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68wm6 p2 intro GI
Introduction to the GI system
| Question | Answer |
|---|---|
| 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
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