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Chapter 16

Gastrointestinal exams and procedures

QuestionAnswer
GASTROENTEROLOGIST Physician who specializes in diagnosis and treatment of GI disorders
HEPATOLOGIST Physician who specializes in diagnosis and treatment of diseases of the liver Gallbladder, biliary tree , pancreas
PROCTOLOGIST Physician who specializes in diagnosis and treating diseases of the anus and The rectum
DIETICIAN Professional who counsels PT on special diets required for specific diseases
ENDOCRINOLOGIST Physician who diagnosis and treats diseases of endocrine system, includes Pancreas and treatment of diabetes
GASTROESOPHAGEAL REFLUX DISEASE ( GERD) Stomach acid backs up into esophagus due to leakage in value between stomach and esophagus ( PT complains of heartburn or chest pain )
COLITIS Acute or chronic inflammation of the colon
Symptoms of colitis Abdominal pain / fatigue, bloody diarrhea, cramping , bloating , changes in bowel habits
CROHNS DISEASE Inflammation of any portion of the GI track ( TERMINAL ILIUM MOST COMMON SITE )
CIRRHOSIS Chronic progressive inflammatory disease of the liver
CIRRHOSIS TREATMENT Cannot cure but can delay or reduce complications
CIRRHOSIS CAUSE Commonly long term heavy alcohol consumption or drugs
COLORECTAL CANCER (Colon cancer) COLON CANCER ( Cancer of the colon )
COLORECTAL CANCER ( rectal cancer) RECTAL CANCER ( cancer of the rectum)
COLORECTAL CANCER COLON/ RECTAL In early stages there may be no symptoms As tumor grows constipation or complete obstruction of colon may occur
COLON / RECTAL CANCER TREATMENT Surgical intervention to remove tumor
RECTAL EXAMS DONE WHEN Done when PT complains rectal bleeding or pain
RECTAL EXAM CONSISTS OF Palpate anus and rectum for tenderness , nodules and irregularities
RECTAL EXAM POSITIONS Sims or left lateral position / Lithotomy position ( examine pelvis and lower abdomen) Standing position with PT bent over exam table
ANOSCOPE Instrument to examine anus
RECTOSCOPE Instrument to examine rectum
PTOCTOSCOPE Instrument to examine both anus and rectum
FECAL OCCULT BLOOD TEST To check for blood in the stool that is not visible
HEMORRHOIDS Swollen blood vessels both inside and outside anus that stretch under pressure and bleed
FISSURES Cracks in the anal usually caused by hard bowel movements causing bleeding
BLOOD IN STOOL MAY INDICATE Ulcers or cancers in the GI track
BRIGHT RED BLOOD IN STOOLS MAY INDICATE Bleeding in colon or hemorrhoids
DARK BLACK STOOL MAY INDICATE Bleeding from upper GI tract
STOOL CULTURE Test that looks for various types of bacteria or other microorganism
CLOSTRIDIUM DIFFICILE OR ( C-DIFF ) TESTING Done when PT suffers from explosive diarrhea often side effect of Antibiotic therapy
OVA AND PARASITE ( O &.P ) TESTING Identify intestinal parasites and their eggs or cysts in PT with symptoms of GI Infection
BLOOD IN THE STOOL CAN OCCUR FROM Hemorrhoids , polyps , fissures, diverticulitis , ulcers and colorectal cancer
MELENA Stool that is black and tarry and often result of blood entering stool from upper GI tract
MEDICAL ASSISTANT WILL TEST SPECIMEN FOR BLOOD BY Applying reagent to opposite side of card from where specimen was applied
FECAL OCCULT BLOOD TESTING (HEMATOCHEZIA) HEMATOCHEZIA : bleeding originates in lower GI tract
HEMATOCHEZIA Associated with bright red blood , but can occur in case of high - volume upper GI bleeds
OCCULT BLOOD TESTING SHOULD BE PREFORMED ? Annually in high risk populations (PT 50 years of age and older)
SIGMOIDOSCOPE Flexible tube used to examine sigmoid colon
SIGMOIDOSCOPY Examination of the lower colon or sigmoid colon ( screening test helps to detect colorectal cancer in its early stages )
PREPARING FOR A SIGMOIDOSCOPY PT will need to clean out colon prior to exam PT directed not to eat the day before exam PT should take laxative the night before and in the morning of exam possibly PT taking aspirin or NSAIDs will need to stop two days prior
(COLONOSCOPY) Flexible lighted viewing with videos cope inserted into PTs rectum
COLONOSCOPE ATTACHES TO A VIDEO TO ? Display viewing of the lining of the colon If the provider finds abnormalities such as a polyp it will be removed and sent to a pathologist for examination
LAB TEST COINCIDING WITH GASTROINTESTINAL DISORDERS Comprehensive GI function Panal / CBC / protein / bulirubin / alkaline / phosphatase / gamma - globin
DIGESTIVE SYSTEM Long twisting Hollow tube with opening at each end
DIGESTIVE SYSTEM ( four layers ) Mucosa / submucosa / musculari / serosa
MUCOSA Innermost layer
SUBMUCOSA Second layer
MUSCULARI Third layer
SEROSA External layer ( also known as visceral peritoneum)
peristalsis a series of wave-like contractions of the smooth muscles in a single direction that moves the food forward into the digestive system
hematemesis (vomiting blood) hematemesis (vomiting blood), and bright red blood in the feces or black tarry stools
Crohn’s disease and ulcerative colitis are known as inflammatory bowel diseases (IBD).
idiopathic meaning there is no known cause
Crohn’s disease is an inflammation of any portion of the GI tract, but the terminal ileum is the most common site
Cirrhosis is a chronic, progressive inflammatory disease of the liver As the disease progresses, complications include edema and ascites, ascites, which is abnormal accumulation of serous fluid in the peritoneal cavity, as well as bruising, bleeding, and jaundice. Treatment cannot cure, but can only delay or reduce complications
nonsteroidal anti-inflammatory drug (NSAID): a drug that reduces inflammation and is not a steroid medication
anastomosis: a surgical connection between two hollow, or tubular structures
anorexia of aging the loss of appetite for food in the later years of life
aspiration pneumonia (inhaling a foreign substance into the upper respiratory tract, resulting in inflammation of the lung), drop in blood pressure after eating, and bowel incontinence
Clostridium difficile or “C-Diff” Testing : Done when a patient suffers from explosive diarrhea that is often the side effect of antibiotic therapy.
erosion the wearing away of a surface
etiology: the study of the causes of disease
Crohn’s disease Fistulas Inflammation leads to intestinal thickening, edema, abscesses, and fistulas, the abnormal connection between two surfaces.
gastritis Inflammation of the stomach lining, caused by an irritant (alcohol) or from an infection from a bacteria Treated w/antacids to decrease stomach acid, diet modifications to decrease irritants, and antibiotics when the infective agent is bacteria.
Hiatal hernia is a protrusion of a portion of the stomach through the thorax due to a weakness in the diaphragm wall.
Chemical digestion is initiated in the mouth through the secretion of saliva, which contains a digestive enzyme.
Mechanical digestion is accomplished in the mouth, where food is mechanically broken down into small pieces by the action of the teeth
The digestive tube has several different names: the alimentary canal, the GI tract, and the digestive tract.
The major function of the system is digestion by first breaking down food through mechanical and then chemical processes so that nutrients can be absorbed into the bloodstream and utilized by all cells in the body. The final function of the digestive tract is the concentration and elimination of wastes through the act of defecation.
The peritoneum is a two-layered membrane: the visceral peritoneum covering the outside of each abdominal organ and the parietal layer covering the abdominal cavity.
ileostomy: the surgical creation of an artificial excretory opening between the ileum, at the end of the small intestine, and the outside of the abdominal wall
VISCERAL PAIN Pain that occurs when hollow organs of the GI tract contract or distend
PARIETAL PAIN Pain caused by inflammation and aggravated by movement
REFFERED PAIN Pain felt away from the actual pain site
RISK FACTORS ( ASSOCIATED WITH ) COLORECTAL CANCER FX , Eastern Europe Jews, history of polyps , inflammatory bowel disease , Increased age , high fat diet ,inactive, diabetes , smoking , heavy alcohol use
FIRST AT 50 then every 10 yrs Recommendations for early colorectal detection for PT with average risk
EVERY 1 to 6 yrs PT with strong risk factors or history of polyps should be screened
24- HR. PH MONITORING Probe is places through PT nose down to the distal esophagus to record The ph for 24 hours
ENDOSCOPY The esophagus stomach and first portion of the small intestine is examined with a lighted videoscope
POLYPS An abnormal growth extending from the interior of the colon
INSTRUCTIONS GIVEN TO PT PRIOR TO AN ENDOSCOPY OR COLONOSCOPY NPO AFTER MIDNIGHT , clear liquids day before test : avoid dairy products , alcohol and blood thinners , have a ride home
IV OR CONSCIOUS SEDATION PT RECIEVING AN ENDOSCOPY OR COLONOSCOPY NEED SOMEONE TO DRIVE THEM HOME
ADDITIONAL INSTRUCTIONS GIVEN TO A PT RECIEVING A COLONOSCOPY Various forms of laxatives prescribed by the doctor
ESOPHAGOGASTRODUODENOSCOPY Medical term for endoscopy
Recommend interval for fecal occult blood test Every year
Recommended interval for colonoscopy Every 10 years with no risk factors
Stool that is black and tarry MELENA
Acute or chronic inflammation of the colon Ulcerative colitis
Inflammation from CROHNS can lead to Intestinal thickening /edema/ abscesses/Fistulas
TREATMENT FOR CROHNS CAN INCLUDE Steroids / antibiotics/ immunosuppressive drugs
RISK (. FACTORS FOR ) COLORECTAL CANCER Advanced age / fx / diet high in red and processed meats /IBS / type 2 diabetes /
SIGNS AND SYMPTOMS OF IBS Intermittent abdominal pain / cramping / bloating/ diarrhea / constipation
LAXATIVE Miralax
ANTACID Prilosec / Zantac / protonix
Antidiarrheal Imodium
Antiemetic Zofran / compazine
MEDS for IBS Lotronex / amitiza
MEDS for GERD Aciphex
MEDS for ulcerative colitis Asacol
Common antibiotics for intra abdominal infection Cipro and flagyl
Small intestines consisting of the duodenum, jejunum, and ileum)
Large intestines (consisting of the sigmoid, ascending, transverse, and descending colon)
fistula a crack-like sore of the skin surface
fissure: linear ulcer located on the edge of the anus
Laxatives Miralax / ducolax
Antacids ( for reflux ) Pepcid / protonix/ nexium / Zantac/ aciphex/Prilosec
Antidiarrheal Imodium q
Antiemetic (!throwing up ) Zofran/ compazine/
MEDS for IBS Lotrinix
MEDS for COLITIS Asacol ( decreases inflammation in colon )
Common ABX for GI INFECTIONS Citroen/ flagyl/ rocephin
7 days No iron supplements
5 days No aspirin/ NSIDS/blood thinners like cumonin/heprin
3 days No nuts seeds popcorn raw fruits or veggies
1 day No dairy / red or purple dye /clear liquids/ start laxatives as directed/ NPO BY MIDNIGHT
Day of Take MEDS as ordered /only a sip of h2o / have someone to drive you home
8 oz cups of water Every 20 mins until poop comes out clear
MELENA Upper GI BLEEDING
HEMATOCHEZIA Lower GI BLEEDING
ascites: the abnormal accumulation of serous fluid in the peritoneal cavity
1 mouth teeth and tongue begin mechanical digestion by breaking apart food
2. Salivary glands begins chemical digestion as salivary amylase begins to change starch to maltose
3 esophagus Peristalsis and gravity move food along
4 stomach Hydrochloride acid prepares the gastric area for enzyme action/ Pepsin breaks down protein into smaller proteins / In children RINNE breaks down milk proteins / lipase acts on emulsified fats
5. Liver Produces bile
6 gallbladder stores bile and releases it into the small intestines to emulsify fats
7 pancreas enzymes are released into the small intestines / amylase breaks down starch / lipese breaks down fats / pancreatic protease break down proteins
8 small intestines produces enzymes prepares foods For absorption/ lactas converts to lactose/ Maltese converts to maltose/ Sucrose converts to simple augers / peptides further reduce proteins to amino acids
9 large intestine absorbs water And some other nutrients and collects food residue for excreation
Created by: Tbella