GI System Flashcards by Chloe Derks

physcial exam

inspect, auscultate, percuss, palpate

How well did you know this?

Not at all

Perfectly

absent/dec bowel sounds

inflamm, late bowel obstruction

How well did you know this?

Not at all

Perfectly

hyperactive bowel sounds

gastroenteritis, early bowel obstruction,

NG can mimic (shut off suction to auscultate)

How well did you know this?

Not at all

Perfectly

physical exam- monitor

severe abdom pain, prolonged vomiting, blood while vomiting, tarry stool, fever, htn, tachycardia

How well did you know this?

Not at all

Perfectly

CBC- Hbg

12-16 F and 14-18 males g/dL
reflects blood vol
dec= blood/Gi loss
inc+ dehydration, chronic respir distress

How well did you know this?

Not at all

Perfectly

CBC- Hct

37-47% F and 42-52%
reflects blood vol
dec= blood/Gi loss
inc+ dehydration, chronic respir distress

How well did you know this?

Not at all

Perfectly

CBC-WBC

5-10,000 mm^3
inc- infection, steroid meds, appendicitis
dec= immunocomp, cancer

How well did you know this?

Not at all

Perfectly

K+ and Na levels

k- 3.5-5.0

Na- 135-145 mEq/L

How well did you know this?

Not at all

Perfectly

Fecal occult blood test

suspect if Hbg or Hct low

false-positive- iron, lrg amnt red meat digestion, recent nose bleed, vigorous excercise

How well did you know this?

Not at all

Perfectly

CT scan considerations

radiographic, use contrast dye
check kidney function (creatinine lvl) if impaired= give extra fluid or dec dose
shell fish allergies- can pretreat or give more fluid

How well did you know this?

Not at all

Perfectly

MRI considerations

magnet
check metal- rods, pacemaker, aneurysm clip
NPO if abdomen concerns

How well did you know this?

Not at all

Perfectly

age r/t changes

min effects on Gi function
conspitation
heartburn- relaxation lwr es
tooth loss
slower perstalsis- loss sm musc tone

How well did you know this?

Not at all

Perfectly

stomatitis

ulceration mouth
upper gi tract more prone trauma *pt induced
risk factors- thrush, chem/radiation therapy, vitamin def, chronic dis (kidney/inflamm bowel)
epidemiology- inflamm condition affecting orla mucosa, dentition
occurs 40% chemo pati
patho- “oral mucositis”
painful inflamm/ulceration lining of mouth
management- assessment oral cavity b,d,a chemo and radiation, rinse mouth norm saline/ Na bicarb, lidocaine suspension, diet modif, chart I/O
complications- dysphagia/ odynophagia (painful swallowing), xerostomia

How well did you know this?

Not at all

Perfectly

GERD

Risk- girls, preg, obesity, lrg meals, tight clothing, ng tubes, excessive acid secretion
patho- pressure grad diff btw stomach and LES, irreg LES function
can aspirate Gi contents if not controlled
epidem- common western countries, 10-20%
management- pH monitoring, esophageal manometry/motility testing (most effective)
esophagogastrodudodenoscopy (EGD)
meds (PPI, H2 blocker, antacids)
head elevated > 30
cessation alcoh/smoking, weight loss, stress reduc, smllr meals, avoid dietary irritants

How well did you know this?

Not at all

Perfectly

peptic ulcer dis- types, cause, patho

types- duodenal 80%
chronic w/ periods exacerb
gastric- 20% common lesser curvature stomach
causes- h- pylori (secrete toxin destroys stomach mucous protection= infection)
Nsaids, exposure irritants
patho- gastroduodenal mucosa destroyed by gastric acid and pepsin

How well did you know this?

Not at all

Perfectly

peptic ulcer dis- manifestations/management, complications

manif- burning pain, worse when hungry/fasting (duodenal)
gastric- worse when eating, pain
management- diagnosed during upper endoscopy, lab,radiological tests
lab- h-pylor, stool antigen testing, CBC (elevated WBC, dec Hbg, Hct), positive fecal occult blood test
upper GI endoscopy preferred
meds- pain relief, ulcer healing, acid suppression, therapy for h-pylori
monitor I+O, smoking cessation, NG tube for decompression (eliminate caustic blood)
complications- fluid shift, dec Na and K

NG tube placement

nose, ear, xiphoid process + 6 in
check placement w/ xray/imaging, ph paper test < 4, Co2 gas detection, WHOSH test(20 mL air into tube and listen) , visual assess of placement

Sm/ Lrg intestine function

sm- dig/ absorp nutrients
protein, carbs, fat 
lrg- absorp water, fluid/electrolyte reaborb/elimin
*loss function 2-3 days after surgery
     use NG tube for decompression

inflamm bowel dis- manif- epidem-patho

incl crohn’s, ulcerative colitis
manif- weight loss, fever, malnutrition, oral ulcerations
epidem- 1.4 million
patho- cause unknown
linked genetic predisposition (autoimm), environmental conditions, defects in immune regulation

crohn’s dis

affect entire gi tract
inc risk- small bowel cancer, absess/fistual, peritonitis (inflamm abdom wall), adhesions/narrowing lead obstruction/impaired absorp, fluid/electrolyte imbal, abdom pain RLQ
common- terminal ileum and colon
transmural (across wall) can penetrate
diarr less severe
pain worse, blood less common stool
noted to skip lesions w/ normal appearing bowel btw lesions

ulcerative colitis

affects Lrg intestine (mucosa and sub-muc)
inc risk colon
diarrh common
blood, mucus, pus common
abdom pain/ tenderness in LLQ
tenesmus- spasm anal sphincter (constant feeling need empty bowels)

IBD management

periods remission/exacerbation
rest bowels (no lax) control inflamm
stress control
meds( immuno suppr, cortical steroids) surgery, correct nutritional deficits, fluid/electrolyte balance
total parenteral nutrition (TPN) via central line
complications- bg lvls, correct position line, electroly imbal
low ruffage diet- low residue (fiber)= dec effort digestion, avoid lactose
risk dec musc mass, immune system, poor wound healing

IBD complications/ surgical management

comp- fistulas/abscess w/ crohns
short bowel syndrome- dec absorp
chronic abdom pain
surgical management- if meds don’t work or run into complications

total parenteral nutrition

TPN
protein, CHO, fat, minerals, electrolytes, vitamins
bypasses normal digestion
nurse considerations- correct placement line, sterile dressing change, verify nutrient order, monitor bg levels

Diverticulitis- epidem, patho, management, complications

epidem- small herniation in GI tract (often colon) common western industrialized societies and older ppl patho/manif- extraluminal "outpouching" diverticulosis- NONinflammed diverticula management- uncomplicated -antibio lax and enemas avoided, pain meds, monitor I+Os, and CBC/ electrolytes complications- perforation, fistula/ abscess formation, bowel obstruction, bleeding, inflamm (can result in fistula to o/organs)

appendicitis- epidem-patho-manif- management

abdomin pain RLQ epidemi- acute inflamm of vermiform appendix common in 10-19yr olds * if occur in adult more likely rupture patho- result foreign body blocking the opening leads to inflamm/infection manif- elevated WBC, fever, tachycardia, n/v, peritonitis (bowel contents in abdom) if rupture management- scope or open, meds- antiemetics ,antipyretic (dec fever) avoid lax/enemas

mechanical v functional intestinal obstruction- care and manif

mech- tumor/food functional- interrupts/ slower peristalsis care- NG tube, I&Os, iv analgesics, iv fluid, bowel tones manif- n/v, abdominal pain

bowel surgery- after surgery care

create stoma trtment chronic ulcer, obstructions, tumors can be reversed after surgery- low/ semi-fowlers position, TPN, or iv fluids, NG tube, daily weights, I&Os, bowel sounds, wrk from fluid- low residue diet (avoid raw fruit/veg and seeds)

liver function

blood storage, blood filtration, production bilirubin, syn clotting factors, removal clotting factors metab carbs, fat and protein detoxify blood (Kuppfer cells) storage vitam A,D,E,K and Fe

cirrohsis- cause, patho, manif

cause- hep C, alcoholic liver dis and NASH non alcoholic fatty liver dis patho- chronic dis causes cell destruction and fibrosis hepatic tissues manif- dec liver function (inc AST/ALT released w/ cell death) ascites= low albumin- leak fluid portal htn w/ varices hepatic encephalopathy- confusion, elevated ammonia, change motor fun, abnormal sleep cycle, coma remove ammonia w/ lactulose coagulopathy hepatorenal syndrome (HRS) spontaneous bacterial peritonitis jaundice- excess bilirubin

cirrohsis- management

lab/diag testing withhold hepatoxic meds Na restriction or diuretics use w caution (used trt edema/ascites but pull fluid frm vascular system and can cause hypovolemia (dec bp)) lactulose admin (titrate) monitor I&O, nutr supp TIPS trans jugular intrahepatic portosystemic shunt (temporary bypass vascular system liver ex. hepatic/portal veins) used trt portal htn

biliary disorders

inc gallbladder and bile ducts bile breaks down fat system transports bile frm liver to gallb and the sm intestine

cholecystitis

gallbladder dis inflamm frm obstruction bile flow manif- none or RUQ pain, fever, tachycardia, cramping, assoc w/ fatty meals, common females 45-50 management- antib, food avoidance trtment- surgery (cholecystectomy)