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68wm6 p2 intro GI

Introduction to the GI system

Define Achalasia: An abnormal condition characterized by the inability of a muscle, particularly the cardiac sphincter of the stomach, to relax
What is achalasia als known as? cardiospasms
What does achalasia result in? *Decrease motility of lower esophagus *Absence of peristalsis *Dilation of lower portion
What is the cause of achalasia? Cause is unknown
Define Achlorhydria: Abnormal condition characterized by the absence of hydrochloric acid in the gastric secretions (Gastric Analysis).
Define Anastomosis: Surgical joining of two ducts or blood vessels to allow flow from one to the other
Define Cachexia: General ill health and malnutrition marked by weakness and emaciation; usually associated with a serious disease, such as cancer (Subjective symptom)
What is Carcinoembryonic antigen (CEA)? Oncofetal glycoprotein antigen found in colonic adenocarcinoma and other cancers; also found in nonmalignant conditions.
Define Intussusception: Infolding of one segment of the intestine into the lumen of another segment; occurs in children
What is Leukoplakia? A white firmly attached patch in the lips, and the mouth tongue and buccal mucosa which a SMALL percentage can develope into squamous cell carcinoma.
At what ages does leukoplakia generally present, and in who? Ages 50-70, and it is more common in men.
As leukoplakia progresses, what symptoms may the PT c/o? *Difficulty chewing, swallowing or speaking *Edema, numbness, or loss of feeling in any part of the mouth *Pain: Earache, facial pain and toothache
Define Pathognomonic: Sign or symptom specific to a disease condition
What GI disorder are exacerbations and remissions are often seen with? Irritable Bowel Syndrome (IBD)
Define Steatorrhea: Excessive fat in the feces
Define Tenesmus: Ineffective and painful straining with defecation.
Define Volvulus: Twisting of the bowel on itself, causing intestinal obstruction
What is involved in a Upper GI study? A series of X-rays of the lower esophagus, stomach, and duodenum
What is used as a contrast medium in an upper GI study? Barium sulfate
What is an upper GI study used to detect? any abnormal conditions of the upper GI tract, any tumors, or other ulcerative lesions
When should a PTs NPO begin? After midnight
Why must smoking be avoided? It stimulates gastric secretions
How long after a UGI will the stool be light in color? 72 hours
What is given after UGIs to prevent constipation? Milk of magnesia
What is involved in a tube gastric analysis? Stomach contents are aspirated to determine the amount of acid production by the parietal cells in the stomach
What is done to determine the completeness of a vagotomy, confirm hypersecretion or achlorhydria, estimate acid secretory capacity, or assess for intrinsic factor Tube Gastric Analysis
What should NOT be taken for 24 hours before a Tube Gastric Analysis, and why? Anticholinergic drugs, because the gastric secretions can be altered
How are stomache contents aspirated during a tube gastric analysis? Via NG tube
How long must a PT wait to eat after NG tube is removed after a tube gastric analysis? Patient may eat once NG tube is removed unless contraindicated
What is used for direct visualization of the UGI by way of flexible fiberoptic scope. Esophagogastroduodenoscopy
True or False: Areas of narrowing may NOT also be dilated via the Esophagogastroduodenoscopy scope, and it should not be used to remove polyps, coagulate sources of active GI bleeding, and perform sclerotherapy of esophageal varices through endoscopy False. That is a part of its purpose.
What is the intravenous sedative (according to PPT slides) that is used to sedate the PT prior to an Esophagogastroduodenoscopy? midazolalm (Versed).
Why will the PT not be able to eat or drink after a Esophagogastroduodenoscopy? Because the patient’s pharnyx will be anesthetized with lydocaine
How long after a Esophagogastroduodenoscopy can a PT eat? When the gag reflex returns (2-4 hours)
What provides a more thorough study of the esophagus than most UGI examinations? Gastrografin Studies
What is now used in place of barium for patients with GI bleed and where surgery is being considered. Gastrografin
True or False: Gastrografin is not water soluable and disolves slowely, so it is prefered for GI use. False. Gastrografin is water soluble and rapidly absorbed
Complications result if gastrografin or barium escapes from the GI tract into tissues? Barium. Gastrgrafin disolves safely
What is used to produce the symptoms of gastroesophageal reflux (heartburn).? Bernstein test (acid-perfusion test)
What used to differentiate esophageal pain from angina pectoris? Bernstein test
When is the bernstein test positive of esophageal reflux? if the patient suffers pain with the installation of hydrochloric acid into the esophagus
What kind of substance is used in a bernstein test? Mild hydrochloric acid will be sent down the tube, followed by salt water (saline) solution
How long prior to a bernstein study must a PT remain NPO? 8 hours
What medications must be avoided prior to a bernstein test? antacids, analgesics, and sedatives (PT must participate)
What should be suspected if occult blood is found in the stool? A benign or malignant GI tumor
How long prior to a guaiac test should the PT avoid red meat? 24-48 hours.
What diagnostic test allows visualization of the lower GI tract and, if indicated, access to obtain biopsy specimens of tumors, polyps, or ulcerations of the anus, rectum and sigmoid colon? Sigmoidoscopy
Which portion of the GI tract is difficult to visualize radiographically? Lower portion
What are the three basic tests to catch colon cancer in the early stages? *Stool Test *Sigmoidoscopy *Colonoscopy
When must enemas be administered prior to a sigmoidoscopy? Evening prior and/or morning before examination
What substance is more effective for visualizing mucosal detail in lower GI studies? Barium Sulfate
What study may be used therapeutically to reduce nonstrangulated ileocolic intussusception (infolding of one segment of the intestine into the lumen of another segment) in children? Barium enema
If the patients fails to expel all the barium, it could cause what? hardened impaction
What allows early detection of any primary or secondary tumors for patients at high risk for colon cancer? Colonoscopy
On what diet should the PT be on 1-3 days before a colonoscopy, and how long prior should the PT be NPO? Clear liquids dieta 1-3 days before, NPO 8hrs before.
How much and how quicky must golytely be taken? 1 gallon over a 2hr period (8oz q15 min)
Define Ascites: Accumulation of fluid and albumin in the peritoneal cavity
Increaed protein intake while the PT cannot metabolize protein may result in what? increased blood pneumonia
Define Asterixis: A hand flapping tremor in which the patient stretches out an arm and hyperextends the wrist with the fingers separated, relaxed, and extended
Define Esophageal Varices: A complex of longitudinal, tortuous veins at the lower end of the esophagus resulting from portal HTN; complication of cirrhosis
Define Hepatic Encephalopathy: A type of brain damage caused by liver disease and consequent ammonia intoxication
What is Hepatic Encephalopathy It is a complication of cirrhosis caused by an inability to metabolize proteins
Define Hepatitis: *Inflammation of the liver caused by viruses, bacteria, and noninfectious causes of liver inflammation *Six viruses recognized: A, B, C, D, E, G
What is jaundice caused by? greater than normal amounts of bilirubin in the serum
Define Parenchyma: Tissue of an organ as distinguished from supporting or connective tissue
What are Spider Telangiectases? Small, dilated blood vessels with a bright red center point and spiderlike branches
The hepatobiliary system is comprised of what? the organs and duct system that create, transport, store and release bile into the duodenum for digestion.
The liver receives approximately how much blood via the portal vein and hepatic artery? 1500mL/min
The liver releases how much bile per day? 500-1000 mL/day
What produces bile? (Specific cells) Hepatocytes
Where is bile from the liver stored? Gall bladder
Where is the gall bladder located? Located on the right inferior surface of the liver
How much pancreatic juice does the pancreas produce per day to aid in digestion? 1000mL - 1500mL qDay
What are the three major components of chyme, and what digests it? *Proteins *Fats *Carbohydrates
Define chyme: a semi-fluid, creamy material produced by the action of gastric juices of ingested food by the stomach and discharged through the stomach through the pyloris into the duodenum
What are the contents of pancreatic juice? *Protease (Trypsin) *Lipase (Steapsin) *Amylase (Amylopsin)
What neutralizes the hydrochloric acid that enters the small intestine from the stomache Sodium bicarbonate released from the pancreas
What is the normal serum levels for Direct (conjugated) bilruben? 0.1-0.3 mg/dl
What is the normal serum levels for Indirect (unconjugated) bilruben? 0.2-0.8 mg/dl
What is the normal serum levels for Total bilruben? 0.3-1.0 mg/dl
If total biliruben exceeds _____ jaundice occure 2.5 mg/dl
What is the most common sign of a liver disorder? Jaundice
What is converted into inderect bilirubin? Hemoglobin from old broken blood cells
Where is indirect biliruben converted to direct bilirubin? Liver
Testing for this in the blood provides information for diagnosis and evaluation of liver disease, biliary obstruction and hemolytic anemia. Biliruben
When can a PT be removed from NPO for a biliruben test? patient NPO until blood specimen is drawn
How long must pressure be held on a venupuncture site if there a re problems clotting? 5 minutes
What is the normal value for AST (Aspartate Aminotransferase)? 0-35 Units/L
When is AST elevated? myocardial infarction, hepatitis, cirrhosis, hepatic necrosis, hepatic tumor, acute pancreatitis, acute renal disease, and acute hemolytic anemia.
What is the normal value for ALT (Alanine aminotransferase)? 4-36 Units/L
When is ALT elevated? hepatitis, cirrhosis, hepatic necrosis, and hepatic tumors and by hepatotoxic drugs
What is the normal value for LDH (Lactic Dehydrogenase)? 100 to 190 Units/L
When is LDH elevated? myocardial infarction, pulmonary infarction, hepatic disease, pancreatitis, hemolytic anemia and skeletal muscle disease
What is the normal value for Alkaline Phosphatase? 30 to 120 Units/L
When is Alkaline Phosphatase elevated? obstructive disorders of the biliary tract, hepatic tumors, cirrhosis, primary and metastatic tumors, hyperparathyroidism, metastatic tumor in bones, and healing fractures
What is the normal value for Gamma GT (Gamma glutamyltransferase) *Male: 8 to 38 Units/L *Femal over 45: 8 to 38 Units/L *Female under 45: 5-27 U/L
When is Gamma GT elevated? liver cell dysfunction: hepatitis, cirrhosis, hepatic tumors, hepatotoxic drugs, myocardial infarction (4-10 days later), congestive heart and alcohol ingestion.
What is normal prothrombin time? 11.0sec - 12.6sec
Serum protein test: Normal value for total protein 6.4 to 8.3 g/dl
Serum protein test: Normal value for albumin 3.5 to 5 g/dl
Serum protein test: Normal value for globulin 2.3 to 3.4 g/dl
Serum protein test: Normal value for Albumin globulin (A/G ratio) 1.2 to 2.2 g/dl
With liver disease, hepatocytes lose the ability to synthesize what? Albumin
What is most ammonia in the body made by? bacteria acting on protein present in the intestine
What is the normal value for serum ammonia? 10-80 mcg/dl
How the values of ammonia and BUN change in a PT with a liver dysfunction? serum ammonia level increases and BUN level decreases
The oral cholecystography may not be used in Which PTs, and why? PTs with jaundice, it will not be able to visualize the biliary tree.
How are radiopaque tablets for a PT receiving a oral cholecystography taken? six iopnoic tablets; one every 5 minutes after evening meal
What may a PT be given after a cholecystography is started, and why? high fat diet to stimulate emptying of the gallbladder.
What is test performed to identify stones, stricture, or tumor of the hepatic duct, common bile duct, and gallbladder? Intravenous Cholangiography (IVC)
What may a PT be given after a Intravenous Cholangiography (IVC) is started, and why? high fat diet to stimulate emptying of the gallbladder.
In what test Common bile duct is injected with dye to allow surgeon to view this anatomically difficult area before interventions to decrease chance of injuring common bile duct. Operative Cholangiography
What may a PT be given after a Intravenous Operative Cholangiography is started, and why? high fat diet to stimulate emptying of the gallbladder.
What test is used to diagnose for acute cholecystitis? Gallbladder Scanning (Nuclear medicine scan with radioactive isotope)
For the diagnostic tests that use radioactive isotopes, the nurse should wear full protective suit with lead lining, and inform the PT that the test is very dangerous, but necessary. False. Educate patient that the small dose of radiation used is harmless
What test is good for a PT who is allergic to the contrast mediums used in diagnostic tests? Ultrasonography
Ultrasound waves cannot penetrate what contrast medium? Barium
A PT is experiencing severe pain after a liver biopsy. What can this indicate? Large leakage of blood or bile
How should the PT be placed after a liver biopsy? on right side for a minimum of 2 hours and flat for 12 to 14 hours.
What is the most common Endosopic Retrograde Cholangiopancreatography (ERCP) complication? Pancreatitis
Pancreas: Normal Serum Amylase Test 30 to 220 Units/L
Pancreas: Normal Serum Lipase Test 10 to 140 Units/L
Which test is more specific for pancreatitis, especially later in the course of acute pancreatitis; Serum Amylase or Serum Lipase? Serum Lipase
Created by: Shanejqb