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102 > PT 4 GI > Flashcards

PT 4 GI Flashcards

1
Q

What organs/things make up the digestive tract 10

A
  • Mouth
  • Esophagus
  • Stomach
  • Small intestine
  • Large intestine
  • Rectum
  • Anus
  • Liver
  • Pancreas
  • Gallbladder
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2
Q

What should I remember about the mouth

A
  • Mastication - oral cavity has teeth used for chewing
  • Deglutition - swallowing
  • Buccal - Lips and the oral cavity
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3
Q

What should I remember about the esophagus

A
  • Hollow muscular tube, which receives food from the pharynx and moves it to the stomach
  • Peristaltic movements push the food down
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4
Q

What are the two sphincters for the esophagus

A
  • Upper esophageal sphincter (UES) - allows the bolus to enter the esophagus from the mouth
  • Lower esophageal sphincter (LES) - controls the opening to the stomach (stops gastric acid from entering the esophagus)
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5
Q

Does the stomach do a lot of absorption

A

No - it only absorbs a small amount of water, alcohol, electrolytes and certain drugs

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6
Q

What are the 3 main parts of the stomach

A
  1. Fundus (cardia)
  2. Body (corpus)
  3. Antrum
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7
Q

What stops the stomach contents from entering into the small intestine

A

The pyloric sphincter

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8
Q

What 3 cells are essential for the stomach

A
  1. Mucous cells
  2. Parietal cells (secrete hydrochloric acid, water and intrinsic factor(promotes vitamin B12 absorption in the small intestine))
  3. Chief cells (secrete pepsinogen)
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9
Q

What is the largest internal organ in the body

A

The liver

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10
Q

How many lobes does the liver have

A

Two - left and right.

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11
Q

What do the Kupffer cells in the liver do

A

They carryout phagocytic activity by removing bacteria and toxins from the blood (they detoxify)

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12
Q

What do the hepatic cells in the liver do

A

They make bile

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13
Q

What are the major functions of the liver

A
  1. Absorption and metabolism of nutrients
  2. Degradation of toxins, hormones and medications
  3. Synthesis of proteins
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14
Q

What are the 3 parts of the pancreas

A
  1. Head
  2. Body
  3. Tail
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15
Q

What are the functions of the pancreas

A
  1. Exocrine - Produces and releases enzymes
  2. Endocrine - Secrets insulin and amylin for glucose regulation
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16
Q

Why do we have a gallbladder

A

To store and and secrete bile

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17
Q

When will the gallbladder release bile

A

When there is a presence of fat in the upper duodenum

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18
Q

What are the functions of the small intestine

A

Protein, carbohydrate and fat digestion and absorption

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19
Q

What are the 3 parts of the small intestine

A
  1. Duodenum
  2. Jejunum
  3. Ileum
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20
Q

What is the purpose of villi

A

To produce digestive enzymes and increase the surface area for digestion and absorption

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21
Q

What is the function of goblet cells in the small intestine

A

To secrete mucus and protect the mucosa

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22
Q

What is the most important function of the large intestine

A

Water and electrolyte absorption

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23
Q

Besides water and electrolyte absorption, what is also important for the large intestine to do

A

Produce vitamin K and some B vitamins, and breaking proteins that are not digested or absorbed in the small intestine down into amino acids

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24
Q

What is the purpose of the ANS and the GI tract

A
  1. Parasympathetic (cholinergic) excites the tract and gets things moving
  2. Sympathetic (adrenergic) inhibits the tract to slow things down
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25
Q

What is also unique about the GI tract

A

It has it’s own nervous system - the enteric (intrinsic) nervous system

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26
Q

What is happening in this enteric nervous system in the GI tract

A

You have the meissner plexus and the auerbach plexus. Both are working to control movement. They function independently from the brain and spinal cord.

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27
Q

Where does venous blood from the GI tract go

A

Into the portal vein leading to the liver - this allows the liver to detoxify the blood from bacteria and toxins from the GI tract

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28
Q

What three arteries supply blood to the GI tract

A
  • Celiac artery (stomach and duodenum)
  • Superior mesenteric artery (SMA) (distal small intestine to mid-large intestine)
  • Inferior mesenteric artery (IMA) (distal large intestine through anus)
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29
Q

What is an appendectomy

A

Removing the appendix

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30
Q

What is a cholecystectomy

A

Removing the gallbladder

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31
Q

What is a choledochojejunostomy

A

Opening between common bile duct and jejunum

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32
Q

What is a colectomy

A

Removing the colon

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33
Q

What is a colostomy

A

Opening into the colon

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34
Q

What is a esophagoenterostomy

A

Connecting the esophagus with the small intestine

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35
Q

Esophagogastrostomy

A

Removal of esophagus and anastomosis of remaining part to stomach

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36
Q

What is a gastrectomy

A

Removing the stomach

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37
Q

What is a gastrostomy

A

Opening into the stomach

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38
Q

What is a glossectomy

A

Removing the tongue

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39
Q

What is a hemiglossectomy

A

Removing half of the tongue

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40
Q

What is a herniorrhaphy

A

Repair of a hernia

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41
Q

What is a ileostomy

A

Opening into the ileum

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42
Q

What is a mandibulectomy

A

Removing the mandible

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43
Q

What is a pyloroplasty

A

Enlargement and repair of pyloric sphincter area

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44
Q

What is a vagotomy

A

Resection of branch of vagus nerve

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45
Q

What position should the pt be in when examining their abdomen

A

Supine with knees flexed and the HOB raised slightly

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46
Q

What should you have your pt do before you examine their abdomen

A

Go to the bathroom

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47
Q

What is the correct order for examining the abdomen

A
  1. Inspect
  2. Auscultate
  3. Percuss
  4. Palpate
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48
Q

Should you auscultate the abdomen with both the diaphragm and the bell

A

Yes - listen for at least two minutes

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49
Q

When you percuss the abdomen, what should you hear

A

Tympany (high pitched hollow), with dullness (fluid or masses) over the organs.

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50
Q

When examining the rectum and anus, what test do you want to perform

A

Test for occult blood

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51
Q

In terms of subjective data, why do we want to ask the pt about alcohol or nicotine use

A
  • Long periods of alcohol decrease the stomach mucus lining
  • Nicotine is an irritant to the GI tract
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52
Q

When preparing a pt for a scan, what should you ask them in regards to allergies

A

Ask them if they are allergic to iodine, shellfish or contrast media

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53
Q

What should we always make sure has been completed prior to a scan

A

Signed consent.

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54
Q

What do we have pts swallow for an upper gi scan

A

Barium solution or gastrografin

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55
Q

What can we look at for the upper GI scans

A
  • Oropharyngeal area
  • Esophagus
  • Stomach
  • Small intestine
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56
Q

How can we look at the upper GI

A
  • Fluoroscopy, which is an x-ray.
  • X-ray
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57
Q

To carryout a lower GI study, what happens

A
  • Pt has a barium enema
  • Observe via fluoroscopy the colon filling with the contrast media and to look at the filled colon via x-ray
  • Adding air after the barium provides better visualization
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58
Q

What bowel prep goes into preparing for a colonoscopy 5

A
  • Avoid fiber for up to 72hrs prior
  • Clear or full liquid diet 24hrs before
  • Evening before, drink a cleansing solution
  • Drink another dose 4-6hrs before the procedure
  • Stools will be clear or clear yellow liquid when the colon is clean
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59
Q

What is important to remember about colonoscopies

A

The patient will be put under sedation

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60
Q

Before an endoscopy, how long should the pt be NPO

A

8-12hrs prior

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61
Q

What procedure can be used to retrieve gallstones from distal common bile ducts

A

Endoscopic retrograde cholangiopancreatography (ERCP)

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62
Q

What is the biggest risk with an endoscopy

A

Aspiration - so make sure you maintain their airways

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63
Q

Are patients put to sleep during endoscopies

A

Yes, they are put under sedation

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64
Q

What is cool about video capsule endoscopy

A
  • Vitamin sized camera takes over 50,000 pictures of GI tract not accessible by upper or lower endoscopy
  • 8hrs after swallowing the device, they will come back to have it removed
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65
Q

Why would we get a liver biopsy

A
  • Diagnosis cancer
  • Stage fibrosis (liver damage)
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66
Q

What are the two types of liver biopsies

A
  • Open: making an incision and removing tissue
  • Closed: Uses a needle to remove tissue
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67
Q

What can a CT scan be used for

A

With oral or IV contrast dye we can detect biliary tract, liver and pancreatic disorders

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68
Q

What can an MRI be used for

A

Hepatobiliary disease, hepatic lesions and stage colorectal cancer

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69
Q

What might be some symptoms of malnutrition 10

A
  1. Dry skin
  2. Brittle hair
  3. Hair loss
  4. Mouth and tongue are dry and crusty
  5. Mental changes
  6. Confusion
  7. Fatigue
  8. Chronic anemia (lack iron and folic acid to make red blood cells)
  9. Susceptible to infection
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70
Q

Describe starvation-related malnutrition or primary PCM (protein-calorie malnutrition)

A

When there is chronic starvation without inflammation (anorexia)

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71
Q

Describe chronic disease-related malnutrition or secondary PCM

A

Where there is mild-moderate inflammation and a disease is causing you to have malnutrition (organ failure, cancer, rheumatoid arthritis and obesity)

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72
Q

What is acute disease-related or injury-related malnutrition

A

Where their is inflammation and malnutrition (major infection, burns, trauma, surgery)

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73
Q

What is the difference between enteral and parenteral nutrition

A

Enteral goes into the GI system, while parenteral goes into the bloodstream

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74
Q

What are indications for enteral feedings

A
  • Anorexia
  • Orofacial fractures
  • Head and neck cancers
  • Neurologic or psychiatric conditions that prevent intake
  • Extensive burns
  • Critical illness
  • Chemo or radiation therapy
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75
Q

Where is a gastrostomy placed

A

Into the stomach

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76
Q

Where is a jejunostomy placed

A

Into the small intestine

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77
Q

To prevent aspiration with tube feedings, what should you do

A

Keep the HOB elevated to 30-45 degrees

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78
Q

How often should feeding tubes be flushed

A

Every 4 hrs with 30mLs

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79
Q

What would be a contraindications for enteral feedings

A

Where their GI tract isn’t working, so use parenteral feedings

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80
Q

Should a nasogastric tube or any tube going through the pts nose be used for short term or longer term

A

Nose ones are for short term, for long term use a gastrostomy or jejunostomy

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81
Q

When would we use parenteral nutrition

A

Basically whenever their GI system is not functioning properly

  • Chronic/severe diarrhea/vomiting
  • Complicated surgery or trauma
  • GI obstruction
  • GI tract abnormalities
  • Severe anorexia
  • Severe malabsorption
  • Short bowel syndrome
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82
Q

What is the difference between anorexia and bulimia

A

With bulimia, people will binge eat and then do things to avoid the weight, like vomiting, taking laxatives or overexercising

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83
Q

What are we worried about developing with bulimia

A

The frequent vomiting may cause macerated knuckles, swollen salivary glands, broken blood vessels in the eyes and dental problems. They can also develop hypokalemia, metabolic alkalosis and increased serum amylase

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84
Q

What is the only approved antidepressant for treating bulimia

A

Fluoxetine (Prozac)

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85
Q

What is the difference between primary and secondary obesity

A

Primary obesity is caused by an excessive caloric intake over exercise, whereas secondary obesity is caused by something else, such as a metabolic disorder, meds, lesions, etc.

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86
Q

What obesity class is a person in with a BMI between 30-34.9

A

Class I

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87
Q

What obesity class is a person in with a BMI between 35-39.9

A

Class II

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88
Q

What obesity class is a person in with a BMI between 40.0

A

Class III

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89
Q

What if your BMI is under 18.5

A

You’re underweight

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90
Q

What if your BMI is between 18.5-24.9

A

You’re normal weight

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91
Q

What if your BMI is between 25-29.9

A

You’re overweight

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92
Q

What if your BMI is between 30-39.9

A

You’re obese

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93
Q

What if your BMI is above 40

A

You’re extremely obese

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94
Q

What has been shown to be the only successful tx option for extreme obesity

A

Bariatric surgery

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95
Q

What is the criteria for bariatric surgery

A
  • BMI over 40
  • BMI over 35 with a significant co-morbidity like hypertension or type 2 diabetes
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96
Q

What are some short term complications following bariatric surgery 6

A
  • Pulmonary embolism
  • Infection
  • Anastomosis leak (surgical connection between removed structures begin to leak)
  • Adipose tissue stores anesthetics, so these anesthetics may be released back into the bloodstream after surgery
  • Breaths may be shallow and rapid from all of the extra adipose tissue on the chest and abdomen
  • Dehiscence
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97
Q

How high should we have the HOB after bariatric surgery

A

At 45 degrees to reduce abdominal pressure and increase lung expansion

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98
Q

When should the pt start walking after bariatric surgery

A

They should begin walking that evening and then 3 times per day

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99
Q

What are some long term complications from bariatric surgery 9

A
  • Band slippage
  • Obstruction hernia
  • Esophageal erosion
  • Ulcers
  • Acid reflux
  • Vitamin deficiency
  • Osteoporosis
  • Anemia
  • Dumping syndrome (stomach stops absorbing anything)
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100
Q

What is a typical diet for a post op after bariatric surgery

A
  • Give room temperature water and low-sugar clear liquids as soon as pt is awake
  • Begin with 15mL increments every 10-15 minutes until you are at 90mL every 30 minutes by post op day 1
  • If tolerated, move to low-fat, full-liquid diet on post op day 3
  • 10-14 days can move to pureed diet
  • 4-6 weeks after surgery, they can move to the bariatric surgery diet
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101
Q

What is the post bariatric surgery diet

A
  • High in protein and low in carbs, fats and roughage
  • 6 small feedings a day
  • Most will need a protein supplement
  • Don’t drink fluids when you’re eating food
  • No carbonated drinks
  • Will be on multivitamins for life
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102
Q

When might pts begin to see the success of their bariatric surgery

A

6-8 months, they should see some big changes

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103
Q

Who is more likely to have n + v with anesthesia and motion sickness

A

Women

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104
Q

Where is the vomiting center located

A

In the medulla

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105
Q

What are we scared about when someone is continuously vomiting

A

Dehydration and loss of electrolytes

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106
Q

Besides dehydration and the loss of electrolytes, what can continuous vomiting lead too

A
  • Fluid volume loss
  • Decreased plasma volume
  • Circulatory failure
  • Metabolic alkalosis
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107
Q

How does metabolic alkalosis occur from vomiting

A

You are losing your gastric hydrochloric acid, so you’re becoming less acidic

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108
Q

How can antiemetics help to treat n + v

A

They block the neurochemicals that trigger n + v

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109
Q

What type of anticholinergic drug can we use for n + v

A

Transdermal scopolamine patch, which blocks the cholinergic pathway to the vomiting center (often used for motion sickness)

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110
Q

What are some common antihistamines that can be used to treat n + v

A
  • Dimenhydrinate (Dramamine)
  • Meclizine
  • Hydroxyzine
  • Benadryl
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111
Q

What does a patient with severe vomiting need

A

IV fluids with electrolytes and glucose (don’t forget to be checking their glucose levels)

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112
Q

After symptoms of n + v have subsided, what should we do

A

Have the patient drink 5-15mL of water every 15-20 minutes

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113
Q

When a person is recovering from n + v, what should you never give them

A
  • Drinks that are hot or col
  • Drinks that are carbonated
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114
Q

Why should we be careful giving broth or sports drinks to someone who has been vomiting

A

Because they items can have very high sodium concentrations

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115
Q

Once a patient with n + v is able to tolerate dry toast, crackers or gelatin, what can they begin to eat

A

A diet high in carbs and low in fat and bland (easier for the stomach to breakdown) such as potatoes, rice, cooked chicken and cereal

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116
Q

What is emesis has partially digested food after several hours after a meal

A

Then there is a gastric outlet obstruction or delayed gastric emptying (the stomach isn’t emptying)

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117
Q

What if there is a fecal odor and bile in the emesis

A

This can indicate an intestinal obstruction below the pylorus, while bile also suggests obstruction below the ampulla of Vater

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118
Q

What is a mallory-weiss tear and what could it cause

A

It is tear in the mucosal lining near the esophagogastric junction, which can produce coffee ground emesis

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119
Q

Why does a gastric bleed look like coffee grounds

A

Because the blood is coming into contact with gastric acid, making it look like coffee grounds

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120
Q

What complementary therapies may help with n + v

A
  • Acupuncture
  • Acupressure
  • Botanicals like ginger and peppermint oil
  • Relaxation and breathing exercises
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121
Q

What are some gerontologic considerations for n + v

A
  • More likely to have cardiac or renal problems (which means electrolyte and fluid loss can put them at an increased risk for these problems)
  • Greater risk for aspiration due to decreased levels of consciousness
  • Antiemetic drugs can cause them to increase their risk for confusion and falls
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122
Q

Who is at risk for oral infections

A

Immunosuppressed (chemo for cancer) or using corticosteroid inhalant to treat asthma

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123
Q

What can oral pathogens increase your risk of

A

Diabetes and heart disease

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124
Q

What is stomatitis

A

Inflammation in the mouth (often having ulcers)

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125
Q

What can cause stomatitis

A
  • Trauma, pathogens, irritants (tobacco, alcohol)
  • Renal, liver and hematologic diseases
  • Side effect of chemo and radiation
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126
Q

Who is at the biggest risk for stomatitis

A

Patients receiving chemo

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127
Q

What are symptoms of stomatitis

A
  • Excessive salivation
  • Halitosis (bad breath)
  • Sore mouth
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128
Q

What are the treatments for stomatitis

A
  • Oral hygiene with soothing solutions, topical medications
  • Soft, bland diet
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129
Q

What are the two types of oral cancer

A
  • Oral cavity cancer (mouth cancer)
  • Oropharyngeal cancer (throat cancer)
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130
Q

What are some predisposing factors for oral cancer

A
  • History of tobacco or alcohol use
  • Having an outdoor occupation (lip cancer and sunlight)
  • Pipe smoking
  • HPV (having multiple oral sex partners)
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131
Q

What are some symptoms of oral cancer 7

A
  • Chronic sore throat, sore mouth and voice changes
  • Leukoplakia “smokers patch” white patch on the mouth mucosa or tongue (precancerous lesion from smoking that may develop into cancer)
  • Erythroplasia - red velvety patch on the mouth or tongue (another precancerous lesion)
  • Asymptomatic neck mass
  • Ulcer on lip
  • Ulcer/thickening of tongue
  • Ulcers that are not healing after 2-3 weeks
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132
Q

Are symptoms of oral cancer known right away

A

No, most are asymptomatic in early stages

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133
Q

What are the treatment options for oral cancer

A

Radiation, chemo drugs, surgery

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134
Q

What is GERD caused by

A

Reflux of stomach acid into the lower esophagus, which causes mucosal damage

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135
Q

Is GERD a disease

A

No, it is a syndrome of a disease (caused by other GI problems)

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136
Q

Is there one single cause of GERD

A

NO

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137
Q

What is happening with the LES and GERD

A

The LES should stop acid reflex from entering the esophagus, but it isn’t working right

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138
Q

What are somethings that can cause GERD 3

A
  • Obesity (increased intraabdominal pressure pushing contents back up)
  • Smoking
  • Hiatal hernia
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139
Q

Why would the LES not being working in GERD

A

It’s an issue affecting it’s pressure, can be caused by many different things like food, drugs and alcohol.

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140
Q

What is the most common symptom of GERD

A

Heartburn

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141
Q

What are other symptoms of GERD besides heartburn

A
  • Dyspepsia (pain in the upper abdomen)
  • Regurgitation (contents coming into throat or mouth)
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142
Q

What is scary about GERD

A

People may think they’re having GERD when they have chest pain, but it could actually be a cardiac event.

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143
Q

What are some complications from GERD 4

A
  • Esophagitis (inflammation of the esophagus)
  • Barrett’s esophagus (BE) cause cells to change to precancerous cells, which increases cancer risk
  • Respiratory complications, where fluid can enter the airway
  • Dental erosion
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144
Q

Why is chronic esophagitis from GERD bad

A

Repeated esophagitis may lead to scar tissue formation, stricture and dysphagia

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145
Q

Besides diagnosing GERD based on symptoms, how else can we diagnosis

A
  • Upper endoscopy
  • Barium swallow
  • Measure pressure in esophagus and LES
  • Esophageal manometric (motility) studies
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146
Q

How can people usually treat their GERD

A

Through lifestyle changes

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147
Q

What are some modifications that can be made to treat GERD

A
  • Keep HOB elevated at least 30 degrees
  • Stop smoking
  • Avoid caffeine, alcohol and spicy foods
  • Lose weight
  • Eat small frequent meals
  • Avoid late night meals
  • Drink fluid between meals
  • Chew gum or oral lozenges
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148
Q

What are the top drug choices for GERD

A

Proton pump inhibitors (PPIs) or histamine (H2) blockers

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149
Q

What is nice about PPIs

A

They are more effective at healing esophagitis than H2 receptor blockers

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150
Q

When should a pt take their PPIs

A

Once daily, before their first meal

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151
Q

What are some scary things about PPIs 4

A

Long-term use may cause:

  • Decreased bone density
  • Kidney disease
  • Vitamin B12 and magnesium deficiency
  • Increase risk for dementia
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152
Q

When is the best time to take an antacid for GERD

A

1-3 hours after meals and at bedtime

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153
Q

What is the downfall to antacids

A

Their effects don’t last very long and they interact with a lot of other drugs

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154
Q

What foods should you avoid eating that decrease LES pressure and lead to GERD

A
  • Chocolate
  • Peppermint
  • Fatty foods
  • Coffee and tea
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155
Q

Why would we do a surgery for GERD

A

The patient may have severe complications like esophagitis, medication intolerance, stricture and BE

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156
Q

What is a common laparoscopic antireflux surgery

A

Nissen and Toupet fundoplications

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157
Q

What is a hiatal hernia

A

Where a portion of the stomach goes into the esophagus through an opening or hiatus in the diaphragm

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158
Q

Who do we commonly see have hiatal hernias

A

Older adults and women

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159
Q

What are the 2 types of hiatal hernias

A
  1. Sliding: Part of the stomach slides through the hiatal opening in the diaphragm, while the patient is supine. It goes back into place when the pt stands up.
  2. Paraesophageal or rolling: the fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket. This is a medical emergency, because it will not go back into place.
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160
Q

What can cause hiatal hernias

A
  • Weakening of the muscles in the diaphragm and esophagogastric opening as we age
  • Increasing intra-abdominal pressure, which can be from obesity, pregnancy, ascites, tumors, intense physical exertion and heavy lifting on a continual basis.
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161
Q

What are symptoms of hiatal hernia

A

Symptoms are like having GERD (heartburn and dysphagia)

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162
Q

What can a hiatal hernia lead too 7

A
  • GERD
  • Esophagitis
  • Hemorrhage from erosion
  • Stenosis (narrowing of the esophagus)
  • Ulcerations of the herniated part of the stomach
  • Strangulation of the hernia
  • Regurgitation
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163
Q

How can we diagnosis hiatal hernias

A
  • Barium swallow
  • Endoscopy
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164
Q

What are some conservative ways to treat hiatal hernias

A
  • Eliminate alcohol
  • Stop smoking
  • Keep HOB elevated
  • Avoid lifting/straining
  • Reduce weight if needed
  • Don’t wear tight clothes
  • Anti-secretory agents and antacids
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165
Q

What are some surgical options for hiatal hernias 4

A
  • Herniotomy (remove the hernia sac)
  • Herniorrhaphy (close off the hernia)
  • Nissen fundoplication (fundus of stomach is wrapped around the esophagus or the fundus is sutured to itself)
  • Gastropexy (attach stomach to diaphragm so it doesn’t move)
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166
Q

What sucks about esophageal cancer

A

By the time the pt has symptoms, the tumor is often advanced

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167
Q

What are symptoms of esophageal cancer

A
  • Progressive dysphagia is the most common, having a feeling that food is not passing, then slowly no foods passes.
  • Pain develops late, increases with swallowing.
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168
Q

How can they diagnosis esophageal cancer

A
  • Endoscopic biopsy
  • Barium swallow (esophagram)
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169
Q

Is esophageal cancer treatable? How?

A

Yes, unfortunately, prognosis is poor due to most being diagnosed until advanced.
The best way to treat is with a multimodal approach (surgery, endoscopic ablation (using radiofrequencies and electric currents to kill the cancer cells by heating them), chemo and radiation)

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170
Q

What should you be checking for in your assessment for esophageal cancer

A
  • History of GERD, achalasia, BE, tobacco and alcohol.
  • Progressive dysphagia
  • Odynophagia (burning, squeezing pain with swallowing)
  • Pain
  • Choking
  • Heartburn
  • Hoarseness, cough, anorexia, weight loss, regurgitation
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171
Q

What typically causes eosinophilic esophagitis

A

Allergies

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172
Q

What is the tx for eosinophilic esophagitis

A

Corticosteroids

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173
Q

What are esophageal diverticula

A

Saclike pouches in the esophagus

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174
Q

What is the tx for esophageal diverticula

A

There isn’t one specific tx. Some people can empty the pouches by applying pressure. Others may need surgery.

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175
Q

What is esophageal stricture

A

Narrowing of the esophagus

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176
Q

What usually causes esophageal strictures

A

GERD

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177
Q

How do we treat esophageal strictures

A

Mechanical dilation (such as applying a balloon or stint to keep it open)

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178
Q

What is achalasia

A

No peristalsis in the lower two thirds of the esophagus

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179
Q

What is interesting about achalasia

A

It is very rare and the cause is unknown

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180
Q

How do they diagnosis achalasia

A

Barium swallow test

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181
Q

What is the tx goal of achalasia

A

Relieve the dysphagia

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182
Q

What should I know about esophageal varices

A

They are dilated, tortuous veins in the lower part of the esophagus, usually from portal vein hypertension. Common complication of liver cirrhosis.

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183
Q

What is gastritis

A

Inflammation of the gastric mucosa in the stomach

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184
Q

What is happening in gastritis

A

The mucosal barrier that protects the gastric mucosa from the stomach acid is broken.

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185
Q

What is the most common cause of gastritis

A

Helicobacter pylori

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186
Q

Besides H. pylori, what are other causes of gastritis

A

Alcohol, NSAIDs, Crohn’s disease, tuberculosis and bile reflux

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187
Q

What is autoimmune gastritis

A

Where the immune system kills parietal cells, which can lead to an inadequate production of intrinsic factor (B12) this leads to pernicious anemia

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188
Q

What are symptoms of gastritis 7

A
  • Epigastric pain
  • Nausea and vomiting
  • Weight loss
  • Decreased appetite
  • Stool color changes
  • Feeling full
  • Epigastric tenderness
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189
Q

How is gastritis usually diagnosed

A
  • Usually based on symptoms
  • Can use an endoscopic exam with biopsy as well to test for the presence of H. pylori
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190
Q

How is acute gastritis treated

A

Similar to n + V (rest, NPO, IV fluids, antiemetics, monitor for dehydration)

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191
Q

What is interesting about gastritis

A

Healing may spontaneously occur in a few days

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192
Q

What kind of drugs can you use for gastritis

A

PPIs and H2 receptor blockers to help reduce gastric HCL acid secretion

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193
Q

What is an example of a PPI

A

Omeprazole - basically any drug ending in “zole”

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194
Q

What do H2 receptor drugs end in

A

“tidine”

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195
Q

What is peptic ulcer (PUD) disease

A

Where there is erosion of the GI mucosa by digestive HCL and pepsin, which can lead to ulcers

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196
Q

What is the most common symptom of PUD

A

Pain

  • For gastric ulcers, pain is usually felt 1-2 hrs after a meal.
  • For duodenal ulcers, pain is usually felt 2-5hrs after meal, which can come and go throughout the day (these ulcers can also cause back pain)
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197
Q

What is interesting about PUD

A

A majority of gastric and duodenal ulcers are caused by H. pylori

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198
Q

How can we diagnosis PUD

A

Labs and endoscopy, specifically a esophagogastroduodenoscopy, which looks at the mucosal lining of the stomach.

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199
Q

What are the medications used to treat PUD

A
  • Antibiotics if they have H. pylori
  • PPIs (help reduce gastric acid secretion)
  • H2 receptor blockers, cytoprotective drugs and antacids can also work alongside.
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200
Q

If H pylori is causing the PUD, what medications are prescribed

A

An antibiotic, like amoxicillin, and a PPI are used together

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201
Q

What are the 3 main complications from PUD, which require immediate medical attention

A
  • Hemorrhage (most common)
  • Perforation (most lethal) where the ulcer penetrates through the serosal surface and spills the gastric or duodenal contents into the cavity.
  • Gastric outlet obstruction where the ulcer is obstructing the normal path of food, so now the stomach is filling up because it can’t empty, which can lead to vomiting.
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202
Q

When would surgery be provided for a PUD

A

If the ulcers are not healing or if they are causing bleeding

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203
Q

What happens in PUD surgery

A

Minimally invasive procedure where the ulcers are removed or the bleeding is stopped. Most have the ulcer sewn together, patched or a distal gastrectomy (remove part of the stomach)

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204
Q

What causes stomach cancer

A

There isn’t one specific cause. It could be from an infection of H. pylori, autoimmune-related inflammation, repeated exposure to irritants such as bile or NSAIDs.

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205
Q

What are some symptoms of stomach cancer 5

A

(cancer has usually spread before any symptoms are manifested)

  • Weight loss
  • Indigestion
  • Abdominal discomfort or pain
  • Anemia (due to the chronic blood loss from the lesions)
  • Early satiety (feeling full soon)
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206
Q

What is the tx for stomach cancer

A
  • Surgery (gastrectomy)
  • Chemo
  • Radiation
  • Targeted therapy (target specific cells)
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207
Q

What is interesting about upper GI bleeds

A

They can have a little bit of blood in their stool, but they may not even be aware due to how small the amount is.

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208
Q

What are the two types of upper GI bleeds

A
  • Occult bleeding, where they may not even be aware that they have any blood in their stool due to the small amount.
  • Obvious bleeding, which includes hematemesis (Fresh, bright blood or “coffee-ground” appearance from digested blood. Or melena, which look like black, tarry stools (usually foul smelling) caused by digestion of blood in the GI tract. The black appearance is from iron.
How well did you know this?
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2
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209
Q

How do we diagnosis upper GI bleeds

A

From an endoscopy

210
Q

What will a BUN tell us in terms of an upper GI bleed

A

If the BUN is high, this indicates that there could be a significant hemorrhage due to the GI tract breaking down proteins

211
Q

What is interesting about upper GI bleeds

A

80-85% of pts with massive hemorrhage spontaneously stop bleeding

212
Q

What are we very concerned about with an upper GI bleed

A

If it is an acute GI bleed, they may go into hypovolemic shock

213
Q

What are the symptoms of hypovolemic shock 6

A
  • Low BP
  • Tachycardia
  • Cool, clammy skin
  • Slow cap refill
  • Decreased level of consciousness
  • Decreased urine output
214
Q

What are emergency management interventions for an upper GI bleed 6

A
  • Replace fluids via an IV
  • Give O2
  • Have on ECG
  • Insert NG tube
  • Insert indwelling catheter
  • Give IV PPI to decrease acid secretion
215
Q

What is considered diarrhea

A

At least 3 loose or liquid stools per day

216
Q

How long does acute diarrhea last

A

Less than 14 days

217
Q

How long does chronic diarrhea last

A

Over 30 days

218
Q

What is the most common intestinal parasite that causes diarrhea here in the U.S.

A

Giardia lamblia

219
Q

Where can giardia lamblia be found and how is it transmitted

A

It can be found in lakes, rivers, swimming pools, water parks and hot tubs. It is transmitted by fecal oral route

220
Q

What is the most common cause of bloody diarrhea

A

E. Coli

221
Q

How long can C. Diff spores last on objects

A

Up to 70 days

222
Q

What is happening in C. diff

A

It destroys all of your good cells, which causes the colon to become inflamed which produces toxins which causes nasty diarrhea.

223
Q

What is happening in secretory diarrhea

A

A pathogen survives long enough to be absorbed into the enterocytes, which causes the oversecretion of water, sodium and chloride ions into the bowel.

224
Q

Do hand sanitizers kill c. diff?

A

No, you need to use soap and water, and use bleach on surfaces

225
Q

What can severe diarrhea cause

A

Life-threatening dehydration, electrolyte problems and acid base imbalances (metabolic acidosis)

226
Q

What are risk factors for diarrhea

A
  • Being old
  • Using PPIs which decrease stomach acid (stomach acid kills pathogens)
  • Antibiotics
  • Immunocompromised
227
Q

What are some diagnostics with diarrhea

A
  • If there diarrhea is lasting longer than 3 days, or it’s bloody, they have a fever or they are very ill then we will do a stool culture
  • We can do a blood culture when there are signs of sepsis, infection (high fever) or the pt is immunocompromised
228
Q

What might we see in a blood culture for diarrhea

A
  • Increased WBC count
  • Anemia because iron and folate aren’t being absorbed in the gut
  • Hematocrit, BUN and creatinine might be high due to fluid deficit (dehydration)
229
Q

What can we give to help replace mild symptoms of diarrhea

A

Pedialyte (has glucose and electrolytes in it)

230
Q

Do we treat diarrhea with antidiarrheals

A

Yes, we can (these help to slow down the stimulation of the GI tract). However, we don’t want to use if a person has infectious diarrhea, because it could prolong their exposure to the organism

231
Q

Do we use antibiotics to treat diarrhea often

A

No, antibiotics are rarely used.

232
Q

To help avoid contamination, how should we treat all cases of diarrhea

A

As if they are infection. Wash hands with soap and water. Use bleach for cleaning.

233
Q

What can cause fecal incontinence

A

There could be problems with the motor function (contraction of sphincters and rectal floor muscles) and/or sensory function (might not feel the urge)

234
Q

What is the most common cause of fecal incontinence for women

A

Obstetric (due to childbirth), can also be from trauma, aging or menopause.

235
Q

How can chronic constipation lead to fecal incontinence

A

You could have a hardened stool that is stuck, which causes lose stool to leak around

236
Q

What kind of diet can help treat fecal incontinence

A
  • Diet high in soluble fiber (fiber we can break down, so it can help slow down digestion), increase your intake of caffeine free drinks
  • Avoid caffeine, artificial sweeteners, high-gas producing veggies, veggies that contain insoluble fiber (beans, potatoes - just go right through you)
237
Q

Besides changing your diet, how else can you treat fecal incontinence 6

A
  • Physical therapy
  • Biofeedback
  • Mild electrical stimulation to target the nerves that control the pelvic floor muscles and sphincters
  • Dextranomer/hyaluronic acid gel can be injected into the anal canal, which can cause tissue buildup to narrow the canal and allow muscles to more adequately close
  • Bowel schedule
  • Surgery to repair a prolapse or anal sphincter
238
Q

Is constipation a symptom or a disease

A

It is a symptom, not a disease

239
Q

What is cathartic colon syndrome

A

Caused by chronic laxative use, where the laxatives cause the colon to become dilated and atonic (lacking muscle), which leads to a person not being able to poop without laxatives

240
Q

What are symptoms of constipation

A
  • Painful abdomen, distention, bloating, increased rectal pressure
241
Q

What is a common complication of chronic constipation

A

Hemorrhoids from the repeated valsalva manuver (bearing down)

242
Q

How can the valsalva maneuver kill someone with a heart condition or hypertension

A

When you’re straining, you’re increasing blood flow to other parts of the body and not your heart. This decreases your HR. When you relax, blood flow will rush back to your heart, which can increase rate and pressure. If you can’t compensate for the sudden change, then you could die

243
Q

What are some concerning signs regarding a change in bowel habits for people over 50 lasting longer than 6 weeks

A
  • Rectal bleeding
  • Bloody stools
  • Irion deficiency anemia
  • Weight loss
  • Significant abdominal pain
  • Family history of colorectal cancer or inflammatory bowel disease
244
Q

What foods could we give to someone who is constipated

A
  • Beans
  • Broccoli
  • Carrots
  • Baked potatoes
  • Tomatoes
  • Apples
  • Strawberries
  • Oranges
  • Whole wheat bread
  • Cereal
245
Q

What foods should you avoid if you have constipation

A

Foods low in fiber and high in fat like cheese, ice cream, potato chips, red meat, processed foods.

246
Q

What are good sources of soluble fiber to give to someone with fecal incontinence

A
  • Oats
  • Peas
  • Beans
  • Apples
  • Carrots
  • Barley
  • Citrus fruits
247
Q

What is scary about abdominal trauma

A

It can lead to death pretty quickly from hypovolemic shock and compartment syndrome(fluid is moving somewhere it shouldn’t be) and peritonitis (inflammation of the tissues that line your abdomen)

248
Q

What are symptom of abdominal trauma 9

A
  • Guarding/splitting the abdomen
  • Hard, distended abdomen
  • Decreased or absent bowel sounds
  • Pain
  • Hematuria (peeing blood)
  • Hematemesis (throwing up blood)
  • Cullen’s sign
  • Grey Turner’s sign
  • S + S of hypovolemic shock
249
Q

What may indicate a retroperitoneal hemorrhage in abdominal trauma

A
  • Cullen’s sign (ecchymosis around the umbilicus)
  • Grey Turner’s sign (ecchymosis around the flanks)
250
Q

What are signs of hypovolemic shock

A
  • Decreased level of consciousness
  • Tachypnea
  • Tachycardia
  • Decreased BP
  • Decreased pulse pressure
251
Q

If the diaphragm ruptures, where can you hear bowel sounds

A

In the chest

252
Q

What are diagnostics for abdominal trauma

A
  • CBC and UA (looking for blood in the urine)
  • Abdominal CT
253
Q

What is important to remember about CTs and abdominal trauma

A

The pt must be stable before going to a CT, if they are bleeding out or have hypovolemic shock, they can not go to CT

254
Q

What is a hernia

A

When part of an internal organ like an intestine goes through (protrusion) a weak area of muscle.

255
Q

Where to hernias occur

A

Anywhere in the body

256
Q

What is a reducible hernia

A

When the hernia easily returns back to where it belongs either manually or spontaneously

257
Q

What is a irreducible hernia

A

When the hernia cannot go back into place, basically results in strangulation and loss of blood supply which can lead to gangrene and necrosis

258
Q

What is an inguinal hernia

A

Most common type of hernia, where the spermatic cord in men or the round ligament in women emerges through the abdominal wall and your thigh (basically groin region)

259
Q

What is a femoral hernia

A

Protrusion through the femoral ring into the femoral canal, usually results in strangulation

260
Q

What is an umbilical hernia

A

Part of your intestine bulges through the opening in your abdominal muscle near your bellybutton

261
Q

What is a ventral or incisional hernia

A

Hernia due to weakness of the abdominal wall at the site of the incision

262
Q

What is the most common symptom of a hernia

A

Pain (worsens with activity, straining and coughing)

263
Q

What are symptoms of a strangulated hernia 5

A
  • Severe pain
  • Bowel obstruction
  • Vomiting
  • Cramping
  • Distention
264
Q

How do you treat strangled hernias

A

Resecting the involved area, may need temporary colostomy

265
Q

What is a herniorrhaphy

A

Surgical repair of a hernia

266
Q

What is a hernioplasty

A

Reinforcing the weakened area to prevent another hernia

267
Q

What should you watch for after a hernia repair

A

The pt may have trouble voiding. Measure Is and Os

268
Q

What should you teach your pts after hernia surgery

A

To deep breath, but don’t cough. No heavy lifting for 6-8 weeks. Keep mouth open if you need to cough or sneeze.

269
Q

What are hemorrhoids

A

Dilated hemorrhoidal veins

270
Q

What are factors that can increase your risk for hemorrhoids 8

A
  • Pregnancy
  • Constipation
  • Straining to defecate
  • Diarrhea
  • Heavy lifting
  • Prolonged standing and sitting
  • Obesity
  • Ascites (fluid collection in abdomen)
271
Q

Are hemorrhoids usually painful

A

No, for the most part their painless

272
Q

Which bleed, internal or external hemorrhoids

A

Internal hemorrhoids. External hemorrhoids very rarely bleed.

273
Q

What can help treat hemorrhoids besides managing symptoms of constipation 8

A
  • Dibucaine ointment
  • Creams
  • Suppositories
  • Impregnated pads with anti-inflammatory agents like hydrocortisone (can help shrink the mucous membrane to help with discomfort)
  • Astringents and anesthetics to shrink the mucous membrane and relieve discomfort (Witch hazel or benzocaine)
  • Topical corticosteroids should be limited to 1 week to prevent side effects like contact dermatitis and mucosal atrophy
  • Sitz baths to help relieve pain
  • Stool softeners
274
Q

What is the surgery treatment for hemorrhoids and when would it be needed

A

Hemorrhoidectomy, if there is a marked prolapse, excessive pain or bleeding or large/multiple thrombosed (filled with blood) hemorrhoids

275
Q

Describe IBS

A

Chronic abdominal pain or discomfort and alterations in bowel patterns. Can have diarrhea or constipation, or both.
IBS-C = constipation
IBS-D = Diarrhea
IBS-M = mixed

276
Q

What are the causes of IBS

A

There’s really no known cause but it has been associated with the following:

  • Psychologic stressors (anxiety, depression, etc)
  • History of GI infections
  • Adverse reactions to foods (undiagnosed or diagnosed)
277
Q

How is IBS diagnosed

A

Solely on symptoms

278
Q

Based on symptoms, what do we use to diagnosis IBS

A

The Rome criteria, in order to have IBS, you have to have abdominal pain/discomfort for at least 1 day a week for 3 months, with a change in stool frequency and change in stool form.

279
Q

What are other common symptoms of IBS 10

A
  • Abdominal distention
  • Nausea
  • Flatulence
  • Bloating
  • Urgency
  • Mucus in the stool
  • Sensation of incomplete evacuation
  • Fatigue
  • Headache
  • Sleep problems
280
Q

What is the tx for IBS

A

No one tx that works for everyone

  • Deal with psychological factors
  • Dietary changes
  • Medications to help regulate stool output, like a softener, bulk forming laxative.
281
Q

What can be beneficial to pts with IBS 5

A
  • Keep a diary of their symptoms, diet and episodes of stress to help identify factors and triggers
  • Cognitive behavior therapy and stress management techniques to help
  • Regular exercise to help with bloating and constipation
  • Following a diet low in FODMAPs (FODMAPs are types of carbs that can cause digestive issues like wheat and beans)
  • Yogurt with lactobacillus bacteria can help if diary is an issue
282
Q

What CAM therapies may help with IBS 8

A
  • Relaxation
  • Acupuncture
  • Hypnosis
  • Hypnotherapy
  • Peppermint
  • Fennel
  • Herbal teas like chamomile
  • Ginger
283
Q

What is inflammatory bowel disease

A

Chronic inflammation of the GI tract. People can have periods of remission followed by periods of exacerbation.

284
Q

What are the two ways we classify IBD

A
  • Crohn’s disease
  • Ulcerative colitis
285
Q

What areas does ulcerative colitis and Crohn’s disease effect

A

Ulcerative colitis effects the colon while Crohn’s disease effects any segment of the GI tract from the mouth to the anus.

286
Q

When does IBD usually occur

A

In your teen years to early adulthood

287
Q

What is the cause of IBD

A

Don’t know the exact cause. They think it is an autoimmune disease that cab be triggered by the environment or bacteria, which results in inflammation and tissue destruction

288
Q

What is interesting about IBD and the U.S.

A

They think that dietary factors unique to industrialized countries can contribute to IBD, like having refined sugar, high fats, fatty acid.

289
Q

What can increase your risk for having IBD 4

A
  • Poor diet
  • Use of NSAIDs
  • Antibiotics
  • Oral contraceptives
290
Q

What is interesting about Crohn’s

A

You can great looking parts of your bowel and then you can random diseased portions

291
Q

Does Crhon’s involve all layers of the bowel wall

A

Yes, it just doesn’t have to involve the entire length of the bowel

292
Q

What does Crohn’s look like

A

Deep ulcerations that penetrate the mucosa, causing a cobblestone appearance

293
Q

What can Crohn’s cause

A

Strictures, adhesions, abscesses and fistulas

294
Q

Does Crohns or ulcerative colitis have worse diarrhea

A

Ulcerative colitis has worse diarrhea

295
Q

Where will a person with crohns complain of pain

A

Right lower quadrant

296
Q

Where does Ulcerative colitis (UC) start and end

A

Usually starts in the rectum and moves upwards towards the cecum

297
Q

Does UC have any “skips” like crohns

A

No, UC is continuous

298
Q

What is rare in UC

A

Fistulas and abscesses are rare because inflammation doesn’t extend all the way through the bowel wall layers like in crohns

299
Q

What do you usually have a lot of with UC

A

Liquid diarrhea, because the water and electrolytes aren’t being absorbed in the colon.

300
Q

Where is pain reported in UC

A

Left lower quadrant

301
Q

What are the signs of IBD

A
  • Diarrhea
  • Weight loss
  • Abdominal pain
  • Fever
  • Fatigue
302
Q

Where will we see rectal bleeding in crohns or UC

A

UC

303
Q

Where will we see bloody diarrhea in crohns or UC

A

UC

304
Q

If the small intestine is involved with crohns, what do we see

A

Weight loss, because nutrients aren’t being absorbed

305
Q

How many stools can you have a day if you have moderate UC

A

10 stools a day

306
Q

If a pt is in severe UC, where they are going 10-20 times per day, what will we see 5

A
  • Fever
  • Rapid weight loss
  • Anemia
  • Tachycardia
  • Dehydration
307
Q

What are complications of IBD 8

A
  • Hemorrhage
  • Strictures
  • Perforation
  • Abscesses
  • Fistulas
  • Intestinal cancer (crohns)
  • Colorectal cancer
  • Toxic megacolon (UC)
308
Q

What can toxic megacolon do

A

It can cause perforation and may need an emergency colectomy

309
Q

Are abscesses and fistulas more common in crohns or UC

A

Crohns

310
Q

With IBD, what is important to get screened for

A

Cancer, because you are at an increased risk

311
Q

What is interesting about diagnosing chrons

A

Early chrons can look like IBS

312
Q

What diagnostic studies will we do for IBD

A
  • CBC will show high WBC, iron deficiency anemia
  • Electrolytes (we will see a decrease in sodium, potassium, chloride, bicarbonate, magnesium levels due to fluid and electrolyte loss from diarrhea and vomiting)
  • Decrease in protein (hypoalbuminemia) disease is pretty advanced because gut can no longer absorb that protein
  • High CRP from inflammation
  • Look at stool for blood, pus, mucus
  • Barium enema
  • Small bowel series
  • Ultrasound
  • CT
  • MRI
  • Colonoscopy
313
Q

What might a high WBC indicate for IBD

A

They may have toxic megacolon or perforation

314
Q

What is the main goal of IBD

A

Rest the bowel

315
Q

What are the 5 classes of drugs that we usually use to treat IBD

A
  • Aminosalicylates (5-ASA)
  • Antimicrobials
  • Corticosteroids
  • Immunomodulators
  • Biologic therapies
316
Q

Why would we use 5-ASA to treat IBD

A

It works to decrease inflammation by suppressing proinflammatory cytokines and other inflammatory mediators (pretty much the number one treatment option to prevent flareups - golden standard)

317
Q

What is the “step up” vs “step down” approach for treating IBD

A

With “step up” a pt with mild symptoms begins with less toxic drugs first like 5-ASA or a antimicrobial. With a “step down” approach immunosuppressants and biologic therapies are used first.

318
Q

Name a few 5-ASA drugs

A

Sulfasalzine, balsalazide, mesalamine, olsalazine

319
Q

What sucks about surgery and chrons

A

Chrons will usually come back

320
Q

What is diverticulitis

A

When the outpouches in the colon become inflamed

321
Q

What is diverticulosis

A

When small pouches, or sacs, form and push outward from weak spots in your colon

322
Q

What can diverticulitis lead too

A

Perforation, abscess, fistula and bleeding

323
Q

What is interesting about diverticulitis

A

Most people have diverticula, but rarely does it develop into diverticulitis

324
Q

What is thought to cause diverticulitis

A

Both genetic and environmental.

  • Constipation
  • Lack of dietary fiber
  • See it more in industrialized populations, where people consume diets low low in fiber and high in refined carbs
  • Obesity
  • Smoking
  • Alcohol use
  • NSAIDs
325
Q

What is interesting about diverticulosis

A

You can be asymptomatic

326
Q

What is the preferred diagnostic for diverticulitis

A

CT with oral contrast

327
Q

How can we treat diverticulitis

A
  • Maintain a high fiber diet
  • Decrease in intake fat and red meats
  • Increase exercise
  • There is no connection between nuts and seeds
328
Q

How can we treat acute diverticulitis

A

Want to rest the colon

  • Clear liquid diet
  • Bed rest
  • Analgesics
329
Q

If hospitalization is needed for diverticulitis how are we going to treat

A
  • NPO
  • Bed rest
  • IV fluids and antibiotics
  • NG tube for decompression
330
Q

If the pt does need surgery due to diverticulitis, what will happen

A

They will likely have a colostomy, which may be reversed, and they can reconstruct the colon.

331
Q

What is the most common reason for emergency abdominal surgery

A

Appendicitis

332
Q

What is a common cause of appendicitis

A

Obstruction of the lumen by a fecalith (accumulated feces)

333
Q

What can an obstruction in appendicitis lead too

A
  • distention
  • Venous engorgement
  • Accumulation of mucus and bacteria which can lead to gangrene perforation and peritonitis
334
Q

What are signs of appendicitis

A
  • Dull pain around the umbilics
  • Anorexia
  • N + V
  • Pain will then shift to right lower quadrant at McBurney’s point (halfway between the umbilicus and right iliac crest)
  • Low grade fever
  • Assess for rebound tenderness - increased pain when pressure is released (classic sign)
335
Q

How can we help relieve pain for pt with appendicitis

A
  • Help the pt lie still with right leg flexed up to relieve pressure
336
Q

What will be a symptom of appendicitis for older adults

A

They will report less severe pain, but they will say that their right hip hurts

337
Q

What will labs look like for appendicitis

A

High WBCs

338
Q

What lab should you also do for appendicitis to rule out other genitourinary issues like a UTI

A

Do a UA

339
Q

What is the preferred diagnosis for appendicitis

A

CT scan

340
Q

What is the standard tx for appendicitis

A

Appendectomy to remove the appendix

341
Q

What happens if the appendix burst before surgery and their is evidence of peritonitis or an abscess

A

The pt will need parenteral fluids and antibiotic therapy 6-8 hrs before surgery to help prevent dehydration and sepsis

342
Q

What are risk factors for colorectal cancer

A

No single factor

  • Risk highest due to family history
  • Or pts that have IBD
343
Q

Why is colorectal cancer a higher killer

A

Because pts won’t have symptoms until it’s really advanced

344
Q

What are signs of colorectal cancer

A
  • Unexplained weight loss and fatigue may be the first signs
  • Iron deficiency anemia
  • Rectal bleeding
  • Abdominal pain
  • Change in bowel habits
  • Advanced disease we will see abdominal tenderness, palpable mass, hepatomegaly (enlarged liver), ascites (fluid collection in abdomen)
345
Q

What tests will they do with colorectal cancer

A
  • Tissue biopsy
  • CBC to check anemia and liver function tests
  • CT/MRI to look for spreading
346
Q

What is interesting about liver tests and colorectal cancer

A

Liver function tests can come back normal even if it has spread. So not a super great test.

347
Q

What are the stages of colorectal cancer

A

Stage 0: not grown passed the inner mucosa
Stage 1: Grown into the submucosa
Stage 2: Grown to the outermost layers but has not gown through
Stage 3: Spread to lymph nodes, but not to other sites
Stage 4: In lymph nodes and has spread to other organs

348
Q

What are the two types of bowel obstructions

A
  • Small bowel obstruction (SBO) in the small intestine
  • Large bowel obstruction (LBO) in the large intestine
349
Q

What is the difference between a partial or complete obstruction

A

In partial, some fluids and gas can pass. In complete, no fluids can pass. Partial can usually be treated by conservative therapy, while complete needs surgery.

350
Q

What is the difference between a simple and strangulated bowel obstruction

A

Simple has an intact blood supply, while strangulated does not.

351
Q

What is the difference between a mechanical and non-mechanical bowel obstruction

A

Mechanical bowel obstruction is when there is a physical obstruction usually in the small intestine due to surgical adhesions. Whereas a non-mechanical bowel obstruction id due to reduced or absent peristalsis from altered neuromuscular transmission.

352
Q

What is the most common non-mechanical bowel obstruction

A

Paralytic ileus

353
Q

What are the 4 hallmark signs and symptoms of a bowel obstruction

A
  • Abdominal pain
  • Nausea and vomiting
  • Distention
  • Constipation
354
Q

How can we diagnosis these bowel obstructions

A

Do a CT scan, x-ray, barium contrast enema or colonoscopy.

355
Q

What would we see in a CBC for a bowel obstruction

A
  • High WBC may mean strangulation or perforation
  • Hematocrit (proportion of red blood cells in your blood) may reflect hemoconcentration
  • Decreased hemoglobin and hematocrit may be from bleeding, strangulation or cancer.
356
Q

How do we typically treat surgical adhesions causing bowel obstructions

A

They usually resolve on their own

357
Q

For pts who are not going to emergency surgery for bowel obstruction, what are we going to do

A
  • Place on an NPO status
  • Give IV fluids
  • IV antiemetics
  • Insert NG for decompression
  • Give IV electrolytes
  • Get a culture in case they need antibiotics
  • Might need PN therapy
358
Q

What are anorectal abscesses

A

Abscesses that are from an obstruction of the anal glands, which can lead to infection.

359
Q

Why might anorectal abscesses form

A

From anal fissures, trauma or IBD. Or from the overgrowth of e. coli, staph or strep.

360
Q

What are symptoms of anorectal abscesses

A
  • Local pain and swelling
  • Foul-smelling drainage
  • Tenderness
  • Fever (if it has gone septic)
361
Q

What is an anal fistual

A

An abnormal tunnel leading from the anus or rectum to the outside like the skin, vagina or butt.

362
Q

What normally causes anal fistuals

A

Crohn’s disease

363
Q

How can we treat anal fistuals

A

They may resolve on their own with medication or they will need surgery, especially if they are infected.

364
Q

What is a pilonidal sinus

A

A small hole or tunnel in the skin at the top of the butt.

365
Q

How does a pilonidal cysts present

A

Some people may have a little abscess or bump there that isn’t open. Others may have an open bump that can become infected.

366
Q

What should a stoma look like

A

Rosey pink to red. Might have some mild edema (swelling) if new.

367
Q

What does a dusky blue stoma indicate

A

Ischemia (not enough blood supply)

368
Q

What does a brown-black stoma indicate

A

Necrosis

369
Q

What are the most common bacteria that cause UTIs

A
  • E. coli
  • Candida albicans usually from indwelling catheters
370
Q

What patients would we see fungal and parasitic infections from

A

From are immunosuppressed diabetic patients. Or patients with kidney problems or are receiving multiple antibiotics.

371
Q

What is included in the upper UTI, and what do we call it

A

Renal parenchyma, pelvis and ureters. Pyelonephritis.

372
Q

What is included in the lower UTI, and what do we call them

A

Bladder (cystitis) and urethra (urethritis)

373
Q

What do we call a UTI when it has spread everywhere

A

Urosepsis (life-threatening)

374
Q

What is the difference between uncomplicated and complicated

A

Uncomplicated involves the bladder only, complicated means that there is something else also going on, like a kidney injury or kidney disease

375
Q

What are some factors that may cause UTIs

A
  • Obesity
  • Aging
  • Diabetes
  • Obstruction like BPH
  • Catheters
  • Urinary tract stones
  • Instruments (cystoscopy)
  • Ureter reflex (anatomical feature in babies - continues through life)
  • HIV
  • Constipation
  • Pregnancy
376
Q

What are upper UTI symptoms

A
  • Flank pain
  • Chills
  • Fever
    Might also have fatigue, anorexia or asymptomatic
377
Q

What are classic manifestations of UTIs in older adults

A
  • Non-localized abdominal discomfort
  • Cognitive impairment
  • Generalized deterioration
  • Often afebrile (no fever)
  • Don’t usually have a fever as opposed to young people (remember this one)
378
Q

If someone has asymptomatic bacteriuria (colonization of bacteria in the bladder) what do you do

A

You do not screen or treat, just let it go. Unless, they are pregnant or undergoing a urologic procedure

379
Q

What are some symptoms for lower UTI

A
  • Dysuria (painful urination)
  • Hesitancy (hard to start a stream)
  • Postvoid dribbling
  • Urinary retention
  • Incontinence
  • Nocturia
  • Urgency
  • Frequency (need to go a lot)
380
Q

What are the two ways we can test for a UTI

A
  • Dipstick UA looking for nitrities (indicating bacteriuria), white blood cells and leukocyte esterase (indicates pyuria from WBCs)
  • Urine culture from clean catch
381
Q

When picking an antibiotic for a UTI, what does it depend on

A

The bacteria and if the UTI is complicated or uncompleted (upper vs. lower)

382
Q

What drugs are typically used to treat lower uncomplicated UTIs

A
  • Trimethoprim/sulfamethoxazole (TMP/SMX)
  • Nitrofurantoin
  • Macrodantin
  • Cephalexin
  • Fosfomycin
  • Ampicillin
  • Amoxicillin
  • Cephalosporins
383
Q

What should be used to treat complicated UTIs

A
  • Levofloxacin
  • Ciprofloxacin
    These are in the fluoroquinolones family = REMEMBER THERE IS A RISK OF TENDON RUPTURE
384
Q

What drug is good to help relieve UTI pain

A

Phenazopyridine (stain your urine reddish orange)

385
Q

If someone is taking prophylactic antibiotics to prevent a UTI, what should they also be doing

A

Taking probiotics

386
Q

What is the area called when you’re checking for tenderness over kidney

A

Costovertebral angle

387
Q

How can we treat acute UTIs

A
  • Local heat might help
  • Avoid caffeine, alcohol, citrus juice, chocolate, highly spiced foods may irritate bladder
  • Get a lot of fluid intake
  • Void regularly
388
Q

What should the WBC range be in a UA. What would an abnormal WBC indicate

A

WBCs should be between 0-5/hpf. If it is greater than 5, then it might indicate a UTI

389
Q

What is important to remember about UAs

A

A lot of things can cause UAs to be off, even dehydration

390
Q

What is nephrolithiasis

A

Kidney stones in the kindey

391
Q

What is urolithiasis

A

Kidney stones in the ureter

392
Q

What are most stones made up of

A

Calcium

393
Q

What are the symptoms of kidney stones

A

Severe, sudden sharp pain in flank area, back or lower abdomen. Can have nausea and vomiting due to the extreme pain.

394
Q

How can we diagnosis kidney stones

A

Noncontrast CT scan or ultrasound

395
Q

If the stone is less than 5 mm, will it pass spontaneously

A

Maybe. It has a 50% chance.

396
Q

If the kidney stone is greater than 10mm, what happens

A

They will need surgery, by putting in a stint to help the stone pass.

397
Q

If calcium is causing your stones, what should you avoid

A
  • Milk
  • Cheese
  • Ice cream
  • Yogurt
  • Chocolate
  • Cocoa
  • Nuts
  • Fish with bones
  • All beans except green beans
398
Q

If purine is causing your stone, what should you avoid

A
  • Sardines
  • Herring
  • Mussels
  • Liver
  • Kidney
  • Goose
  • Venison
  • Sweet breads
399
Q

If oxalate is causing your stones, what should you avoied

A
  • Dark roughage
  • Spinach
  • Rhubarb
  • Asparagus
  • Cabbage
  • Beets
  • Nuts
  • Cocoa
  • Coffee
  • Tea
  • Celery
  • Parsley
400
Q

Why might it be bad to eat purines if you have stones

A

Because uric acid is a by-product of purines

401
Q

What are risk factors for BPH

A
  • Aging
  • Obesity
  • Lack of physical activity
  • Alcohol consumption
  • Erectile dysfunction
  • Smoking
  • Diabetes
402
Q

Is BPH a form of cancer

A

No, you can actually have BPH while also having prostate cancer

403
Q

What are the two types of symptoms of BPH

A
  1. Irritative
  2. Obstructive
404
Q

What are the two types of BPH symptoms called together

A

LUTS (lower urinary tract symptoms)

405
Q

What are the irritative symptoms of BPH

A
  • Nocturia (usually first symptom)
  • Urinary frequency
  • Urgency
  • Dysuria (pain)
  • Bladder pain
  • Incontinence
406
Q

What are the obstructive symptoms of BPH

A
  • Decrease in the caliber and force of the urinary stream
  • Intermittency (starting and stopping several times while voiding)
  • Dribbling at the end of urination
407
Q

What is happening in BPH

A

The prostate is enlarging and decreases the diameter of the urethra

408
Q

What are the rare complications of BPH

A
  • UTIs (due to the bladder not completely emptying)
  • Pyelonephritis
  • Sepsis
  • Bladder calculi (not kidney stones - there is not risk for kidney stones)
  • Renal failure by hydronephrosis and bladder damage (distention)
409
Q

What fluids may you want to avoid if you have BPH

A

Alcohol and caffeine

410
Q

What are some drug treatments for BPH

A
  • 5a-reductase inhibitors help to reduce the size of the prostate gland
  • a-adrenergic receptors help to promote smooth muscle relaxation and facilitate urinary flow
    (more effective when used together)
  • Saw palmetto as an herbal therapy
411
Q

How might they diagnosis BPH

A
  • History and physical
  • Digital rectal exam
  • UA
  • Prostate specific antigen (PSA)
  • Postvoid residual via an ultrasound
412
Q

What are good ways to help prevent BPH

A
  • Yearly physical exam with a digital rectal exam for men over 50
  • Teach pts that alcohol, caffeine and cold and cough meds can increase symptoms
  • Receive a PSA (prostrate specific antigen) screening at least every 2 years for men ages 55-69
413
Q

If a man has slightly increased levels of PSA, what might that indicate

A

BPH

414
Q

What is the gold standard in surgery to treating BPH

A

Transurethral resection of the prostate (TURP)

415
Q

What is happening in TURP.

A

No incision is made (you use a scope to go through the penis), and you remove or cauterize the obstructing prostatic tissue. A large 3-way indwelling catheter with a 30mL balloon is placed after to provide hemostasis and to facilitate drainage.

416
Q

In a TURP, how long is the bladder irrigated for to prevent mucus and clots

A

24 hrs.

417
Q

What is a BIG complication with TURP

A

Hemorrhage

418
Q

Why do we want to irrigate the bladder after a TURP

A

To remove clotted blood from the bladder and ensure drainage of the urine.

419
Q

What are you watching for with TURPS

A

You want to watch for LARGE blood clots 24-36 hours after the surgery. Small clots are expected during this time frame, just not large ones.

420
Q

Do you want your pts on anticoagulants before TURP surgery

A

NO! This can increase their risk of surgery.

421
Q

Due to having poor sphincter tone after a TURP, what exercise can a pt do to help

A

Kegel exercises.

422
Q

What is good pt teaching after a TURP

A
  • The bladder may take up to 2 months to return to its normal capacity
  • Drink at least 2-3L of fluid per day
  • Urinate every 2-3 hrs
  • Limit bladder irritants like caffeine, citrus juice and alcohol.
  • Avoid heavy lifting. No more than 10 lbs.
  • Refrain from driving or intercourse.
423
Q

What is dysmenorrhea

A

Painful and/or disabling menstrual cramps

424
Q

What may cause dysmenorrhea

A

The increased release to prostaglandins, which then stimulates the uterus to contract and shed the lining, which can constrict small blood vessels and cause pain

425
Q

What drugs can help treat dysmenorrhea

A
  • NSAIDs like ibuprofen
  • Hormonal contraceptives
  • Naproxen
  • Serotonin-reuptake inhibitors
426
Q

When does premenstrual syndrome (PMS) occur

A

After ovulation and before menstrual flow (last half of your cycle)

427
Q

What might make PMS worse

A
  • Stress
  • Lack of exercise
  • Vitmain and nutrition deficiencies
  • Depression
  • Thyroid problems
  • Anemia
  • Uterine fibroids
  • Endometriosis
  • Autoimmune disorders
428
Q

What is endometriosis

A

When endometrial tissue implants outside of the uterine cavity.

429
Q

What is one of the most common causes of secondary dysmenorrhea

A

Endometriosis

430
Q

What are symptoms of endometriosis

A
  • Dysmenorrhea
  • Excessive bleeding during menses
  • Pain during intercourse
  • Infertility
  • Can cause excessive pain overall.
431
Q

How might they diagnosis endometriosis

A

Through a laparoscopy to get a biopsy of the suspected lesions

432
Q

What is the first line of tx for endometriosis

A

Oral contraceptives to help relieve symptoms and cause regression of tissue

433
Q

How can you tell the difference between endometriosis and dysmenorrhea

A

Ibuprofen and regular pain meds do not relieve the pain as they do for dysmenorrhea

434
Q

How long does pelvic pain last for in order to be considered chronic

A

6 months

435
Q

What is interesting about pelvic pain

A

It can be hard to find the actual cause of pelvic pain.

436
Q

Do ovarian cysts need to be removed.

A

Not necessarily, only if they are larger than 5cm or it’s solid. Otherwise, the cysts often resolve on their own.

437
Q

How might you diagnosis ovarian cycts

A

Through a pelvic ultrasound

438
Q

Who do we see have dysfunctional uterine bleeding (DUB)

A

Younger women and peri-menopausal.

439
Q

What is happening in dysfunctional uterine bleeding (DUB)

A

You’re bleeding so much during your period, you may even need a blood transfusion.

440
Q

What might cause dysfunctional uterine bleeding

A
  • Endocrine disturbances
  • Polycystic ovary disease
  • Stress
  • Obesity or underweight
  • Long-term drug use
  • Anatomic abnormalities
441
Q

When does menopause occur

A

12 months after no vaginal bleeding

442
Q

What is the perimenopause stage, how long can it last

A

The perimenopause stage is right before you have menopause, where you’ll have changes in your menstrual cycle (longer, less frequent, lighter or heaver). Can last for up to 10 years.

443
Q

What is happening during menopause

A
  • Ovaries fail to produce estrogen through ovulation
  • Menses slows down and becomes irregular
  • Uterine lining becomes thin and atrophic
  • Less vaginal secretions
  • Vasomotor instability (hot flashes)
444
Q

What test can you do to confirm menopause

A

If the pt hasn’t had a period in over a year, you can test their FSH levels. If they are elevated, then they have menopause.

445
Q

What is the most effective tx for menopause, but might be very dangerous

A

Estrogen therapy. It might reduce the symptoms of menopause, like bone loss, hot flashes, weight gain, diabetes, but it can also increase your risk for breast cancer, endometrial cancer and blood clots.

446
Q

What is the most common cause of breast masses during reproductive years

A

Fibroadenoma

447
Q

What do the masses in fibroadenoma feel like

A

Solid, slowly enlarging, benign mass, round, firm, easily movable, non-tender and clearly delineated from the surrounding tissue. Located in the upper outer quadrant of the breast.

448
Q

What ages would we see fibrocystic changes of the breast

A

20-30 years old.

449
Q

What changes are occurring in fibrocystic

A

Changes in the lobules, ducts and stromal tissue. Can then lead to the development of cysts and scar-like fibrous tissue, which can make breasts feel lumpy or “ropy”

450
Q

What is the cause of fibrocystic changes

A

Imbalance between the normal estrogen-to-progesterone ratio

451
Q

Why might a mammogram be important in fibrocystic changes

A

To determine if it is cancer, the changes may be so dense that it may be hard to do a mammogram, so they may need to do an ultrasound.

452
Q

What can help treat fibrocystic changes 6

A
  • Hormonal manipulation
  • Diuretics - premenstrually in severe cases
  • Mild analgesics like NSAIDS
  • Nutrition like Vitamins C and B, avoid caffeine, reduce fat, limit salt intake before menses
  • Wear a well-padded supportive bra
  • Local heat and ice for pain relief
453
Q

At what ages should you have your yearly mammograms

A

45-54

454
Q

When will you receive mammograms every 2 years

A

Over age 55

455
Q

Besides genetics, what can increase your risk of breast cancer

A

Early periods and late menopause

456
Q

What is gynecomastia

A

Benign condition of breast enlargement in men

457
Q

What are common causes of gynecomastia

A
  • Drugs
  • Aging
  • Obesity
  • Underlying condition causing estrogen excess
  • Androgen deficiency
  • Breast cancer
458
Q

Is prostate cancer quick or slow growing

A

Slow growing

459
Q

What are the symptoms of prostate cancer

A

Trouble urinating or having a weak stream of urine

460
Q

How do we detect for early prostate cancer

A

PSA test (high levels indicate cancer)

461
Q

How can we treat prostate cancer 5

A
  • Radiation
  • Cryotherapy
  • Albative hormone therapy (reducing androgens which can help stop the growth)
  • Chemo
  • Surgery (radical prostatectomy - remove the entire prostrate)
462
Q

What is hydrocele

A

Nontender, fluid-filled mass that fills with fluid due to improper lymphatic drainage (what Alex had)

463
Q

What is the treatment for hydrocele

A

No tx unless swelling becomes large or uncomfortable or if there is a risk of infertility

464
Q

What is testicular torsion

A

The spermatic cord that supplies blood to the testes and epididymis becomes twisted (considered a medical emergency)

465
Q

Who do we see have testicular torsion

A

Mostly young males under 20

466
Q

Why does testicular torsion occur

A

Can happen spontaneously or from a trauma or anatomic abnormality

467
Q

What are the symptoms of testicular torsion

A

Severe, sudden onset of scrotal pain, tenderness, swelling, n/v

468
Q

What is mor common, prostate cancer or testicular

A

Prostate, most men will end up having prostate cancer, but they won’t die from it.

469
Q

What is good about testicular cancer

A

It is one of the most curable cancers, and prognosis is usually good.

470
Q

What should we teach our pts about testicular cancer

A

Feel your scrotum for any lumps

471
Q

Besides finding a lump, what are other symptoms of testicular cancer

A

Dull ache or heavy sensation in lower abdomen, peri area or scrotum

472
Q

How do we diagnosis testicular cancer

A

First by palpation, where mass is firm and does not transilluminate (light doesn’t pass through the mass)

473
Q

What is priapism

A

Painful erection lasting longer than 6 hours, may be a medical emergency.

474
Q

What causes priapism

A

Vascular and neuro factors that result in the obstruction of venous outflow in the penis.

475
Q

What things may be associated with priapism

A
  • Diabetes
  • Trauma to spinal cord
  • Sickle cell disease
  • Drugs
476
Q

What are complications of priapism

A

Penile tissue necrosis

477
Q

What is hypogonadism

A

Gradual decline in androgen secretion (testosterone) that occurs in most men as they age

478
Q

What can be given to treat hypogonadism

A

Tetosterone, but the risks include high levels of HDLs, increased hematocrit, worsening sleep apnea, increased growth of prostate tissue (can’t use for people with BPH or prostate cancer)

479
Q

If you have one STI what are you at risk for

A

Having another STI

480
Q

What are the STIs that we need to report

A

Gonorrhea, chlamydia and syphilis

481
Q

What are our bacterial infections

A
  • Chlamydial
  • Gonorrhea
  • Syphilis
482
Q

What are our viral infections

A
  • Genital herpes
  • Genital warts
  • HIV
  • Hep B and C
483
Q

Can STIs be spread skin to skin

A

Yes, especially HPV

484
Q

What is the intubation period

A

Time from the initial infection from when your symptoms first appear (this can increase the risk of spreading because you don’t know you’re infected)

485
Q

What is the main barrier for protection

A

Condoms

486
Q

What is the most common STI

A

Chlamydia

487
Q

What is important to know about chlaydia

A

Transmission may occur during childbirth which can lead to conjunctivitis, pharyngitis and pneumonia

488
Q

How is chlamydia transmitted

A

Through sexual fluids (ejaculation does not have to occur) during oral, vaginal or anal sex.

489
Q

Can you be re-infected with chlamydia if you’ve had it once

A

Yes, you can be reinfected again

490
Q

How do we treat chlamydia

A

Doxycycline and azithromycin for 7 days.

491
Q

How long should you abstain from sex after tx of chlamydia

A

Abstain for 7 days after treatment and until all partners within the last 60 days have been treated.

492
Q

What are the symptoms of chlamydia

A
  • Mucopurulent discharge
  • Bleeding
  • Dysuria (burning urination)
  • Pain with intercourse
493
Q

How is gonorrhea transmitted

A

Same as chlamydia. Sexual fluids during vaginal, anal or oral sex.

494
Q

How do they diagnosis gonorrhea

A

Through the NAAT assay

495
Q

What are the symptoms of rectal gonorrhea

A
  • Mucopurulent rectal discharge
  • Bleeding
  • Pain
  • Pruritus (itchy)
  • Painful bowel movements
496
Q

What are the symptoms of urethra gonorrhea

A
  • Dysuria
  • Discharge
  • Pain
  • Redness
  • Swelling
497
Q

What are the symptoms of oral gonorrhea

A

Few symptoms if any. Maybe a sore throat.

498
Q

What can both men and women develop from gonorrhea

A

Disseminated gonococcal infection (DGI) - which is associated with lesions, fever, arthralgia, arthritis and endocarditis

499
Q

What is scary about gonorrhea and giving both

A

An infected mother can pass gonorrhea onto their baby, which causes them to have gonococcal conjunctivitis, which can lead to permanent blindness

500
Q

What do we give to prevent gonococcal conjunctivitis in babies, even if mom tests negative

A

Prophylactic erythromycin ointment. (same thing with chlamydia)

501
Q

What is important to remember about chlamydia and gonorrhea

A

If you have one, you will most likely be treated for both, because they usually go hand-in-hand

502
Q

How do we diagnosis syphilis

A

We screen first through a blood test either by venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR), and if they come back positive, then we do a confirmation test either by FTA-Abs or TP-PA tests.

503
Q

What is given to treat syphilis

A

Penicillin

504
Q

What is important to remember about diagnostic tests and syphilis

A

You can have a false positive or negative, because the test can be done before antibodies are produced, so that’s why we do a screen and then a confirmation test of the results (so you’re going to do two tests)

505
Q

What are our standard treatments for bacterial infections

A

Azythromycin and doxycycline.

506
Q

How can genital herpes be transmitted

A

Through skin-to-skin (through oral, genital and anal)

507
Q

Is there a cure for genital herpes

A

No, you’ll have outbreaks

508
Q

What is the most commonly transmitted sexual virus in the US

A

HPV

509
Q

What is the most common cause of cervical cancer

A

HPV

510
Q

What are the symptoms of HPV

A

Usually none, some females with non-oncogenic HPV may get genital warts

511
Q

What is the vaccine schedule for HPV

A
  • Two shot series for 11-26
  • Three shot series if starting at 15-26
    Not given passed 26
512
Q

What does pelvic inflammatory disease impact

A

Originates in the vagina or cervix, goes up the genital tract, infects the uterus, fallopian tubes and ovaries

513
Q

What are the most common causes of PID

A

chlamydia and gonorrhea

514
Q

What are symptoms of PID

A
  • Lower abdominal pain
  • Uterine tenderness
  • Adnexal tenderness (pain in the ovaries or fallopian tubes during the exam
  • Cervical motion tenderness
515
Q

What is a big complication of PID

A

Infertility

516
Q

What is the treatment of PID

A

Antibiotics

517
Q

What are you going to assess for with dysfunctional uterine bleeding

A

Blood pressure (they maybe losing pressure due to the bleeding), might also see a HR to compensate.

518
Q

What tests might you do for someone with dysfunctional uterine bleeding

A

Hematocrit and Hemoglobin, CBC

519
Q

With a TURP, should we see clots in the first 24hrs

A

Yes

520
Q

When foley is removed after a TURP, what color will the urine be

A

It will have a pink tinge to it.

521
Q

What are some signs of shock from sepsis

A
  • HYPOTENSION
  • Tachycardia
  • Change in temp.
522
Q

What will indicate an upper UTI

A

Flank pain, chills and fever

102 (5 decks)

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