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wvc GI notes by sol
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| Question | Answer |
|---|---|
| Upper GI (4)? | 1. Oral cavity 2.Esophagus 3.Stomach 4.Small Intestine |
| Lower GI(3) | 1.Large intestine 2.Rectum 3.Anal Sphincter |
| Constipation? | BM htat are infrequent, hard/dry, and difficult to pass. |
| Diarrhea? | An increased number of loose, liquid stools. |
| 4 layers of the GI Tract? | Mucosa, submucosa, muscularis, serosa. |
| 5 functions of the GI Tract? | 1.Ingestion of food 2.Propulsion of food and water form mouth to the anus. 3.Secretion of mucus/water/enzymes. 4/5.Chemical/Mechanical digestion 6. Absorption of digested foods 7.Elimination of waste products. |
| How long if the GI tract? | 25 ft. |
| 4 layers of the GI tract and what makes them up (inner to outer)? | 1.Mucosa: smooth muscle. 2.Submucosa: connective tissue 3.Muscularis: circular/longitudinal smooth muscle 4.Serosa: connective tissue. |
| Enteric Plexus: What, control (5), located where, controlled by (2)? | Network of intrinsic nerves. Controls: mobility, secretion, secretion, sensation and blood flow. Located solely within the GI tract. Controlled by 1.local and 2.autonomic nervous system stimuli. |
| 2 parts of the enteric plexus? | Myenteric plexus and sub-mucosal plexus. |
| Sympathetic GI stimulation does what (3)? | 1.Slows movement 2. Inhibits secretion 3.Contracts sphincters. |
| Parasympathetic stimulation does what (3)? | 1.Increased motor activity 2.Increased secretory activity 3.Relaxes sphincters of the esophagus, stomach, small intestine, gallbladder, and large intestine. |
| GI blood supply? And liver? | Begins in aorta and feeds into the arteries along the length of the tract. Venous blood, nutrients drain into portal vein of liver and return via hepatic vein to the IVC. |
| 7 parts of the oral cavity? | :Lips, Buccal mucosa, Tongue, Hard Palate, Soft Palate, Teeth, Salivary Glands. |
| What helps initiate salivation? | Taste, food odors. |
| Mouth is important for? | Speech and mastication. |
| The 3 pairs of salivary glands? | 1.Submandibular 2.Sublingual 3.Parotids. |
| Number of permanent teeth? | 32 |
| Phases of eating: in order with name and fxn (4)? | 1.Oral Prepartory: bolus is formed 2.Oral: food is moved into the back of the mouth 3.Pharyngeal: swallowing reflex is triggered 4.Esophageal: food passes into the esophagus to move to the stomach. |
| Amt of saliva produced per day? | 1L |
| Ptyalin? | Enzyme secreted in saliva that begins the breakdown of starches. |
| Saliva (6)? | 1.Water 2.Mucus that contains: 3.Sodium bicarbonate 4.Chloride 5.Potassium 6.Ptyalin. |
| What stimulates saliva production neuronally? | Cholinergic/Parasympathetic. |
| Med that inhibits salivation? | Atropine |
| Where is the swallowing center located? | The medualla of the brainstem. |
| Ph of saliva ,why, and benefits? | 7.4, bicarbonate concentration, neutralized bacterial acids and helps to prevent tooth decay. |
| Where are the parotid glands located? | In the inner cheeks. |
| Primary peristalsis? | Initial swallowing motion of the pharynx. |
| Secondary peristalsis? | Movement of food down the esophagus. |
| Cardiac sphincter: aka, where? | AKA lower esophageal. Between distal portion of eso and the stomach. |
| Upper esophageal sphincter? | |
| What helps the food slide down eso? | Mucus that is secreted there. |
| Length of eso? | 10 inches |
| What two things increase lower esophageal sphinchter tone? | Cholinergic vagal input and gastrin (a digestive hormone). |
| Digestive enzymes of the salivary glands (2)? | 1.Sailary amylase (ptyalin) 2.Lingual lipase |
| DE of the stomach (2)? | 1.Pepsin 2.Lipase |
| DE of the liver? | Bile |
| DE of the pancreas (7)? | 1.Pancreatic amylase 2.Pancreatic lipase 3.Trypsin 4.Chymotrypsin 5.Carboxypeptidase 6.Ribonuclease 7.Deoxyribonuclease |
| DE of the small intestine (8)? | 1.Aminopeptidase 2.Peptidase 3.Enterokinase 4.Amylase 5.Sucrase 6.Maltase 7.Isomaltase 8.Lactase. |
| Absorption and the stomach (2)? | 1.Water 2.Alcohol |
| Absorption and the duodenum (9)? | 1.Iron 2.Ca 3.Fat 4.Sugars 5.Water 6.Protein 7.Vitamins 8.Mag 9.Sodium. |
| Absorption and the jejunem (2)? | 1.Sugars 2.Proteins |
| Absorption and the ileum (3)? | 1.Bile salts 2.B12 3.Chloride |
| Absorption and the colon (2)? | 1.Water 2.Electolytes. |
| 3 facets of mechanical digestion? | 1.Mastication 2.Gastric motility 3.Peristalsis |
| 2 facets of chemical digestion? | 1.Enzymes 2.Bile |
| Mechanical digestion and the oral cavity (2)? | Teeth and tongue. |
| Stomach and mechanical digestion (2)? | Gastric peristalsis and retropulsion. |
| Intestine and mechanical digestion (2)? | Haustal segementation. Peristalsis. |
| Stomach: quadrant, type of organ (2), 3 regions and where? | LUQ. 1.Digestive 2.Glandular. Fundus (upper portion) 2.Corpus (body) 3.Antrum (lower portion). |
| Swallowing causes? | Fundus of stomach to relax to accomadate a bolus of food. |
| Relaxaton facilitated by (2)? | 1.Gastrin 2.Cholecystokin. |
| Gastric motility goes where? | Along the body of stomach towards the fundus. |
| What churns the food into chyme(2)? | 1.Peristalsis 2.Retropulsion |
| Frequency of peristaltic contractions in the stomach? | 3 per minute. |
| Stomach content amount at rest? | About 50 mL’s. |
| Where do muscles in the stomach become progressively thicker? | In the antrum and body of the stomach. |
| Ph of the stomach? | 1-3 (high acidity, low pH). |
| Gastrin? | Hormone that stimulates secretion of gastric acid in the stomach by parietal cells (released by G Cells in the stomach and duodenum). |
| Delta cells? | Somatostatin producing cells (inhibit acid secretion). They can be found in the stomach, intestine and the Islets of Langerhans in the pancreas. |
| 5 things that make up gastric juices? | 1.Mucus 2.Acid 3.Enzymes 4.Hormones 5.Intrinsic |
| Factor. | |
| Which cells (in the gastric mucosa) are responsible for the production of gastric acid? | Parietal Cells (acid secretion is stimulated by acetylcholine, gastrin, and histamine. |
| Who does pepsinogen become pepsin? | Converts to pepsin in an acidic environs (ph of 2.0 is best). |
| What happens to pepsin in the dudodenum? | |
| Ileocecal Sphincter? | Controls the flow of digested material from the ileium into the large intestine preventing reflux into the small intestine. |
| Cephalic phase of gastric secretion? | Stimulated by thought, smell, and taste of food. |
| Gastric phase? | Stimulated by distention of the stomach. |
| Intestinal phase? | Stimulated by histamine and digested proteins. |
| Haustral segmentation? | Localized rhythmic contractions of circular smooth muscles that divide and mix the chyme, bringing it into contact with the absorbent mucosal surface an propelling it toward the large intestine. |
| Peristalsis? | Waves of contraction along short segments of longitudinal smooth muscle that allow time for digestion and absorption. |
| Duodenum: where, what happens, how long? | Begins at pyloric sphincter and ends at the sphincter of oddi. Bile enters throught bile duct, acidic stomach contents are neutralized by secretions from the pancreas, liver, and duodenal mucosa. 10 in long. |
| Jejunum: where, what, how long? | Sphincter of oddi to the ilieum. Chyme is mixed moved and absorbed. About 8 ft long. |
| Ileum: where, what, how long? | Last 8 to 12 ft of small intestine ending at the Ileocecal valve. Chyme is mixed, moved and absorbed. 8 to 12 ft. |
| Longest section of the GI tract? How long? | Small intestine. About 6 meters (19.7 ft). |
| Large intestine: length, where, 4 divisions? | 5-6 ft. Ileocecal valve to the anus. Ascending colon, transverse colon, descending colon, sigmoid colon. |
| Cecum? | Beginning of the LI. Appendix is located here. |
| LI and absorption? | Some water and electrolytes are absorbed here (to form feces), but no real nutritive absorption occurs here. |
| Second largest organ in the body? First? | 2nd: liver. 1st: skin. |
| Liver: where, which lobe is larger, secretes? | RUQ. Right lobe is larger. Secretes bile via the common bile duct into the duodenum (helps break down fat). |
| What accounts for the yellow tinge of jaundice? | Elevated levels of bilirubin due to inability to excrete or metabolize it (acute hepatitis, obstruction of bile duct, hemolytic anemia). |
| Cholelithiasis? | Gallstone (composed of lecithin and bile acids). |
| Gallbladder: where, does what, how much? | Anterior surface of the liver. Stores and concentrates bile form the liver; releases bile for fat metabolism. Stores about 50 mL of bile. |
| Cholestasis? | Blockage of supply of bile into the digestive tract (which causes jaundice). |
| Exocrine fxns of the pancreas? | Secretion of enzymes necessary for the digeston of carbs fats and proteins. Secretion of bicarbonate and pancreatic fluids. |
| Endocrine fxns of the pancreas? | |
| Pancreas: where? | Retroperitoneal (extends for the duodenum c-loop to the spleen. |
| Proteases: what, where, two types? | Pancreatic enzymes. Produced and secreted by the pancreas to aid in the bulk of protein digestion. 1.Trypsin 2.Chymotrypsin. |
| 3 major pancreatic enzymes? | Proteases, Pancreatic Lipase, and Amylase. |
| Most frequent cause of GI bleeding in adults? | GI bleeds. |
| Barium (upper GI and enema): NPO, bowel cleansing, to prevent post procedural constipation (2)? | NPO for 8 hours. Bowel cleansing with Fleet’s phosphosoda and Golytely. 1.Hydration 2.Laxative. |
| Upper GI with small bowel follow through? | Watches the barium through the remainder of the small bowel to the ileocecal valve. |
| Barium enema: comfortable, how long? | Very uncomfortable. Takes 45 min to 1 hour. |
| Percutaneous Transhepatic Cholangiography: what, post-procedure? | Studies the biliary duct system using iodine dye instilled into the hepatic ducts of the liver by percutaneous catheter. Bed rest for 6 hours following the procedure. |
| Gallbladder series: what and how, evening meal the night before, 2 hrs after meal, NPO…, after first films taken? | Visualization of the gallbladder by ingestion of oral iodine radiographic contrast medium and subsequent imaging. Fat free diet for evening meal. Take tablets 2 hrs after meal. NPO after midnight. Eat high fat meal in between first and second films. |
| Intravenous cholangiography: what, how, NPO, test takes how long, x-rays taken when? | Visualizes the gallbladder and biliary ducts. Via iodine IV contrast. Takes 2-4 hours. X-rays taken at 20 minute intervals. |
| CT of the GI tract: contrast medium, NPO, in the scanner, takes how long? | IV iodine contrast medium. NPO 4-8 hrs prior to imaging. Lie still in the scanner. Takes 30min – 2 hrs. |
| Endoscopy: NPO, evaluates (6), obtains (2)? | NPO after midnight the night before. Evaluates: 1.bleeding 2.ulceration 3.masses 4.tumors 5.Inflammation 6.cancerous lesions. Obtains: 1.biopsy specimens 2.cytologic specimens. |
| EGD: postion, sedation, sore..? | Sims positon: on side (remove dentures). Conscious sedation: versed(benzodiazepine) and fentanyl(analgesic). Sore throat for a few days after. |
| ERCP: what, NPO, papillotomy? | Endoscopic retrograde cholangiopancreatography (ERCP): visualizes liver, gallbladder, and pancrease with the common bile duct. NPO after midnight the night before (6-8hrs). Papillotomy: small incision around the ampulla of vatar to remove gallstones. |
| Check what after the test (2)? | 1.VS every 15 min until stable. 2.Gag reflex to prevent aspiration (HOB up, have pt take sip of water, start low, go slow). |
| Colonoscopy: what, 24 hr diet, NPO, prep, vagal induced bradycardia, no***? | Endoscopic exam of the entire large colon. Liquid diet 24 hrs before. NPO after midnight. Bowel prep. Atropine administered for vagal induced bradycardia. No jello, grape juice, cran juice (can dye the bowel). |
| Proctosigmoidoscopy: visualizes, screens for (4), position, sedation? | Visualizes the rectum and sigmoid colon. Screens for: colon cancer, GI bleeding, hemorrhoids, IBD. Left sidein the knee-chest position. No conscious sedation used. |
| Gastric analysis: measures, how, NPO, avoid (3), samples collected, Rx to stimulate gastric secretions? | Measures HCl and pepsin. Via NG tube. NPO for 12 hrs prior. Avoid: alcohol, tobacco, meds that affect secretions for 24hrs prior. Samples collected every 15 min for 1 hour. Pentagastrin/Histalog can be given subq to stimulate gastric secretions. |
| Ultrasound: used to visualize what, NPO, bladder visualization? | Visualizes soft tissues and organs. NPO 12 hrs prior. Drink 1-2L of fluid to fill bladder and enhance visualization. |
| Liver-Spleen scan: contrast medium, breastfeeding/pregnancy, elimination? | IV radioactive colloid. Contraindicated due to radioactivity. Eliminated via urine in 24 hrs (handwashing and toileting must be done carefully). |
| 3 indications for an NG tube? | Decompress stomach. Introduce fluids. Assist in clinical dx via analysis of gastric contents. |
| Stomatitis? | Painful inflammation and ulceration of the oral mucosa. |
| Aphtous stomatitis? | The most common type, characterized by canker sores in the buccal mucosa. |
| 6 types of stomatitis? | 1.Primary 2.Herpes simplex 3.Candidiasis 4.Vincents 5.Traumatic ulcers 6.Lichen planus. |
| Candidiasis/Moniliasis: what, why, rx? | Fungal infection of the mouth (thrush). Immunosuppression of normal flora: HIV, IV antibiotics. Mycostatin/Nystatin 4x daily for 7-10 days. |
| 2 types of premalignant lesions of the mouth? | Leukoplakia (white patch in mouth or throat – 25% are precancerous or cancerous). Erythroplakia (slightly raised red area the bleeds easily-70% are cancerous or precancerous). |
| Sqamous cell carcinoma: what, common, risk factor? | Cancerous tumor of the mouth. Most common (90%). Risk factor is tobacco use. |
| Basal cell carcinoma: what, risk factor? | Cancerous tumor found on the lips mostly, Risk factor is sun exposure. |
| Kaposi’s sarcoma? | Cancerous lesion seen in the hard palate of AIDS pts. |
| Signs and symptoms of oral cancer (least common)? | Lump in cheek. Sore throat. Feeling that something is caught in throat. Difficultly chewing/swallowing. Numbness of the tongue/mouth. Loose teeth. Changes in voice. Lump in neck. Difficult moving tongue/jaw. Bad breath. |
| Two most common symptoms of oral cancer? | 1.Sore in mouth that wont heal (most common) 2.Perpetual pain in mouth (also very common). |
| 3 priorities for nursing care of the pt with oral cancer? | 1.Airway mgmt 2.Cough enhancement 3.Aspiration precautions. |
| Acute sialadenitis: what, interventions (5)? | Inflammation of a salivary gland. 1.Hydration 2.Application of warm compress 3.massage of the gland 4.Use of saliva substitute 5.Use of sialogogues (incease saliva flow: citrus candy, lemon slices). |
| Most common upper GI disorder in the US? | GERD |
| Factors that contribute to LES tone (13)? | 1.Fatty foods 2.Caffeinated beverages 3.chocolate 4.citrus 5.tomatoes and products 6.Smoking/tobacco 7.CCB 8.Nitrates 9.-mint 10.Alcohol 11.anticholinergics 12.high levels of est and prog 13.NG tube placement. |
| Symptoms of GERD (8)? | 1.Dyspepsia 2.Regurgitation 3.Coughing/hoarseness/wheezing at night 4.Water brash: excessive saliva 5.Odynophagia: painful swallowing 6.Chest pain 7.Eructation: belching 8.Flatulence. |
| 4 methods of testing for GERD? | 1.Barium swallow 2.Endoscopy 3.Laryngoscopy 4.24 hr ph monitoring (most accurate). |
| 5 interventions for GERD? | 1.Client education (primary) 2.Diet therapy 3.Lifestyle changes 4.Drug Therapy 5.Surgical mgmt. |
| Client education and GERD: meals per day, NPO, upright, elevate? | 4-6 small meals per day, no food 2-3 hrs before bed, remain upright for 1-2 hrs after meals, elevate head of bed 6-12 inches (left lateral position; never sleep flat). |
| Step 1 drug therapy for GERD (3)? | Antacids: Elevate ph level of gastric contents: Maalox, Mylanta, gaviscon. |
| Step 2 rx for GERD (4)? | Histamine receptor antagonists: decrease acid. 1.famotidine/pepcid 2.Rantidine/Zantac 3.cimetidine/Tagamet 4.nizatidine/Axid |
| Step 3 rx for GERD (4)? | Proton pump inhibitors: inhibit gastric acid secretion by the parietal cells (mainstay of tx). 1.Omeprazole/prilosec 2.lansoprazole/Prevacid 3.Rabeprazole/Aciphex 4.Pantoprazole/Protonix. |
| Mucosal cytoprotectant: what, action? | sucralfate/Carafate. Binds to surface of ulcers to protect them, inhibits pepsin, binds bile salts (protecting the stomach lining), increase prostaglandin production (protects stomach lining). |
| Prokinetic drugs and GERD: what, action? | Metoclopramide/Reglan. Increases gastric emptying and improves LED pressure. |
| Cholinergics and GERD? | Bethanechol. Speeds up GI tract. |
| Hiatal hernia? | Protrusion of the stomach through the esophageal hiatus of the diaphragm into the thorax. |
| Sliding hiatal hernia? | Most common (90%). Cause hearburn, regurgitation, chest pain, belching, and dysphgia (GERD symptoms). |
| Rolling hiatal hernia? | Not very common (10%). Reflux is usually not present. |
| Fundoplication? | Surgical mgmt for GERD or hiatal hernia which tightens and reinforces the LED area. |
| Barrett’s esophagus? | Sequalea of GERD: abnormal growth of intestinal type cells above the esophageal border into the eso. Tissue changes are a forerunner for adenocarcinoma of the lower eso. |
| Cancer of the eso can be…? | Malignant or benign. |
| Esophageal CA rank: GI CA’s, general CA’s? | 3rd most common GI Cancer. 8th most common cancer. |
| Squamous cell carcinoma’s: where, %? | Upper 2/3 of eso. 50% of all eso tumors. |
| Adenocarcinomas: where, %? | Lower 2/3 (barrett’s, GERD). 50% of eso tumors. |
| Risk factors for eso CA (3)? | 1.Tobacco use 2.Alcohol use 3.GERD |
| Five year survival rate for eso CA? | 5% |
| S s/x of eso CA (? | 1.Persistent dysphagia 2.weight loss (20+) 3.odynophagia 4.hoarseness 5.chronic cough 6.N/V 7.Hiccups 8.pneumonia (aspiration) 9.changes in bowel habits 10.Melena (black, tarry stool). |
| 3 nursing diagnoses for eso CA? | 1.Risk for aspiration 2.Impaired swallowing 3.Acute/Chronic pain. |
| NG tube post eso surgery: check placement when, drainage in 1st day, irrigate or reposition when, oral/hygiene? | Every 4-8 hrs. Drainage should go from bloody to yellowish green by first day. Only with MD orders, Meticulous oral hygiene every 2-4 hrs. |
| How do you diagnose eso cancers? | Barium swallow. |
| Esophageal diverticulosis: what, symptoms (4)? | Herniation of the esophageal mucosa and submucosa into the surrounding tissue. Symptoms: dysphagia, regurgitation, nocturnal cough, halitosis. |
| Zenkers diverticulum? | Most common form (often in older adults) caused by high pressure in the hypopharynx. |
| Esophageal trauma causes (8)? | 1.Straining 2.Seizures 3.Trauma 4.Foreign objects 5.Intstuments/tubes 6.Chemical injury 7.Complication of esophageal surgery 8.Ulcers. |
| Bifurcation? | Term used to describe two of something (bifurcated diverticulosis: two pouched). |
| Gastritis: what, why, long term risks? | Inflammation of gastric mucosa. Prostaglandin protective barrier is breached and HCL acid injures the lining. Long term risks of inflammation are hemorrhage and stomach cancer. |
| Erosive gastritis? | Acute gastritis; stress ulcers. |
| Nonerosive gastritis? | Chronic gastritis. |
| Sequalae of chronic gastritis? | Pernicious anemia. |
| Gastritis and intrinsic factor? | Intrinsic factor is necessary for the absorption of B12. When the source of intrinsic factor is lost due to progressive gastric atrophy, pernicious anemia results. |
| ICU and stress ulcers: two facts? | Increase stay up to 11 days. Increase mortality risk up to 50%. |
| PUD: includes (3), bacterium, sphincter? | 1.Gastric ulcers 2.Duodenal ulcers 3.Stress ulcers. Helicobacter pylori. Incompetent pyloric sphincter. |
| 4 complications of ulcers? | 1.Hemorrhage 2.Perforation 3.Pyloric obstruction 4.Intractable disease. |
| Hemorrhage occurs in what % of PUD pts? | 15-25%. |
| PUD symptoms? | Dyspepsia. Pain in upper epigastrium. Vomiting. Hematemesis. Black, tarry stools. |
| Causes of PUD (4)? | 1.H. pylori bacteria 2.Regular use of ASA/NSAIDS 3.Older age. |
| Mucosal Protectant: what, dose? | sucralfate/Carafate. 1g 4x daily. |
| PUD diagnosis (5)? | 1.CBC 2.Stool occult blood 3.Upper GI radiographic study 4.Endoscopy (EGD) 5.Text for H. pylori. |
| 2 meds to prevent stress ulcers in Surgery/ICU? | 1.IV famotidine/Pepcid 2.pantoprazole/Protonix. |
| 4 tests used to detect H. Pylori? | 1.Blood antibody test 2.Urea breath test 3.Stool antigen test 4.Stomach biopsy. |
| 3 goals of drug therapy for PUD? | 1.Decrease acid 2.Provide pain relief 3.Eradicate H. pylori. |
| 6 different drug therapies for PUD? | 1.Antacids 2.H2 receptor antagonists 3.Proton pump inhibitors (-azole) 4.Mucosal barrier fortifier 5.Prostaglandin analogues (misoprostol/Cytotec) 6.Antimicrobials (triple therapy). |
| 4 ways to deal with hemorrhage mgmt in the PUD pt? | 1.NG Tube 2.Acid Suppression 3.Saline lavage 4.Endoscopic therapy to stop hemorrhage. |
| 3 methods in dealing w/ hypovolemia associated with PUD? | 1.IV isotonic crystalloid 2.Blood replacement 3.Frequent monitoring (orthostatic VS). |
| Rx for active Upper GI bleeding? | IV octreotide/Sandostatin to suppress acid secretion and production. |
| Vagotomy? | Surgical intervention for PUD: the branch of the vagus nerve that supplies the stomach is cut to decrease stimulus to gastric cells and acid secretion. |
| Bilroth I? | Surgical mgmt of PUD: gastroduodenostomy. |
| Bilroth II? | Gastrojejunostomy: both bilroth I and II permit neutralization of gastric acid by regurgitation of alkaline (small bowel) contents. |
| Pyloroplasty? | Surg for PUD: enlargement of the pyloric sphincter. |
| Complications of removal of the stomach? | Dumping syndrome, reflux gastropathy, bile reflux gastrophathy. |
| Dumping Syndrome? | Vasomotor symptoms that may result from rapid emptying of gastric contents into the small intestines. |
| Symptoms of DS? | Vertigo, tachycardia, syncope, sweating, pallor, need to lie down. |
| Mgmt of dumping syndrome? | 1.Don’t date 2.Smaller meals 3.No fluid with meals (1 hr before or after) 4.High-protein, high-fat, low carb diet 5.Sandostatin/octreotide sub q before meals. 6.No milk products, no sugars. |
| Most common form of stomach CA? | Adenocarcinoma (85-95%). |
| Stomach CA: onset, bacterium, foods that are strongly linked? | Onset is insidious and often advanced when detected. H pylori strongly linked. Foods: pickled, salted meats, nitrates, bracken fern. |
| Early s and s/x of CA (3)? | 1.Dyspepsia 2.Loss of appetite (meat especially) 3.Epigastric, back, or retrosternal pain. |
| Late s and s/x of CA (7)? | 1.Abd pain 2.N/V 3.Diarrhea/Constipation 4.Bloating 5.Weight loss 6.Weakness/fatigue 7.Melena |
| Causes of constipation (9)? | 1.Freq use of laxatives 2.Advanced age 3.Inadeq fiber 4.Inadeq fluid 5.Immobilization 6.Sedentery lifestyle 7.Medications 8.IBS 9.Valsalva maneuver |
| Causes of diarrhea (6)? | 1.Viral gastroenteritis 2.Overuse of laxatives 3.Use of certain antibiotics/meds 4.IBD 5.Irritable bowel syndrome 6.Food borne pathogens. |
| Nursing assessment for const/diarrhea should include (6)? | 1.Abd 2.Head to toe 3.Hx 4.Nutrition 5.Hydration 6.Hematoccult |
| 4 complications of constipation? | 1.Fecal impaction 2.Hemorrhoids 3.Rectal fissure 4.Hypotension/bradycardia with valsalva maneuver. |
| 2 complications of diarrhea? | 1.Dehydration/electrolyte imbalances 2.Skin breakdown. |
| What to do if a clint is NPO w/NG tube? | IV fluid therapy and TPN. |
| Irritable bowel syndrome: what, 2 aka’s? | Non-inflammatory chronic GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abd pain or bloating. 1.Spastic colon 2.Nervous colon. |
| IBS: Tx…, common, usually starts when, dx, bowel mucosa, gender? | Based on symptomolgy. Most common digestive disorder. Usually starts in young adulthood. Diagnosed by ruling out other disorders. No chg in bowel mucosa. Women are 2x as likely to get IBS. |
| Reducible hernia? | Contents of the hernia sac can be placed back into the abd cavity with pressure. |
| Irreducible hernia? | contents cannot be reduced or placed back into the abd sac. |
| Strangulated hernia? | Blood supply to herniated segment is cut off from pressure of the hernia ring. Signs: abd distention, nausea, vomiting, pain, fever, tachycardia. |
| Tx of irreducible hernia? | Immediate surgical evaluation. |
| Complications of hernia (2)? | 1.Ischemia 2.Mechanical obstruction. |
| Colorectal CA: common, major risk factor, most are this type, metastasis %? | Third most common CA. Age is major risk factor (50%). 95% are adenocarcinomas. Metastasis with 15-30%. |
| Risk factors for colorectal CA (4)? | 1.Age 2.Genetic predisposition 3.High fat, refined food diet. 4.IBD. |
| Screening recommendations for colorectal CA (3)? | 1.FOBT every year afte age 50. 2.Flex sigmoidoscopy/barium enema every 5 years. 3.Colonoscopy every 10 years. |
| Interventions for colorectal CA (4)? | 1.Early detection 2.Radiation 3.Chemotherapy 4.Surgical excision (resection/colostomy). |
| Mechanical bowel obstruction (5)? | 1.Adhesions 2.Hernias 3.Blockages 4.Intussception 5.Volvulus |
| Nonmechanical bowel obstruction? | Adynamic of paralytic ileus. |
| Electrolyte imbalance caused by obstruction high in the small intestine? | Metabolic alkalosis. |
| Electrolyte imbalance caused by obstruction at the end of the s mint/or lrg int? | Metabolic acidosis. |
| 3 complications of a bowel obstruction? | 1.Hypovolemia 2.Renal insufficiency 3.Peritonitis. |
| Polyps? | small growths attached to the mucosa; most are benign but adenomas can pose a cancer risk. |
| Hemorrhoids? | Swollen or distended veins in the anorectal area; can be internal or external, caused by increased abd pressure (obese, fighter pilots). |
| Rectal bleeding intervention? | Must always be checked by an MD. |
| 4 s/x of hemorrhoids? | 1.Persistent itching 2.Anal bleeding 3.Pain 4.blood clots. |
| Interventions for hemorrhoids (4)? | 1.Sitz bath/cold packs 2.High fiber diets 3.Lots of fluid 4.Stool softeners. |
| 4 surgical treatments for hemorrhoids? | 1.Banding 2.Surgical ligation 3.Injection of sclerosing agents 4.Cryosurgery. |
| Bile salt deficiencies and malabsorption syndrome? | Cannot absorb fat soluble vitamins: ADEK. |
| Enzyme deficiencies and malabsorption? | Cannot breakdown carbs or lactose. |
| Symptoms of appendicitis (3)? | Pain in RLQ. Rebound tenderness at McBurney’s pt. Temp is normal or mildy febrile. |
| Appendicitis and peritonitis can progress to gangrene or perforation in…? | 24-36 hrs. |
| Peritonitis: fever, WBC’s, -cardia, decreased…, mouth? | High fever. Elevated WBC’s. Tachycardia. Decresed urine output (dehydration). Hiccups (mouth). |
| Gastroenteritis: what, cause (2), morbidity? | Acute N/V in response to inf of the mucous mem of the intestinal tract. Cause can be viral or bacterial. Most common cause of morbidity and mortality in asia, Africa, and latin America. |
| Key to gastroenteritis? 4 nursing interventions? | Assessment is key. 1.Fluid replacement 2.Diet therapy 3.Drug therapy 4.Health teaching. |
| Ulcerative colitis: definition, regional progression, major complication? | Chronic inflammation of mucosal lining in colon or rectum. Starts at rectum and moves towards cecum. Poor absorption of nutrients and thickening of the colon wall. |
| Symptoms of ulcerative colitis? | Abdominal pain, bloody diarrhea, tenesmus (uncontrolled straining), low grade fever. |
| Lab values and ulcerative colitis: decreased (6), increased (2)? | Decreased: 1.Hgb 2.Hct 3.Na 4.K 5.Cl 6.Albumin. Increased: 1.WBC 2.ESR. |
| Diagnostics for UC (4)? | 1.Lab tests 2.Colonoscopy 3.CT scan 4.Barium enema. |
| 5 interventions for UC? | 1.Diarrhea mgmt 2.Drug therapy 3.Low-fiber diet 4.Rest 5.Surgical mgmt (-ostomy). |
| Crohn’s disease: what, most common where, two common complications, bloody stool? | Inflammatory disease of the GI tract (usually the small intestine). Terminal portion of the ileum is most common. 1.Malabsorption deficiencies 2.Fistula formation. Stool is not usually bloody. |
| Chron’s symptoms (7)? | 1.Abd pain 2.Diarrhea/freq stools 3.Steatorrhea 4.Low grade fever 5.Decreased bowel tones 6.Guarding 7.Weight loss. |
| Diverticula? | Pouchlike herniations of the mucosa through the muscular wall of any portion of the gut but most commonly the colon. |
| Diverticulosis? | The prescence of many diverticula in the wall of the intestine. |
| Diverticultitis? | Inflammation of one or more diverticula. |
| Symptoms of diverticulitis? | Abd pain (lower quadrant). Low grade fever. N/V. Tenderness to palpation. Perforation/Hemorrhage (leads to sever symptoms: dehydration, fever, hypovolemia, shock). |
| Interventions for diverticulitis? | Low fiber diet. Clear liquids. Antibiotics. Rest (refrain from coughing, straining, bending), Surgical intervention, Colostomy. |
| Anal abcess? | Localized area of induration and pus caused by inflammation fo the soft tissue near the rectum or anus most often caused by obstruction of the ducts of the glands in the anorectal area. |
| Anal fissures? | Superficial erosions of the anal canal. |
| Anal fistulas? | Abnormal tracts from the anal canal to the perianal skin. |
| 4 causes of anal fistulas? | 1.Anorectal abcess 2.TB 3.Crohn’s disease 4.Cancer. |
| 4 major types of cirrhosis? | 1.Portal HTN 2.Ascites 3.Varices 4.Encephalopathy |
| Acute liver disease? | less than 6 months (chronic: greater than six months). |
| Cirrhosis of the liver? | Progressive inflammatory liver condition that is insidious, prolonged, and destructive. |
| 8 common causes of cirrhosis of the liver? | 1.Alcoholic liv dz 2.Viral hepatitis 3.Autoimmune hepatitis 4.Steatohepatitis (fatty liver) 8.Cardiovscular dz.5.Drugs/chemical toxins 6.Gallbladder disease 7.Metabolic/genetic causes |
| Laennec’s Cirrhosis: what, liver becomes enlarged with (3), over time…? | Alcoholic liver disease. Liver becomes enlarged by: 1.Fatty deposits 2.Leukocytes 3.Lymphocytes. Over time the inflammatory phase decreases and the destructive phase increases. |
| Symptoms of Laennec’s cirrhosis (4)? | 1.Fatigue 2.Weight loss 3.Anorexia 4.Nausea |
| Viral hepatitis scarring of the liver takes…? | Decases |
| Biliary cirrhosis? | Develops as a result of chronic biliary obstruction, bile stasis, inflammation, diffuse hepatic fibrosis. |
| Cardiac cirrhosis? | Occurs with right-sided heart failure, cor pulmonale, constrictive pericarditis, or valvular insufficiency. |
| Percutaneous liver biopsy? | Local anesthesia is used to numb the skin where a small incision is made. Small needle is used to take up to multiple samples. Liver found through auscultation and percussion (cooperation is critical). |
| Percutaneous CT guided biopsy? | Same as above except imaging is used to guide the biopsy (helpful when small spots are diseased). |
| Laproscopic liver biopsy? | Uses a laproscope to visualize the liver. |
| Major complication of liver disease/cirrhosis? | Prolonged bleeding!!! |
| Portal hypotension? | Abnormally high blood pressure in the portal venous system (caused by cirrhosis, obstruction of portal vein, pancreatitis, thrombosis, abdominal trauma. |
| Ascites? | 3rd space fluid in the abd cavity caused by increased pressure in the mesenteric tributaries of the portal vein (hydrostatic pressure forces water out of vessels and into the peritoneal cavity). |
| Intake restrictions for ascites? | 1000 mL a day. |
| Most common cause of upper GI bleeding? | Esophageal varices. |
| Esophageal varices? | Prolonged elevation of pressure in the collateral veins causes them to become distended and torturous; rupture causes bleeding (can also occur in the stomach and rectum). |
| Splenomegaly? | Increase size of spleen caused by increased pressure in the splenic vein form prolonged portal hypotension. |
| Coagulation defects from cirrhosis? | Decrease in ability to absorb fat soluble vitamins (K is necessary for clotting factors). |
| Jaundice? | Yellowing of skin and sclera caused by hyperbilrubinemia (accumulates and enters the bloodstream). |
| Icterus? | Jaundice of the sclera. |
| Portal-systemic encephalopathy: aka (2), result of (2), progresses from…., and ammonia? | 1.Hepatic encephalopathy 2.Hepatic coma. Result of: 1.End stage hepatic failure 2.Cirrhosis. Progresses from subtle personality changes to coma. High levels of serum ammonia often seen. |
| Hepatorenal syndrome: what, can follow a…, precipitated by? | Hepatic failure can lead to renal failure. Can follow a GI bleed. May be precipitated by medications. |
| Hepatorenal syndrome: lab values in blood vs urine? | Decreased sodium levels in the urine. Elevated BUN, Creatinine, Ammonia, bilirubin, and sodium levels in the blood. |
| Interventions for cirrhosis of the liver? | 1.Low sodium diet 2.Fluid restriction 3.Rx: diuretics, antacids, lactulose, neomycin 4.Paracentesis 5.Shunt 6.Esophageal balloon tamponade. |
| Hep A: spread via, symptoms, incubation period? | Oral-fecal route. Typical symptoms of viral infection, jaundice. 15-50 days. |
| Hep B: aka, transmission, incubation period? | Aka: serum hepatitis. Mode of transmission is through skin or mucous membranes contaminated with blood or serous fluid. 45-180 days. |
| Risk factors for Hep C? | People who share needles. Health workers exposed to infected blood. |
| Symptomso of Hep C? | Pain in URQ, N/V, loss of appetite, jaundice, fatigue, itching. |
| Hep D: spread via, co-infection, incubation? | Spread via parenteral route. Co infects with Hep B (can act as super infection). Incubation 14-56 dys. |
| Hep E: transmission, clinical course similar to, chronic form, incubation? | Transmitted after flooding via waterborne epidemics. Clinical course similar to Hep A. No known chronic form. Incubation is 15-64 days. |
| Toxic/drug induced hepatitis: what, causes, specific toxins (4)? | Systemic poisons are converted by the liver into toxic metabolites. Causes necrosis and fatty infiltration of the liver. 1.Lrg doses of Tylenol 2.Carbon Tetrachloride 3.Trichloroethylene 4.Yellow Phosphorus. |
| 2 drugs known to cause idiosyncratic toxic hepatitis? | 1.Isoniazid 2.Dilantin (causes morphologic chgs in the liver similar to viral hepatitis). |
| Leading cause of death in the world? | Primary hepatocellular carcinoma. |
| Liver tumors: group most at risk, metastasis? | African-American Males. Metastasis is common due to vascularity of the liver. |
| Immunosuppresive drugs used in liver transplantation (3)? | 1.Cyclosporine 2.Asathioprine 3.Prednisone. |
| Cholelithiasis: what, common, cause? | Prescence of one or more gallstones caused by hardened bile. Most common disorder of the biliary duct. Cause is often bilestasis (cystic duct is blocked/impacted). |
| Cholecystitis: what, symptoms? | Inflammation of the gallbladder (can be chronic or acute). Symptoms: vague episodic abd pain triggered by high-fat or high volume meal, flatulence, eructatation, and jaundice. |
| Interventions for cholecystitis? | Dietary restrictions of fat, restriction in amt of food. Rx: analgesics, anti-cholinergics. |
| Pancreatitis? | Inflammation from increased pancreatic enzymes destroys ductal tissue (causes autodigestion and fibrosis of the pancreas). |
| Altered lab values for pancreatitis? | Lipase and amylase. |
| Complications of enteral feedings? | Tube blockage, fluid/electrolyte imbalance, dehydration. |
| TPN? | must use a central line due to higher concentration of dextrose and proteins. |
| PartionPN? | Can use peripheral IV line. |
| PN and $? | More expensive and less effective than using GI tract. |
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