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ACLS > CEN study set 4, GI, GU, OB-GYN > Flashcards

CEN study set 4, GI, GU, OB-GYN Flashcards

1
Q

At the completion of this section, the learner will be able to:

A

Prioritize treatments for patients with esophageal emergencies
Recognize signs of gastritis
Verbalize discharge instructions for patients with hepatitis
Differentiate between symptoms of small bowel obstructions and large bowel obstructions
Identify the abdominal organ most frequently injured in traumatic situations

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2
Q

The CEN exam contains ten questions on gastrointestinal emergencies which involve the following topics:

A

Acute Abdomen, e.g. peritonitis, appendicitis, Bleeding, Cholecystitis, Cirrhosis, Diverticulitis, Esophageal varices, Esophagitis, Foreign bodies, Gastritis, Gastroenteritis, Hepatitis, Hernia, Inflammatory Bowel Disease, Intussusception,
Obstructions, Pancreatitis, Trauma, Ulcers

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3
Q

what is a Mallory-Weiss tear?

A

small tears in the junction of the esophagus and stomach caused by violent retching and vomiting.

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4
Q

describe the treatment and bleeding of a Mallory-Weiss tear

A

Bleeding is usually self limiting

In rare cases, may need fluid resuscitation and injection of epinephrine to control bleeding.

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5
Q

what is Boerhaave’s syndrome

A

Rupture of the esophageal wall secondary to violent retching and vomiting.

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6
Q

what is involved in the treatment of Boerhaave’s syndrome

A

IV fluids
Antibiotics
Surgical repair

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7
Q

explain Esophageal varices

A

bleeding from distended blood vessels in the esophagus and stomach, usually secondary to liver disease

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8
Q

explain the treatment of Esophageal varices

A 
Treat hypovolemic shock with intravenous fluids and blood products
 Vasopressin (Pitressin) or sandostatin (Octreotide) - may be given with nitroglycerin to prevent cardiac ischemia
 Vitamin K (aquaMEPHYTON) to reverse underlying coagulopathies of liver disease
 Endoscopic procedures to control bleeding
 Sengstaken-Blakemore tube or Minnesota tube
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9
Q

what are the causes of Esophagitis

A

Gastroesophageal Reflux Disorder (GERD), Achalasia impaired motility of the lower 2/3 of the esophagus, Esophageal infections, drugs that inflame the esophagus.

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10
Q

what are some causes of Gastritis

A

Helicobacter Pylori infection, ingestion of noxious substances, stress, tobacco

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11
Q

what are the symptoms of Esophagitis

A

Pain
Burning in the chest
Worse with activities that increase intra-abdominal pressure
Worse 30 - 60 minutes after eating.

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12
Q

what are the symptoms of Gastritis

A 
Epigastric pain relieved by eating food
 Nausea and vomiting (hematemesis)
 Diarrhea
 Anorexia
 Intestinal gas
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13
Q

what are some of the treatments of gastritis and esophagitis

A

cholinergics, dopamine antagonists, antacids, histamine H2 receptor antagonists, proton pump inhibitors, and acid protective agents such as carafate

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14
Q

how do cholinergics treat esophagitis and gastritis?

A

such as bethanechol (Urecholine), increase lower esophageal sphincter pressure and promote gastric emptying.

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15
Q

how are dopamine antagonists used to treat esophagitis and gastritis?

A

such as metoclopramide (Reglan), move food through the gastrointestinal system faster.

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16
Q

what is the mechanism of action of antacids that make it useful in the treatment of esophagitis and gastritis

A

such as aluminum and magnesium (Maalox), neutralize stomach acid.

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17
Q

what do proton pump inhibitors do that make them useful in the treatment of gastritis and esophagitis?

A

Proton pump inhibitors, such as lansoprazole (Prevacid), shut down the acid pump in the stomach.

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18
Q

what do Histamine (H2)-receptor antagonists do that make them useful in the treatment of gastritis and esophagitis?

A

Histamine (H2)-receptor antagonists, such as ranitidine (Zantac), block acid production.

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19
Q

Acid-protective agents, such as sucralfate or Carafate do what

A

provide a thick protective coat over the lower esophagus and stomach.

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20
Q

discharge instructions for the treatment of gastritis and esophagitis might include:

A

Avoid irritating substances (NSAIDs, alcohol)
Avoid foods which decrease pressure on lower esophagus (chocolate, fatty foods, onion, garlic, peppermint, spearmint, tea and coffee).
Avoid medications which relax the lower esophagus (anticholinergics, beta-blockers, calcium channel blockers, diazepam, morphine sulfate, nicotine, nitrates, progesterone, estrogen and theophylline)
Eat small meals
Elevate HOB on 6 - 8” blocks
Encourage weight loss and smoking cessation

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21
Q

Regardless of site of ulcer, typical pain is described as

A

“squeezing”, “indigestion”, “gnawing”, “colicky”, “aching” or “feeling of fullness” that is often epigastric and may radiate through to the mid back

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22
Q

what is the common demographic or age group affected by Duodenal ulcers and what causes and relieves pain?

A

Common between the ages of 30 and 55

•Pain starts prior to meals and is relieved by food or antacids

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23
Q

what is the common age group affected by gastric ulcers and when does the pain usually start?

A

Common between the ages of 55 and 70.

•Pain usually occurs after eating

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24
Q

describe the pain usually associated with cholecystitis

A

RUQ tenderness, guarding and rigidity, aggravated by taking a deep breath
Typically follows ingestion of fried ro fatty foods or ingestion of a large meal.
Murphy’s sign (inability to inhale deeply during palpation under the right costal margin near the liver).

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25
Q

define Murphy’s sign

A

inability of the patient to inhale deeply during palpation under the right costal margin

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26
Q

what is cholecystitis

A

acute or chronic inflammation of the gallbladder, usually caused by a gallstone that cannot pass

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27
Q

what are some of the signs and symptoms of cholecystitis?

A

pain, fever with infection, jaundice and dark urine

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28
Q

what is used to diagnose cholecystitis?

A

Elevated white blood cell count, serum and urine bilirubin and ALT.
Thickened gallbladder wall, gallstones and pericholecystic fluid on ultrasound.

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29
Q

what is the method used in the treatment of cholecystitis?

A 
IV fluids
 Antiemetics and analgesics
 NPO/Gastric tube
 Antibiotics
 Cholecystectomy after infection has subsided
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30
Q

what are the clinical manifestations of pancreatitis?

A

Pain - Rapid onset epigastric through to the back aggravated by eating, alcohol intake,
walking or lying supine but relieved by leaning forward or assuming fetal position
Abdomen tender to palpation
Abnormal labs include elevated WBC, serum amylase, serum glucose and serum triglycerides.

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31
Q

what are some Complications associated with pancreatitis

A

Pleural effusion and acute respiratory distress syndrome (ARDS), Pancreatic abscess and sepsis, Retroperitoneal bleeding and hypovolemia, hypocalcemia

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32
Q

how does pancreatitis lead to PE and ARDS?

A

Pancreatic inflammation can lead to activation of the inflammatory response with capillary permeability can lead to fluid accumulation in the lungs (ARDS) and pleural effusions.

33
Q

Pancreatic abscess and sepsis will manifest as

A

The infection can lead to pancreatic abscesses and sepsis. Symptoms may include a worsening fever, increasing abdominal pain and indications of sepsis.

34
Q

why does pancreatitis cause retroperitoneal bleeding and hypovolemia

A

Autolysis caused by release of pancreatic enzymes can cause bleeding from the pancreas and other abdominal structures. Signs and symptoms include hypotension, tachycardia, a diminishing hematocrit, abdominal distension, bruising of the flanks and umbilicus

35
Q

pancreatitis can cause hypo_______. What are the symptoms of this condition?

A

Symptoms include tetany and serum calcium levels below 8 mg/100 dL.

36
Q

how are Nitroglycerin or papaverine used to treat pancreatitis

A

relaxation of the smooth muscles

37
Q

how are Antispasmodics such as dicyclomine (Bentyl or propantheline bromide (Pro-Banthine) used to treat pancreatitis

A

Decrease vagal stimulation and release of pancreatic enzymes

38
Q

how are Carbonic anhydrase inhibitors such as acetazolamide or Diamox used to treat pancreatitis?

A

reduction on volume and concentration of pancreatic juices

39
Q

how are antacids effective in the treatment of pancreatitis?

A

neutralize gastric secretions

40
Q

how do Carbonic anhydrase inhibitor such as acetazolamide (Diamox) treat pancreatitis?

A

Reduction in volume and concentration of pancreatic juices)

41
Q

how do Histamine H2-receptor antagonists such as cimetidine (Tagamet) and ranitidine (Zantac) help with the treatment of pancreatitis?

A

decreases hydrochloric acid which can diminish pancreatic secretions

42
Q

how does calcium gluconate help with the treatment of pancreatitis?

A

it helps to alleviate hypocalcemia

43
Q

how do corticosteroids help with the treatment of pancreatitis?

A

treatment of sepsis

44
Q

how does glucagon help with the treatment of pancreatitis?

A

reduces the pancreatic inflammation and decreases serum amylase as well as suppressing pancreatic secretions

45
Q

how is hepatitis A transmitted and what are two notable details

A

transmission is through the fecal/ oral route. It causes epidemic and there is a vaccine available

46
Q

how is hepatitis B transmitted and what are two notable details

A

Parenteral/Sexual/ occupational exposure/ perinatal/human bites
Can be acute (< 6 months) or chronic (> 6 months)
• Vaccine available

47
Q

how is hepatitis C transmitted and what are two notable details

A

Parenteral/occupational exposure/deviant sexual practices, perinatal
50% become chronic
• May be asymptomatic at first

48
Q

how is hepatitis E transmitted and what are two notable details

A

Similar to Hepatitis A

• Rare in the USA, more common in Asia, Mexico and Africa

49
Q

what are the indications of liver dysfunction (10)

A

Elevated ammonia levels/decreased urea levels treated with lactulose
Decreased albumin and calcium levels with generalized edema and ascites, treated with albumin administration and
removal of fluid from the peritoneum
Lack of clotting factors leading to petechiae, easy bruising and bleeding, treatedwith vitamin K
Elevated serum and urine bilirubin, decreased fecal bilinogens.
Clay colored stools and dark colored urine which foams when shaken.
Jaundice
Steattorhea
Liver enzymes (ALP, SGOT, SGPT and GGT) elevate.
Albumin decreases
PT and PTT climb

50
Q

what liver enzymes are elevated with liver dysfunction?

A

Liver enzymes ALP, SGOT, SGPT and GGT elevate.

51
Q

what are the clinical manifestations of mild hepatitis

A

malaise, fatigue, anorexia, nausea and vomiting, right upper quadrant pain, joint pain

52
Q

what are the clinical manifestations of severe cases of liver dysfunction

A

jaundice, clay colored stools, dark colored urine

53
Q

treatment of liver dysfunction include what

A 
Acute cases must run their course
 Severity of chronic cases may be diminished with:
 Interferon-alpha
 Pegylated interferon
 Adefovir dipivoxil
 Lamivudine
 Riboflavin
54
Q

what is Steatorrhea

A

Chunky yellow foul

smelling fatty stools which float in toilet water

55
Q

what are the symptoms of appendicitis

A

Pain starts umbilical, then localizes to McBurney’s point in
the RLQ.
Pressure on the LLQ results in pain in the RLQ Rovsing’s
sign.
Flexion of the knees decreases pain
Pain may be in the RUQ in pregnant women
Elevated WBC
Fever
Vomit ing
Enlarged appendix on ultrasound or CT scan.

56
Q

what is involved in the treatment for appendicitis?

A

surgery

57
Q

what are the symptoms of peritonitis?

A 
Pain
 Diffuse abdominal pain which worsens with movement or coughing.
 Relieved with flexion of the knees
 Tenderness to palpation
 Rigid (washboard) abdomen.
 Fever/sepsis
 Decreased bowel sounds
 Dehydration/electrolyte imbalances
 Respiratory difficulties
58
Q

what is involved in the treatment of peritonitis?

A

NPO/Surgery
IV fluids and antibiotics
Analgesics/Antiemetics/Antipyretics

59
Q

what is diverticulitis and what are the clinical manifestations

A

Inflammation of the diverticula of the colon, usually the sigmoid colon.
Clinical manifestations
Generalized abrupt onset aching cramping pain which localizes to the LLQ.
Fever and WBC
Abdominal tenderness

60
Q

what is involved in the treatment of diverticulitis

A

NPO/gastric tube to rest bowel
IV fluid replacement
Antibiotics
Surgery for ruptured diverticuli

61
Q

what is pyloric stenosis and where is it found in the body

A

Marked hypertrophy and hyperplasia of the pylorus muscle and narrowing of the gastric antrum. The pylorus is found between the stomach and the small intestine.

62
Q

what is intussusception? Where does it usually present?

A

telescoping of the bowel within itself. Most common near the ileocecal valve or a Merkel’s diverticulum in adults, may occur near a colon tumor or polyp

63
Q

what demographic is most effected by pyloric stenosis?

A

95% occur during the first 3 - 12 weeks of life.

64
Q

what are the symptoms of pyloric stenosis

A

Projectile vomiting

  • Poor weight gain
  • Continual hunger and constipation
  • Jaundice
  • Gastric peristalsis prior to emesis
  • Mobile, hard, “olive” shaped mass over pylorus
  • Elevated bilirubin, hypochloremia, and hypokalemia
65
Q

what are the symptoms of intussusception?

A

Colicky pain associated with peristalsis. Child may sleep for 15 - 30 minutes, then scream with pain and pull legs to abdomen for 15-30 minutes, then fall back asleep

  • Lethargy and fever which worsen due to increased ischemia of the bowel.
  • Mucusy bloody stool that may look like grape jelly
  • Vomiting food, mucus or fecal matter
  • Increased bowel sounds during painful episodes
  • Tender, palpable “sausage-shaped” mass over the site of the intussusceptions in the right lower and middle abdomen
66
Q

Treatment for bowel obstruction

A 
IV fluids for fluid and electrolyte imbalance.
 Antiemetics and analgesics
 Rest the bowel (NPO and gastric tube)
 Barium enema - Intussusception
 Surgery -
 Volvulus
 Pyloric stenosis
 Indications of perforation
67
Q

what are some clinical manifestations of regional ileitis?

A 
Abdominal distension
- Anemia
- Weight loss
- Low-grade fever
- Nausea and Vomiting
- Dehydration and fluid/electrolyte
imbalances
- Abdominal cramping and
tenderness
- Flatulence
- 3 - 4 semi-soft stools daily with
no blood, some fat is present and
stools are foul smelling
68
Q

what is Ulcerative colitis?

A

Chronic inflammatory disease affecting only the
large intestine commonly in the sigmoid and
rectal areas.
• Affects only the mucosal and sub-mucosal layers

69
Q

what are the clinical manifestations of Ulcerative colitis?

A

Abdominal distension
• Anemia
• Weight Loss
• Fever
• Nausea and Vomiting
• Dehydration and fluid/electrolyte imbalances
• Abdominal cramping typically in the left lower
quadrant
• Diarrhea (5 - 25 stools/day) with blood, mucus
and pus but no fat
• Rectal Bleeding

70
Q

regional ileitis and Ulcerative colitis are categorized as what?

A

functional bowel syndromes

71
Q

what are the potential complications of functional bowel syndromes such as ulcerative colitis and regional ileitis?

A 
Fistulas (with regional ileitus)
 Intestinal obstructions
 Malnutrition
 Bowel perforation
 Toxic megacolon
72
Q

Most frequently injured abdominal organ

Associated with fractures of ribs 10 - 12 on the left.

A

spleen

73
Q

what are the signs and symptoms of an injured spleen?

A

LUQ pain (referred to left shoulder)
LUQ bruising
Hypovolemia
Signs of peritoneal irritability

74
Q

what are the signs and symptoms of an injured liver and what rib fx are associated with it locally?

A

RUQ pain (referred to right shoulder)
RUQ bruising
Hypovolemia
Rigid abdomen/rebound tenderness

75
Q

Which of the following lab values is likely to be decreased in a patient with cirrhosis of the liver?

a) Serum bilirubin
b) Serum ammonia
c) Blood urea nitrogen
d) Partial thromboplastin time

A

c) Blood urea nitrogen

76
Q

Which of the following presentations is most consistent with a patient who has pancreatitis?

a. Epigastric pain that radiates to the umbilical region
b. Epigastric pain that radiates midline through to the back
c. Left upper quadrant pain that radiates to the left shoulder
d. Right upper quadrant pain that radiates to the right shoulder

A

b. Epigastric pain that radiates midline through to the back

77
Q

Which of the following conditions will likely go directly to the operating room from the emergency department?

a. Pancreatitis
b. Cholecystitis
c. Ulcerative colitis
d. Boerhaave’s syndrome

A

d. Boerhaave’s syndrome

78
Q

The emergency nurse knows a patient with end stage cirrhosis of the liver has understood their discharge instructions if they state that they will minimize their intake of:

a) Starch
b) Protein
c) Carbohydrates
d) Fresh fruits and vegetables

A

b protein

79
Q

what is renal colic?

A

accumulation of materials within the renal pelvis into a stone which typically exits out the genitourinary system causing significant discomfort.

ACLS (6 decks)

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