Unit 3 - GI
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| Gastrogafen | Contrast used for perforations
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| Hepatobiliary Scentigraphy (HIDA) | Dx study for liver biopsy. Nuke med test that checks integrity of ducts
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| Marasmus | Very skinny, emaciated
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| Kwashiorkor | Low protein, pot belly
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| Coumadin | Vitamin K
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| Dilantin | Folic Acid
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| Questran | Fat Soluble Vitamins
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| Where does PEG tube come out | ULQ
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| Fluids for NG/PEG tube | Polymeric Formulas
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| Fluids for Jejunostomy | Elemental Formulas
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| Signs of aspiration | Crackles/Rhonchi on Right side
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| TPN | 70% dextrose
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| PPN | 10% dextrose, add lipids, watch triglycerides
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| Anorexia Nervosa | Low Fe (anemia), electrolyte imbalance
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| Banding | Restriction on stomach, removable
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| Malabsorptive | Small intestine
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| Gastric Bypass | On life long supplements (Fe, B12, folic acid)
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| Metabolic Syndrome (central obesity) | High BP & Triglycerides, Low HDL cholesterol. Type II DM insulin resistant
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| Esophogeal = Mallory Weiss Tear | From chronic GERD, ETOH, smoking, continuous vomit. Low BP, High heart rate
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| Esophogeal = Esophogeal Varices | Massive bloody vomit / Veins engorge in esophagus from pressue on portal vein w/ cirrhosis
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| Rx: Esophogeal Varices | Vasopressin/Sandostatin
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| Gastric Ulcer (PUD) | Weight Loss, pain 1-2 hrs after eating, food aggrevates, massive blood loss, can result in obstruction, common women 50+
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| Duodenal Ulcer (PUD) | pain 2-4 hrs after eating, hunger pain - relieved w/ food, anyone 35-45 yrs old
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| Complications of Peptic Ulcer Disease | Acute exacerbation, perforation, Gastric Outlet Obstruction
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| Gastric Outlet Obstruction | Swells shut w/ very small outlet. Abdominal pain worsens at end of day. Relief w/ belching/self induced vomit. Offensive odor to vomit/breath
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| Bill Roth II -- surgical treatment for PUD | Remove portion of stomach and connect whats left to Jejunum
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| Complications of Bill Roth II | Dumping Syndrome, Postprandial Hypoglycemia, Bile Reflux Gastritis
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| Postprandial Hypoglycemia | Over production of insulin occurs 2 days after eating. s/s: sweating, weakness, confusion, tachy, anxiety
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| Bile Reflux Gastritis | Bile in stomach, gastric distress, worsens after meals. Rx: Questran
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| Cullen Sign | Bruise around umbilicus common in blunt trauma
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| Crohn's Disease (Inflammatory Bowel Disease) | Diarrhea, weight loss, nutritional deficiencies/malabsorption, fistulas, strictures, anal abscess, recurs after surgery
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| Ulcerative Colitis (Inflammatory Bowel Disease) | Bloody diarrhea, rectal bleeding, tenesmus, start in rectum -> colon, curable
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| Rx: for Inflammatory Bowel Disease | Asacol, Imuran, Sulfasalazine, prednisone
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| Anal Fissure | Skin ulcer or crack in lining of anal wall caused by trauma, infection or inflammation. Painful. Tx: Decrease straining, can heal on own
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| Anorectal Abscess | Pus - drain, wet-dry leave open. Low fiber diet
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| Anal Fistula | Complication of Crohn's. Abnormal tunnel leading from anus or rectum to outside of skin, buttocks, vagina
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| Pilonidal Sinus | "Nest of Hair" pain/swelling at base of spine. Abscess or cysts requires drainage. Leave open, heal by 2ndary intention
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| Hemolytic Jaundice | High breakdown in RBCs producing high unconjugated bilirubin in blood. Causes: blood transfusion, sickle cell, hemolytic anemia
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| Hepatocellular Jaundice | Liver cannot conjugate or excrete bilirubin. Causes: Hepatic cirrhosis
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| Obstructive Jaundice | Bilirubin not getting extcreted into intestines/stool causing it to turn gray
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| Hep A | fecal->oral. Poor personal hygiene, daycares, contaminated food, milk, water, shellfish "wash hands"
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| Hep B | Blood bourne - practice "safe sex" contracted like STD (semen, vaginal, blood), needles, tattoo/body piercing
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| Hep C | Sharing needles, unprotected sex, linked to HIV "safe sex, clean needles"
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| Symptoms of Hepatitis | Rash, fever, malaise, nausea, vomiting, clay colored stool
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| Lab for Hep C | CD4 counts (WBC), >200 continue tx, <200 stop tx
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| Biliary Cirrhosis | Chronic Inflammatory liver disease, T cells attack bile duct causing blockage. s/s: fatigue, pruritis
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| Rx: Biliary Cirrhosis | Questran (itching), Actigall - dissolves bile clogging duct
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| Non-Alcoholic Fatty Liver Disease | Major complication of obesity. s/s: asymptomatic unless goes to liver failure. Dx: High liver enzymes. Tx: Stable weight loss, not rapid
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| Oral & Esophogeal Cancer meds | 5FU, methotrexate, platinol
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| GERD complications | Esophagitis, Barretts esophagus (pre-cancerous lesions)
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| GERD Tx: | Fundiplication - surgery if hiatal hernia or sphincter not working
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| Hiatal Hernia s/s | Heartburn at night or when lying down
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| Hiatal Hernia Dx | barium swallow (Upper GI series)
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| Esophogeal Cancer s/s | Increased dysphagia, coarse foods (steak) gets stuck in throat then progress to soft foods. Pain late sign
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| Esophogeal Cancer complications | Nutrition & Breathing is issue, will have NG Tube for suctioning but not a lot of residue will come out
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| Esophogeal Cancer Tx: | Endoscopy w/ photofrin IV injected, a photo sensitizer, absorbed by cancerous tissue -- Esophagetctamy - Remove part of esophagus w/ other parts (stomach is in chest)
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| Irritable Bowel Syndrome | Fluctuations between constipation, diarrhea and regularity
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| Irritable Bowel Syndrome s/s | Excessive flatulance, bloating, urgency -- Avoid gassy foods
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| Irritable Bowel Syndrome meds | Metamucil, imodium, Bentyl
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| Appendicitis Dx | High WBC, ultrasound
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| Appendicitis s/s | Rebound tenderness, pain at RLQ (Macburney's Point), guarding, fever, anorexia
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| Appendicitis complications | Peritonitis, Abscess, perforation
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| Peritonitis | Inflammation of peritoneum from rupture in bowel or foreign body (break in intestine/rupture appendix)
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| Peritonitis complications | Hypovolemic shock, sepsis, intrabdominal abscess, paralytic ileus, acute respiratory distress
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| Peritonitis s/s | Hypoactive/absent Bowel Sounds, rebound tenderness, distended abdomen
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| Upper GI Bleed (esophagus, stomach, duodenum) Dx: | Hemoglobin, INR, stool for cult blood
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| Upper GI Bleed s/s | Hematemesis, melana, Distention of stomach w/ blood
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| Hematemesis | Vomiting blood (red, coffee ground)
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| Melana | Black, tarry stool
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| Upper GI Bleed interventions | Start IV normal saline, Type/cross blood, gets labs & blood drawn, lavage w/ cold ice water (acts as vasoconstrictive)
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| H-pylori | Bacterial infection related to gastric/duodenum ulcers. Tx: Flagyl
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| Gastritis (treat like GERD patient) | Stomach is raw, can have some blood loss
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| Gastritis Meds | Pepcid & Protonix (decrease acid in stomach)
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| Gastritis s/s | Apigastric tenderness, general malaise, upset stomach
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| Peptic Ulcer Disease teaching | Decrease meal size, avoid simple carbs, drink less than 4 oz fluids
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| Perforation s/s | Difuse abdominal pain, rigid board like abdomen, distention, ridgity, elevated WBC, fever
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| Stomach Cancer risks | perniscious anemia (B12) and dumping syndrome
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| Intestinal Obstruction causes | paralytic ileus, adhesion, tumors, hernias
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| Bowel sounds | Distal to obstruction - no BS, proximal to obstruction - high pitched BS
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| Stoma | Can be swollen up to 3 weeks, no output for couple days, may be mucousy or blood tinged initially post-op -- OKAY
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| Colon Cancer | Want clean margins and remove lymph nodes
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| Colon Cancer Tx: | Chemo/Radiation can be done before surgery to shrink cells and decrease vascular supply.
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| Diverticulitis | Outpouching of mucosa in sigmoid colon
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| Diverticulitis s/s | Abdominal pain in LLQ, high WBC, fever -- rest bowel, put on IV fluids
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| Diverticulitis prevention | high fiber diet w/ fruits & veggies, low fat, no red meat, weight loss
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| Diverticulitis | CT scan w/ oral contrast
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| Diverticululitis complications | perforation, abscess, fistula, bleeding
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| Celiac Disease | Immune response, allergic to gluten, test for antibodies, biopsy of bowel
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| Gluten Foods | wheat, barley, rye, oats, flour, bread, pasta, pizza, bagels
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| Celiac Disease s/s | malnutrition, osteoperosis, vitamin deficiencies
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| elevated ammonia levels | Decrease protein in diet
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| New colostomy diet 4-6 weeks post-op | Low fiber
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| Complete Proteins | Derive from animal sources (meat, cheese, milk, eggs)
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