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MC Med Surg Exam 3
Crouch & Trivette
| Question | Answer |
|---|---|
| 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
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