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MC Med Surg Exam 3

Crouch & Trivette

enzymes mix. proteins, fat, sugar break down. digestion
move through walls of intestinal walls into the bloodstream absorption
waste products move out of the body elimination
saliva, salivary amylase mouth
hydrochloric acid, pepsin, intrinsic factor stomach
amylase, lipase, trypsin, bile small intestine
correct order for physical assessment in GI inspect, auscultate, percuss, palpation
cullen's sign indicate bleeding especially pancreas. found around umbilicus.
CEA & CA sensitivity for colorectal cancer
alpha-fetoprotein liver cancer
urea breath test presence of H. pylori
hydrogen breath test carb absorption, bacterial growth
heartburn, regurgitation type 1 hiatal hernia
paraesophageal fullness, chest pain after eating type 2 hiatal hernia
opening in diaphragm enlarged, upper stomach moves up into the thorax hiatal hernia
treatments for hiatal hernia freq small feedings, stay upright for at least 1 hr after eating, elevate HOB on 4-8 inch blocks to reverse trendelenburg, surgery if complications
pyrosis, dyspepsia, hypersalivation, esophagitis, odynophagia GERD
odynophagia painful swallowing
dyspepsia indigestion
pyrosis burning in esophagus
hiatal hernia dx xray & barium swallow
GERD dx endoscopy, barium swallow, 12-36 hr esophageal pH monitoring
tx for GERD low fat diet, avoid caffeine, tobacco, beer, milk, peppermint & spearming, & carbonated beverages, NPO 2 hrs before bed, H2 receptor antagonists, Proton Pump Inhibitors, prokinetic agents, Nissen fundoplication
GERD symptoms & peptic ulcer s&s Barrett's esophagus
usually occurs with longstanding untreated GERD where there are changes in teh cells of the esophagus that can be precancerous Barrett's esophagus
reducing the risk for aspiration for tube feeding elevate HOB at least 30-45 degrees during & for 1 hr after feedings & monitor residual volumes
how often are tubes checked for placement? every 4 hrs or prior to feeding or medication administration
fullness, N/D, DHD, hypotensive, tachycardic dumping syndrome
can be caused by high-osmolarity formulas. pulls water out of the GI causing D. dumping syndrome
complex mixture containing proteins, carbohydrates, fats, electrolytes, vitamins, trace minerals, & steril water is administered in a single container parental nutrition
potential complication of parenteral nutrition pneumothorax, embolism, sepsis, hyperglycemia, fluid overload
rapid onset of symptoms usually caused by dietary indiscretion, alcohol, bile reflux, radiation therapy, ingestionof stron acid or alkali acute gastritis
prolonged inflammation due to benign or malignant ulcers of the stomach, H. Pylori, associated with some autoimmune (pernicious anemia), dietary factors, medications, alcohol, smoking, & chronic reflux of pancreatic secretions or bile, caffiene large amts chronic gastritis
abd discomfort, HA, lassitude, N/V, & hiccupping acute gastritis
epigastric discomfort, A, heartburn after eating, belching, sour taste in the mouth, N/V, intolerances to some foods. may cause vitamin deficiency due to malabsorption of B12 chronic gastritis
may be associated with hydrochloric acid changes gastritis
tx for acute gastritis refrain from alcohol & food until S&S subside, neutralize agent if strong acid or alkali, supportive therapy to prevent complications
tx for chronic gastritis modify diet, promote rest, reduce stress, & avoid alcohol & NSAIDs, & pharmacolgic therapy (tetracycline, amoxacillin, H2 Antagonist, PPI)
risk factors for developing PUD excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, & familial tendencies. O blood, chronic renal failure.
dull gnawing pain or burning in the midepigastrium, pyrosis, & V PUD
erosion of mucous membrane forms an ecavation in the stomach, pylorus, duodenum, or esophagus PUD
tx for PUD medications, lifestyle changes & occassionally surgery
interventions for PUD reduce anxiety, promote optimal nutrition, discourage caffeinated beverages, alcohol, & cigarette smoking, refer to counseling for alcohol & smoking, promote F/E balance, monitor I&O, hemorrage, measures to relieve pain. surgical vagotomy, bilroth I or II
Complications for PUD hermorrhage, perforation, penetration, pyloric obstruction
scar tissue from repeats, N/V/C, > 400 ml in stomach NG, dilate to get open or surgery pyloric obstruction
bloody tinge v hemorrhage
sudden severe abd pain, circ collapse, board like abd perforation
fewer than 3 BM/wk, abd distention, decreased appetite, HA, fatigue, indigestion, sensation of incomplete evacuation, straining at stool, elimination of small volume, hard or dry stools Constipation
all of s&S of C for at least 12 weeks of preceeding 12 months Rome Criteria
complications of C HTN, fecal impaction, hemorrhoids, fissures, & mega colon
up to 1-2 weeks acute D
2-3 weeks or longer chronic D
usually high volume, increased production & secretion of water & lytes by mucosa into lumen. associated with bacterial toxins & neoplasms secretory D
water pulled in by osmotic pressure of unabsorbed particles. lactase deficiency, pancreatic dysfunction, hemorrhage. osmotic D
swelling of mucosa & liquid stool. interferes with absorption of nutrients malabsorptive D
C diff most common Infectious D
change in mucosa or tissure destruction, radiation, chemo. exudative D
increased freq & fluid content of stools, abd cramps, distention, borborygmus, painful spasmodic contractions of the anus, tenesmus D
ineffective straining tenesmus
Tx of D F/E replacement, antibiotics, antiinflammatory, & immodium & lamotil
sac-like herniations of the lining of the bowel that extend through a defect in the muscle layer. may occur anywhere in the intestine. diverticulum
most likely spot of diverticulum sigmoid colon
multiple diverticula without inflammaiton, usually asymptomatic diverticulosis
risk factors for diverticular disease over 40, congeintal, low dietary fiber intake, obesity, ethnic
chronic c, irregularity, D/A, bloating, repeated inflammations narrowing of bowel (cramping, narrow stools, C, obstruction), abscess formation diverticular disease
retained food & bacteria causes infection & inflammation. possible complications peritonitis, abscesses, fistulas, & bleeding diverticulitis
dx diverticular disease colonscopy, CT with contrast, abd x-ray show free air under diaphragm with perforation or elevated WBC, LLQ pain, N/V
complications of diverticular disease perforation, peritonitis, abscess formation, bleeding, & fistula formation
tx for diverticular diseas fluids 2L/day, soft foods increased fiber, exercise, bulk laxatives, stool softner
tx inflammation or infection related to diverticular disease antibiotics, NPO with IVF, NG suction, opioid pain meds (demerol), antispasmodics
which pain med do you not give to a pt with diverticular disease morphine b/c increases spasms
surgical tx of diverticular disease resection of affected area extent depends on involvement
usually seen in adolescents or young adults. subacute & chronic inflammation that extends through all layers of GI tract crohn's disease
edema & thickening mucosa that lead to ulcerations causing a cobblestone appearance crohn's disease
most common location for crohn's disease distal/terminal ileum
RLQ pain, D, crampy abd pain, tenderness, spasm associated with eating, wt loss, malnutrition, anemia, chronic GI inflammation, steatorrhea crohn's disease
which is confused with appendicitis crohn's disease
dx for crohn's disease procto, stool for OB & fat, UGI, CT, BE, & Colonoscopy
string sign constriction of the bowel seen in crohn's disease
complications of crohn's disease intestinal obstruction, stricture formation, perianal disease, F/E imbalance, malnutrition, increased risk for colon Cancer
recurrent ulcerations & inflammatory disease of mucosal & submucosal layers of colon & rectum ulcerative colitis
high incidence in caucasians & Jerwish heritage. usually systemic complications, high mortality, & increased risk for cancer ulcerative colitis
shedding of epithelial lining with periods of exacerbation & remission ulcerative colitis
D with mucus & pus, LLQ pain, rebound tenderness in RLQ, intermittent tensmus, rectal bleeding, A/V, wt loss, fever, DHD, cramping, hypocalcemia, anemia, 10-20 stools/day ulcerative colitis
DX ulcerative colitis S&S shock, stool for blood, low H&H, elevated WBC, low albumin, abnormal electrolytes, abd xrays, colonscopy, BE
complications for ulcerative colitis toxic megacolon, perforation, & bleeding
fever, abd pain & distention, V, fatigue toxic megacolon
tx for toxic megacolon NG, IVF, electrolytes, antibiotics, steroids. possible total colectomy & colostomy.
hypotension, tachycardia, tachypnea, pallor, fever Shock
avoid what if have inflammatory or irritable bowel disease spicy foods, nuts, popcorn, poppy seeds, corn, hard to digest foods
nutrition for inflammatory bowel bland low residue diet high in protien & vitamins. avoid certain foods.
medications are taken when for inflammatory bowel 30 mins ac
preop care for intestinal diversion enema, balance F/E, antibiotics, steroids
postop care for intestinal diversion VS, assess site, pain, bowel sounds
RLQ 2" below waist for what? ileostomy
from pressure on intestinal wall (tumors, neoplasms, strictures, adhesions) mechanical obstruction
muscular dysfunction (muscular dystrophy, Parkinson's) functional obsturction
most common site for intestinal obstruction small bowel obstruction
most common cause adhesions followed by hernias & neoplasms small bowel obstruction
sigmoid common most common large bowel obstruction
carcinomas, diverticulitis, IBD, tumors large bowel obstruction
crampy, colicky pain, bloody & mucus via rectum, no stool or gas, v possible fecal, DHD, abd distention, shock SBO
dx for SBO V fecal matter, abd xray, CT, labs for DHD & infection
tx for SBO NG, surgery, NGT, I&O, F&E
slow development & progression Large bowel obstruction
c, blood in stool ,weakness, wt loss, A, abd distention, crampy lower abd pain, fecal V large bowel obstruction
why is large bowel obstruction worse? often blood flow affected
dx large bowel obstruction symptoms, abd xray, CT, MRI
Barium studies contraindicated (CI) large bowel obstruction
tx for large bowel obstruction F/E replacement, NGT, surgical resection, temp/permanent colostomy, monitor VS, F/W, I&O, pain
risk factors for colorectal cancer age, hx, alcohol, cigarettes, obesity, genital cancer, family hx, hx of IBD or polyps, increased fat & protein diet
dx for colorectal cancer CEA, BE, & colonoscopy
cardinal sign of colorectal cancer feeling of incomplete evacuation
change in bowel habits, blood in stool, tarry bleeding, tensmus, S&S of obsturction, pain abd or rectal colorectal cancer
stages for colorectal cancer A-D. D being metastasis to liver, bone, & lung
tx for colorectal cancer radiation, chemo, surgery
Created by: midnight1854