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Advanced clinical practice: examining the complex patient > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What is the pathophysiology of a bowel obstruction?

A

A blockage prevents the content of the intestine from passing normally through the digestive tract. The cause of this can be inside or outside the intestine

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2
Q

What are some of the causes of a bowel obstruction inside the intestine?

A

A tumor or swelling

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3
Q

What are some of the causes of a bowel obstruction outside the intestine?

A

The adjacent organs or area of tissue to pinch, compress or twist a segment of the bowel

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4
Q

Where does a bowel obstruction occur?

A

In the small or large bowel

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5
Q

A bowel obstruction can be total or partial. What determines what type of obstruction present?

A

It depends on whether any intestinal content can pass through the obstructed area

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6
Q

What does the obstruction of the small intestine present with?

A

Cholic, abdominal pain and vomiting.

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7
Q

What does the obstruction of the large intestine present with?

A

Distention and absolute constipation

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8
Q

What are the common causes and risk factors of a small bowel obstruction?

A
  • Adhesions: bands of scar tissue that may form after abdominal or pelvic surgery
  • Hernias caused by a breakthrough of the weakened abdominal wall (2nd most common cause of an obstruction in the USA)
  • Inflammatory diseases(chromes disease or a fistula)
  • Tumors (rare, usually spreads to the small bowel from the colon, reproductive organs, breast, lungs or skin)
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9
Q

____ is the leading risk factor for small bowel obstruction in the USA

A

Earlier abdominal surgery is the leading risk factor for small bowel obstruction in the USA

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10
Q

What are the signs and symptoms of a small bowel obstruction?

A
  • Cramping and abdominal pain
  • Nausea and vomiting
  • No gas passing through the
    rectum
  • Abdominal bloating or tenderness
  • Rapid pulse and rapid breathing
  • Upper epigastric distension
  • Constipation
  • Lack of appetite
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11
Q

What is constant abdominal pain a sign of?

A

Maybe a sign os bowel strangulation

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12
Q

__ is the most common cause of a large bowel obstruction in the USA

A

Adhrsions is the most common cause of a large bowel obstruction in the USA/developed countries

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13
Q

____ is the most common cause of obstruction

A

Adenocarcinoma of the colon is the most common cause of obstruction

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14
Q

About half of all large bowel obstructions are caused by ____

A

About half of all large bowel obstructions are caused by colorectal cancer

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15
Q

How does undiagnosed colon or rectal cancer cause large bowel obstruction?

A

It may cause a gradual narrowing of the large intestines in our passageway.

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16
Q

Before the large bowel becomes obstructed, what does the pt feel?

A

Intermittent constipation

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17
Q

What is volvolus?

A

An abdominal twisting of a segment of the bowel around itself. This typically produces a closed loop bowel with a pinched bowel, which leads to a bowel obstruction

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18
Q

In what population is a volvolus most common?

A

People over 65, in western countries, often with a history of chronic constipation

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19
Q

What are the common causes of large bowel obstruction?

A
  • Colorectal cancer
  • Volvolus
  • Diverticular disease
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20
Q

What is a colonstricture?

A

A scar that encircles the colon, which narrows the intestine gradually as it ages, which will eventually cause a closed colon

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21
Q

What are the signs and symptoms of large bowel obstruction?

A 
- Lower abdominal
bloating/distension
- Lower abdominal cramping and pain, which can be vague and mild, or sharp and severe depending on the cause
- Constipation
- Diarrhea
- Possible rectal bleeding
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22
Q

What are the red flags for immediate medical referral in a pt with a possible large bowel obstruction?

A
  • Intense and/or constant abdominal pain
  • Vomiting
  • Bloating
  • Blood in the stool
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23
Q

What are the checklist items that must be screened when there is a suspicion of a GI system abnormality?

A 
• Nausea
• Vomiting
• Swallowing difficulties	
• Indigestion, heartburn	
• Food intolerance	
• Bowel dysfunction	
– Color of stool	
– Shape,	caliber of stool	
– Constipation	
– Diarrhea	
– Difficulty initiating	
– Incontinence
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24
Q

What are swallowing difficulties/dysphagia typically a result of?

A

A loss of coordinated local muscle activity or a mechanical obstructive disorder

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25
Q

What are the disorders that can result in muscle incoordination, resulting in swallowing difficulties/dysphagia?

A
  • Myasthenia gravis
  • Multiple sclerosis
  • Amyotrophic lateral sclerosis
  • Parkinson’s disease
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26
Q

What are the disorders that can result in a mechanical obstruction, resulting in swallowing difficulties/dysphagia?

A 
• Tumors	
• Thyroid	goiter	
• Osteophytes of the cervical	
spine
• Aortic aneurysm
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27
Q

What is the onset, progression, ability to swallow solid food/liquids, ability to swallow cold substances, and bolus passage of dysphagia caused by motor incoordination?

A

• Onset: Gradual onset
• Progression: Slow
• Swallowing solid foods vs. liquids: Equal difficulty
• Swallowing cold substances: Worsening of swallowing
difficulties
• Bolus passage: Facilitated by repeated swallowing. Valsalva
maneuver, throwing back head and shoulders

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28
Q

What is the onset, progression, ability to swallow solid food/liquids, ability to swallow cold substances, and bolus passage of dysphagia caused by mechanical obstruction?

A
  • Onset: Faster onset
  • Progression: Faster
  • Swallowing solid foods vs. liquids: More difficulty swallowing solids
  • Swallowing cold substances: Swallowing difficulties not affected by temperature
  • Bolus passage: Can be accompanied by regurgitation
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29
Q

What are the symptoms that fall under the category of dyspepsia/heartburn?

A

Indigestion, and Heartburn

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30
Q

The use of what type of drugs has been associated with dyspepsia/heartburn?

A

NSAIDs

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31
Q

In what part of the body does a pt with dyspepsia/heartburn feel their symptoms?

A

Retrosternally in the epigastric region

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32
Q

What are the questions to ask a pt, when there is a suspicion for dyspepsia/heartburn?

A
  • How long have you had these symptoms?
  • Do you know what is causing them?
  • Are they constant or intermittent?
  • How are you treating the symptoms?
  • Are there any associated symptoms such as fatigue, weakness or shortness of breath
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33
Q

Many OTC medications for heartburn/dyspepsia are designed to treat what?

A

They are designed to treat the symptoms of heartburn, not the actual problem, so increasing the dose will not help the condition

34
Q

What are the self- management options that a pt can take to treat heartburn/dyspepsia?

A 
Antacids:	
• Milk of Magnesia	
• Alu-Tab	
• Tums	
• Maalox	
Histamine (H2) antagonists	
• Tagamet
• Zantac
• Pepcid	AC
35
Q

Where is the referral site of a gallbladder disorder?

A

The mid thoracic or right scapula region

36
Q

____ is associated with the provocation of symptoms can be a warning sign of underlying pathology of the GI system

A

Food intolerance is associated with the provocation of symptoms can be a warning sign of underlying pathology of the GI system

37
Q

What are the foods that can stimulate gallbladder activity and may result in the precipitation of gallbladder symptoms?

A
  • Cheese
  • Chocolate
  • Citrus fruits
  • Nuts
  • Red wine
38
Q

What does melena represent?

A

GI bleeding most likely from the upper GI structures, such as the esophagus, stomach, and duodenum

39
Q

What are the important follow-up questions that a physician should ask a pt who complains of melena?

A
  • How long have you been having black, tarry stools?
  • Have you felt lightheaded?
  • Have you had any nausea, vomiting, diarrhea, fatigue, lightheadedness, abdominal or back pain, or sweats associated with these stools?
40
Q

What is the role of the PT in the management of melena?

A

Check the pt’s HR and BP, in preparation to produce important info for the physician who will need it to determine the urgency of the situation

41
Q

In addition to melena, light grey or pale stools can be associated with what?

A

Obstructive Jaundice

42
Q

What are the questions that should be asked when a pt reports obstructive jaundice ?

A
  • How long have you noticed the light, pale colored stools?
  • Have you noticed an atypical color (e.g., dark) of your urine?
  • Have you noticed any associated symptoms, such as fatigue, fever, chills, unexplained weight change, or nausea?
43
Q

What questions are included in the screening of the lower GI system?

A

Questions about bowel function, including:

  • Characteristics of the stool
  • Constipation
  • Diarrhea
  • Difficulty initiating a bowel movement
  • Incontinence
44
Q

What is the question to ask a pt in regard to the lower GI system?

A

Have you recently noted any problems or difficulties with bowel function?

45
Q

What is hematochezia?

A

The passage of bright blood red stools, which usually originates in the left side of the colon or anorectal area

46
Q

What are the questions that should be asked when a pt complains of hematochezia?

A
  • How long have you noticed bright red blood in your stools?
  • Is the red blood mixed within the stools (red streaks) or not?
  • Are there any associated symptoms, such as difficulty in initiating bowel movements or a feeling of lightheadedness or fatigue?
47
Q

What should the PT do when a pt answers questions regarding hematochezia in the positive?

A

Check BP and HR

48
Q

What may be indicative of a colon carcinoma, and what should you ask your pt in regards to this?

A

Stool unusual shapes may be suggestive of a colon carcinoma.
Ask your pt “Have you noticed any unusual shape of your stool
recently, such as pencil like in diameter, flat and ribbon-like?

49
Q

What are the potential causes of constipation?

A
  • Impaired motility, Inadequate dietary fiber
  • Inactivity
  • Diverticulitis
  • Hypothyroidism
  • Hypercalcemia
  • Scleroderma
  • Neurologic dysfunction
  • Multiple sclerosis
  • Spinal cord injury
  • Psychosocial dysfunction
  • Depression
  • Situational stress
  • Anxiety
50
Q

What are the potential causes of diarrhea?

A
  • Infectious agents
  • Laxative abuse
  • Colon cancer
  • Irritable bowel syndrome
  • Crohn’s disease
  • Ulcerative colitis
  • Diabetic enteropathy
51
Q

What are the questions to ask a pt when there is a suspicion of dehydration and in order to determine the severity?

A

• How many episodes do you have each day?
• How long have you had diarrhea?
• Do you ever have periods of diarrhea alternating with periods of constipation?
• Is the diarrhea worse at certain times of the day?
• Do family members or companions have similar
symptoms?
• Do you have any associated symptoms, such as fever, chills, nausea, vomiting, confusion, or abdominal pain or distention?

52
Q

What are the signs and symptoms of dehydration?

A
  • Thirst and dry mouth
  • Postural hypotension
  • Rapid breathing
  • Rapid pulse (higher than 100 beats/min)
  • Confusion, irritability, lethargy
  • Headache
53
Q

___ is the 3rd leading cause of cancer in USA in women, and the 2nd in men

A

Colorectal cancer is the 3rd leading cause of cancer in USA in women, and the 2nd in men

54
Q

What are the signs and symptoms of renal failure?

A
  • Decreased urine output
  • Nausea
  • Vomiting
  • Fatigue
  • Increased BP
  • SOB
55
Q

What physiologic functions is the genitourinary system?

A

Urination and reproduction

56
Q

What are the symptoms that are commonly associated with a dysfunction of the male reproductive system?

A

• Urethral discharge
• Sexual dysfunc:on
• Pain during intercourse,
ejaculation

57
Q

What are the symptoms that are commonly associated with a dysfunction of the female reproductive system?

A 
• Vaginal	discharge	
• Pain with intercourse	
• Menstruation
– Frequency of periods	
– Length	of cycle	
– Dysmenorrhea	
– Blood flow	
• Number of pregnancies and	
deliveries	
• Menopause	
• Perimenopausal
– Postmenopausal	vaginal	bleeding	or spotting
58
Q

What are the symptoms that are commonly associated with a dysfunction of the urinary system?

A 
• Color	
• Flow	
– Frequency	
– Urgency	
– Output	
– Retention	
– Dysuria	
• Reduced caliber or force of	urine stream		
• Difficulty initiating urine stream	
• Incontinence
59
Q

What is dark color of urine an indication of?

A

Can be associated with hepatic or biliuary obstructive disease and acute exertional rhabdomyolysis

60
Q

A pt presents to the clinic with shoulder pain, and weakness, and a report of dark urine. What is the possible diagnosis?

A

Acute exertional rhabdomyolysis

61
Q

What is the medication that can lead to reddish color urine?

A

Pyridium

62
Q

What are the questions to ask a pt when suspecting hematuria?

A
  • How long have you noticed the red urine?
  • Do you have a history of bleeding problems?
  • What medications are you currently taking?
  • Do you currently have or have you recently recovered from an upper respiratory infection or sore throat?
63
Q

What may red urine d/t upper respiratory tract infection be associated with?

A

Acute glomerular nephritis

64
Q

What are the questions to ask a pt when they complain red urine d/t upper respiratory tract infection?

A

• Have you noticed whether the urine starts red and then clears,
starts clear and then turns red, or is red throughout?
• Do you have any associated symptoms, such as items on the general health checklist,
including fever, weight loss, fatigue, or flank or abdominal pain?

65
Q

True or False

Nocturia increases with age

A

True, Nocturia increases with age

66
Q

What can urinary urgency/the intense an immediate sensation of the need to urinate be associated with?

A

Infection or irritation

67
Q

What is dysuria, and when can it occur?

A

Pain on urination, it can occur with inflammation, infection, and sudden distention of a structure

68
Q

What is polyuria and when can it be associated with?

A

Increased amounts of urine, which can be associated with diabetic conditions

69
Q

What are the questions related to urinary flow that we can ask a pt?

A

• Have these changes occurred quickly or over a long period
of time?
• Have you been drinking more fluids (with an excessive thirst) than usual lately?
• What medications are you taking (diuretics)?
• Have you noticed that, despite the urge to urinate, you cannot start urination?
• After urine flow has stopped, do you experience the sensation of still needing to urinate?
• Do you have any associated symptoms, such as headaches or visual problems (possibly diabetes-related), or items on
the general health checklist, such as fever, nausea, and weight loss?

70
Q

What are the common symptoms associated with obstructive disorders/urinary retention?

A
  • Reduced force or urine
  • Reduced caliber of urine flow
  • Difficulty in starting urine stream
71
Q

What is a disorder that true urinary retention is associated with?

A

Cauda equina syndrome

72
Q

What are some red flags in pts with LBP that might be indicative of a genitourinary problem?

A
  • Recent onset of urinary dysfunction

- Retention, frequency or overflow incontinence and saddle anesthesia

73
Q

What are follow up questions to ask a pt complaining of incontinence?

A
  • Circumstances
  • Causes
  • Timing
  • Frequency
  • Volume of urine loss
74
Q

When a pt complains of discharge, which may be associated with reproductive function, what are the follow up questions to ask?

A
  • What is the frequency?
  • Is it a continuous flow, spotting, or sporadic episodes?
  • What is the color of the discharge?
  • Is the discharge accompanied by an odor?
  • Are there associated symptoms, such as pruritus (itching), local pain or inflammation, fever, nausea, or dyspareunia?
75
Q

Why is the early treatment of UTIs and STDs important?

A

Untreated infections may increase the risk of developing an ectopic pregnancy, and may lead to infertility

76
Q

What is dyspareunia?

A

Mechanical low back, SIJ, or hip pain during or after intercourse

77
Q

True or False

Pain during intercourse that is associated with pelvic organ disease occurs regardless of the sex position

A

True, Pain during intercourse that is associated with pelvic organ disease occurs regardless of the sex position

78
Q

What are the possible causes of erectile dysfunction?

A 
• Spinal cord	injury	
• Herniated disk	
• Postsurgical	complica:ons	
– Radical prostate	
– Bladder	
– Colon procedures	
• Diabetes	mellitus	
• Medication side effects	
• Psychogenic disorders
79
Q

What are the items to assess in a pt in regard to menstruation?

A 
• Frequency and	length	of	
periods,	
• Dysmenorrhea	
– Loca:on	
– Cycle	
– Intensity	
– Quality	
– Duration	
• Blood	flow
80
Q

What is dysmenorrhea?

A

Pain with menstraution

81
Q

What are the questions to ask a pt in regards to menstruation?

A 
• When was your last period?	
• Was it a normal period for you	(timing of the period compared	with	her normal cycle, pain	pattern, blood flow)	
• Have you experienced any	
vaginal bleeding between	
periods?
82
Q

What are the common manifestations in pts during early pregnancy?

A
  • Increased urinary frequency
  • Breast tenderness
  • Fatigue
  • Weight loss (associated with nausea and vomiting)
  • Heartburn
  • Constipation
  • Leukorrhea (white, yellowish vaginal discharge)

Advanced clinical practice: examining the complex patient (7 decks)

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