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186 Cards in this Set
- Front
- Back
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?
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Definition of Ulcerative Colitis
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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?
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Etiology
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Begins in the rectum and moves upward to the secum in a continuous manner?
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Ulcerative Colitis
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What ages does ulcerative colitis first peak in?
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15-35
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What ages does ulcerative colitis later peak in?
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50-70
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A spasmotic contration with chronic pain?
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Tenesmus
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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
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Sometimes called regional enteritis?
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Crohn's Disease
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Described as Skip Lesions?
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Crohn's Disease
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An inflammatory disease of the small or large intestine, can be anywhere in the GI tract and invades all layers of the bowel?
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Definition of Crohn's Disease
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Not well understood but they think that genetics plays a part in it as does myobacterium paratuberculosis and there is also the autoimmune component?
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Etiology of Crohn's Disease
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IBD's tend to run in?
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Families
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American Jews of European decent are expected to develop IBDs how many times more than everybody else?
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4 to 5 times higher risk of developing IBDs
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You may hear Crohn's disease described as?
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Cobble Stones
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Why is Croh's disease sometimes described as Cobble Stones?
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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.
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Between what ages does Crohn's usually peak?
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15-40
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Fatty stools are called?
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Steatorrhea
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What is the most common site for Crohn's?
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The terminal illeum
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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
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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?
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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?
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Toxic Megacolon.....away!
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Fever, tachycardia, hypotension, dehydration, cramping, change in the number of stools per day are S&S of?
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Toxic Megacolon....away!
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How many times higher is the risk for colorectal cancer in a pt with long standing UC?
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5 to 6 times higher
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CBC
ESR C-reactive protein Stool culture Fecal occult blood are what in IBDs? |
Laboratory Diagnostic tests
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What is an ESR test?
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Eurethrocyte Sedementation Rate test
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Flat plate or KUB or ultrasonography
Upper and lower GI series CT scans |
Radiological Diagnostic Tests
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They would use this to see if there is a perforation?
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Flat plate or KUB or ultrasound
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If the flat plate or KUB or ultrasound found a perforation, what would be the sign?
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It would show free air under the diaphragm.
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What is an EGD?
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Esophagogastroduodenoscopy
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EGD
Sigmoidoscopy Colonoscopy are what in IBDs? |
Scoped Diagnostic tests
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5-aminosalicylates, Sulfasalazine (Azulfidine), Mesalamine (Asacol, Rowasa, Pentasa)
are used in what type of treatment of IBDs? |
Pharmacology treatment
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A sulfonamide antibiotic that is poorly absorbed from the GI tract so it as topically on the IBD to help inhibit the inflammatory process?
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Sulfasalazine (Azulfidine)
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Which 5-aminosalicylates do not contain sulfa?
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The Mesalamines (Asacol, Rowasa, Pentasa)
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Used to treat acute exacerbations in IBDs?
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Corticosteroids
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Given in IBDs to reduce the inflammation and induce remission?
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Corticosteroids
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Methylprednisone/solu medrol
Prednisone Budesonide/Entrocort EC are what type of medication? |
Corticosteroids
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Used in IBD pts that have not responded to other treatments or require chronic steroid therapy?
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Immunosuppressant
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Imuran (azathioprine) is what type of medication?
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Immunosuppressant
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Why is Flagyl the most used antibiotic in IBD?
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Because of it's inflammatory effect.
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Cephalosporins
Fluoroquinolones Flagyl are what type of medication used in IBDs? |
Antibiotics
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What type of medication is given to a IBD pt to slow GI motility and reduce the diarrhea?
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Antidiarrheal
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Diphenoxylate/atropine (Lomotil)
Loperamide (Imodium) are what type of medication used in IBDs? |
Antidiarrheal
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Why can't antidiarrheals be given during acute IBD attacks?
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They can precipitate the Toxic Megacolon....away!
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What type of medication is Remicade?
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Biological response modifier
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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?
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Infleximab/Remicade
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Remicade is very?
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Expensive
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This medication can cause an decrease in blood pressure and neutropenia?
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Infleximab/Remicade
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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
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Bowel resection
Bowel resection with temporary or permanent ostomy Take down (reversal) of ostomy Total colectomy with ileostomy are what in IBDs? |
Surgeries
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If they do a total colectomy with ileostomy they will consider the ulcerative colitis?
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Cured
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Why are surgeries utilized in Crohn's disease?
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In response to complications in Crohn's disease.
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The third most common cancer after prostate and lung and there are more than a 150,000 new cases every year?
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Colorectal Cancer
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30% of Colorectal cancer happen here?
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Rectum
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30% of Colorectal cancer happen here?
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Sigmoid
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15% of Colorectal cancer happen here?
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Descending colon
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10% of Colorectal cancer happen here?
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Transverse colon
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25% of Colorectal cancer happen here?
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Ascending colon
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An increase in Colorectal cancer in highly industrialized countries. This statement shows the?
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Incidence/prevalence of Colorectacl cancer
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The individual that is African-American,Hispanic, Jewish or Eastern-European decent has increased risk for developing?
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Colorectal cancer
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Over 50
Ethnic background Personal/family history Dietary habits Obesity Sedentary lifestyle Smoking ETOH are what for Colorectal cancer? |
Risks
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Change in bowel habits
Weight loss Melena Hematochezia Abdominal cramping are S&S for? |
Colorectal cancer
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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.
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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.
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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
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If a pt is doing an FOBT at home, what medications should they not take?
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Aspirin or non-steroidals.
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When should screening begin for a pt at high risk for Colorectal cancer, due to personal/family hx?
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Screening should begin at age 40 or 10 years before the youngest case in the immediate family.
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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
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What does CEA stand for?
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Carcinoembryonic Antigen test
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What does LFT stand for?
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Liver function test
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What does TNM stand for in TNM classification?
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Tumor Nodes Metastasis
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TNM classification is used for what in Colorectal cancer?
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Staging of Colorectal cancer
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TNM Classification
What stage is Cacinoma Insichu? |
Stage 0
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TNM Classification
What stage is, Tumor starts to invade sub-mucosa? |
Stage 1
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TNM Classification
What stage is, Tumor starts to invade muscle? |
Stage 2
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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
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Can be delivered concurrently with chemo for pts with T4, stage II and III?
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Radiation regarding Colorectal cancer
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What can be done for Colorectal cancer pts after surgery for residual tumor?
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Radiation
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What types of laser surgeries can be performed for Colon cancer?
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Endoscopy and Laproscopy
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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
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The anus, rectum and part of the sigmoid colon are removed. The rectal area is sutured closed and the pt has a permanent cholostomy?
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Abdominoperineal Resection
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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
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They have sutured the incision closed, there may be a drain.
This is termed? |
Primary intention
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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
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They have removed the rectum and they are letting it heal from the inside out. This is termed?
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Tertiary intention
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Wound infection
Wound disruption Intraperioneal infection with wound infection Dehiscence of anastomosis Fistulas are all complications after what? |
Intestinal surgery
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What is it called when the bowel comes out?
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Evisceration
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A wound opens. The sutures don't hold for whatever reason and the wound opens is called?
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Dehises
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Cover the wound with sterile gauze and let the physician know if the wound?
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Dehises
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Cover the wound with saline soaked gauze and let the physician know if the wound?
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Eviscerates
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Where they have sutured two parts together is called?
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An Anastomosis
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At some point down the road, they are going to go back in and reconnect everything so the ostomy is what?
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Temporary
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An ostomy that a person will have for the rest of their life is a?
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Permanent Ostomy
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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?
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Loop transverse colostomy
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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?
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Double Barrel Colostomy
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Where the ascending colon is brought to the outside and you have an?
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Ascending colostomy
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The descending colon is brought to the outside?
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Descending colostomy
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The sigmoid colon is brought to the outside?
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Sigmoid colostomy
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The Ileum is brought to the outside?
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Ileostomy
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When is a Hartman's procedure usually done?
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For a temporary colostomy
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The mucus fistula is closed in what procedure?
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Hartman's Procedure
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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?
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Kock (continent) Ileostomy with nipple valve
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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?
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Ileoanal Reservoir
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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
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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
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Nuts
Raisins Popcorn Seeds Raw vegetables Celery Corn Can do what to an ileostomy? |
Obstruct an ileostomy
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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
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Can you touch the stoma?
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Yes, yes you can!
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Why is an Ostomy irrigation done?
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Bowel regulation
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Enema bag
Ostomy nipple Lubricant Ostomy drainage bag for toilet are the equipment needed for? |
Ostomy irrigation
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Can the bowel (Ostomized) be trained?
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Yes
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Mouth
Esophagus Lower esophageal sphincter Stomach Duodenum Jejunum Ileum Make up? |
Upper GI System
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What does GERD stand for?
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Gastric Esophageal Reflux Disease
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Where does GERD accur?
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By the Lower Esophageal Sphincter and the Diaphragm.
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Problems that a pt will experience with their esophageal sphincter is called what?
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GERD
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How can GERD be avoided?
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By eating smaller meals.
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Increased abdominal pressure and position changes and do what to GERD?
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Aggravate it.
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High fat and acidic diet, hiatal hernia can what GERD?
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Worsen it.
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What two things can GERD cause?
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A precancerous state and Barrett's esophagus.
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A chronic inflammation and irritation to your esophagus is called?
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Barrett's esophagus
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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
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Caused by a break in the mucosal barrier?
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Peptic Ulcer Disease
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More often in men than women. 10% of the population have this?
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Peptic Ulcer Disease
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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
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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
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CBC
Coagulation studies IgG antibodies Urea breath series Upper GI series EGD are diagnostic tests for what? |
Peptic Ulcer Disease
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How long does a pt need to be NPO for either the Barium Swallow Upper GI series or the Upper GI Endoscopy?
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6-8 hours
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When can a pt eat after an EGD?
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When their gag reflex has returned.
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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)
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What must be continued for at least 8 weeks for ulcer healing in Peptic Ulcer Disease?
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H2 Receptor blockers
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What is drug type preffered for sever GERD?
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Proton pump inhibitors (PPIs)
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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?
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Proton pump inhibitors (PPIs)
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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)
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Most of the drugs of this type are once a day, do not crush and they are best on an empty stomach?
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Proton Pump Inhibitors (PPIs)
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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?
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H2 Receptor blockers
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Maalox
Mylanta Gaviscon Tums Riopan are what type of drug? |
Antacids
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Why do you not give antacids with the PPIs or the H2 Blockers?
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Because the antacids interfere with drug absorption.
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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?
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Antacids
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Neutralize the acid and is usually given 1 hour before meals or 2 hours after?
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Antacids
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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
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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
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The #1 cause of ulcers?
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H pylori treatment
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2 antibiotics and a PPI make a?
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Prev-pak
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A Prev-pak is used in the tx of?
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H pylori
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Omeprazole 20mg BID+Clarithromycin 500mg BID
What do you need to make this Prevpac complete? |
Amoxicillin 1g BID
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Lansoprazole 30mg BID+Clarithromycin 500mg BID
What do you need to make this Prevpac complete? |
Metronidazole 500mg BID
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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
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Omeprazole 20mg BID+Clarithromycin 500mg BID
What do you need to make this Prevpac complete? |
Metronidazole 500mg BID
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Helidac (BSS, Metronidazole, tetracycline) QID
What do you need to make this Prevpac complete? |
Famotidine 40mg QD
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How many days is a Prevpac administered?
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14 days
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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
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Occurs in 10-20% of PUD pts?
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Hemorrhage
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Those with gastric ulcers and the elderly are at an increased risk for?
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Hemorrhage
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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
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Do you keep a pt that has had a Hemorrhage related to Peptic Ulcer Disease NPO?
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Yes
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Why would you give rapid fluid replacement in a PUD patient who has had a hemorrhage?
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They are probably hypovolemic
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If a PUD pt has had a hemorrhage has a low H&H, what do you do?
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Blood transfusion
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If a PUD pt has had a hemorrhage, why would you use a low intermittent suction NG placement?
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To relieve some of the pressure by getting some of the gastric secretions out.
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If a PUD pt has had a hemorrhage, what drug do you give them?
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IV Protonix
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If a PUD pt has had a hemorrhage, why would you give an emergency EGD?
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To find where they are bleeding and possibly coterize the site to stop the bleeding.
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If a PUD pt has had a hemorrhage, why would surgery be needed?
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If the emergency EGD was ineffective or they have a rebleed.
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Tachycardia
Hypotension Low urine output Pallor are symptoms to assess for? what |
Hemorrhagic shock
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May result from edema surrounding the ulcer, spasm of smooth muscle or scar tissue?
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Obstruction
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If obstruction becomes complete in a PUD pt, what will the pt do?
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Vomit
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Epigastric fullness
N/V Electrolyte imbalances Metabolic alkalosis Are symptoms of? |
Obstruction (complication of PUD)
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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
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Because their mucosa is thinner, the elderly are at an increased risk for which complication of PUD?
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Perforation
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What is the most lethal complication of PUD making it a medical emergency?
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Perforation
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How do you see the PUD complication of Perforation on an x-ray?
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It will show as free air on an x-ray
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What complication of PUD directly causes peritonitis?
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Perforation
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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
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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
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What is the most common type of Stomach Cancer?
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Adenocarcinoma
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What surgeries are done for Stomach Cancer?
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Billroth I
Billroth II |
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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?
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Billroth I
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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?
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Billroth II
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What is the major complication that can occur after a stomach cancer surgery?
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Dumping syndrome
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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?
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Dumping syndrome
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Can be caused by high carbohydrate foods?
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Dumping syndrome
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Occur 5-30 minutes after a meal and are characterized by sweating, abd. pain, weakness, vomitin, dizziness, diarrhea, borborygmi, tachycardia, hypotension and diaphoresis?
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Dumping syndrome
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Hypoglycemia develops 2-3 hours after a meal due to increased release of insulin in this complication of stomach cancer surgery?
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Dumping syndrome
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This complication of stomach cancer surgery is usually self limiting, lasting about 6-12 months after surgery?
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Dumping syndrome
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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
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Failure of intestinal contents to move through the bowel lumen?
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Definition of Intestinal Obstructions
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The most common reason for small bowel surgery?
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Intestinal Obstructions
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The functional kind include the Ileus as the most common obstruction and also Neurogenic or muscular impairment?
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Intestinal Obstructions
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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?
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Paralytic Ileus defined
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