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risk factors: alcoholism, biliary tract disease, possible complication of ERCP b. procedures for diagnosis: rise in serum amylase, lipase, (in pancreatitis the “ases” are elevated) , WBC, decreased calcium and magnesium, elevated glucose, CT scan c. Medications: Opioid analgesics, antibiotics, anticholinergics, histamine receptor antagonists d. procedures for treatment: ERCP to create an opening in spincter of Oddi if caused by gallstones, Cholecystectomy if pancreatitis is result of cholecystitis and gallstones, Pancreaticojejunostomy rerourtes dranage of secretions 14. Achalsia: difficulty swallowing, possible regurgitation a. procedures for diagnosis: Upper GI, Manometry b. Medications: calcium channel blockers c. procedures for treatment: balloon dilation of lower esophageal sphincter 15. Hiatal Hernia: stomach protrudes up into chest through diaphragm a. procedures for diagnosis: EGD b. treatment: small frequent meals, elevate bed, sit up for one hour after meals 16. Gastroenteritis/Dysentery: inflammation of stomach and intestinal tract. a. symptoms: dirrhea, bloody diarrhea, cramping b. treatment: rest GI tract, replace fluids, antidiarrheals, antibiotics 17. Peritonitis: fecal matter enters abdominal cavity, causes inflammation of peritoneum a. caused from: ulcer or bowel perforations, appendicitis trauma, inflammation of other organs b. treatment: laparotomy to clean out gut c. procedures for diagnosis: barium enema, colonoscopy 18. Anal Fissure: tear or ulceration of anal canal, results from excessive tissue stretching from hard stools a. treatment: cleanings, correct consipation, surgical excision, keep stools soft, exercise, sitz baths 19. Anal fistula: tiny, tubular tunnels that extend into anal canal, usually from trauma/infection a. treatment: surgical 20. Hemorrhoids: Perianal vericose veins. Can be internal or external a. procedures for diagnosis: external visual exam. internal: digital palpation, proctoscopy b. procedures for treatment: treat constipation, relieve pain, sclerotherapy, rubber band, cryo, laser
DISCUSS COMMON MEDS GIVEN FOR GI COMPLAINTS SUCH AS ANTIULCER AGENTS, PPI’S, ETC… See GI drug chart. DESCRIBE DIFFERENT DIETS, FROM CLEAR LIQUIDS TO THE BRAT AND LOW RESIDUE DIET, WHAT DISEASES GET PRESCRIBED THESE. Brat: acronym for bananas, rice, apple sauce, toast. Typically prescribed for patients with diarrhea, dyspepsia, gastroenteritis. Diet is low fiber Low Residue: also designed to decrease frequency and volume of stools, low fiber diet
DESCRIBE THE DIFFERENCES BETWEEN A DUODENAL AND A GASTRIC ULCER. Gastric: 1. pain that is caused by food, relieved by vomiting 2. poor appetite 3. loss of weight 4. belching 5. nausea/vomiting 6. feeling tired/weak 7. bleeding hematemesis Duodenal:
1. pain that occurs when stomach is empty, relieved by food 2. normal appetitie or increased weight 3. feeling tired/weak 4. Bleeding: Melena 5. more common in elderly DIFFERENTIATE BETWEEN HEPATITIS A, B, C IN THEIR CLINICAL PRESENTATIONS, ROUTES OF TRANSMISSION, TREATMENT OPTIONS, AND RISK FACTORS; SURFACE ANTIGEN Hepatitis: viral infection witch causes necrosis and inflammation of liver cells, can be acute or chronic Hep A: 1. clinical features: jaundice, fatigue, anorexia, diarrhea 2. causes: contaminated food and water, blood exposure 3. risk factors: sexual contacts, international travelers, poor sanitation 4. prognosis: least serious, never becomes chronic 5. route of transmission: oral-fecal route Hep B: 1. clinical features: nausea, vomiting, loss of appetite, abdominal pain, fatigue, may or may not have jaundice, liver enlargement, mild fever, increase in liver enzymes, dark urine, light stool 2. causes: contaminated body fluids 3. risk factors: IV druge users, sex, infants born to infected mothers, hemo dialysis 4. Prognosis: lethal in only 1percent, 5 - 10 percent become carriers, 15 - 25percent will die prematurely, PT is best indicator of prognosis 5. prevention: Heb B vaccine 6. route of transmission: Blood. Heb B markers: HBsAg: patient infected with virus Anti-HBs: patient is immune Anti-Hbc: petient has been in contact with Heb B and may or may not still be infected IgM anti-HBc: signifies recent infection with Heb B, patient usually not a carrier IgG anti HBc: signifies past infection with Heb B Hep C: Clinical features: jaundice, anorexia, fatigue, stomach ache, abdominal pain, vomiting/nausea, Causes: blood and body fluids Risk factors: IV drug use, organ transplant, hemodialysis, sex Prognosis: increased risk for liver cancer and cirrhosis, liver damage may occur for years before symptoms occur Treatment: Interferon and Ribaviron, or Liver transplant. Route of transmission: Blood. EXPLAIN THE DIFFERENCE BETWEEN DIFFERENT TYPES OF G.I. INTUBATION FROM YOUR BOOK, AND THE COMPLICATIONS ASSOCIATED WITH THEM (NGT, DHT, PEG TUBES, ETC…). NGT: introduced through nose into stomach, primarily used to remove fluid and gas from upper GI tract (decompression), also occasionally used for short term (3-4 weeks) administration of meds/feedings. 1. Levin Tube: plasic, single lumen, placement is checked by pH, connected to low intermittent suction. 2. Gastric Sump: radiopague, clear plastic double lumen, can protect gastric suture lines because it maintains suction at a lower level than Levin tube. must keep vent lumen above patients waist to prevent siphon effect of stomach contents
Enteric Tubes/ DHT (dobbhoff tubes): feeding tubes that are inserted through nose into the stomach or past the stomach into the jejunum. Can be placed before or during surgery by interventional radiologists. Percutaneous endoscopic gastrostomy (PEG) tube: surgical procedure in which an opening is created in the stomach for the purpose of administering foods and fluids Low Profile gastrostomy device (LPGD): may be inserted 3 to 6 months after initial gastrostomy tube placement, devices are inserted flush with skin, eliminating possibility of tube migration and obstruction. DESCRIBE THE PRESENTING CLINICAL SIGNS AND SYMPTOMS OF: CHRON’S, ULCERATIVE COLITIS, AND IRRITABLE BOWEL SYNDROME. Crohn’s disease: 1. inflammation and ulceration of GI tract, all bowel layers become involved, fistulas are common 2. Malabsorption and malnutrition may develop, B12 injections may be necessary 3.subjective: abdominal pain/cramping, often right lower quadrant, anorexia/weight loss 4. Objective: fever, diarrhea with mucus or pus, abdominal distension/tenderness, high pitched bowel sounds, steatorrhea Ulcerative Colitis: 1. edema and inflammation of the rectum may progress to sigmoid colon, may progress the entire length of colon. 2. bowel obstruction may occur due to mucosal cell changes 3. subjective: abdominal cramping, often left lower quadrant, anorexia/weight loss 4. objective: fever, diarrhea, may have up to 15 to 20 liquid stools/day!..bummer. Abdominal distension, tenderness, high pitched bowel sounds, rectal bleeding IBS: different than the two above in that is no structural damage to GI tract with no inflammatory process, it does not predispose patient to cancer. 1. Subjective: cramping pain, nausea with means or passing stool, anorexia, abdominal bloating, belching, diarrhea, constipation 2. objective: CBC, serum albumin, ESR and occult stools, however ATI says difficult to diagnose so diagnoses usually made on symptoms.