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Unit 4 Exam

Medical-Surgical Nursing

QuestionAnswer
What is an inflammation of the gastric mucosa? Gastritis
What causes gastritis? It's the result of a breakdown in the normal gastric mucosal barrier.
What drugs can cause gastritis? NSAIDs, corticosteroids, digoxin, and Fosamax
What bacteria is closely associated with gastritis? Helicobacter pylori
What is autoimmune metaplastic atrophic gastritis? An inherited condition in which there is an immune response directed against parietal cells
What fluid and electrolyte imbalances are associated with autoimmune gastritis? Low chloride levels and pernicious anemia
What is a complication of chronic gastritis? If parietal cells are atrophied, the source of intrinsic factor is lost resulting in pernicious anemia
What are the S/S of acute gastritis? Anorexia, N/V, epigastric tenderness, and a feeling of fullness
How is acute gastritis usually diagnosed? Based on the patient's symptoms and a history of drug or alcohol use
What is the main treatment for acute gastritis? Eliminating the cause and avoiding it in the future
What is prescribed if vomiting occurs with acute gastritis? Rest, NPO status, IV fluids, and antiemetics. NG tube may necessary if vomiting still persists.
What are examples of serotonin (5-HT3) antagonists (antiemetics)? Dolasetron Granisetron Ondansetron (Zofran) Palonosetron
What are examples of phenothiazines (antiemetics)? Chlorpromazine Perphenazine Prochlorperazine Trifluoperazine Promethazine (Phenergan)
What are examples of PPIs? Dexlansoprazole Esomeprazole Lansoprazole Omeprazole Pantoprazole Rabeprazole
What are examples of H2 blockers? Cimetidine Famotidine Nizatidine Ranitidine
What does treatment of chronic gastritis focus on? Evaluating and eliminating the specific cause
What diet is recommended with chronic gastritis? A nonirritating diet consisting of 6 small feedings a day
What is peptic ulcer disease (PUD)? A condition characterized by erosion of the GI mucosa from the digestive action of HCl acid and pepsin
How are peptic ulcers classified? As either acute or chronic
What is an acute ulcer associated with? Superficial erosion and minimal inflammation
Do chronic ulcers form fibrous tissue? Yes
Which is more common: An acute or chronic peptic ulcer? Chronic
Where are gastric ulcers predominantly located? Antrum of stomach
How do gastric ulcers affect gastric secretion? It remains normal or decreases
How do duodenal ulcers affect gastric secretion? Increase it
What is the peak age for gastric ulcers? 50-60 years
What is the peak age of duodenal ulcers? 35-45 years
Describe the pain of gastric ulcers. Burning or gaseous pressure in epigastrium; aggravated by food; begins 1-2 hours after meals
Describe the pain of duodenal ulcers. Burning, cramping across the midepigastrium and upper abdomen; relieved with food and antacids; begins 2-5 hours after meals
What chemical does H. pylori produce? Urease, which increases gastric secretion
Why do people of lower socioeconomic status have a higher risk of PUD? They have a higher prevalence of H. pylori infection
What is the main cause of the majority of non-H. pylori peptic ulcers? Use of NSAIDs
What drugs increase the risk of PUD? Corticosteroids, anticoagulants, SSRIs, and NSAIDs
What ulcer has a higher mortality rate: Gastric or duodenal? Gastric
Which type of ulcer accounts for the majority of peptic ulcers? Duodenal
What is Zollinger-Ellison syndrome? A rare condition characterized by severe peptic ulceration and HCl acid hypersecretion
Which patients are more at risk for silent peptic ulcers? Older adults and those taking NSAIDs
What the 3 major complications of PUD? Hemorrhage, perforation, and gastric outlet obstruction
Which ulcers account for more upper GI bleeding: Gastric or duodenal? Duodenal
Which ulcers commonly perforate? Large penetrating duodenal ulcers
What are the clinical manifestations of perforation? Sudden, severe upper abdominal pain unrelieved by food or antacids; rigid abdomen; shallow, rapid respirations; tachycardia with weak pulse; absent bowel sounds
What happens if perforation of an ulcer is left untreated? Bacterial peritonitis occurs in 6-12 hours
What are the clinical manifestations of gastric outlet obstruction? Pain that is worse at the end of the day; projectile vomiting; constipation; visible abdominal swelling
What is the most accurate diagnostic procedure for PUD? Endoscopy
What is used to diagnose H. pylori? A biopsy of the antral mucosa with testing for urease
What's used to diagnose gastric outlet obstruction? Barium contrast study
How long does complete healing of an ulcer take? 3-9 weeks
How long after diagnosis and treatment of PUD is a follow-up endoscopy done? 3-6 months
If aspirin is necessary for a patient with PUD, what other medications are prescribed? PPI, H2 blocker, or misoprostol (Cytotec). Consider enteric-coated aspirin
What is the treatment for appendicitis? An immediate appendectomy
What is inflammatory bowel disease (IBD)? A chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation
How is IBD classified? As either ulcerative colitis or Crohn's disease
Which racial groups are most at risk for IBD? White and Ashkenazic Jewish
When does IBD usually occur? In adolescence and early adulthood with a second peak in the 6th decade
True or False: IBD is an autoimmune disease. True
What gene is associated with Crohn's disease? NOD2 gene
What part of the GI tract is most commonly involved with Crohn's disease?D Distal ileum and proximal colon
Does inflammation of Crohn's disease affect all layers of the bowel wall? Yes
True or False: Fistulas are uncommon in active Crohn's disease. False; Fistulas are common
How does ulcerative colitis progress? It begins in the rectum and moves in a continual fashion toward the cecum
Which layer of the intestinal wall does ulcerative colitis affect? Mucosal layer
Are fistulas common with ulcerative colitis? No
What are the S/S of Crohn's disease? Diarrhea and cramping abdominal pain. Rectal bleeding can occur.
What are the primary manifestations of ulcerative colitis? Bloody diarrhea occurring up to 20 times a day ad abdominal pain
What are the GI complications of IBD? Hemorrhage, strictures, perforation, abscesses, fistulas, CDI (C. diff infection), and toxic megacolon
Is toxic megacolon more common with ulcerative colitis or Crohn's disease? Ulcerative colitis
What drugs are used with IBD? Aminosaliylates, antimicrobials, corticosteroids, immunosuppressants, and biologic & targeted therapy
What ulcerative colitis procedure occurs in 2 phases? Total proctocolectomy with ileal pouch/anal anastomosis (IPAA)
What are diverticula? Saccular outpouchings of the mucosa that develop in the common
What is diverticulitis? Inflammation of one or more diverticula, resulting in perforation into the peritoneum
Where are diverticula most common? The descending and sigmoid colon
What is the main contributing factor of diverticulosis? Lack of dietary fiber intake
What is the preferred method of diagnosis of diverticulitis? CT scan with contrast
What is celiac disease? An autoimmune disease characterized by damage to the small intestinal mucosa from ingesting wheat, barley, and rye
Is celiac disease more common in men or women? Women
What are typical S/S of celiac disease? Foul-smelling diarrhea, steatorrhea, flatulence, abdominal distension, and malnutrition
What are atypical S/S of celiac disease? Osteoporosis, dental enamel hypoplasia, iron and folate deficiencies, peripheral neuropathy, and reproductive problems
What are the S/S of diverticulitis? It can be asymptomatic, but if symptoms occur they include abdominal pain in LLQ, bloating, flatulence, changes in bowel habits, abdominal mass, N/V, and systemic symptoms of infection
What is mastitis herpetiformis? A pruritic, vesicular skin lesion occurring on the buttocks, scalp, elbows, face, and knees; associated with celiac disease
How is H. pylori infection treated? Antibiotic therapy concurrently with PPI for 7-14 days
What are the S/S of dumping syndrome? Generalized weakness, sweating, palpitations, and dizziness
How long after eating of S/S of dumping syndrome begin? 15-30 minutes
What is appendicitis? Inflammation of the appendix
What age group is at the highest risk for appendicitis? 10-30 years old
What are systemic complications of IBD? Joint, eye, mouth, kidney, bone, vascular and skin problems
How does appendicitis begin? With dull periumbilical pain, anorexia, and N/V
How does pain at the beginning of appendicitis change? Shifts to RLQ and localizing at Murphey's point
What is the preferred method of diagnosis for appendicitis? CT scan
Are PPIs or H2 blockers more effective for ulcer healing? PPIs
Why is misoprostol (Cytotec) prescribed with PUD? To prevent gastric ulcers caused by NSAIDs and aspirin
What antibiotics are prescribed after perforation of an ulcer? Broad-spectrum to treat bacterial peritonitis
What type of ulcer is most likely to cause gastric outlet obstruction? A gastric ulcer close to the pylorus
What is dumping syndrome? The direct result of surgical removal of a large portion of the stomach and pyloric sphincter
What is the only effective treatment for celiac disease? A gluten-free diet
What cancers are more common in patients with celiac disease? Non-Hodgkin's lymphoma and GI cancers
What are S/S of lactose intolerance? Bloating, flatulence, cramping abdominal pain, and diarrhea after ingesting a milk product
What is irritable bowel syndrome (IBS)? A disorder characterized by chronic abdominal pain or discomfort and alteration of bowel patterns
True or False: IBS has no known organic cause? True
How is IBS diagnosed? Solely on patient's symptoms
Created by: shrewsburysd