A patient with chronic reflux esophagitis is evaluated for which possible complication?
Barrett esophagus.
This is evaluated with and esophagoscopy to determine if the cells of the lower esophagus have changed to precancerous cells through metaplasia.
A common cause of chronic reflux esophagitis is hiatal hernia. This is where the stomach herniated above the diaphragm causing reflux of the stomach contents
How would you tell if your patient had a paralytic ileus?
Paralytic ileus is the loss of peristalsis in the colon associated with abdominal surgery, trauma, and peritonitis.
- With complete intestinal obstruction the following show upon assessment:
- The frequency of bowel sounds increases, and crampy colicky pain occurs as the colon attempts to overcome the obstruction
- Later the abdomen becomes distended and can push against the diaphragm and interfere with respiration.
- Constipation occurs as nothing can pass through the lumen.
- Fluid and electrolyte imbalances lead to signs of dehydration and hypovolemia due to fluid and electrolyte accumulation in the lumen of the colon behind the obstruction.
- Auscultation would tell us if there is loss of peristalsis
Which type of gastritis puts a patient at risk for gastric carcinoma?
Chronic fundal gastritis (Type A) and Lack of absorption of vitamin B-12 increases the ris
Differentiate the clinical manifestations of a duodenal ulcer and a gastric ulcer
Duodenal ulcers:
- Occur more frequently than other types of peptic ulcers
- Usually caused by H. Pylori infection and chronic use of NSAIDs
- Chronic intermittent pain in the epigastric area. The pain usually begins 2-3 hours after eating when the stomach is empty.
- Complications: bleeding, perforation, and obstruction of the duodenum
- Bleeding from these ulcers cause hematemesis or melena
Gastric ulcers:
- About a quarter as common as duodenal ulcers.
- Caused by H. Pylori infection and use of NSAIDs
- Pain immediately after eating (food-pain pattern), anorexia, vomiting, and weight loss
- Complications of bleeding and perforation can occur
*Pain at night that disappears by morning occurs in patients with duodenal ulcer
What treatments are associated with Crohn Disease?
medication to decrease the amount of acid in the stomach, such as proton pump inhibitors, H2 blockers, and antacids. Weight loss is recommended, as is avoidance of tight clothing because both can increase intra-abdominal pressure making it more likely that reflux will occur. Smoking cessation is encouraged because nicotine increases acid production. At night, the head of the bed should be elevated on 6-inch blocks to keep the esophagus higher than the stomach, thereby reducing reflux by gravity
What is the treatment for diverticulosis?
treatment of diverticulosis includes an increase in dietary fiber which often relieves the symptoms and helps prevent the formation of more diverticula. Diverticulitis is treated with nonabsorbable antibiotics. Complications are treated with surgical intervention.
What clinical manifestations occur with diverticulitis?
Fever, leukocytosis, and tenderness in the left lower quadrant.
What clinical manifestation usually signals the appendix has ruptured?
If the patient has a relief of symptoms followed by an increasing amount of pain the appendix has probably ruptured and peritonitis will follow.
Symptoms include: Periumbilical pain that increases over 3 to 4 hours then can subside then pain can reoccur in right lower quadrant, nausea, vomiting, anorexia, low-grade fever, rebound tenderness, and elevated WBC’s.
Compare anorexia nervosa and bulimia nervosa.
Anorexia nervosa is characterized by the following:
- fear of becoming obese despite progressive weight loss
- distorted body image with the perception that the body is fat when it is actually underweight,
- body weight 15% less than normal for age and height because of refusal to eat, and
- absence of three consecutive menstrual periods in females.
Bulimia nervosa is characterized by bingeing (consumption of large amounts of food, often several thousand calories) followed by purging (self-induced vomiting, laxative use, or fasting).
What are clinical manifestations of portal hypertension?
Portal hypertension is a complication of all liver disorders.
It is caused by obstruction or impedance of blood flow through the portal venous system or the vena cava. The most common cause of portal hypertension is fibrosis and obstruction caused by liver cirrhosis. Long-term portal hypertension leads to varices, splenomegaly, ascites, and hepatic encephalopathy.
The main symptoms and complications of portal hypertension include:
- Gastrointestinal bleeding: Black, tarry stools or blood in the stools; or vomiting of blood due to the spontaneous rupture and bleeding from varices.
- Ascites: An accumulation of fluid in the abdomen.
- Encephalopathy: Confusion and forgetfulness caused by poor liver function and the diversion of blood flow away from your liver.
- Reduced levels of platelets or decreased white blood cell count
Which type(s) of hepatitis can cause jaundice?
All five types of viral hepatitis (HAV, HBV, HDV, HCV, & HEV) can cause acute icteric disease (jaundice). The icteric phase of viral hepatitis consists of jaundice, dark urine, and light stools along with hepatomegaly and tenderness.
During which phase(s) is hepatitis transmissible?
- The prodromal phase begins two weeks after exposure and ends with the onset of jaundice. Fatigue, anorexia malaise, nausea, vomiting, headache cough, and low grade fever are commonly seen, the disease is highly transmissible at this time.
- The icteric phase begins with the onset of jaundice, usually 1 to 2 weeks after the prodromal phase, and lasts 2 to 6 weeks. Besides jaundice, other clinical manifestations include dark urine, light stools, and liver enlargement (hepatomegaly) with tenderness.
- The recovery phase begins with the resolution of jaundice, about 6 to 8 weeks after exposure. The liver remains enlarged and tender but other symptoms diminish. Liver function returns to normal 2 to 12 weeks after the onset of jaundice.
What clinical manifestations usually accompany jaundice in a patient with hepatitis?
A patient becomes jaundiced during the icteric phase of viral hepatitis. During this time the patient may also have dark urine and light stools. The patient may have hepatomegaly (liver enlargement) with abdominal tenderness over the upper right quadrant. Liver function tests will be abnormal with elevated liver enzyme levels (AST and ALT); however, the values are not consistent with the extent of damage to the liver cells.
How is hepatitis transmitted?
Fecal/Oral Route:
Hepatitis A
Hepatitis E
Parenteral (Blood) & Sexual Routes:
Hepatitis B
Hepatitis D
Hepatitis C
- fecal/oral, pare teal (blood) and sexual contact
What puts a patient at risk for developing cirrhosis?
The most common causes are hepatitis virus (HBV&HCV) and excessive alcohol intake. Other causes include biliary disease from either an autoimmune response (Primary biliary cirrhosis or prolonged or partial complete obstruction of the common bile duct (Secondary biliary cirrhosis).
What are clinical manifestations of gall bladder disease?
- Heartburn, flatulence, epigastric discomfort, and food intolerances, especially to fats and cabbage.
- Pain that usually occurs 30 minutes to several hours after eating a fatty meal (it is caused by one or more gallstones lodging in the cystic or common bile duct). * Pain can be intermittent or steady and usually occurs in the RUQ, radiating to the mid-upper area of the back.
- Jaundice indicates the stone is located in the common bile duct.
- Obstruction can lead to reflux of bile into the pancreatic duct, causing acute pancreatitis.
What lab results are characteristic of acute pancreatitis?
Elevated serum amylase is a characteristic but not a diagnostic.
Elevated serum lipase is the primary diagnostic marker
What are the risk factors for esophageal cancer?
Risk factors:
- Change in structure/function as a result of food and drinks remaining in the esophagus for prolonged periods of time. These changes can be caused by chronic malnutrition
- Metaplasia caused by esophageal reflux
- Chronic exposure to irritants such as alcohol and tobacco
- Obesity
What are the screening recommendations for colon/rectal cancer?
Screening should begin at age 50 for individuals with an average risk for colon/rectal cancer. People at higher risk should begin screening at a younger age and may need to be tested more frequently. High-sensitivity fecal occult blood tests (FOBT) check for hidden blood in stool samples and should be done every year. A flexible sigmoidoscopy or a virtual colonoscopy should be done every five years. A colonoscopy should be done every 10 years.
Primary gall bladder cancer is most commonly associated with which other disease?
Primary gallbladder cancer is commonly associated with cholelithiasis or the formation of gallstones.
What characterizes normal synovial fluid?
Normal synovial fluid is clear, straw colored, and moderately viscous. A drop of synovial fluid from a syringe will form a “string” a few inches long. The number of WBCs should be less than 200 cells per milliliter
What characterizes oblique fractures?
An oblique fracture occurs at an angle across the bone by a slanted blow to the bone (most frequent in the long bones of arms and legs).
What characterizes spiral fractures?
A spiral fracture encircles the bone and is caused by a twisting of the limb.
What characterizes stress (fatigue) fractures?
Occurs in bone that is subject to repeated pain, seen in athletes. stress fatigue fractures can occur in people who engage in new or strenuous activity like joggers, skaters, dancers, and people in the military. Initial X-ray usually does not reveal a fracture, bone is immobilized and a repeated X-ray in two weeks will show new bone growth.
