Buscar
Estás en modo de exploración. debe iniciar sesión para usar MEMORY

   Inicia sesión para empezar

level: Level 1 of Chapter 32 Gastroenterology

Questions and Answers List

level questions: Level 1 of Chapter 32 Gastroenterology

QuestionAnswer
Gastritisinflammation of the lining of the stomach
ligament of Treitzsupports the doudenojejunal junction
Cullen's signecchymosis in the periumbilical area
Grey-Turner's signecchymosis in the flank
visceral paindull, poorly localized pain that originates in the wall of hollow organs, PT will show location of pain with hand
PeritonitisInflammation of the peritoneum, which lines the abdo cavity
Somatic painsharp, localized pain that originates in wall of the body, such as skeletal muscles, PT show be able to point with one finger the location of pain
referred painpain originates in a region other than where it is felt
Structures of the lower GI tractjejunum, ileum, large intestine, rectum, anus
functions of lower GI tractAbsorbing nutrients, reabsorption of water, formation of wastes
with severe peritoneal irritation how with PT usually be positionedwill be lying as still as possible usually in the fetal position
where does upper GI tract bleeds occurproximal to the ligament of Treitz
when can you administer gravolif your PT has N/V >25 and unaltered Has no allergy or sensitivity to dimenhydrinnate or other antihistamines did not overdose on antihistamines or anticholinergics or tricycilic antidepressants
Conditions that cause upper GI bleedingPeptic ulcer disease, Gastritis, Esophageal varicies, Mallory-Weiss tear, Esophagitis, Doudenitis
S&S > Vary widely, PT may be asymptomatic or may have wide range of abdo complaints including hematemesis.Gastritis
General complaints of Upper GI bleedMalaise, weakness, syncopal and near syncopal, tachycardia, indigestion
Esophageal varicesswollen vein of the esophagus (usually result of portal hypertension )
Common causes of Esophageal varicesChronic alcohol abuse, ingestion of caustic substances
PT is presenting S&S including the following : painless bleeding, hematemesis, dysphagia, burning or tearing sensation, hemodynamic instability, delayed clotting due to force of blood backup and into spleen destroying platelets, classic signs of shockEsophageal varices
Tx for Esophageal varicesAggressive airway management, aggressive Fluid resuscitation, be prepared to suction frequently
Acute GastroenteritisSudden onset of inflammation of stomach and intestines
Causes of Acute GastroenteritisAlcohol -ETOH- and Drug -Rx- abuse, Tobacco use, aspirin, Stress, Chemotherapy, Ingestion of acidic or alkatic agents, Infection from ingested pathogens(normally fecal-oral)
S&S Rapid onset of hematemesis + hematochezia or melena, may complain of diffuse & widespread abdo pain with palpation, tenderness in all quadrants, Fever, General malaise, Sx dehydration, Sx of hypovolemic shockAcute Gastroenteritis
Most common causes of lower GI bleedingDiverticulosis, Colon lesions (cancer or benign polyps), Rectal lesions( hemorrhoids, anal fistulas anal fissures), Inflammatory bowel disorder (ulcerative colitis, Crohns)
Peptic UlcersErosion caused by gastric acid
Gastric Ulcersoccur exclusively in the stomach
S&S for gastric ulcersmost common in 50yrs working a job with physical activity: increase pain after eating or on a full stomach
S&S of duodenal ulcersmost common in 25-50yrs who are under high stress: increased pain at night or on a empty stomach
Management of peptic ulcersBOMB - high flow O2, Fluid resuscitation, Medication admin: consider histamine blockers (zantac, pepsid) & antacids (Rolaids, Tums)
Lower GI tract bleed is located where?Anywhere distal of the ligament of Trietz
how does G. Pylori bacteria play a role in peptic ulcersit breaks down the barrier and exposes the mucosa to highly acidic fluid which causes peptic ulcers to arise.
what is the difference between Crohn's and Ulcerative colitisCrohn's can affect any part of the gastrointestinal system from mouth to anus, when Ulcerative colitis only affects the colon
S&S insidious onset, occasional bloody diarrhea or stool containing mucous, colicky adbo pain usually limited to lower quadrants, N/S, occasional fever or weight loss, restless but hemodynamically stableUlcerative colitis
What does BOMB stand forBed, O2, Monitor, Blanket
Crohn's DiseaseIdiopathic inflammatory bowel disorder associated with the small intestine
S&S > GI bleeding, Recent weight loss, Intermittent abdominal cramping/pain, N/V, Diarrhea, Fever, Flare ups are rapid with severe acute onset of abdo pain, Difficult to differentiate as pain is nonspecific with diffuse tendernessCrohn's Disease
Tx for Crohn'sBOMB, Airway management,Transport to hospital, Usually hemo stable so Tx is usually pallative
DiverticulitisInflammation of the diverticulosis : secondary to infection - Small outpockets that push through the outermost mucosal and submucosal lining (muscle) secondary to infection, Bleeding or infection
Diverticulosispresence of diverticula, with or without associated bleeding
most common cause of lower GI bleedingDiverticulosis
S&S > Pts will complain of localized lower left sided colicky pain (95% of offending diverticula are in the sigmoid colon) - Often called left sided appendicitis - Low grade fever- N/V- Tenderness on palpation -Sx of shock (CPC, tachy) - Bright red and bloody feces (hematochezia)- c/o perception they cannot empty their rectum even after defecationDiverticulitis
HemorrhoidsSmall masses of swollen veins that occur in the anus or rectum
what does this Presentation -Limited bright red bleeding and painful stools. -Consider lower GI bleeding.Hemorrhoids
Bowel Obstructionblockage of the hollow space within the intestines; Can be catastrophic if not rapidly diagnosed and treated. - The most dangerous result is sepsis.
S&S - Diffuse poorly-localized pain –palpation will reveal tenderness, Decreased appetite, Fever, malaise, N/V, wt loss, Peritonitis if ruptures, Maybe shock, May vomit feces if long standing, Maybe distention, Look for surgery scars and ecchymosisBowel Obstruction
Tx for Bowel ObstructionBOMB Fluid resuscitation
what are common causes of Bowel obstructionHernia – intestine has pushed through muscle wall • most dangerous is strangulate hernia Intussusception Adhesion Volvulus  Chronic as in tumour growth or adhesion or
what causes hemorrhoidsIdiopathic, from pregnancy, or external may result from heavy lifting
HerniaProtrusion of an organ through its protective sheath
what is the most dangerous herniastrangulate hernia
intussusceptioncondition that occurs when part of the intestine slips into the part just distal to itself
adhesionunion of normally separate tissue surfaces by a fibrous band of new tissue
volvulustwisting of intestine on itself
Hiatus Herniawhen the esophageal spincter allows the top of the stomach to herniate through the diaphragm into the esophagus
S&S of Hiatus herniaBurning sensation like heart burn, sharp easily localized pain
AppendicitisInflammation of the vermiform appendix at the juncture of the large and small intestines
S&S - Frequently misdiagnosed due to wide variety of presentations Early Diffuse colicky pain with nausea and vomiting, Tenderness and guarding, Often localized to periumbilical region As the appendix continues to dilate, Pain migrates to McBurney’s point, Rebound tendernessAppendicitis
Tx for AppendicitisRecognition and supportive care, Hemodynamically stable as long as appendix hasn’t ruptured Follow general management guidelines
what most often causes AppendicitisObstruction of the appendiceal lumen by fecal material.
CholecystitisInflammation of the gallbladder
HepatitisInjury to hepatocytes associated with infection of inflammation
HBVHepatitis B; Serum hepatitis, Blood borne pathogen, Can stay active in body fluids outside the body for days, ~310 million carriers worldwide, Effects may be minimal but can also range to severe liver ischemia and necrosis
HAVHepatitis A; Most common, Infectious hepatitis, Spread by oral-fecal contamination, Self limiting, lasting ~2-8 weeks, Rarely causes severe hepatic injury and thus has a low mortality
HCVHepatitis C; Pathogen most commonly responsible for spreading hepatitis through blood transfusions Marked by chronic and often debilitating damage to the liver
HDVHepatitis D; less common Pathogen is dormant until activated by HBV
HEVHepatitis E; Waterborne infections, Epidemic in Africa, Mexico and other less-developed nations
Presentation of HepatitisURQ abdominal tenderness May radiate into right shoulder Loss of appetite, weight loss, malaise Clay-colored stool, jaundice, scleral icterus Photophobia, nausea/vomiting May appear jaundiced May have fever due to infection or tissue necrosis May reveal liver enlargement