final - lower GI

Question 1

acute pancreatitis risk factors

Answer 1

result of cholelithiasis or sustained alcohol
abuse in addition to self-digestion, infections, trauma, PUD,
hyperlipidemia, hypercalcemia, steroid use, OCPs.

Question 2

Mild acute pancreatitis s/s

Answer 2

• edema and inflammation confined to the pancreas
• function usually occurs within 6 months
• Patient is acutely ill and at risk for hypovolemic shock, fluid
  and electrolyte disturbances, and sepsis

Question 3

Severe acute pancreatitis s/s

Answer 3

• Severe abdominal pain (midepigastric) and tenderness
  radiating to the back
• Pain increases after food intake and is not relieved by
  antacids
• Abdominal distention, guarding, poorly defined palpable abdominal
  mass, rigid or boardlike abdomen
• Decreased peristalsis, vomiting (bile stained)
• Ecchymosis or bruising in the flank area or around the
  umbilicus
• Fever jaundice, mental confusion, agitation
• Hypotension, hypovolemia, shock

Question 4

Acute Pancreatitis Assessment and Diagnostics

Answer 4

• History of abdominal pain
• Presence or risk factors
• Increased serum amylase and lipase
• Urinary amylase levels elevated
• WBC
• Hypocalcemia (severe)
• Hyperglycemia and glycosuria
• Elevated serum bilirubin
• Hb, Hct (bleeding)
• Abdominal x-ray and CXR
• U/S, CT with contrast, MRI

Question 5

Acute Pancreatitis Medical management

Answer 5

• Goal: relieve symptoms and prevent or treat complications
• NPO to stop pancreatic stimulation to excrete enzymes
• TPN
• H2 antagonists, PPI
• Pain management: opioids
• ICU: correct fluid and blood loss, low albumin levels,
  ABGs, antibiotics, glycemic control, electrolyte balance
• Respiratory care and biliary drainage
• Semi-Fowler’s position
• Surgery

Question 6

acute pancreatitis medical management post acute phase

Answer 6

• Low fat diet
• Eliminate caffeine and alcohol
• D/C thiazide diuretics, steroids, OCPs
• Maintain skin integrity
• F/U to assess for resolution of pancreatitis and
  complications

Question 7

chronic pancreatitis risk factors

Answer 7

Alcohol consumption, smoking, and malnutrition

Question 8

Chronic Pancreatitis s/s

Answer 8

Recurring attacks of severe upper abdominal pain
radiating to the back and accompanied by vomiting
* Opioids do not relieve pain due to severity
* Weight loss, decreased PO intake, anorexia, fear to eat
* Frothy and foul smelling stool, steatorrhea

Question 9

Chronic Pancreatitis assessment and diagnostics

Answer 9

ERCP
* MRI, CT scan, U/S
* Glucose tolerance test
* Increased amylase

Question 10

chronic pancreatitis treatment

Answer 10

• Endoscopy or ERCP to remove pancreatic duct stones,
  correct strictures, drain cysts…
• Glycemic control and electrolyte balance
  surgical
  Whipple resection: pancreaticoduodenectomy= removal of
  part of the pancreas, gall bladder, duodenum, and part of
  jujenum
• Biliary drainage

Question 11

Cholecystitis s/s

Answer 11

• RUQ pain, tenderness, and rigidity
• Pain radiates to midsternal area or Rt shoulder
• Nausea, vomiting, and signs of inflammation

Question 12

Cholecystitis risk factors

Answer 12

Gall bladder stones, infection as a
result of surgery, trauma, burns, More prevalent with increasing age
and women, Risk increases with diabetes, liver
cirrhosis, hemolysis, and infections of
biliary tract, More prevalent with OCPs and
estrogen intake

Question 13

Cholelithiasis risk factors

Answer 13

• Obesity
• Women, especially those who have had multiple
  pregnancies or who are of Native American or U.S.
  southwestern Hispanic ethnicity
• Frequent changes in weight
• Rapid weight loss
• Treatment with high-dose estrogen (e.g., in prostate
  cancer)
• Low-dose estrogen therapy
• Ileal resection or disease
• Cystic fibrosis
• Diabetes

Question 14

Cholelithiasis clinical manifestation

Answer 14

• May be asymptomatic with mild GI
  symptoms
• Epigastric distress, fullness,
  abdominal distention, and vague
  pain in RUQ, may occur.
• This distress may follow a meal rich
  in fried or fatty foods

Question 15

Cholelithiasis assessment and diagnostic

Answer 15

• Abdominal x-ray
• U/S**
• Cholescintigraphy
• Endoscopic Retrograde
  Cholangiopancreatography
  (ERCP)

Question 16

gallstone obstruction of cystic duct

Answer 16

• Fever with palpable abdominal mass
• Excruciating RUQ pain radiating to back or Rt. Shoulder
• Nausea and vomiting– several hours after heavy meal
• Pain may be colicky or continuous
• Morphine is not recommended because it can cause spasm of the sphincter
  of Oddi
• Jaundice and pruritis due to obstruction of CBD
• Changes in urine (dark) and stool (grayish, clay) color
• Vitamin deficiency: interfere with absorption of Vit A,D,E,K

Question 17

Cholelithiasis Medical management

Answer 17

• Nutritional and supportive theraoy
• Remission can be achieved with rest, IV fluids, NG
  suction, analgesia, and antibiotics
• Laparoscopic cholecystectomy
• Diet: low fat
• Pharmacologic therapy
• Ursodeoxycholic acid (UDCA [Urso, Actigall]) and
  chenodeoxycholic acid (chenodiol or CDCA [Chenix])
  have been used to dissolve gallstones (6-12 months)

Question 18

appendicitis s/s

Answer 18

Periumbilical or epigastric pain that progresses to RLQ
pain
* Low grade fever, anorexia, nausea, vomiting

Question 19

appendicitis patient assessment

Answer 19

Pain at McBurney’s point
when applying pressure
* Rebound tenderness– pain
when pressure is released
* Rovsing’s sign– palpate the
LLQ and pain is felt in RLQ
* Psoas sign– patient lying on
left side, pain when slowly
extending Rt thigh
* Obturator sign– with the
patient supine, pain that
occurs with passive internal
rotation of the flexed right
thigh

Question 20

Appendicitis
* Assessment and Diagnostics

Answer 20

• Detailed history and physical examination
• Labs: WBC, neutrophils
• Abdominal x-rays, U/S, CT scan**
• R/O pancreatitis
• R/O ectopic pregnancy
• R/O UTI with U/A

Question 21

Appendicitis treatment

Answer 21

• Immediate surgery! Appendectomy
• In the absence of perforation, empyema, abscess…
  conservative management can be an option.
  However, recurrence is common.
• Before surgery: IV hydration, electrolyte imbalance,
  IV antibiotics

Question 22

diverticular disease risk factors

Answer 22

low fiber diet, obesity

Question 23

Diverticular Disease
* Clinical manifestation

Answer 23

Chronic constipation for several years precedes
* May be asymptomatic
* Symptoms might be mild to severe
* Bowel irregularities with intervals of diarrhea
* Nausea and anorexia
* Bloating and abdominal distension
* Repeated inflammation (diverticulitis) may narrow the
fibrotic strictures leading to:
* Cramps, narrow stools, constipation, intestinal obstruction
* Weakness, fatigue, anorexia
* Pain in LLQ, fever, leukocytosis, nausea, vomiting
* Untreated may lead to peritonitis and septicemia

Question 24

Diverticular Disease
* Assessment

Answer 24

Colonoscopy, biopsy
* CT without contrast
* Abdominal x-rays
* CBC: WBC, ESR

Question 25

diverticular disease treatment

Answer 25

* Rest, pain management, and antispasmotic agents * Dietary management * Clear liquid diet until inflammation subsides * High fiber, low fat diet * Antibiotics for 7-10 days * Bulk forming laxative * Probiotics

Question 26

diverticular disease acute cases treatment

Answer 26

hospitalization might be necessary * NPO, IV fluids * NG to suction if there is vomiting and/or distention * Broad spectrum antibiotics (e.g., ampicillin...) * Pain management: opioids (e.g., oxycodone, percocet, or IV hydromorphone, morphine, fentanyl) * Antispasmodic agents (e.g., bromide and oxyphencyclimine) * Bulk preparations (psyllium) or stool softeners (docusate), by instilling warm oil into the rectum, or by inserting an evacuant suppository (bisacodyl)

Question 27

Diverticular Disease surgical management

Answer 27

* Necessary if complications occur * 2 types of surgery * One-stage resection, in which the inflamed area is removed and a primary end-to-end anastomosis is completed * Multiple-stage procedures for complications such as obstruction or perforation

Question 28

crohn's s/s

Answer 28

* Insidious onset * RLQ pain and diarrhea unrelieved by defecation * Abdominal cramps due to inability of food to pass through constricted intestine (from scars and granuloma) * Pain occurs after meals– due to trigger of peristalsis * Weight loss and malnutrition, anemia * Diarrhea, steatorrhea– fluid and electrolyte imbalance * Intestine may perforate * Abscesses, fistulas, and fissures * Other symptoms may also include: * Arthritis, skin lesions, occular disorders, and oral ulcers

Question 29

Crohn’s Disease * Assessment and diagnostics

Answer 29

* Proctosigmoidoscopy * Stool examination for occult blood and steatorrhea * Barium study of upper GI to show the “string sign” highlighting at the terminal of the ileum the constriction * Endoscopy, colonoscopy, video capsule endoscopies * Barium enema * Intestinal biopsies * CT scan * Hb, Hct, ESR, Albumin and proteins (malnutrition)

Question 30

crohns disease risk factors

Answer 30

diagnosed more in adolescents, smoking

Question 31

ulcerative colitis s/s

Answer 31

Characterized by exacerbations and remissions * Diarrhea, passage of mucus and pus * LLQ pain, cramping, rebound tenderness in RLQ * Intermittent tenesmus (painful to defecate), passage if 10 to 20 liquid stools * Rectal bleeding, pallor, anemia, fatigue, hypocalcemia * Anorexia, weight loss, fever, vomiting, dehydration * Other symptoms: * Skin lesions (e.g., erythema nodosum), eye lesions (e.g., uveitis), joint abnormalities (e.g., arthritis), and liver disease

Question 32

Ulcerative Colitis * Assessment and Diagnostics

Answer 32

* Tachycardia, hypotension, tachypnea, fever, pallor * Level of hydration and nutritional status * Assess for bowel sounds, distention, tenderness * Stool for blood * Labs: Hb, Hct, WBC, albumin, electrolytes * Elevated antineutrophil cytoplasmic antibody levels * Abdominal x-ray, sigmoidoscopy, colonoscopy, barium enema * CT scan U/S, MRI

Question 33

hemorrhoids treatment

Answer 33

* Symptoms and discomfort are relieved by good personal hygiene and avoiding excessive defecation * High residue diet with fruits and bran with increased fluids * Bulk-forming agents are encoouraged * Warm compresses, sitz bath, analgesic ointments and suppositories, bed rest * Nonsurgical treatment: infrared photocoagulation, bipolar diathermy, laser therapy, sclerotherapy * Surgery (ligation) for internal hemorrhoids