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MS 2 > LOWER GI > Flashcards

LOWER GI Flashcards

1
Q

Also known as surgical Abdomen

A

Acute Abdomen

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2
Q

Sudden onset of abdominal pain without traumatic etiology and requires swift surgical intervention to prevent peritonitis, sepsis, and septic shock.

A

Acute Abdomen

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3
Q

is the inflammation of the appendix

A

Appendicitis

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4
Q

Obstruction of the appendix is caused by

A

-Fecalith
- Foreign bodies
- Infection

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5
Q

Presenting symptom of appendicitis

A

Abdominal Pain

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6
Q

What is the location or the localized pain of appendicitis?

A

Right Lower Quadrant

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7
Q

Clinical Manifestation of Appendicitis

A

-Presenting symptom (abdominal pain that eventually becomes localized to RLQ
-Anorexia, nausea and vomiting
- Decreased or absent bowel sounds
- High grade fever: 38C-38.5C
- Rigid abdomen, guarding behavior

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8
Q

Patient on left side-lying. Extended right leg is gently pulled back

A

Eliciting the Psoas Sign

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9
Q

Patient is on supine. Right hip and knee flexed at 90⁰. Gently rotate thigh towards the midline

A

Eliciting the Obturator Sign

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10
Q

What are the physical exam findings that indicate appendicitis?

A

(+) Mcburney’s Sign
(+) Rovsing’s sign
(+) Psoas sign
(+) Obturator sign

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10
Q

rebound tenderness on RLQ

A

McBurney’s Sign

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11
Q

RLQ pain upon deep palpation of LLQ

A

(+) Rovsing’s sign

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12
Q

Pain on passive extension of the right thigh

A

(+) Psoas Sign

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13
Q

Pain on passive internal rotation of the flexed thigh

A

(+) Obturator Sign

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14
Q

-Sudden relief of abdominal pain followed by severe pain
- Abdominal rigidity
-Leukocytosis (WBC > 20,000/mm3)

A

Perforated Appendix

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15
Q

-Fever
-Rigid Abdomen
- Early signs of shock (hypotension, tachycardia)

A

Peritonitis

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16
Q

First Line Medical Surgical Management of Appendicitis

A

Conservative Medical management

-Antibiotic therapy, as ordered
- Decrease peristalsis to prevent rupture
-Bed rest
-Maintain NPO
-Avoid factors that increase peristalsis
- Hot compress over abdomen
-Laxatives
-Enema

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17
Q

Second-line management of appendicitis

A

Surgical Management

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18
Q

Surgical removal of the appendix by laparotomy or laparoscopy

A

Appendectomy

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19
Q

For acute uncomplicated appendicitis

A

Laparoscopic appendectomy

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20
Q

for ruptured appendicits

A

Open appendectomy

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21
Q

What is the method of anesthesia for surgical management of Appendicitis?

A

Spinal

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22
Q

Pre-Op of Appendectomy

A

-Facilitate signing of consent form
-Start IV line and pre-op antibiotics, as ordered
-Transport to OR ASAP

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23
Q

Post-Op Nursing Care of Appendicitis

A

-Flat on bed 6 to 8 hours post op to prevent spinal headache
-Monitor return of sensation in the lower extremities
-Facilitate early ambulation (Day 0- day of surgery)

-Post op position: HIGH- FOWLERS to reduce tension on incision and abdominal organs
-DAT if bowel sounds are present
-Facilitate wound care and monitor surgical site for signs of infection
-Administer antibiotics, as ordered

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24
Q

What is the type of surgical drain when ruptured?

A

Penrose Drain

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25
Q

Discharge Instructions of Appendectomy

A

-Wound care
-Instruct to avoid heavy lifting post op, but can resume normal activity within 2 to 4 weeks
-Instruct on take home meds (i.e., antibiotics, analgesics

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26
Q

Saclike herniation of the lining of the bowel that extends through a defect in the muscle layer

A

Diverticulum

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27
Q

presence of multiple diverticula without inflammation or symptoms

A

Diverticulosis

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28
Q

a diverticulum that becomes inflamed, causing perforation and potential complications

A

Diverticulitis

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29
Q

Risk factors of Diverticular Diseases

A

-Increasing Age
- Low fiber Diet
- Obesity
- Family History
-Smoking

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30
Q

Clinical Manifestations of Diverticulosis

A

Asymptomatic

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31
Q

Clinical Manifestation of Diverticulitis

A

C- chronic constipation
A- Anorexia
N- Nausea
A- Abdominal Pain (LLQ)
L- Low-grade Fever

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32
Q

Diagnostic in Diverticular Disease

  • Screening test
  • Permits visualization of the extent of diverticular disease
A

Colonoscopy

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33
Q

Confirmatory test of Diagnostic of Diverticular Disease

A

Abdominal CT Scan w/contrast

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34
Q

Localized pericolic or mesenteric abscess

A

Stage 1

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35
Q

Walled- off pelvic, intra-abdominal, or retroperitoneal abscess

A

Stage 2

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36
Q

Generalized purulent peritonitis

A

Stage 3

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37
Q

Generalized fecal peritonitis

A

Stage 4

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38
Q

-Outpatient treatment
-Rest, oral fluids, analgesic
-Clear liquid diet until inflammation subsides; then a high- fiber, low fat diet

A

Stage 1

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39
Q

Stage 2 in Medical-Surgical Management (Diverticular Diseases)

A

-May require hospitalization
-NPO
-Nasogastric decompression if with vomiting or abdominal distention
-IV fluids, as prescribed
-Broad-spectrum antibiotics, as ordered
-DOC: Ampicillin- sulbactam (Unasyn)
-Analgesics, as ordered
DOC: Oxycodone – does not cause constipation

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40
Q

Surgical resection of the colon with anastomosis

A

Hartmann Procedure

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41
Q

Hartmann Procedure

The inflamed area is removed and a primary end-to- end anastomosis is completed

A

One-stage resection

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42
Q

Used for diverticulitis with complications

A

Multi-stage Resection

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43
Q

Nursing Care of Patients with Diverticulosis

A

-Promote lifestyle modification
-High- fiber diet
-Encourage an individualized exercise program
-Smoking cessation

Prevent increase in intraabdominal pressure
-Bulk- forming laxatives, as ordered
-DOC: Psyllium fiber
-Liberal fluid intake of 2,000
mL/day

-Avoid nuts and seeds (sesame seeds, cucumber, tomatoes, popcorn)

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44
Q

exists when a blockage prevents the normal flow of intestinal contents through the intestinal tract

A

Intestinal Obstruction

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45
Q

Obstruction is due to narrowing of intestinal lumen

A

Mechanical Obstruction

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46
Q

-Most common cause: surgical adhesions

-Other causes: hernia, Chron’s disease, volvulus, tumor

A

Mechanical Obstruction

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47
Q

Obstruction is due to failure of the intestinal musculature to propel its contents

A

Functional Obstruction

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48
Q

-Most common cause: paralytic ileus

-Other causes: hypokalemia, cervical/thoracic/lumbar spinal cord injury

A

Functional Obstruction

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49
Q

The obstruction occurs anywhere along the small intestine

A

Small Bowel Obstruction (SBO)

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50
Q

Clinical Manifestations of Small Bowel Obstruction

A

C- Cramp-like Abdominal Pain
A- Absent flatus/stool, only mucus
R- Reflux vomiting
D- Dehydration (thirst, weakness, dry mucous membranes)

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51
Q

Medical Management of Intestinal Obstruction

A

-Rest the bowel
- Nasogastric decompression x 3 days
-IV fluids
-Treat reversible underlying cause
-Potassium replacement, f with hypokalemic
- Anti-inflammatory drugs, if with chron’s disease

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52
Q

Herniorrhaphy

A

Hernia

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53
Q

Adhesiolysis

A

Adhesions

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54
Q

Tumor Resection

A

Tumor

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55
Q

The obstruction occurs anywhere along the large intestine

A

Large Bowel Obstruction

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56
Q

Clinical Manifestations of Large Bowel Obstruction

A

S-Slow onset of symptoms
C- Constipation
U- Unusual stool shape
B- Bleeding
A- Abdominal Distention (Late)

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57
Q

Performed to untwist and decompress the bowel

A

Colonoscopy

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58
Q

Surgical opening into the cecum for patients who are poor surgical risks; provides an outlet for releasing gas and a small amount of drainage

A

Cecostomy

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59
Q

In both types of Obstruction, what we need to watch out for?

A

Watch out for:

-Discrepancies in I & O
- Worsening of pain or distention
-Increased NG output

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60
Q

Is the inflammation of the peritoneum (serous membrane lining the abdominal cavity)

A

Peritonitis

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61
Q

What causes peritonitis?

A

-Bacterial Etiology (E.coli, Klebsiella)
- Fungal Etiology
- External Causes:
-Abdominal Surgery
- Abdominal Trauma (Gun Shot Wound, stab wound)

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62
Q

A transparent membrane that covers the abdominal organs

A

Peritoneum

63
Q

Clinical Manifestations of Peritonitis

A

T- Temperature Elevation
A- Abdominal pain (Severe)
L- Loss of Appetite
E- Early signs of shock
R- Rigid, board-like abdomen

64
Q

Medical Management of Peritonitis

A

-Oxygen supplementation
-IV fluid replacement (use large-bore IV cath)
-Isotonic Fluids: PNSS/PLR
- Broad- spectrum antibiotics, as ordered

-Decrease GI stimulation
-NPO
-Nasoenteric tube insertion and decompression
-Bed rest in semi- Fowlers

-Symptomatic treatment:
-Analgesics for pain
-Anti-emetics for n&v
-Encourage DBE to prevent respiratory complications

65
Q

What needs to be closely monitor when patient is having a peritonitis?

A

Closely monitor the patient’s VS as he/she may decompensate anytime

66
Q

Vital signs must be monitored for how many minutes?

A

5 minutes using electrocardiac monitor

67
Q

Diarrhea, constipation, or both may be the main manifestation

A

Irritable Bowel Syndrome

68
Q

Affects women greater than men

A

Irritable Bowel Syndrome

69
Q

Age at time of diagnosis is less than 45 years old

A

Irritable Bowel Syndrome

70
Q

Diarrhea is the only main manifestation

A

Inflammatory Bowel Disease

71
Q

Affects women = men

A

Inflammatory Bowel Disease

72
Q

Age at time of diagnosis is greater than 30 years old

A

Inflammatory Bowel Disease

72
Q

Triggers of Irritable Bowel Syndrome

A

-Chronic Stress
-Sleep Deprivation
- Surgery
- Infections
- Diverticulitis
- Food (milk,yeast products, eggs, wheal products, red meat)

72
Q

IBS type where main symptom is constipation

A

IBS- C

73
Q

IBS type where the main symptom is diarrhea

A

IBS- D

74
Q

IBS type where the main symptom is a combination of constipation and diarrhea

A

IBS-M

75
Q

What is the associated symptoms of Irritable Bowel Syndrome

A

-Abdominal Pain which is precipitated by eating and relieved by defecation

-Bloating and distention

76
Q

A diagnostic that is used to describe the shape and types of stool

A

Bristol Stool Chart

77
Q

What are the types of bristol stool chart that cause constipation?

A

Type 1 and 2

78
Q

What are the types of bristol stool chart that indicates Ideal Stool Forms

A

Type 3 and Type 4

79
Q

Type of Bristol Stool Chart that indicates Diarrhea

A

Type 5, 6, 7

80
Q

Irritable Bowel Syndrome

What drugs will you administer if diarrhea occurs?

A
  • Loperamide (Diatabs)
  • Alosetron (Lotronex): for severe IBS- D that persists for at least 6 months and is unresponsive to therapies
81
Q

What are the symptoms of Irritable Bowel Syndrome

A

-Diarrhea
- Constipation
- Abdominal bloating and gas
- Abdominal pain

82
Q

Irritable Bowel Syndrome

What drugs will you administer if constipation occurs?

A

-Psyllium fiber

83
Q

Irritable Bowel Syndrome

What drugs will you administer if abdominal bloating and gas occurs?

A

-Probiotics (Lactobacillus)

84
Q

Irritable Bowel Syndrome

What drugs will you administer if abdominal pain occurs?

A

-Dicyclomine

85
Q

Nursing Management of Irritable Bowel Syndrome

A

Lifestyle Modification

  • Emphasize and reinforce good sleep habits and good dietary habits
    -Encourage to eat at regular times and to avoid food triggers
    -Do not take fluid with meals as this may result to bloating
    -Encourage smoking cessation and avoidance of alcoholic beverages
86
Q

Risk factors of Inflammatory Bowel Disease (Environmental Exposures)

A

-Antibiotic use/abuse
- Hygiene Hypothesis
- Western Diet: highly processed/fast foods
- Cigarette smoking- increased risk for chron’s
- Smoking cessation- increased risk for UC
- Oral contraceptives
- NSAIDS
-Lack of Vitamin D
- Air Pollution
- Urban Residence
- Temperate climate

87
Q

What are the Layers of Intestinal Wall?

A

-Serosa
- Muscularis externa
- Submucosa
- Mucosa

88
Q

is the subacute and chronic inflammation of the GI tract wall that extends through all the layers

A

Chron’s Disease

89
Q

Classifications of Chron’s Disease

A

R- Regional Enteritis
R- Right side (Distal Ileum and ascending colon)
R- Remission and exacerbation

90
Q

Clinical manifestations of Chron’s Disease

A

C-Cobblestone Appearance
D- Diarrhea
RLQ Pain
-Crampy
- Occurs after meals
- Unrelieved by defecation
A- Avoidance behavior: avoids intake of food
W- Weight loss, malnutrition, anemia
S- String sign seen in barium studies

91
Q

Indicates constriction of a segment of the intestine

A

String sign

92
Q

Ulceration and inflammation of mucosal and submucosal layer

A

Ulcerative Colitis

93
Q

Inflammatory changes begin in the rectum and progresses proximally into the colon

A

Ulcerative Colitis

94
Q

Unpredictable periods of remission and exacerbation

A

Ulcerative Colities

95
Q

Clinical Manifestations of Ulcerative Colitis

A

B- Bloody or purulent diarrhea
E- Elevated temperature
L- Left lower quadrant pain
A- Anorexia, weight loss, dehydration
T- Tenesmus (Intermittent)

96
Q

Age of Onsets Jey differences of Chron’s Disease and Ulcerative Colitis

A

Chron’s Disease (20 to 29 years old)

Ulcerative Colitis (15 to 30 years)

97
Q

Site of Onset key differences of Chron’s disease and Ulcerative Colitis

A

Chron’s Disease (Distal ileum and/or cecum)

Ulcerative Colitis (Rectum)

98
Q

Progression Differences of Chron’s Disease and Ulcerative Colitis

A

Chron’s Disease (Distally, but some areas of the colon are skipped)

Ulcerative Colitis (Proximally and mat affect entire length of colon)

99
Q

Layers involved differences in chron’s disease and ulcerative colitis

A

chron’s disease (transmural)- affect all parts of intestinal wall

Ulcerative Colitis (left lower quadrant)

100
Q

Severity of Diarrhea Differences of Chron’s disease and Ulcerative Colitis

A

Chron’s Disease (Less severe, may involve steatorrhea)

Ulcerative Colitis (Severe and may be bloody)

101
Q

What is the treatment of medication for Ulcerative Colitis?

A

Aminosalicylates

102
Q

The drugs of Aminosalicylates

A

-Sulfasalazine (Asulfidine)
- Mesalamine (Asacol)

103
Q

For treatment of flare ups and maintenance of remission

A

Aminosalicylates

104
Q

Side effects of Aminosalicylates

A

Folate deficiency anemia (if it occurs, give folic acid as ordered)

105
Q

Treatment of Medication for Chron’s Disease

A

Corticosteroids

106
Q

What are the corticosteroids drugs?

A
  • Hydrocortisone (IV)
  • Prednisone (PO)
  • Dexamethasone (PO)
107
Q

This kind of drugs is for acute flares only

A

Corticosteroids

108
Q

Special Considerations of Corticosteroids

A
  • Rapid Acting
  • Cannot be used to maintain remission
  • Dose must be tapered once remission has been induced
109
Q

Indication of this drug is maintenance of remission

A

Immunomodulators

110
Q

Special Considerations of Immunomodulators

A
  • Slow- acting
  • Should not be used to induce remission (has a 2 to 3 month lag period)
  • Monitor CBC every month and LFT intermittently
111
Q

What is the side effects of immunomodulators

A

Pancytopenia (Low RBC, low platelet, low WBC)

112
Q

Inflammatory Bowel Diseases

Antibiotic Therapy Drugs of Choice

A

-Metronidazole (Flagyl)
- Ciprofloxacin (Ciprobay)

113
Q

If patients develops peripheral neuropathy

A

Discontinue Metronidazole if patient develops peripheral neuropathy

114
Q

Chron’s Disease

widening of a narrowed portion of the small intestine

A

Stricturoplasty

115
Q

Chron’s Disease

Chron’s Disease

removal of the affected portion of the colon and anastomosis of remaining parts

A

Bowel Resection

115
Q

Chron’s Disease

Chron’s Disease

Removal of the entire colon

A

Total Colectomy

116
Q

Chron’s Disease

Chron’s Disease

Removal of the entire colon and the rectum

A

Proctolectomy

117
Q

Is the most common procedure to treat UC

A

Proctocolectomy with Ileal Pouch- Anal Anastomosis (IPAA)

118
Q

What is the texture of ileostomy output?

A

Watery

119
Q

PRE-OPERATIVE PREPARATIONS of Proctocolectomy with Ileal Pouch- Anal Anastomosis (IPAA)

A

Bowel Preparation

-Reduce risks of infectious complications and allow easier handling of the colon and rectum
- Enema until clear a day before surgery
-Clear liquid diet a day before surgery
- NPO on midnight before surgery

120
Q

What kind of anesthesia is used in (IPAA)

A

General Anesthesia

121
Q

What is the IntraOP position of IPAA?

A

Lithotomy

122
Q

POST-OPERATIVE CARE of IPAA

A

-Reinforce health teaching on changes bowel patterns and stool characteristics

-Initially, expect to pass liquid stools up to 15 times a day
-Frequency will eventually slow down to three to eight per day, with a toothpaste consistency
-Drink copious amounts of fluids. Electrolyte drinks may be taken to correct electrolyte losses

Dietary modifications
-High carbohydrate diet (to thicken stool output)
-Small, frequent meals (to avoid large small- bowel loads)
-Avoid late night meals (to prevent nighttime awakenings for bowel movement)

123
Q

occurs when the wall of a muscle weakens, and the intestine protrudes through the muscle wall of a cavity

A

Hernia

124
Q

What are the risk factors of hernia?

A

-Multiparity
-Anything that increases abdominal

125
Q

Clinical Manifestations of Hernia

A

-Bulging over herniated area which appears when patient stands or strains, and disappears when supine
-Pain (may or may not be present)

126
Q

A portion of the intestine protrudes through the umbilicus

A

Umbilical Hernia

127
Q

Occurs in the midline of the abdomen between the umbilicus and the xiphoid process

A

Abdominal Hernia

128
Q

Occurs in the groin; most common

A

Inguinal Hernia

129
Q

Complications of Hernia

A

-Incarcerated Hernia
-Strangulated Hernia

130
Q

Hernias that do not return to the abdominal cavity with rest or manipulation and cause complete bowel obstruction

A

Incarcerated Hernia

131
Q

Similar characteristic with incarcerated hernias but blood supply to hernia is cut off

A

Strangulated Hernia

132
Q

A device that applies pressure to the hernia, thus keeping the intestine in the abdominal cavity.

A

Hernia Truss

133
Q

Management of Hernia that involves making an incision in the abdominal wall, replacing the contents of the hernial sac, repairing the weakened tissue, and closing the opening.

A

Herniorrhaphy

134
Q

Involves replacing the hernia into the abdomen and reinforcing the weakened muscle wall with wire, mesh, or fascia

A

Hernioplasty

135
Q

Are dilated portions of veins in the anal canal

A

Hemorrhoids

136
Q

This may be internal of external

A

Hemorrhoids

137
Q

Appear outside the external sphincter

A

External Hemorrhoids

138
Q

located above the internal sphincter

A

Internal Hemorrhoids

139
Q

What type of degree in internal hemorrhoids that do not prolapse and protrude into anal canal

A

First degree

140
Q

What type of degree in internal hemorrhoids that prolapse outside the anal canal during defecation but reduce spontaneously

A

Second degree

141
Q

What type of degree in internal hemorrhoids that prolapsed to the extent that they require manual reduction

A

Third degree

142
Q

What type of degree in internal hemorrhoids that prolapsed to the extent that they may not be reduced

A

Fourth degree

143
Q

Causes of Hemorrhoids

A

-Constipation (most common)
-Pregnancy
-Obesity
-Liver Cirrhosis
-Right-sided heart failure

144
Q

Clinical Manifestations of Hemorrhoids

A

-Constipation
-Anal pain
-Rectal bleeding with defecation (hematochezia)
-Anal itchiness

145
Q

Collaborative Management of Hemorrhoids

A

-High- residue diet and increased oral fluid intake
-Bulk- forming laxatives, as ordered
(DOC: Psyllium)
-Cold packs to anal area followed by warm sitz bath
-Astringents, as ordered to reduce engorgement
(DOC: witch hazel)

146
Q

The sclerosing agent is injected into the base of the hemorrhoid to cause blood vessel thrombosis, which helps prevent prolapse

A

Sclerotherapy

147
Q

Sclerosing agent percent phenol in saline

A

5%

148
Q

Hemorrhoid is visualized through an anoscope, and the proximal portion is grasped with an instrument

A

Rubber band Ligation

149
Q

RUBBER BAND LIGATION

This band is slipped over the hemorrhoid.

A

Small rubber band

150
Q

Surgical excision of hemorrhoids

A

Hemorrhoidectomy

151
Q

How does hemorrhoids removed?

A

Hemorrhoids are removed with a clamp and cautery, or are ligated and then excised

152
Q

Diet for patient with hemorrhoidectomy

A

Low residue diet to reduce bulk of feces

153
Q

Hemorrhoidectomy Post-Operative Care

A

-Administer analgesics, as ordered
-Assist client to side- lying or prone position
-Apply ice packs over dressing for the first 12 hours to prevent bleeding
-Warm sitz bath 12 to 24 hours post op. Best time to do sitz bath is after every bowel movement
-Administer stool softeners, as ordered
-Encourage increase oral fluids and high- residue diet
-WOF: rectal bleeding, suppurative drainage, continued pain on defecation, continued constipation

MS 2 (27 decks)

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