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
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
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
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)
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
6
Q
What are the 3 main parts of the stomach
A
- Fundus (cardia)
- Body (corpus)
- Antrum
7
Q
What stops the stomach contents from entering into the small intestine
A
The pyloric sphincter
8
Q
What 3 cells are essential for the stomach
A
- Mucous cells
- Parietal cells (secrete hydrochloric acid, water and intrinsic factor(promotes vitamin B12 absorption in the small intestine))
- Chief cells (secrete pepsinogen)
9
Q
What is the largest internal organ in the body
A
The liver
10
Q
How many lobes does the liver have
A
Two - left and right.
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)
12
Q
What do the hepatic cells in the liver do
A
They make bile
13
Q
What are the major functions of the liver
A
- Absorption and metabolism of nutrients
- Degradation of toxins, hormones and medications
- Synthesis of proteins
14
Q
What are the 3 parts of the pancreas
A
- Head
- Body
- Tail
15
Q
What are the functions of the pancreas
A
- Exocrine - Produces and releases enzymes
- Endocrine - Secrets insulin and amylin for glucose regulation
16
Q
Why do we have a gallbladder
A
To store and and secrete bile
17
Q
When will the gallbladder release bile
A
When there is a presence of fat in the upper duodenum
18
Q
What are the functions of the small intestine
A
Protein, carbohydrate and fat digestion and absorption
19
Q
What are the 3 parts of the small intestine
A
- Duodenum
- Jejunum
- Ileum
20
Q
What is the purpose of villi
A
To produce digestive enzymes and increase the surface area for digestion and absorption
21
Q
What is the function of goblet cells in the small intestine
A
To secrete mucus and protect the mucosa
22
Q
What is the most important function of the large intestine
A
Water and electrolyte absorption
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
24
Q
What is the purpose of the ANS and the GI tract
A
- Parasympathetic (cholinergic) excites the tract and gets things moving
- Sympathetic (adrenergic) inhibits the tract to slow things down
25
What is also unique about the GI tract
It has it's own nervous system - the enteric (intrinsic) nervous system
26
What is happening in this enteric nervous system in the GI tract
You have the meissner plexus and the auerbach plexus. Both are working to control movement. They function independently from the brain and spinal cord.
27
Where does venous blood from the GI tract go
Into the portal vein leading to the liver - this allows the liver to detoxify the blood from bacteria and toxins from the GI tract
28
What three arteries supply blood to the GI tract
- 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)
29
What is an appendectomy
Removing the appendix
30
What is a cholecystectomy
Removing the gallbladder
31
What is a choledochojejunostomy
Opening between common bile duct and jejunum
32
What is a colectomy
Removing the colon
33
What is a colostomy
Opening into the colon
34
What is a esophagoenterostomy
Connecting the esophagus with the small intestine
35
Esophagogastrostomy
Removal of esophagus and anastomosis of remaining part to stomach
36
What is a gastrectomy
Removing the stomach
37
What is a gastrostomy
Opening into the stomach
38
What is a glossectomy
Removing the tongue
39
What is a hemiglossectomy
Removing half of the tongue
40
What is a herniorrhaphy
Repair of a hernia
41
What is a ileostomy
Opening into the ileum
42
What is a mandibulectomy
Removing the mandible
43
What is a pyloroplasty
Enlargement and repair of pyloric sphincter area
44
What is a vagotomy
Resection of branch of vagus nerve
45
What position should the pt be in when examining their abdomen
Supine with knees flexed and the HOB raised slightly
46
What should you have your pt do before you examine their abdomen
Go to the bathroom
47
What is the correct order for examining the abdomen
1. Inspect
2. Auscultate
3. Percuss
4. Palpate
48
Should you auscultate the abdomen with both the diaphragm and the bell
Yes - listen for at least two minutes
49
When you percuss the abdomen, what should you hear
Tympany (high pitched hollow), with dullness (fluid or masses) over the organs.
50
When examining the rectum and anus, what test do you want to perform
Test for occult blood
51
In terms of subjective data, why do we want to ask the pt about alcohol or nicotine use
- Long periods of alcohol decrease the stomach mucus lining
- Nicotine is an irritant to the GI tract
52
When preparing a pt for a scan, what should you ask them in regards to allergies
Ask them if they are allergic to iodine, shellfish or contrast media
53
What should we always make sure has been completed prior to a scan
Signed consent.
54
What do we have pts swallow for an upper gi scan
Barium solution or gastrografin
55
What can we look at for the upper GI scans
- Oropharyngeal area
- Esophagus
- Stomach
- Small intestine
56
How can we look at the upper GI
- Fluoroscopy, which is an x-ray.
- X-ray
57
To carryout a lower GI study, what happens
- 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
58
What bowel prep goes into preparing for a colonoscopy 5
- 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
59
What is important to remember about colonoscopies
The patient will be put under sedation
60
Before an endoscopy, how long should the pt be NPO
8-12hrs prior
61
What procedure can be used to retrieve gallstones from distal common bile ducts
Endoscopic retrograde cholangiopancreatography (ERCP)
62
What is the biggest risk with an endoscopy
Aspiration - so make sure you maintain their airways
63
Are patients put to sleep during endoscopies
Yes, they are put under sedation
64
What is cool about video capsule endoscopy
- 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
65
Why would we get a liver biopsy
- Diagnosis cancer
- Stage fibrosis (liver damage)
66
What are the two types of liver biopsies
- Open: making an incision and removing tissue
- Closed: Uses a needle to remove tissue
67
What can a CT scan be used for
With oral or IV contrast dye we can detect biliary tract, liver and pancreatic disorders
68
What can an MRI be used for
Hepatobiliary disease, hepatic lesions and stage colorectal cancer
69
What might be some symptoms of malnutrition 10
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)
10. Susceptible to infection
70
Describe starvation-related malnutrition or primary PCM (protein-calorie malnutrition)
When there is chronic starvation without inflammation (anorexia)
71
Describe chronic disease-related malnutrition or secondary PCM
Where there is mild-moderate inflammation and a disease is causing you to have malnutrition (organ failure, cancer, rheumatoid arthritis and obesity)
72
What is acute disease-related or injury-related malnutrition
Where their is inflammation and malnutrition (major infection, burns, trauma, surgery)
73
What is the difference between enteral and parenteral nutrition
Enteral goes into the GI system, while parenteral goes into the bloodstream
74
What are indications for enteral feedings
- Anorexia
- Orofacial fractures
- Head and neck cancers
- Neurologic or psychiatric conditions that prevent intake
- Extensive burns
- Critical illness
- Chemo or radiation therapy
75
Where is a gastrostomy placed
Into the stomach
76
Where is a jejunostomy placed
Into the small intestine
77
To prevent aspiration with tube feedings, what should you do
Keep the HOB elevated to 30-45 degrees
78
How often should feeding tubes be flushed
Every 4 hrs with 30mLs
79
What would be a contraindications for enteral feedings
Where their GI tract isn't working, so use parenteral feedings
80
Should a nasogastric tube or any tube going through the pts nose be used for short term or longer term
Nose ones are for short term, for long term use a gastrostomy or jejunostomy
81
When would we use parenteral nutrition
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
82
What is the difference between anorexia and bulimia
With bulimia, people will binge eat and then do things to avoid the weight, like vomiting, taking laxatives or overexercising
83
What are we worried about developing with bulimia
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
84
What is the only approved antidepressant for treating bulimia
Fluoxetine (Prozac)
85
What is the difference between primary and secondary obesity
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.
86
What obesity class is a person in with a BMI between 30-34.9
Class I
87
What obesity class is a person in with a BMI between 35-39.9
Class II
88
What obesity class is a person in with a BMI between 40.0
Class III
89
What if your BMI is under 18.5
You're underweight
90
What if your BMI is between 18.5-24.9
You're normal weight
91
What if your BMI is between 25-29.9
You're overweight
92
What if your BMI is between 30-39.9
You're obese
93
What if your BMI is above 40
You're extremely obese
94
What has been shown to be the only successful tx option for extreme obesity
Bariatric surgery
95
What is the criteria for bariatric surgery
- BMI over 40
- BMI over 35 with a significant co-morbidity like hypertension or type 2 diabetes
96
What are some short term complications following bariatric surgery 6
- 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
97
How high should we have the HOB after bariatric surgery
At 45 degrees to reduce abdominal pressure and increase lung expansion
98
When should the pt start walking after bariatric surgery
They should begin walking that evening and then 3 times per day
99
What are some long term complications from bariatric surgery 9
- Band slippage
- Obstruction hernia
- Esophageal erosion
- Ulcers
- Acid reflux
- Vitamin deficiency
- Osteoporosis
- Anemia
- Dumping syndrome (stomach stops absorbing anything)
100
What is a typical diet for a post op after bariatric surgery
- 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
101
What is the post bariatric surgery diet
- 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
102
When might pts begin to see the success of their bariatric surgery
6-8 months, they should see some big changes
103
Who is more likely to have n + v with anesthesia and motion sickness
Women
104
Where is the vomiting center located
In the medulla
105
What are we scared about when someone is continuously vomiting
Dehydration and loss of electrolytes
106
Besides dehydration and the loss of electrolytes, what can continuous vomiting lead too
- Fluid volume loss
- Decreased plasma volume
- Circulatory failure
- Metabolic alkalosis
107
How does metabolic alkalosis occur from vomiting
You are losing your gastric hydrochloric acid, so you're becoming less acidic
108
How can antiemetics help to treat n + v
They block the neurochemicals that trigger n + v
109
What type of anticholinergic drug can we use for n + v
Transdermal scopolamine patch, which blocks the cholinergic pathway to the vomiting center (often used for motion sickness)
110
What are some common antihistamines that can be used to treat n + v
- Dimenhydrinate (Dramamine)
- Meclizine
- Hydroxyzine
- Benadryl
111
What does a patient with severe vomiting need
IV fluids with electrolytes and glucose (don't forget to be checking their glucose levels)
112
After symptoms of n + v have subsided, what should we do
Have the patient drink 5-15mL of water every 15-20 minutes
113
When a person is recovering from n + v, what should you never give them
- Drinks that are hot or col
- Drinks that are carbonated
114
Why should we be careful giving broth or sports drinks to someone who has been vomiting
Because they items can have very high sodium concentrations
115
Once a patient with n + v is able to tolerate dry toast, crackers or gelatin, what can they begin to eat
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
116
What is emesis has partially digested food after several hours after a meal
Then there is a gastric outlet obstruction or delayed gastric emptying (the stomach isn't emptying)
117
What if there is a fecal odor and bile in the emesis
This can indicate an intestinal obstruction below the pylorus, while bile also suggests obstruction below the ampulla of Vater
118
What is a mallory-weiss tear and what could it cause
It is tear in the mucosal lining near the esophagogastric junction, which can produce coffee ground emesis
119
Why does a gastric bleed look like coffee grounds
Because the blood is coming into contact with gastric acid, making it look like coffee grounds
120
What complementary therapies may help with n + v
- Acupuncture
- Acupressure
- Botanicals like ginger and peppermint oil
- Relaxation and breathing exercises
121
What are some gerontologic considerations for n + v
- 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
122
Who is at risk for oral infections
Immunosuppressed (chemo for cancer) or using corticosteroid inhalant to treat asthma
123
What can oral pathogens increase your risk of
Diabetes and heart disease
124
What is stomatitis
Inflammation in the mouth (often having ulcers)
125
What can cause stomatitis
- Trauma, pathogens, irritants (tobacco, alcohol)
- Renal, liver and hematologic diseases
- Side effect of chemo and radiation
126
Who is at the biggest risk for stomatitis
Patients receiving chemo
127
What are symptoms of stomatitis
- Excessive salivation
- Halitosis (bad breath)
- Sore mouth
128
What are the treatments for stomatitis
- Oral hygiene with soothing solutions, topical medications
- Soft, bland diet
129
What are the two types of oral cancer
- Oral cavity cancer (mouth cancer)
- Oropharyngeal cancer (throat cancer)
130
What are some predisposing factors for oral cancer
- History of tobacco or alcohol use
- Having an outdoor occupation (lip cancer and sunlight)
- Pipe smoking
- HPV (having multiple oral sex partners)
131
What are some symptoms of oral cancer 7
- 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
132
Are symptoms of oral cancer known right away
No, most are asymptomatic in early stages
133
What are the treatment options for oral cancer
Radiation, chemo drugs, surgery
134
What is GERD caused by
Reflux of stomach acid into the lower esophagus, which causes mucosal damage
135
Is GERD a disease
No, it is a syndrome of a disease (caused by other GI problems)
136
Is there one single cause of GERD
NO
137
What is happening with the LES and GERD
The LES should stop acid reflex from entering the esophagus, but it isn't working right
138
What are somethings that can cause GERD 3
- Obesity (increased intraabdominal pressure pushing contents back up)
- Smoking
- Hiatal hernia
139
Why would the LES not being working in GERD
It's an issue affecting it's pressure, can be caused by many different things like food, drugs and alcohol.
140
What is the most common symptom of GERD
Heartburn
141
What are other symptoms of GERD besides heartburn
- Dyspepsia (pain in the upper abdomen)
- Regurgitation (contents coming into throat or mouth)
142
What is scary about GERD
People may think they're having GERD when they have chest pain, but it could actually be a cardiac event.
143
What are some complications from GERD 4
- 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
144
Why is chronic esophagitis from GERD bad
Repeated esophagitis may lead to scar tissue formation, stricture and dysphagia
145
Besides diagnosing GERD based on symptoms, how else can we diagnosis
- Upper endoscopy
- Barium swallow
- Measure pressure in esophagus and LES
- Esophageal manometric (motility) studies
146
How can people usually treat their GERD
Through lifestyle changes
147
What are some modifications that can be made to treat GERD
- 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
148
What are the top drug choices for GERD
Proton pump inhibitors (PPIs) or histamine (H2) blockers
149
What is nice about PPIs
They are more effective at healing esophagitis than H2 receptor blockers
150
When should a pt take their PPIs
Once daily, before their first meal
151
What are some scary things about PPIs 4
Long-term use may cause:
- Decreased bone density
- Kidney disease
- Vitamin B12 and magnesium deficiency
- Increase risk for dementia
152
When is the best time to take an antacid for GERD
1-3 hours after meals and at bedtime
153
What is the downfall to antacids
Their effects don't last very long and they interact with a lot of other drugs
154
What foods should you avoid eating that decrease LES pressure and lead to GERD
- Chocolate
- Peppermint
- Fatty foods
- Coffee and tea
155
Why would we do a surgery for GERD
The patient may have severe complications like esophagitis, medication intolerance, stricture and BE
156
What is a common laparoscopic antireflux surgery
Nissen and Toupet fundoplications
157
What is a hiatal hernia
Where a portion of the stomach goes into the esophagus through an opening or hiatus in the diaphragm
158
Who do we commonly see have hiatal hernias
Older adults and women
159
What are the 2 types of hiatal hernias
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.
160
What can cause hiatal hernias
- 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.
161
What are symptoms of hiatal hernia
Symptoms are like having GERD (heartburn and dysphagia)
162
What can a hiatal hernia lead too 7
- GERD
- Esophagitis
- Hemorrhage from erosion
- Stenosis (narrowing of the esophagus)
- Ulcerations of the herniated part of the stomach
- Strangulation of the hernia
- Regurgitation
163
How can we diagnosis hiatal hernias
- Barium swallow
- Endoscopy
164
What are some conservative ways to treat hiatal hernias
- Eliminate alcohol
- Stop smoking
- Keep HOB elevated
- Avoid lifting/straining
- Reduce weight if needed
- Don't wear tight clothes
- Anti-secretory agents and antacids
165
What are some surgical options for hiatal hernias 4
- 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)
166
What sucks about esophageal cancer
By the time the pt has symptoms, the tumor is often advanced
167
What are symptoms of esophageal cancer
- 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.
168
How can they diagnosis esophageal cancer
- Endoscopic biopsy
- Barium swallow (esophagram)
169
Is esophageal cancer treatable? How?
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)
170
What should you be checking for in your assessment for esophageal cancer
- 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
171
What typically causes eosinophilic esophagitis
Allergies
172
What is the tx for eosinophilic esophagitis
Corticosteroids
173
What are esophageal diverticula
Saclike pouches in the esophagus
174
What is the tx for esophageal diverticula
There isn't one specific tx. Some people can empty the pouches by applying pressure. Others may need surgery.
175
What is esophageal stricture
Narrowing of the esophagus
176
What usually causes esophageal strictures
GERD
177
How do we treat esophageal strictures
Mechanical dilation (such as applying a balloon or stint to keep it open)
178
What is achalasia
No peristalsis in the lower two thirds of the esophagus
179
What is interesting about achalasia
It is very rare and the cause is unknown
180
How do they diagnosis achalasia
Barium swallow test
181
What is the tx goal of achalasia
Relieve the dysphagia
182
What should I know about esophageal varices
They are dilated, tortuous veins in the lower part of the esophagus, usually from portal vein hypertension. Common complication of liver cirrhosis.
183
What is gastritis
Inflammation of the gastric mucosa in the stomach
184
What is happening in gastritis
The mucosal barrier that protects the gastric mucosa from the stomach acid is broken.
185
What is the most common cause of gastritis
Helicobacter pylori
186
Besides H. pylori, what are other causes of gastritis
Alcohol, NSAIDs, Crohn's disease, tuberculosis and bile reflux
187
What is autoimmune gastritis
Where the immune system kills parietal cells, which can lead to an inadequate production of intrinsic factor (B12) this leads to pernicious anemia
188
What are symptoms of gastritis 7
- Epigastric pain
- Nausea and vomiting
- Weight loss
- Decreased appetite
- Stool color changes
- Feeling full
- Epigastric tenderness
189
How is gastritis usually diagnosed
- Usually based on symptoms
- Can use an endoscopic exam with biopsy as well to test for the presence of H. pylori
190
How is acute gastritis treated
Similar to n + V (rest, NPO, IV fluids, antiemetics, monitor for dehydration)
191
What is interesting about gastritis
Healing may spontaneously occur in a few days
192
What kind of drugs can you use for gastritis
PPIs and H2 receptor blockers to help reduce gastric HCL acid secretion
193
What is an example of a PPI
Omeprazole - basically any drug ending in "zole"
194
What do H2 receptor drugs end in
"tidine"
195
What is peptic ulcer (PUD) disease
Where there is erosion of the GI mucosa by digestive HCL and pepsin, which can lead to ulcers
196
What is the most common symptom of PUD
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)
197
What is interesting about PUD
A majority of gastric and duodenal ulcers are caused by H. pylori
198
How can we diagnosis PUD
Labs and endoscopy, specifically a esophagogastroduodenoscopy, which looks at the mucosal lining of the stomach.
199
What are the medications used to treat PUD
- Antibiotics if they have H. pylori
- PPIs (help reduce gastric acid secretion)
- H2 receptor blockers, cytoprotective drugs and antacids can also work alongside.
200
If H pylori is causing the PUD, what medications are prescribed
An antibiotic, like amoxicillin, and a PPI are used together
201
What are the 3 main complications from PUD, which require immediate medical attention
- 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.
202
When would surgery be provided for a PUD
If the ulcers are not healing or if they are causing bleeding
203
What happens in PUD surgery
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)
204
What causes stomach cancer
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.
205
What are some symptoms of stomach cancer 5
(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)
206
What is the tx for stomach cancer
- Surgery (gastrectomy)
- Chemo
- Radiation
- Targeted therapy (target specific cells)
207
What is interesting about upper GI bleeds
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.
208
What are the two types of upper GI bleeds
- 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.
209
How do we diagnosis upper GI bleeds
From an endoscopy
210
What will a BUN tell us in terms of an upper GI bleed
If the BUN is high, this indicates that there could be a significant hemorrhage due to the GI tract breaking down proteins
211
What is interesting about upper GI bleeds
80-85% of pts with massive hemorrhage spontaneously stop bleeding
212
What are we very concerned about with an upper GI bleed
If it is an acute GI bleed, they may go into hypovolemic shock
213
What are the symptoms of hypovolemic shock 6
- Low BP
- Tachycardia
- Cool, clammy skin
- Slow cap refill
- Decreased level of consciousness
- Decreased urine output
214
What are emergency management interventions for an upper GI bleed 6
- Replace fluids via an IV
- Give O2
- Have on ECG
- Insert NG tube
- Insert indwelling catheter
- Give IV PPI to decrease acid secretion
215
What is considered diarrhea
At least 3 loose or liquid stools per day
216
How long does acute diarrhea last
Less than 14 days
217
How long does chronic diarrhea last
Over 30 days
218
What is the most common intestinal parasite that causes diarrhea here in the U.S.
Giardia lamblia
219
Where can giardia lamblia be found and how is it transmitted
It can be found in lakes, rivers, swimming pools, water parks and hot tubs. It is transmitted by fecal oral route
220
What is the most common cause of bloody diarrhea
E. Coli
221
How long can C. Diff spores last on objects
Up to 70 days
222
What is happening in C. diff
It destroys all of your good cells, which causes the colon to become inflamed which produces toxins which causes nasty diarrhea.
223
What is happening in secretory diarrhea
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
Do hand sanitizers kill c. diff?
No, you need to use soap and water, and use bleach on surfaces
225
What can severe diarrhea cause
Life-threatening dehydration, electrolyte problems and acid base imbalances (metabolic acidosis)
226
What are risk factors for diarrhea
- Being old
- Using PPIs which decrease stomach acid (stomach acid kills pathogens)
- Antibiotics
- Immunocompromised
227
What are some diagnostics with diarrhea
- 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
What might we see in a blood culture for diarrhea
- 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
What can we give to help replace mild symptoms of diarrhea
Pedialyte (has glucose and electrolytes in it)
230
Do we treat diarrhea with antidiarrheals
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
Do we use antibiotics to treat diarrhea often
No, antibiotics are rarely used.
232
To help avoid contamination, how should we treat all cases of diarrhea
As if they are infection. Wash hands with soap and water. Use bleach for cleaning.
233
What can cause fecal incontinence
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
What is the most common cause of fecal incontinence for women
Obstetric (due to childbirth), can also be from trauma, aging or menopause.
235
How can chronic constipation lead to fecal incontinence
You could have a hardened stool that is stuck, which causes lose stool to leak around
236
What kind of diet can help treat fecal incontinence
- 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
Besides changing your diet, how else can you treat fecal incontinence 6
- 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
Is constipation a symptom or a disease
It is a symptom, not a disease
239
What is cathartic colon syndrome
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
What are symptoms of constipation
- Painful abdomen, distention, bloating, increased rectal pressure
241
What is a common complication of chronic constipation
Hemorrhoids from the repeated valsalva manuver (bearing down)
242
How can the valsalva maneuver kill someone with a heart condition or hypertension
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
What are some concerning signs regarding a change in bowel habits for people over 50 lasting longer than 6 weeks
- Rectal bleeding
- Bloody stools
- Irion deficiency anemia
- Weight loss
- Significant abdominal pain
- Family history of colorectal cancer or inflammatory bowel disease
244
What foods could we give to someone who is constipated
- Beans
- Broccoli
- Carrots
- Baked potatoes
- Tomatoes
- Apples
- Strawberries
- Oranges
- Whole wheat bread
- Cereal
245
What foods should you avoid if you have constipation
Foods low in fiber and high in fat like cheese, ice cream, potato chips, red meat, processed foods.
246
What are good sources of soluble fiber to give to someone with fecal incontinence
- Oats
- Peas
- Beans
- Apples
- Carrots
- Barley
- Citrus fruits
247
What is scary about abdominal trauma
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
What are symptom of abdominal trauma 9
- 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
What may indicate a retroperitoneal hemorrhage in abdominal trauma
- Cullen's sign (ecchymosis around the umbilicus)
- Grey Turner's sign (ecchymosis around the flanks)
250
What are signs of hypovolemic shock
- Decreased level of consciousness
- Tachypnea
- Tachycardia
- Decreased BP
- Decreased pulse pressure
251
If the diaphragm ruptures, where can you hear bowel sounds
In the chest
252
What are diagnostics for abdominal trauma
- CBC and UA (looking for blood in the urine)
- Abdominal CT
253
What is important to remember about CTs and abdominal trauma
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
What is a hernia
When part of an internal organ like an intestine goes through (protrusion) a weak area of muscle.
255
Where to hernias occur
Anywhere in the body
256
What is a reducible hernia
When the hernia easily returns back to where it belongs either manually or spontaneously
257
What is a irreducible hernia
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
What is an inguinal hernia
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
What is a femoral hernia
Protrusion through the femoral ring into the femoral canal, usually results in strangulation
260
What is an umbilical hernia
Part of your intestine bulges through the opening in your abdominal muscle near your bellybutton
261
What is a ventral or incisional hernia
Hernia due to weakness of the abdominal wall at the site of the incision
262
What is the most common symptom of a hernia
Pain (worsens with activity, straining and coughing)
263
What are symptoms of a strangulated hernia 5
- Severe pain
- Bowel obstruction
- Vomiting
- Cramping
- Distention
264
How do you treat strangled hernias
Resecting the involved area, may need temporary colostomy
265
What is a herniorrhaphy
Surgical repair of a hernia
266
What is a hernioplasty
Reinforcing the weakened area to prevent another hernia
267
What should you watch for after a hernia repair
The pt may have trouble voiding. Measure Is and Os
268
What should you teach your pts after hernia surgery
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
What are hemorrhoids
Dilated hemorrhoidal veins
270
What are factors that can increase your risk for hemorrhoids 8
- Pregnancy
- Constipation
- Straining to defecate
- Diarrhea
- Heavy lifting
- Prolonged standing and sitting
- Obesity
- Ascites (fluid collection in abdomen)
271
Are hemorrhoids usually painful
No, for the most part their painless
272
Which bleed, internal or external hemorrhoids
Internal hemorrhoids. External hemorrhoids very rarely bleed.
273
What can help treat hemorrhoids besides managing symptoms of constipation 8
- 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
What is the surgery treatment for hemorrhoids and when would it be needed
Hemorrhoidectomy, if there is a marked prolapse, excessive pain or bleeding or large/multiple thrombosed (filled with blood) hemorrhoids
275
Describe IBS
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
What are the causes of IBS
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
How is IBS diagnosed
Solely on symptoms
278
Based on symptoms, what do we use to diagnosis IBS
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
What are other common symptoms of IBS 10
- Abdominal distention
- Nausea
- Flatulence
- Bloating
- Urgency
- Mucus in the stool
- Sensation of incomplete evacuation
- Fatigue
- Headache
- Sleep problems
280
What is the tx for IBS
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
What can be beneficial to pts with IBS 5
- 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
What CAM therapies may help with IBS 8
- Relaxation
- Acupuncture
- Hypnosis
- Hypnotherapy
- Peppermint
- Fennel
- Herbal teas like chamomile
- Ginger
283
What is inflammatory bowel disease
Chronic inflammation of the GI tract. People can have periods of remission followed by periods of exacerbation.
284
What are the two ways we classify IBD
- Crohn's disease
- Ulcerative colitis
285
What areas does ulcerative colitis and Crohn's disease effect
Ulcerative colitis effects the colon while Crohn's disease effects any segment of the GI tract from the mouth to the anus.
286
When does IBD usually occur
In your teen years to early adulthood
287
What is the cause of IBD
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
What is interesting about IBD and the U.S.
They think that dietary factors unique to industrialized countries can contribute to IBD, like having refined sugar, high fats, fatty acid.
289
What can increase your risk for having IBD 4
- Poor diet
- Use of NSAIDs
- Antibiotics
- Oral contraceptives
290
What is interesting about Crohn's
You can great looking parts of your bowel and then you can random diseased portions
291
Does Crhon's involve all layers of the bowel wall
Yes, it just doesn't have to involve the entire length of the bowel
292
What does Crohn's look like
Deep ulcerations that penetrate the mucosa, causing a cobblestone appearance
293
What can Crohn's cause
Strictures, adhesions, abscesses and fistulas
294
Does Crohns or ulcerative colitis have worse diarrhea
Ulcerative colitis has worse diarrhea
295
Where will a person with crohns complain of pain
Right lower quadrant
296
Where does Ulcerative colitis (UC) start and end
Usually starts in the rectum and moves upwards towards the cecum
297
Does UC have any "skips" like crohns
No, UC is continuous
298
What is rare in UC
Fistulas and abscesses are rare because inflammation doesn't extend all the way through the bowel wall layers like in crohns
299
What do you usually have a lot of with UC
Liquid diarrhea, because the water and electrolytes aren't being absorbed in the colon.
300
Where is pain reported in UC
Left lower quadrant
301
What are the signs of IBD
- Diarrhea
- Weight loss
- Abdominal pain
- Fever
- Fatigue
302
Where will we see rectal bleeding in crohns or UC
UC
303
Where will we see bloody diarrhea in crohns or UC
UC
304
If the small intestine is involved with crohns, what do we see
Weight loss, because nutrients aren't being absorbed
305
How many stools can you have a day if you have moderate UC
10 stools a day
306
If a pt is in severe UC, where they are going 10-20 times per day, what will we see 5
- Fever
- Rapid weight loss
- Anemia
- Tachycardia
- Dehydration
307
What are complications of IBD 8
- Hemorrhage
- Strictures
- Perforation
- Abscesses
- Fistulas
- Intestinal cancer (crohns)
- Colorectal cancer
- Toxic megacolon (UC)
308
What can toxic megacolon do
It can cause perforation and may need an emergency colectomy
309
Are abscesses and fistulas more common in crohns or UC
Crohns
310
With IBD, what is important to get screened for
Cancer, because you are at an increased risk
311
What is interesting about diagnosing chrons
Early chrons can look like IBS
312
What diagnostic studies will we do for IBD
- 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
What might a high WBC indicate for IBD
They may have toxic megacolon or perforation
314
What is the main goal of IBD
Rest the bowel
315
What are the 5 classes of drugs that we usually use to treat IBD
- Aminosalicylates (5-ASA)
- Antimicrobials
- Corticosteroids
- Immunomodulators
- Biologic therapies
316
Why would we use 5-ASA to treat IBD
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
What is the "step up" vs "step down" approach for treating IBD
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
Name a few 5-ASA drugs
Sulfasalzine, balsalazide, mesalamine, olsalazine
319
What sucks about surgery and chrons
Chrons will usually come back
320
What is diverticulitis
When the outpouches in the colon become inflamed
321
What is diverticulosis
When small pouches, or sacs, form and push outward from weak spots in your colon
322
What can diverticulitis lead too
Perforation, abscess, fistula and bleeding
323
What is interesting about diverticulitis
Most people have diverticula, but rarely does it develop into diverticulitis
324
What is thought to cause diverticulitis
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
What is interesting about diverticulosis
You can be asymptomatic
326
What is the preferred diagnostic for diverticulitis
CT with oral contrast
327
How can we treat diverticulitis
- Maintain a high fiber diet
- Decrease in intake fat and red meats
- Increase exercise
- There is no connection between nuts and seeds
328
How can we treat acute diverticulitis
Want to rest the colon
- Clear liquid diet
- Bed rest
- Analgesics
329
If hospitalization is needed for diverticulitis how are we going to treat
- NPO
- Bed rest
- IV fluids and antibiotics
- NG tube for decompression
330
If the pt does need surgery due to diverticulitis, what will happen
They will likely have a colostomy, which may be reversed, and they can reconstruct the colon.
331
What is the most common reason for emergency abdominal surgery
Appendicitis
332
What is a common cause of appendicitis
Obstruction of the lumen by a fecalith (accumulated feces)
333
What can an obstruction in appendicitis lead too
- distention
- Venous engorgement
- Accumulation of mucus and bacteria which can lead to gangrene perforation and peritonitis
334
What are signs of appendicitis
- 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
How can we help relieve pain for pt with appendicitis
- Help the pt lie still with right leg flexed up to relieve pressure
336
What will be a symptom of appendicitis for older adults
They will report less severe pain, but they will say that their right hip hurts
337
What will labs look like for appendicitis
High WBCs
338
What lab should you also do for appendicitis to rule out other genitourinary issues like a UTI
Do a UA
339
What is the preferred diagnosis for appendicitis
CT scan
340
What is the standard tx for appendicitis
Appendectomy to remove the appendix
341
What happens if the appendix burst before surgery and their is evidence of peritonitis or an abscess
The pt will need parenteral fluids and antibiotic therapy 6-8 hrs before surgery to help prevent dehydration and sepsis
342
What are risk factors for colorectal cancer
No single factor
- Risk highest due to family history
- Or pts that have IBD
343
Why is colorectal cancer a higher killer
Because pts won't have symptoms until it's really advanced
344
What are signs of colorectal cancer
- 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
What tests will they do with colorectal cancer
- Tissue biopsy
- CBC to check anemia and liver function tests
- CT/MRI to look for spreading
346
What is interesting about liver tests and colorectal cancer
Liver function tests can come back normal even if it has spread. So not a super great test.
347
What are the stages of colorectal cancer
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
What are the two types of bowel obstructions
- Small bowel obstruction (SBO) in the small intestine
- Large bowel obstruction (LBO) in the large intestine
349
What is the difference between a partial or complete obstruction
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
What is the difference between a simple and strangulated bowel obstruction
Simple has an intact blood supply, while strangulated does not.
351
What is the difference between a mechanical and non-mechanical bowel obstruction
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
What is the most common non-mechanical bowel obstruction
Paralytic ileus
353
What are the 4 hallmark signs and symptoms of a bowel obstruction
- Abdominal pain
- Nausea and vomiting
- Distention
- Constipation
354
How can we diagnosis these bowel obstructions
Do a CT scan, x-ray, barium contrast enema or colonoscopy.
355
What would we see in a CBC for a bowel obstruction
- 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
How do we typically treat surgical adhesions causing bowel obstructions
They usually resolve on their own
357
For pts who are not going to emergency surgery for bowel obstruction, what are we going to do
- 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
What are anorectal abscesses
Abscesses that are from an obstruction of the anal glands, which can lead to infection.
359
Why might anorectal abscesses form
From anal fissures, trauma or IBD. Or from the overgrowth of e. coli, staph or strep.
360
What are symptoms of anorectal abscesses
- Local pain and swelling
- Foul-smelling drainage
- Tenderness
- Fever (if it has gone septic)
361
What is an anal fistual
An abnormal tunnel leading from the anus or rectum to the outside like the skin, vagina or butt.
362
What normally causes anal fistuals
Crohn's disease
363
How can we treat anal fistuals
They may resolve on their own with medication or they will need surgery, especially if they are infected.
364
What is a pilonidal sinus
A small hole or tunnel in the skin at the top of the butt.
365
How does a pilonidal cysts present
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
What should a stoma look like
Rosey pink to red. Might have some mild edema (swelling) if new.
367
What does a dusky blue stoma indicate
Ischemia (not enough blood supply)
368
What does a brown-black stoma indicate
Necrosis
369
What are the most common bacteria that cause UTIs
- E. coli
- Candida albicans usually from indwelling catheters
370
What patients would we see fungal and parasitic infections from
From are immunosuppressed diabetic patients. Or patients with kidney problems or are receiving multiple antibiotics.
371
What is included in the upper UTI, and what do we call it
Renal parenchyma, pelvis and ureters. Pyelonephritis.
372
What is included in the lower UTI, and what do we call them
Bladder (cystitis) and urethra (urethritis)
373
What do we call a UTI when it has spread everywhere
Urosepsis (life-threatening)
374
What is the difference between uncomplicated and complicated
Uncomplicated involves the bladder only, complicated means that there is something else also going on, like a kidney injury or kidney disease
375
What are some factors that may cause UTIs
- 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
What are upper UTI symptoms
- Flank pain
- Chills
- Fever
Might also have fatigue, anorexia or asymptomatic
377
What are classic manifestations of UTIs in older adults
- 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
If someone has asymptomatic bacteriuria (colonization of bacteria in the bladder) what do you do
You do not screen or treat, just let it go. Unless, they are pregnant or undergoing a urologic procedure
379
What are some symptoms for lower UTI
- Dysuria (painful urination)
- Hesitancy (hard to start a stream)
- Postvoid dribbling
- Urinary retention
- Incontinence
- Nocturia
- Urgency
- Frequency (need to go a lot)
380
What are the two ways we can test for a UTI
- Dipstick UA looking for nitrities (indicating bacteriuria), white blood cells and leukocyte esterase (indicates pyuria from WBCs)
- Urine culture from clean catch
381
When picking an antibiotic for a UTI, what does it depend on
The bacteria and if the UTI is complicated or uncompleted (upper vs. lower)
382
What drugs are typically used to treat lower uncomplicated UTIs
- Trimethoprim/sulfamethoxazole (TMP/SMX)
- Nitrofurantoin
- Macrodantin
- Cephalexin
- Fosfomycin
- Ampicillin
- Amoxicillin
- Cephalosporins
383
What should be used to treat complicated UTIs
- Levofloxacin
- Ciprofloxacin
These are in the fluoroquinolones family = REMEMBER THERE IS A RISK OF TENDON RUPTURE
384
What drug is good to help relieve UTI pain
Phenazopyridine (stain your urine reddish orange)
385
If someone is taking prophylactic antibiotics to prevent a UTI, what should they also be doing
Taking probiotics
386
What is the area called when you're checking for tenderness over kidney
Costovertebral angle
387
How can we treat acute UTIs
- 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
What should the WBC range be in a UA. What would an abnormal WBC indicate
WBCs should be between 0-5/hpf. If it is greater than 5, then it might indicate a UTI
389
What is important to remember about UAs
A lot of things can cause UAs to be off, even dehydration
390
What is nephrolithiasis
Kidney stones in the kindey
391
What is urolithiasis
Kidney stones in the ureter
392
What are most stones made up of
Calcium
393
What are the symptoms of kidney stones
Severe, sudden sharp pain in flank area, back or lower abdomen. Can have nausea and vomiting due to the extreme pain.
394
How can we diagnosis kidney stones
Noncontrast CT scan or ultrasound
395
If the stone is less than 5 mm, will it pass spontaneously
Maybe. It has a 50% chance.
396
If the kidney stone is greater than 10mm, what happens
They will need surgery, by putting in a stint to help the stone pass.
397
If calcium is causing your stones, what should you avoid
- Milk
- Cheese
- Ice cream
- Yogurt
- Chocolate
- Cocoa
- Nuts
- Fish with bones
- All beans except green beans
398
If purine is causing your stone, what should you avoid
- Sardines
- Herring
- Mussels
- Liver
- Kidney
- Goose
- Venison
- Sweet breads
399
If oxalate is causing your stones, what should you avoied
- Dark roughage
- Spinach
- Rhubarb
- Asparagus
- Cabbage
- Beets
- Nuts
- Cocoa
- Coffee
- Tea
- Celery
- Parsley
400
Why might it be bad to eat purines if you have stones
Because uric acid is a by-product of purines
401
What are risk factors for BPH
- Aging
- Obesity
- Lack of physical activity
- Alcohol consumption
- Erectile dysfunction
- Smoking
- Diabetes
402
Is BPH a form of cancer
No, you can actually have BPH while also having prostate cancer
403
What are the two types of symptoms of BPH
1. Irritative
2. Obstructive
404
What are the two types of BPH symptoms called together
LUTS (lower urinary tract symptoms)
405
What are the irritative symptoms of BPH
- Nocturia (usually first symptom)
- Urinary frequency
- Urgency
- Dysuria (pain)
- Bladder pain
- Incontinence
406
What are the obstructive symptoms of BPH
- 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
What is happening in BPH
The prostate is enlarging and decreases the diameter of the urethra
408
What are the rare complications of BPH
- 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
What fluids may you want to avoid if you have BPH
Alcohol and caffeine
410
What are some drug treatments for BPH
- 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
How might they diagnosis BPH
- History and physical
- Digital rectal exam
- UA
- Prostate specific antigen (PSA)
- Postvoid residual via an ultrasound
412
What are good ways to help prevent BPH
- 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
If a man has slightly increased levels of PSA, what might that indicate
BPH
414
What is the gold standard in surgery to treating BPH
Transurethral resection of the prostate (TURP)
415
What is happening in TURP.
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
In a TURP, how long is the bladder irrigated for to prevent mucus and clots
24 hrs.
417
What is a BIG complication with TURP
Hemorrhage
418
Why do we want to irrigate the bladder after a TURP
To remove clotted blood from the bladder and ensure drainage of the urine.
419
What are you watching for with TURPS
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
Do you want your pts on anticoagulants before TURP surgery
NO! This can increase their risk of surgery.
421
Due to having poor sphincter tone after a TURP, what exercise can a pt do to help
Kegel exercises.
422
What is good pt teaching after a TURP
- 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
What is dysmenorrhea
Painful and/or disabling menstrual cramps
424
What may cause dysmenorrhea
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
What drugs can help treat dysmenorrhea
- NSAIDs like ibuprofen
- Hormonal contraceptives
- Naproxen
- Serotonin-reuptake inhibitors
426
When does premenstrual syndrome (PMS) occur
After ovulation and before menstrual flow (last half of your cycle)
427
What might make PMS worse
- Stress
- Lack of exercise
- Vitmain and nutrition deficiencies
- Depression
- Thyroid problems
- Anemia
- Uterine fibroids
- Endometriosis
- Autoimmune disorders
428
What is endometriosis
When endometrial tissue implants outside of the uterine cavity.
429
What is one of the most common causes of secondary dysmenorrhea
Endometriosis
430
What are symptoms of endometriosis
- Dysmenorrhea
- Excessive bleeding during menses
- Pain during intercourse
- Infertility
- Can cause excessive pain overall.
431
How might they diagnosis endometriosis
Through a laparoscopy to get a biopsy of the suspected lesions
432
What is the first line of tx for endometriosis
Oral contraceptives to help relieve symptoms and cause regression of tissue
433
How can you tell the difference between endometriosis and dysmenorrhea
Ibuprofen and regular pain meds do not relieve the pain as they do for dysmenorrhea
434
How long does pelvic pain last for in order to be considered chronic
6 months
435
What is interesting about pelvic pain
It can be hard to find the actual cause of pelvic pain.
436
Do ovarian cysts need to be removed.
Not necessarily, only if they are larger than 5cm or it's solid. Otherwise, the cysts often resolve on their own.
437
How might you diagnosis ovarian cycts
Through a pelvic ultrasound
438
Who do we see have dysfunctional uterine bleeding (DUB)
Younger women and peri-menopausal.
439
What is happening in dysfunctional uterine bleeding (DUB)
You're bleeding so much during your period, you may even need a blood transfusion.
440
What might cause dysfunctional uterine bleeding
- Endocrine disturbances
- Polycystic ovary disease
- Stress
- Obesity or underweight
- Long-term drug use
- Anatomic abnormalities
441
When does menopause occur
12 months after no vaginal bleeding
442
What is the perimenopause stage, how long can it last
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
What is happening during menopause
- 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
What test can you do to confirm menopause
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
What is the most effective tx for menopause, but might be very dangerous
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
What is the most common cause of breast masses during reproductive years
Fibroadenoma
447
What do the masses in fibroadenoma feel like
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
What ages would we see fibrocystic changes of the breast
20-30 years old.
449
What changes are occurring in fibrocystic
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
What is the cause of fibrocystic changes
Imbalance between the normal estrogen-to-progesterone ratio
451
Why might a mammogram be important in fibrocystic changes
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
What can help treat fibrocystic changes 6
- 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
At what ages should you have your yearly mammograms
45-54
454
When will you receive mammograms every 2 years
Over age 55
455
Besides genetics, what can increase your risk of breast cancer
Early periods and late menopause
456
What is gynecomastia
Benign condition of breast enlargement in men
457
What are common causes of gynecomastia
- Drugs
- Aging
- Obesity
- Underlying condition causing estrogen excess
- Androgen deficiency
- Breast cancer
458
Is prostate cancer quick or slow growing
Slow growing
459
What are the symptoms of prostate cancer
Trouble urinating or having a weak stream of urine
460
How do we detect for early prostate cancer
PSA test (high levels indicate cancer)
461
How can we treat prostate cancer 5
- Radiation
- Cryotherapy
- Albative hormone therapy (reducing androgens which can help stop the growth)
- Chemo
- Surgery (radical prostatectomy - remove the entire prostrate)
462
What is hydrocele
Nontender, fluid-filled mass that fills with fluid due to improper lymphatic drainage (what Alex had)
463
What is the treatment for hydrocele
No tx unless swelling becomes large or uncomfortable or if there is a risk of infertility
464
What is testicular torsion
The spermatic cord that supplies blood to the testes and epididymis becomes twisted (considered a medical emergency)
465
Who do we see have testicular torsion
Mostly young males under 20
466
Why does testicular torsion occur
Can happen spontaneously or from a trauma or anatomic abnormality
467
What are the symptoms of testicular torsion
Severe, sudden onset of scrotal pain, tenderness, swelling, n/v
468
What is mor common, prostate cancer or testicular
Prostate, most men will end up having prostate cancer, but they won't die from it.
469
What is good about testicular cancer
It is one of the most curable cancers, and prognosis is usually good.
470
What should we teach our pts about testicular cancer
Feel your scrotum for any lumps
471
Besides finding a lump, what are other symptoms of testicular cancer
Dull ache or heavy sensation in lower abdomen, peri area or scrotum
472
How do we diagnosis testicular cancer
First by palpation, where mass is firm and does not transilluminate (light doesn't pass through the mass)
473
What is priapism
Painful erection lasting longer than 6 hours, may be a medical emergency.
474
What causes priapism
Vascular and neuro factors that result in the obstruction of venous outflow in the penis.
475
What things may be associated with priapism
- Diabetes
- Trauma to spinal cord
- Sickle cell disease
- Drugs
476
What are complications of priapism
Penile tissue necrosis
477
What is hypogonadism
Gradual decline in androgen secretion (testosterone) that occurs in most men as they age
478
What can be given to treat hypogonadism
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
If you have one STI what are you at risk for
Having another STI
480
What are the STIs that we need to report
Gonorrhea, chlamydia and syphilis
481
What are our bacterial infections
- Chlamydial
- Gonorrhea
- Syphilis
482
What are our viral infections
- Genital herpes
- Genital warts
- HIV
- Hep B and C
483
Can STIs be spread skin to skin
Yes, especially HPV
484
What is the intubation period
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
What is the main barrier for protection
Condoms
486
What is the most common STI
Chlamydia
487
What is important to know about chlaydia
Transmission may occur during childbirth which can lead to conjunctivitis, pharyngitis and pneumonia
488
How is chlamydia transmitted
Through sexual fluids (ejaculation does not have to occur) during oral, vaginal or anal sex.
489
Can you be re-infected with chlamydia if you've had it once
Yes, you can be reinfected again
490
How do we treat chlamydia
Doxycycline and azithromycin for 7 days.
491
How long should you abstain from sex after tx of chlamydia
Abstain for 7 days after treatment and until all partners within the last 60 days have been treated.
492
What are the symptoms of chlamydia
- Mucopurulent discharge
- Bleeding
- Dysuria (burning urination)
- Pain with intercourse
493
How is gonorrhea transmitted
Same as chlamydia. Sexual fluids during vaginal, anal or oral sex.
494
How do they diagnosis gonorrhea
Through the NAAT assay
495
What are the symptoms of rectal gonorrhea
- Mucopurulent rectal discharge
- Bleeding
- Pain
- Pruritus (itchy)
- Painful bowel movements
496
What are the symptoms of urethra gonorrhea
- Dysuria
- Discharge
- Pain
- Redness
- Swelling
497
What are the symptoms of oral gonorrhea
Few symptoms if any. Maybe a sore throat.
498
What can both men and women develop from gonorrhea
Disseminated gonococcal infection (DGI) - which is associated with lesions, fever, arthralgia, arthritis and endocarditis
499
What is scary about gonorrhea and giving both
An infected mother can pass gonorrhea onto their baby, which causes them to have gonococcal conjunctivitis, which can lead to permanent blindness
500
What do we give to prevent gonococcal conjunctivitis in babies, even if mom tests negative
Prophylactic erythromycin ointment. (same thing with chlamydia)
501
What is important to remember about chlamydia and gonorrhea
If you have one, you will most likely be treated for both, because they usually go hand-in-hand
502
How do we diagnosis syphilis
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
What is given to treat syphilis
Penicillin
504
What is important to remember about diagnostic tests and syphilis
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
What are our standard treatments for bacterial infections
Azythromycin and doxycycline.
506
How can genital herpes be transmitted
Through skin-to-skin (through oral, genital and anal)
507
Is there a cure for genital herpes
No, you'll have outbreaks
508
What is the most commonly transmitted sexual virus in the US
HPV
509
What is the most common cause of cervical cancer
HPV
510
What are the symptoms of HPV
Usually none, some females with non-oncogenic HPV may get genital warts
511
What is the vaccine schedule for HPV
- Two shot series for 11-26
- Three shot series if starting at 15-26
Not given passed 26
512
What does pelvic inflammatory disease impact
Originates in the vagina or cervix, goes up the genital tract, infects the uterus, fallopian tubes and ovaries
513
What are the most common causes of PID
chlamydia and gonorrhea
514
What are symptoms of PID
- Lower abdominal pain
- Uterine tenderness
- Adnexal tenderness (pain in the ovaries or fallopian tubes during the exam
- Cervical motion tenderness
515
What is a big complication of PID
Infertility
516
What is the treatment of PID
Antibiotics
517
What are you going to assess for with dysfunctional uterine bleeding
Blood pressure (they maybe losing pressure due to the bleeding), might also see a HR to compensate.
518
What tests might you do for someone with dysfunctional uterine bleeding
Hematocrit and Hemoglobin, CBC
519
With a TURP, should we see clots in the first 24hrs
Yes
520
When foley is removed after a TURP, what color will the urine be
It will have a pink tinge to it.
521
What are some signs of shock from sepsis
- HYPOTENSION
- Tachycardia
- Change in temp.
522
What will indicate an upper UTI
Flank pain, chills and fever
