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Test #3 GI PART 1

NUR 201

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