Inflammatory bowel disease is chronic inflammation characterized by periods of remission interspersed with periods of exacerbation.  The two categories are:

Select two

A. necrotizing colitis

B. Crohn's disease

C. ulcerative colitis

D. paralytic ileus

Both are an autoimmune response

B,C

-both occur in the teenage years and young adulthood, then fade and reappear in the person's 60s

-the tissue damage is due to an overactive, inappropriate, and sustained inflammatory response

-genetic mutations result in an abnormal autoimmune response to normal intestinal flora, both the mutation and flora must be present for symptoms to exist

__________ can occur anywhere in the GI tract from mouth to anus, but occurs mostly in the terminal ileum and colon.  Also segments of normal bowel can occur within the diseased sements

A. Crohn's disease

B. ulcerative colitis

A. Crohn's disease

-fistulas can occur creating passage ways between sections of bowel, between bowel and bladder.  UTI is usually the first sign of a fistula.

(Poop gets in your bladder and the bacteria causes a UTI)

________ usually starts in the rectum and moves in a continual fashion toward the cecum.  It is a disease of the colon and rectum and the ulcerations occur only in the innermost layer of bowel wall.

A. Crohn's disease

B. ulcerative colitis

These are a few of the biggest differences between ulcerative colitis and Crohn's disease.  Name the disease each is associated with:

1. weight loss
2. rectal bleeding
3. fistulas
4. anal abscesses

1. Crohn's
2. ulcerative colitis
3. Crohn's
4. Crohn's

Weight loss, malabsorption, and F&E imbalances are concerns with Crohn's and ulvcerative colitis.  When ulcerative colitis is severe diarrhea can occur up to ____ times a day.

A. 5

B. 10

C. 15

D. 20

D. 20

-Hemorrhage is a complicatoin, as is toxic megacolon, and perforation leading to peritonitis

The 5 classes of meds for inflammatory bowel disease are:

Select 5

A. aminosalicylates

B. antimicrobials

C. corticosteroids

D. immunosuppressants

E. radiation therapy

F. biologic and targeted therapy

A,B,C,D,F

-5-ASA (which is in Azulfidine) has the therapuetic effect  of suppressing the proinflammatory cytokines and other inflammatory mediators

Approximately 85% of colorectal cancer arise from _________, which can be detected and removed by sigmoidoscopy or colonoscopy.

A. fistulas

B. rectal abscesses

C. pseudopolyps

D. adenomatous polyps

D. adenomatous polyps

-obesity, smoking, alcohol, and a large intake of processed or red meat are risk factors

-complications include obstruction, bleeding, perforation, peritonitis, and fistula formation

-surgery: removal of part or all of the rectum or colon

-chemotherapy, biologic and targeted therapy, and radiation therapy

-ostomy bags have a measureable ring that fits the stoma, cutting it too large will leave skin exposure that can result in skin breakdown and infection

-bags should be emptied when they are 1/3 full because of the weight pulling down on the bag

-remember psychological effects of the patient with a new stoma

Mild to moderate swelling of the stoma is normal in the first 2-3 weeks post op so the size of the ring will have to be adjusted.  What do the following colors indicate if observed of the stoma?

1. rose to brick red
2. pale
3. dark red to purple
4. dusky blue
5. brown-black

1. viable stoma mucosa
2. may indicate anemia
3. indicates inadequate blood supply to the stoma or bowel from adhesions, low-flow state, or excessive tension on the bowel at the time of construction
4. ischemia
5. necrosis

1. Place 500-1000mL of water in the bag, prime the line, and hang the bag from an IV pole or whatever
2. apply irrigating sleeve to the stoma and open end resting in the toilet, apply lubrication to the cone and insert through the bag into the stoma
3. open the flow valve and allow to run, stop flow if cramping occurs
4. clamp tubing and remove cone, allow 30-45 mins for exacuation, initial exacuation takes 10-15 mins then you can close the bag off and carry on with activites will exacuation finishes
5. clean peristomal skin, replace sleeve with desired stoma covering
6. clean all supplies

http://www.youtube.com/watch?v=g14kbuw1fU8

this is a good demonstration

Hepatitis is inflammation of the liver.  Viral Hepatitis is the most common (Hep A, B, C, D, E, and G).  Hepatitis can also be caused by: Select all that apply

A. drugs, including alcohol

B. chemicals

C. autoimmune disease

D. metabolic abnormalities

Approximately ____ of patients with chronic Hep C will advance to cirrhosis within 20-30 years.

A. 5%

B. 20%

C. 45%

D. 60%

B. 20%

-with Hep C there is a 15-20 year delay from infection to clinical appearence of liver damage

-30-40% of HIV patients also have Hep C, the high rate of co-infection is primarily related to IV drug use

-having both places the patient at greater risk for serious liver disease

______ is primarily transmitted via fecal-oral route.  Poor hygeine, improper handling of food, crowded situations, and poor sanitary conditions are likely causes.

A. Hep A

B. Hep B

C. Hep C

D. Hep D

A. Hep A

-there is no chronic carrier state for Hep A

-presence of Hep A IgM indicates acute infection

-presence of Hep A IgG indicates past infection and provides lifetime immunity

True

-90% of infants infected with Hep B at birth develop chronic Hep B

-blood is the most infective bodily fluid but is can also be transmitted via: semen, saliva.

-there is no evidence Hep B can be transmitted by urine, feces, breast milk, tears, or sweat

Hep C is an RNA virus primarily transmitted by ________.

A. unprotected sex with multiple partners

B. perinatal transmission

C. unknown causes

D. IV drug use

D. IV drug use

-contaminated shared needles is the primary cause of Hep C

-all are causes of Hep C transmission

Primary tests to detect Hepatitis test for the presence of:

A. bilirubin

B. amalyase

C. AST

D. anitbodies

Interferon Drug Card

(for Hepatitis B&C)

-given sub q 3 X weekly for 18-24 months

-inhibits viral replication on a number of levels in infected cells

-Peak 6-8 hr

-Half life 6-7 hrs

-can cause flu-like symptoms

_____ is the primary treatment of an acute Hepatitis infection.

A. Interferon

B. dietary changes

C. Epivir

D. rest

D. rest

-there is no specific treatment for acute viral hepatitis

-rest reduces metabolic demands on the liver and promotes cell regeneration

________ is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells.

A. cirrhosis

B. ascites

C. jaundice

D. Hepatitis

A. cirrhosis

-the liver will atempt to regenerate but the process is disorganized.  There is an overgrowth of fibrous tissue that distorts the normal shape and size.  Irregular blood flow results in scar tissue and decreased liver functionality

-any chronic liver disease, including alcoholism can lead to cirrhosis

________ is the single most common cause of cirrhosis.

A. alcoholism

B. Hep B

C. Hep C

D. ascites

A. alcoholism

-alcohol is directly hepatoxic

-accompanying malnutrition can also lead to cirrhosis

___ of patients with chronic Hep C and ___ of patients with chronic Hep B will develop cirrhosis.

A. 15%, 20-30%

B, 20%, 10-20%

C. 30%, 5-15%

D. 20%, 20-30%

B. 20%. 10-20%

-chronic Hepatitis combined with alcohol intake is synergistic with accelerating liver damage

Early manifestations of cirrhosis include all of the following except:

A. ascites

B. anorexia

C. dyspepsia

D. flatulence

E. nausea/vomiting

A. ascities

-ascites is a manifestation of later cirrhosis along with jaundice and peripheral edema

______ is the accumulation of serous fluid in the peritoneal or abdomenal cavity.

A. varices

B. encephalopathy

C. ascites

D. paracentesis

C. ascites

-drug therapy with diuretics is used such as: spironolactone and Lasix

-ascites may lead to impaired respirations or abdominal pain then a paracentesis may be performed

-paracentesis is a needle puncture of the abdomenal cavity to aspirate the fluid

-inflammation of the pancreas

-the primary causes are biliary tract disease and alcoholism

-trauma and viral infections may also be causes

-abdonmenal pain is the predominant sign (LUQ or midepigastric)

-other signs are: nausea/vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice

Complications of pancreatitis

-pseudocyst

-a pseudocyst is a cavity surrounding the outside of the pancreas.  It is filled with necrotic products and liquid secreations such as: plasma, pacreatic enzymes, and inflammatory exudates.

-manifestations: abdomenal pain, palable epigastric mass, nausea/vomiting, and anorexia

-may perforate and cause peritonitis

treated with internal drainage

Complications of pancreatitis

abscess

-abscess is a large fluid-filled cavity within the pancreas

-it results from extensive necrosis

-it may become infected or perforate into adjacent organs

-manifestations: upper abdomenal pain, abdomenal mass, high fever, leukocytosis

-treatment requires prompt surgical drainage to prevent sepsis