Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
96 Cards in this Set
- Front
- Back
|
GERD what is it |
backwards flow of gastric secretions into esophagus |
|
|
GERD causes |
transient relaxation or incompetent sphincter, increased stomach pressure
-position, anesthesia, tight clothing, hiatal hernia, CA, NG tube, purging, surgery |
|
|
GERD s&sx |
heartburn post meal, when bending or lying down, sore throat, hoarseness, regurg of sour material |
|
|
complications of GERD |
esophagus strichters, can lead to dysphagia and later Barrett's esophagus |
|
|
Barrett's esophagus |
change in lining of esophagus cells that then leads to an increase for esophageal cancer |
|
|
GERD tx |
antacids, PPI's, H2 blockers diet- no coffee, alcohol, smolking, reduce fat, no food prior to bed maintain ideal body wt, small meals |
|
|
what is a hiatal hernia |
part of stomach protrudes through esophageal hiatus of diaphragm into thoracic cavity
normally asymptomatic |
|
|
hiatal hernia sliding vs paraesophogeal |
sliding- gastroesophogeal junction and fundus of stomach slide through esophageal hiatus
paraesophogeal- junction is normal place but part of stomach herniates through, can become strangulated pt may develop bleeding gastritis |
|
|
hiatal hernia tx |
diet and lifestyle chgs, med similar to GERD surgery Nissan- fundus is sutured down |
|
|
function of gallbladder |
bile is made in liver and STORED in gallbladder |
|
|
cholelithiasis |
formation of stones in gallbladder |
|
|
cholecystitis |
inflammation of gallbladder |
|
|
choleangitis |
inflammation of bile ducts |
|
|
why do gallstones form |
abnormal bile compostition, inflammation of gallbladder |
|
|
risk factors for cholelithiasis |
female, fair skin, fat, 40 prolonged TPN (bile just sits there and collects) age, fam hx, native americans, obesity, high cholesterol diets, pregnancy |
|
|
common s&sx cholelithiasis |
early- fullness after fatty meals RUQ steady pain, n/v jaundice if blockage |
|
|
complications of cholelithiasis |
pancreatitis, liver dmg, empyema of gallbladder, gangrene gallbladder, intestinal obstruction |
|
|
chole dx |
serum bilirubin levels- elevated bili CBC- elevation in WBC amylase & lipase- elevated w/pancreatitis ultrasound of gallbladder- inflammation & stones |
|
|
chole tx |
lap cholecystectomy if unable to do surgery can try to dissolve stones with long term meds |
|
|
lap cholecystectomy |
minimally invasive, normally outpatient surgery |
|
|
liver function (review) |
manufactures bld proteins- clotting, immune system, O2 transport manufactures bile- digestion stores sugar- forms glycogen rids harmful substances- drugs/alcohol breaks down sat fat produces cholesterol |
|
|
order of events portal HTN to ascites & fluid retention |
obstruction of flow bld thru liver portal HTN thru portal system ascites decreased fluid vol (decreased BP) release of renin by kidneys increase in aldosterone secretion by glands retention of Na+ & H2O to increase vol |
|
|
hepatitis |
inflammation of liver due to virus
metabolic function and bile elimination are disrupted |
|
|
Hepatitis that has a vaccination |
A & B |
|
|
s&sx that relate to all acute hepatitis |
malaise, dark urine, anorexia, n/v, jaundice |
|
|
Hep A/B which is a CHRONIC condition |
B!
A is acute lasting about 1-2 months |
|
|
Hep A transmission |
stool fecal-oral route, contaminated food/water |
|
|
Hep B transmission |
blood and bodily fluids
liver cells damaged by immune response |
|
|
Hep C transmission |
blood and bodily fluids injection drug users primary factor |
|
|
Hep B associated delta virus (HDV) |
blood and bodily fluids infects people who already have Hep B |
|
|
Hep E transmission |
fecal oral route contaminated water in developing nations rare in US |
|
|
primary worldwide cause of Hep C |
chirrosis |
|
|
"big one" hepatitis |
Hep B! damages liver through bodily fluids high risk in healthcare workers, increases risk of liver cancer |
|
|
disease pattern |
incubation --> prodromal --> icteric --> convalescent phase |
|
|
incubation period w/hep |
period after exposure no symptoms |
|
|
prodromal phase |
flu like symptoms malaise, anorexia, fatigue, aches, n/v, diarrhea, chills, fever, RUQ pain |
|
|
icteric phase |
5-10 days after prodromal symptoms jaundice of sclera, elevation of bili levels, light brown or clay colored stool, dark urine |
|
|
convalescent phase |
in uncomplicated cases, symptoms improve spontaneous recovery occurs within 2 wks of jaundice |
|
|
other types of hepatitis |
chronic- cirrhosis, live CA, tx- enzymes elevated fulminant- rapidly progressive, liver fx w/in 2-3 wks toxic- alcohol, meds, drugs hepatobiliary - interruption of normal flow of bile (gall stones) |
|
|
med/nursing care with hepatitis |
prevention- vaccine for A & B meds, rest, avoid alcohol & substances detoxified in liver |
|
|
hepatitis dx LFT's |
ALT- liver specific AST- heart and liver ALP- liver and bones GGT- rises w/hepatitis LDH- ldh5 liver specific serum bilirubin- elevation |
|
|
med for acute hep C |
interferon A (alpha) to prevent chronic hep |
|
|
med for chronic hep B |
interferon A (alpha) lamivudine |
|
|
med for chronic hep C |
interferon A (alpha) with ribavirin (rebetol) antiviral |
|
|
acute hep tx |
rest, nutrition, avoid substances filtered by liver (ETOH) |
|
|
chirrosis |
functional liver tissue replaced with scar tissue
end stage chronic liver disease, progressive and irreversible, 10th leading cause of death in US |
|
|
early chirrosis s&sx |
liver enlargement & tenderness dull ache in RUQ wt loss, weakness, anorexia, diarrhea, constipation, |
|
|
later states of chirrosis s&sx |
impaired metabolism causing bleeding, ascites, gynecomastia, jaundice, periph edema, low wbc and platelets |
|
|
complications with chirrosis |
portal hypertension splenomegaly ascites esophageal varcies hepatic encepholopathy hepatorenal syndrome |
|
|
hepatic enceohalopathy |
increased ammonia levels = decreased brain function |
|
|
hepatorenal syndrome |
renal failure with azotemia (high urea levels) |
|
|
liver disorder dx lab results |
elevated AST, ALT, alkaline phosphate, GGT CBC & platelets- decrease prothrombin time- prolonged decrease Na+, K+, Mg+, phosphate elevated bilirubin & ammonia decrease albumin |
|
|
liver disorder dx tests |
abd ultrasound- liver size, nodule, ascites upper endoscopy liver biopsy |
|
|
meds |
diuretics lactulose vit k antacids |
|
|
diet/fluid mgmt |
limit protein 60-80g/day with elevated ammonia otherwise 75-100g/day high carb, moderate fat |
|
|
surgical tx |
TIPS- go around liver with shunt balloon tamponade liver tx
|
|
|
pancreatitis |
inflammation of pancrease low mortality rate 10% |
|
|
risk factor of pancreatitis |
alcohol gall stones |
|
|
acute pancreatitis |
interstitial- mild form, inflammation & edema of pancreas necrotizing- inflammation hemorrhage, necrosis of pancreatic tissue |
|
|
acute cause |
unknown!
could be trauma, surgery, tumors, alcohol, gallstones |
|
|
acute s&sx |
severe abd pain nausea & vomiting jaundice hypotension bleeding |
|
|
acute pancreatitis complications |
renal ARDS local necrosis, abscess, pseudocyst |
|
|
chronic pancreatitis |
gradual destruction of pancreas tissue #1 cause alcohol ducts are blocked causing inflammation and fibrosis |
|
|
chronic panc s&sx |
recurrent LUQ pain n/v, wt loss, steatorrhea (fatty stools) |
|
|
chronic panc complications |
malabsporption pseudocyst diabetes panc CA |
|
|
#1 test for pancreatitis |
serum amylase 2-3 times nor |
|
|
other dx for pancreatitis |
serum lipase- elevated for 7-14 days serum typsinogen- elecated w/acute, decreased w/chronic ultrasound, CT, ERCP |
|
|
tx for pancreatitis |
NPO then to low fat diet hydration pain control meds |
|
|
meds for pancreatitis |
antibiotics PPI, antacids, H2 blockers enzyme supplements octreotide (sandostatin)- reduces pressure |
|
|
peritonitis |
infection or chemical irritant in peritoneal cavity bacteria enters normally sterile space |
|
|
peritonitis s&sx |
3rd spacing causes hypotension "acute abdomen"- board like elderly- confusion, decrease output, abd complaints |
|
|
complications of peritonitis |
life threatening 40% abcess sepsis |
|
|
dx peritonitis |
elevated WBC abd x-ray shows free air shows GI perforation |
|
|
peritonitis tx |
broad spectrum anitbiotics analgesics surgery- fix perforation IV fluids NG |
|
|
ulcerative colitis |
rectum thru colon anscess leads to scarring= narrows colon |
|
|
ulcerative colitis s&sx |
rectal bleeding diarrhea (5-10 stools/day) anemia malnutrution LLQ pain
*increased risk of CA* (repeated "injury") |
|
|
crohn's disease |
any segment of bowel- common is iliem and ascending colon ulcers transmural and lead to fistulas
|
|
|
crohn's s&sx |
rectal bleeding, diarrhea, anemia, malnutrition RLQ pain relieved by defecation fever, fatigue, malaise, wt loss, anemia |
|
|
crohn's complications |
scarring causing strictures perforation hemorrhage increased risk of CA |
|
|
dx |
colonoscopy, upper GI, stool culture albumin & folic acid- low due to malabsorption LFT's may be elevated |
|
|
medications for bowel disorders |
sulfasalazine- abx with topical effect in colon (ulcerative colitis) corticosteroids, immunisupression, metronidazole (flagyl) anti-diarrheal |
|
|
neoplastic disorders of bowel |
colon CA 2nd leading cause of cancer death in US |
|
|
polys |
considered pre malignant tissue mass protruding from wall of bowel most often in sigmoid and rectum |
|
|
CDC guidelines |
fecal occult blood test at age 50 flexible sigmoidoscopy q 5 yr colonoscopy q 10 yr |
|
|
colorectal cancer risks |
fam hx IBD high fat diet
commonly metastasized to lymph then liver, lungs, brain, kidney |
|
|
colorectal CA s&sx |
none until late stages bleeding, wt loss, pain, abd mass, anemia |
|
|
screening |
**early detection & intervention** digital done at age 40
|
|
|
mechanical vs functional bowel obstruction |
mechanical- adhesions, tumore, strictures partial or complete- intusseption, volvulous, foreign body, stricture
functional- neurological or muscular post surgery, hypokalemia, meds, peritonitis |
|
|
bowel obstruction s&sx |
colicky pain, vomiting, decreased bowel sounds |
|
|
bowel obstruction complications |
hypovolemia perforation septic shock |
|
|
obstruction tx |
NG IV fluids surgery early ambulation after surgery |
|
|
diverticular disease |
sacs form in colon mainly sigmoid diverticulitis is when the colon is inflamed from food getting caught in diverticuli |
|
|
diverticular dx |
abd xray- free air, perforation barium enema- contraindicated abd CT or colonoscopy WBC- shift to left with diverticulitis |
|
|
diverticular compications |
perforation, peritonitis, abscess |
|
|
s&sx diverticular disease |
L side pain n/v fever distension |
|
|
tx of diverticular disease |
meds- abx analgesic
low fiber diet with exacerbation to rest bowel then high fiber diet
no seeds, popcorn
surgery- resction, Hartman (reconnecting to give bowel rest)
|
