adult gi Flashcards
(211 cards)
1
Q
gastroesophageal reflux disease
A
upper gastrointestinal disease caused by reflux of gi contents into esophagus; relaxation of lower esophageal sphincter
2
Q
gastroesophageal reflux disease
A
relaxation of lower esophageal sphincter
3
Q
gerd: causes
A
- fatty foods, caffeinated bevs, chocolate, citrus, tomatoes
- stress
- body habitus
- gastric anatomy
4
Q
gerd: effects
A
- esophageal stricture
- esophagitis, erosion, ulceration
- aspiration
- barrett’s epithelium
5
Q
barrett’s epithelium
A
COLUMNAR epithelium instead of normal SQUAMOUS cell that develops in lower esophagus when healing from gerd (exposed to acid, pepsin)
considered premalignant, associated with increased risk of CANCER after prolonged disease.
6
Q
gerd: manifestations/dx
A
not much objective, rely on patient report: dyspepsia, regurgitation, dysphagia, odynogphagia
crackles (aspiration)
7
Q
odynophagia
A
painful swallowing
8
Q
barrett’s esophagus: interventions
A
- esophagectomy
- ablative therapy: radiofrequency, photodynamic, cryotherapy
9
Q
esophagectomy
A
remove esophagus, reanastemose stomach to what’s left of upper esophagus.
because stomach stretched and in the thoracic cavity, exposed to pressures from lungs. HIGH RISK OF ASPIRATION.
10
Q
hiatal hernia
A
protrusion of stomach through diaphragm
high risk for aspiration
11
Q
hiatal hernia: effects
A
gerd, impaired esophageal emptying, volvulus
12
Q
volvulus
A
obstruction of bowel caused by twisting of bowel
13
Q
hiatal hernia: manifestations
A
s: chest pain, breathlessness, worse when lying down
o: belching, dysphagia
14
Q
hiatal hernia: eating habit modification
A
more frequent small meals closer together = easier to manage
15
Q
esophageal varices
A
dilation of esophageal and gastric veins
- high risk of bleeding, associated with cirrhosis (liver failure, blood backs up into portal veins then into mesoteric veins, then vessels in esophagus)
16
Q
hiatal hernia: nursing implications (3)
A
- caution with ng tube placement
- monitor vitals: slow downward trend (HR higher, BP lower)
- hypovolemic shock, signs of bleeding in stools (extreme situation)
17
Q
gastritis
A
inflammation of stomach lining!
- acute v chronic
18
Q
gastritis: causes
A
- increased acid production
- decreased protective mechanism
- exposure to irritants (chemical ingestion, bleach)
- meds/therapies (chemo, radiation)
- h. pylori
19
Q
gastritis: compromised protective mechanisms
A
- mucus
- bicarb (acids go wild)
- blood flow
- prostaglandins (pivotal in production of mucus & bicarb)
20
Q
pivotal in production of mucus, bicarb in stomach
A
prostaglandins
21
Q
acute gastritis: effects
A
localized;
- thickened, irritated rugae
- mucosal necrosis in isolated area
- edema, swelling
healing, regeneration usually within a few days
22
Q
chronic gastritis: effects
A
diffuse/generalized;
- gastric atrophy
- impaired absorption
23
Q
gastritis: manifestations
A
s: anorexia, nausea, dyspepsia, cramping
o: epigastric pain, vomiting, hematemesis, melena
24
Q
dyspepsia
A
indigestion, heartburn following meals
25
hematemesis
blood vom
26
peptic ulcer disease
impairment of gastric mucosal defenses so they no longer protect the epithelium from the effects of acid and pepsin;
localized tissue erosion in stomach or duodenum;
27
melena
blood in stool: black tarry
28
peptic ulcer disease
localized tissue erosion in stomach or duodenum
29
peptic ulcer disease: causes
- h. pylori
- stress (ICU patients 15%)
- nsaid exposure
30
peptic ulcer disease: effects
- upper gi bleeding
- coffee ground emesis
- perforation
- peritonitis
- septic shock
31
coffee ground emesis sign of
peptic ulcer disease
32
melena, hematemesis sign of
gastritis
| upper gi bleed
33
pain left of midline with food sign of
gastric ulcer
34
pain right of midline 1.5 to 3 hours after food
duodenal ulcer
35
peptic ulcer disease: manifestations
s: sharp abdominal pain, dyspepsia
o: acute abdomen, pain left of midline with food (gastric ulcer), pain right of midline 1.5 to 3 hours after food (duodenal ulcer)
36
acute abdomen
firm, hard abdomen, severe pain
37
acute abdomen sign of
peritonitis
38
pain left of midline with food sign of
gastric ulcer
39
pain right of midline 1.5 to 3 hours after food
duodenal ulcer
40
upper gi bleed
varying degrees of severity: can vary from trickle to massive, fulminant barfing
41
upper gi bleed: effects
- risk of hemodynamic instability
- hypovolemia
- anemia
- hemodilution, f&e imbalances
42
upper gi bleed: manifestations
s: minimal complaints -> abdominal pain, hematemesis, melena
o: vitals, presyncope, lethargy, hypoperfusion, hematemesis, melena
43
presyncope
lightheadedness
44
hypoperfusion
crummy capillary refill, weak pulses; cool/pale/clammy
45
mallory-weiss tears
tear in mucosal lining of lower esophagus/upper stomach; occurs with longterm vomiting, coughing
46
upper gi bleed: nursing implications
- fluid replacement (revive circulating volume)
- packed rbc transfusion (prevent hemodilution)
- ngt placement to prevent mallory-weiss tears
- meds, dx, surgery possible
47
gastric cancer
often associated with chronic gastritis, h. pylori
- tumor invasion to surrounding tissues
- VERY FEW SYMPTOMS
48
gastric cancer: manifestations
dyspepsia, abdominal/epigastric pain, back pain, weight loss, n/v
49
gastric cancer: interventions
- radiation, chemo
| - surgical resection (partial or total gastrectomy)
50
dumping syndrome
rapid transit of nutrients through gi tract
51
mucoid stools sign of...
iritable bowel syndrome
52
dumping syndrome: management
- numerous small meals
- increased fiber (increased bulk = increased transit time)
- limit sugars (irritant, speeds up motility)
- cautious fluid intake
53
dumping syndrome: management
- numerous small meals
- increased fiber (increased bulk = increased transit time)
- limit sugars (irritant, speeds up motility)
- cautious fluid intake
54
irritable bowel syndrome
altered bowel motility: increased/decreased transit time
| - unclear etiology: inflammatory, bacterial, genetic, stress
55
ibs: effects
diarrhea, constipation, abdominal pain, bloating
56
ibs: manifestations
s: abdominal pain, mucoid stools, inconsistent bowel pattern
o: llq pain, observe stool variations
57
mucoid stools sign of...
iritable bowel syndrome
58
hernia
intestinal protrusion through weakened muscle layer (abdominal wall, diaphragm)
59
reducible/irreducible hernia
can be placed back into abdominal cavity by gentle pressure
cannot be reduced/placed back into abdominal cavity: requires IMMEDIATE surgical evaluation
60
hernia: strangulation
blood supply to herniated segment of bowel is cut off by pressure from the hernial ring (band of muscle around the hernia) --> ischemia, obstruction of bowel loop --> can lead to necrosis, perforation
61
hernia: incarceration
irreducible hernia
62
hernia: effects
- pain (not always), discomfort
- ischemic bowel
- sepsis
- body image alteration
- adl impairment
63
hematochezia
blood in stool: via rectum, bright red
64
occult blood
in stool but not readily apparent
65
hernia: manifestations
s: pain, mass, nausea
o: v, abd tenderness, vitals variability, palpable mass, weakened muscle wall
66
hernia: nursing implications
core strengthening! supportive devices, minimize heavy lifting, weight management
67
colorectal cancer
colon + rectum = large intestine; common
| - often metastasizes to liver
68
colorectal cancer: initial presentation
polyp, 55% in rectum and sigmoid colon
69
colorectal cancer: associated with
hpv, smoking, alcohol, physical inactivity
70
colorectal cancer: manifestations
s: rectal bleeding, abdominal pain, difficulty passing stool
o: hematochezia, anemia, occult blood, carcinoembryonic antigen
71
hematochezia
blood in stool: via rectum, bright red
72
occult blood
in stool but not readily apparent
73
colostomy
surgical creation of opening between colon and surface of abdomen
74
high pitched/absent bowel sounds are a sign of...
bowel obstruction
75
ascending colostomy
for right sided tumors
76
descending colostomy
for left sided tumors
77
sigmoid colostomy
for rectal tumors
78
transverse (double-barrel) colostomy
often used in EMERGENCIES (intestinal obstruction, performation) because it can be created quickly.
TWO stomas: proximal (closest to small intestine) drains feces, distal drains mucus
79
transverse (double-barrel) colostomy
often used in EMERGENCIES (intestinal obstruction, performation) because it can be created quickly.
TWO stomas: proximal (closest to small intestine) drains feces, distal drains mucus
80
mechanical bowel obstruction
intussusception, volvulus, adhesions
81
maroon stools sign of
lower gi bleed
82
visible blood clots in stools sign of
lower gi bleed
83
nonmechanical bowel obstruction
ileus (can happen as a result of handling bowels during surgery, they are "paralyzed" temporarily)
84
bowel obstruction: effects
- fluid/electrolyte alterations
- metabolic alkalosis
- nutritional alterations
85
bowel obstruction: manifestation
s: abdominal pain, nausea, no flatus/stool (diarrhea)
o: abdominal pain/distension, vomiting, high pitched/absent bowel sounds
86
steatorrhea sign of
malabsorption syndromes
| + celiac disease in children
87
high pitched/absent bowel sounds are a sign of...
bowel obstruction
88
hemorrhoids
swollen/distended veins of anorectal region, increased intraabdominal pressure
- internal v external
89
rebound tenderness sign of
peritonitis/appendicitis
90
hemorrhoids: manifestations
s: rectal pain/itching, rectal bleeding/mucoid discharge
o: visible external, thrombosed hemorrhoid, bright red blood after wiping
91
lower gi bleed
passage of blood directly into the large bowel
92
rlq pain sign of
appendicitis
93
llq pain sign of
irritable bowel syndrome
| diverticulitis
94
lower gi bleed: causes
diverticulitis, polyps, colitis (c diff), malignancy
95
diverticula
sacs resulting from herniation of mucosa and submucosa of tubular organ into surrounding tissue
96
lower gi bleed: manifestations
s: abdominal pain/cramps, passing of clots with bowel movements, frequent stools
o: hematochezia, maroon stools, visible blood clots
97
maroon stools sign of
lower gi bleed
98
visible blood clots in stools sign of
lower gi bleed
99
malabsorption syndromes (+ types)
deterioration of colonic wall: thinning, flattening
- inability of appropriate nutritional absorption
deficiencies: bile salt, enzyme
bacteria (c diff), disruption of mucosal lining (ulcers, gastritis, etc)
altered lymphatic/vascular circulation
decreased gastric/intestinal surface (surgery or disease)
100
minimal movement due to pain sign of
peritonitis
101
malabsorption syndromes: assessment
- chronic diarrhea, steatorrhea
- bloating, flatus
- anemia
- edema
102
malabsorption syndromes: assessment
- chronic diarrhea, steatorrhea
- bloating, flatus
- anemia
- edema
103
steatorrhea sign of
malabsorption syndromes
| + celiac disease in children
104
frequent loose stools sign of
gastroenteritis
105
appendicitis
blockage of the lumen of the appendix
accumulation of secretions within the appendix leading to inflammation, gangrene, rupture
106
appendicitis: effects
- abscess
- peritonitis (rebound tenderness)
- perforation
- sepsis
107
tenesmus
sudden urges to defecate
108
rebound tenderness sign of
peritonitis/appendicitis
109
tenesmus sign of
ulcerative colitis
110
blood & mucus in stool sign of
ulcerative colitis
111
ileum
final section of small intestine
112
appendicitis: assessment
s: nausea, anorexia, abdominal pain
o: vomiting, rlq pain, rebound > deep palpation, fetal position
113
rlq pain sign of
appendicitis
114
llq pain sign of
irritable bowel syndrome
115
peritonitis
inflammation of the visceral/parietal layers of the abdominal cavity; usually bacterial
116
perianal ulcers and fissures sign of
crohn's disease
117
severe diarrhea sign of
crohn's disease
118
peritonitis is usually due to...
bacterial infection
119
peritonitis: effects
- abscess formation
- ascites
- hypovolemia
- decreased peristalsis
- increased intraabdominal pressure
- usually due to significant abdominal trauma
120
ascites
accumulation of free fluid within the peritoneal cavity; increased hydrostatic pressure from portal hypertension causes this fluid to leak into the peritoneal cavity
121
peritonitis: effects
- abscess formation
- ascites
- hypovolemia
- decreased peristalsis
- increased intraabdominal pressure
- usually due to significant abdominal trauma
122
ascites
accumulation of free fluid within the peritoneal cavity; increased hydrostatic pressure from portal hypertension causes this fluid to leak into the peritoneal cavity
123
peritonitis: manifestations
s: generalized abdominal pain, comfort through no movement
o: low grade fever, minimal movement, guarding, abdominal pain/tenderness
124
minimal movement due to pain sign of
peritonitis
125
gastroenteritis
inflammation of stomach and intestinal mucosa with frequent, watery stools
- bacterial OR viral
- self-limiting
126
gastroenteritis: effects
secretions of fluid & electrolytes into bowel
| increased gi motility
127
gastroenteritis: manifestations
s: possible exposure/history, nausea, diarrhea, fatigue/malaise
o: vomiting, frequent loose stools
128
frequent loose stools sign of
gastroenteritis
129
ulcerative colitis
widespread inflammation, may be extensive. rectum and rectosigmoid colon
- edematous mucosa
- erosions, ulcers develop
130
jaundice sign of
cirrhosis
131
liver tenderness sign of
cirrhosis
132
ulcerative colitis: effects
- stools with blood & mucous
- intraabdominal abscesses
- tissue necrosis (lack of blood flow)
- tenesmus
133
tenesmus
sudden urges to defecate
134
ulcerative colitis: manifestations
s: tenesmus, cramping
o: tachycardia/fever, distension
135
itching due to bile salt accumulation in skin sign of
hepatitis
136
tenesmus sign of
ulcerative colitis
137
ulcerative colitis
chronic inflammatory process affecting mucosal lining of rectum/colon; widespread (sometimes extensive) inflammation
- intestinal mucosa becomes hyperemic, edematous
- erosions, ulcers, bleeds develop
138
blood & mucus in stool sign of
ulcerative colitis
139
llq pain sign of
irritable bowel syndrome
| diverticulitis
140
ulcerative colitis
chronic inflammatory process affecting mucosal lining of colon or rectum; widespread (sometimes extensive) inflammation
- edematous mucosa
- erosions, ulcers develop
141
blood & mucus in loose stool sign of
ulcerative colitis
142
crohn's disease
inflammatory disease of small intestine (most often), colon, or both. can affect tract from mouth to anus but most commonly affects terminal ileum.
- slowly progressive, unpredictable
- frequent remission, exacerbation
- transmural inflammation causes thickened bowel wall
143
crohn's disease: effects
- fistula formation
- bowel perforation
- severe diarrhea
- malabsorption
144
crohn's disease: assessment
s: weight loss, abdominal pain, diarrhea
o: distension, perianal ulcers/fissues
145
dark foamy urine sign of
cholecystitis
146
clay-colored feces sign of
cholecystitis
147
perianal ulcers and fissures sign of
crohn's disease
148
severe diarrhea sign of
crohn's disease
149
diverticular disease
pouch-like herniations of mucosa
- diverticulosis, diverticulitis
- blockage is a concern (ex: nuts, seeds)
150
diverticular disease: effects
perforation, intraabdominal abscess, peritonitis, lower gi bleed
151
diverticulosis
presence of many abnormal pouchlike herniations (diverticula) in wall of intestine
152
third spacing a sign of
pancreatitis
153
if you give someone with pancreatitis something to eat...
it will stimulate their irritated pancreas, so don't do that shit.
NOT EVEN ICE CHIPS OR SIPS YO
154
diverticulitis
inflammation of one or more diverticula
155
severe abdominal pain radiating to back and left side sign of
pancreatitis
156
steatorrhea sign of
malabsorption syndromes
+ celiac disease in children
if + clay-colored feces, cholecystitis
157
ascites
accumulation of free fluid within the peritoneal cavity; increased hydrostatic pressure from portal hypertension causes this fluid to leak into the peritoneal cavity
liver creates albumin for blood; in ascites liver unable to create as much
158
diverticular disease
pouch-like herniations of mucosa, most commonly colon
- diverticulosis, diverticulitis
- blockage is a concern (ex: nuts, seeds)
159
diverticulitis
inflammation of one or more diverticula
160
cirrhosis
extensive, irreversible SCARRING of liver; response to chronic inflammation (due to: hep c, alcoholism, biliary obstruction aka scar tissue, hep b & d)
end stage!!!
161
cirrhosis: effects
- obstructed bile, blood flow
- jaundice (can't extract bilirubin from blood)
- portal hypertension, esophageal varices, ascites
- coagulation defects
- hepatorenal syndrome
- spontaneous bacterial peritonitis
- hepatic encephalopathy
162
hepatorenal syndrome
state of progressive oliguric renal failure associated with hepatic failure, resulting in functional impairment of kidneys with normal anatomic, morphologic features. poor prognosis for hepatic failure patient, often cause of death in patients with CIRRHOSIS
163
hepatic encephalopathy
clinical disorder seen in hepatic failure, CIRRHOSIS; manifested by neurologic symptoms, characterized by altered level of consciousness, impaired thought process, neuromuscular disturbances; aka "hepatic coma" aka "portal-systemic encephalopathy"
164
cirrhosis: manifestations
s: contributing fh, sh, pmh; anorexia, nausea, abdominal pain
o: distension, liver tenderness, jaundice/icteric, liver function panel
165
jaundice sign of
cirrhosis
166
liver tenderness sign of
cirrhosis
167
hepatitis
catch all term for liver inflammation
| - causes: viral, medication, toxin, non-hepatitis viruses
168
hepatitis: effects
acute, chronic hepatitis; hepatocellular carcinoma
169
hepatitis: manifestations
s: pmh, fh, sh; flulike sx, abdominal pain, n/v
o: lab findings (hep titers), abdominal pain, jaundice, itching (bile salts accumulate in skin)
170
itching due to bile salt accumulation in skin sign of
hepatitis
171
hepatitis: nursing implications
hand washing, food sanitation, cautious sexual practices, vaccination, clean needle programs
172
cholecystitis
inflammation of gallbladder; acute v chronic
173
cholecystitis: effects
- necrosis
- perforation
- acute --> chronic
- - fibrous
- - dyskinetic
174
acute cholecystitis types (2)
calculous (cholelithiasis), acalculous
175
cholelithiaisis aka
aka calculous cholecystitis -- ACUTE!
- chemical irritation, inflammation result from gallstones (cholelithiasis) that obstruct cystic duct, gallbladder neck, or common bile duct
176
acalculous cholecystitis
inflammation NOT due to gallstones -- ACUTE!
| - typically associated with biliary stasis caused by any condition that affects regular filling/emptying of gallbladder
177
chronic cholecystitis
results when repeated episodes of cystic duct obstruction cause chronic inflammation: gallbladder becomes fibrotic and contracted (decreased motility, deficient absorption)
- calculi almost always present
fibrous, dyskinetic
178
cholecystitis: manifestations
s: pruritis, epigastric pain referred to right shoulder, intolerance of fatty foods
o: jaundice, clay-colored feces & steatorrhea, dark foamy urine
179
dark foamy urine sign of
cholecystitis
180
clay-colored feces sign of
cholecystitis
181
cholecystitis: nursing implications
```
surgical intervention (cholecystectomy, biliary drain)
- let infectious process decrease BEFORE doing surgery so infectious bile won't explode all over peritoneum resulting in peritonitis
```
182
pancreatitis
inflammatory process of the pancreas
- premature activation of pancreatic enzymes; autodigestion (also of other internal organs)
POTENTIALLY LIFE THREATENING
183
pancreatitis: effects
- edema, inflammation, hemmorhage
- necrosis, abscess formation
- third spacing (LOTS)
- endocrine, exocrine dysfunction
- MODS, ARDS, shock
- chronic pancreatitis, pseudocyst
184
pancreatitis: effects
- edema, inflammation, hemmorhage
- necrosis, abscess formation
- third spacing (LOTS)
- endocrine (insulin), exocrine (enzymes) dysfunction
- MODS, ARDS (pancreas sits under diaphragm!), shock
- chronic pancreatitis, pseudocyst
185
third spacing
fluid moves from vascular to interstitial space, resulting in shock
186
third spacing a sign of
pancreatitis
187
if you give someone with pancreatitis something to eat...
it will stimulate their irritated pancreas, so don't do that shit.
NOT EVEN ICE CHIPS OR SIPS YO
188
pancreatitis: manifestations
s: severe abdominal pain radiating to back and left side, n/v, pmh (significant etoh), sh
o: acute abdomen, lipase/amylase, decreased bowel sounds
189
severe abdominal pain radiating to back and left side sign of
pancreatitis
190
sphincter of oddi
muscular valve surrounding bile duct and pancreatic duct at beginning of duodenum; only opens in response to meal so juices can enter and mix with food
191
pancreatitis: pain management considerations
morphine: can cause spasm of sphincter of oddi!
nsaid: platelet affect, so careful if hemmorhagic pancreatitis
dilaudid, fentanyl work great
192
whipple procedure
- aka pancreaticoduodenectomy; for pancreatic cancer
resection of: head of pancreas, full duodenum, portion of jejunum and stomach and gallbladder, then sewing dat shit back together (pancreas to jejunum, common bile duct to jejunum, stomach to jejunum). spleen may go byebye too.
193
esophageal pH monitoring
for gerd - constant recording of pH of esophagus to dx reflux
194
upper gi series
similar to barium swallow + fluoroscopy
195
esophagogastroduodenoscopy
poke around to check squamus v columnar changes in esophagus, can also stick band around esophageal varices to make it necrose and fall off
196
esophageal dilation
balloon opens lower esophageal sphincter to restore flow
- risk rupture = emergent situation
197
endoscopic ultrasound
allows provider to evaluate depth of tumor, presence of lymph node involvement = more accurate staging of disease
198
endoscopic retrograde cholangiopancreatography (ercp)
visual, radiographic examination of liver, gallbladder, bile ducts, pancreas via endoscope + radiopaque dye to identify cause, location of obstruction
you can put stents in!
199
capsule endoscopy
camera goes down the hatch and out the back door! find source of bleed in that tangled mess.
200
hepatobiliary iminodiacetic acid (hida) scan
dye shows where bile leak is; shows path of tracer over time
201
transjugular intrahepatic portosystemic shunt (tips)
non-surgical procedure: enter through jugular > SVC > IVC > hepatic vein to insert the bypass (sheath + stent + balloon) through the liver - alleviates symptoms of extreme cirrhosis; also controls long-term ascites, reduces variceal bleeding
LOTS of risks, so rare usage.
202
transjugular intrahepatic portosystemic shunt (tips)
non-surgical procedure: enter through jugular > SVC > IVC > hepatic vein to insert the bypass through the liver - alleviates symptoms of extreme cirrhosis; also controls long-term ascites, reduces variceal bleeding
LOTS of risks, so rare usage.
203
paracentesis
trocar catheter inserted into abdomen to drain ascitic fluid from peritoneal cavity; removal of all fluid could lead to hemodynamic collapse.
ps. body will create more fluid to fill up space again.
204
positron emission tomography (pet)
injection of molecule tagged with isotope, which emits activity in form of positrons that are picked up by computer. highlights areas of active metabolism, specifically, cancer cells - more definitive than ct or mri
205
computed tomography (ct) scan
x-ray images at many angles processed by computer to create horizontal levels (slices), results: cross sectional 3d pictures. iv contrast can be used to visualize bits on x-ray.
iodine/shellfish allergy = BIG NO NO (or premed)
206
tagged red blood cell
finds bleeds that can't be found in traditional fashion; results within 1 or 2 hours
207
paracentesis
remove fluid if medically indicated; removal of all fluid could lead to hemodynamic collapse. however, body will also create more fluid to fill up space you are removing from.
208
positron emission tomography (pet)
highlights areas of active metabolism, specifically, cancer cells - more definitive than ct or mri
209
computed tomography (ct) scan
iv contrast used to visualize bits on x-ray;
iodine/shellfish allergy = BIG NO NO (or premed)
210
magnetic resonance imaging (mri)
picks up densities using magnetic fields
high definition but longer to process, iv contrast can be given
211
epigastric pain referred to right shoulder sign of
cholecystitis
