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Flashcards in adult gi Deck (211):
1

gastroesophageal reflux disease

upper gastrointestinal disease caused by reflux of gi contents into esophagus; relaxation of lower esophageal sphincter

2

gastroesophageal reflux disease

relaxation of lower esophageal sphincter

3

gerd: causes

- fatty foods, caffeinated bevs, chocolate, citrus, tomatoes
- stress
- body habitus
- gastric anatomy

4

gerd: effects

- esophageal stricture
- esophagitis, erosion, ulceration
- aspiration
- barrett's epithelium

5

barrett's epithelium

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

gerd: manifestations/dx

not much objective, rely on patient report: dyspepsia, regurgitation, dysphagia, odynogphagia

crackles (aspiration)

7

odynophagia

painful swallowing

8

barrett's esophagus: interventions

- esophagectomy
- ablative therapy: radiofrequency, photodynamic, cryotherapy

9

esophagectomy

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

hiatal hernia

protrusion of stomach through diaphragm

high risk for aspiration

11

hiatal hernia: effects

gerd, impaired esophageal emptying, volvulus

12

volvulus

obstruction of bowel caused by twisting of bowel

13

hiatal hernia: manifestations

s: chest pain, breathlessness, worse when lying down
o: belching, dysphagia

14

hiatal hernia: eating habit modification

more frequent small meals closer together = easier to manage

15

esophageal varices

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

hiatal hernia: nursing implications (3)

- caution with ng tube placement
- monitor vitals: slow downward trend (HR higher, BP lower)
- hypovolemic shock, signs of bleeding in stools (extreme situation)

17

gastritis

inflammation of stomach lining!
- acute v chronic

18

gastritis: causes

- increased acid production
- decreased protective mechanism
- exposure to irritants (chemical ingestion, bleach)
- meds/therapies (chemo, radiation)
- h. pylori

19

gastritis: compromised protective mechanisms

- mucus
- bicarb (acids go wild)
- blood flow
- prostaglandins (pivotal in production of mucus & bicarb)

20

pivotal in production of mucus, bicarb in stomach

prostaglandins

21

acute gastritis: effects

localized;
- thickened, irritated rugae
- mucosal necrosis in isolated area
- edema, swelling

healing, regeneration usually within a few days

22

chronic gastritis: effects

diffuse/generalized;
- gastric atrophy
- impaired absorption

23

gastritis: manifestations

s: anorexia, nausea, dyspepsia, cramping

o: epigastric pain, vomiting, hematemesis, melena

24

dyspepsia

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