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Unit 8 - Test 3

Digestive System

What is the condition when the esophageal sphincter is weak and does not close completely after food enters the stomach, which allows the backflow of gastric juices from the stomach to enter the esophagus. Gastroesophageal Reflux Disease (GERD)
When is GERD normally developed? Many patients develop this condition as they get older (lifetime of “bearing down” to have bowel movements the internal pressure pushing against the closed sphincter). Also, weight lifters who hold their breath when training will have the same problem.
___________ is caused as chyme and gastric acid regurgitates into the esophagus. Heartburn
When does heartburn pain start? 30 to 60 minutes after a meal
Many patients self medicate for heartburn with over the counter medications. Why is this a problem Over the counter meds are a temporary fix as they do not prevent the release of acid. Also they can cause an electrolyte imbalance because they are high in sodium, calcium or magnesium.
When is pain worst for heartburn? What may patients complain of? When patient is lying down or bending over. Patients will complain of having to sleep in a recliner or with the head of the bed elevated.
Patients with heartburn may associate pain with a heart attack or patients may tell themselves they are having heartburn. It is important to teach patients not to assume their chest pain is _______. Heartburn
Obesity, pregnancy, smoking, hitatal hernia, fatty foods, alcohol and chocolate are risk factors for what? (GERD) Gastroesophageal Reflux Disease
What is the treatment or Rx for GERD? Take Acid-suppressing meds (proton-pump inhibitor-omeprazole).Stop Smoking/avoid 2nd hand smoke, stop caffeine, check for gluten intolerance, high-protein, low-fat diet. Sleep with the head of the bed elevated. Stay upright for 2-3 hrs after eating.
Why should you not smoke when you have GERD? increases gastric irritation and causes vasoconstriction which decreases healing
What type of diet should be maintained with GERD. high-protein, low-fat diet.
What is a Nissen Wrap/ fundoplication
What can a patient no do after a Nissen Wrap/ fundoplication vomit or blech air from the stomach
Over time GERD causes the tissue of the throat to develop precancerous dysplasia (Barrett’s Esophagitis) and could develop into esophageal cancer – so advise your patients to what? Do not ignore heartburn because it can lead to cancer
Protrusion of the upper part of the stomach through the diaphragm into the thorax causing congestion of blood flow and ischemia. Hiatal Hernia
What are the risk factors for Hiatal Hernia? aging, pregnancy, obesity, habitual vomiting, weight training and smoking/alcohol.
Hiatal hernias rarely cause s/s unless_________ is present. GERD
Hiatal hernia pain can mimic what? Heart attack
What is the treatment for Hiatal Hernias? Acid suppressing medication and if severe enough, surgery
Erosion of the stomach lining. Peptic Ulcer Disease (PUD)
What bacteria is present in 90% of duodenal ulcers and 80% of Stomach ulcers? Helicobacter pylori (H. Pylori)
______ ulcers are common is hospitalized patients. Stress ulcers
What are 3 common causes of ulcers? burn traumas, head injuries, critically ill patients
How are Peptic ulcers treated? PPI (proton pump inhibitor drugs) - IV pantoprazole (protonix)
What are some risk factors for peptic ulcers? smoking, alcohol use and NSAID use
When does peptic ulcer pain happen? about 2 hours after eating or in the middle of the night when stomach has emptied
Peptic ulcer disease if often relieved by what? eating - Putting substance back in the stomach
What is a common finding with ulcers? unexplained low hematocrit/hemoglobin.
What are some of the dangers of peptic ulcers? anemia, profuse bleeding and stomach cancer.
Ulcers can self resolve or worsen causing what? upper gastrointestinal bleeding or stomach/ duodenal perforation.
What are the test for peptic ulcer disease and upper gastrointestinal bleeding? Complete Blood Count, hematocrit & Hemoglobin, H. Pylori blood test, occult blood smear, EGD (EsophagogastroduodenoSCOPY) and Biopsy of stomach tissue to check for h.pylori.
What is the treatment for peptic ulcers? combination drug therapy - antibiotics and acid suppressing meds.
What type of ulcer: Duodenal, Gastric or Stress: 25 to 50 years of age. any age usually early adulthood. Stress is not a factor. Duodenal
What type of ulcer: Duodenal, Gastric or Stress: 55 to 70 years of age. hyperacidity is normal to low. Stress does not appear to be a factor. Gastric
What type of ulcer: Duodenal, Gastric or Stress: Person with very severe stress (hospitalized patient). Increase with stress and affects both genders. Stress
What type of ulcer: Duodenal, Gastric or Stress: increase uses of ETOH/tobacco. Duodenal
What type of ulcer: Duodenal, Gastric or Stress: Moderate use of ETOH/Tobacco. Gastric
What type of ulcer: Duodenal, Gastric or Stress: Increase use of ETOH, ASA, NSAID's Stress
What type of ulcer: Duodenal, Gastric or Stress: H.plyori often present. Pain relieved by eating-common nocturnal, remissions and exacerbations. Hemorrhage is common Duodenal
What type of ulcer: Duodenal, Gastric or Stress: Bacteria may be present. Pain is relieved by eating-uncommon nocturnal, no remission and exacerbation. Hemorrhage is less common. Gastric
What type of ulcer: Duodenal, Gastric or Stress: Bacteria infection is not a factor. Asymptomatic until hemorrhage or perforation. Hemorrhage is very common Stress
Stress ulcers are so common in hospitalized patients that they are given an acid-suppressing mediation by IV_________ to prevent ulcers from occurring. (Usually pantoprazole/Protonix) Prophylactically
True or False: Upper and lower GI bleeds can be either slow/chronic with minimal S/S or sudden and life threatening True
If an ulcer perforates through the stomach lining, acid will enter the peritoneal cavity causing what? What will a perforated ulcer cause? sudden agonizing pain and a rigid abdomen - perforated ulcer will cause sepsis and can progress to shock due to blood loss or systemic infection.
What may a patient experience if a perforated ulcer bleed slowly. Fatigue and anemia without realizing there is an ulcer.
A positive fecal occult blood test result when there is no evidence of visible blood in feces. Occult GI Bleed
May manifest as hematemesis, melena or hematochezia. Overt GI Bleed
indicates that the bleeding is from the upper gastrointestinal tract, usually from the esophagus, stomach, or proximal duodenum Hematemesis
What are the two types of hematemesis? What do they indicate?  “Bright red emesis” (very dangerous sign – requires emergency treatment)  “Coffee-ground emesis” due to partial digestion of blood in the stomach by stomach acids.
black “sticky” stools that look like tar (and smell awful!) is caused by the partial digestion of blood in the small/large intestines (where alkaline digestive enzymes breakdown the blood). Melena
Where can Melena originate from? Bleeding site in the stomach or intestines
bright red blood from the rectum (due to hemorrhoids & anal fissures, diverticulosis, or infection). Bright red blood from rectum is usually not a serious problem (although your patient will THINK it is!!!) Hematochezia
functional gastrointestinal (GI) disorder- symptoms are caused by changes in how the GI tract works - without damage to the GI tract. Symptoms occur together but not a disease Irritable Bowel syndrome (IBS)
What is a defining characteristic of IBS? Pain that is relieved by defecation
True or False. IBS has both a mental and physical cause. True
____ accompanies anxiety or depression. IBS
When is IBS diagnosed When a person has had abdominal pain or discomfort at least three times a month for the last 3 months without any other disease of injury that could explain the pain.
What are some s/s of IBS? Persistent or recurrent symptoms of abdominal pain, altered bowel function w/o GI damage, and varying complaints of flatulence, bloating, nausea, anorexia, constipation or diarrhea. IBS accompanies anxiety or depression.
IBS is an umbrella term that includes _____ and _________. Crohn's Disease and Ulcerative Colitis
This is a painful autoimmune disorder (no medical cure) results in inflammatory lesions that may occur anywhere in the G.I. tract (from mouth to anus) but more often in the ascending colon and terminal ileum. Crohn's Disease
Tunnel to other organ caused by lesion involved in all layers of the bowel wall. fistulas
Fistulas and the colon not absorbing properly can result in what for patients? fluid and electrolyte imbalance and malabsorption of vitamins and minerals
These involve some areas of the bowl but not all. Characteristic of Crohn's Disease Skip lesions
The bowel wall becomes congested, thickened, leading development of abscesses and fistulas. Scar tissue interferes with movement of chyme through the intestine and perforation or obstruction can occur. complications of Crohn's Disease
What are some significant complications for the chronic inflammation cause by Crohn's Disease? Malabsorption, fluid and electrolyte imbalance, Diarrhea and dehydration, anal fissures
What can the malabsorption of Crohn's Disease lead to? decreased folic acid --> Anemia and decrease calcium/vitamin D ---> bone weakness
What are the acute complications of Crohn's Disease?  Intestinal obstruction or perforation  Perianal abscesses, fistulas  May require removal of the inflamed intestine requiring an “ostomy”
An autoimmune disease where lesions only occur in the colon and ulcerative lesions only involve the mucosal layer. Ulcerative Colitis
list the complications of ulverative colitis  Intestinal obstruction  Dehydration, Fluid and electrolyte imbalances  Malabsorption, Iron deficiency anemia  Chronic bloody diarrhea mixed with mucus  Weight loss  Abdominal cramping and pain  Nausea vomiting and the urge to defecate
What are the acute complications of ulcerative colitis? hemorrhage, toxic megacolon and possible colon perforation.
Ulcerative Colitis is a high risk for what do the development of dysplasia. Cancer
In severe cases UC can cause damage to the nerve plexus, resulting in colonic dysmotility, dilation, and eventual infarction and gangrene. This condition is characterized by a thin-walled, large, dilated colon that may eventually become perforated. Toxic Megacolon
Ulcerative Colitis or Crohn's Disease: Family history is a frequently associated factor. Crohn's Disease
Ulcerative Colitis or Crohn's Disease: Location of lesions is in the large intestine only, mucosal layer is only affected and no skip lesions Ulcerative colitis
Ulcerative Colitis or Crohn's Disease: Skip lesions are common and affects entire bowl wall thickness Crohn's Disease
Ulcerative Colitis or Crohn's Disease: Anal/perianal fistulas are common Crohn's Disease
Ulcerative Colitis or Crohn's Disease: Bloody stool ulcerative colitis
Ulcerative Colitis or Crohn's Disease: treatment is steroids, Mab drugs and possible surgery Both
Ulcerative Colitis or Crohn's Disease: treatment steroid, mab drugs and surgery to remove portions of nonfunctioning colon Crohn's Disease
This the 2nd leading cause of cancer related deaths in the US and the most common cancer in men and in women. Colorectal cancer
risk factors for colorectal cancer. Age 50 or older, greater in men than women, black and Caucasian, medical history of crohn's or ulcerative colitis, obesity/ lack of exercise, smoking, alcohol and family history of colon cancer
Pathophysiology: Most colorectal cancers begin as a growth called a ______ on the inner lining of the colon or rectum. Some types of _______ can change into cancer over the course of several years, but not all _______ become cancer. polyp
What are the two main types of polyps? 1. Adenomatous polyps (adenomas) 2. Hyperplastic polyps and inflammatory polyps
these polyps sometimes change into cancer -- pre-cancerous condition. Adenomatous polyps (adenomas)
These polyps are more common, but in general they are not pre-cancerous. Hyperplastic polyps and inflammatory polyps
T or F - There are usually s/s of colorectal cancer in the early stages. False
Changes in bowel movements (constipation or diarrhea), Cant empty bowels or urgent BM, Rectal bleeding or cramping, Dark patches of blood in or on stool; or long, thin stool.,Abdominal pain/ bloating, fatigue, loss of appetite, weight loss, Pelvic pain, s/s of late stage colorectal cancer
DX test for colorectal cancer Fecal occult blood test (stool smear) because cancerous polyps bleed a small amount that does not show in the stool but can be detected with this method); and colonoscopy (to locate, biopsy, and remove polyps).
Which hepatic pathology: portal vein --> thrombosis, cancer, enlarged lymph nodes, compression. Prehepatic
Which hepatic pathology: conditions that cause obstruction of blood flow within the liver such as alcoholic cirrhosis. Intrahepatic
Which hepatic pathology: any obstruction to flow through the hepatic veins beyond the liver lobules, either within or distal to the liver such as right sided heart failure or thrombosis of hepatic veins. Post hepatic
What are the functions of the liver? People Drink so Much P: Produce Albumin, Bile, coagulation factors D: Detox S: Storage of glycogen M: Metabolism of protein
This primary plasma protein for oncotic/osmotic pressure in blood veins & made in liver. Not enough protein in the plasma means body fluid is stuck in 3rd space b/c there is no protein in blood veins available to PULL --> causes ASCITES & PORTAL HTN Albumin
What does a build up of bilirubin in the tissue lead to? Jaundice
Protein digested in Small Intestine -->Ammonia byproduct -->liver and metabolized into urea --> sent to kidney for removal in urine. Metabolism of protein - liver function
scarred liver tissue that does not function normally Cirrhosis
What is the most common cause of Cirrhosis? Why Chronic Alcohol use (alcoholic hepatitis) - Ethyl alcohol (ETOH) is oxidized by the liver to acetaldehyde which damages hepatocytes.
other than chronic alcohol use what can cause cirrhosis Viral hepatitis or hepatotoxic drugs
Cirrhosis (scar tissue) prevents the normal flow of blood through the liver causing fluid back-up that leads to _____________ Portal hypretention
damaged liver tissue cannot synthesize protein, so there is not enough protein in the blood to pull fluids out of the tissue leading to _____ Ascites
What are the manifestations of Portal Hypertension? Esophageal / stomach varices, splenomegaly, ascites, hemorrhoids
What are the manifestations of Ascites? Abdominal distension, displaced diaphragm leading to dyspnea, peritonitis.
Pressure in portal vein forces fluid out of the veins into the abdomen (Free fluid in the abdomen). What is this condition? Ascites
Why is portal Hypertension a problem in the esophagus? What is a sigh the portal hypertension has effected the esophagus? causes the veins in the esophagus to engorge with blood, causing the veins to distend (esophageal varices) and possibly to burst . Bright red blood vomit (hematemesis) is a sign this and Emergency Action is required.
What does portal hypertension do to vital organ? fluid backup in organs do to increase pressure. Example splenomegaly
What are the two causes of free fluid in the abdomen? 1- Portal Hype increases capillary hydrostatic pressure (“PUSHES” fluid out of vessels into the gut) #2 – damaged liver can't make serum protein -decreased oncotic pressure (no protein in vessels to “PULL” the fluid out of the gut back into the veins).
What is the treatment for Ascites? Parecentesis
What is the conditions when liver will not break down or synthesize protein which results in elevated ammonia levels Hepatic Encephalopathy
_____________ is a brain toxin and high levels will cause changes in LOC. Ammonia
In Hepatic Encephalopathy the increase toxins and ammonia unable to be processed are moved in to the GI Tract. Many of them can cross what and lead to what kind of problems Blood-brain barrier. Lead to neurological problems
Manifestations of Hepatic Encephalopathy? Confusion, asterixis, apraxia, stupor, seizures, coma
Jaundices is caused by liver not being able to break down what found in RBC's. Where is it deposited and what does it cause. Bilirubin - deposited in skin and sclera causing a yellowish orange color and intense pruritis (itching)
manifestations of Jaundice Jaundice – aka, “Icterus,” S/S = Yellow orange sclera/skin, dark urine "coke syrup", light color stools "clay colored", anorexia, fatigue, pruritus
Cause of Jaundice __________ of RBC's increases Bilirubin levels. ___________ of bile flow from liver increases reabsorption __________ inhibits Bilirubin conjugation and excretion -Hemolysis -Obstruction -Intrahepatic disease
Manifestations of hepatorenal syndrome Na+ and H2O retention Oliguria Increased BUN and Creatinine levels
In hepatorenal syndrome decrease circulating blood volume leads to decreased renal perfusion triggering what? What does this lead to? Triggers the renin-angiotensin systems that leads to vasoconstriction and increased B/P.
Hepatic failure prevents removal of excess___________ causing Hypertension to worsen in hepatorenal syndrome. Angiotensin
Waste products that contain nitrogen build up in the bloodsteam Azotemia
In hepatorenal syndrome the kidney produces less urine leading to azotemia. Why does this happen. Kidney damage
Hepatorenal syndrome occurs in about 40% of patients with liver failure. What is the prognosis? Poor because renal failure is irreversible unless liver transplantation is performed.
This is an early sign of hepatic encephalopathy. The hand will flap involuntarily when the wrist is extended; caused by metabolic encephalopathy of any cause, but especially decompensated liver failure; aka, “Liver Flap”: Asterixis Factoid
This is a procedure to aspirate fluid [ascites] that has collected in the abdomen (peritoneal fluid). Paracentesis
What do we need to be concerned about with Paracentesis? removing fluid could result in low blood pressure that can lead to shock or kidney damage.
Is Paracentesis a curative procedure? No
What lab test: test for bleeding problems PT, PTT, INR
What lab test: test to measure liver's ability to break down protein Ammonia
What lab test: test stool samples for hidden blood Occult blood smear
What lab test: specifically the liver enzymes ALT and AST Liver Function Test (LFT)
What lab test: Blood break-down product Bilirubin
What lab test: check RBC's and platelet status Complete Blood Count
Blood that can only be detected by a stool smear test Occult Blood
Black and tar looking stool Melena
UGIB, life-threatening emergency Red Blood Emesis
Bright red blood caused by hemorrhoids, not usually serious Hematochezia
results from the partial gastric digestion of blood Coffee-ground vomitus
__________ __________ _________ slowly attacks the liver over many years without causing symptoms. When s/s do appear, they are vague and nonspecific so this can go undetected until significant liver damage is present. Chronic viral hepatitis
List some s/s of Viral Hepatitis. Acute or Chronic -  Fatigue, weakness, loss of stamina  Nausea, vomiting, diarrhea, anorexia  Fever and flu-like symptoms  Dark colored urine  Jaundice of skin and sclera (aka, icterus)  Intense Pruritis due to icterus
What s/s of viral hepatitis are specific to liver disease?  Jaundice of skin and sclera (aka, icterus)  Intense Pruritis due to icterus
What are the major causes of liver cancer? Hep B anc C
T or F - If Liver cancer is caught early it is easily treatable but if it is caught late liver cancer is lethal. False - even is liver cancer is caught early, only a small proportion of patients can be cured.
Oral-fecal (food borne) - most common type of Hepatitis in the US. Havrix vaccine, gG immunoglobulin is given after an exposure to unvaccinated patient. It is spread from person to person via fecal contamination because the virus is present in the stool. Hep A
Blood/body fluid borne. Most common cause in US is through unprotected sex or needle sticks, Mom-to-baby, etc. - Heptavax vaccine* (must complete series of 3); IgG immunoglobulin and Interferon (Intron-A) can be given to unvaccinated patient. Hep B
Blood/body fluid borne. – No Vaccine available. Treated with antiviral med - Interferon (Intron A). With acute from, the virus is eliminated in 25% of ppl but 75% become chronically infected - high chance of liver damage and cancer. Hep C
___ are given before exposure to prevent hepatitis (A or B) ______shot is a short term general antibody that can be given after exposure to hepatitis to strengthen the immune system and help the body fight the hepatitis virus - not curative Vaccines, IgG (Gammaglobulin) immunoglobulin
What disease? Injury or obstruction of pancreas causing digestive enzymes to leak into pancreatic tissue --> auto- digestion of tissue or formation of cysts Pancreatic Disease (pancreatitis)
What is the primary cause of pancreatitis Alcohol abuse
Why does alcohol abuse cause pancreatitis? ETOH stimulates pancreatic enzymes and causes obstruction of pancreatic duct/sphincter.
Why do gallstones cause pancreatitis? get into common bile duct and block pancreas excretion.
What are the s/s of pancreatitis? PAIN!!!!!!!! Especially epigastric pain, fever, leukocytosis, nausea and vomiting, abdominal distention, increased bowel sounds, hypotension and shock
What is Pancreatic stool? Foamy floaters” – bulky unformed stools, unusually foul-smelling, greasy stools (steatorrhea). The stool is light-colored and may even contain oil droplets. This is caused because pancreas enzymes are not breaking down fat in the intestines
Treatment for pancreatic disease. GI Rest ( nothing by mouth or NG tube) until condition is controlled.
What condition: associated with cholelithiasis (gallbladder stones composed of gholesterol and bile) Cholecystitis (gallbladder)
What are the 6 F risk factors for Cholecystitis Fair Fat Fertile Female Forties Family
When does pain occur in cholecystitis immediately after eating - especially fatty foods
how could cholecystitis affect a person stool? Light color or Clay-colored stools because bile is being blocked from entering the intestine. Bile (bilirubin in the bile) gives stool a brown color, so without bile the stools will lack color.
Cholecystitis pain can mimic___________ (severe, radiating to between shoulder blades and up neck, unrelenting and non-reproducible just like cardiac pain). heart attack
What are some s/s of cholecystitis other than a heart attack s/s? nausea, vomiting, fever, leukocytosis, jaundice (with obstruction) and Light color or Clay-colored
Specific to what condition: Pain right after eating fatty foods Cholecystitis
Specific to what condition: Accites, portal hypertension, Jaundice and encephalopathy Cirrhosis
Specific to what condition: Affects all layers of the intestines, fistulas and skip lesions Crohn's Disease
Specific to what condition: Pain increase when bending or laying down GERD
Specific to what condition: virus with late s/s, can lead to liver cancer Hepatitis
Specific to what condition: No GI damage, psych, same s/s as inflamed bowl disease IBS
Specific to what condition: Melena, occult blood, hematochezia Lower GI Bleed
Specific to what condition: Pain 2 hours after eating or in the middle of the night Peptic ulcer disease
Specific to what condition: vague or no specific, sever pain, must be kept NPO Pancreatitis
Specific to what condition: only effect mucosal layer of the intestine. ulcerative colitis
Specific to what condition: Hematemesis (bright red or coffe grounds) Upper GI Bleed
Created by: sbertelsen



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