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NUR 235 - GI
GI
| Question | Answer |
|---|---|
| Ulcerative colitis (UC) affects where? | Only the large intestine |
| Higher incidence of UC and Crohn's in the following? | whites, industrialized nations (urban areas more than rural areas), Ashkenazi Jews (genetic), mostly females, bowel habits (constipation), teenage yrs and early adulthood, sec. peak in 60's. |
| National Pt Safety Goal | Communication question on test |
| IBD - symptoms correspond with what? | degree of inflammation |
| UC always starts where? | in the RECTUM and continuous until some proximal part of the colon |
| UC involves what layers? | mucosa and submucosa |
| With severe attack of UC mucosa becomes what? | hemorrhagic and ulcerated |
| What happens to the colon when UC becomes chronic | becomes rigid and loses its haustral (pouch-like) markings |
| Crohn's Disease (CD) or regional enteritis can affect where in the GI tract? | any part |
| What kind of pattern does CD have? | non-continuous pattern "skip lesions" |
| CD affects what layers of the affected bowel | all of it |
| CD histologically shows what? | granulomas |
| CD increases the incidence of what? | gallstones and kidney stones (due to malabsorption of fats and bile salts) |
| CD increased risk of what? | cancer in affected areas |
| UC increased risk of developing cancer when? | 8-10 years after initial diagnosis |
| CD have what signs in GI tract? | cobblestoning, fat wrapping, fissure, thickened wall |
| UC have what signs in the GI tract | ulcerations, surviving mucosa, loss of haustra |
| CBC's in IBD | Anemia is common, leuokocytosis and thrombocytosis common, sed rate elevated, |
| Toxic megalcolon can be caused by what in UC? | narcotics, catharitics, enemas, antidiarrheal meds |
| Complication of IBD | Strictures, fistulas and abscesses, stenosis and obstruction |
| Liver and gallbladder are located where? | upper right quadrant |
| Spleen and most of stomach are located where? | upper left quadrant |
| What is lactase? | digestive enzyme necessary for the absorption of the CHO lactose (milk sugar) |
| Signs and symptoms of lactose intolerance | abdominal pain, bloating and flatulence |
| Measures to enhance abd wall relaxation | bladder empty, warm room, supine with knees bent, warm steth, inquire about painful areas and examine last, use distraction |
| Prominent dilated veins may indicate what? | portal HTN, cirrhosis, ascites, vena caval obstruction |
| Someone who is restless and constant turning to find a comfortable position may have what? | gastroenteritis or bowel obstruction |
| Someone with peritonitis may show what s&s? | absolute stillness, knees flexed, facial grimacing, rapid/uneven respirations |
| Cullen Sign | Bluish discoloration of the peri-umbilical skin caused by intraperitoneal hemorrhage. |
| Cullen Sign may be caused by what? | acute pancreatitis |
| Grey Turner's Sign | Bluish discoloration of the skin around the flanks or umbilicus in a patient with hemorrhagic pancreatitus. |
| Caput Medusae | Plexus of dilated veins around the umbilicus |
| Caput Medusae is usually seen in what type of patients? | Patients with portal hypertension as the result of cirrhosis of the liver |
| What side of the stethoscope is used to listen to bowel sounds? | diaphragm |
| Why do you auscultate before you percuss the abd? | percussion and palpation increases peristalsis |
| 3 reasons you may have hypoactive or absent bowel sounds | after abd surgery, inflammation of the peritoneum, late bowel obstruction |
| What do you do if the patient is on suction? | briefly turn off the suction for assessment of bowel sounds |
| Another name for rebound tenderness | blumberg's sign |
| Another name for inspiratory arrest | murphy's sign |
| How can you test for appendicitis? | iliopsoas muscle test (pt. supine, life right leg straight up, flexed at hip, push down on pt's thigh as they lift leg - pain in RLQ present) |
| How do you test for perforated appendix? | obturator test |
| Accumulation of ammonia and other toxic metabolites in the blood may cause what? | Hepatic encephalopathy |
| What is fector hepaticus? | sweet, slightly fecal odor to breath |
| What is Asterixis and what pt may show this sign? | arm in held out with hand held upward, with in few sec hand falls forward and then quickly returns back up. Hepatic encephalopathy |
| what does the pancreas do? | releases insulin and glycogen into the bloodstream, produces pancreatic enzymes that are released into the duodenum for digestion |
| age-related considerations | slight decrease in size of liver, decreased in blood flow, reduced drug metabolism, increased chance of gallstones |
| Never palpate if you suspect what? | appendicitis or dissection abd aortic aneursym |
| What will you not do if the pt has had an organ transplant? | palpate or percuss the organs |
| If a pt is in abd pain look for and test what signs? | tachypneic, leaning forward, murphy's sign, rovsing's sign and iliopsoas test |
| The pancreas releases what into the bloodstream? | insulin and glycogen |
| What does the pancreas release into the duodenum and what does it help with? | pancreatic enzymes and bicarbonate. Helps with digestion and protects the bowel from the acidity of gastric contents. |
| IBD is 4 times higher among who? | Whites |
| IBD has the highest incidence among what group of people? | Ashkenazi Jews |
| UC histologically shows what? | Crypt abscess |
| Symptoms in both US and CD? | diarrhea, bloody stools, weight loss, abd. pain, fever, fatigue |
| Most common location for CD? | terminal ileum and colon |
| Strictures in CD at the areas of inflammation may cause what? | bowel obstruction |
| microscopic leaks can allow bowel contents to enter the peritoneal cavity and form what? | abscesses or peritonitis |
| In CD what is usually the first sign of a bowel/bladder fistula? | UTI and feces seen in the urine |
| pt has diarrhea with large fluid and electrolyte losses, protein loss in the stool and pseudopolyps in the bowel lumen. What does this pt have? | UC |
| Pt has diarrhea, colicky abd pain, weight loss and fever what may the pt have and where is it located? | CD and small intestines |
| Pt has two semiformed stools daily with small amt of blood and abd pain. What does the pt have? | Mild UC |
| Pt has 5-6 stools per day, increased bleeding, fever, malaise and anorexia. What does the pt have? | Moderate UC |
| Some complications of the GI tract? | hemorrhage, strictures, perforation, fistulas, and colonic dilation |
| Colonic dilation greater than 5 cm is called what? | toxic megacolon |
| Pts with toxic megacolon are at high risk for what and what is the treatment? | Perforation and emergency colectomy |
| Hemorrhage in IBD may lead to what and how is it treated? | anemia/corrected with blood transfusions and iron supp. |
| Bile salts and cobalamin are only absorbed where in the body? | terminal ileum |
| Disease at the terminal ileum can result in what? | fat malabsorption and anemia |
| Toxic megacolon is more common in UC or CD? | UC |
| Strictures and fistulas are more common in UC or CD? | CD |
| Systemic complications of IBD are? | fever, anorexia, malaise (due to inflammatory response) |
| Some extraintestinal complications of IBd are? | Arthritis, ankylosing spondylitis, eye inflammation and skin lesions |
| In IBd there is an increased incidence of what? | thromboembolism, kidney stones, primary sclerosing cholangitis, and gallstones |
| Primary sclerosing cholangitis may cause what? | liver failure |
| Microperforation or peritonitis from CD may be confused with what disease? | appendicitis |
| In IBD blood loss may cause what? | iron deficiency anemia |
| Elevated WBC may indicate what in IBD? | toxic megacolon or perforation |
| Elevated ESR may indicate what in IBD? | chronic inflammation |
| In IBD the stool should be assessed for what? | Blood, pus and mucus |
| What 2 diagnostic studies allow for direct examination of the large intestine mucosa and are able to obtain biopsy specimens? | Sigmoidoscopy and colonoscopy |
| What diagnostic study is used in the diagnosis of small intestines diseases? | Capsule endoscopy |
| Goals of treatment for IBD? (7) | Rest the bowel, control the inflammation, combat infection, correct malnutrition, alleviate stress, provide symptomatic relief and improve quality of life |
| When is hospitalization necessary for IBD? | pt fails to respond to drug therapy, diseases is severe, complications are present |
| Five major classes of drugs for treatment of IBD? (all of these are used in CD) - Lewis book pg. 1053 | aminosalicylates, antimicrobials, corticostreoids, immunosuppressants, and biologic therapy |
| Of the five major classes of drugs to treat IBD which 2 are the main treatment for UC? | Aminosalicylates and corticosteroids |
| Name some antibiotics to treat IBD - Kaye's ppt | metronidazole (Flagyl), ampicillin, cephalosporins, amonioglycosides, ciprofloxacin (Cipro) |
| Name some antidiarrheal agents to treat IBD - Kaye's ppt | loperamide (Imodium), Atropine (Lomotil), Cholestyramine (Questran)-this one inhibits reuptake of bile salts. |
| Name one antispasmodic agent used to treat functional disturbances of GI motility | dicyclomine (Bentyl) |
| What class of drugs are recommended for both achieving and maintaining a remission? | aminosalicylate - usually end in azine or amine (drug chart in Lewis book pg. 1055) |
| What class of drugs are most useful for pts with CD that do not repond to aminosalicylates, antibiotics or corticosteroids? | immunosuppressants |
| Surgery in CD is reserved for emergency situations or when medical treatment has failed. Name 3 emergency situations | excessive bleeding, obstruction, peritonitis |
| Surgery in UC is indicated for what main reasons? | treatment has failed, complications (toxic megacolon, massive bleeding, perforation, obstruction), or carcinoma develops |
| What is a curative surgery for UC? | Resection of colon and rectum (panproctocolectomy) |
| Surgery in CD is curative. True or False? | False. There is a high recurrance rate following surgery |
| Changes in lifestyle for CD? | physical rest, restricted fiber diet (no fruits or veggies), elimination of dairy products for lactose intolerance |
| Foods IBD pts should avoid | Milk if lactose intolerant, high fat foods, cold foods and high fiber foods (cereal with bran, nuts, raw fruit) |
| What is cirrhosis? | extensive degeneration and destruction of the liver parenchymal cells. The liver attempts to regenerate but cannot |
| What is the ninth leading cause of death in the US? | Cirrhosis |
| Cirrhosis occurs between what ages and most common in whom? | 40-60 and men |
| What are the 4 types of cirrhosis? | alcoholic (Laemmec's), postnecrotic, biliary, and cardiac |
| Postnecrotic cirrhosis is caused by what? | complication of viral, toxic, or idiopathic hepatitis |
| Biliary cirrhosis is associated with what? | chronic biliary obstruction and infection |
| What is the main feature in biliary cirrhosis? | jaundice |
| Cardiac cirrhosis is caused by what? | long-standing, severe right-sided heart failure |
| What is a common nutritional problem in alcoholics? | protein malnutrition |
| Early symptoms of cirrhosis are? | anorexia, dyspepsia, flatulence, N&V, and change in bowel habits (diarrhea or constipation) |
| How may a pt describe abd pain in cirrhosis? | dull, heavy feeling in the RUQ or epigastrium |
| Other early manifestations of cirrhosis | fever, lassitude, slight weight loss, and enlargement of liver and spleen |
| Late symptoms of cirrhosis that develop gradually? | jaundice, peripheral edema, and ascites |
| Jaundice occurs as a result of what in cirhosis? | the decreased ability to conjugate and excrete bilirubin |
| What is a small, dilated blood vessels with a bright red center point and branches usually seen on the nose, cheeks, upper trunk, neck and shoulders in cirrhosis? | Spider angiomas (telangiectasia or spider nevi) |
| What is a red area that blanches with pressure and is located on the palms of the hands in cirhosis? | Palmar erythema |
| Thrombocytopenia, leukopenia, and anemia are probably caused by what in cirhosis? | splenomegaly |
| Anemia may be caused by what in cirrhosis? | splenomegaly, inadequate RBC production and survival, poor diet, poor absorption of folic acid, and bleeding from varices |
| Why is there a coagulation problem in cirrhosis? | liver is unable to produce prothrombin and other clotting factors |
| Coagulation problems in cirrhosis are seen how? | By hemorrhage, epistaxis, purpura, petechiae, easy bruising, gingival bleeding and heavy menstrual bleeding |
| What are some major complications of cirrhosis? | Portal hypertension with resultant esophageal varices, peripheral edema and ascites, and hepatic encephalopathy (coma). |
| Portal HTN is characterized by what? | increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, systemic HTN, and esophageal varices |
| What are esophageal varices? | complex of tortuous veins at the lower end of the esophagus, enlarged and swollen as a result of portal HTN |
| Where are gastric varices located? | in the upper portion of the stomach (cardia, fundus). Occur alone or in combination with esophageal varices. |
| What is the most life-threatening complication of cirrhosis? | Esophgeal varices (they rupture and bleed in response to ulceration and irritation) |
| Factors that can produce ulceration and irritation in cirrhosis are? | alcohol ingestion, swallowing or poorly masticated food, ingestion of coarse food, acid regurgitation from the stomach, increased intraabdominal pressure |
| What can cause increased intraabdominal pressure? | N&V, straining at stool, coughing, sneezing or lifting heavy objects |
| What is ascites? | accumulation of serous fluid in the peritoneal or abd. cavity |
| In cirrhosis pts with ascites are at risk for what? | spontaneous bacterial peritonitis |
| Pt has abd striae with distended abd wall veins, sunken eyballs, muscle weakness and decreased urine output. What does the pt have? | ascites |
| Pt has insomnia, impaired handwriting and tremors. What does the pt have? | Hepatic encephalopathy grade 0 |
| What are the S&S of hepatic encephaolpathy grade 4? | Not rousable, Absent intellectual function, decerebrate position and may respond to painful stimuli |
| Pt is asleep but rousable, have incomprehensible speech and loss of meaningful conversation, and asterixis. What does this pt have? | Hepatic encephaolpathy grade 3 |
| What are the s&s for hepatic encephalopathy grade 1? | Lack of awareness; personality change, short attention span; mild confusion; depression, incoordination; asterixis |
| What are the s&S for hepatic encephalopathy grade 2? | Lethargy; drowsiness; inappropriate behavior, disoriented, asterixis and abnormal reflexes |
| What are some factors precipitation hepatic encephalopathy? | GI hemorrhage, constipation, hypokalemia, hypovolemia, infection, cerebral depressants (opioids), metabolic alkalosis, paracentesis, dehydration, increased metabolism and uremia (renal failure) |
| What is the musty, sweet odor of the patient's breath called and what pt may have this? | fetor hepaticus; hepatic encephalopathy |
| What is heptorenal syndrome? | functional renal failure with advancing azotemia, oliguria, and intractable ascites. Serious complication of cirrhosis. |
| heptorenal syndrome frequently follows what in cirrhosis? | diuretic therapy, GI hemorrhage, or paracentesis |
| What is the management of ascites? | sodium restriction, diuretics and fluid removal |
| What is the main therapeutic goal for esophageal and gastric varices? | avoidance of bleeding and hemorrhage |
| Pt with esophageal varices should avoid ingesting what? | alcohol, aspirin and irritating foods |
| What is the prophylactic treatment for esophageal and gastric varices? | nonselective B-blockers (propranolol(Inderal) reduce the risk of bleeding |
| When variceal bleeding occurs the first step is to what? | stabilize the pt and manage the airway |
| Diet for cirrhosis without complications? | high in calories (3000 kcal/day) with high carbohydrate content and moderate to low fat levels |
| Pts with ascites and edema should be on what kind of diet? | low sodium |
| List some foods high in sodium | canned soups and vegs, chips, nuts, smoked meats and fish, crackers, breads olives, pickles, ketchup and beer |
| What seasonings can the pt use instead of salt? | garlic, parsley, onion, lemon juice, and spices |
| What are the 3 overall goals for a pt with cirrhosis? | have relief of discomfort, have minimal to no complications, return to as normal a lifestyle as possible |
| Name some acute interventions for pt with cirrhosis | rest, oral hygiene before meals to improve taste sensation, I&O, daily weight, meticulous skin care and turning schedule |
| How does the urine and stool appear if a pt has jaundice? | Urine is dark brown and foamy when shaken. Stool is gray or tan |
| When a paracentesis is one what must the pt do prior to procedure? | void immediately before the procedure |
| What is a frequent problem with ascites and what nursing intervention can be done for it? | Dyspnea/sit the pt up in a semi-Fowler's or Fowler's position |
| Hypokalemia may be manifested by what? | cardiac dysrhythmias, hypotension, tachycardia, and generalized muscle weakness |
| Water excess may be manifested by what? | muscle cramping, weakness, lethargy, and confusion |
| What are two signs of bleeding from varices? | hematemesis, melena |
| In hepatic encephalopathy what should be prevented? | constipation - to decrease ammonia production |
| Physical activity should be limited for a pt with what? why? | hepatic encephalopathy/it produces ammonia as a by product of metabolism |
| What are some hepatotoxic drugs? | acetaminophen, amiodarone, carbamazepine, isoniazid, niacin, statins, sulfonamides, thiazide diuretics (box on pg 934 Lewis bk) |
| alcoholic cirrhosis results from what? | malnutrition and chronic alcohol ingestion |
| First line of therapy for ascites? | spironolactone (Aldactone), sodium restriction and daily weight |
| What drug should be used to decrease ammonia levels? | lactulose |
| Who is acute pancreatitis most common in? | middle-age men and women, affect both sexes equally, in African Amer three times more than whites |
| What is the most common cause for women to get pancreatitis? | biliary tract disease |
| what is the most common cause for men to get pancreatitis? | alcoholism |
| What is the most common cause in the US for ppl to get pancreatitis? | gallbladder disease (gallstones) |
| Pt has abdominal pain located in the left upper quadrant which is radiating to the back. It came on as a sudden, deep, piercing pain right after eating lunch. What may the pt have? | pancreatitis |
| Pt is have abd. pain that is not relieved by vomiting. Pain is accompanied by flushing, dyspnea. Pt is assuming various positions to try and relieve pain. Bowel sounds are decreased, crackles are present in the lungs. What may the pt have? | pancreatitis |
| what are the 2 significant local omplications of acute pancreatitis? | pseudocyst and abscess |
| what is a pseudocyst? | a cavity continuous with or surrounding the outside of the pancreas, filled with necrotic products and liquid secretions |
| Pt has abd pain, palpable epigastric mass, nausea, vomiting and anorexia. What may the pt have? | pseudocyst |
| What is a pancreatic abscess? | a large fluid containing cavity within the pancreas |
| Pt has upper abd pain, abd mass, high fever and leukocytosis. What may the pt have? | pancratic abscess |
| What are some main systemic complications of acute pancreatitis? | pulmonary and cardiovascular complications |
Created by:
blj84