Ex4 Extra

Front 1

What treatment steps are appropriate for patients with cholecystitis or cholangitis?

Back 1

1. For cholecystitis or cholangitis, start broad-spectrum IV antibiotics to cover gram-negative enterics, gram-positives (Clostridium, enterococcus) and anaerobes (Bacteroides).

2. Volume resuscitate as needed.

3. Patients with cholecystitis may respond to antibiotics alone and warrant elective cholecystectomy

Front 2

What to look for on a physical exam to indicate cholecystitis or cholangitis?

Back 2

For both cholecystitis and cholangitis:

1. Fever
2. Tachycardia
3. Hypotension
4. RUQ pain
5. Guarding

Peritoneal signs are usually absent.

Jaundice is a feature of cholangitis, but is absent in cholecystitis.

50% of patients with cholecystitis have a palpably enlarged gallbladder

Front 3

What are the complications of cholecystitis?

Back 3

# Empyema (pus in the gallbladder)
# Peritonitis (inflammation of the lining of the abdomen)
# Gangrene (tissue death) of the gallbladder
# Injury to the bile ducts draining the liver

Front 4

The classic exam finding for cholecystitis is Murphy's sign. How do you elicit it?

Back 4

Palpate the liver edge deeply at the midclavicular line and ask the patient to inhale. When the inflamed gallbadder meets the hand, the patient abruptly stops breathing in.

Front 5

How does cystic duct occlusion (cholecystitis) present?

Back 5

Cystic duct occlusion occurs as postprandial right upper quadrant pain, worse with fatty food ingestion, as much as 3-4 hours after eating. It commonly occurs at night between 10pm and 2am. It can be intermittent or progressive.

If blockage persists, pain becomes steady, often radiating to the right shoulder. High fever is rare.

Front 6

What are the risk factors for gallstones (cholecystitis)?

Back 6

The classic patients with gallstones is "fat, fertile, forty and female", a derogatory but accurate characterization of the risk factors.

Front 7

Progressive parenchymal fibrosis, associated w/ alchoholism/cholecystitis, can have calcifications & pseudocysts

Back 7

Chronic pancreatitis

Front 8

What is a priority for a pt admitted w/cholecystitis & cholelithiasis Sympts.acute RUQ pain that radiates to her back, N/V.

Back 8

Pain

Front 9

Medication for N/V due to cholecystitis ?

Back 9

Compazine, Meclazine, and Tigan

Front 10

Findings in acute cholecystitis

Back 10

Sonographic murphy's (most specific)
Visualized gallstones
GB wall thickening > 3mm
Pericholecystic fluid

Front 11

What are S&S of cholecystitis?

Back 11

Pain in RUQ (radiating to shoulder or scapula), anorexia, N, V, dyspepsia, flatulence, eructations (burping), abdominal fullness, fever, jaundice & steatorrhea, rebound tenderness with peritonitis.

Front 12

What are diagnostic tests for cholecystitis?

Back 12

Liver function studies, CBC (inc. WBC), serum & urine amylase (inc. amylase with pancreatic involvement), abdominal ultrasound (most common), cholangiography (IV contrast injected, xrays taken over 1-2 hr. period)

Front 13

What is the clinical management of cholecystitis?

Back 13

Diet (small, frequent meals), decrease fat & volume of food, analgesics (demoral), morphine is avoided d/t cauases spasms, antiemetics, bile acids and fat soluable vitamin replacement (ADEK) with gallstones.

Front 14

What are the causes of pancreatitis?

Back 14

gallstone obstruction, excessive alcohol ingestion, trauma, tumors, metabolic, renal or GI complications, viral infection, drug toxicity, abdominal surgery or invasive procedure.

Front 15

What is acute pancreatitis?

Back 15

inflammation of the pancrease due to premature activation of pancreatic enzymes that destroy the pancrease (autodigestion

Front 16

What are complications of acute pancreatitis?

Back 16

paralytic ileus, pleural effusion (collection of fluid in plural space), multisystem failure (NHP)

Front 17

How is acute pancreatitis diagnosed?

Back 17

Inc. serum/urine amylase and serum lipase, inc. liver function tests if liver involvement, inc. wbc and glucose d/t inflammation, dec. ca and mg, abdominal ct scan and ultrasound.

Front 18

What are the S&S of Acute pancreatitis?

Back 18

Abdominal pain (sudden, mid-epigastric or LLQ), weight loss, N, V, jaundice, discoloration of abdomen & flank(pancreatic enzyme leakage), dec. or absent bowel sound, W&W of peritonitis, behavioral changes, impending shock (d/t pancreatic hemorrhage)

Front 19

What diet is recommended for chronic pancreatitis?

Back 19

inc. carbs, proteins, dec. fat, TPN or TEN, supplements., IV fluids, F&E,

Front 20

What are S&S of chronic pancreatitis?

Back 20

Intense abdominal pain, ascities, LUQ mass (if cyst), respiratory symptoms (if fluid buildup), loss of exocrine function (steatorrhea, clay colored stools, frequent defecation), wt. loss, jaundice, dark urine, signs of diabetes,

Front 21

What is done for management of acute pancreatitis?

Back 21

Pin (demoral), NPO, IV fluids, NG tube, antacids, histamine receptor antagonists, anticholinergics, comfort measures, surgery with complications

Front 22

What is an indicator of pancreatitis?

Back 22

serum amylase and lipase in the blood

Front 23

what are some causes of acute pancreatitis?

Back 23

gallstone obstrucion
excessive alcohol
trama, tumors
metabolic, renal , gi complications
viral , drug toxicity, penetrating duoddenal ulcer, infection

Front 24

Features of Chronic pancreatitis

Back 24

Pain after eating and radiates to back (worse when supine), malabsorption, jaundice, DM

Front 25

What are three conditions that can cause acute pancreatitis?

Back 25

1)obstruction of main pancreatic duct, frequently by gallstones with reflux of bile
2)injection of bile or other chemicals into the pancreatic duct
3)mechanical disruption of the pancreatic acinar cells (seatbelt trauma)

Front 26

What is the pathology of acute hemorrhagic pancreatitis?

Back 26

-massive edema, hemorrhage, and necrosis of tissue
peritoneal irritation or chemical peritonitis occurs due to leakage of enzymes
-serum levels of lipase and amylase are high

Front 27

Complications of cholelithiasis

Back 27

Biliary colic,common bile duct obstruction,ascending cholangitis, cholecystitis,acute pancreatitis, gallstone ileus,mucocele,malignancy

Front 28

Which sx would be most consistent with a dx of cholelithiasis?

Back 28

ultrasound shows stones in the common bile duct

Front 29

Symptoms of cholelithiasis include what?

Back 29

nausea, vomiting, right upper quadrant tenderness, jaundice, abdominal distress

Front 30

Diagnosis of hernia are confirmed by________, ________, and _____.

Back 30

x-ray
Barium Swallow
Floroscopy

Front 31

What are 4 types of hernias?

Back 31

Inguinal, Femoral, Umbilical, Incisional.

Front 32

where is a Inguinal hernia

Back 32

Hernia in the groin, where abdomial folds of meet the thighs

Front 33

What is an inguinal hernia?

Back 33

When a portion of the bowel herniates into the inguinal canal. In males, herniation can be seen in the scrotum

Front 34

This hernia occures in obese or pregnant woman

Back 34

femoral

Front 35

femoral hernia involves enlarged femoral ring which invites herniation

Back 35

very susceptible to incarceration

Front 36

_________ hernia occurs when the upper stomach and the gastroesophagel junction (GEJ) are displaced upward and slide in and out of the thorax.

Back 36

Sliding

Front 37

Who usually get an indirect hernia and why?

Back 37

infants, because of the failure of processus vaginalis to close

Front 38

Diaphragmatic Hernia Diagnosis & Tests

Back 38

The pregnant mother may have shown signs of polyhydramnios (excessive amounts of amniotic fluid). Fetal ultrasound may show abdominal contents in the chest cavity.
Examination of the infant shows:
* chest movements asymmetric with breathing
* breath sounds absent on the affected side
* bowel sounds heard in the chest
* concave abdomen

Front 39

Who usually gets a direct hernia?

Back 39

older men

Front 40

Interventions for hernia

Back 40

modify diet to include smaller, more frequent meals, eliminate spicy foods, avoid coffee/caffeine, sleep in reverse Trendelenburg position,

Front 41

How are peptic ulcers treated?

Back 41

antisecretory agents

Front 42

What are the 3 main causes of peptic ulcers?

Back 42

1. helicobacter pyloric infections
2. use of certain anti-inflammatory medications
3. disorders that cause excessive gastric acid secretion

Front 43

Common surgical procedures involved with peptic ulcers disease are?

Back 43

Gastroenterrostomy,
Vagotomy,
Gastrectomy
anterectomy

Front 44

management for pt with peptic ulcers include what labs?

Back 44

i and o, hct, hgb, cbc

Front 45

What pain is associated with peptic ulcers?

Back 45

1. Duodenal: food brings relief, there is often nocturnal pain, there are remissions and exacerbations.
2. Gastric: food brings releif, noctural pain, chronic pain without remissions & exacerbations.
3. Stress: usually asymptomatic until hemmorhage occurs or perforation

Front 46

Gastric Ulcer Symptoms & Signs Include ?

Back 46

* Abdominal pain
o May wake you at night
o May be relieved by antacids or milk
o May occur 2 to 3 hours after a meal
o May be worse if you don't eat
* Nausea
* Abdominal indigestion
* Vomiting, especially vomiting blood
* Blood in stools or black, tarry stools
* Weight loss
* Fatigue

Front 47

Gastric Ulcer Diagnosis & Tests include?

Back 47

* EGD (esophagogastroduodenoscopy) and biopsy showing a benign gastric ulcer
* Upper GI series showing a gastric ulcer

Front 48

Gastric Ulcer Prognosis (Expectations)

Back 48

Most ulcers heal with medication in 6 to 8 weeks. Recurrence is common but is less likely if H. pylori infection is treated and acid-blocking medications are continued.

Front 49

Gastric Ulcer Complications

Back 49

* Bleeding from the ulcer
* Perforation (hole) in the stomach
* Obstruction of the passage of stomach contents
Complications are often corrected by medication, through an endoscope, or (in rare instances) with surgery.

Front 50

How is hepatitis transmitted?

Back 50

A: fecal-oral, parenteral, sexual
B: parenteral, sexual
C: perenteral

Front 51

what is diagnostics for suspected hepatitis

Back 51

alt ast
IgM anti HAV
HbsAg
Anti HCV
possibly anti hep b core antigen to check for window period

Front 52

How does cirrhosis manifest?

Back 52

Chronic alcohol abuse is the most common cause. Other causes: some infections, prolonged obstruction or diseases of the bile ducts, severe heart disease, severe reactions to medications, and exposure to toxic chemicals.

Front 53

3 manifestations seen in alcoholic cirrhosis

Back 53

esoph. Varices, hemorrhoids, caput medusae "Gut, butt and caput"

Front 54

Reasons why patients with cirrhosis and ascitis have Spontaneous bacterial peritonitis?

Back 54

1. Poor removal of bacteria by liver
2. low levels of complement in ascitis
3. Poor function of neutrophils in advanced liver disease.

Front 55

Name 9 causes of liver cirrhosis.

Back 55

alcohol
drugs/chemicals
hepatitis (B,C,D,TTV)
AI (PBC)
Wilson's dis
haemocromatosis
secondary cirrhosis
secondary to any CAH
cystic fibrosis

Front 56

What are the manifestations of cirrhosis?

Back 56

chronic indigestion
weight loss
spleenomegally
spider telangiectasis
varices-d/t portal hypertension
decrease in albumin
vitamin deficiency
gastritis
ascites
caput medusae-enlarged vessels ATC belly button
anemia
coma
encephalopathy
bleeding

Front 57

It is given to treat bleeding of the esophagus that may result from cirrhosis of the liver.

Back 57

Terlipressin, somatostatin

Front 58

What lab value is elevated in the end stage of cirrhosis of the liver?

Back 58

ammonia

Front 59

Tests can reveal liver problems including

Back 59

* Anemia (detected on a CBC)
* Coagulation abnormalities
* Elevated liver enzymes
* Elevated bilirubin
* Serum albumin low
* Enlarged liver (seen with an abdominal X-ray)

Front 60

Tests can reveal liver problems including

Back 60

# Anemia (detected on a CBC)
# Coagulation abnormalities
# Elevated liver enzymes
# Elevated bilirubin
# Serum albumin low

Front 61

Treatment for managing the complications of cirrhosis

Back 61

* Offending medications and alcohol are stopped.
* Bleeding varices are treated by upper endoscopy with banding or sclerosis.
* Ascites (excess abdominal fluid) is treated with diuretics, fluid and salt restriction, and removal of fluid (paracentesis).
* Coagulopathy may be treated with blood products or vitamin K.
* Encephalopathy is treated with the medication lactulose; sometimes antibiotics are used and patients should avoid a diet high in protein.
* Infections are treated with antibiotics.
* If cirrhosis progresses and becomes life-threatening, a liver transplant should be considered.

Front 62

Cirrhosis Complications include?

Back 62

* Bleeding esophageal varices
* Portal hypertension
* Hepatic encephalopathy
* Mental confusion
* Coma
* Abdominal fluid retention (ascites) and infection of the fluid (bacterial peritonitis)
* Sepsis
* Liver cancer (hepatocellular carcinoma)
* Kidney failure (hepatorenal syndrome)

Front 63

What are Bleeding Esophageal Varices ?

Back 63

result from dilated veins in the walls of the lower part of the esophagus and sometimes the upper part of the stomach.

Front 64

What is Hepatic Encephalopathy

Back 64

Hepatic encephalopathy is brain and nervous system damage that occurs as a complication of liver disorders. It is characterized by various neurologic symptoms including changes in reflexes, changes in consciousness, and behavior changes that can range from mild to severe

Front 65

Nasogastric Tube (NG tube)

Back 65

Short tube - goes from nose to stomach - includes types such as Levin & Salem Sump. Removes gas & fluid from upper GI. Sometimes used for meds or feedings.

Front 66

Levin Tube

Back 66

Single lumen, 14-18fr.

Front 67

Salem Sump

Back 67

Double lumen, plastic 12-18fr. Smaller inner tube vents larger suction/drainage tube to atmosphere.

Front 68

Nasoenteric Tubes

Back 68

Go from nose to intestine - can be medium or long in length (placed in either duodenim or jejunum)

Front 69

DobHoff Tube

Back 69

small-bore nasoenteric feeding tube. Weighted at bottom. Placement must be verified by xray.

Front 70

Miller-Abbott Tube

Back 70

Long nasoenteric tube. Goes into small intestine. Used for aspiration. Weighted with mercury, water, or saline.

Front 71

Harris Tube

Back 71

Long nasoenteric tube - used for suction & irrigation. Is weighted by mercury.

Front 72

Cantor Tube

Back 72

Long nasonenteric tube. Balloon @ distal end is weighted w/ 4-5mL mercury, water, or saline.

Front 73

Documenting Tube (what to note)

Back 73

Tube type & size; Drainage - amt color & consistency; irrigation type & amt; suction type/level (eg: low intermittent); feeding: type & amt; pt tolerance; pt education & response.

Front 74

NG suction

Back 74

Keep btwn 20-80 mm/Hg. Continuous suction> 25mm/Hg can cause damage to gastric mucosa.

Front 75

Changing NG tubing

Back 75

For feeding: Must change q24h. For suction change tubing q48h. Cannister changed prn, but must be emptied & output documented on I&O qShift.