Chapter 13 Abdomen and GI System Flashcards
(140 cards)
1
Q
The abdominal cavity is the largest cavity within the human body. It contains the?
A
stomach, intestines, liver, gallbladder, pancreas, spleen, kidneys, ureters, bladder, adrenal glands, and large vessels.
- in women the uterus, fallopian tubes, and ovaries are located w/in the abdominal cavity
- lying outside the cavity is the esophagus
2
Q
The peritoneum is a?
A
membrane that forms a protective cover over the abdominal cavity.
-two layers: parietal peritoneium and the visceral peritoneium
3
Q
Parietal peritonium
A
lines abdominal wall
4
Q
Visceral peritonium
A
covers organs
5
Q
The main function of the alimentary tract is?
A
ingest and digest foods, absorb nutrients, and excrete waste.
-products of digestion are moved along the digestive tract by peristalsis, under the control of the autonomic nervous system
6
Q
Adult alimentary tract extends?
A
27 feet (8.2 m)
7
Q
Esophagus
A
10 inches (25.4 cm) long connecting the pharynx to stomach & extending posterior to trachea through the mediastinal cavity & diaphragm -usual pH is 6.0-8.0
8
Q
Stomach
A
Hollow, flask-shaped, muscular organ located directly below diaphragm in LUQ
- contents from esophagus enter stomach through lower esophageal sphincter and mix w/digestive enzymes and hydrochloric acid
- gastric acid continues breakdown of carbohydrates that began in mouth
- pepsin breaks down proteins, converting them to peptones and amino acids
- gastric lipase acts on emulsified fats to convert triglycerides to fatty acids and glycerol
- stomach liquifies food into chyme & propels it into duodenum of small intestine
- pH 2.0-4.0
- pyloric sphincter regulates outflow of chyme into duodenum
9
Q
Small intestine
A
longest section of alimentary tract
- 21 feet (6.4 m) long, beginning at pylori orifice and joining the large intestine at the ileocecal valve
- ingested food is mixed, digested, & absorbed
- 3 segments: duodenum, jejunum, ileum
- duodenum occupies first 1 foot (30 cm) & forms a C-shaped curve around head of pancreas
- absorption occurs through intestinal villi of duodenum, jejunum (8 feet [2.4 m] long), & ileum (12 feet [3.6 m] long)
- ileocecal valve between the ileum and large intestine prevents backward flow of fecal material
10
Q
Large intestine (Colon) and Rectum
A
5 feet (1.5 m) long, consisting of cecum, appendix, colon, rectum, anal canal
- ileal contents empty into cecum through ileocecal valve; appendix extends from base of cecum
- colon divided into 3 parts: ascending, transverse, descending
- end of descending colon turns medially and inferiorly to form the S-shaped sigmoid colon
- rectum extends from sigmoid colon to pelvic floor, where it continues as the anal canal, terminating at anus
- large intestine absorbs water and electrolytes
- feces are formed in large intestine and held until defecation
11
Q
Accessory organs of the GI tract?
A
Salivary glands, liver, gallbladder, pancreas
12
Q
Liver
A
largest organ in the body (3.5 lbs) lying under the right diaphragm, spanning the UQ of the abdomen from the fifth intercostal space to slightly below the costal margin and has a variety of functions.
-Some of the functions of the liver include bile production and secretion; synthesis of most plasma proteins (albumin and globulin), carbohydrate, and fat metabolism; glucose storage; and production of clotting factors & fibrinogen,, and detoxification of a variety of substances including drugs and alcohol
13
Q
The gallbladder is attached to the?
A
liver and concentrates/stores the bile that is produced in the liver.
- pear shaped sac, 3 inches (7.6 cm)
- cystic duct combines w/hepatic duct to form the common bile duct, which drains bile into the duodenum
- bile contained in feces creates the brown color
14
Q
Pancreas
A
lies in upper left abdominal cavity, under the left lobe of the liver, behind the stomach
- has both endocrine and exocrine functions
- endocrine secretions include: release of insulin, glucagon, somatostatin, and gastrin for carbohydrate metabolism
- exocrine secretions contain bicarbonate & pancreatic enzymes that flow into the duodenum
- lipase breaks down fats, amylase breaks down carbohydrates, protease breaks down proteins for absorption
15
Q
Spleen
A
Highly vascular, concave, encapsulated organ about the size of a fist, situated in ULQ
- two systems: white pulp (consisting of lymphatic nodules and diffuse lymphatic tissue) and red pulp (venous sinusoids)
- functions: removal of old or agglutinated erythrocytes and platelets and activation of B & T lymphocytes
16
Q
The urinary tract is responsible for?
A
The removal of water-soluble wastes. The urinary tract is composed of the kidneys, ureters, bladder, and urethra.
17
Q
Kidneys
A
Located posterior abdominal cavity on either side at the spinal levels T12 through L3
- partially protected by ribs and a cushion of fat and fascia
- R kidney slightly lower than L kidney
- functions: secretion of erythropoietin to stimulate RBC production & production of a biologically active form of vitamin D
- nephron regulates fluid & electrolyte balance through filter and pressure system that produces urine
18
Q
Ureters
A
Long, intertwining muscle bundles that extend for approximately 12 inches (30 cm) to insertion points at base of bladder
19
Q
Some chronic diseases such as diabetes mellitus may affect the GI or urinary systems. Diseases such as?
A
chronic hepatitis or cirrhosis may impair the ability of the liver to metabolize nutrients and drugs
20
Q
Because drugs are metabolized in the liver, they may not be metabolized well in patients with liver diseases, which causes?
A
increased blood levels of these drugs
21
Q
Patients who have had bariatric procedures for weight loss or gastrectomies ay have changed the?
A
Foods they eat and the amount and frequency of meals
22
Q
Patients may have a colostomy or an ileostomy after surgery for such disorders as?
A
Colon cancer or ulcerative colitis
23
Q
Patients who have had bladder cancer may have an?
A
Ileal conduit as an alternative route for urine excretion
24
Q
Stress incontinence is?
A
The most common type & is characterized by involuntary loss of small amounts of urine during physical exertion such as coughing, sneezing, jogging, and lifting
-many women with urinary stress incontinence can be diagnosed from the history data alone
25
Urge incontinence is?
Associated w/a sudden strong urge to void
| -people can have both types (stress & urge)
26
Risk factors for esophageal cancer
- age: increases w/age. less than 15% of cases are younger than 55yrs
- gender: men 3x greater
- gastroesophageal reflux disease: higher risk of adenocarcinoma of esophagus
- Barrett's esophagus: associated w/long term gastroesophageal reflux & results in higher risk
- Smoking: longer they smoke the greater the risk
- Alcohol use: long term use increases risk. Alcohol+smoking=higher risk
- obesity: increases risk of esophageal reflux
- diet: high in processed meats and low in fruits and vegies increases risk
- workplace exposure: exposures to chemical fumes such as solvents used by dry cleaners increases risk
- injury to esophagus: Lye is a chemical found in drain cleaners that is a corrosive agent. Accidentally drinking from a lye-based cleaner bottle can cause severe chemical burn in the esophagus and stictures that can increase cancer risk
27
Stomach cancer risk factors
- Gender: men
- age: increase after 50, most diagnosed between 60-80
- race: higher in hispanic americans, african americans, asian/pacific islanders
- where they live: worldwide, stomach cancer more common in Japan, China, Southern & Eastern Europe, South and Central America
- Infection: Helicobacter pylori infection major cause
- Diet: large amounts of smoked foods, salted fish and meat, pickled vegies
- smoking
- previous stomach injury: surgery such as peptic ulcer
- blood type: blood type A
- Family history: first-degree family member with stomach cancer
- Work environment: workers in coal, metal, and rubber industries have higher risk
28
Colorectal cancer risk factors
- Diet: high in red and/or processed meats
- Physical activity: lack of regular exercise
- obesity: stronger association observed in men
- smoking
- alcohol
- age: 90% over 50
- personal history of colorectal polyps or colorectal cancer: history of adenomatous polyps. Even if colorectal cancer was removed it can develop cancers elsewhere
- personal history of chronic inflammatory bowel disease: inflammatory bowel disease (IBD) includes Crohn disease or ulcerative colitis. People w/IBD often develop dysplasia that can change to cancer
- family history: first-degree relative
- Inherited syndrome: 5-10% of those who develop colorectal cancer have inherited gene defects
29
GERD is associated with mutation of?
G-protein beta 3 subunit gene (GNB3)
30
Genetic factors play a role in the acquisition of Helicobacter pylori infection causing?
Peptic ulcer disease
31
People with a first-degree relative who have had stomach cancer are?
More likely to develop this disease
32
People with a history of colorectal cancer in a first-degree relative are?
At increased risk
-risk is even higher if that relative was diagnosed with cancer younger than 45, or if more than one first-degree relative is affected
33
People who have a family member with renal cell cancer or bladder cancer have?
An increased risk
34
Personal and psychosocial history: Do you drink alcohol? If so, how much? How often? When was your last drink?
Alcohol is a risk factor for peptic ulcer disease; esophageal, stomach, and colon cancer; pancreatitis; & cirrhosis. Alcoholism may damage the liver, the organ that metabolizes alcohol
35
Cigarette smoking is a risk factor for?
Peptic ulcer disease, and cancers of the stomach, colon, pancreas, liver, kidney, and bladder
36
Right upper quadrant pain is associated with?
Disorders of the gallbladder, colon, liver, lung, and kidney
37
Left upper quadrant pain is associated with?
Cardiac, pancreatic, gastric, renal, or vascular disorder
38
Both right and left lower quadrant pain is associated with?
Colonic, gynecologic, or renal disorders
39
Sudden severe pain that awakens the patient may be associated with?
Acute perforation, inflammation, or torsion of an abdominal organ
40
Abdominal pain: Intense pain may be caused by a stone in the?
Biliary tract or ureter, rupture of a fallopian tube from an ectopic pregnancy, or inflammation such as peritonitis following perforation of a gastric ulcer
41
Visceral pain arises from the?
GI tract and pancreas and may be described as an ache and well-defined as a result of tumor growth; or it may be cramping, diffuse, and poorly localized because of obstruction
42
Pain from acute appendicitis starts around the?
Umbilicus and radiates to the RLQ
43
Back pain is associated with?
Abdominal aneurysms or duodenal ulcers
44
Pain from gallbladder disease may be felt in the?
Right shoulder
45
Pain od duodenal ulcer may?
Awaken the patient from sleep
46
Pain in gastroenteritis and irritable bowel disease is worse in the presence of?
Food because peristalsis is stimulated, which causes pain
47
A particular position may relieve abdominal pain
- pain from pancreatitis may be relieved in the?
- colicky pain from gallbladder or kidney stone is relieved by?
- Appendicitis pain is relieved by?
- Pain relieved after bowel movement may indicate?
- pancreatitis pain is relieved by: Knee-chest position
- colicky pain relieved with restless movement
- appendicitis pain relieved by lying very still
- pain relieved after bowel movement may indicate diverticulitis
48
Constipation is the symptom with the highest positive predictive value for diagnosing?
Bowel obstruction
49
```
Abdominal pain: Gastroesophageal reflux
quality
location
associated symptoms
aggravated by
alleviated by
```
quality: gnawing, burning
location: midepigastric; may radiate to jaw
associated symptoms: weight loss
aggravated by: recumbency, bending, stooping
alleviated by: antacids, sitting up
50
Abdominal pain: Gastroenteritis
- quality
- location
- associated symptoms
- aggravated by
- alleviated by
- findings
quality: cramping
location: diffuse
associated symptoms: N/V, fever, diarrhea
aggravated by: food
alleviated by: vomiting, diarrhea
findings: hyperactive bowel sounds
51
Abdominal pain: Gastritis
- patient characteristics:
- quality:
- location:
- associated symptoms:
- aggravated by:
- alleviated by:
- findings:
patient characteristics: alcoholism
quality: constant, burning
location: epigastric
associated symptoms: hemorrhage, N/V, diarrhea, fever
aggravated by: alcohol, food, salicylates
alleviated by: antacids
52
Abdominal pain: Peptic ulcer
- patient characteristics:
- quality:
- location:
- associated symptoms:
- aggravated by:
- alleviated by:
- findings:
- patient characteristics: 30-50 yrs; more males than females
- quality: Gnawing, burning
- location: Epigastric, back, upper abdomen; Gastric 1-2 hrs after meals; Duodenal 2-4 hrs after meals, midmorning, midafternoon, middle of night
- associated symptoms: N/V, weight loss
- aggravated by: stress, alcohol; gastric ulcer aggravated by food; duodenal ulcers by empty stomach
- alleviated by: food, antacids (duodenal ulcers only)
- findings: Epigastric tenderness on palpation
53
Abdominal pain: Pancreatitis
- patient characteristics:
- quality:
- location:
- associated symptoms:
- aggravated by:
- alleviated by:
- findings:
- patient characteristics: Alcoholism, cholelithiasis
- quality: Steady, severe to mild, knifelike, sudden onset
- location: LUQ and epigastric; radiates to back
- associated symptoms: N/V, diaphoresis
- aggravated by: Lying supine
- alleviated by: Leaning forward
- findings:Abdominal distention, Decrease bowel sounds, LUQ tenderness
54
Abdominal pain: Appendicitis
- patient characteristics:
- quality:
- location:
- associated symptoms:
- aggravated by:
- alleviated by:
- findings:
- patient characteristics: any age; peak 10-20yrs
- quality: Colicky, progressing to constant
- location: Umbilicus, moving to RLQ
- associated symptoms: Vomiting, constipation, fever
- aggravated by: worse with moving, coughing
- alleviated by: lying still
- findings: rebound tenderness RLQ, positive obturator, positive iliopsoas
55
Abdominal pain: Cholecystitis or cholelithiasis
- patient characteristics:
- quality:
- location:
- associated symptoms:
- aggravated by:
- findings:
- patient characteristics: Adults; more females than males
- quality: Colicky, progressing to constant
- location: RUQ radiates to right scapula
- associated symptoms: N/V, dark urine, light stools, jaundice
- aggravated by: fatty foods, drugs
- findings: Tender to palpation or percussion of RUQ
56
Abdominal pain: Ectopic pregnancy
- patient characteristics:
- quality:
- location:
- associated symptoms:
- findings:
- patient characteristics: History of menstrual irregularity
- quality: sudden onset, persistent pain
- location: lower quadrant referred to shoulder
- associated symptoms: tender adnexal mass, vaginal bleeding
- findings: palpable mass on affected side
57
Abdominal pain: Diverticular disease
- patient characteristics:
- quality:
- location:
- associated symptoms:
- aggravated by:
- alleviated by:
- findings:
- patient characteristics: older adults
- quality: intermitten cramping
- location: LLQ
- associated symptoms: Constipation, diarrhea
- aggravated by: eating
- alleviated by: bowel movement, passing flatus
- findings: palpable mass in LLQ
58
Abdominal pain: Irritable bowel disease
- patient characteristics:
- quality:
- location:
- associated symptoms:
- alleviated by:
- findings:
- patient characteristics: young women
- quality: cramping, recurrent, sharp, burning
- location: LLQ
- associated symptoms: Mucus in stools
- alleviated by: defecation
- findings: colon tender on palpation
59
Abdominal pain: Intestinal obstruction
- patient characteristics:
- quality:
- location:
- associated symptoms:
- findings:
- patient characteristics: Older adults; those with prior abdominal surgery
- quality: Colicky, sudden onset
- location: may be localized or generalized
- associated symptoms: vomiting, constipation
- findings: hyperactive bowel sounds in small obstruction
60
Dysmenorrhea (pain associated with menstruation) may cause?
Lower abdominal pain and vomiting because of the increase in protaglandin
61
Vomiting that precedes the onset of abdominal pain may suggest?
Infection as a possible cause of pain
62
Abdominal pain that precedes vomiting may indicate?
Appendicitis
63
Acute gastritis lead to vomiting of?
Stomach contents
64
Obstruction of the bile duct results in what type of vomiting?
Greenish-yellow
65
An intestinal obstruction may have what odor to the vomit?
Fecal odor
66
Stomach or duodenal ulcers or esophageal varices may cause what type of vomit?
Blood in the vomit (hematemesis)
67
Pregnant women have high levels of what that can stimulate vomiting
high serum levels of chorionic gonadotropin
68
Nausea w/out vomiting is a common symptom of?
Pregnant patients or those with metastatic disease
69
Liver disease may change what?
stool color from brown to tan
70
infection such as hepatitis may cause?
Fever and chills
71
Indigestion: Heartburn felt in the chest, over the esophagus or in the stomach that occurs after eating may indicate?
GERD
72
Heartburn caused by GERD or hiatal hernia is often worse when the patient lies down because the?
Gastric acids move by gravity toward the esophagus
73
What may be the cause when acid-reducing drugs relieve the indigestion?
Excessive acid may be the cause
74
Angina or myocardial infarction may be the cause of the?
Indigestion-like symptoms
75
Distention caused by ascites is a progressive process and increases?
Abdominal girth
76
Vomiting may indicate intestinal obstruction as a cause of?
Distention
77
Loss of appetite is associated with?
cirrhosis and malignancy
78
Shortness of breath is associated with?
Heart failure and with ascites that occurs with chronic liver disease
79
Changes in bowel habits can be related to a number of factors, including changes in diet, activity, stress, and medications. A change in bowel habits is one of the?
Seven warning signs of cancer
80
Watery diarrhea containing blood, mucus, and pus may indicate?
Ulcerative colitis
81
A greater than expected amount of fat in the stool (steatorrhea) may indicate?
Pancreatitis
82
Abdominal cramping with diarrhea may indicate?
Gastroenteritis
83
Liver cancer risk factors
- gender: men 7x more
- race: Asian Americans and Pacific Islanders have highest rate
- liver disease: Hepatitis B and C infections or cirrhosis
- Obesity: can result in fatty liver disease and cirrhosis
- smoking
84
Pancreatic cancer risk factors
- smoking: important risk factor
- obesity: 20% higher risk
- workplace exposure to certain chemicals: heavy exposure to certain pesticides, dyes, and chemicals used in metal refining may increase risk
- age: 71 yrs
- gender: men 30% more likely
- race: African American
- family history 5-10% of cases is inherited tendency for this
- genetic syndromes: inherited gene changes can be passed from parent to child
- cirrhosis
- stomach ulcers: infection of the stomach with the ulcer causing bacteria Helicobacter pylori may increase risk
85
Jaundice indicates?
Elevated serum bilirubin that can be caused by liver disease or obstruction of bile flow from gallstones
86
Jaundice: fever, nausea, vomiting, and loss of appetite are also signs of?
Hepatitis
87
In the last year have you had a blood transfusion or tattoos? Are you using any intravanous drugs? Do you eat raw shellfish (oysters)? Have you traveled abroad in the leas year? Where? Did you drink unclean water?
-These are possible sources of transmission of?
Hapatitis virus
88
Urine changing from amber to brown and stools changing from brown to tan suggest?
High serum bilirubin that occurs with liver disease or obstruction of the common bile duct
89
Have you had associated s/s such as fever, chills, and backpain?
These s/s may indicate a kidney disorder such as pyelonephritis or kidney stones
90
Dark amber urine is associated with?
Kidney or liver disease
91
Blood in the urine is associated with?
Menstrual periods or kidney disease
92
Unexplained weight gain, swelling in ankles, SOB, urinating less are all clinical manifestations that may indicate?
Renal failure when kidney dysfunction causes fluid retention
93
Patients with pancreatitis may prefer what type of breathing?
Knee-chest position
94
Patients with peritonitis or appendicitis may do what type of breathing?
May lie very still
95
Patients with colicky gallstones or ureteral stones may?
Rock back and forth
96
An inverted umbilicus is often a sign of?
Increased abdominal pressure, usually from ascites or a large mass
97
Glistening or taut appearance on the torso is associated with?
Ascites
98
In patients with portal HTN, the veins of the torso are?
Dilated and appear to radiate from the umbilicus cause by backflow through collateral veins
99
A scaphoid contour is seen in?
Thin adults
100
Concavity is associated with?
general wasting signs or anteroposterior rib expansion
101
Abdominal distention may result from the seven Fs
```
Fat (obesity)
fetus (pregnancy)
fluid (ascites)
flatulence (gas)
feces (constipation)
fibroid tumor
fatal tumor
```
102
Females exhibit thoracic movements during inhalation, whereas males exhibit?
Abdominal movments
103
Note visible peristalsis or marked pulsations. The area of pulsation observed is not palpated because?
It may indicate an abdominal aneurysm
104
Decreased or absent bowel sounds occur with?
Mechanical obstruction or paralytic ileus and with peritonitis and bowel obstruction
105
Audible bowel sounds produced by hyperactive peristalsis are termed?
Borborygmi and create rumbling, gurgling, and high-pitched tinkling sounds
106
RUQ organs
- Liver and gallbladder
- Pyloris
- Duodenum
- Head of pancreas
- Right adrenal gland
- Portion of right kidney
- Portions of ascending and transverse colon
107
RLQ organs
- Lower pole of right kidney
- Cecum and appendix
- Portion of ascending colon
- Bladder
- Right ureter
- Right ovary and salpinx
- Uterus if enlarged
- Right spermatic cord
108
LUQ
```
Left lobe of liver
Spleen
Stomach
Body of pancreas
Left adrenal gland
Portion of left kidney
Portions of transverse and descending colon
```
109
LLQ
```
Lower pole of left kidney
Sigmoid colon
Portion of descending colon
Bladder
Left ureter
Left ovary and salpinx
Uterus if enlarged
Left spermatic cord
```
110
For venous vascular sounds listen with the bell over the?
Epigastric region and around the umbilius for a venous hum (soft, low-pitched, and continuous)
111
Bruits occur in?
4-20% of healthy people
112
Bruits over the aorta suggest?
Aneurysm
113
Venous hums are?
Soft, low pitched, & continuous. They are associated with portal HTN and cirrhosis
114
Rigidity of abdomen is associated with?
Peritoneal irritation and may diffuse or localized
115
Abnormal findings for deep palpation
Masses that descend during inspiration, lateral pulsatile masses (abdominal aortic aneurysm), laterally mobile masses, and fixed masses
116
Tympany is the most common percussion tone heard and is caused by the?
Presence of gas
117
The suprapubic area my be dull when the urinary bladder is?
Distended
118
Abnormal findings for abdominal tones
Any marked dullness in a localized area may indicate distention, fluid, or an abdominal mass
119
The midclavicular liver span is expected to be?
6-12 cm
120
Liver span correlates with?
Body size and gender
121
An enlarged liver (hepatomegaly) is indicated when the?
Lower border of the liver exceeds 2-3 cm below the costal margin. This enlargement may be associated with cirrhosis and hepatitis
122
Common causes of enlarged spleen
Hepatic disease (portal HTN), hematologic disorders (leukemia or lymphomas), infectious disease (HIV), or primary splenic disorders (splenic infarction or hematoma)
123
A palpable, painful gallbladder may indicate?
Cholecystitis. Test for this by asking patient to take a deep breath during palpation. It is suspected if patient experiences pain and abruptly stops inhaling during palpation (Murphy's sign)
-a non tender enlarged gallbladder suggests common bile duct obstruction
124
Abnormal findings: A palpable spleen feels like a?
Firm mass that bumps against the nurse's fingers. Spleen pain may indicate infection or trauma
125
Kidney pain is associated with?
Kidney trauma or infection (pyelonephritis or glomerulonephritis)
126
Normal findings for percussing the kidneys for costobertebral angle pain
The patient should perceive a thud but no pain
127
Costovertebral (CVA) pain may indicate?
Pyelonephritis, glomerulonephritis, or nephrolithiasis (kidney stones)
128
Advanced practice: Assess the abdomen for fluid. Assess for?
| Assess for fluid wave when?
Shifting dullness when fluid in the peritoneal cavity (ascites) is suspected.
Assess for fluid wave when ascites is confirmed and the fluid wave resembles fluid moving w/in the abdomen
129
Rebound tenderness
Present if patient experiences more pain when pressure applied to the abdomen is released than when pressure is exerted and indicates peritoneal inflammation
130
This technique is performed when appendicitis is suspected
Iliopsoas muscle test
-when patient reports RLQ pain to pressure against the raised leg, his or her iliopsoas muscle in irritated indicating an inflammed appendix
131
When a ruptured appendix or pelvic abscess is suspected this technique is performed
Obturator muscle test
-pain in the hypgastric region when the right leg is rotated is a positive sign indicating irritation of the obturator muscle
132
Assess the abdomen for a floating mass
Ballottement is a palpation technique used to determine a floating mass, which may be an abnormal growth or a fetal head
133
Gastroesophageal reflux disease
Flow of gastric secretions into the esophagus is termed gastroesophageal reflux disease (GERD)
-clinical findings: heartburn, regurgitation, dysphagia (difficulty swallowing), aggravated by lying down and releived by sitting up, antacids, and eating
134
Hiatal Hernia
Protrusion of stomach through esophageal hiatus of the diaphragm into mediastinal cavity
-clinical findings: same for GERD: heartburn, regurgitation, dysphagia
135
Peptic ulcer disease
Ulcer occurring in lower end of esophagus, in the stomach, or in the duodenum
- 500,000 new cases each year and 4 million cases of ulcer recurrence
- duodenal ulcer is most common caused by a break in the duodenal mucosa that scars with healing
- gastric and duodenal ulcres may result from infection with Helicobacter Pylori
- clinical findings: epigastric pain to palpation, burning pain in the left epigastrium and back 1-2 hrs after eating
- duodenal ulcers complain of burning pain 2-4 hrs after eating and at midmorning, midafternoon, middle of night, pain relief after taking antacids or eating
136
Crohn disease
Chronic inflammatory bowel disease (IBD) also called regional enteritis or regional ileitis
- may occur from mouth to anus commonly affects terminal ileum and colon
- affected mucosa is ulcerated, with presence of fistulas, fissures, and abscesses that may form adjacent to healthy bowel segments
- clinical findings: periods of remission with relapses. Can't be cured but treated, severe abdominal pain, cramping, persistent diarrhea, rectal passage of blood and mucus, fever, constipation
137
Ulcerative Colitis
Starts in rectum & progresses through large intestine
- common form of IBD
- submusoca becomes engorged and mucosa becomes ulcerated and denuded with granulation tissue; may progress to colon cancer
- clinical findings: periods of remission & relapses. mild-severe cramping abdominal pain, fever, chills, anemia, weight loss, profuse water diarrhea of blood mucus, puss
138
Diverticulitis
Inflammation of diverticula
- herniations through muscular wall in the coon. Presence of fecal material through the thin-walled diverticular causes inflammation and abscesses
- clinical findings: cramping pain in LLQ, N/V, altered bowel habits, constipation, abdomen distended, and tympanic with decreased bowel sounds and localized pain
139
Viral hepatitis
Inflammation of liver often results from different viruses most common hepatitis A and B & C
-clinical findings: anorexia, vague abdominal pain, N/V, fatigue, fever, enlarged liver and spleen , jaundice, tan colored stools, dark urine
140
Cirrhosis
Chronic degenerative disease of liver in which diffuse destruction and regeneration of hepatic parenchymal cells occur
- 12th leading cause of death
- cobblestone appearance of the cirrhotic liver that results in impaired liver function and blood flow
- causes: viral hepatitis, biliary obstruction, alcohol abuse
- clinical findings: liver becomes palpable and hard, ascites, jaundice, cutaneous spider angiomas, dark urine, tan colored stools and spleen enlargement
- end stage cirrhosis characterized by portal HTN, esophageal varies, hepatic encephalopathy and coma
