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Meg Surg 155-02 > Week 10 Study Guide > Flashcards

Week 10 Study Guide Flashcards

1
Q

Innate Immune Response

A

FIRST LINE
- Physical barriers: skin, mucosal linings at bodies opening
- Mechanical barriers: coughing, sneezing, vomiting, urination
- Biochemical barriers: saliva, tears, earwax, perspiration
SECOND LINE - Inflammatory response
- Generalized response: infectious agent, trauma, exposure to toxins, burns, etc. (Scorched earth policy, kill everything in the area)
- Tissue damage -> pathogenic invasion -> vasodilation and increased capillary permeability -> invading organisms EATEN ALIVE & fibrinogen clot formation -> LOCALIZED RESPONSE: signs of inflammation (erythema, warmth, edema, pain) -> SYSTEMIC RESPONSE: Fever, malaise, chills, increased WBCs, (figure 18.7)

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2
Q

Acquired Immune Response

A

Natural vs. artificial
- B & T cells mediated
- Actively adapts to new and interesting virus and bacteria exposure
*Reactive and specific (SLOW) response compared to innate immunity
- Passive adaptive immunity: immunizations, newborn from mom through placenta/breastmilk, transfusion of antibodies
- Active adaptive immunity: “normal” method of acquiring immunity. Body experiences illness or an invading pathogen, learns to recognize and fight it for next time

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3
Q

Lymphatic System

A
  • Filtration system for the blood
  • Lymph Nodes: grain of rice sized nodes with ton of macrophages, lymphocytes, monocytes within filtering out and destroying invaders (police check points watching for bad guys)
  • Spleen: the main filter point, filters out old and broken RBCs and also has WBCs, like the lymph nodes, for capture and destruction of invaders
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4
Q

Thymus

A
  • Trains the WBCs for adaptive immunity
  • Teaching T-cells what invaders look like so thy can go out and kill them
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5
Q

Bone Marrow

A
  • Builds lymphocytes and then separates them into B-cells and T-cells
  • T-cells go to finishing school at the thymus
  • B-cells mature at home in the bone marrow
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6
Q

Tonsils, Adenoids, Peyer’s Patches

A
  • Tonsils and adenoids are traps inhaled viruses and bacteria
  • Peyer’s patches are in the intestine- intestinal lymph nodes
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7
Q

B Cells

A
  • Apart of the bodies adaptive immunity
  • B cells mature in the (B)ones,
    -Attack external invaders (bacteria, viruses)
    *Have memory cells and antibodies
    *Memory to mount a more effective attack next time
    *Antibodies to ‘mark’ cells for destruction
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8
Q

T Cells

A
  • Part of the adaptive immunity
  • T Cells matured in the (T)hymus
  • T Cells attack infected cells and cancerous cells
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9
Q

Immunoglobulins (IG)

A
  • Specific antibodies that the B cells produce
  • Antibodies attach to invaders, marking them for destruction
    • Like a bright neon sign to T-cells saying “Please come and destroy these”
  • Types of IGs (Table 18.2)
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10
Q

Risk Factors for Decreased Immune Response

A
  • Lifestyle factors: smoking, ETOH, drug use, nutritional status
  • Past medical history: HIV/AIDs, cancer, Splenectomy, immune disorders, TB
  • Medications: chemo/radiation, immunosuppressive medications like DMARDs and corticosteroids, anti-inflammatories
  • Allergies
    Age-related changes
  • TLDR: immune system weakens with age in a variety of ways
  • Pg. 353, Table 18.6 and Figure 18.9
  • Death from viruses such as pneumonia, influenza, ect. increase with age
    * Vaccinations even more important in the elderly
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11
Q

Hernia

Risk Factors

Signs and Symptoms

A
  • Protrusion of abdominal contents (bowel/organ) through a weakening of the muscle in the abdominal area
  • Reducible: goes back through the muscle and into its proper spot easily.
  • Incarcerated: trapped beyond the muscle, unable to go back in. Can be strangulated (pressure from muscles is squeezing off the blood supply)
  • Both incarcerated and strangulated hernias are a medical emergency requiring surgical intervention
  • Risk factors: age, straining with the abdominal muscles (such as for a BM or urination), lifting heavy objects, twisting movements, obesity, chronic cough
  • S&S: bulge or visible swelling, dull achy pain in area of the hernia
  • Strangulated hernia S&S: severe pain, N/V, abdominal pain, abdominal distention, fever, tachycardia
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12
Q

Types of Hernias

A
  • Indirect inguinal: congenital muscle weakness that potentially leads to hernia in the inguinal canal (groin area)
  • Direct inguinal: only in men. Weakening of the connective tissue and muscles eventually leads to hernia
  • Femoral: more often in women in a weak spot called the femoral canal. 40% present as incarcerated or strangulated
  • Umbilical: more common in women. R/T increased abdominal pressure like obesity/pregnancy
  • Ventral (Incisional): forms at the site of a previous surgery that has weakened the muscle.Typically related to poor wound healing (poor nutrition, smoking, immunosuppressive meds, obesity)
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13
Q

Diagnosis and Treatment of a Hernia

A
  • Diagnosis: seen with the eye but if questionable, a U/S, CT, or MRI
  • Treatment: surgically repair. Un-incarcerate the hernia, push it back through the abdominal muscle, suture up the muscle so it doesn’t re-herniate
    *Can use mesh to reinforce a weakened area
    *May need significant surgery for severe cases up to and including ostomy formation
    *Post-op care exactly like any other abdominal surgery, EXCEPT NO COUGHING
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14
Q

Hemorrhoids

Risk Factors

Signs and Symptoms

A
  • Swollen and dilated veins in the anorectal area (Varicose veins of the rectum)
  • Risk Factors: prolonged constipation, straining during BM, heavy lifting, prolonged standing or sitting, increased intra-abdominal pressure, obesity heart failure
    *Affects both men and women approximately equally, more women report it
  • S&S: painless bleeding during BM, itching, irritation, pain. *40% are completely asymptomatic
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15
Q

Hemorrhoids Treatment

A

Conservative management
- Topical medications like local anesthetics, protectants astringents, corticosteroids (Table 58.1)
- Symptom relief with cold packs, Sitz baths, increase of fluids, increased in fiber intake
Surgical management
- Removal of hemorrhoids in a variety of different ways (Pg. 1335)

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16
Q

Irritable Bowel Syndrome

A
  • Causes are unknown. Patient experience symptoms but little (if any change) to structure of the bowel.
    *In contract to IBD and Celiac
  • Functional disorder of the bowel
  • Twice as often in women
  • Mostly diagnosed between 30-50 years
  • IBS-C(onstipation), IBS-D(iarrhea), or IBS-M(ixed)
  • S&S: can have abdominal pain, abdominal distention, constipation, diarrhea, both, bloating, flatulence
17
Q

IBS Treatment & Complications

A
  • Treatment: Manage symptoms
    *Variety of medications that must be individualized between doctor and patient (Table 58.2)
    *Track foods that cause symptoms, elimination diet and slowly add back in foods
    *Avoid caffeine, ETOH
  • Complications: fluid & electrolyte imbalances, issues related to chronic constipation
18
Q

Inflammatory Bowels Disease

A
  • Crohn’s disease and ulcerative colitis
  • Key Term = Inflammatory
    * Inflammation-based changes to the GI tract
    * Crohn’s disease: patchy inflammation all throughout GI tract from mouth to anus
    * Ulcerative colitis: continuous, diffuse inflammation starting at the rectum and working upwards
    *TABLE 58.4 for comparison of two disorders
  • S&S: chronic conditions with remissions and exacerbations
    * persistent diarrhea, abdominal pain, cramping, fever, weight loss, anemia, GI bleeding
19
Q

IBD Treatment

A
  • Medication management
  • Psychosocial management
    * Exacerbations seem to occur R/T emotional or physical stress
  • Nutrition
    * Long-term IBD leads to malabsorption of nutrients and/or fluid
  • Surgical management
    * Only in severe cases, can have an ostomy
20
Q

Celiac Disease

A
  • Autoimmune disease that damages small intestine R/T eating gluten-containing foods
  • Body has an immune response to the gluten, creating inflammation in the intestine. Inflammation damages the intestine and can, eventually, cause enough damage that absorption is affected
  • There is a difference between a Celiac disease, gluten allergy, and gluten intolerance
  • S&S: diarrhea that is light-colored and frothy, steatorrhea, flatulence, weight loss, signs and symptoms of malabsorption/nutrition
  • Diagnosis can be complicated by symptoms similar to that of the previous diseases we’ve talked about
21
Q

Celiac Disease Treatment

A
  • AVOID GLUTEN
  • 70% of patients see a reduction in symptoms within 2 weeks of going gluten free, but can take months to heal previous damage
    Things that contain gluten
  • wheat, rye, barley, Semolina, spelt, bulgur, Farro
  • Malt: beer, malt vinegar, milkshakes with malted milk
  • Brewer’s yeast
    Things that are okay to eat
  • Rice, corn, buckwheat, quinoa, potatoes, soybean flour, tapioca flour,
  • Distilled alcoholic beverages, vinegar, wine
    (C)onsult a dietitian
    (E)ducation about the disease
    (L)ifelong adherence to a gluten-free diet
    (I)dentify and treat malabsorption and malnutrition
    (A)ccess support groups
    (C)ontinue management with an interdisciplinary team
22
Q

Diverticulitis

A
  • Inflammation (-itis) of diverticula in the GI tract
  • Diverticula are small, pouch-like protrusions in the GI tract (tiny little hernias on the intestines and colon)
  • Having diverticula is called diverticulosis (-osis meaning abnormal condition)
  • When those diverticula becoming inflamed or infected, thats when it is called diverticulitis
  • Diverticula becomes increasingly common as people age
    *30%-50% of people over 60 have diverticula
    *65% of all people by age 85
  • Risk factors for the development of diverticula: age, heredity, NSAIDS, acetaminophen, corticosteroids, opioids, high red meat diet, high fat diets, lack of fiber, obesity, sedentary lifestyle
23
Q

Signs & Symptoms/ Treatment and Complications of Diverticulitis

A
  • S&S: abdominal pain over involved area. May have fever, elevated WBC, palpable mass over involved area, anorexia, abdominal distention, diarrhea/constipation, bleeding, mucus in stool
  • Treatment: ABX & period of bowel rest followed by gentle, slow resumption of diet *Patient mat need hospitalization for fluid/ electrolyte monitoring and replacement
  • Complications: perforation, abscess, fistula, bowel obstruction
24
Q

Appendicitis

A
  • Acute inflammation of the appendix, which is the weird-looking little tail that projects off the cecum
  • Appendix is made of lymphatic tissue but purpose is unknown
  • Affects more men than women
  • Affects ages 10-19
  • When the elderly are effected, there is a higher risk for rupture and mortality
25
Q

Appendicitis S&S/Management/Complications

A

S&S
- Early: peri-umbilical pain, anorexia, nausea, vomiting
- Later: pain shifts to RLQ and becomes more severe and constant
- Also: may show S&S of infection - fever, tachycardia, elevated WBC, etc
- Clinical signs: McBurney’s point (tenderness on site), Rovsing’s sign (tenderness opposite of site)
Management
- cut the appendix out with a simple post-op recovery
Complications
- rupture which can lead to peritonitis, which can further lead to sepsis

26
Q

Colorectal Cancer

A
  • Any cancer of the rectum or large intestine
  • Risk Factors: family history of colorectal CA, IBD, obesity, sedentary lifestyle, high fat diets, consumption of a lot of red meats, inadequate fruit and veggie intake
  • 3rd and most common form of cancer, 2nd leading cause of death
  • Incidence and death rates have been declining for nearly 2 decades (better detection. when caught early enough, it is the most curable of all cancer types
    *Stage I colon cancer 5 year survival rate = 74%
    *Stage IV colon cancer 5 year survival rate = 6%
27
Q

S&S of Colorectal Cancer

A
  • Colonoscopy to detect: the entire area is visualized, and polyps and questionable areas removed and/or biopsied
  • Stay up to date on recommendations for you and your patients (BOX 58.3)
  • S&S: early -> none or just vague symptoms like weight loss, fatigue, anorexia. Late -> blood in stool, pain, abdominal distention, etc
  • If cancer is found, treatment is typical for CA. Surgery to remove tumor, chemo/radiation to destroy what is left. *Metastasis is a bad sign
28
Q

Abdominal Trauma

A
  • Blunt or penetrating trauma to the abdomen
    Biggest concerns
  • Bleeding= liver is highly vascularized, aorta runs through abdomen, lots of opportunity for lots of bleeding
  • Hollow organ penetration= spills undigested food, feces, or urine into abdominal cavity leading to peritonitis and possibly sepsis
  • Airway, Breathing, Circulation
  • Obvious injuries
  • Signs of internal bleeding like Cullen’s sign or Grey Turner’s sign
29
Q

Abdominal Trauma

A
  • Start 2 large- bore (18 G. or bigger) IVs, start administering fluids
  • VS monitoring
  • Labs and diagnostic tests
    *Focused abdominal sonography for trauma (FAST) - quick bedside U/S is performed by physician to look for free fluid in abdomen (FREE FLUID= abdominal contents or blood)
  • Prep patient for surgery
  • If there is a knife in the wound it stays there until the patient goes back to surgery and wrap cloth or gauze around it to stabilize until surgery

Meg Surg 155-02 (5 decks)

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