GI Exam Flashcards
(237 cards)
1
Q
What are the GI organs?
A
1) Mouth
2) Stomach
3) Rectum
4) Esophagus
5) Intestines (small & large)
6) Anus
2
Q
What are the associated organs of the GI tract?
A
1) Liver
2) Pancreas
3) Peritoneum
4) Gall bladder
5) Mesentery & omentum
3
Q
Name the associated organ:
-Covers the small intestines, the large intestines, and attaches these to the abdominal walls
-Has blood and lymph vessels
A
Mesentery
4
Q
Name the associated organ:
-Covers stomach to intestines
-Includes fat and lymph vessels
-“Apron”
A
Omentum
5
Q
What layer of the peritoneum covers the organs?
A
Visceral
6
Q
What layer of the peritoneum covers the walls?
A
Parietal
7
Q
What are the 4 layers of the intestinal tract?
A
1) Mucosa (innermost)
2) Submucosa
3) Muscle
4) Serosa (most external
8
Q
What layer of the intestinal tract produces bicarb to help neutralize and protect the GI tract against any acidic environments?
A
Mucosa
9
Q
What layer of the intestinal tract has glands, blood vessels, and lymph nodes?
A
Submucosa
10
Q
What is the function of the digestive system?
A
Supply nutrients to the body’s cells through ingestion, digestion, absorption, and excretion of waste products
11
Q
What is the parasympathetic response for GI?
A
Increased peristalsis (excitatory)
12
Q
What is the sympathetic GI response?
A
Decreased peristalsis (inhibitory)
13
Q
What make up the enteric system for GI neural stimulation?
A
1) Meissner (submucosal) plexus – secretions and sensation
2) Auerbach (Myenteric) plexus – GI motility
14
Q
True or False:
The enteric system is independent of the brain and spinal cord & are specific to the GI system to help regulate motility and secretions
A
True
15
Q
How much of CO goes to the GI?
A
25-35% dependent on resting or actively digesting
16
Q
What are the main vessels involved in the GI tract?
A
1) Celiac artery
2) Superior Mesenteric artery
3) Inferior mesenteric artery
17
Q
What organs does the celiac artery supply?
A
Stomach & duodenum
18
Q
What organs does the superior mesenteric artery supply?
A
Small to mid-large intestine
19
Q
What organs does the inferior mesenteric artery supply?
A
Distal larger intestine to anus
20
Q
What makes up the upper GI tract?
A
1) Mouth
2) Pharynx
3) Esophagus
4) Stomach
5) Small Intestines
21
Q
What makes up the lower GI tract?
A
1) Large intestine
2) Rectum
3) Anus
22
Q
What are the salivary glands?
A
-Parotid
-Submaxillary
-Sublingual
23
Q
What is the function of the lips?
A
Speech
24
Q
What is the function of the oral cavity?
A
-Teeth
-Mastication
25
What is the function of the tongue?
-Chewing
-Talking
-Taste
-Speech
26
What is the function of the salivary glands?
-Lubricate food
27
True or false:
Salivary glands release salivary amylase to help begin the breakdown of carbs and starches in your food
True
28
Name the part of the upper GI:
1) 3 parts --> naso, oro & laryngeal
2) Initiate swallow reflex
3) Same mucosal layer as the nasal cavity, auditory tubes, mouth, and larynx
Pharynx
29
Name the part of the upper GI:
-Hollow tube with striated skeletal muscle and smooth muscle
-2 sphincters
Esophagus
30
Name the esophageal sphincter:
-Between mouth and esophague
-Prevents regurgitation of food back into the mouth
UES
31
Name the esophageal sphincter:
-Between stomach and esophagus
-Prevents gastric acid regurgitation from stomach into esophagus
LES
32
When is the LES opened?
Belching, swallowing, vomiting
33
Where is the stomach located?
LUQ
34
What are the parts of the stomach?
-Fundus (top)
-Body
-Antrum/pylorus (end)
-4 layer wall
35
Where is the pyloric sphincter located?
Between duodenum and pylorus
36
What is the function of the pyloric sphincter?
Prevents chyme from regurgitating back from the small intestine
37
Name the vocab:
Broken down chunk of food when it first comes through
Chyme
38
How long does it normally take for the body to empty out food?
2-3 hrs
39
What are the functions of the stomach?
1) Store food
2) Mix with gastric secretions
3) Empty into small intestine
4) Absorption of small amts of alcohol, water, drugs, electrolytes
40
What does the stomach secrete?
1) Pepsinogen
2) HCl
3) Lipase
4) Intrinsic factor
5) Proteins
6) Fat
**Converts pepsinogen to pepsin & contributes to VitB12 absorption
41
What are the sections of the small intestines?
-Duodenum
-Jejunum
-Illeum
42
What do microvilli do in the small intestine?
Help secrete digestive enzymes to help with breakdown and increase surface area of intestine
43
What are the functions of the small intestines?
Digestion and absorption
44
What happens during digestion?
1) Carbs --> simple sugars/monosaccharides
2) Fats --> glycerol & fatty acids
3) Proteins --> amino acids
45
Name the organ:
Coiled tube from pylorus to ileocecal valve
Small intestine
46
Name the organ:
-Less coiled hollow tube
-Slower peristaltic movement
Large intestine
47
What are the portions of the large intestine?
-Ascending
-Transverse
-Descending
-Sigmoid colons
48
What do microorganisms do in the large intestine?
1) Help produce Vit K & B
2) Assist with deamination of amino acids and proteins to ammonia
49
What is the function of the large intestine?
-Fecal formation & resevoir
-Water & electrolyte absorption
50
What is ingestion influenced by?
1) Appetite
2) Glucose levels (hyper)
3) Temp
4) Stomach contents
5) Illness
6) Abdominal distention
7) N/V
8) Drugs
51
Name the process:
Deglutination (swallowing) + mastication (chewing)
Ingestion
52
What does ghrelin do?
Stimulate appetite
53
What does Leptin do?
Suppress appetite
54
What organs are involved in ingestion?
1) Mouth
2) Salivary glands
3) Oropharynx
4) Esophagus
5) Epiglottis
55
Name the process:
Physical and chemical breakdown of food into absorbable substances
-Breaking down food into chyme
Digestion
56
What organs are involved in digestion?
1) Mouth
2) Stomach
3) Small intestine
57
What are the gastric ezymes secreted during digestion?
1) HCl acid
2) Pepsinogen
3) Intrinsic Factor
58
What are the pancreatic ezymes secreted during digestion?
1) Amylase
2) Lipase
59
What do the liver and gallbladder secrete?
Bile
60
Name the process:
-Uptake of nutrients from gut into bloodstream
-Triggered by movement of chyme past the pyloric sphincter
-Breaking down food
Absorption
61
What are the digestive secretions released during absorption?
1) Amylase
2) Lipase
3) Bile
62
What does IF help absorb?
Cobalamin
63
What does pepsin break down?
Proteins
64
Name the process:
Final "absorption" & defacation
Elimination
65
What organ is involved in absorption?
Small intestine
66
What organ is involved in elimination?
Large intestine
67
What is produced during the elimination process?
1) Feces
2) Some vitamins
3) Urea
4) Flatulence
68
What stimulates defecation?
-Vagal stimulation from parasympathetic response
-Feces in rectum pressing against vagus nerve in sacral spine
69
How much of feces is made up of bacteria/unabsorbed or undigested food?
25%
70
What can the valsalva maneuvar cause?
Hypotension & bradycardia
71
What pts cannot do the valsalva maneuvar?
-Head trauma
-Eye injury
-Cardiac disease
-Hemorrhoids
-Abdominal surgery
-Portal HTN w/ cirrhosis of liver
72
What is the correct order of assessment for the abdomen?
Inspect
Auscultate
Percuss
Palpate
73
If you hear a bruit upon auscultation of the abdomen, what can be inferred?
AAA or partial aortic obstruction
74
What does an upper abdominal x-ray look at?
Strictures, hernias, or foreign bodies
**Kid who swallows a coin
75
What does a lower abdominal x-ray look at?
Colon -- polyps, tumors, lesions
**Will see barium going through colon
76
What are the nursing responsibilities for a pt having an abdominal x-ray?
1) Assess for dye allergy
2) Educate -- NPO or not?
3) Barium excreted with stool -- grayish/white color = NORMAL`
77
What does and ERCP (endoscopy) look at?
Gallbladder & pancreas
78
What does an EGD (endoscopy) look at?
Esophagus, stomach, upper duodenum
79
Name the procedure:
-Pt swallows radiographic capsule
-Has to wear external radiographic belt that takes images of capsule as it moves through the body
Capsule endoscopy
80
What are the nursing responsibilities for a pt having an endoscopy?
1) Educate about procedure & sedation -- rxns?
2) Bowel prep/NPO
3) Verify consent
4) VS
5) Return of gag reflex
6) Assess for esophageal bleeds or perforations
7) Let pt know post-op pain (sore throat = normal)
81
What are nursing responsibilities with a colonoscopy?
1) Educate about sedation
2) Bowel prep (colon cleanse)
3) Verify consent
4) VS
5) Educate post-op pain may include abdominal cramping & expect flatulence after
82
Name type of nutritional therapy:
-Supplemental formulated nutrition admin directly into GI system
-Specific caloric, fat, and carb composition
-Increases nutrients & cals & easier to absorb
-Admin through tube, catheter, or stoma
-AKA "tube" feedings
Enteral
83
True or False:
Parenteral feeding is better than enteral feeding
False-- Enteral > parenteral
84
What are the types of enteral feedings?
1) NG/OG/naso-ingestinal tube
2) G-tube or J-tube
3) PEG tube
85
What enteral feeding is for short-term use < 4 weeks?
NG/OG/naso-ingestinal
86
What enteral tube feeding has a small/narrow lumen, prone to occlusion, and difficult to check residuals?
NG/OG/nago-ingestinal
87
What enteral feeding is for long-term use > 4 weeks?
G-tube or J-tube
88
What is the greatest benefit of enteral feeding?
Can come lactose free -- not as many intolerances
89
What are comps of enteral feedings?
1) Constipation
2) Diarrhea
3) Aspiration
90
What test verifies tube placement?
KUB X-ray
91
How much water do you flush into an enteral tube to check patency?
30 mL warm tap water
**Sterile water if immunocompromised
92
True or False:
Continuous feeds are better than intermittent feeds via enteral
True -- little bit over a longer time
93
Name the type of nutritional therapy:
-Feed goes through blood
-Used in pts who cannot go through GI tract
-Mixture of vitamins, dextrose, protein, and electrolytes (mostly carbs)
-About 1g/kg/day
Parenteral
94
What are limitations for using parenteral feedings?
1) Hyperlipidemia
2) Egg or soy allergies
95
Name the type of parenteral nutrition:
-Short-term use
-Fewer nutrients, less hypertonic
-Used for those where CPN is too high
-Goes into large peripheral vessel
-Less protein/caloric intake needed
Peripheral Parenteral Nutrition
96
Name the type of parenteral nutrition:
-Long-term use
-High protein, high caloric, high glucose
-Hypertonic solution
Central Parenteral Nutrition
97
What are comps of parenteral nutrition?
1) Hypo or hyperglycemia
2) Weight changes
3) Infection
98
How long after opening a container of parenteral nutrition does it need to be discarded?
24 hrs
99
Name the disorder:
-Sx of repeat mucosal damage
-Reflux of acid into lower esophagus
-Most common GI disorder
GERD
100
What the the RFs of GERD?
1) Weak LES
2) Obesity
3) Smoking
4) Hernia
5) Drugs, ETOH, spicy foods
101
What are the sx of GERD?
1) Pyrosis
2) Dyspepsia
3) Regurgitation
4) Dyspnea, cough, wheezing
5) Hoarseness
6) Nocturnal discomfort or disturbances
7) Sore throat or globus sensation
102
What is dyspepsia?
Central abdominal pain
103
True or false:
If pt > 40 c/o pyrosis, tx like angina (get trop & EKG to rule out MI)
True
104
What are comps of GERD?
1) Esophagitis
2) Esophageal Metaplasia
3) Respiratory troubles --> bronchospams, laryngospasms, cricospasms, wheezing
4) Oral (dental erosion)
105
What does a motility study assess?
LES pressure and function
106
What does a radionuclide study assess?
Rate of esophageal clearance and reflux of gastric contents
107
What are the dx studies for GERD?
1) Endoscopy
2) Biopsy
3) Motility
4) Radionuclide
108
How long should someone with GERD be sitting up for after eating?
2-3 hrs
109
How long should a person with GERD eat before bedtime?
3 hrs
110
What lifestyle modifications should someone with GERD make?
1) Modify eating habits
2) Weight management
3) Smoking reduction
111
What classes of drug therapy are used in GERD?
1) PPIs, H2Bs
2) Antacids
3) Cytoprotective
4) Prokinetics
112
What kind of foods should a person with GERD avoid?
1) Spicy foods
2) Acidic foods -- tomato based
3) Chocolate
4) Caffeine
5) Tea (natural
113
What surgical therapies can be done for GERD?
1) Fundoplication (Nissan & Toupet)
2) LINX Reflux Management System
114
Name the surgical procedure for GERD:
-Take portion of stomach and wrap around esophagus to reduce pressures
-Full or partial --> both only effective for 5-10 yrs
-Most common
Fundoplication (Nissan & Toupet)
115
Name the surgical tx for GERD:
-Ring of magnets that snap together and wrap around the esophageal sphincter
-Have to let providers know if you are getting an MRI
LINX
116
What medication combo gives the best effective tx for GERD?
PPI & H2B
**Both have SE of abdominal discomfort
117
What do PPIs do for GERD?
Reduce production of HCl & tx esophagitis
118
What are examples of PPIs for GERD?
1) Omeprazole
2) Esomeprazole
3) Pantoprazole
119
What are comps of long-term PPI use?
1) Mg+ & Vit B12 deficiencies --> cardiac dysrhythmias
2) Kidney disease
3) Decreased bone density
4) Increased risk of dementia
120
True or False:
Prilosac must be taken at the same time every day otherwise HCl will produce
True
121
What are examples of H2RBs in GERD?
1) Ranitidine
2) Cimetidine
3) Famotidine
122
What are examples of anatacids used in GERD?
1) Aluminum hydrozide
2) Ca+ carbonate
3) Sodium bicarbonate
4) Sodium citrate
123
What do anatacids do in GERD?
Neutralize HCl
124
Who should the use of antacids be cautioned with?
-Renal failure
-Cardiac dysrhythmias
-Elderly
**Can cause electrolyte imbalances
125
True or False:
Anatacids can be used for severe and frequent sx of GERD
False-- ineffective tx for severe and frequent sx
126
True or false:
Antacids decrease the absorption or enhances the effects of meds they take like benzos, diazepems, and thyroid meds
True
127
How long before or after a meal can a pt with GERD take an antacid?
1-3 hrs
128
What do prokinetics do in GERD?
1) Increase LES pressure & gastric emptying
2) Decrease reflux
129
When are prokinetics used in GERD?
For thsoe with delayed gastric emptying
130
What are examples of prokinetics for GERD?
1) Metoclopramide (Reglan)
2) Baclofen
131
What does cytoprotective do in tx of GERD?
Forms a protective mucosal layer
132
What is an example of cytoprotective used in GERD?
Sucralfate
133
Name the disorder:
Gastric mucosal inflammation d/t breakdown of the mucosal barrier d/t increased HCl & Pepsin
Gastritis
134
What can gastritis lead to?
Tissue edema, hemorrhage, or stomach cancer
135
What are RFs of gastritis?
1) Drugs
2) Diet
3) Microorganisms
4) Environment
5) Bile or pancreatic acid reflux
6) Procedures
7) Diseases/disorders
136
What drugs are RFs of gastritis?
-NSAIDs
-Aspirins
-Corticosteroids
137
What microorganism is the most common cause of gastritis?
H. pylori
138
What procedures can put a pt at risk of gastritis?
-NG tube placement
-Endoscopy
-Stress
***Intereferes with sphincters coming back to normal positions
139
What diseases/disorders put a pt at risk for gastritis?
1) Autoimmune atrophic gastritis
2) Chrons
3) Hernia
4) Sepsis
140
Name the risk factor for gastritis:
-Parietal cells attacked
-Leads to decreased IF and decreased HCl
-Can lead to anemia
-Decreased digestion, food backs up, decreased nutrient absorption
Autoimmune atrophic gastritis
141
What are sx of gastritis?
1) Anorexia
2) N/V
3) Epigastric pain
4) Feeling full/bloated
5) Hemorrhage
6) Pernicious Anemia
142
Name the type of CM of gastritis:
-Mucosa can repair
-Eliminating cause & avoiding trigger
Acute
143
Name the type of CM of gastritis:
-Poor mucosal repair
-Eliminating cause & medication
Chronic
144
Why is pernicious anemia a sx of gastritis?
-IF damaged & not produced
-Decreased B 12 absorption
145
What are the dx studies for gastritis?
1) Sx & Hx (ETOH & drugs)
2) Endo/colonoscopy
3) Biopsy
4) CBC
5) Occult stool
6) H. pylori
146
What is the tx for gastritis
1) H2RBs & PPIs --> most likely IV Protonix
2) Vit B12
3) NG tube
147
What antbx are given for H. pylori?
1) Clarithromycin
2) Metronidazole
3) Amoxicillin
148
True or False:
When using sucralfate, it needs to be paired with a PPI because it does not neutralize the acid
True
149
What does misoprostol do in tx of gastritis?
1) Decrease HCl
2) Increase mucosal bicarb to neutralize HCl
3) Slows down/prevents further disruption of clotting factors
150
What is a major SE of misoprostol?
Diarrhea
151
Name the problem:
-Sudden onset, occult bleeding
-MED EMERGENCY
-Venous will bleed more than arterial
Upper GI bleed
152
What are the types of upper GI bleed?
1) Occult --> small amt
2) Obvious --> to nurse, not pt
153
What are characteristics of obvious upper GI bleed?
1) Clear hematemesis or blood in the stool
2) Melena (dark, tarry stool)
154
What is the most common cause of upper GI bleeds?
Peptic ulcers (h. pylori)
155
What are stomach and duodenal causes of upper GI bleeds?
1) Peptic ulcers
2) Non-illicit drugs
3) Gastritis
4) Polyps
5) Stress-induced mucosal disease
6) Stomach cancer
156
What are esophageal causes for an upper GI bleed?
1) Chronic esophagitis
2) Esophageal varicies
3) Mallory-Weiss tear
157
Name the esophageal cause of upper GI disease:
-Severe vomiting (retching)
-Chronic alcoholics
-Pregnant women w/ hyperemesis gravidarium
-Resolution in 1-2 days
Mallor-Weiss tear
158
What are the dx of upper GI bleed?
1) Labs
2) Occult blood
3) Endoscopy
4) Angiography
159
How many hrs can H&H be falsely elevated for?
4-6 hrs
160
What types of labs should you get for dx testing of upper GI bleed?
1) CBC --> anemia or blood loss
2) Electrolytes
3) Liver enzymes --> protein breakdown & function
4) Type & cross --> anticipate transfusion
5) BUN --> better than H&H
6) PT/PTT
7) ABG --> vomiting = metabolic acidosis
161
What comps do you have to watch for in pts with upper GI bleed?
1) Hypotension
2) Weak thready pulses
3) Tachycardia
4) Cool, clammy skin
5) Restlessness
6) Increased thirst
162
How many mL of output of blood is very concerning in an upper GI bleed?
> 1500 mL
163
What would the cap refill be of someone with an upper GI bleed?
> 3 sec
164
What would the UO be of someone with a GI bleed?
< 30 mL/hr
165
What interventions should be done for a pt with an upper GI bleed?
1) 2 larger bore IV in ACs
2) EKG
3) Urinary cath
4) Supplemental O2
5) NG tube
6) NPO
166
Name the disorder:
-Erosion of the GI mucosa d/t HCl & pepsin
-Can occur in acidic environment or less acidic (neutralized) environment --> pH > 3 (normal 2-3)
PUD
167
What are RFs of PUD?
1) H. pylori
2) Meds
3) Smoking, ETOH, coffee
4) Zollinger-Ellison Syndrome
168
What are sx of PUD?
**Initially asympx
1) Dyspepsia
2) Upper abdominal pain
3) Nausea, hematemesis, melena
169
What is Zollinger-Ellison Syndrome?
Increased acid secretion
170
What are the types of PUD based on?
Duration of sx & location
171
Name the type of PUD:
Superficial erosion, resolves quickly
Acute
172
Name the type of PUD:
-Mucosal erosion with possible fibroid
-For months of lifetime, does not have to be consistent
Chronic
173
Name the type of PUD:
-Women, > 50
-Elderly pts may be asympx
-Higher mortality
Gastric
174
What are the sx of gastric PUD?
-Upper epigastric pain 1-2 hrs after a meal
-"Gaseous" or "burning"
175
Name the type of PUD:
-Most common
-35-45 y/o, comorbidities
-Chronic in nature & penetrating
-Worsens w/ COPD, pancreatitis, hyperparathyroidism, and CKD
Duodenal
176
What are the sx of duodenal PUD?
-Mid epigastric or back pain 3-5 hrs after eating
-"Cramplike"
177
What are comps of PUD?
1) Hemorrhage
2) Perforation --> most LETHAL
3) Gastric outlet obstruction
178
Name the comp of PUD:
-Most common
-Duodenal > gastric
Hemorrhage
179
Name the comp of PUD:
-Gastric > duodenal d/t elderly
-Rigid abdomen
-Sx --> sudden severe abdominal pain, absent bowel sounds
***Pts try to take antacids to fix this
Perforation
180
Name the PUD comp:
-D/t edema, inflammation, pylorospasm, or fibrous scar tissue
-C/o pain at end of day
-Relief only with vomiting or belcing
-Constipation d/t dehydration
-May require surgery to fix
Gastric Outlet Obstruction
181
What is the gold standard dx for PUD?
Biopsy
182
What is acute uncomplicated therapy for PUD?
1) NPO
2) NG suction
3) IV fluids
4) Drugs
5) Frequent VS
183
What is acute complicated tx for PUD --> PUD + 1 other comp?
1) IV PPIs, fluids, pain meds
2) Tx comp
3) Bedrest
184
What is the surgical therapy for PUD?
1) Partial gastrectomy
2) Vagotomy
3) Pyloroplasty
185
Name the surgical tx for PUD:
-Removal of distal 2/3 of stomach
-Anastomosis of gastric stump to either duodenum or jejunum
-Absorption rate decreases --> may suffer from short bowel syndrome
-Requires gen anesthesia/intubation
Partial gastrectomy
186
Name the surgical therapy for PUD:
-Sever the vagal nerve to decrease gastric acid secretion
-SNS may not turn off
Vagotomy
187
Name the surgical procedure for PUD:
Surgical reinforcement of pyloric sphincter to ease passage into the stomach
Pyloroplasty
188
What are comps of PUD?
1) Post-op bleed
2) Dumping Syndrome
3) Postprandial hypoglycemia
4) Bile reflux gastritis
189
Name the comp of PUD:
-Sudden get rush of sugar causing weakness and fatigue
-May get lightheaded, nauseous, and diaphoretic
Dumping syndrome
190
What is the tx for bile reflux gastritis (comp of PUD)?
Cholestyramine
191
True or False:
Pts with partial gastrectomy will have anemia or mineral loss for life
True
192
Name the disease:
-Autoimmune disorder characterized by chronic inflammation
-Unknown cause
-Ex: Ulcerative Colitis & Crohns
Inflammatory bowel disease
193
What organs does ulcerative colitis involve?
Colon & rectum
194
What organs involved in Crohns?
Entire GI tract
195
What population of people typically have IBD?
1) Caucasian
2) Rural
3) Women
4) < 40 and > 60
5) Jewish
6) Family hx --> monozygotic twins
196
What classes of meds are used to tx IBD?
1) Anti-microbial
2) Aminosalicylates
3) Corticosteroids
4) Immunosuppressants
5) Biologics
197
What anti-microbials are given for IBD?
1) Bismuth (Pepto-Bismal)
2) Metronidazole (Flagyl)
198
What class of meds are the most effective in tx IBD?
Aminosalicylates
199
What is an example of an aminosalicylate given to pts with IBD?
Mesalamine
200
What is an example of corticosteroid given for IBD?
Methylpredisolone
201
What immunosuppressant is given for IBD?
Methotrexate -- harsh, > infection risk
202
What is the harshest med to give for IBD?
Adalimumab
203
What is an example of biologics given for IBD?
Adalimumab
204
What are the SEs of Adalimumab?
1) UTI
2) URI
3) TB
4) Hepatitis
205
What factors contribute to IBD exacerbations?
1) Smoking
2) Diet & stress
3) Meds
4) Genetic inflammatory disorders (MS, CF, psoriasis)
206
What are sx of IBD?
1) Diarrhea & malabsorption -- wt loss
2) Abdominal cramping/pain
3) Liver disease
4) Fever & fatigue
207
What are comps of IBD?
1) Cancer
2) Strictures, fissures
3) Perforations or abscesses (increased risk for peritonitis)
4) Osteoporosis
5) Ankylosing spondylitis
6) C.diff
7) Proctitis & left-sided UC (elderly)
208
Name the disorder:
-Chronic inflammatory disease involving all layers of GI tract
-RLQ
-Most common ascending & descending colon or terminal ileum
-Genetic mutations
Crohns
209
What kind of GI tract appearance does someone who has Crohns have?
Cobblestone
210
True or False:
People with Crohn's often have "skip lesions" -- periods of inflammation and none
True
211
What are comps of Crohns?
1) Fissures, deep ulcers, granulomas
2) Abscesses
3) Strictures
4) Possible obstruction
5) Small intestinal cancer
6) Inflammation
212
What are sx of Crohns?
1) Non-bloody, small-volume diarrhea (less water:feces)
2) Cramping
3) Sense of urgency
4) Low-grade fever
5) Wt loss
6) RLQ pain
7) Abdominal distention
8) Fatigue
9) Tachycardia
10) Secondary anemia d/t malabsorption of cobalamin
11) Osteoporosis d/t poor VitD & Ca+ absorption
213
Name the diesase:
-Colorectal inflammation (rectum to cecum)
-Ulcers in mucosal layer
-Pseudopolyps develop in lumen
Ulcerative Colitis
214
Name the class of UC:
< 4 semi-form stools/day
Mild
215
Name the class of UC:
-5-10 semi-formed stools/day
-Micro tears/fissures at anus
-Dehydration, start having systemic sx like fatigue
Moderate
216
Name the class of UC:
-10-20 episodes of stool/day
-Typically bloody mucosal diarrhea
Severe
217
What are sx of severe UC?
1) Fever
2) Weight loss
3) Anemia
4) Dehydration
5) Tachycardia
218
What are comps of UC?
1) Fissures
2) Toxic megacolon
3) Colorectal cancer
4) C. diff
219
What comp of UC requires an emergency colectomy?
Toxic megacolon
220
Name the comp of UC:
Severe inflammation of the colon that causes a perforation that is leaks out into peritoneal cavity that causes peritonitis
Toxic megacolon
221
What are S&S of UC?
1) Bloody diarrhea
2) Constant urge to pass stool
3) Weight loss
4) Abdominal cramps
5) Fever
6) Severe rectal pain
7) Fatigue
8) Pain with stools
222
What does UC put the pt at risk for?
1) Cancer
2) Hypovolemia/electrolyte imbalances
3) Anal fissures & rectal bleeds
4) Peri-anal abscess
223
What are imaging can be dx for IBD?
1) Barium enema
2) Small bowel series --> looks for "string sign" r/t Crohns
3) Transabdominal US
4) CT
5) MRI
6) Colonoscopy --> IDEAL
224
True or False:
IBD tx is only palliative, not curative
True
225
What are nursing interventions during the acute (exacerbation) phase of IBD?
1) Pain control
2) Hemodynamic stability
3) Nutrition & electrolyte replacement
4) I&Os
5) Hematemesis or rectal bleeding
226
What are nursing interventions for the ambulatory (at home) phase of IBD?
1) Teach rest & diet management
2) Perineal care/hygiene
3) Med education
4) When to seek tx
227
What is the least harmful drug therapy for IBD (step up)?
Aminosalicylates
228
What disease are aminosalicylates most effective in treating by decreasing inflammation?
Ulcerative Colitis
229
What med is most effective in Crohn's?
Methyltrexate (immunosuppressant)
230
True or false:
IBD meds (step up and down) are effective in reducting diarrhea
False-- they help decrease inflammation, but need to take antidiarrheals in conjunction
231
True or False:
A total proctolectomy with ileal pouch/anal anastomosis or with permanent ileostomy can be considered curative in Crohn's
False -- it can be considered curative for UC
232
True or false:
A stoma immediately post-op should be pink
False-- will be bright red, then brick red, then pink further post op
233
What kind of supplements would someone with IBD potentially need to take
1) Vitamins
2) Iron
3) Zinc
4) Bile salts
5) Folic acid
6) Calcium
7) Potassium
234
What eating patterns should someone with IBD have?
Frequent, small meals --> 4-6 a day with rest between
235
What does the diet of someone with IBD need to consist of?
Low residue, high protein, high cal, no dairy
236
What kinds of foods does someone with IBD need to avoid?
1) Beans
2) Nuts
3) Popcorn
4) Fribrous fruits & veggies
237
True or False:
People with IBD cannot have live vaccines because they are immunosuppressed
True
