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Ch 39
GI Dysfunction
175
Science
Graduate
04/09/2012

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Cards

Term
What are the 5 clinical manifestations of GI dysfunction?
Definition
  • Anorexia
  • Nausea
  • Vomiting
  • Retching
  • Projectile vomiting 
Term
What is anorexia?
Definition
No desire to eat despite physiologic stimuli that would normally produce hunger 
Term
What is nausea?
Definition
A subjective experience 
Term
What is vomiting? 
Definition
  • Foreful emptying of stomach and intestinal contents through mouth 
  • Several types of stimuli initiate the vomiting reflex 
Term
What is retching?
Definition
Non productive vomiting 
Term
What is projectilie vomiting? 
Definition
  • Spontaneous vomiting 
  • It does NOT follow nausea or retching 
Term
What is constipation defined as? 
Definition
Infrequent of difficult defecation 
Term
What are some characteristics of constipation?
Definition
  • Decrease in number of bowel movements/week
  • Hard stools
  • Difficult evacuation 
Term
What can constipation be caused by? 
Definition

Neurogenic disorders
Functional or mechanical conditions
Low-residue diet – what does this mean? Low fiber
Sedentary lifestyle
Excessive use of antacids – why? Decreases motilit
Specific medications – colace

Term
What does a low residue diet mean? 
Definition
  • A diet low in fiber foods or foods that cause bowel movements like cheese of prune juice
Term
How does excessive use of antacids cause constipation? 
Definition
Antacids decrease motility of the bowels
Term
What are some examples of medications that cause constipation?
Definition
  • Colace 
Term
What type of diet helps manage constipation? 
Definition
High fiber or bulk forming diet 
Term
What characteristics classify diarrhea? 
Definition
3 of more bowel movements per day 
Term
What are some things the nurse should notice about diarrhea? 
Definition
  • Volume
  • Fluidity 
  • Weight
Term
How could diarrhea be protective?
Definition
It expels pathogens quickly so they don't harm the rest of the body 
Term
What are the 3 types of diarrhea? 
Definition
  • Osmotic - water 
  • Secretory - mucosal 
  • Motility - blockage 
Term
Diarrhea can lead to what?
Definition
  • Dehydration
  • Electrolyte imbalance
  • Metabolic acidosis
  • Weight loss
  • Acute bacterial or viral infection
  • Inflammatory bowel disease
  • Malabsorption syndromes 
Term
What patient age groups are more susceptible to diarrhea? 
Definition
  • Elderly
  • Infants 
Term
What is the BRAT diet? 
Definition
  • Bananas
  • Apply sauce
  • Rice
  • Toast 
Term
If a patient is on coumadin and they have diarrhea what should you pay attention to? 
Definition
INR 
Term
What is the major symptom of several GI disorders?
Definition
Abdominal pain 
Term
What are some characteristics of abdominal pain?
Definition
  • Acute or chronic
  • Generalized or local
  • Sharp
  • Dull
  • Colicky 
Term
What are 3 types of pain? 
Definition
  • Parietal
  • Visceral
  • Referred 
Term
What are the characteristics of parietal pain? 
Definition
  • Somatic pain
  • Localized 
  • Intense 
Term
What are the characteristics of visceral pain?
Definition
  • Poorly localized
  • Dull
  • Distension
  • Inflammation 
  • Ischemia 
Term
Where would an upper GI bleed occur? 
Definition
  • Esophagus
  • Stomach
  • Duodenum 
Term
What is an upper GI bleed causes by? 
Definition
Eeophageal varicies 
Term
What color is the blood if the pt is experiencing an upper GI bleed?
Definition
More red 
Term
Where would a lower GI bleed occur? 
Definition
  • Below the ligament of Treitz
  • Jejunum
  • Ileum
  • Colon
  • Rectum 
Term
What color will the blood be in a lower GI bleed? 
Definition
More black color 
Term
What kind of patients experience a lot of GI bleeds?
Definition
Alcoholics 
Term
What is hematemesis? 
Definition
Bloody vomit 
Term
What is hematochezia? 
Definition
Bright red blood that is passed through the rectum 
Term
What is melena? 
Definition
Dark tarry stool
Term
What is occult bleeding? 
Definition
Caused by slow chronic blood loss that is NOT obvious and results in iron deficiency anemia 
Term
What is dysphagia?
Definition
Difficulty swallowing? 
Term
2 types of dysphagia?
Definition
  • Mechanical
  • Functional 
Term
What are some examples of pts that have an inability to swallow? 
Definition
  • Stroke
  • Parkinson's 
  • Myesthena Gravis 
Term
What is GERD? 
Definition
Back flow or reflux of gastric and duodenal content into the esophagus
Term
What are some causes of GERD? 
Definition
  • Incompetent esophageal sphincter
  • Pyloric stenosis
  • Motility disorder
Term
What maintains the high pressure zone and prevents reflux? 
Definition
Lower esophageal sphincter 
Term
What is GERD that causes inflammation of the esophagus? 
Definition
Eosinophilic Exophagitis 
Term
What common conditions are associated with GERD? 
Definition
  • Obesity 
  • Sleep apnea 
Term
GERD develops from what? 
Definition
Any condition that increases abdominal pressure 
Term
What are clinical manifestations of GRED? 
Definition
  • Heartburn
  • Regurgitation of chyme
  • Upper abdominal pain within 1 hour of eating
  • Difficulty swallowing 
Term
What is a hiatial hernia? 
Definition
When a portion of the stomach herniates through the diaphragm 
Term
Hiatial Hernia is AKA? 
Definition
  • Esophageal Hernia
  • Diphragmatic Hernia 
Term
What are complications of a Hiatal Hernia? 
Definition
  • Heartburn 
  • Feelings of fullness 
Term
A Pyloric Obstruction is a blockage or narrowing of what opening? 
Definition
The opening between the stomach and duodenum 
Term

True of False?

Pyloric Obstruction can be congenital or aquired 

Definition
True 
Term
What are clinical manifestations of Pyloric Obstruction? 
Definition
  • Epigastric pain
  • Fullness
  • Nausea
  • Vomiting 
Term
What happens when a pt has a pyloric obstruction and there has been prolonged obstruction? 
Definition
  • Malnutrition
  • Dehydration
  • Extreme debilitation 
Term

True or False?

An intestinal obstruction and an ileus is the same thing?

Definition
True 
Term
What is an intestinal obstruction or ileus? 
Definition
  • Any condition preventing flow of chyme through the intestinal lumen 
  • Failure of normal intestinal motility in absence of an obstructing lesion 
Term
Why does an intestinal obstruction or ileus occur after surgery sometimes?
Definition
Because we give anesthetics to put the bowel to sleep 
Term
What is the best nursing intervention to get the bowels moving again?
Definition
Have the pt get up and walk! 
Term
What is a nursing indication that the bowels are moving again?
Definition
Bowel sounds 
Term
What are the clinical manifestations of an intestinal obstruction or ileus?
Definition
  • Colicky pain
  • Vomiting
  • Distention
  • Hypovolemia
  • Metabolic acidosis 
Term
What is gastritis? 
Definition
Inflammatory disorder of gastric mucosa 
Term
What are somethings that can cause acute gastritis? 
Definition
  • H. Pylori
  • NSAIDs
  • Aspirin
  • Hot spicy foods
  • Alcohol 
Term
What causes chronic gastritis? 
Definition
  • Same as acute
  • Could also be autoimmune 
Term

True or False?

Signs and symptoms of chronic gastritis often do NOT correlate with the severity of the disease

Definition
True 
Term
What is a Peptic Ulcer? 
Definition

An ulceration in the protective mucosal lining of:

  • Lower esophagus
  • Stomach
  • Duodenum  
Term
Peptic Ulcers can be what? (4 things)
Definition
  • Acute 
  • Chronic
  • Superficial
  • Deep 
Term
What is a superficial peptic ulcer? 
Definition
An erosion 
Term
What is a deep peptic ulcer? 
Definition
A true ulcer - these damage blood vessels and cause hemorrhage 
Term
What are the risk factors of peptic ulcers?
Definition
  • Stress
  • Smoking
  • Steroids
  • Gastritis 
Term
What is the main difference between peptic ulcers and gastric ulcers? 
Definition
  • Peptic ulcers - more general occur in all different areas
  • Gastric ulcers - more specific to the stomach 
Term
What is a gastric ulcer? 
Definition
A stomach ulcer that develops in the antral region 
Term
What is the primary defect of a gastric ulcer? 
Definition
  • It involves the mucosal lining extending to the submucosal layer
  • This increases the permeability to H+ ions 
Term
What is the most common peptic ulcer?
Definition
Duodenal Ulcer 
Term
What causes Duodenal Ulcers? 
Definition
  • H. Pylori
  • Hypersecretion of stomach acid and pepsin
  • NSAIDs
  • High gastrin levels
  • Smoking
  • Caffeine 
Term
What is an acute form of a peptic ulcer?
Definition
A stress ulcer
Term
What causes a stress ulcer? 
Definition
  • Severe illness
  • Neural injury
  • Systemic trauma
Term
What are 2 types of stress ulcers that cause systemic trauma?  
Definition
  • Ischemic ulcers
  • Cushing ulcers
Term
What are cushing ulcers associated with?
Definition
Head trauma 
Term
What is Dumping Syndrome? 
Definition
Rapid emptying of gastric contents into small intestine
Term
What does dumping syndrome result from?
Definition
  • Surgically created residual stomach
  • Partial gastrectomy
  • Pyloroplasty 
Term
What does dumping syndrome cause? 
Definition
Loss of:
  • Gastric capacity
  • Emptying control
  • Feedback control
Term
What does late dumping syndrome cause? 
Definition
  • Diarrhea
  • Weight loss
  • Anemia 
Term
What is Pancreatic Insufficiency? 
Definition
A type of malabsorption syndrome 
Term
What enzymes are insufficiently produced when the  Pancreas is Insufficient? 
Definition
  • Lipase
  • Amylase
  • Trypsin
  • Chymotrypsin 
Term
What causes Pancreatic Insufficiency?
Definition
  • Pancreatitis
  • Pancreatic Carcinoma
  • Pancreatic Resection 
  • Cystic Fibrosis 
Term
What generally happens when a pt has pancreatic insufficiency? 
Definition
They have poor digestions of fats
Term
Pancreatic Insufficiency leads to what? 
Definition
  • Fatty Stools
  • Weight Loss 
Term
What is a Lactase Deficiency?
Definition
  • Type of malabsorption
  • Inability to break down lactose into monosaccharides 
Term
What is Bile Salt Deficiency?
Definition
  • A type of malabsorption syndrome
  • It results from liver diesase and bile obstructions 
Term
Conjugated bile salts are needed to? 
Definition
  • Emulsify fats 
  • Absorb fats
Term
Conjugated bile salts are synthesized from what?
Definition
Cholesterol in the liver 
Term
Poor intestinal absorption of lipids cause what? 
Definition
  • fatty stools
  • Diarrhea
  • Loss of fat soluble vitamins 
Term
What are the fat soluble vitamins? 
Definition
DEAK 
Term
A deficiency in Vitamin A causes? 
Definition
Night Blindness
Term
A deficiency in Vitamin E causes? 
Definition
Not sure
Term
A deficiency in Vitamin D causes? 
Definition
  • Decreased calcium absorption
  • Bone pain
  • Osteoporosis
  • Fractures
Term
A deficiency in Vitamin K causes? 
Definition
  • Prolonged prothrombin time
  • Purpura
  • Petechiae 
Term
What is Inflammatory Bowel Disease?
Definition
  • Chronic
  • Relapsing inflammatory bowel disorder
  • Unknown Origin 
Term
What causes Inflammatory Bowel Disease? 
Definition
  • Genetics
  • Alterations of epithelial barrier functions
  • Immune reactions to intestinal flora
  • Abnormal T cell responses
Term
What is Ulcerative Colitis?
Definition
Chronic inflammatory disease causing ulceration of colon mucosa, bleeding, and poor absorption of nutrients
Term
What are some possible causes of Ulcerative Colitis?
Definition
  • Infections
  • Immunologic
  • Dietary
  • Genetic 
Term
What are the clinical manifestations of Ulcerative Colitis?
Definition
  • Diarrhea
  • Bloody stools
  • Cramps
Term
What is the treatment of Ulcerative Colitis?
Definition
  • Broad spectrum antibiotics 
  • Steroids
  • Immunosuppressive agents
  • Surgery 
Term

True of False?

Ulcerative Colitis pt are at increases risk for colon cancer? 

Definition
True 
Term
Crohn's Disease is?
Definition
An idiopathic inflammatory disorder
Term
Crohn's is AKA?
Definition
  • Granulomatous colitis
  • Ileocolitis
  • Reginal Enteritis 
Term
Crohn's affects ...
Definition
ANY part of the digestive tract
Term
What is one of the biggest differances between Crohn's and Ulcerative Colitis?
Definition
Crohn's causes "skip lesions"
Term
In Crohn's the ulcerations can produce what? 
Definition
Longitudinal and transverse inflammatory fissures that extend into the lymphatics 
Term
Why might a pt with Crohn's be Anemic?
Definition
Bc they have a malabsorption of vitamin B12 and folic acid 
Term
What is Diverticula?
Definition
Herniations of mucosa through muscle layers of colon wall, especially sigmoid colon 
Term
What is Diverticulosis?
Definition
Asymptomatic diverticular disease
Term
What is Diverticulitis?
Definition
Inflammatory stage of diverticulosis 
Term
What is Appendicitis? 
Definition
Inflammation of appendix
Term
What are some possibly causes of appendicitis?
Definition
  • Obstruction 
  • Ischemia
  • Increases intraluminal pressure
  • Infection
  • Ulceration 
Term
What are the clinical manifestations of Appendicitis? 
Definition
  • Epigastric Pain
  • Right lower quadrant pain
  • Rebound tenderness 
  • Nausea
  • Vomiting
  • Fever
  • Leukocytosis 
Term
What is the most serious complication of Appendicitis?
Definition
Peritonitis due to repture 
Term
What is vascular insufficiency? 
Definition
Where there is not adequate blood supply to the stomach and intestine
Term
What are the blood supplies of the stomach and intestines?
Definition
  • Celiac axis
  • Superior mesenteric artery
  • Inferior mesenteric artery 
Term

True of False?

Two of the three blood supplies must be compromised to cause ischemia?

Definition
True 
Term
What can cause a vascular insufficiency?
Definition
Mesenteric venous thrombosis 
Term

True of False?

There can be acute or chronic mesenteric ischemia?

Definition
True 
Term
What makes a pt obese? 
Definition
Body Mass index >30
Term
Obesity is the major cause of what?
Definition
  • Morbidity
  • Death
  • Increased health care costs
Term
What part of the brain controls hunger?
Definition
Hypothalamus
Term
What are the hormones that control appetite and weight?
Definition
  • Insulin
  • Ghrelin
  • Peptide YY
  • Leptin
  • Adiponectin
  • Resistin
Term
Anorexia Nervosa Characteristics
Definition
  • Body image disorder
  • Refusal to eat
  • Loss of fat and muscle
  • Associated with binge eating/purging
Term
Anorexia Nervosa can lead to?
Definition
  • Starvation induced cardiac failure 
  • Absence of 3 consecutive menstrual periods 
Term
Bulimia Characteristics 
Definition
  • Body weight near normal; desire for weight loss
  • Self inducing vomiting
  • Two binge eating episodes per week for at least 3 months
  • Fasting to oppose the affect of binge eating of exercise 
Term
Continual vomiting of chyme causes?
Definition
  • Pitted teeth
  • Pharyngeal and esophageal inflammation
  • Tracheo esophageal fistulae
Term
Overuse of laxatives can lead to 
Definition
Rectal bleeding 
Term
What is portal hypertension?
Definition
Abnormally high blood pressure in portal venous system 
Term
Portal hypertension is caused by what?
Definition
Resistance to portal blood flow 
Term
What are the 3 areas of the protal system that could have an obstruction or impeded blood flow?
Definition
  • Prehepatic
  • Intahepatic
  • Posthepatic
  • (sorry I know this is a bad card!)
Term
What are the clinical manifestations of portal hypertension? 
Definition
  • Varices
  • Splenomegaly
  • Ascites 
  • Hepatic encephalopathy
Term
What are the 3 types of varices that are associated with portal hypertension? 
Definition
  • Esophagus
  • Stomach
  • Rectum 
Term
What is ascites? 
Definition
Accumulation of fluid in the peritoneal cavity 
Term
What is hepatic encephalopathy?
Definition
Accumulation of toxins in blood from liver failure 
Term
These toxins affect what? 
Definition
  • Neurotransmission 
  • Ammonia - deamination of amino acids
Term
What are the clinical manifestations of hepatic encephalopathy?
Definition
  • Personality changes
  • Confusion
  • Disorientation
  • Memory loss
  • Stupor - coma
  • Death 
Term
What is Jaundice?
Definition
Yellow discoloration of skin and sclera 
Term
What is Jaundice caused by?
Definition
Accumulation of bile pigment in tissues and body fluids 
Term
What are the 3 types of Jaundice? 
Definition
  • Obstructive
  • Hepatocellular
  • Hemolytic 
Term
What causes Obstructive Jaundice?
Definition
When the bile duct is obstructed by a tumor or stone 
Term
What causes Hepatocellular Jaundice?
Definition
When there is liver injury which impairs ability to conjugate bilirubin 
Term
What causes Hemolytic Jaundice? 
Definition
Increased breakdown of red blood cells 
Term
What is Hepatorenal Syndrome? 
Definition

Renal failure with:

  • Oliguria
  • Sodium and water retention 
  • Peripheral vasodilation 

This is all due to advanced liver disease 

Term
What happens when you have renal failure associated with liver failure?
Definition
  • Hypovolemia
  • Hypotension
  • Decreased renal blood flow
  • Intrarenal vasoconstriction
  • Decreased GFR and urine output 
Term
What is Hepatitis? 
Definition
A systemic viral disease that primarily affects the liver 
Term
Hepatitis A is what kind of hepatitis?
Definition
Infectious 
Term
How is Hepatitis A transmitted? 
Definition
  • Fecal-oral route
  • Crowded, unsanitary conditions
  • Food and water contamination 
Term
What type of Hepatitis is Hep B?
Definition
Serum 
Term
How is Hep B transmitted? 
Definition
  • Blood or body fluid
  • Contaminated needles
  • Sexual contact
  • Maternal transmission if mother infected during 3rd trimester 
Term
How is Hep C transmitted? 
Definition
  • Transfusions
  • IV drugs 
Term
Characteristics of Hep D 
Definition
  • Occurs with Hep B
  • Common Mediterranean and middle east areas
Term
Characteristics of Hep E
Definition
  • Fecal-oral transmission
  • Developing countries 
Term
Characteristics of Hep G
Definition
  • Recently discovered
  • Parenterally and sexually transmitted 
Term
What are the phases of Hepatitis? 
Definition
  • Incubation
  • Prodromal
  • Icteric
  • Recovery 
Term
3 kinds of Hepatitis
Definition
  • Chronic 
  • Fulminant
  • Acute 
Term
What causes acute hepatic failure? 
Definition
Acetaminophen overdose 
Term
What is Cirrhosis?
Definition
Irreversible inflammatory disease of the liver 
Term
Cirrhosis is a complication of what? 
Definition
Hepatitis 
Term
What happens when a pt has Cirrhosis?
Definition
  • Decreased hepatic function from nodular and fibrotic tissue synthesis
  • Obstruction of biliary channels cause portal hypertension 
Term
Cirrhosis results in what? 
Definition
  • Blood being shunted away from the liver
  • Hypoxic necrosis 
Term
3 types of Cirrhosis
Definition
  • Alcoholic
  • Biliary
  • Postnectotic 
Term
Characteristics of Alcoholic Cirrhosis
Definition
Oxidation of alcohol damages hepatocytes 
Term
Characteristics of Biliary Cirrhosis
Definition
  • Cirrhosis begins in bile canaliculi and ducts
  • Primary 
  • Secondary 
Term
Characteristics of Postnecrotic Cirrhosis
Definition
Consequences of chronic disease 
Term
What is Cholecystitis?
Definition
Inflammation of the gallbladder 
Term
What is Cholecystitis caused by?
Definition
Gall stones lodged in the cyctic duct 
Term
What are the gall stones made up of?
Definition
Cholesterol 
Term
What is Pancreatitis? 
Definition
Inflammation of the pancreas 
Term
What happens when you have Pancreatitis? 
Definition
  • Enzymes cause autodigestion of pancreatic tissue
  • Leak into the bloodstream 
  • Cause injury to blood vessels and other organs 
Term
What are the clinical manifestations of Pancreatitis? 
Definition
  • Epigastric pain radiating to back
  • Fever and leukocytosis
  • Hypotension and hypovolemia
  • Increase serum amylase level 
Term
Chronic pancreatitis is related to what? 
Definition
Chronic alcohol abuse 
Term
What are types of GI Cancers? 
Definition
  • Esophagus
  • Stomach
  • Colon and rectum
  • Liver 
  • Gallbladder
  • Pancreas 
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