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Level 3 > Complex Exam 3 - inflammation and digestion/metabolism > Flashcards

Complex Exam 3 - inflammation and digestion/metabolism Flashcards

1
Q

Where is appendicitis pain?

A
  • RLQ
  • dull around navel
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2
Q

Where is pancreatitis pain?

A
  • epigastric
  • radiates to back, left flank, left shoulder
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3
Q

Where is perforation pain?

A

all over the abdomen

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4
Q

Where is diverticulitis pain?

A

LLQ

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5
Q

What type of diet will a patient with abdominal pain be on?

A

NPO

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6
Q

Does anything help appendicitis pain go away?

A

NO

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7
Q

What characterizes a ruptured appendix?

A

going from extreme pain to no pain at all
- increased HR, RR, temp
- abdominal distention/bloating

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8
Q

What tests for rebound tenderness?

A

Blumberg’s sign

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9
Q

If the appendix has ruptured, what should be done?

A
  • washing out the abdominal cavity
  • appendectomy
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10
Q

What cannot be given to someone with appendicitis due to causing rupture?

A
  • laxatives
  • enemas
  • opioids
  • heat
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11
Q

What can a ruptured appendix lead to?

A

peritonitis (rigid, boardlike abdomen)

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12
Q

What are the most common causes of drug-induced hepatitis?

A

acetaminophen and “statins”

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13
Q

What does combining drugs with alcoholic drinks do?

A

increases the risk of liver damage

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14
Q

What is given for acetaminophen OD?

A

acetylcysteine

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15
Q

What pooping problems can occur with acute hepatic failure?

A
  • constipation or diarrhea
  • steatorrhea
  • chalky stool
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16
Q

AHF can have hepatic encephalopathy. What can this lead to?

A

coma

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17
Q

What labs are elevated from AHF?

A
  • bilirubin
  • PT
  • AST/ALT
  • ammonia
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18
Q

What AHF diagnostic can identify the size of the liver, the presence of ascites, tumors, and patency of blood vessels?

A

CT/MRI

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19
Q

What should be kept at the bedside of a patient with AHF?

A

ET tube and oral airway

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20
Q

What should be avoided to keep ICP WNL with AHF?

A

overstimulation

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21
Q

What should be done to help with ascites from AHF?

A

paracentesis

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22
Q

What is the only treatment for liver failure?

A

liver transplant

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23
Q

After ABC’s are stable, what is the priority with AHF?

A

new-onset restlessness, confusion, or deteriorating LOC

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24
Q

Why is lactulose given for AHF?

A

to decrease ammonia levels

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25
Q

Why are beta blockers or vasoconstrictors given for AHF?

A

esophageal varicies

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26
Q

Why is vitamin K given for AHF?

A

clotting

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27
Q

What medications cannot be given with AHF?

A
  • nephrotoxic
  • sedatives
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28
Q

What is the biggest complication with AHF?

A

portal HTN

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29
Q

What should be restricted in the diet of a patient with AHF?

A

sodium and fluids

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30
Q

What should be increased in the diet of a patient with AHF?

A

carbs and protein, vitamin supplements

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31
Q

When should protein be decreased in a patient with AHF?

A

if they have hepatic encephalopathy

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32
Q

What causes esophageal varices?

A

portal HTN

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33
Q

What happens to HR and BP with esophageal varices?

A

tachycardia and hypotension

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34
Q

What bleeding manifestations occur with esophageal varices?

A
  • hematemesis
  • melena
  • decreased H&H
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35
Q

Why is it important to control bleeding with esophageal varices?

A

to prevent hemorrhage and hypovolemic shock

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36
Q

What medications are used for esophageal varices?

A
  • BB (propranolol)
  • octreotide
  • vasoconstrictors and vasopressors
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37
Q

Where is banding done for esophageal varices?

A

at the base of the varices to stop bleeding

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38
Q

Where is the catheter placed during a TIPS procedure for esophageal varices?

A

in the liver between the portal and hepatic vein

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39
Q

What does a balloon tamponade do?

A

compress blood vessels in the esophagus and stomach with balloons and traction

40
Q

What can cause hemorrhage in the upper GI tract?

A
  • varices
  • PUD
  • gastritis
  • tumors
  • esophagitis
41
Q

What can cause hemorrhage in the lower GI tract?

A
  • diverticulosis
  • cancer
  • polyps
  • IBD
  • UC
42
Q

Does hematemesis and melena characterize an upper or lower GI bleed?

A

upper

43
Q

Does hematochezia characterize an upper or lower GI bleed?

A

lower

44
Q

What happens to capillary refill with a GI bleed?

A

it is increased, >3 seconds

45
Q

What does the skin feel like with a GI bleed?

A
  • cool, clammy
  • rigid abdomen
46
Q

What is a symptom of hemodynamic compromise that occurs with GI bleed?

A

chest pain

47
Q

Signs and symptoms of anemia can occur with a GI bleed. What can this include?

A
  • fatigue
  • SOB
  • tachycardia
48
Q

What type of GI bleed can H. pylori cause?

A

upper

49
Q

What diagnostics should be done for GI bleed?

A
  • H&H
  • type and crossmatch
  • stool sample
  • BUN
  • H. pylori
50
Q

When would an endoscopy be done?

A

w/in 24 hours of identifying a GI bleed

51
Q

What is given through the 2 large bore IV’s with a GI bleed?

A
  • fluids (LR)
  • PRBC’s
  • meds (PPI)
52
Q

What medication is given if H. pylori caused a GI bleed?

A

antibiotics (metronidazole)

53
Q

What diet should a patient with a GI bleed be on?

A

NPO while bleeding, clear liquids after

54
Q

Who can not be a candidate for liver transplant?

A
  • severe cardiac/respiratory disease
  • metastatic malignant liver cancer
  • alcohol or substance use disorder
55
Q

Who can be a candidate for liver transplant?

A
  • end stage liver disease
  • chronic liver disease
56
Q

What type of shower should be done before a liver transplant?

A

shower with chlorhexidine soap

57
Q

What type of medication will patients be on for life after a liver transplant?

A

immunosuppressants

58
Q

What is important to monitor after a liver transplant?

A
  • VS
  • neuro status
  • s/sx of rejection, acute renal failure, infection, and clotting issues
59
Q

What happens to amylase and lipase levels with acute pancreatitis?

A

they increase

60
Q

When does pancreatitis pain worsen?

A

when laying down

61
Q

What helps pancreatitis pain?

A
  • fetal position
  • sitting still and up
  • leaning forward
62
Q

Do patients with pancreatitis gain or lose weight?

A

lose

63
Q

What does hypocalcemia cause with acute pancreatitis?

A
  • positive trousseau’s sign
  • positive chvostek’s sign
64
Q

What is trousseau’s sign?

A

hand spasm

65
Q

What is chvostek’s sign?

A

facial twitching

66
Q

Turner’s sign is ecchymoses on the flanks. What causes this?

A

pancreatitis

67
Q

Where does Cullen’s sign cause bluish-gray discoloration? What causes this?

A
  • around the belly button (periumbilical)
  • acute pancreatitis
68
Q

What diet should someone with pancreatitis be on?

A

NPO, possible TPN

69
Q

What is an NG tube used for with pancreatitis?

A

to empty the stomach

70
Q

What pain medication cannot be used for pancreatitis?

A

morphine

71
Q

What is important to give with pancreatitis?

A

FLUIDS

72
Q

If a patient with pancreatitis has unstable glucose levels what should be done?

A

give supplemental insulin

73
Q

What causes hypovolemia with pancreatitis?

A

third spacing

74
Q

What can hypovolemia from pancreatitis lead to?

A

shock

75
Q

What causes a pancreatic infection leading to a pseudocyst or abcess?

A

leakage of fluid out of the damaged pancreatic duct

76
Q

If pancreatitis is not treated, what can it lead to?

A

MODS

77
Q

Where is a palpable mass found with pyloric stenosis/intestinal obstruction?

A

RUQ

78
Q

What abdominal s/sx occur with pyloric stenosis/intestinal obstruction?

A
  • pain
  • distention
  • rigidity
  • hypoactive bowel sounds
  • vomiting
79
Q

Pyloric stenosis/intestinal obstruction can cause increased hgb, hct, BUN, and creatinine. What are these signs of?

A

dehydration

80
Q

What diagnostic evaluates the presence of free air and gas patterns with pyloric stenosis/intestinal obstruction?

A

x-ray

81
Q

What diagnostic determines the cause of intestinal obstruction?

A

endoscopy

82
Q

What diagnostic determines the cause and exact location of intestinal obstruction?

A

CT

83
Q

What develops with diverticulitis?

A

small pouches throughout the intestinal wall

84
Q

How does diverticulitis develop?

A

diverticulosis pouches get inflamed/infected by bacteria/food/fecal matter

85
Q

What can perforation of diverticulosis pouches cause?

A
  • peritonitis (increased temp/HR/RR)
  • severe bleeding
86
Q

What medications can be given for diverticulosis/diverticulitis?

A
  • fluids
  • antibiotics
  • opioids
  • psyllium and probiotics
87
Q

Patients with diverticulosis/diverticulitis will move from clear liquids to a low fiber diet. What can this include?

A
  • white rice
  • cooked/skinned fruits/veggies
  • eggs
88
Q

What should not be eaten with diverticulosis/diverticulitis?

A
  • popcorn/seeds/nuts
  • alcohol
89
Q

What should you monitor for if bowel perforation occurs?

A
  • peritonitis
  • infection
  • sepsis
90
Q

What is the late symptom of dumping syndrome?

A

hypoglycemia

91
Q

What happens to BP and HR with dumping syndrome?

A

hypotension and tachycardia

92
Q

What should a patient experiencing dumping syndrome do?

A

lay down

93
Q

What medication can be given SQ to manage s/sx of dumping syndrome?

A

octreotide

94
Q

Should you have liquids with meals with dumping syndrome?

A

NO

95
Q

What foods should be avoided with dumping syndrome?

A

milk and sugars

Level 3 (29 decks)

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