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186 Cards in this Set

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This is an inflammatory bowel disorder that affects the mucosal lining of the rectum and the colon, characterized by remissions and exacerbations and what you see is diffuse inflammation of the internal mucosa resulting in a loss of the surface epithelium causing ulcerations and potentially abcess formation?
Definition of Ulcerative Colitis
They speculate that it could be genetic or an autoimmune disorder. They used to say that IBD was caused by stress. Now they say that stress causes IBD and exacerbate the problems?
Etiology
Begins in the rectum and moves upward to the secum in a continuous manner?
Ulcerative Colitis
What ages does ulcerative colitis first peak in?
15-35
What ages does ulcerative colitis later peak in?
50-70
A spasmotic contration with chronic pain?
Tenesmus
5-30+ stools daily
Diarrhea - some mucous & blood
Melena
Hematochezia
Left Lower Quadrant pain
Tenesmus
S&S of hypovolemia
are S&S of what?
Ulcerative Colitis
Sometimes called regional enteritis?
Crohn's Disease
Described as Skip Lesions?
Crohn's Disease
An inflammatory disease of the small or large intestine, can be anywhere in the GI tract and invades all layers of the bowel?
Definition of Crohn's Disease
Not well understood but they think that genetics plays a part in it as does myobacterium paratuberculosis and there is also the autoimmune component?
Etiology of Crohn's Disease
IBD's tend to run in?
Families
American Jews of European decent are expected to develop IBDs how many times more than everybody else?
4 to 5 times higher risk of developing IBDs
You may hear Crohn's disease described as?
Cobble Stones
Why is Croh's disease sometimes described as Cobble Stones?
You will have an area that is affected by the Crohn's then you will have an unaffected area. Another area affected by the Crohn's then more unaffected. Hence the name Skip Lesions.
Between what ages does Crohn's usually peak?
15-40
Fatty stools are called?
Steatorrhea
What is the most common site for Crohn's?
The terminal illeum
5-6 stools a day that are steatorrhea and clay colored
RLQ pain
possible RLQ mass
possible weight loss and malaise
are S&S of what?
Crohn's Disease
Development of fistulas
Perforation leading to hemorrhage and peritonitis
Toxic megacolon
Strictures leading to obstructions
Colorectal cancer
Arthritis, uveitis, liver & biliary disorders, oral & skin lesions
are all complications of?
Crohn's & UC, huh, both? who knew?
This is a condition where there is motor paralysis and dilation of the colon to greater than 6 centimeters. It can affect part or all of the colon. The transvers section is the area most often affected?
Toxic Megacolon.....away!
Fever, tachycardia, hypotension, dehydration, cramping, change in the number of stools per day are S&S of?
Toxic Megacolon....away!
How many times higher is the risk for colorectal cancer in a pt with long standing UC?
5 to 6 times higher
CBC
ESR
C-reactive protein
Stool culture
Fecal occult blood
are what in IBDs?
Laboratory Diagnostic tests
What is an ESR test?
Eurethrocyte Sedementation Rate test
Flat plate or KUB or ultrasonography
Upper and lower GI series
CT scans
Radiological Diagnostic Tests
They would use this to see if there is a perforation?
Flat plate or KUB or ultrasound
If the flat plate or KUB or ultrasound found a perforation, what would be the sign?
It would show free air under the diaphragm.
What is an EGD?
Esophagogastroduodenoscopy
EGD
Sigmoidoscopy
Colonoscopy
are what in IBDs?
Scoped Diagnostic tests
5-aminosalicylates, Sulfasalazine (Azulfidine), Mesalamine (Asacol, Rowasa, Pentasa)
are used in what type of treatment of IBDs?
Pharmacology treatment
A sulfonamide antibiotic that is poorly absorbed from the GI tract so it as topically on the IBD to help inhibit the inflammatory process?
Sulfasalazine (Azulfidine)
Which 5-aminosalicylates do not contain sulfa?
The Mesalamines (Asacol, Rowasa, Pentasa)
Used to treat acute exacerbations in IBDs?
Corticosteroids
Given in IBDs to reduce the inflammation and induce remission?
Corticosteroids
Methylprednisone/solu medrol
Prednisone
Budesonide/Entrocort EC
are what type of medication?
Corticosteroids
Used in IBD pts that have not responded to other treatments or require chronic steroid therapy?
Immunosuppressant
Imuran (azathioprine) is what type of medication?
Immunosuppressant
Why is Flagyl the most used antibiotic in IBD?
Because of it's inflammatory effect.
Cephalosporins
Fluoroquinolones
Flagyl
are what type of medication used in IBDs?
Antibiotics
What type of medication is given to a IBD pt to slow GI motility and reduce the diarrhea?
Antidiarrheal
Diphenoxylate/atropine (Lomotil)
Loperamide (Imodium)
are what type of medication used in IBDs?
Antidiarrheal
Why can't antidiarrheals be given during acute IBD attacks?
They can precipitate the Toxic Megacolon....away!
What type of medication is Remicade?
Biological response modifier
This medications action is that it neutralizes and prevents activity of tumor necrosis factor alpha (TNF-alpha); anti-inflammatory and proliferative activity, mainly for Crohn's disease?
Infleximab/Remicade
Remicade is very?
Expensive
This medication can cause an decrease in blood pressure and neutropenia?
Infleximab/Remicade
Rest & reduce anxiety
NPO
IV therapy (TPN, PPN)
or
Elemental diet (feeding tube)
are treatments used in what phase of IBD?
Treatment in the Acute phase of an IBD
Bowel resection
Bowel resection with temporary or permanent ostomy
Take down (reversal) of ostomy
Total colectomy with ileostomy
are what in IBDs?
Surgeries
If they do a total colectomy with ileostomy they will consider the ulcerative colitis?
Cured
Why are surgeries utilized in Crohn's disease?
In response to complications in Crohn's disease.
The third most common cancer after prostate and lung and there are more than a 150,000 new cases every year?
Colorectal Cancer
30% of Colorectal cancer happen here?
Rectum
30% of Colorectal cancer happen here?
Sigmoid
15% of Colorectal cancer happen here?
Descending colon
10% of Colorectal cancer happen here?
Transverse colon
25% of Colorectal cancer happen here?
Ascending colon
An increase in Colorectal cancer in highly industrialized countries. This statement shows the?
Incidence/prevalence of Colorectacl cancer
The individual that is African-American,Hispanic, Jewish or Eastern-European decent has increased risk for developing?
Colorectal cancer
Over 50
Ethnic background
Personal/family history
Dietary habits
Obesity
Sedentary lifestyle
Smoking
ETOH
are what for Colorectal cancer?
Risks
Change in bowel habits
Weight loss
Melena
Hematochezia
Abdominal cramping
are S&S for?
Colorectal cancer
Black, tarry stools or rectal bleeding
Intermittent abdominal fullness or cramping; rectal pressure
Obstipation
Diarrhea or "ribbonlike" stool
Dark or bright red blood in stool; mucus in or on stool.
These are indications of Colorectal cancer in what possible areas of the colon?
Rectum, Sigmoid, Descending, and the left half of the Transverse.
Black, tarry stools
Rectal bleeding
Anemia
Abdominal aching, pressure, or dull cramps
Weakness
Fatigue
Exertional dyspnea
Diarrhea
Obstipation
Anorexia
Weight loss
Vomiting.
These are indications of Colorectal cancer in what possible areas of the colon?
The Ascending colon and the right half of the Transverse colon.
Yearly if >50 or have a family hx
Fecal occult blood test (FOBT) yearly
Sigmoidoscopy Q 5 years
Colonoscopy Q 10 years (&after + results)
Double-contrast barium enema Q 5 years
are what for Colorectal cancer?
Screening
If a pt is doing an FOBT at home, what medications should they not take?
Aspirin or non-steroidals.
When should screening begin for a pt at high risk for Colorectal cancer, due to personal/family hx?
Screening should begin at age 40 or 10 years before the youngest case in the immediate family.
Digital rectal exam
Fecal occult blood test (FOBT)
CBC, CEA, CMP, LFT
Barium enema
Endoscopies
Chest x-rays
CT scan
are diagnostic tests for what type of pt concerning Colorectal cancer?
Diagnostic tests for High Risk Pts for Colorectal Cancer
What does CEA stand for?
Carcinoembryonic Antigen test
What does LFT stand for?
Liver function test
What does TNM stand for in TNM classification?
Tumor Nodes Metastasis
TNM classification is used for what in Colorectal cancer?
Staging of Colorectal cancer
TNM Classification
What stage is Cacinoma Insichu?
Stage 0
TNM Classification
What stage is, Tumor starts to invade sub-mucosa?
Stage 1
TNM Classification
What stage is, Tumor starts to invade muscle?
Stage 2
Can be done pre & post-surgery
5-FU/fluorouracil + Leucovorin +/- Oxaliplatin are the most common drugs used
Not recommended for Stage I or II?
Chemotherapy regarding Colorectal Cancer
Can be delivered concurrently with chemo for pts with T4, stage II and III?
Radiation regarding Colorectal cancer
What can be done for Colorectal cancer pts after surgery for residual tumor?
Radiation
What types of laser surgeries can be performed for Colon cancer?
Endoscopy and Laproscopy
Depends on location and extent of involvment
Laser (endoscopy or laparoscopy)
Bowel resection with or without an ostomy
Possible urostomy if bladder or ureter involved
are what for Colon Cancer?
Surgeries
The anus, rectum and part of the sigmoid colon are removed. The rectal area is sutured closed and the pt has a permanent cholostomy?
Abdominoperineal Resection
They have a permanent cholostomy, may have a urostomy or some type of bladder reconstruction. With females the vagina, cervix, uterus, falopian tubes, ovaries and possibly the vulva, all removed depending on how diffused the cancer is.
This is called?
Pelvic Exhoneration
They have sutured the incision closed, there may be a drain.
This is termed?
Primary intention
Monitor drains and/or packing
Incision: primary or tertiery
May have Urinary incontinence
May have Urinary dysfunction
May have Sexual dysfunction
These are things to monitor in post-op care in what?
Abdominoperineal Resection
They have removed the rectum and they are letting it heal from the inside out. This is termed?
Tertiary intention
Wound infection
Wound disruption
Intraperioneal infection with wound infection
Dehiscence of anastomosis
Fistulas
are all complications after what?
Intestinal surgery
What is it called when the bowel comes out?
Evisceration
A wound opens. The sutures don't hold for whatever reason and the wound opens is called?
Dehises
Cover the wound with sterile gauze and let the physician know if the wound?
Dehises
Cover the wound with saline soaked gauze and let the physician know if the wound?
Eviscerates
Where they have sutured two parts together is called?
An Anastomosis
At some point down the road, they are going to go back in and reconnect everything so the ostomy is what?
Temporary
An ostomy that a person will have for the rest of their life is a?
Permanent Ostomy
A loop of intestine is brought out through an abdominal incision to the abd. suface and is supported with a rod or a bridge, usually plastic X. This supports that loop of bowel. They will usually leave the bridge in for 5 to 7 days depending on the pt. They then open the loop of bowel with a small incision and the proximal end will be fecal and the distal end is non-functioning?
Loop transverse colostomy
Where the colon is divided in two and both ends are brought through the abd. wall to the abd. surface. Proximal end will drain stool. Distal end will drain mucus. Destal end will be refered to as mucus fistula?
Double Barrel Colostomy
Where the ascending colon is brought to the outside and you have an?
Ascending colostomy
The descending colon is brought to the outside?
Descending colostomy
The sigmoid colon is brought to the outside?
Sigmoid colostomy
The Ileum is brought to the outside?
Ileostomy
When is a Hartman's procedure usually done?
For a temporary colostomy
The mucus fistula is closed in what procedure?
Hartman's Procedure
Part of the bowel is utilized to make a pouch and then they do what's called a intesceception (turn inside out), making a type of nipple valve. Pts that have Kock ileostomy don't have to wear an appliance. May wear a pad over the nipple valve to help prevent leakage. The pt has to learn how often they need to go in an catheterize this pouch to drain the stool out. This is called?
Kock (continent) Ileostomy with nipple valve
A temporary ileostomy then they strip the rectal mucosa and let the rectal area heal. They will then go back and reconnect the ileostomy and the anal anastamosis. This method provides a near normal method of having stools. They will have 6-8 stools a day. Sometimes they have difficulty telling stools from gas. What is this crazy thing called?
Ileoanal Reservoir
Avoid gas forming foods (Broccoli, cabbage, beans)
Avoid foods that cause odors (Asparagus, eggs, fish, garlic, onions)
Avoid a lot of high fiber at a meal to avoid blockage
Avoid constipation
are diet recommendations for a pt with a?
Colostomy
Teach not to drink with meals
Eat foods that thicken stools
Maintain an eating schedule
Increased fluid intake to 3000cc or more as needed
BRAT diet
are diet recommendations for a pt with an?
Ileostomy
Nuts
Raisins
Popcorn
Seeds
Raw vegetables
Celery
Corn
Can do what to an ileostomy?
Obstruct an ileostomy
Skin prep
Skin powder
Skin paste/sealant
Wafer/skin barriers
Pouches
Clip, clamp, wire, valve
belt
are equipment that a pt will need to maintain their?
Ostomy
Can you touch the stoma?
Yes, yes you can!
Why is an Ostomy irrigation done?
Bowel regulation
Enema bag
Ostomy nipple
Lubricant
Ostomy drainage bag for toilet
are the equipment needed for?
Ostomy irrigation
Can the bowel (Ostomized) be trained?
Yes
Mouth
Esophagus
Lower esophageal sphincter
Stomach
Duodenum
Jejunum
Ileum
Make up?
Upper GI System
What does GERD stand for?
Gastric Esophageal Reflux Disease
Where does GERD accur?
By the Lower Esophageal Sphincter and the Diaphragm.
Problems that a pt will experience with their esophageal sphincter is called what?
GERD
How can GERD be avoided?
By eating smaller meals.
Increased abdominal pressure and position changes and do what to GERD?
Aggravate it.
High fat and acidic diet, hiatal hernia can what GERD?
Worsen it.
What two things can GERD cause?
A precancerous state and Barrett's esophagus.
A chronic inflammation and irritation to your esophagus is called?
Barrett's esophagus
Weight loss, stop smoking
Avoid high fat meals and eating within 2-3 hours of bedtime
Avoid lying down after meals or bending over
Avoid acidic foods
Avoid alcoholic beverages
Avoid carbonated beverages and caffeine
Elevate HOB 6-8 inches
Avoid tight and restrictive clothing
Medications can be used
and surgery is also an option
These are what for GERD?
GERD Treatment
Caused by a break in the mucosal barrier?
Peptic Ulcer Disease
More often in men than women. 10% of the population have this?
Peptic Ulcer Disease
Smoking
H pylori
NSAIDs, coricosteroid, anticoagulants and aspirin use
Family Hx of the disease
Zollinger-Ellison Syndrome
are all risk factors for?
Peptic Ulcer Disease
N/V, may have bloody or coffee ground emesis
Blood in stools, lack tarry stools
Unintentional weight loss and fatigue
Anemia
Epigatric pain that may wake you at night, may be relieved by antacids or mild or eating, may occur 2-3 hours after a meal, descibed as gnawing, burning, aching, or hungerlike which can radiate to the pt's back. These are S&S of?
Peptic Ulcer Disease
CBC
Coagulation studies
IgG antibodies
Urea breath series
Upper GI series
EGD
are diagnostic tests for what?
Peptic Ulcer Disease
How long does a pt need to be NPO for either the Barium Swallow Upper GI series or the Upper GI Endoscopy?
6-8 hours
When can a pt eat after an EGD?
When their gag reflex has returned.
Pepcid - Famotidine
Zantac - Ranitidine
Tagment - Cimitedine
Axid - Nizatidine
are what type of medications used in the treatment of Peptic Ulcer Disease?
H2 Receptor blockers (block histamine in parietal cells which stimulates acid secretion, which reduces acid secretions)
What must be continued for at least 8 weeks for ulcer healing in Peptic Ulcer Disease?
H2 Receptor blockers
What is drug type preffered for sever GERD?
Proton pump inhibitors (PPIs)
Decreases gastric acid by slowing the pump on the surface of the parietal cells. This is the action for what type of drug used in Peptic Ulcer Disease?
Proton pump inhibitors (PPIs)
Nexium - Esomeprazole
Prilosec - Omeprazole
Prevacid - Lansoprazole
Protonix - Pantoprazole
Aciphex - Rabeprazole
Are what type of drugs used in the Tx of Peptic Ulcer Disease?
Proton Pump Inhibitors (PPIs)
Most of the drugs of this type are once a day, do not crush and they are best on an empty stomach?
Proton Pump Inhibitors (PPIs)
What drug type blocks histamine in parietal cells which stimulates acid secretion, which reduces acid secretions and is used in the tx of Peptic Ulcer Disease?
H2 Receptor blockers
Maalox
Mylanta
Gaviscon
Tums
Riopan
are what type of drug?
Antacids
Why do you not give antacids with the PPIs or the H2 Blockers?
Because the antacids interfere with drug absorption.
May cause bowel disturbances, they have salt and sugar and they cause compliance problems because of how many times a day they have to be taken?
Antacids
Neutralize the acid and is usually given 1 hour before meals or 2 hours after?
Antacids
Acts on the CNS by increasing gastric motility and stomach emptying
Used for N/V and GERD
Monitor for extrapyramidal side effects
This is what drug used in the tx of peptic ulcer disease?
Metoclopramide-Reglan
Forms a paste that adheres to damaged mucosal tissue and promotes healing
Don't crush and shake the suspension well
Increase fluid and fiber intake to prevent constipation
This is what drug used in the tx of peptic ulcer disease?
Sucralfate-Carafate
The #1 cause of ulcers?
H pylori treatment
2 antibiotics and a PPI make a?
Prev-pak
A Prev-pak is used in the tx of?
H pylori
Omeprazole 20mg BID+Clarithromycin 500mg BID

What do you need to make this Prevpac complete?
Amoxicillin 1g BID
Lansoprazole 30mg BID+Clarithromycin 500mg BID

What do you need to make this Prevpac complete?
Metronidazole 500mg BID
Bismuth Subsulfate 525 mg (2 tablets) BID+Metronidazole 500mg PO TID+tetracycline 500mg QID

What do you need to make this Prevpac complete?
Lansoprazole 30mg PO QD
Omeprazole 20mg BID+Clarithromycin 500mg BID

What do you need to make this Prevpac complete?
Metronidazole 500mg BID
Helidac (BSS, Metronidazole, tetracycline) QID

What do you need to make this Prevpac complete?
Famotidine 40mg QD
How many days is a Prevpac administered?
14 days
No smoking
No excessive use of alcohol, coffee, caffeine
Maintain good nutrition, do not need a restrictive diet
No medications that harm mucosa (NSAIDs, ASAs, Steroids)
Are what kind of changes for Peptic Ulcer Disease and Gerd?
Lifestyle changes
Occurs in 10-20% of PUD pts?
Hemorrhage
Those with gastric ulcers and the elderly are at an increased risk for?
Hemorrhage
Hematemesis, may be coffee ground
Occult blood or visible blood in stool
Fatigue
Weakness or dizziness
Orthostatic hypotension
Hypovolemic shock
are what you would assess in someone who is having this complication of Peptic Ulcer Disease?
Hemorrhage
Do you keep a pt that has had a Hemorrhage related to Peptic Ulcer Disease NPO?
Yes
Why would you give rapid fluid replacement in a PUD patient who has had a hemorrhage?
They are probably hypovolemic
If a PUD pt has had a hemorrhage has a low H&H, what do you do?
Blood transfusion
If a PUD pt has had a hemorrhage, why would you use a low intermittent suction NG placement?
To relieve some of the pressure by getting some of the gastric secretions out.
If a PUD pt has had a hemorrhage, what drug do you give them?
IV Protonix
If a PUD pt has had a hemorrhage, why would you give an emergency EGD?
To find where they are bleeding and possibly coterize the site to stop the bleeding.
If a PUD pt has had a hemorrhage, why would surgery be needed?
If the emergency EGD was ineffective or they have a rebleed.
Tachycardia
Hypotension
Low urine output
Pallor
are symptoms to assess for? what
Hemorrhagic shock
May result from edema surrounding the ulcer, spasm of smooth muscle or scar tissue?
Obstruction
If obstruction becomes complete in a PUD pt, what will the pt do?
Vomit
Epigastric fullness
N/V
Electrolyte imbalances
Metabolic alkalosis
Are symptoms of?
Obstruction (complication of PUD)
NG tube to LIS for gastric decompression
Monitor fluid and electrolyte status
IV NS and potassium replacement as needed
EGD for balloon dilation
Surgery if balloon dilation fails
are treatment for?
PUD obstruction
Because their mucosa is thinner, the elderly are at an increased risk for which complication of PUD?
Perforation
What is the most lethal complication of PUD making it a medical emergency?
Perforation
How do you see the PUD complication of Perforation on an x-ray?
It will show as free air on an x-ray
What complication of PUD directly causes peritonitis?
Perforation
Severe upper abd. pain radiates to shoulder
Rigid boardlike abdomen
Diaphoresis and fever
Tachycardia and hypotension
Rapid shallow respirations
are all symptoms of what PUD complication?
Perforation
IV fluids to maintain fluid and electrolyte balance
NPO and NG tube to LIS
Position pt in semi fowlers or fowlers position
Watch for shock, monitor vitals and urine output
IV antibiotics
Surgical intervention
are treatment for what PUD complication?
Perforation
What is the most common type of Stomach Cancer?
Adenocarcinoma
What surgeries are done for Stomach Cancer?
Billroth I
Billroth II
In this stomach cancer surgery, the distal part of the stomach is removed and the surgeon dews the remainder of the stomach directly to the duodenum. Another name is gastroduodenostomy?
Billroth I
In this stomach cancer surgery, the distal portion of the stomach is removed. The stomach is attached to the jejunum. This creates a "y" with the bile drainage and the duodenum forms the second branch of the "y". Also called a gastrojejunostomy?
Billroth II
What is the major complication that can occur after a stomach cancer surgery?
Dumping syndrome
Caused by hypertonic food bolus (chyme)rapidly into intestine which causes water to be drawn into hyperosmolar intestine and leads to decreased blood volume and increased intestinal dialation and increased peristalsis?
Dumping syndrome
Can be caused by high carbohydrate foods?
Dumping syndrome
Occur 5-30 minutes after a meal and are characterized by sweating, abd. pain, weakness, vomitin, dizziness, diarrhea, borborygmi, tachycardia, hypotension and diaphoresis?
Dumping syndrome
Hypoglycemia develops 2-3 hours after a meal due to increased release of insulin in this complication of stomach cancer surgery?
Dumping syndrome
This complication of stomach cancer surgery is usually self limiting, lasting about 6-12 months after surgery?
Dumping syndrome
Small frequent meals
Avoid fluids with meals
Eat slowly
Increased fat and protein in the diet
Limit carbohydrates and simple sugar foods
Lie down after eating
Medications used as a last resort
this is management for what complication of stomach cancer surgery?
Dumping syndrome
Failure of intestinal contents to move through the bowel lumen?
Definition of Intestinal Obstructions
The most common reason for small bowel surgery?
Intestinal Obstructions
The functional kind include the Ileus as the most common obstruction and also Neurogenic or muscular impairment?
Intestinal Obstructions
Occurs when peristalsis fails to move intestinal contensts through the bowel in abscence of mechanical obstruction. It leads to bowel distension and decreased to absent bowel sounds?
Paralytic Ileus defined