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365 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Three functions of the G.I. tract are |
Ingestion, digestion, and absorption. |
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Digestion starts in the |
Mouth |
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The G.I. tract is approximately how many feet long? |
30 feet |
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What controls the G.I. tract? |
The autonomic nervous system |
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The parasympathetic nervous system is excitatory therefore it stimulates what? |
Peristalsis |
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The sympathetic nervous system is inhibitory therefore it does what to the G.I. tract? |
It slows down the G.I. tract. |
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The enteric nervous system or the "gut brain" controls what? |
Movement and secretion of gastric juices. |
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What are the four layers of the G.I. tract? |
Mucosa, sub mucosa, muscle and serosa. |
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Name the three types of muscle found in the G.I. tract. |
Circular bands (inner) longitudinal bands (outer) oblique bands (stomach only) |
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Serosa is the outer layer of the G.I. tract except in what area, where it is fibrous tissue. |
The outer layer of the esophagus is fibrous tissues. |
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Segmentation also means ________ and occurs in the stomach. |
Mixing |
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Propulsion also means ________ and is the movement from the esophagus to lower G.I. tract. |
Peristalsis |
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The appetite center in the brain is the______ ? |
Hypothalamus |
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What two sleep hormones affect appetite? |
Gherlin and Leptin. |
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High levels of Gherlin does what? |
Triggers increased appetite |
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The main function of the gastrointestinal system is to supply what to the body cells? |
Nutrients |
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Low levels of Leptin increases appetite by sending signals to the fat cells saying what? |
Insufficient metabolic reserves, increase caloric intake. |
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The secretions of the G.I. system consist of ________and ________for digestion, _______to provide protection and lubrication , and water and electrolytes. |
Enzymes and hormones, mucus |
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High levels of Gherlin does what? |
Triggers increased appetite |
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The secretions of the G.I. system consist of ________and ________for digestion, _______to provide protection and lubrication , and water and electrolytes. |
Enzymes and hormones, mucus |
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The main function of saliva is to do what? |
Lubricate and soften the food mass, facilitating swallowing. |
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What is a hollow, muscular tube that receives food from the pharynx and moves it to the stomach by Peristaltic contractions. |
Esophagus |
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What are the three functions of the stomach? |
1. Store food 2. Mix the food with gastric secretions 3. Empty contents into the small intestine at a rate at which digestion can occur. |
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What are the three functions of the stomach? |
1. Store food 2. Mix the food with gastric secretions 3. Empty contents into the small intestine at a rate at which digestion can occur. |
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What are the two primary functions of the small intestine? |
Absorption and digestion |
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The secretion of hydrochloric acid makes gastric juice ______. |
Acidic |
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Intrinsic factor promotes the absorption of what vitamin? |
Vitamin B 12 |
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What are the four parts of the large intestine? |
1.The cecum an appendix 2. The colon 3. The rectum 4. The anus |
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The most important function of the large intestine is? |
Absorption of water and electrolytes. |
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The liver is the major site for ________ and ________ metabolism. |
Drug and hormone |
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The most important function of the large intestine is? |
Absorption of water and electrolytes. |
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The biliary tract consists of the ______ and the _______. |
Gallbladder and the duct system. |
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Bile is produced in the _______ and stored in the _______. |
Liver and gallbladder |
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The most important function of the large intestine is? |
Absorption of water and electrolytes. |
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True or false: the pancreas has exocrine and endocrine functions. |
True |
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Bile consists of bilirubin, water, cholesterol, bile salts, electrolytes, and __________. |
Phospholipids |
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True or false: the pancreas has exocrine and endocrine functions. |
True |
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The exocrine function of the pancreas contributes to_______. |
Digestion |
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The endocrine function occurs in the Islets of Langerhans, who's beta cells secrete ___________, alpha cells secrete___________, and Delta cells secrete __________________. |
Insulin = beta cells glucagon = alpha cells Somatostatin = delta cells. |
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What is used to show the size and configuration of organs? |
Ultrasonography |
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Virtual colonoscopy combines _______ and ______ to produce images of the colon and rectum. |
CT and MRI |
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Name the G.I. structures that can be examined by Endoscopy. |
Esophagus, stomach, duodenum, and colon. |
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Retrograde Cholangiopancreatography is an endoscopic procedure that visualizes the________, _________, and _________________________. |
Pancreatic, hepatic, and common bile ducts. |
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_________ is a non-invasive approach to visualize the G.I. tract. |
Capsule Endoscopy |
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Liver biopsy is performed to obtain tissue for diagnosis of _________, _______, and __________. |
Fibrosis, cirrhosis, and neoplasms. |
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Liver function tests reflect ________ disease and function. |
Hepatic |
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Leptin found in adipocytes suppress appetite and hunger and regulate eating behavior resistance develops with high levels the people may lose the effect of appetite suppression. |
Page 909 Table 41-3 |
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The mucosal layer forms folder called ______ that contain many small glands. |
Rugae |
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In the fundus, the glands contain chief cells which secrete _______________ and parietal cells which secrete, _________, water and __________ __________. |
Pepsinogen Hydrochloric acid Intrinsic factor |
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Why is the pH of gastric juice so acidic? |
To protect against ingested organisms. |
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The small intestine is a coiled tube approximately _____ ft long, it extends from the _____ to the ______________, and it is composed of three parts the _________, _________ and __________. |
23ft Pylorus Ileocecal valve Duodenum Jejunum Ileum |
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The physical and chemical breakdown of food into absorbable substances is called. |
Digestion |
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Saliva contains ______, which breaks down starch is to maltose. |
Amylase |
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Salivary gland secretion is stimulated by ________movements and the _______, ________, _______and ______ of food. |
Chewing Sight, smell, thought, and taste |
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The stomachs acidic environment results in the conversion of pepsinogen to its active form, ________. |
Pepsin |
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Pernicious anemia |
*Malabsorption of B12. *More common in women than men. *causes demyelination of peripheral nerves(eventually spinal cord). |
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Early S/S of Pernicious Anemia |
Infections, mood swings, and G.I., cardiac, or kidney ailments. |
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The stomachs acidic environment results in the conversion of pepsinogen to its active form, ________. |
Pepsin |
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Pernicious anemia |
*Malabsorption of B12. *More common in women than men. *causes demyelination of peripheral nerves(eventually spinal cord). |
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Early S/S of Pernicious Anemia |
Infections, mood swings, and G.I., cardiac, or kidney ailments. |
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Late S/S of Pernicious Anemia |
Weakness,fatigue, Paresthesias (tingling, itching, burning, numbness) of the feet and fingers difficulty walking loss of appetite abdominal pain weight loss and a sore tongue that is smooth and beefy red. |
Classic symptoms of anemia |
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A test that is used to determine whether the body absorbs vitamin B12 normally. |
Schilling Test |
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The enteric nervous system is located between what two layers? |
Between the mucosa and the muscle layers. |
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Gastrin stimulates what to actions? |
Gastric juice secretion and stomach motor function. |
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Food remains in the stomach for how many hours? |
3 to 4 hours |
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Name the three areas of the stomach? |
Fundus, body, and Antrum. |
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What sphincter prevents food and gastric juices from moving back up the esophagus? |
Lower Esophageal sphincter (LES) also known as cardiac sphincter. |
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What sphincter prevents backflow of the small intestine back into the stomach? |
The pyloric sphincter. |
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Factors that affect appetite include: |
Hypoglycemia,empty stomach, body temperature, input from higher brain centers, sleep hormones (Gherlin and Leptin). |
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Digestion begins in the mouth with mechanical and chemical digestion what is an example of mechanical and chemical? |
Mechanical =mastication(chewing) chemical = saliva |
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Name the two phases of digestion. |
Cephalic and gastric. |
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The stomach secretes hydrochloric acid which converts Pepsinogen to pepsin to aid in the breakdown of food. What phase of digestion does this describe? |
Cephalic phase |
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Food exits the esophagus passing the cardiac sphincter and enters the stomach, distention of the stomach stimulates gastrin. What phase of digestion is this describing? |
Gastric phase |
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Gastric juice is acidic, what is the pH range? |
0.9-1.5 pH |
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The largest internal organ in the body is the_____? |
Liver |
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The liver is located in what region? |
Right epigastric region |
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What are the three main functions of the liver? |
Storage, protection, and metabolism. |
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The gallbladder function is to concentrate and store _____. |
Bile
(Holds 45mL) |
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Functions of bile for digestion include: |
1. Emulsify lipids 2. Stimulate peristalsis 3. Neutralize chyme 4. Excrete pigments |
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The color of the ________ (vomit) aids in identifying the presence and source of bleeding. |
Emesis |
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Vomiting can occur when the G.I. tract becomes overly ________, _______, or ________. |
Irritated, excited, or distended. |
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The patient with severe or prolonged vomiting is at risk for______________ and ________ and _______________ imbalances. |
Dehydration,acid-base, and electrolyte. |
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Older patients are more likely to have cardiac or renal insufficiency that places them at greater risk for life-threatening fluid and electrolyte imbalances caused by ____________. |
Vomiting |
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_______________________ Is umbrella term for cancers of the oral cavity,pharynx, and larynx. Most of the oral malignant lesions occur on the lower lip. |
Head and neck squamous cell carcinoma. |
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This diagnostic test provides visualization of the esophagus, stomach, and small intestine all the way to the ileocecal valve. |
An upper G.I. series with small bowel follow-through. |
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Fluroscopic x-ray study using contrast medium used to diagnose structural abnormalities of the esophagus, stomach, and duodenum is called a __________ _______. |
Barium swallow. |
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Patient prep for swallow studies includes: *** |
1.NPO for 8 to 12 hours prior to procedure 2. No smoking after midnight the night before procedure 3. The patient will be asked to drink a contrast medium and assume several positions on an x-ray table. |
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Nursing implications of swallow studies includes: *** |
1. Patient education - drink plenty of fluids, may need a laxative, stools maybe white for up to 72 hours following procedure. 2. Monitor for complications (perforation*, constipation, nausea, impaction)*** |
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An x-ray in which a contrast medium is used to outline the hepatic, cystic, and common bile ducts is called a _________________. |
Cholangiogram. |
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Patient Prep for a Cholangiogram includes: |
1. NPO after midnight or eight hours before procedure 2. Patient is administered a laxative and/or an enema to cleanse the bowel. 3. report abdominal pain |
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Nursing implications for a cholangiogram include: |
1. Consent 2. Assess for iodine allergies 3. Premedicate in the presence of an iodine allergy. 4. Post procedure: monitor vital signs, and NPO until gag reflex returns. |
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Diagnostic procedure that shows the size and configurations of organs is called an _________ ________. |
Abdominal ultrasound |
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Allows visualization of the gallbladder in common bile duct. |
Gallbladder scan |
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Failure to visualize the gallbladder 1 to 2 hours after the injection of die is diagnostic of an obstruction of the _______ _________.  |
Cystic duct (acute cholecystitis) |
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Diagnostic procedure that shows the size and configurations of organs is called an _________ ________. |
Abdominal ultrasound |
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Diagnostic procedure of choice for the detection of appendicitis, acute cholecystitis, cholelithiasis, and other changes and abdominal organs is the __________ ___________. |
Abdominal ultrasound |
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Failure to visualize the gallbladder 1 to 2 hours after the injection of die is diagnostic of an obstruction of the _______ _________.  |
Cystic duct (acute cholecystitis) |
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This test evaluate swelling masses in the parotids, detects blocked ducks of the parotid and submaxillary glands, tumors of the parotid, and salivary gland. |
Parotid scan |
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Used to demonstrate the function, anatomy and size of the liver, gallbladder and upper intestine. Uses a radiopaque dye injected intravenously, the procedure lasts approximately one hour with no prep. |
Liver scan |
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Direct visualization of a body structure three lighted fiber optic instrument. |
Endoscopy. |
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Patient prep for endoscopy includes: |
1. NPO eight hours prior to testing 2. Local anesthetic may be sprayed on the throat prior to insertion of the endoscope. 3. Sedation is used |
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Nursing implications of Endoscopy include: |
1. Signed consent 2. Administer pre-op meds as ordered. 3. Keep patient NPO until gag reflex returns 4. Encourage use of warm Saline gargles. 5. Monitor vital signs following procedure. |
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Direct visualization of the stomach. |
Gastroscopy |
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Direct visualization of the esophagus, stomach, and the beginning of the duodenum. |
Esophogastroduodenscopy. |
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After endoscopic procedures what do you monitor for? |
Signs and symptoms of dyspnea, dysphagia, abdominal pain, fever, and bleeding. |
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__________ describes a state of poor intake as a result of inadequate diet or diseases that interfere with normal appetite and assimilation of ingested food. |
Undernutrition |
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__________ is a deficit,excess, or imbalance of the essential components of a balanced diet. |
Malnutrition |
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_______________ refers to the ingestion of more food than is required for body needs, as in obesity. |
Overnutrition |
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Major complication of Endoscopy is __________. |
Perforation |
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The most common manifestations of gastrointestinal diseases are: |
Nausea and vomiting |
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Oral infections may predispose the patient to infection in _______ ________ _________. |
Other body organs |
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Risk factors for oral Cancer include: |
excessive alcohol intake, a diet low in fruits/vegetables, tobacco use, poor dental care, HPV. |
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Nursing Implications for Liver Biopsy |
Check bleeding studies, type and cross match blood, obtain baseline VS, Monitor VS q 15,30,1hr, obtain consent, keep on right side for minimum of 2 hrs. |
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What is the result of the break down of hemoglobin? |
bilirubin |
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The overall goals of the patient with carcinoma of the oral cavity are: |
patent airway, be able to communicate, adequate nutrition intake to promote wound healing, and pain relief. |
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Amylase is secreted from the ______. |
pancreas
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High levels of Amylase may indicate: |
Pancreatitis, perforated bowel, duodenum obstruction
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Low level of Amylase may indicate: |
Hepatitis, cirrhosis |
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Used to analyze gastric contents for acidity and volume. |
Gastric Analysis |
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Involves partial or total removal of the stomach. |
Gastrectomy |
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_______ is a syndrome, not a disease, in which there are chronic symptoms or mucosal damage resulting from reflux of gastric contents into the lower esophagus. |
Gastrointestinal Reflux disease (GERD) |
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What are the two most common symptoms for GERD? |
Heartburn and dyspepsia(indigestion) |
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A complication of GERD is ________ _________, which is considered a precancerous lesion that increases the patients risk for esophageal cancer. |
Barret's esophagus (esophageal metaplasia) |
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Patient Teaching for GERD: |
Avoid factors that cause acid reflux, elevate the head of the bed 6 to 8 inches, losing weight (if needed), avoid tobacco, and stress management. |
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Surgical procedure where the pyloric valve is cut and resected is called _____________. |
Pyloroplasty |
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Surgical cutting of the vagus nerve is called__________. |
Vagotomy |
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Higher amounts of stomach acid can lead to ________. |
Ulcers |
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Patient Prep for Vagotomy |
Placed on fluid diet for 24 hours and then on NPO after midnight prior to procedure. Bowel preps are done to cleanse the intestine. |
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Uncomfortable feeling caused by the rapid passing of food from the stomach to the small intestine. |
Dumping syndrome
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Nursing Care for Vagotomy |
NG tube in place for several days (until bowel sounds and flatus) Oral intake is started slowly, increased to 6 small meals daily. Fluid is given between meals to prevent bloating. Mx surgical sites. Turn, cough, deep breath VS |
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After a Vagotomy, if an NG tube becomes displaced, what do you do? |
Leave it or take it out. DO NOT replace it as it might puncture through the stiches in the stomach. |
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Complications of a Vagotomy include: |
Hemorrhage, Gastric dilation, Dumping syndrome, Impaired absorption of B12, iron, and calcium, Nutritional deficiency. |
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A herniation of a portion of the stomach into the esophagus through an opening in the diaphragm is called _____ ______. |
Hiatal Hernia |
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Complications of Hiatal Hernia include: |
GERD, esophagitis, hemorrhage, stenosis, ulcerations of the herniated part of the stomach, strangulation of the hernia, and regurgitation with tracheal aspiration. |
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Dilated veins in the lower esophagus are called ________ ________. |
Esophageal varices |
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The inflammation of the gastric mucosa, occurs as the result of a breakdown in the normal gastric mucosal barrier. |
Gastritis |
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Symptoms of Acute Gastritis include: |
anorexia, nausea, and vomiting, epigastric tenderness, and a feeling of fullness. |
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Treatment of Acute Gastritis is ________. |
Supportive and similar to that of nausea and vomiting . |
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The treatment of Chronic Gastritis focuses on ______. |
Evaluating and eliminating the specific cause (alcohol, drugs, H. pylori.) |
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Symptoms of Malabsorption Syndrome include: |
Anemia Diarrhea Steatorrhea (Fat) Edema Weight Loss Muscle cramping Irregular heart rhythms Clotting disorders |
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Factors causing GERD |
Hiatal Hernia Incompetent LES Decreased esophageal clearance Decreased gastric emptying Body weight Foods and Medications
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Manifestations of GERD |
Heartburn, Regurgitation, Flatulence, Eructation (belching), chronic cough, chest pain, dysphagia. |
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Complications of GERD |
Esopagitis Esophageal strictures Barret's esophagus Aspiration Pneumonia Asthma or chronic bronchitis Dental Erosion
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Treatment of GERD includes: |
Avoid irritating factors Small frequent meals Avoid late evening meals/snacks Take fluids b/t meals Weight loss, Drug therapy, Surgery.
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Drug Treatment of GERD: |
Antacids (Tums), Proton Pump inhibitors (omeprazole), H2 Blockers (rantidine), Anti-ulcer Agents (sucralfate), and Prokinetics (Reglan) |
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Inflammation of the esophagus. |
Esophagitis |
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Precancerous lesion caused by frequent exposure of the esophageal epithelium to gastric contents is called _______ ________. |
Barrett's esophagus |
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Diagnosis of GERD will include: |
Assessment Upper GI with biopsy and cytologic analysis Barium swallow Motility studies pH monitoring Medicinal trials |
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How do Antacids works to help GERD? |
Neutralize the hydrochloric acid (short term) Taken 1-3 hours after meals and at bedtime |
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How do Proton Pump Inhibitors work to help GERD? |
Decrease stomach acid secretions. |
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A condition characterized by erosion of the GI mucosa from the digestive action of hydrochloric acid and pepsin. |
Peptic Ulcer Disease (PUD) |
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Three major complications of PUD are: |
Hemorrhage, perforation, and gastric outlet obstruction. |
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Treatment of PUD includes: |
adequate rest, dietary modications, drug therapy, elimination of smoking, and long-term follow-up care. |
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Surgical procedures for Peptic Ulcer Disease include: |
Partial gastrectomy, vagotomy, and/or pyloroplasty. |
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Surgical Treatment for GERD |
Nissen fundoplication Stretta device
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The fundus is wrapped around the LES, this procedure is called _________ ________. |
Nissen Fundoplication
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Endoscope into the stomach, emits radio frequency waves directed at the LES, this increases collagen growth and strengthens the LES. |
Stretta Device |
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When assessing the abdominal area after pateitn complains of pain, what do you do? |
Visualize, Auscultate, Palpate
Always Listen before touching! |
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A birth defect in which there is an abnormal opening in the diaphragm . |
Diaphramatic Hernia |
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Another term for Hiatal Hernia is: |
Esophageal Hernia |
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Complications of Hiatal Hernias: |
Esophagitis Esophageal ulceration Hemorrhage Peritonitis Aspiration
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Manifestations of Hiatal Hernia: |
Heartburn, Regurgitation, Chest pain, Dysphagia, Belching, Feeling of fullness, Dyspnea after eating. |
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Diagnosis of a Hiatal Hernia will include: |
Assessment (H&P) Barium Swallow Endoscopy and biopsy Esophageal motility studies |
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Treatments of Hiatal Hernia will include: |
Lifestyle changes Medications (symptomatic) Patient Education |
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Nursing Interventions for a Patient with Hiatal Hernia: |
Mx for s/s of perforation (falling BP, tachycardia, sudden chest pain, shock) Administer meds ordered and monitor for response Pt. Education Reduce pressure (sleep at 30*)
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The Acute ______ is associated with superficial erosion and minimal inflammation. |
Ulcer |
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A _______ Ulcer is one of ling duration, eroding though the muscular wall with the formation of fibrous tissue. |
Chronic |
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Gastic ulcers are more common in |
women
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Duodenal ulcers are more common in |
men |
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Causes of Peptic Ulcers include:
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H. Pylori Aspirin Arthritis Medicine (NSAIDs) Benign Pancreatic Tumor secretions Diet (Tea, cola) |
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Name four diseases that stimulate gastric acid secretions, and erode the mucosa and contribute to ulcers. |
Pancreatitis
Hepatic Disease
Crohn's Disease
Gastritis |
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Factors for Peptic Ulcers |
Alcohol use Smoking Stress Trauma Aging |
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Manifestations of Peptic Ulcer |
*Pain occurs after eating*
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_____ _____ probably begins with a nonspecific mucosal injury as a result of infection (H. pylori), autoimmune-related inflammation, or repeated exposure to irritants. |
Stomach cancer |
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Treatment of Ulcers |
Eliminate irritants Rest Pain relief Eliminate infection Heal of ulceration (3-10wks) Preventing reoccurrence Nutrition/Diet Changes Medications (PPI, Antibiotic)
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Manifestations of Stomach Cancer |
Weight loss Lack of appetite Abdominal pain Indigestion Symptom related to anemia |
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Treatment of Stomach Cancer |
Depends on the location of the tumor and stage at time of diagnosis: Surgical options with chemotherapy and radiation.
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Nursing Interventions of Stomach Cancer |
Minimize their discomfort Achieve optimal nutrition Maintain a degree of well-being appropriate to disease stage. |
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A nonspecific term that describes acute GI symptoms such as nausea, vomiting, diarrhea, and cramping caused by the intake of contaminated food or drink. |
Foodborne Illness (food Poisoning) |
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The organism most commonly associated with foodborne illness is ______________. |
Escherichia Coli (E-Coli) |
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Manifestations of E-Coli: |
Diarrhea, and abdominal cramping
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_________ affects body composition and functional status.
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Malnutrition |
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Manifestations of Malnutrition include: |
Range from mild (excessively dry skin, rashes, hair loss) to emaciation and death. |
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Self-imposed weight loss, endocrine dysfunction, and a distorted psychopathologic attitude toward weight and eating. |
Anorexia nervosa |
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Disorder characterized by frequent binge eating and self-induced vomiting associated with loss of control related to eating and a persistent concern with body image. |
Bulimia Nervosa |
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Passage of at least 3 loose stools per day |
Diarrhea |
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Acute Abdominal Pain is |
A new pain that may require immediate surgery or other medical treatment.
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Common causes of Chronic abdominal pain are |
Irritable bowel syndrome (IBS) Diverticulitis. peptic ulcer disease, chronic pancreatitis, hepatitis, PID, and vascular insufficiency. |
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_____ ______ ______ commonly occurs with motor vechile accidents and falls and may not be obvious since it doesn't leave an open wound. |
Blunt abdominal trauma |
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_______ ______ occurs with gunshot or knife wounds. |
Penetrating trauma |
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Emergency management of abdominal trauma: |
Establishing a patent airway Adequate breathing Fluid replacement Prevention of shock
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Normal Range for Albumin |
3.4-5.4g/dl |
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Albumin less than 3.4 can indicate: |
Hepatitis, cirrhosis, liver cell death, malabsorption syndrome, malnutrition. |
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Normal Range for ALT Alanine Transminase |
5-36 U/L |
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Normal Range for AST Aspartate Aminotransferase |
10 - 34 IU/L
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AST above 34 IU/L indicates: |
Liver disease, acute pancreatitis |
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ALT above 36 U/L indicates |
Obstructed jaundice, biliary obstruction, hepatitis, infectious mononucleosis, pancreatitis, liver cancer.
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Normal Range of Bilirubin for Adults and Infants |
0.2-1.0 mg/dl (Adults) 1.5-12.0 mg/dl (infants) |
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Normal Range for ALP Alkaline Phosphatase |
30-120 U/L |
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ALP above 120 U/L may indicate: |
Liver disease, acute pancreatitis |
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Normal Range for Amylase: |
70-200 U/L
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Amylase above 200 U/L indicates: |
Pancreatitis. perforated bowel. duodenal obstruction. |
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Normal Range for Lipase: |
7-58 U/L |
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Lipase above 58 U/L may indicate: |
Pancreatitis, cirrhosis of the liver
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How many types of Hepatitis are there? |
5 types (A, B, C, D, and E) |
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The pancreas is both an _______ gland and ________ gland. |
Exocrine & Endocrine |
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Two main hormones that are produced by the pancreas are _________ & __________. |
Insulin & Glucagon |
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Insulin and glucose play an important role in regulation of glucose homeostasis specifically the _______, _________,and _______ of glucose by the body. |
Use, mobilization, and Storage |
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___________ is one of the primary sources of energy for the cells of the body. |
Glucose |
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The simplest form of Carbohydrates found in they body is also known as _________? |
Dextrose |
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Hepatitis B Info |
Mode of Transmission: percutaneous, secretions (mucosal, blood), Sexual activity with infected person. Acute- may become Chronic S/S: Flu-like, dark urine, light stools, jaundice, fever, fatigue. |
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Hepatitis C Info |
Mode of transmission: percutaneous or mucosal, exposure to blood or blood products. Not easily spread through sexual contact. Chronic S/S: None to flu-like, jaundice |
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Hepatitis D Info: |
Only occurs in conjunction with Hep B. Sources: blood, blood products, needles, sexual contact. Chronic S/S: may increase severity of Hep B symptoms (flu-like, dark urine, light stools, fatigue and fever) |
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Hepatitis E Info: |
Rare in the U.S Mode of transmission: Oral-fecal *Associated with contaminated water* Acute |
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Hepatitis A Info: |
Mode of transmission: Oral-fecal Acute S/S: flu-like, jaundice
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_________ is primarily a disorder of carbohydrate metabolism that involves either a deficiency of insulin, a resistance of tissue (e.g., muscle, liver) to insulin, or both. |
Diabetes Mellitus |
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_________ __________diabetes insulin dependent. |
Type one or juvenile-onset |
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______ ________ diabetes non-insulin dependent. |
Type two or adult-onset |
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X-ray in which a contrast medium is injected intravenously to outline the hepatic, cystic and common bile ducts is called a _____________. |
Cholangiogram |
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______ function should be checked before a Cholangiogram is performed. |
Liver |
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The procedure where a tube is placed into the common bile duct, either during surgery or post surgery, to drain fluid is called ________________. |
T-tube Cholangiogram |
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Endoscope is inserted through the mouth to the duodenum, then into the common bile duct. Allows for direct visualization of the structures. |
(ERCP) Endoscopic retrograde Cholangiogram |
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A major complication of G.I. endoscopy is _________. |
Perforation |
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Monitor temp every 15-20 min after endoscopy because fever is a sign of ___________. |
Perforation |
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Direct visualization of the stomach is called? |
Gastroscopy |
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Direct visualization of the esophagus, stomach and the beginning of the duodenum is called? |
Esophogastroduodenoscopy |
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Insertion of a needle between the sixth and seventh or eighth and ninth intercostal on the right side while the patient lies supine with right arm above the head is what type of Liver biopsy? |
Closed liver biopsy. |
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What type of liver biopsy is performed in the OR where an incision is made to remove a wedge of tissue? |
Open liver biopsy |
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Nursing implications for a liver biopsy include: |
Check coagulation studies, Type and crossmatch the blood, obtain baseline vital signs, informed consent, post procedure vital signs every 15 x 2, every 30 x 4, and every hour x4, placed patient on right side for a minimum of two hours to allow pressure to be kept on-site. |
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Partial Gastroectomy: Bilroth 1 attaches the esophagus to the __________. |
duodenum. |
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Partial gastrectomy: Bilroth 2 connects the esophagus to the __________. |
Jejunum |
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Pyloroplasty is used for ___________ and ___________ disease. |
Gastric and peptic ulcer disease. |
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The purpose of a vagotomy is to reduce _________ ______ secretion. |
Stomach acid |
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S/S of Malnutrition: |
Fatigue, irritability and lethargy |
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The impaired absorption of nutrients from the G.I. tract is called? |
Malabsorption syndrome |
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Causes of malabsorption syndrome include: |
Enzyme deficiency from diseases of the pancreas, gallbladder, or liver, inflammation, infection, trauma or injury, reduced stomach or bowel surface, bacterial proliferation, use of antibiotics, |
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Risk factors for Malabsorption syndrome include: |
Family history, use of certain drugs like laxatives/mineral oil, foreign travel, intestinal surgery, excessive alcohol consumption, cystic fibrosis. |
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S/S of malabsorption syndrome: |
Anemia, weakness, fatigue, diarrhea, steatorrhea, edema, Weight loss, muscle cramping, bloating and gas, irregular heart rhythm or clotting disorders. |
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The regurgitation of stomach acid, gastric and other contents into the esophagus resulting in esophageal irritation and inflammation is called? |
GERD |
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Inflammation of the esophagus is called? |
Esophagitis |
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Factors causing GERD include: |
Hiatal hernia, incompetent lower esophageal sphincter, decreased esophageal Clearance, decreased gastric emptying,bodyweight, food and medications. |
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Manifestations of GERD include: |
Heartburn, regurgitation, flatulence and belching, dysphagia, odynophagia, chronic cough, and chest pain. |
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A pre-cancerous lesion causes by frequent exposure of the esophageal epithelium to gastric contents is called? |
Barrett's Esophagus. |
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S/S of Barrett's Esophagus: |
None at all to bleeding and perforation, and bronchospasm. |
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Postop care for surgical treatments of Gerd include: |
Monitor abdominal incision, monitor for respiratory complications, IV fluids, NG patency, Monitor for return of bowel sounds, monitor I&O and lab. |
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Sliding hiatal hernia manifestations include: |
Heartburn, regurgitation, chest pain, dysphagia and belching. |
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Rolling hernia manifestations include: |
Feeling a fullness after eating, breathlessness after eating, feeling of suffocation, chest pain that mimics angina, **worsening of signs and symptoms in a recumbent position** |
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Inflammation of the pancreas that occurs in acute and chronic forms and may stem from edema, necrosis, or hemorrhage. |
Pancreatitis |
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Causes of Acute Pancreatitis |
Alcohol Gallstones Trauma Viral infections (mumps, HIV) Medications |
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Causes of Chronic Pancreatitis |
Alcoholism Blocked or narrowed duct because of trauma or pseudocyts have formed heredity unknown cause (idiopathic)
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Manifestations of Acute Pancreatitis: |
Intense LUQ or mid-epigastric pain, radiating to the back, left flank, or left shoulder Weight Loss Nausea Vomiting Altered VS Cullen's & Turner's signs |
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Manifestations of Chronic Pancreatitis: |
Intense abdominal pain Ascites Mass in the LUQ Respiratory Steatorrhea Weight Loss Jaundice Dark Urine Polyuria, polydipsia, polyphagia |
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Serum _____ and ______ levels are elevated, which is the diagnostic hallmark that confirm acute pancreatitis. |
Amylase and Lipase |
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_________ and ______ X-rays will differentiate pancreatitis from other diseases that cause similar symptoms and detect pleural effusions. |
Abdominal and Chest |
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Nursing Interventions for Pancreatitis: |
Pain control Maintain NG tube Restrict activity Positioning Assess Pulmonary status Monitor Fluids and labwork I&O Daily weight IV fluids Monitor Blood Sugars Emotional Support Diet will be high in carbs, low protein, low fat. |
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The fourth most lethal of all carcinomas. The prognosis is poor; most patients die within 1 years of diagnosis. |
Pancreatic Cancer |
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Pancreatic Cancer is most common in __________. |
Male African Americans |
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Factors involved with Pancreatic Cancer include: |
Cigarette Smoke Excessive fat and protein Food additives Industrial Chemicals Chronic Pancreatitis Diabetes Mellitus Chronic Alcohol Abuse |
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Manifestations of Pancreatic Cancer include: |
Dull, intermittent epigastric pain Anorexia Nausea & Vomiting Rapid weight loss Jaundice A palpable, well defined mass |
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Complications of Pancreatic Cancer |
Malabsorption of nutrients Insulin dependent diabetes Liver and GI problems Mental status changes Death |
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Nursing Interventions for a patient with Pancreatic Cancer:
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Monitor Fluid balance Abdominal girth Serve small frequent meals Administer meds as ordered Watch for complications from surgery Mx for infections Ensure rest & sleep ROM and isometric exercises Mx Blood glucose levels Keep skin clean and dry Pain control
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A condition in which the gall bladder becomes acutely or chronically inflamed, usually because a gallstone becomes lodged in the cystic duct, causing painful gallbladder distention is called _______? |
Cholecystitis |
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Factors of Cholecystitis include: |
Family history People who eat a high-fat diet Obese people Anyone older than 60 Diabetics People who lost weight quickly. |
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Manifestations of Cholecystitis: |
Upper abdominal pain; may radiate Anorexia N/V Dyspepsia Belching Flatulence Abdominal fullness Rebound fullness (Murphy's & Blumberg's sign) Fever Jaundice |
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Symptoms off Chronic Cholecystitis usually occur after a meal containing ______ and _____ foods. |
Fried and Fatty |
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True or False: As you age, your risk of Cholecystitis increases. |
True
(60 and over) |
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The four F's that put you most at risk for Cholecystitis are: |
Female
Fat
Forty
Fertile
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Treatment of Cholecystitis include: |
Surgery: open or laparoscopic cholecystectomy (with/without an intraoperative cholangiogram)
Lithrotripsy (ultrasonic waves break up stones)
Low Fat Diet
Medications:narcotics, antispasmotics, antiemtics, antibiotics
NG tube, low intermittent low pressure suction
IV fluids |
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Complications Of Cholecystitis: |
Empyema (Pus) Gangrene Perforation Peritonitis Fistula formation Pancreatitis |
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Stones in the gallbladder is called ___________. |
Cholelithiasis |
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Nursing Interventions for Cholelithiasis and Cholecystitis |
Provide low fat diet, frequent meals Replace Vitamins (A, D, E, K) Pain control I&O VS After surgery: watch for bleeding Mx color of the drainage (should be serosanguinous for 24-28 hours) |
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A Chronic liver disease characterized by widespread destruction and scarring of the hepatic cells is called? |
Cirrhosis |
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Common causes of Cirrhosis: |
Alcoholism Hepatitis (C in US and D, E in other areas of the world) Toxins Infection |
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Effects of Advanced Cirrhosis: |
Confusion Edema Infections Nausea Impaired absorption Rectal Varices Increased bruising Fatigue Jaundice |
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Major complications of Cirrhosis include? |
Portal hypertension Esophageal and Gastric bleeding Peripheral edema Ascites Hepatic encephalopathy Hepatorenal syndrome |
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Hyperbilirubinemia means? |
excessive bilirubin in the blood |
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The Adrenal Medulla secretes these three hormones _____ (the major hormone), ________, and _______. |
Epinephrine, Norepinephrine and dopamine |
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The examination of the stomach contents to determine pH and the amount of acid present is called ______ ______. |
Gastric Analysis |
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The organism ___ _______ is found in the majority of people with Peptic Ulcer Disease. |
H. Pylori. |
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_______ _________ is considered a terminal complication in liver disease, characterized by asterixis (flapping tremors). |
Hepatic Encephalopathy |
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A chemical substance synthesized and secreted by a specific organ or tissue is called a __________. |
Hormone |
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Main conductor of both the Endocrine and Autonomic nervous system is the ___________. |
Hypothalamus |
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The _________ releases hormones produced in the hypothalamus when stimulated by either a neural or hormonal pathway. |
Pituitary |
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The hormones produced by the Anterior Pituitary gland (Tropic hormones) are: |
Growth Hormone (somatropin) Thyroid-Stimulating (Thyrotropin) Adrenocorticotropic Hormone (ACTH) Gonadotropic Hormones: Lutenizing (LH) and Follicle-stimulating (FSH) Melanocyte-stimulating hormone (MSH) Prolactin
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The hormones produced by the Posterior Pituitary gland include: |
Oxytocin Antidiuretic Hormone (ADH)-(vasopressin) |
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The over production of hormones is called _________. |
Hyperpituitarism |
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Causes of hyperpituitarism include: |
Tumors, hyperplasia, radiation, head trauma, stroke, brain surgery, infections. |
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Prolactin produces _____. |
milk |
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_________ is rare and involves a decrease in one or more of the tropic hormones (Ant. pituitary). |
Hypopituitarism |
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Most deficiencies with hypopituitariam are due to a pituitary tumor, most often a _________. |
Adenoma |
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The thyroid gland, which is regulated by Thyroid-stimulating hormone, produces _______, _______, and __________. |
Thyroxine (T3) Triiodothyronine (T4) Calcitonin
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________ is responsible for calcium levels in bone, inhibits calcium loss from bone, regulates amount of calcium and phosphorus excreted by Kidneys. |
Calcitonin |
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The enlargement of the thyroid gland, not caused by inflammation or malignancy is called______. |
Goiter |
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The most common cause of goiter worldwide is from a lack of ______ in the diet. |
Iodine |
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___________ involves increased secretion of parathyroid hormone (PTH) that leads to hypercalcemia and hypophosphatemia. |
Hyperparathyroidism |
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Manifestations of Hyperparathroidism include: |
Muscle weakness Loss of appetite Constipation Emotional disorders Shortened Attention Span Osteoporosis Fractures Kidney Stones |
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The most effective treatment of hyperparathyroidism is __________. |
Parathyroidectomy |
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Non-surgical treatment of hyperparathyroidism includes: |
Increased fluid intake Moderate Calcium intake Drugs that lower calcium levels: bisphosphonates, estrogen, oral phosphates, diuretics and calcimimetics |
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Increases in Phosphorus will result in decreases in _______ absorption. |
Calcium |
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Calcium provides electrical energy for the _______ and _______ systems and provides strength to the skeletal system. |
Nervous and Muscular |
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**The ______ gland is associated with the Circadian Rhythm. |
Pineal |
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________ is a deficiency of thyroid hormone (T3 and T4) that causes a general slowing of the metabolic rate. May be primary (destruction of tissue, defective hormone synthesis) or Secondary (pituitary disease or hypothalamic dysfunction). |
Hypothyroidism |
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Cause of Hypothyroidism include: |
Iodine deficiency (most common)
Thyroid gland atrophy Hashimoto's thyroidistis Grave's Disease Discontinuance of thyroid hormone therapy. |
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**Treatment of Hypothyroidism |
levothyroxine (Synthoid) is the drug of choice. Goal is restoration of euthriod state as safely and rapidly as possible with Hormone Replacement Therapy. |
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One stomach condition requiring drug therapy is__________, or excessive acid production. |
Hyperacidity |
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Left untreated, ____________ can lead to serious conditions such as acid reflux, ulcer disease, esophageal damage, and even esophageal cancer. |
Hyperacidity |
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Name six substances secreted by the stomach. |
1. Hydrochloric Acid 2. Pepsinogen 3. Mucus 4. Bicarbonate 5. Intrinsic Factor 6. Prostaglaglandins |
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Gastric Glands are highly specialized secretory glands composed of what cells?(5 Kinds) |
1. parietal 2. chief 3. mucous 4. endocrine 5. enterochromaffin |
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Parietal Cells produce and secrete _____________ _______ and are the primary site of the many drugs used to treat acid-related disorders. |
Hydrochloric Acid (HCl) |
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Chief Cells secrete ____________, that is a proenzyme that becomes pepsin when activated by exposure to acid. |
Pepsinogen |
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Mucous cells or mucus secreting cells are also called_______________?
|
Surface epithelial cells
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When the balance of the gastric gland cells and secretions are impaired ____________disease can occur?
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Acid-related
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The most harmful of the acid related diseases involve hypersecretion of acid and include __________ ___________ disease and _____________ __________.
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peptic ulcer
esophageal cancer |
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Several substances stimulate hydrochloric acid secretion by the parietal cells, examples are?
|
Such as foods, caffeine, chocolate, and alcohol. (In moderation any of these is usually not problematic.)
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___________ is a general term for gastric or duodenal ulcers that involves digestion of the GI mucosa by the enzyme pepsin?
|
Peptic ulcer disease
(PUD) |
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___ _____is found in the GI tract of roughly 90% of patients with duodenal ulcers and 70% of those with gastric ulcers?
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H. Pylori
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________ _______ ____________ is used in almost all patients in intensive care units and some on general medical surgical units? (Causes mucosal damage)
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Stress Ulcer Prophylaxis |
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Type _____ DM is characterized by lack of insulin production or by the production of defective insulin. |
ONE |
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Type _____ DM accounts for at least 90% of all cases of diabetes mellitus. |
TWO |
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_________ _________ is a type of hyperglycemia that occurs in about 2% to 10% of pregnancies. |
Gestational Diabetes |
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Patients diagnosed with type 1 DM will _________ require insulin therapy. |
Always |
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The first step in treatment for patients with Type 2 DM would be? |
Lifestyle changes (diet and exercise) |
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The major classes of drugs used to treat DM are the _________ and the oral ________________ drugs. |
Insulins and antidiabetic |
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__________ insulin functions as a substitute for the ___________ hormone. |
Exogenous
Endogenous |
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Fluoroscopic x-ray examination of colon using a contrast medium, which is administered rectally is called a ______ _______. |
Barium Enema |
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Nursing Interventions Before Barium Enema: |
Bowel Prep Clear liquid diet evening before NPO eight hours prior to procedure Educate that cramping may occur Educate that pt may be placed in various positions on table. |
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Nursing Interventions After Barium Enema: |
Give fluids, laxatives and mx for passage of contrast medium. |
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Pineal Gland is responsible for the hormone ______. |
melatonin |
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Systemic effects of hypothyroid: |
Decreased CO2 Poor circulation Heart Failure Intestinal Obstruction Impaired memory Slurred speech Depression Insomnia Anemia Cold intolerance Dry Skin Weight Gain |
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A medical emergency of hypothyroidism is a __________ coma. |
Myxedema |
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S/S of Myxedema: |
Low body temp Mental changes Systemic edema Dyspnea Cardiac s/s ileus
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Treatment of Myxedema Coma: |
Thyroid replacement IVF Respiratory and Cardiovascular support Temperature support (no hot blankets) |
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True or False: When insulin pumps are used they are constantly administering insulin 24 hours a day? |
TRUE |
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True or False: If a patient is on an Insulin pump, they are allowed to give bolus injections based on the amount of food ingested? |
TRUE |
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Hypoglycemia resulting from excessive insulin dosing can result in? *** |
1. Brain damage 2. Shock 3. Possibly death |
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The most immediate and serious adverse effect of insulin is? |
Hypoglycemia |
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Two special patient populations for whom careful attention is required during insulin therapy are ____________ & ___________. |
Pediatric patients and Pregnant women |
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What are the four major classes of insulin? |
1. Rapid-acting 2. Short-acting 3. Intermediate-acting 4. Long-acting |
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True or False: The duration of action ranges from several hours to over 24 hours depending on the insulin class. |
TRUE |
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_______ _____ is a clinical condition that results from chronic exposure to excess corticosteroids, particularly glucocorticoids. |
Cushing's Syndrome
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Endocrine glands are also called _________ glands. |
Ductless |
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Endocrine glands responsibility is to maintain _____________. |
Homeostasis
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_____ pathways have a direct link between the hypothalamus and the pituitary gland. |
Neural |
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_______ pathways: Hypothalamic control of pituitary through hormones of its own. |
Hormonal |
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The onset of the over production of the Growth Hormone in children is called ___________. |
Gigantism |
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The onset of the over production of the Growth Hormone in Adults, which causes a thickening of the bones and facial changes, is called ___________. |
Acromegaly |
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Disorder characterized by elevated levels of calcium and low levels of phosphorus is called _____________. |
Hyperparathyroid |
S/S: hypercalcemia and hypophosphatemia |
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Disorder characterized by low level of calcium and an elevated level of phosphorus is called _______________. |
Hypoparathyroid |
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Cullen's Sign, a blue-black bruising of the area around the umbilicus, is present in what disease processes? |
Acute Pancreatitis Ruptured Duodenum Ulcer |
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S/S of Ketoacidosis include: |
Deep, rapid breathing Decreased Alertness Headache Flushed face Fruity-smelling breath N/V Dry skin and mouth Muscle stiffness Stomach pain |
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***When the body cannot use sugar as a fuel source, due to lack of insulin or inability to use insulin properly, it will use fat, when fat is broken down it produces ketones that build up in the blood and urine, this is called _______________. |
Ketoacidosis |
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***A severe complication of DM 2, involving extremely high glucose levels without the presence of ketones is called ____________ ______________. |
Hyperosmolar hyperglycemia |
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***A hypofunction of the Adrenal Cortex causing a lack of corticosteroids is called __________ disease. |
Addison's |
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S/S of Addison's Disease include: |
Fatigue Arthralgia (joint pain) Weight Loss N/V Diarrhea Hypotension Skin changes Hypoglycemia Mental changes |
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***Dx of Addison's Disease is done using a _____ stimulation test. |
ACTH |
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***Tx of Addison'd Disease involves ______________ and __________________ replacements, increase in salt intake. |
Glucocorticoid
Mineralcorticoid |
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Dx of Cushing's Syndrome include a ___________collection, blood tests of cortisol and _______ levels. |
24 hour urine
ACTH |
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S/S of Cushing's Syndrome include: |
Moon face trunk weight gain bruising diabetes osteoporosis striae |
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Tx of Cushing's Syndrome include: |
Discontinue medication
Tumor removal |
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__________ ___ provides an average of your blood sugar control over the past two to three months and is used along with home finger stick monitoring. |
Hgb A1C |
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***Rapid Acting Insulin include ______ and ______ and its peak time is __ to __ hours. |
Lispro and Aspart
1 to 1.5 hours |
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***Short acting Insulin called _______, and its peak is ___ to ___ hours. |
Regular
2 to 3 hours |
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***Intermidate Insulin include ____ or Lente and has a peak time of ___ to ____ hours. |
NPH
4 to 10 hours |
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***Long acting insulin include Ultralente and ___________ and its peak is __ to __. |
Glargine
N/A |
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The most common endocrine disease: |
Diabetes. |
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