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Test #3 GI PART 1
NUR 201
| Question | Answer |
|---|---|
| Weakness in the abd. muscle wall causing protrusion of an organ | Herniation |
| Herniation which passes through a weak point in the adb. wall | Direct Inguinal |
| Most common type of herniation | Indirect Inguinal |
| Obese or pregnanct people get this type of herniation the most | Femoral |
| Congenital or acquired herniation | umbilical |
| Herniation at the site of a previous surgical incision | Incisional / ventral |
| T/F Never forcibly reduce a hernia | True |
| Using gentle pressure, can easily reduce this class of hernia | Reducible |
| This herniation requires immediate surgical evaluation!! | Irreducible or incarcerated |
| MEDICAL EMERCENCY situation. Herniation that cuts blood supply off | Strangulated |
| This herniation class, causes ischemia and obstruction of the bowel loop | Strangulated |
| What are the s/s of strangulated hernias? (4) | Adb. Distention, N/V, fever, and tachycardia |
| Which class of herniation has absent bowel sounds? | Strangulated |
| Name the non-surgical treatment for a herniation. | Truss |
| T/F A truss can be used even when the hernia is incarcerated. | False. Only after the physician has reduced the hernia, can it be used. Apply upon awakening and assess skin qd. |
| A pad made with firm material held in place over the hernia with a belt to keep abd. contents from protruding into the sac. | Truss |
| Surgery of choice for a hernia patient | MIIHR Laparascopy but can be done open (conventional) if needed. |
| Mesh patch reinforces abd. muscle wall. | Hernioplasty |
| Post surgery major things to teach.. | Turn, Ambulation as tolerated, and deep breathing. AVOID COUGHING!!!! |
| minimal fluid intake post-op for hernia pt? | 1500-2500 mL qd |
| Medications given to these patients | Pain, Prophylactics, and ABOX |
| 3rd most common cause of cancer death in the U.S. | Colorectal Cancer |
| Genetic disposition and at risk age for Colorectal Cancer | Familial adenomatous polyposis; 50 years (rare < 40 yrs) |
| Risk of Colorectal Cancer due to what type of diet? | high calorie, high fat diet w/ animal fat from red meats, low fiber, friend meats, high carb) |
| most common type of colorectal cancer | Adenocarcinoma |
| Right-sided lesion manifestations | Usually asymptomatic (no complaints), vague abd. discomfort (shrug it off), iron deficiency anemia, occult bleeding |
| Left-sided lesion manifestations | rectal bleeding, alternating constipation and diarrhea, narrow ribbon-like stools. |
| Most common signs of colorectal cancer (3) | rectal bleeding, anemia, and change in stool |
| At age 50 or greater, sceening/tests that should be done to test for colorectal cancer? | colorectal screening, FOBT OR colonoscopy q 10 years. |
| Personal/family hx: begin earlier and more frequent!! Test to include: | double contrast barium enema q 5 years |
| Visible peristalsis waves and high-pitched bowel sounds are signs of what type of obstruction | possible partial obstruction |
| Total absence of bowel sounds is a sign of what type of obstruction | Complete Obstruction |
| Radiation Therapy (local or regional control) is used to do what during colorectal cancer.. | to control pain, decrease hemorrhage, help with bowel elimination or mets. to the lungs |
| The only curative treatment for colorectal cancer is: | Surgical treatment |
| Combination drug used in conj. w/ surgery: FOLFOX: 5-fu with: (4) | leucovovin (LV), folinic acid, xeloda, eloxatin |
| FOLFOX drugs cannot discriminate btw healthy & cancer cells so the following s/s can happen: | diarrhea, mucositis, leukopenia, mouth ulcers, and peripheral neuropathy |
| irinotecan causes what? (2) | myelosuppression and explosive diarrhea -- give atropine |
| Preop for colorectal surgery: po/iv ABOX prophylactically and bowel prep using ___ | Go-Lytely "whole gut lavage" |
| T/F During initial post-op, slight edema and sm amt of bleeding is normal (colorectal surgery) | True |
| When should a colostomy start functioning? (days) | 2-4 days |
| When should a colostomy be emptied? | when 1/3 to 1/2 full |
| Ascending Colon: | pain, mass, change in bowel habits, anemia |
| Transverse Colon: | pain, obstruction, changes in bowel habits, anemia |
| Descending Colon: | pain, changes in bowel habits, bright red blood in stool, obstruction |
| Rectum: | Blood in stool, change in bowel habits,rectal discomfort |
| what is the most common reason for surgery of the small intestine? | Obstruction |
| physically blocked bowel by problems outside the intestine (adhesions) in the bowel wall (Crohns) or in the intestinal lumen (tumors) | Mechanical |
| Peristalsis is decreased or absent as a result of neuromuscular disturbance, resulting in a slowing or mvmt or backup of intestinal contents. | Nonmechanical (aka paralytic ileus) |
| With mechanical or nonmechanical obst. what can occur because of it.. | distention, edema and increased capillary permeability |
| High obstructions lead to ___ distention and metabolic ____ | rapid, alkalosis |
| Low obstruction at the end of the bowel is a slower process that can cause metabolic ___ | acidosis |
| Telescoping of the intestines | intussecption |
| twisting of the intestines | volvulus |
| strictures cause mechanical obstruction. what dz has these? | crohn's dz |
| most common cause of nonmechanical obstruction | manipulation in surgery |
| which electrolyte is lost thru vomiting and suctioning? | potassium |
| severe pain that stops and changes to tenderness on palpation may indicate ____ | perforation (report the the physician) |
| IV fluids used to treat after obstruction.. | 2-4 liters NS or LR with potassium |
| NPO status from obstruction until when | until peristalsis returns |
| NG tube: salem sump tube, describe. | low, continuous suction which has a vent. MOST used. |
| NG tube: Levin tube, describe. | low, intermittent suction without a vent. less used. |
| When pt has NG tube, what do you check every 4 hrs | placement, patency, and output. Also, aspirate contents, and irrigate tube w/ 30ml NS q4hr |
| What position is a pt in (obstruction)? | semi-fowlers |
| Why is Sandostatin given? | generic name: octreotide acetate, enhances gastric motility. in case of partial obstruction or paralytic ileus |
| T/F N/V are signs of NG tube obstrution or worsening bowel obstr. | True |
| T/F Opiod analgesics are withheld so clinical manifestatoins of perforation or peritonitis are not masked | True |
| This is an open abd. cavity surgery to investigate causes or issues in the bowel.. | exploratory laparotomy |
| Pre-op Bowel Surgery: which ABOX is given if strangulation is suspected? | neomycin PO for 48 hrs to decrease incidence of sepsis and septicemia |
| Which procedure takes longer than exploratory laparotomy but the blood loss is less? | Laparoscopy |
| Post-op bowel surgery, pt is placed on clear liquid diet and progress __ _______. NGT is in place until ____ returns. | as tolerabed; peristalsis |
| When peristalsis returns, remove NGT SLOWLY. First turn off suction and clamp for a sched. amt of time.. if the pt ______ after clear liquid is given, the suction is turned back on. | vomits |
| Teach pt after bowel surgery, to report what.. | abd. pain, distention, N/V, bc this could indicate recurrent obstruction (not common!) |
| Meds given for bowel surgery: | PO opioid analgesics (percocet, tylox, endocet) and laxative with softener (Docusate with senna) |
| Injury to the structures located between the diaphragm and pelvis is known as | Abdominal Trauma |
| First assessment on a pt with abd. trauma?? | ABC's first!! then hemorrhage, shock, peritonitis. |
| Ecchymosis around the umbilicus.. | cullen's sign |
| Ecchymosis on either flank | Turner's sign |
| Bruits could indicate ____ ____ injury | renal artery |
| Left flank dullness and resonance over Right flank )with pt lying on left side) | Ballance's sign -----> ruptured spleen |
| left shoulder pain resulting from diaphragm irritation | Kehr's sign |
| Explain DPL | Diagnostic Peritoneal Lavage, cath into sbd. fill w/ fluid and if return drainage is pink or bloody --> prep for surgery |
| Abd Trauma, get type and crossmatch for how many units of packed RBPs? | 4-8 units |
| ruptered spleen or intestinal injury, lab affected? | increased WBC |
| liver injury, lab affected? | increased serum transaminases |
| pancreas or bowel injury, lab affected? | increased serum amylase |
| do not use a foley for abd. trauma patients when? | where there is blood at the urinary meatus (I&O hourly) |
| Increased Intra-abdominal Pressure (normal 0-5mm hg) put pt at risk for what? | DVT and PE, because pressure is higher than central venous pressure and causes compressed vessels. |
| Over 20 mm Hg intra-abdominal pressure causes | acidosis and ischemia. if left untreated: sepsis, MODS, and death! |
| hemorrhage can occur ____ after blunt abd. trauma. | weeks |
| Small growths covered with mucosa and attached to surface of intestines | polpys |
| Why are polyps significant? | Most are benign, but some have the potential to become malignant. |
| Which two polyps are inherited and progress to CRC by late 40s to early 50s.. | familial adenomatous polyposis (FAP) and hereditary Nonpolyposis Colorectal Cancer (HNPCC) |
| Entirely benign polyps - mucosal and inflammatory | Hyperplastic |
| Juvenile and Peutz-Jeghers and rarely malignant | Hamartomatous polyps |
| Stalk-like "tubular adenomas" a thin stem attaches them to the int. wall | Pedunculated |
| "villous adenomas" GREATER CANCER RISK. attached to the int. wall with a broad base | Sessile |
| Polyps are usually asymptomatic and found during routine exams. But can cause (3) | rectal bleeding, obstruction, intussusception |
| Which patient (type of polyp) usually requires a total colectomy to prevent cancer? | FAP (Familial adenomatous polyposis) |
| T/F A small amt. of blood in the stool after a polypectomy is temporarily normal | True |
| Unnaturally swollen or distended veins in the anorectal region | Hemorrhoids |
| Causes of hemorrhoids? | increased sbd. pressure, straining w/ constipation, obesity, heart failure, prolonged sitting/standing, strenuous lifting/exercise |
| Prevention of constipation is the most preventative measure for | hemorrhoids |
| How do you prevent constipation / hemorrhoids via your diet plan? | increase fiber, increase water, increase activity level |
| How do you manage hemorrhoids? | cold packs 3-4 times day, tepid sitz bath 3-4 times day, Topical anestetics (lidocaine or dibucaine but not for long!), steroid prep (Hydrocortisone) to alleviate in 3-5 days, Avoid irritating foods!, stool softener (Colace!!!) used temp. |
| Surgical procedures for hemorrhoids? | ultrasound coagulation, rubber band ligation, circular stapling (if rubber band falls off & hem, is prolapsed), simple resection |
| After the hemorrhoidectomy, use colace preop, why? | Stool softener because 1st postop bowel mvmt very painful! |
| What do you use if no BM by 3rd postop day? | mild laxative |
| One or more nutrients are not digested or absorbed, a result of a generalized flattening of sm. intestine mucosa. | Malabsorption |
| Causes of malapsorbtion | Bile salt deficiencies, enzyme deficiencies, presence of bacteria, alterations in mucosal lining, altered lymph/vacular circulation |
| the absorptive surface area in the small intestines is lost --> malabsortion of most nutrients. | Celiac Sprue "celiacs disease" - nontropical |
| genetic autoimmune HS response to gluten and may be triggered by surgery, preg, viral inf., emotional distress | celiac sprue |
| symptoms of celiac dz | gas, bloating, pain, chronic diarrhea, constipation, pale, foul-smelling or fatty stool |
| caused by an infectious agent (though to be bacterial) | Tropical Sprue |
| Changes are not as severe but mucosal changes are more widespread | Tropical Sprue |
| Tropical Sprue results in malabsorption of what | fat, folic acid, and B12 |
| How is malabsorption diagnosed? | IgA, tTGA, AEA, small bowel biopsy |
| Clinical Manifestations of Malabsorption | wt loss/gain, fatigue, bone/joint pain, osteoporosis/osteopenia, muscle cramps, missed periods, infertility, failure to thrive, steatorrhea, itchy skin |
| Treatment for malabsorption | gluten-free diet is the only real tx!! |
| Other treatments for malabsorption | corticosteriods (severe case), tropical sprue - bactrim, septra (abox), Flagyl (bacterial overgrowth), antidiarrheal (Lomotril), Anticholinergics (Bentyl to inhibit gastric motility) |
| Lactase deficiency -- s/s? | cramping, bloating, diarrhea several hrs after consumption. It is inherited or acquired |
| How to tell about lactase deficiency? | Breath test -- amt. of hydrogen in the breath. and small bowel biopsy. |
| <6 months of age, what test is done to figure out lactase deficiency? | stool acidity test |
| treatment for lactase deficiency | milk / milk product free diet (and assess for adequete calcium, vit. D, and Riboflavin in diet) |
| Diarrhea, how to treat? | clear liquid diet, antidiarrheals, rest |
| Constipation, how to treat? | causes hemmorhoids, fecal impactions, and megacolon --- TX: increase fiber, increase fluids, and increase activity |
Created by:
Sarahmarie001
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