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Advanced clinical practice: examining the complex patient > Week 7 > Flashcards

Flashcards in Week 7 Deck (82)
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1

What is the pathophysiology of a bowel obstruction?

A blockage prevents the content of the intestine from passing normally through the digestive tract. The cause of this can be inside or outside the intestine

2

What are some of the causes of a bowel obstruction inside the intestine?

A tumor or swelling

3

What are some of the causes of a bowel obstruction outside the intestine?

The adjacent organs or area of tissue to pinch, compress or twist a segment of the bowel

4

Where does a bowel obstruction occur?

In the small or large bowel

5

A bowel obstruction can be total or partial. What determines what type of obstruction present?

It depends on whether any intestinal content can pass through the obstructed area

6

What does the obstruction of the small intestine present with?

Cholic, abdominal pain and vomiting.

7

What does the obstruction of the large intestine present with?

Distention and absolute constipation

8

What are the common causes and risk factors of a small bowel obstruction?

- Adhesions: bands of scar tissue that may form after abdominal or pelvic surgery
- Hernias caused by a breakthrough of the weakened abdominal wall (2nd most common cause of an obstruction in the USA)
- Inflammatory diseases(chromes disease or a fistula)
- Tumors (rare, usually spreads to the small bowel from the colon, reproductive organs, breast, lungs or skin)

9

____ is the leading risk factor for small bowel obstruction in the USA

*Earlier abdominal surgery* is the leading risk factor for small bowel obstruction in the USA

10

What are the signs and symptoms of a small bowel obstruction?

- Cramping and abdominal pain
- Nausea and vomiting
- No gas passing through the
rectum
- Abdominal bloating or tenderness
- Rapid pulse and rapid breathing
- Upper epigastric distension
- Constipation
- Lack of appetite

11

What is constant abdominal pain a sign of?

Maybe a sign os bowel strangulation

12

__ is the most common cause of a large bowel obstruction in the USA

*Adhrsions* is the most common cause of a large bowel obstruction in the USA/developed countries

13

____ is the most common cause of obstruction

*Adenocarcinoma of the colon* is the most common cause of obstruction

14

About half of all large bowel obstructions are caused by ____

About half of all large bowel obstructions are caused by *colorectal cancer*

15

How does undiagnosed colon or rectal cancer cause large bowel obstruction?

It may cause a gradual narrowing of the large intestines in our passageway.

16

Before the large bowel becomes obstructed, what does the pt feel?

Intermittent constipation

17

What is volvolus?

An abdominal twisting of a segment of the bowel around itself. This typically produces a closed loop bowel with a pinched bowel, which leads to a bowel obstruction

18

In what population is a volvolus most common?

People over 65, in western countries, often with a history of chronic constipation

19

What are the common causes of large bowel obstruction?

- Colorectal cancer
- Volvolus
- Diverticular disease

20

What is a colonstricture?

A scar that encircles the colon, which narrows the intestine gradually as it ages, which will eventually cause a closed colon

21

What are the signs and symptoms of large bowel obstruction?

- Lower abdominal
bloating/distension
- Lower abdominal cramping and pain, which can be vague and mild, or sharp and severe depending on the cause
- Constipation
- Diarrhea
- Possible rectal bleeding

22

What are the red flags for immediate medical referral in a pt with a possible large bowel obstruction?

• Intense and/or constant abdominal pain
• Vomiting
• Bloating
• Blood in the stool

23

What are the checklist items that must be screened when there is a suspicion of a GI system abnormality?

• Nausea
• Vomiting
• Swallowing difficulties
• Indigestion, heartburn
• Food intolerance
• Bowel dysfunction
– Color of stool
– Shape, caliber of stool
– Constipation
– Diarrhea
– Difficulty initiating
– Incontinence

24

What are swallowing difficulties/dysphagia typically a result of?

A loss of coordinated local muscle activity or a mechanical obstructive disorder

25

What are the disorders that can result in muscle incoordination, resulting in swallowing difficulties/dysphagia?

• Myasthenia gravis
• Multiple sclerosis
• Amyotrophic lateral sclerosis
• Parkinson's disease

26

What are the disorders that can result in a mechanical obstruction, resulting in swallowing difficulties/dysphagia?

• Tumors
• Thyroid goiter
• Osteophytes of the cervical
spine
• Aortic aneurysm

27

What is the onset, progression, ability to swallow solid food/liquids, ability to swallow cold substances, and bolus passage of dysphagia caused by motor incoordination?

• Onset: Gradual onset
• Progression: Slow
• Swallowing solid foods vs. liquids: Equal difficulty
• Swallowing cold substances: Worsening of swallowing
difficulties
• Bolus passage: Facilitated by repeated swallowing. Valsalva
maneuver, throwing back head and shoulders

28

What is the onset, progression, ability to swallow solid food/liquids, ability to swallow cold substances, and bolus passage of dysphagia caused by mechanical obstruction?

• Onset: Faster onset
• Progression: Faster
• Swallowing solid foods vs. liquids: More difficulty swallowing solids
• Swallowing cold substances: Swallowing difficulties not affected by temperature
• Bolus passage: Can be accompanied by regurgitation

29

What are the symptoms that fall under the category of dyspepsia/heartburn?

Indigestion, and Heartburn

30

The use of what type of drugs has been associated with dyspepsia/heartburn?

NSAIDs