GI Flashcards
(25 cards)
Pyloric Stenosis
The circular muscle of the pylorus thickens causing narrowing which may lead to an obstruction. Common in Caucasian males, and is hereditary.
S/Sx: Projectile vomiting, non-bilious, weight loss, olive sized mass in the right upper quadrant, dehydrated, lethargic & irritable
Dx: Blood tests (water, mineral, and electrolyte imbalance), abdominal X-Ray, ultrasound, barium swallow/upper GI series
Tx: Balance fluid and electrolytes, Surgery- pylomyotomy to release the pyloric muscle.
2nd most common problem requiring surgery within the first two months of a child’s life
Appendicitis
Acute inflammation of the vermiform appendix (common closed loop obstruction blocking the secretory lumen)
S/Sx: N/V, fever, anorexia, muscle rigidity, guarding, rebound tenderness, pain at Mc Burney’s point (RLQ), peritonitis
Dx: Assessment, Ultrasound, CBC
Tx: NPO, IV fluids, Antibiotics, No heat/enemas, Appendectomy
Cholecystitis
Inflammation of the gallbladder
Highest risk: Fat, Fertile, Female, over Forty
S/Sx: pain in the Right Upper Quadrant
Dx: CT of gallbladder, blood tests, hepatobilary iminodiaccitic acid, ultrasound, CBC
Tx: Analgesics, antiemetics, antibiotics, avoid fatty food, hold food for N/V, extracorporeal shock wave lithotripsy (ESWL), per cutaneous transhepatic cholecystotomy (long drain), cholecystectomy, bile acid solution
Gastroenteritis “Stomach Flu”
Inflammation of the mucous membranes of the stomach and intestinal tract (viral or bacterial in nature)
Sx: N/V/D, pain, bloody mucous in stool, hydration level, mental status, recent travel history
Dx: Organism culture (Gram stain), Symptoms and Physical, blood in the stool
Tx: BRAT or CREAM diet, rehydrate, clear liquids, bland food, electrolyte replacement, probiotics, antibiotics, skin care, hand hygiene
No antidiarrheals- you want the infection/contending materials to be excreted by the body
BRAT Diet
B- banana
R- rice
A- apple sauce
T- toast
CREAM Diet
C- cereal
R- rice
M- milk
GERD (gastroesophageal reflux disease)
Backwards flow of gastric content into the esophagus (a decrease in the lower esophageal pressure and an increase in the gastric pressure)
S/Sx (which increase with lying down/bending over): Heartburn, belching, gas, feeling bloated after meals, asthma, chest pain, morning hoarseness, difficulty/painful swallowing; Infants: refusal to eat, arched back, lack of weight gain, respiratory problems
Dx: 24 hour pH monitoring through an NG tube [stomach pH 1-2 and the esophagus has a pH of 6, normally], esophagastroduodenoscopy (EGD)
Tx: modify diet, elevate HOB, loose weight, quit smoking, antacids, histamine blockers (h2), proton pump inhibitors, Regalin, small frequent meals that are high in fiber and low in fat, avoid eating 2-3 hours before bedtime
Most common Upper GI Disorder
Intestinal Obstruction
Can be Partial or Complete; Mechanical (physical block) or non-mechanical: adhesions, tumor, hernias, or fecal impaction. Paralytic Ileus post surgery is also a concern.
S/Sx: gallstones, hernias, history of a tumor or trauma, pain, fowl odor, flatus, blood in stool, hiccups, abdominal discomfort and cramping, borborygmi
Dx: CT, X-Ray, Colonoscopy, Barium enema
Tx: NG tube hooked to suction, NPO, monitor flatus and stool, IVF, VS, fluid status, Dissempaction: enema, manual/ digital, surgery, stimulate gastric motility; AVOID Itracinception (colon telescoping back onto itself - often fatal
*partial bowel obstruction patients may still have diarrhea
Ulcerative Colitis
Ulceration confined to the Colon
S/Sx: Intermittent bouts of bloody diarrhea between periods of normal BM’s; up to 30-40 loose stools/day; Tenesus (urge to deficate), anxiety, fatigue, anemia, electrolyte imbalance
Dx: Colonoscopy with biopsy
Tx: Remove colon (curative), antibiotics, corticosteroids, biological response modifiers, vivanex/Ensure/Probalance supplements, low fiber and low residue diet
Crohn’s Diseas
Affected area of the small bowl becomes rigid and thick => hypertrophy and strictures => abscesses, fistula, and bowl obstruction (can affect the entire GI tract)
S/Sx: abdominal pain, loose stool, loss of appetite and weight, fever, fatigue, rectal bleeding; long term- joint pain, liver inflammation, osteoporosis, skin and eye problems
Dx: CT, Endoscopy; CBC (anemia, leukocytosis), sed rate, CRP, nutritional markers
Tx: Colectomy
Diverticula
Pouch like hernias ions of mucosa in the wall of the intestines, commonly in the colon
Diverticulosis
Presence of many diverticula
Diverticulitis
Inflammation of one or more diverticula
Diverticular Disease
Pouch like herniation of the intestines which can become inflamed (muscular hypertrophy to other structures thickening to herniation)
S/Sx: Intermittent Left Lower Quadrant pain, constipation, low grade fever, N/V, rectal bleeding
Dx: Upper/lower GI with barium contrast, Routine colonoscopies (for diverticulosis only), X-Ray, CT, CBC (decreased H&H, increased WBC), stool positive for blood
Tx: Antibiotics, analgesics, rest, low fiber diet switched to a high fiber diet once symptoms resolve, hospitalization, surgery (colostomy), and AVOID laxatives and enemas
Types of Irritable Bowel Syndrome
IBS-C: constipation
IBS-D: diarrhea
IBS-A: a combination of being constipated and having diarrhea
Irritable Bowel Syndrome
Functional disorder causing changes in normal bowel elimination: onset- young adult, women (impaired motor/sensory of GI)
S/Sx: weight loss, fatigue, malasia, abdominal pain, changes in bowel pattern, food intolerance
Dx: routine lab work, test to tule out other illnesses/ pathogens, pattern of symptoms; no physical change visible
Tx: Decrease stress, eat smaller meals with more fiber and less fat, AVOID carbonated/gas producing food and straws
Obesity
Excess body fat: hereditary/cultural, metabolic disorder, hormonal imbalance, sedentary lifestyle, diet: large portions, high fat foods, excessive cholesterol.
Dx: 20% above healthy weight BMI, high LDLs, high triglycerides, hip to waist ratio, arm & calf circumference, or dunk tank immersion.
Complications: DM, HTN, hyperlipidemia, sleep apnea, gallstones, cancer, pickwickdan syndrome
Tx: dietary program, appetite suppression, behavioral management, exercise programs, complimentary/alternative therapy, bariatric surgery, liposuction
65% of Americans suffer from this
Physical Assessment
Inspect and Observe
Auscultation
Percussion
Palpate
(Look, Listen, Feel)
Pain: PQRST
P- provokation/ palliation Q- quality/ quantity R- region/ radiation S- severity scale T- timing
Borborygmia
A rumbling or gurgling noise made by the movement of fluid and gas in the intestines.
High pitched noise that may be heard early in the obstruction process
GI Diagnostic Labs
CBC: Anemia & Infection
Electrolytes: Malabsorption & N/V can cause abnormalities
Liver enzymes: AST, ALT, amylase lipase ( elevated in pancreatitis [elevated for 5 days after symptoms], liver disease, alcoholics, Hepatitis, cirrhosis)
PT: Prolonged in acute or chronic liver disease
Bilirubin: direct and indirect elevations can indicate impaired secretions
Stool: fecal occult blood test (FOBT), ova and parasites, or Clostridum defficile
Melena
Tarry, dark black stool containing traces of blood
TPN
Total Parenteral Nutrition
Administered via a central line
Composed of: Protein in the form of amino acids, carbohydrates in the form of glucose, and fat as lipid emulsion
Used as long term nutrition supplementation (X> 10 days) and when an individual is unable to eat or absorb nutrients via the GI tract
TPN Complications
Glucose abnormalities Liver abnormalities Electrolyte imbalance Volume overload Gallbladder disorders Metabolic bone disease Catheter-related sepsis Air embolism
