia (HR up, BP down) with hemoconcentration (elevated HCT, Na+, BUN)
Acidosis, elevated WBC
Fever, chills
Free air on KUB, CT with perforation

104
Q

gastroparesis symptoms (full and paralyzed)

A

Patients report feeling full and tired, nauseated and often vomit

XIO (372 decks)

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