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Unit 3 - GI
| Question | Answer |
|---|---|
| Gastrogafen | Contrast used for perforations |
| Hepatobiliary Scentigraphy (HIDA) | Dx study for liver biopsy. Nuke med test that checks integrity of ducts |
| Marasmus | Very skinny, emaciated |
| Kwashiorkor | Low protein, pot belly |
| Coumadin | Vitamin K |
| Dilantin | Folic Acid |
| Questran | Fat Soluble Vitamins |
| Where does PEG tube come out | ULQ |
| Fluids for NG/PEG tube | Polymeric Formulas |
| Fluids for Jejunostomy | Elemental Formulas |
| Signs of aspiration | Crackles/Rhonchi on Right side |
| TPN | 70% dextrose |
| PPN | 10% dextrose, add lipids, watch triglycerides |
| Anorexia Nervosa | Low Fe (anemia), electrolyte imbalance |
| Banding | Restriction on stomach, removable |
| Malabsorptive | Small intestine |
| Gastric Bypass | On life long supplements (Fe, B12, folic acid) |
| Metabolic Syndrome (central obesity) | High BP & Triglycerides, Low HDL cholesterol. Type II DM insulin resistant |
| Esophogeal = Mallory Weiss Tear | From chronic GERD, ETOH, smoking, continuous vomit. Low BP, High heart rate |
| Esophogeal = Esophogeal Varices | Massive bloody vomit / Veins engorge in esophagus from pressue on portal vein w/ cirrhosis |
| Rx: Esophogeal Varices | Vasopressin/Sandostatin |
| Gastric Ulcer (PUD) | Weight Loss, pain 1-2 hrs after eating, food aggrevates, massive blood loss, can result in obstruction, common women 50+ |
| Duodenal Ulcer (PUD) | pain 2-4 hrs after eating, hunger pain - relieved w/ food, anyone 35-45 yrs old |
| Complications of Peptic Ulcer Disease | Acute exacerbation, perforation, Gastric Outlet Obstruction |
| 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 |
| Bill Roth II -- surgical treatment for PUD | Remove portion of stomach and connect whats left to Jejunum |
| Complications of Bill Roth II | Dumping Syndrome, Postprandial Hypoglycemia, Bile Reflux Gastritis |
| Postprandial Hypoglycemia | Over production of insulin occurs 2 days after eating. s/s: sweating, weakness, confusion, tachy, anxiety |
| Bile Reflux Gastritis | Bile in stomach, gastric distress, worsens after meals. Rx: Questran |
| Cullen Sign | Bruise around umbilicus common in blunt trauma |
| Crohn's Disease (Inflammatory Bowel Disease) | Diarrhea, weight loss, nutritional deficiencies/malabsorption, fistulas, strictures, anal abscess, recurs after surgery |
| Ulcerative Colitis (Inflammatory Bowel Disease) | Bloody diarrhea, rectal bleeding, tenesmus, start in rectum -> colon, curable |
| Rx: for Inflammatory Bowel Disease | Asacol, Imuran, Sulfasalazine, prednisone |
| 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 |
| Anorectal Abscess | Pus - drain, wet-dry leave open. Low fiber diet |
| Anal Fistula | Complication of Crohn's. Abnormal tunnel leading from anus or rectum to outside of skin, buttocks, vagina |
| Pilonidal Sinus | "Nest of Hair" pain/swelling at base of spine. Abscess or cysts requires drainage. Leave open, heal by 2ndary intention |
| Hemolytic Jaundice | High breakdown in RBCs producing high unconjugated bilirubin in blood. Causes: blood transfusion, sickle cell, hemolytic anemia |
| Hepatocellular Jaundice | Liver cannot conjugate or excrete bilirubin. Causes: Hepatic cirrhosis |
| Obstructive Jaundice | Bilirubin not getting extcreted into intestines/stool causing it to turn gray |
| Hep A | fecal->oral. Poor personal hygiene, daycares, contaminated food, milk, water, shellfish "wash hands" |
| Hep B | Blood bourne - practice "safe sex" contracted like STD (semen, vaginal, blood), needles, tattoo/body piercing |
| Hep C | Sharing needles, unprotected sex, linked to HIV "safe sex, clean needles" |
| Symptoms of Hepatitis | Rash, fever, malaise, nausea, vomiting, clay colored stool |
| Lab for Hep C | CD4 counts (WBC), >200 continue tx, <200 stop tx |
| Biliary Cirrhosis | Chronic Inflammatory liver disease, T cells attack bile duct causing blockage. s/s: fatigue, pruritis |
| Rx: Biliary Cirrhosis | Questran (itching), Actigall - dissolves bile clogging duct |
| 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 |
| Oral & Esophogeal Cancer meds | 5FU, methotrexate, platinol |
| GERD complications | Esophagitis, Barretts esophagus (pre-cancerous lesions) |
| GERD Tx: | Fundiplication - surgery if hiatal hernia or sphincter not working |
| Hiatal Hernia s/s | Heartburn at night or when lying down |
| Hiatal Hernia Dx | barium swallow (Upper GI series) |
| Esophogeal Cancer s/s | Increased dysphagia, coarse foods (steak) gets stuck in throat then progress to soft foods. Pain late sign |
| Esophogeal Cancer complications | Nutrition & Breathing is issue, will have NG Tube for suctioning but not a lot of residue will come out |
| 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) |
| Irritable Bowel Syndrome | Fluctuations between constipation, diarrhea and regularity |
| Irritable Bowel Syndrome s/s | Excessive flatulance, bloating, urgency -- Avoid gassy foods |
| Irritable Bowel Syndrome meds | Metamucil, imodium, Bentyl |
| Appendicitis Dx | High WBC, ultrasound |
| Appendicitis s/s | Rebound tenderness, pain at RLQ (Macburney's Point), guarding, fever, anorexia |
| Appendicitis complications | Peritonitis, Abscess, perforation |
| Peritonitis | Inflammation of peritoneum from rupture in bowel or foreign body (break in intestine/rupture appendix) |
| Peritonitis complications | Hypovolemic shock, sepsis, intrabdominal abscess, paralytic ileus, acute respiratory distress |
| Peritonitis s/s | Hypoactive/absent Bowel Sounds, rebound tenderness, distended abdomen |
| Upper GI Bleed (esophagus, stomach, duodenum) Dx: | Hemoglobin, INR, stool for cult blood |
| Upper GI Bleed s/s | Hematemesis, melana, Distention of stomach w/ blood |
| Hematemesis | Vomiting blood (red, coffee ground) |
| Melana | Black, tarry stool |
| Upper GI Bleed interventions | Start IV normal saline, Type/cross blood, gets labs & blood drawn, lavage w/ cold ice water (acts as vasoconstrictive) |
| H-pylori | Bacterial infection related to gastric/duodenum ulcers. Tx: Flagyl |
| Gastritis (treat like GERD patient) | Stomach is raw, can have some blood loss |
| Gastritis Meds | Pepcid & Protonix (decrease acid in stomach) |
| Gastritis s/s | Apigastric tenderness, general malaise, upset stomach |
| Peptic Ulcer Disease teaching | Decrease meal size, avoid simple carbs, drink less than 4 oz fluids |
| Perforation s/s | Difuse abdominal pain, rigid board like abdomen, distention, ridgity, elevated WBC, fever |
| Stomach Cancer risks | perniscious anemia (B12) and dumping syndrome |
| Intestinal Obstruction causes | paralytic ileus, adhesion, tumors, hernias |
| Bowel sounds | Distal to obstruction - no BS, proximal to obstruction - high pitched BS |
| Stoma | Can be swollen up to 3 weeks, no output for couple days, may be mucousy or blood tinged initially post-op -- OKAY |
| Colon Cancer | Want clean margins and remove lymph nodes |
| Colon Cancer Tx: | Chemo/Radiation can be done before surgery to shrink cells and decrease vascular supply. |
| Diverticulitis | Outpouching of mucosa in sigmoid colon |
| Diverticulitis s/s | Abdominal pain in LLQ, high WBC, fever -- rest bowel, put on IV fluids |
| Diverticulitis prevention | high fiber diet w/ fruits & veggies, low fat, no red meat, weight loss |
| Diverticulitis | CT scan w/ oral contrast |
| Diverticululitis complications | perforation, abscess, fistula, bleeding |
| Celiac Disease | Immune response, allergic to gluten, test for antibodies, biopsy of bowel |
| Gluten Foods | wheat, barley, rye, oats, flour, bread, pasta, pizza, bagels |
| Celiac Disease s/s | malnutrition, osteoperosis, vitamin deficiencies |
| elevated ammonia levels | Decrease protein in diet |
| New colostomy diet 4-6 weeks post-op | Low fiber |
| Complete Proteins | Derive from animal sources (meat, cheese, milk, eggs) |
Created by:
kristyd02
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