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GI part 2 Flashcards

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0
Q

What can contribute to stress ulcers?

A

trauma or major illness
burns
head injury
drug ingestion

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1
Q

What are stress ulcers?

A

Gastric erosions after major assaults on body

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2
Q

What drugs can cause stress ulcers?

A

NSAIDs and steroids

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3
Q

What is probably the cause of stress ulcers?

A

ischemia and increased acid secretions

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4
Q

What are some characteristics of stress ulcers?

A

Frequently accompanied by hemorrhage
Usually painless
Very acid secretions

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5
Q

Drug treatment for stress ulcers

A

prophylactic treatment with H2 receptor antagonists or proton
pump inhibitor

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6
Q

What are the two diseases labeled as inflammatory bowel disease?

A

Ulcerative colitis and Crohn’s disease

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7
Q

Who is inflammatory bowel disease most common in?

A

More common in developed and industrialized countries
Incidence highest among teenage and young adults
Male = Female
More common among Jewish people

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8
Q

What is the cause of inflammatory bowel disease?

A

Infection, genetics, psychosomatic, immunologic, but nothing conclusive

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9
Q

What other symptoms may show outside of GI with IBD?

A

autoimmune, mouth ulcers, eye problems, etc…

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10
Q

How is smoking associated with Crohn’s?

A

Children exposed to maternal smoking and passive smoking have increased risk of Crohn’s disease

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11
Q

What may smoking protect against?

A

ulcerative colitis

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12
Q

prevention of IBD

A

adequate fiber in diet
decrease psychological stress–learn to relax, rest, sleep, exercise, recreation
be aware of assoc. with smoking and Crohn’s dz

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13
Q

clinical manifestations of IBD

A 
Nausea, vomiting, weight loss
Anemia
Malaise
Flatulence
Fluid and electrolyte imbalances
Nutritional deficits
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14
Q

Where is there inflammation with ulcerative colitis?

A

Inflammation of mucosal layer of the LEFT colon and rectum (works it’s way up the descending colon)

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15
Q

major symptom of ulcerative colitis

A

DIARRHEA (10-25 days) Liquid, blood, pus, mucus, urgency, cramping, abdominal pain

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16
Q

What does ulcerative colitis increase the chance of getting?

A

colon cancer

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17
Q

What drug can be given during a ulcerative colitis flare up?

A

hydrocortisone enema

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18
Q

Where does Crohn’s disease occur?

A

RIGHT colon and distal ileum affected –but can occur anywhere in GI tract
Entire thickness of bowel wall

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19
Q

symptom of Crohn’s?

A

Diarrhea, but less severe than U.C. but usually no blood in stool

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20
Q

what is Crohn’s aggravated by?

A

illness and emotional upset

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21
Q

What does Crohns disease cause?

A

Rectal and anal fissures
Fistulas and abscesses
Malabsorption problems

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22
Q

How is IBD diagnosed?

A

Diagnosed by anemia, increased WBC, increased ESR, increased C-reactive protein, +guiac—may have low electrolytes and albumin secondary to diarrhea
Colonoscopy

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23
Q

What does Crohns look like in a colonoscopy?

A

cobblestone appearance

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24
What does ulcerative colitis look like in a colonoscopy?
vascular engorgement
25
What is given to control diarrhea in IBD?
Immodium and Lomotil
26
What is given to control inflammation?
steroids
27
What is given to prevent ulcerations from steroids?
H2 receptors and PPI
28
What other drugs can be given for IBD?
Antibiotics if warranted (Azulfadine -- antibiotic/anti-inflammatory); immunosuppressants (Imuran; Methotrexate); anti-tumor necrosis factor drug (Remicade; Humira) for Crohn’s
29
diet for IBD
``` Increase fluids low residue (fiber), low fat, high protein, high calorie Lactose restrictions ```
30
When is surgery used for IBD?
common to treat ulcerative colitis (ileostomy), but only used with Crohn’s disease if have complications
31
ileostomy stool characteristics
liquid
32
what should you be careful eating with ileostomy?
high fiber
33
what does effluent mean?
stool out of ostomy
34
what is the stool like with colostomy?
more formed
35
when does an ostomy usually begin functioning post-op?
2-3 days after
36
With a sigmoidostomy, is a bag always needed if it is irrigated and regulated?
no
37
How full should the bag be before emptying stool?
1/3
38
What foods should be avoided with ostomy bag?
foods that cause gas such as beans
39
What are diverticula?
bulging pouches in the bowel wall that push the mucosal lining through surrounding muscle
40
Where are diverticula usually located?
sigmoid colon
41
What is Meckel's diverticulum?
diverticula of the ileum--most common congenital anomaly of the GI tract
42
What do diverticula result from?
high intralumenal pressure in weak areas of the colon (chronic constipation, low fiber, obesity are risks
43
What is diverticulosis?
diverticula present but no symptoms
44
What is diverticulitis?
inflamed diverticula that may potentially cause fatal obstruction, infection, or hemorrhage
45
Prevention of diverticular disease
high fiber diet, lose weight, increase fluids, avoid constipation, avoid tight clothing, avoid improper lifting
46
How can diverticula be seen?
barium enema or with colonoscopy
47
treatment of diverticular disease
Should avoid food with seeds, popcorn, nuts (controversial--questionable practice), keep stools soft, may need bulk meds such as Metamucil, high fiber diet, liquids
48
What leads to diverticulitis?
undigested food mixes with bacteria in diverticular sac, forming a hard mass (fecalith)
49
When the mass is formed in the process of diverticulitis, what does this cause?
cuts off blood supply to sac--> leads to inflammation, perforation, abscess peritonitis, obstruction, hemorrhage, etc.
50
What abnormal labs are seen with diverticulitis?
May see increase WBC; decreased H and H
51
treatment of diverticulitis
May be hospitalized—antibiotics, pain medication, IV fluids, rest
52
diet for diverticulitis
may on low fiber, clear liquids or NPO depending on symptoms then progress to fiber containing diet when inflammation is resolved
53
Is an NG tube used with diverticulitis?
if N/V
54
What tests are done to check for perforation with diverticular disease?
dx with x-ray (check for free air/fluid in abdomen); CT (check for abscess)
55
What surgery may need to be done is perforation or obstruction occurs?
temporary colostomy
56
What collects proximal to the site of a bowel obstruction?
fluid and air
57
At the beginning of a bowel obstruction, what does peristalsis do?
temporarily causes an increase in peristalsis to try and force material through obstructed areas -- may see hyperactive bowel sounds and liquid stools
58
A few hours after an obstruction, what happens to the bowel and what do we worry about?
bowel becomes flaccid, pressure increases in bowel, bowel wall becomes permeable to bacteria (worry about sepsis) prob. on antibiotics
59
If a person as an obstruction, what sign do they normally show?
Nausea/vomiting | May vomit fecal material
60
Are pain meds used for an obstruction?
No, slows the bowels
61
Most common causes for bowel obstruction
adhesions after abdominal surgery and tumors
62
neurogenic causes for obstruction
paralytic ileus with abdominal surgery
63
tube often used to remove air and fluid
commonly nasogastric tube such as a Salem sump tube with air vent
64
What is volvulus?
bowel is twisted
65
Treatment for bowel obstruction
``` NPO NG Tube IV fluid replacement and maintenance May need TPN if NPO for an extended period of time Antibiotics Get OOB to help increase peristalsis ```
66
How do intestinal tubes work?
Act like a bolus of food and stimulate peristalsis (NG tube probably works just as well) not commonly used
67
Causes of upper GI bleed
PUD, gastritis, ruptured esophageal varices, drug irritation
68
Causes of lower GI bleed
diverticula, ulcerative colitis, intestinal cancer
69
What can psychological stress do to GI problems?
trigger them (PUD, ulcerative colitis)
70
If someone has hematemesis, where is the bleed in the GI tract?
upper GI bleed
71
If the person vomits dark, coffee ground appearance, where is the bleed?
stomach
72
If a person has melena, where is the bleed?
upper GI bleed
73
If a person has hematochezia, where is the bleed?
distal portion of lower GI
74
If you can't tell where the bleed is coming from, what test should be run?
guiac stool
75
Treatment of GI bleeding
need to type and crossmatch for several units of blood IV LR at 200cc per hour Vasopressin (ADH), Sandostatin, Vit K, Inderal (propranolol), H2 receptor antagonist or PPI
76
How long will Hgb and Hct lag behind blood loss?
4-6 hours
77
What should be inserted with a UGI bleed?
NGT and lavage
78
How is the lavage done for UGI bleed?
Current thought is to use room temperature tap water--instill 250cc and aspirate till pinkish or clear--process may take hours
79
Should iced saline be used for lavage?
Iced has been used, but cold may cause hypothermia and get better clotting with tap water
80
How does vasopressin help with GI bleed?
vasoconstriction and antidiuresis--constricts arterioles and capillaries of the GI tract
81
How does sandostatin treat GI bleed?
decreases venous pressure, thus decreasing bleeding and decreases acid secretions
82
How does Vit K treat GI bleed?
essential component of coagulation process
83
How does Inderal (propranolol) treat GI bleed?
decreases HR and portal vein pressure (portal vein drains esophagus)
84
How do H2 receptors or PPI treat GI bleed?
prevent rebleeding
85
What are esophageal varices?
Like varicose veins in esophagus, or distended veins, typically from liver problems
86
Why is the mortality rate up to 50% with esophageal varices?
the varices get irritated and bleed causing hemorrhage
87
What obliterates the distended veins?
endoscopic sclerotherapy or endoscopic band ligation
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