GI Flashcards
(247 cards)
1
Q
Which enzyme is found in saliva that starts the breakdown of starch?
A
Amylase
2
Q
Which enzyme is found in gastric secretions?
A
Pepsin - released from the gastric mucosa
3
Q
Which enzymes are secreted into the small intestines to break down food particles?
A
Trypsin, Lipase & Amylase
4
Q
What does Trypsin break down?
A
Proteins
5
Q
What does Lipase break down?
A
Fats
6
Q
What does Amylase break down?
A
Starches
7
Q
From where are Trypsin, Lipase and Amylase secreted from?
A
The Pancreas
8
Q
What breaks down the remaining chyme in the large intestine/colon?
A
Digestive bacteria and microbes that lives in the gut.
9
Q
What is one of the first symptoms of abdominal/Gi issues?
A
Pain.
10
Q
What is another name for Dyspepsia?
A
Indigestion
11
Q
What are some symptoms of Dyspepsia?
A
Feeling of fullness, feeling of food not being digested and just sitting in the stomach, heartburn/pyrolysis, bloating, epigastric discomfort, regurgitation.
12
Q
What is another name for heartburn?
A
Pyrolysis.
13
Q
Why is it important to assess Nausea and or vomiting?
A
Because there will be some form of disease in the GI tract if the patient is vomiting.
14
Q
What does yellow colored emesis mean?
A
It means that the emesis contains stomach acid (which is yellow)
15
Q
What would green colored emesis indicate?
A
It would indicated that there is bile in the emesis, and that bile is staying in the stomach rather than going in the duodenum.
16
Q
Where would patients with Cholelithiasis, Pancreatitis, and duodenum ulcers often feel pain?
A
The right upper quadrant (RUQ) but also close to epigastric area.
17
Q
Where would patients suffering from biliary colic (where gallbladder is) experience pain?
A
Shoulder area.
18
Q
Where would patients with heart issues often experience pain?
A
Left side on body..
19
Q
For patients with Cholelithiasis or Cystitis, would experience pain on which side of their bodies?
A
Right side, often between the ribs.
20
Q
What is referred pain?
A
When a patient is experiencing pain in a different location to their actual problem area.
21
Q
What position do the patient need to be in for an abdominal assessment?
A
Supine position, preferably with knees flexed/bent - to release the pressure on the abdominal muscles so that they are not tight.
22
Q
What is the first thing that we would do during an abdominal assessment?
A
Inspect. We would look for symmetry, shape of the abdomen, see if there are any markings or skin issues, bruises, scars , striae.
23
Q
If the patient has striae’s, what could that indicate?
A
The patient may have lost a lot of weight lately, or gained weight quickly.
24
Q
What is the second thing that we would want to do during an abdominal assessment?
A
Listen/Auscultate for bowel sounds in each quadrant.
25
When auscultating the abdomen, where do we start?
At the right lower quadrant (RLQ) and move clockwise.
26
For severe abdominal issues, how long would you want to auscultate each abdominal quadrant for?
At least 1 minute.
27
How many bowel sounds should we listen for in each abdominal quadrant?
5-34 sounds/ gurgling.
28
What would indicate that the abdomen is hyperactive?
>35 bowel sounds.
29
What would indicate that the abdomen is hypoactive?
<5 bowel sounds.
30
If bowel sounds are absent, how long should you listen in each quadrant? And what else should you do?
At least 2 min and then get a second opinion, No bowel sound may be an emergency.
31
What is percussion and how do we do it?
Percussion is listening for sound by tapping on the abdomen with our fingers.
32
What are we listening for when we are doing percussion?
We are listening for a dull thud or hollowness. Hollowness would indicate that there is air/gas and a thud would indicate fluid.
33
What is the last step of the abdominal assessment?
Palpation.
34
How do we palpate the patients abdomen.
We go to each quadrant and use a wave like form to feel or circular motions.
35
What are we looking for when we are palpating the abdomen?
Pain - doe it hurt to the touch and does it hurt more when we are letting go whihc indicates rebound tenderness.
Masses
36
When we are doing a more focused abdominal assessment, how many quadrants do we assess?
9
37
Pain in which specific area would prompt us to do more research and assessments on the patient?
Pain in the epigastric area (Quadrant 1 on the 9 quadrant assessment)
38
When doing GI diagnostic studies, what would a Serum laboratory study assess?
* CMP (complete metabolic panel)
* CBC ( complete blood count - esp WBC's)
39
Why would we perform a stool test?
* To assess for Parasites and Ova.
* To check if the patient has C.diff.
* To check for occult blood.
40
What would older blood in the stool indicate?
The there might be an upper GI bleed.
41
What could fresh blood in the stool indicate?
A bleed further down in the intestines.
42
When a patient is doin a breath test, what are they testing for?
Hydrogen gasses from the stomach. This could indicate that there is a bacterial overgrowth and that there is a slow digestion of the food that the patient is consuming,
It could also indicate H.Pylori which is the cause of stomach ulcers.
43
What are we assessing for then we are doing an abdominal sonography?
Gallstones, ovarian cysts,
Mainly for things that wouldn't be in the GI tract to rule those problems out.
44
Why would we do a genetic test for a patient suffering from GI issues?
To see if the patient is susceptible for colon cancer, stomach cancer, pancreatic cancer,
45
What would be a more precise way of doing GI imaging?
With a MRI - with this imaging they can pinpoint problems in the GI.
46
What does a Pet scan detect?
Cancer cells and tumors.
47
What type of cells likes glucose?
Cancer cells. So with PET scans they inject a dye and glucose to detect cancer cells.
48
Explain Scintigraphy.
A imagining done with radioactive dye that follows the cells.
49
Explain Virtual Colonoscopy.
The patient swallows a mini camera that provides imaging of the colon.
50
Explain Fluoroscopy of the upper GI.
A trace study. For the upper GI the patient swallow a radioactive dye that enables x-ray images to be taken. It wills provides images of where the barium goes in the upper GI to see what is happening in the small bowel. It could provide images of issues with the stomach, esophagus etc.
51
Explain Fluoroscopy of the lower GI.
A trace study. The patient swallows radioactive dye/ barium and the provider are able to follow this dye down tot he digestive tract OR a barium enema can be done.
52
For endoscopic studies, explain what is done when a patient is having a Esophagogastroduodenoscopy (EGD).
Here a fluoroscopy camera is used and goes down the esophagus, the stomach and into the duodenum to see if there are bleedings, scar tissue, polyps etc.
53
For endoscopic studies, explain what is meant with Endoscopic Retrograde Cholangiopancreatography (ERCP)
Involves the gallbladder and the ducts where the digestive enzymes are secreted.
54
For endoscopic studies, explain what is meant by Fiberoptic colonoscopy.
Provides visualization of the anus, rectum, sigmoid colon, transcending & ascending colon - goes all the way to the cecum.
55
Explain the EGD (esophagogastroduodenoscopy) procedure.
* Should be preformed in a specific location unless there in an emergency and it is done at bedside.
* Patient needs to be NPO for at least 8 hrs.
* Patients usually moderately sedated.
* Procedure approx. 30-60 min and recovery is usally quick.
56
Which drugs are given to patients who are having an EGD?
Midazolam - Produces sleepiness and relieves anxiety prior to surgery.
OR
Propofol - Short acting anesthetic and sedative. Injected IV. Relaxes patients before a medical procedure.
Takes about 1 hr to wear off.
57
After a patient has had a EGD, what are possible post-procedure complications that nurses should be on the look out for? And what should we do if any complications are happening.
* Esophageal perforation
* Increased pain (mild discomfort normal, severe pain abnormal)
* Bleeding (Vitals: BP decreasing, HR elevating)
* Vomiting blood.
* Unusual difficulty swallowing (1st hr is normal, after that they should eb able to swallow normal)
* Rapidly elevating temperature - can indicate a rupture or an infection or inflammation.
A physician should be called if the patient is experiencing these complications.
58
What are signs that a patient may have an internal bleeding?
BP dropping, HR is increasing.
59
Explain the colonoscopy procedure.
* Patient should be in a designated procedure area, can be inpatient or outpatient.
* Patient needs to be on a clear liquid/low residual diet for 24-48 hrs pre procedure.
* Patient given saline bowel prep 24-48 hrs pre-procedure and this clears out the entire bowel (should be running clear)
* Moderately sedated with midazolam or propofol.
* Procedure approx 1 hr
* Recovery 30-60 min.
60
What are some names of Bowel preps that we use?
GoLytely, CoLyte or other saline prep.
61
Why is the bowel prep so important before a colonoscopy?
The patient could possibly be sent home and procedure cancelled because the prep wasn't done properly and the physician cannot get a clear vision of the bowel - This will consequently delay the time of diagnosis.
62
After a patient has had a Colonoscopy, what are possible post-procedure complications that nurses should be on the look out for? And what should we do if any complications are happening.
* S&S of bowel perforation
* Rectal bleeding (monitor vital signs) (small amount normal, but active bleeding - call physician after obtaining vital signs and ensuring patient is stable)
* Severe abdominal pain ( little cramping is normal, severe is not)
* Abdominal distention (small distension normal, but firm stomach is not, patient should be able to pass gas)
* Fever
* Localized peritoneal signs such as specific pain spots.
63
What happens with the esophagus as we age?
The muscles starts to wear off and the motility is declining. People may develop stenosis and have the feeling of food getting stuck. they can develop diverticulum. This usually happens after the age of 65.
64
Explain Gastroesophageal reflux disease (GERD).
Patient's with GERD experiences that hydrochloric content from the stomach comes up through the esophagus. This is usually caused by problems with the closing of the pyloric sphincter at the top of the stomach.
65
Explain Hiatal hernias.
* Commonly associated with GERS
Symptoms :
Pyrosis/Heartburn
Regurgitation - food coming back up from stomach.
Dysphagia - food isn't going down.
Vague symptoms of intermittent epigastric pain
Fullness after eating
Many patients are asymptomatic
66
Explain Barrett's esophagus.
Here the cells in the esophagus has started to change due to long term GERD or indigestion issues. The environment in the esophagus has become so acidic that the cells have started to change into a different type of cell. This is the precursor to cancer and tumors may start to develop.
67
What does non-cancerous issues in the esophagus begin with?
Dysphagia - swallowing difficulties
68
Explain Dysphagia.
As people age swallowing may become more difficult, it may be specific things that are hard to swallow but it usually begins with liquids and then as it progresses may be with both eating and drinking.
69
What is the biggest complication associated with Dysphagia?
Pneumonia or aspiration pneumonia.
70
What is Odynophagia?
Acute pain when swallowing - this is usually a big red flag that something else is going on with the patient
71
What is sliding esophageal hernia?
Occurs when part of the stomach and the lower portion of the esophagus move above the diaphragm.
72
What is paraesophageal hernia?
Occurs when part of the stomach pushes through the diaphragm (the muscle that separates the stomach from the chest cavity) and lies next to the esophagus, rather than above it.
73
Name some risk factors associated with being diagnosed with GERD.
Age >65, IBS & obstructive airway disorder, alcohol use, coffee consumption, gastric infections and H.pylori.
74
How come people with obstructive airways disorders such as COPD are at risk of developing GERD?
The diaphragm is involved in breathing, so if there are airway obstructions then the diaphragm is affected and can be pushed down towards the stomach - this may cause the fundus (upper stomach) to come through the diaphragm & GERD can start to happen.
75
How come people with cystic fibrosis are at risk of developing GERD?
Because the diaphragm isn't allowed to fully expand in patients with this condition.
76
How come caffeine& alcohol drinking is a risk factor in developing GERD?
Caffeine & Alcohol causes a more acidic environment in the stomach and can consequently erode the stomach lining.
77
What is it called when we need to bypass the upper esophagus for the patient to receive nutrition? Often caused by aspiration pneumonia.
Enteral Nutrition.
78
What are some ways that we can give our patients Enteral Nutrition?
It can be given via :
Nasogastric tube, Nasoduodenal or Nasojejunal tube.
If these are not working or patient needs them for more than 4 weeks we would do a
Gastronomy or Jejunostomy tube.
79
What are some important factors when delivering Nutrition Enterally?
* Patients are hydrated and all nutritional requirements met.
* Preserve normal sequence of intestinal and hepatic metabolism
* Maintain fat metabolism and lipoprotein synthesis
*Maintain normal insulin and glucagon ratios.
80
What is Parenteral nutrition?
Nutrition given into the blood stream via IV.
This way is more expensive, and it bypasses the liver and goes straight into the bloodstream and then the liver eventually has to clear everything out which is tough on the liver and kidneys.
81
What is considered safer, Enteral or Parenteral nutrition?
Enteral.
More cost effective and also keeps the patients GI tract intact and keep it functioning throughout treatment. It also preserves the normal sequence of intestinal hepatic metabolism.
82
When assessing patients receiving Enteral feeding, what are some things that we need to assess?
* Tube placement
* Ability to tolerate formula and amount
* Clinical response
* Dehydration signs (lower BP, weight loss)
* Elevated BG lvls, decreased urinary output, sudden weight gain & periorbital or dependent edema
* infection signs
* I&O, daily & weekly weights, dietician consult.
83
Why do we need to monitor glucose levels closely with patients receiving enteral feedings?
The formulas used are known to elevate glucose levels.
84
What is the reason that patients receiving enteral feeding are at a greater risk of infection and the reason that we need to monitor them closely for signs of infection?
* The patients are already immune compromised due to the fact that they cannot use their top part of their digestive tract which puts them in a greater risk of infection.
* The tubes put down can introduce bacteria.
* If we have to do a Gastronomy or Jejunostomy tube in the patient, we go through the skin and that is an invasive procedure that may introduce bacteria.
85
How come it is no longer necessary to check gastric residual volume in patients with enteral feeding tubes?
People are different and digest at different rates, and it didn't provide accurate information.
86
Why is a dietician consult needed for patients with enteral feeding tubes?
This is done to assess the the type of enteral feeding formula that is necessary for the specific patient.
87
For patients with Gastrostomy or Jejunostomy tube, what assessments needs to be done?
* Assess patient knowledge & ability to learn
* Support and self care ability
* Skin condition around the site.
* Nutrition & fluid status
* Inspection of the tube.
88
What are some other names for a Gastrostomy tube?
Peg tube or G tube.
Peg tube or G tube is always going to be in the gastric area/ the stomach itself.
89
what side of the abdomen is the Peg tube/ G tube normally placed?
The right side of the abdomen,
90
You cannot put medications through a G tube.
Ture/False
False: You can put medications, fluids and nutrition through a G tube.
91
how soon after verified placement can the G tube be used?
Within 4 hrs.
92
Explain what is meant by the G tube providing decompression in patients with gastroparesis, GERD, or intestinal obstruction.
These patients may have a digestional slowing and are at risk for bacterial overgrowth. The G tube can reduce this as the stomach can empty into a container if the patients becomes bloated or overfilled.
It can also be used for patients with tumor that causes obstruction.
93
Why is the G tube preferred over the Nasogastric tube for long term patients ?
The nasogastric tube goes through the nose and down through the esophagus and into the stomach and can only be in place for 2 weeks max.
94
How long can a patient have a G-tube?
1-2 years, but should ideally be replaced every 3-6 months.
95
What are some other names for the Jejunostomy tube?
J tube or PEJ tube
96
How long is the Jejunum?
4-5 ft long
97
Where in our intestines are most of our nutrients (Vitamins & Minerals) digested and absorbed into the bloodstream ?
The Jejunum.
98
What would be a reason why a patent would need a J tube instead of a G tube?
The patient may have had a gastrectomy and would no longer be candidate for a G tube, and would need a J tube to be able to still obtain nutrients,
99
What procedure is required to a J tube?
Surgical procedure where an opening into the Jejunum is made and a tube is placed.
100
With the J tube we can still give the patients solid food.
True/False
False.
When food has reached the Jejunum it has become chyme and is liquid. So any food or medication that is given to the patient via the J tube needs to be liquid as well.
With the G tube we can still give the patient solid food through the tube.
101
A patient cannot feed themselves through a G tube.
True/False
False.
The patient can feed themselves food when they have a G tube.
With the J tube the food needs to be liquid and specific.
102
Which tube would decrease aspiration risk, the G tube or the J tube?
The J tube, with the G tube food could still possibly regurgitate up into the esophagus and cause aspiration pneumonia. With the J tube the food is bypassing the stomach and this significally reduces the risk of aspiration as it is past the pyloric sphincter.
103
How often does a J tube need to be replaced?
Every 6-9 months.
104
What is this : (Image of G- tube to be inserted)
105
Explain Gastritis.
When there is an inflammation/disruption to the mucosal barrier that normally protects the stomach tissue from digestive juices.
Beginning stage of erosion of the stomach,
106
What does the protective juices in the mucosal layer of the stomach protect us from?
Hydrochloric acid.
107
Explain acute gastritis.
There is a rapid onset of symptoms such as sudden epigastric pain in the left upper quadrant.
I could be caused by something the person ate that may have been to acidic and caused inflammation in the stomach - this would be self limiting.
It could also be caused by medications such as NSAIDs, acute alcohol intoxication, bile reflux, radiation therapy for cancer, ingestion of strong acid or alkali.
108
What does self-limiting mean?
Means that its temporary and doesn't last long.
109
Explain chronic Gastritis.
Prolonged inflammation f the stomach lining, which may cause atrophy of the stomach tissue and ulcers can start to build in the stomach and if H.pylori is a factor then this may worsen.
it can also be caused when patients are suffering from other autoimmune disorders and are more susceptible to inflammation.
110
How come smoking is a risk factor of developing chronic gastritis?
Because smoking depletes the cell of oxygen and nutrients.
111
how long would a patient have to be experiencing Gastritis for it to be considered chronic?
3-6 months of having symptoms.
112
How does acute gastritis manifest itself clinically?
* Sudden epigastric pain
* dyspepsia and heartburn
* Anorexia
* hiccups due to metabolic functioning whihc irritates the diaphragm
* Nausea and vomiting (disease in the GI)
* Melena
* Hematemesis (Mallory-Weiss tear in esophagus from vomiting and result in streaks of blood int he emesis)
* Hematochezia ( blood in stool)
113
How does chronic gastritis manifest itself clinically?
* Fatigue - due to B12 deficiency
* Pyrosis
* Belching
* Sour taste in mouth
* Halitosis - bad breath due to secretions coming up. & can cause dental caries and dental bacteria to worsen .
* Early satiety - can't eat a lot.
* Anorexia
* N&V
* May have pernicious anemia due to malabsorption of B12..
* Some are asymptomatic.
114
How is definitive diagnosis of Gastritis done?
By EGD/ Endoscopy where they look at the lining of the stomach.
115
What is the main difference between acute and chronic gastritis?
They have very similar symptoms and manifestation and the main difference is that patients with chronic gastritis experience the symptoms for a prolonged time.
116
Explain Peptic ulcer disease.
* Erosion of the mucosal layer of the stomach, duodenum and esophagus.
* associated with infection of H.pylori
117
What are the risk factors of Peptic ulcer disease?
* Excessive secretions of stomach acid
* Dietary factors
* Chronic NSAID use
* Alcohol use
* Smoking
* Familial tendency
118
How does peptic ulcer disease manifest itself clinically?
* Dull gnawing pain and burning sensation in the mid- epigastrium
* Heartburn
* vomiting.
119
What can a peptic ulcer cause?
* Scar tissue
* Susceptibility of rupture or break through into the peritoneum.
120
How do we assess patients w/ gastritis or peptic ulcer disease?
* History of presenting s&s
* Dietary history
* 72- hr diet & diet diary
* Abdominal assessment, vital signs
* Medication history incl use of NSAIDs
* S&S of anemia & bleeding
121
What would be the planning and major goals for patients w/ gastritis or peptic ulcer disease?
* Relief of pain
* Reduce anxiety - less stressful environment
* Maintenance of nutritional requirements
* Absence of complications such as perforation.
122
What are the symptoms of consipation?
Defined as < 3 BM weekly or BM's that are hard, dry, small & difficult to pass.
It doe depend on the persons normal bowel habit - so health history is important to define constipation.
123
What may cause constipation?
* Medications esp. opioids & BP medications
* Chronic Laxative use
* Age & Weakness
* Immobility
* Fatigue
* inability to increase intra-abdominal pressure for example a disorder in the gut.
* diet
* ignoring urge to defecate
* lack of exercise
124
What does Tenesmus mean?
The urge to defecate.
125
Explain perceived constipation.
Subjective problem where the person's elimination pattern is not consistent with what he or she believes is normal because they didn't go everyday.
126
How does constipation manifest itself clinically?
* Fever than 3 BM's a week
* Abdominal distention, pain and bloating
* A sensation of incomplete evacuation
* Straining
* Elimination of small-volume, hard, dry stools.
127
How would we be assessing a patient for constipation?
* Usually idiopathic (exact cause unknown)
* Requires further testing for severe, intractable constipation.
* history & physical examination
* Barium enema, sigmoidoscopy & stool testing
* Defecography & colonic transit studies
* MRI/CT
128
What does Defecography assess for?
Motility of the gut.
129
What are some complications that can be caused by constipation?
* Decreased Cardiac Output
* Fecal Impaction
* Hemorrhoids
* Fissures (tear) - can be caused from straining and large BM's
* Rectal Prolapse - can be caused from straining, the rectum loses its elasticity and protrude through the anus.
* Megacolon - colon stretched from large amount of fecal material being stuck
130
Why does constipation cause decreased Cardiac output?
When everything is backed up in the gut then there is a backwards pressure in the vascular system due to the colon being highly vascular.
131
What are some patient learning needs for constipation?
* Normal variations of bowel patterns
* Establishment of normal pattern
* Dietary fiber and fluid intake
* Responding to the urge to defecate
* Exercise and activity
* Laxative use should be the last resort.
132
Constipation may be r/t to hormonal imbalance.
True/False
True
133
What are the symptoms of Diarrhea?
* Increased frequency of BM's > 3 per day w/ altered consistency (i.e increased liquidity)
* associated w/ urgency, perianal discomfort. incontinence or a combination of these.
* May be acute, persistent or chronic
* Causes: infection, medication, tube feeding formulas, metabolic & endocrine disorder & various disease processes.
134
What is a specific medication that causes Diarrhea?
Metformin - A antidiabetic drug that treats type 2 diabetes.
135
Enteral tube feeding is known to cause diarrhea.
True/False
True - do to it bypassing the stomach, the glucose may contribute to a lot of tube fed patients experiencing diarrhea.
136
Is hyper of hypothyroidism known to cause diabetes?
Hyperthyroidism.
137
What are the clinical manifestations of Diarrhea?
* Increased frequency
* Abdominal cramps
* Distention
* Borborygmus (rumbling noise caused by GI gas)
* Anorexia & thirst
* Painful spasmodic contraction of the anus
* Tenesmus - feeling of needing to defecate.
138
What are some diagnostic testings that we can do in patients suffering from diarrhea?
* CBC (elevated WBC's, low RBC count could indicated that the patient is loosing blood)
* Serum chemistries - electrolytes.
* Urinalysis - ensuring no bacteria in urine.
* Stool examination - for ovum parasites.
* Endoscopy or barium enema.
139
What electrolytes are normally in imbalance when a patient is suffering from diarrhea?
Potassium, Magnesium & sodium.
140
What is the biggest complications of diarrhea?
* Dehydration
* Electrolyte imbalance
* Cardiac dysrhythmias due to being low on electrolytes
* skin breakdown in rectal area due to the acidity of the diarrhea.
141
What are the manifestations of dehydration?
Lower BP. higher HR, Dry mucous membranes, dry skin, dizziness, fatigue.
142
What is currently the most widespread GI disease in the US today?
IBS - 15% of adults report symptoms. more common in women than men. 12% diagnosed with IBS.
143
Define IBS.
Chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may incl. diarrhea, constipation or both.
144
What factors triggers IBS?
* Chronic Stress
* Sleep Deprivation
* Surgery
* Infections
* Diverticulitis
* Specific food types.
145
What are the clinical manifestations of IBS?
* Alteration in bowel patterns
* Pain
* Bloating
* Abdominal distention
146
What diagnostic studies are often done when assessing a patient with IBS?
* Stool studies - to asses for parasites & ova
* Contrast radiography studies - barium drink or enema
* Proctoscopy - assessing the rectum.
* Barium enema
* Colonoscopy
* Manometry
* Electromyography - looks at the pattern of the gut to assess for motility.
147
What patient teachings should be done for patients with IBS.
* Dietary changes
* Food diary
* Adequate fluid intake
* Avoid alcohol & smoking
* Relaxation techniques
* Medication management
* Complimentary medicine.
148
What is a medication that can help with IBS mentioned in the pre-recorded lecture?
Linzess
149
What is IBS-D?
Diarrhea
150
What is IBS-C?
Constipation
151
What is IBS - M
Mixed
152
IBS-U?
Unclassified.
153
What chart is used to assess the consistency of stool and has a scale from 1-7?
The Bristol Stool Form Scale.
Type 1 is extremely hard to pass stool in small lumps.
Type 7 is completely liquid stool without any solid pieces.
154
On the Bristol Stool Form Scale, which types should a persons stool be at?
Between type 3-5.
155
What does the Rome four criteria state that a person must experience to be diagnosed with chronic constipation?
Recurrent abdominal pain at least once daily in the past 3 months & associated with defecation, change in frequency in bowel pattern of with change of form and appearance of the stool.
156
Define Appendicitis
* Most frequent cause of acute abdominal issue in the US - most common reason for emergency abdominal surgery.
* Appendix becomes inflamed due to fecal matter getting stuck in appendix.
* Inflammatory process increases intraluminal pressure causing edema and obstruction of the orifice.
* Once obstructed, Appendix becomes ischemic, bacterial overgrowth occurs & eventually gangrene or perforation occurs.
157
Where can the appendix be found?
At the Cecum & the base of the large intestine (ascending colon)
158
We can live without the appendix, however why should we try to keep it there?
It is one of our lymph organs that helps fight off bacterial infections at this point in the colon,
159
How does Appendicitis manifest itself clinically?
* Vague periumbilical pain >> radiates to RLQ
- Pain described as sharp, discrete, well localized.
* 50% of patients report nausea
* Anorexia
* Low-grade fever
* Local tenderness in McBurney's point
* Rebound tenderness on palpation RLQ
- Rovsing's sign
160
Where would a patient normally experience rebound tenderness from Appendicitis?
With palpation on the RLQ. it is also called Rovsing's sign when it hurts when you let go after palpation.
161
Explain Rovsing sign.
A classic test for diagnosing appendicitis. In this indirect rebound test, the examiner presses on the left lower quadrant, away from the typical area of appendiceal pain. A positive result occurs if the patient feels rebound pain in the right lower quadrant when the pressure is released.
162
Explain McBurney's point.
a specific location on the abdomen that is often tender in patients with appendicitis. It is located in the RLQ near the appendix.
163
What may happen if the appendix ruptures and goes into the peritoneum?
This may lead to Peritonitis.
164
Does Peritonitis only happen from a ruptured appendix?
No, it can happen from any kind of rupture. It can for example happen from a trauma such as a stabbing or gunshot wound or rupture of any other organs such a kidney rupture due to abscess.
165
What is the most common cause of Peritonitis?
From the GI tract such as from diverticulitis.
166
How come Peritoneal Dialysis may lead to Peritonitis?
Due to insertion of a catheter to use for dialysis though the abdomen (similar to G tube but placed different) - this can cause infection due to the insertion of the tube being an invasive procedure.
167
True / False
Peritonitis begins as an bacterial infection.
True - most common bacteria is E.coli.
It may also occur secondary to fungal or mycobacterial infection.
168
Name some bacteria, other than e.coli, that can cause Peritonitis.
Klebsiella, Proteus, Pseudomonas & Streptococcus.
169
What is Primary Peritonitis?
Spontaneous Bacterial Peritonitis (SBP)
When infection gets into the bowel or into the peritoneum from an internal source.
170
What is Secondary Peritonitis?
Caused by ruptured organs.
- Ruptured appendix
- Perforated peptic ulcer
- Perforated sigmoid colon 2 sever diverticulitis
171
What is Tertiary Peritonitis?
Caused by super infection in immunocompromised patients.
172
Which is the most common form of Peritonitis?
Secondary.
173
What are the clinical manifestations of Peritonitis?
* S&S of infection
* Diffuse abdominal pain initially- then constant, localized and intense.
* Movement increases pain
* Abdomen tender to touch, distended & becomes rigid
* Decreased appetite
* N&V
* Severe : paralytic Ileus (small bowel) This is an emergency.
* Fever 100-101, increased HR, low BP - can quickly become septic.
174
Explain Diverticular Disease
* Sac like hernia of the lining of the bowel that extends through a defect in the muscle layer.
* Most common in sigmoid colon & descending colon but can occur anywhere in the intestine.
175
Explain Diverticulosis.
Multiple diverticula without inflammation.
176
Explain Diverticulitis.
Infection and inflammation of diverticula.
177
How is diverticular disease normally diagnosed?
Usually by colonoscopy.
178
What is one of the worst things that can happen to a person that has Diverticulosis?
If the diverticula becomes inflamed or infection it can cause part of the bowel to die. The cells in the sigmoid or descending colon may die off and become ischemic and at this point the patient may need a section of their colon taken out.
179
If a patient gets to the point where they need a part of their colon surgically removed due to diverticulitis, what are the options for recovery after that?
1 ) Patient has a temporary colostomy, let the tissue heal and then go back in again and reattach the remaining colon.
2) Patient had to have too much of the colon removed and needs to have a permanent colostomy bag.
180
Explain intestinal obstruction.
Can happen in the lower and upper GI, the small bowel is however the most common location.
*There is a blockage that prevents the normal flow of intestinal contents through the intestinal tract.
181
Explain mechanical obstruction.
Intraluminal obstruction of mural obstruction from pressure on the intestinal wall.
182
Explain functional or paralytic obstruction.
* The intestinal musculature cannot propel the contents along the bowel.
* The blockage also can be temporary and the result of the manipulation of the bowel during surgery.
183
Explain intussusception of the bowel.
When the bowel tunnels itself, similar to how a telescope - one part of the intestine slips into another part located below it. Occurs more commonly in infants than adults.
184
What is one of the number one reasons for GI obstruction?
Adhesions.
Loops of intestine become adherent to areas that heal slowly or scar after abdominal surgery, occurs most commonly in small intestine
185
What is the most common reason for adhesions?
Surgery & scar tissue.
186
Explain volvulus.
When the bowel twist and turn on itself and occludes the blood supply.
187
What happens if a volvulus doesn't resolve on its own.
It can become gangrenous (gas build up) or ischemic due to cut off of blood supply. Fluid could also get trapped and the patient needs to go in for surgery.
188
Explain Hernia.
Protrusion of intestine through a weakened area in the abdominal muscle wall.
189
Where are Inguinal hernias located?
Lower left groin area.
An inguinal hernia is a condition where a part of the intestine or other abdominal tissue pushes through a weak spot in the abdominal wall, forming a bulge in the groin area.
190
How can we promote a volvulus to heal on its own?
The patient needs to rest and not consume any food or liquids. Can possibly use a Nasogastric tube.
191
Explain Crohn's disease.
* Chronic inflammation through all layers in GI tract.
* Can happen throughout GI tract.
* Most commonly in distal ileum and ascending colon.
192
Explain ulcerative colitis.
* Chronic ulceration of mucosal and submucosal layers of colon and rectum.
* Unpredictable periods of remission and exacerbation.
* Begins in rectum and progresses to colon.
* Mostly happens in the descending colon.
193
Is Chron's disease normally affected on the right or left side of the bowel?
right side.
194
For ulcerative colitis where would the patient most likely experience pain?
On the left side.
195
For Chron's disease, what are some diagnostic testing that we would do?
Labs : CBC (elevated WBC), ESR (usually elevated)
Albumin/protein (if low indicate malnutrition)
196
For Ulcerative Colitis, what are some diagnostic testing that we would do?
Labs : CBC( elevated WBC), Stool for occult blood or O&P. C-reactive protein (elevated from inflammatory response)
197
Would we use an abdominal x-ray for Chron's or Ulcerative colitis?
Ulcerative Colitis.
198
Would we use an abdominal CT/MRI for Chron's or Ulcerative colitis?
Both
199
Would we use an abdominal Colonoscopy for Chron's or Ulcerative colitis?
Ulcerative Colitis. This is because with a colonoscopy we look specifically at the sigmoid colon and the descending colon.
200
Explain what the ESR/ Sed rate is.
It is a diagnostic lab test to see if the body has processes that are attacking itself _ it helps us diagnose autoimmune diseases.
201
Explain what C-reactive protein labs check for?
A lab work that will check from inflammatory responses and can also be used to check if a patient is at risk of a heart attack.
202
How would we assess patients that are suffering from Inflammatory Bowel Disease (Chron's and Ulcerative Colitis)
* health history - identify onset, duration & characteristics of pain, diarrhea, urgency, tenesmus, anorexia, wight loss, bleeding & family history.
* Assess dietary patterns, alcohol, caffeine & nicotine use.
* Assess bowel elimination patterns & stool
* Abdominal assessment,
203
Explain Colorectal Cancer.
* 3rd most common site of new cancer cases in US
* Risk factors: 66+, sedentary lifestyle, familial history.
* Treatment depends on the stage of the disease.
204
How does Colorectal Cancer manifest itself?
* Change in bowel habits
* Blood in stool - occult, tarry bleeding.
* Tenesmus
* Symptoms of obstruction
* Abdominal or rectal pain
* Feeling of incomplete evacuation.
205
What diagnostic testing would we do for Colorectal cancer?
Colonoscopy
206
What are some risk factors for Colorectal cancer?
* Cigarette smoking
* Family history
* High alcohol consumption
* High fat, High protein & low fiber diet
* History of inflammatory bowel disease
* History of type 2 diabetes
* Increasing age
* Male
* Overweight or obesity
* African American or Ashkenazi Jewish.
207
What is bile made up of?
Water, Electrolytes, Lectin, Fatty Acids, Cholesterol, Bilirubin & Bile salts.
208
Where is the most concentrated bile stored?
In the Gallbladder (5-10 x more concentrated than bile coming from the liver)
209
What does bile assist in?
Emulsifying/ break up fats in the distal ileum.
210
Pancreas is an endocrine AND exocrine gland, which enzymes does the exocrine part excrete ?
Amylase, Trypsin, Lipase & Secretin
211
Pancreas is an endocrine AND exocrine gland, which enzymes does the endocrine part excrete ?
Insulin, Glucagon, Somatostatin,
212
Can we live without the Gallbladder?
It is not ideal, but yes.
213
What part of the GI tract are the enzymes from the pancreas and the gallbladder secreted into?
The Duodenum.
214
What is another name for Gallstones?
Cholelithiasis.
215
What are the two types of Gallstones?
* Pigmented stones. - full of bile crystals
* Cholesterol stones - full of cholesterol
216
What are risk factors for developing Cholelithiasis?
* Cystic Fibrosis
* Diabetes
* Frequent changes in weight
* Ileal resection or disease
* Low dose estrogen therapy
* Obesity
* High dose estrogen treatment
* Women who's had multiple pregnancies.
217
How does Cholelithiasis manifest itself clinically?
* Can be minimal symptoms or acute attack after large fatty meals.
* Pain
* Biliary colic - Sphincter of Oddi is dysfunctioning and close too prematurely and doesn't allow for secretion of bile.
* Jaundice
* Changes in urine or stool color - Bright orange or green,
* Fat- soluble vitamin deficiency (A,D,E,K)
218
Where does pain from Cholelithiasis normally manifest itself?
the RUQ and epigastric area.
219
How come patients can get Jaundice from Cholelithiasis?
Because gallstones can become lodged in the common bile duct and not allow for bile secretion, which then backs up into the liver.
220
What tests would be done to diagnose Cholelithiasis?
First we would start with an ultrasound to look at the gallbladder.
If gallstones are found we would do a histogram / cholangiogram to look at those areas radiologically.
MRI or MCP - to asses is there is obstruction in common bile duct.
Endoscopic retrograde cholangiopancreatography - do a scope to go into the common bile duct.
221
Explain Pancreatitis.
Infection in the pancreas can be acute or chronic.
222
Define acute pancreatitis.
Pancreatic duct becomes obstructed, and enzymes back up, causing autodigestion and inflammation of the pancreas,
223
Define chronic pancreatitis.
Progressive inflammatory disorder w/ destruction of the pancreas.
Cells are replaced by fibrous tissue, pressure in the pancreas increase, obstructing the pancreatic and common bile duct.
224
What are the two major risk factors for Pancreatitis?
* Cholelithiasis (80% of patients) - gallstones blocks the common bile duct.
* Sustained alcohol abuse that ahs caused the pancreas to start digesting itself.
225
How does acute Pancreatitis manifest itself clinically?
* Severe abdominal pain mid epigastric - radiates through to the back 24-48 hrs after alcohol or heavy meal.
* N&V - may have bile color but not necessary
* Fever, Jaundice, mental confusion & agitation can occur w/ progression
* Severe cases can develop into peritonitis & sepsis.
226
What diagnostic tests would we use for suspicion of Pancreatitis?
* Assess history of upper abdominal pain
* Elevated serum lipase & amylase
* CBC ( WBC) CMP (transient hyperglycemia, hypocalcemia (comes and goes) )
* Serum bilirubin may be elevated
* CT/ MRI
* Severity based on lab values.
227
What are common GI symptoms?
Pain, dyspepsia, intestinal gas, nausea, vomiting, altered bowel habits
## Footnote
These symptoms are frequent reasons patients seek medical attention for GI issues.
228
What is the digestive process?
Stages include ingestion, digestion, absorption, and elimination with emphasis on enzymes and small intestine
## Footnote
Enzymes play a critical role in nutrient absorption.
229
What does a thorough abdominal assessment include?
Inspection, auscultation, percussion, palpation of all four quadrants
## Footnote
A more detailed evaluation may include nine quadrants.
230
What are essential diagnostic tools for GI issues?
Endoscopic procedures like EGD and Colonoscopy
## Footnote
Nursing care focuses on patient education, hydration, anxiety management, and post-procedure monitoring.
231
What dietary modifications are recommended for GERD?
Avoid fatty foods, caffeine, tobacco, alcohol, dairy, peppermint, carbonated beverages
## Footnote
These trigger foods can exacerbate GERD symptoms.
232
What medications are commonly used for GERD?
PPIs, H2 blockers, prokinetic agents
## Footnote
These medications help manage acid reflux and associated symptoms.
233
What is gastritis?
Inflammation of the stomach lining, often caused by alcohol abuse, infection, or stress
## Footnote
Management includes hydration, antacids, and addressing underlying causes.
234
What characterizes Peptic Ulcer Disease?
Sores in the stomach lining, primarily caused by H. pylori infection
## Footnote
Treatment includes pain relief, PPI therapy, and addressing stress.
235
What are key nursing interventions for GI conditions?
* Pain Management
* Nutrition
* Hydration
* Infection Prevention
* Patient Education
* Symptom Management
## Footnote
These interventions are vital for optimal patient care.
236
What is osmolality?
Concentration of solutes in a solution
## Footnote
Important for managing feeding tube patients.
237
What is aspiration?
Inhalation of foreign substances into the lungs
## Footnote
This can occur if patients are not properly positioned during feeding.
238
What is homeostasis?
The body's ability to maintain a stable internal environment
## Footnote
Crucial for overall health and function.
239
What is H. pylori?
A bacterium that is a common cause of gastritis and peptic ulcer disease
## Footnote
Its presence is often checked in patients with gastric symptoms.
240
What is an electrolyte imbalance?
A disruption in the balance of electrolytes in the body
## Footnote
Often associated with dehydration.
241
What is dehydration?
A condition of fluid loss that can lead to serious health complications
## Footnote
It is critical to monitor fluid intake in GI patients.
242
What is hemorrhage?
Excessive bleeding, a potential complication of gastritis and peptic ulcer disease
## Footnote
Requires immediate medical attention.
243
What is perforation?
A hole in the wall of the stomach or intestine
## Footnote
This serious complication requires surgical intervention.
244
What is a GI cocktail?
A mixture of medications used to relieve acute symptoms of gastritis
## Footnote
Often includes antacids and other agents.
245
What is a PEG tube?
A percutaneous endoscopic gastrostomy tube, a feeding tube placed directly into the stomach
## Footnote
Used for patients requiring long-term feeding support.
246
What is a J-Tube?
A jejunostomy tube, a feeding tube placed into the jejunum
## Footnote
Used when gastric feeding is not possible.
247
What is a hiatal hernia?
A condition where a portion of the stomach protrudes through the diaphragm
## Footnote
Can contribute to GERD symptoms.
