Clinical Manifestations
Epigastric pain that is relieved by food is suggestive of ________ ________.
What is a duodenal ulcer?
Beginning with inflammation at the base of the crypts of Lieberkuhn and leading to the formation of abscesses in the epithelium of the crypts is the etiology for ___________ ____________.
Ulcerative Colitis
keyword here-Lieberkuhn
Banasik pg
What is the priority assessment in patients with peptic ulcer disease?
GI bleeding-you will need CBC (HGB), NG tube, CT, EGD.
In pseudomembranous colitis, what changes in labs do you expect?
Increase in WBC
Banasik pg 743-44
What clinical finding would suggest an esophageal cause of a client's report of dysphagia?
a) nasal regurgitation
b)airway obstruction when swallowing
c)chest pain during meals
d)coughing when swallowing
c: chest pain during meals
Your patient has diarrhea and constipation. (Can also have cramping, abdominal pain, nausea, and mucus in the stool.)
What is IBS or irritable bowel syndrome?
Banasik pg 745
Your patient has severe pain in an area known as "McBurney's Point". This pain is located _________ and this is most associated with what condition?
RLQ/Appendicitis
Banasik pg 744
-affects men more likely than women
-occurs mostly under the age of 45 (peak 10-19y/o)
** The earliest manifestation of appendicitis is generalized periumbilical pain assoc. w/N/D
Pain is often described as "migrating" or localized in the RLQ/McBurney point because of serosa distention. At this time-there will be an elevated temperature
For MS purposes:
Diagnosis-CT and ultrasound (used to do "rebound tenderness", but d/c because appendix could rupture so avoid palpating this area.
Tx-laparoscopic sx removal of the appendix, antibiotics, and prevention w/early detection.
You have a new admit who was brought up from a laparoscopic abdominal surgery. You assess their lung sounds and assess the wound. After this, what is the MOST important assessment following this patient's surgery?
Listening for active bowel sounds. This is important because you could have a paralytic ileus or an obstruction especially due to the surgery being laparoscopic and in the abdominal cavity.
Fecal leukocyte screening would be indicated in a patient with suspected ___________
a)lactose intolerance
b)enterocolitis
c)laxative abuse
d)giardiasis
B-enterocolitis
often manifested as bloody diarrhea, abd pain, fever, leukocytosis, and rarely colonic perforation.
Barrett esophagus is a _______________.
a)gastrin secreting lesion
b) preneoplastic lesion
c)benign condition
d) gastrin-secreting tumor
B-preneoplastic lesion
it is a chronic complication of GERD
What are some factors that can increase symptoms of GERD?
Spicy/fatty foods, caffeine, pregnancy/weight gain, lying flat after eating, tight clothing.
pg 736-chapter 36
(see key points here for reference too-Banasik)
This is known as mid-epigastric pain and is commonly associated with _______ _______ disease.
What is: dyspepsia/peptic ulcer?
banasik pg 739
Your patient has just had chemotherapy and has been hospitalized for extreme exhaustion from N/V/D and dehydration. They present with redness and painful ulcers in their mouth. You know that this is _______________.
Stomatitis. You will educate them on not using alcohol-based mouth washes, having a soft toothbrush, no tobacco use, and not picking at the ulcers.
certain chemotherapy/radiation agents can lead to this-this is important to keep in mind.
Banasik pg 736-Stomatitis
"ulcerative inflammation of the oral mucosa that involves buccal mucosa, lips, and palate"
(in your MS book-this will be under complications with cancer-so keep that in mind)
A patient with chronic gastritis would likely be tested for
a)Helicobacter pylori (H-pylori)
b)occult blood
c)lymphocytes
d)herpes simplex
a-h pylori
A patient receiving chemotherapy may be at greater risk of development of __________.
a)gastroesophageal reflux
b)stomatitis
c)esophageal varices
d)Mallory-Weiss syndrome
b-stomatitis!
Abdominal pain, anorexia, N/V, and postprandial discomfort, hematemesis, and malaise are some manifestations of __________.
What is gastritis?
Banasik pg 738
Your patient complains of pain in the abdomen 2-3 hours after eating. They state they feel better when they have food in their stomach, but once it is empty they have a burning pain in their mid-epigastric area. You know this most likely is a _________ _________.
What is: Duodenal (ulcer)
Pain in the abdomen 2-3 hours after eating (empty stomach), when the stomach empties into the duodenum.
If your patient had pain WITH eating, this would be a gastric ulcer.
What finding would rule out a diagnosis of IBS in a patient with chronic diarrhea?
Bloody stools
Banasik pg 745
Your client has jaundice as a complication of chronic cirrhosis. When you receive his labs back, you expect to find:
elevated _______ & ________ (what will these levels be?)
as well as an elevated __________ (what will this level be?)
Elevated AST & ALT
AST-0-35 IU (Galen lab both sexes)
ALT 4-36 (Galeb lab both sexes)
Elevated bilirubin- biggest lab indicator of jaundice
bilirubin total: 0.3-1mg/dL
pg 773-banasik table 38.2
(refer to Galen labs also)
An urgent surgical consult is indicated for the patient with acute abdominal pain and _________.
a)vomiting
b)CVA tenderness
c)absent bowel sounds
d)borborygmi
c-absent bowel sounds!!!!!!!
You have a newly admitted patient who loves movies. She says she and her husband go to the movies every Tuesday and get a large popcorn to share. She said she had a sudden onset of pain in her LLQ, she complained of constipation, N/V, and anorexia. She most likely has ____________.
Diverticulosis/presence of diverticula-herniations or out pouches in the colon.
Banasik pg 744
pg 745 box 36.1 explains the terminology
This disorder has an unknown etiology. Some would agree that it may have to do with the loosening of the muscular band around the esophageal and diaphragmatic junction, but mostly we know it has something to do with a weakening of membrane walls. Clinical manifestations can be similar to those of GERD, but can also include dysphagia.
What is Hiatal Hernia?
CM can include dysphagia (difficulty swallowing), reflux, dyspepsia, chest pain, and sometimes regurgitation like with GERD. There are two types of hernias:
Sliding hiatal hernia
-portion of the stomach slips UP into the thorax so the gastroesophageal junction is ABOVE the diaphragmatic opening.
Paraesophageal hernia
-greater curvature of the stomach "rolls" through the diaphragmatic defect.
you can also have "mixed" which is a combination of the two.
see page 737 in Banasik-chapter 36
figure 36.2
Perineal fissures, fistulas, and abscesses are associated with what GI disease?
Crohn's disease
Banasik pg 742
Your patient is taking Lactulose as a course of treatment for chronic cirrhosis. What does Lactulose do? What levels would be high in the body? And what would be considered high levels?
Lactulose gets rid of excess ammonia through fecal expelling. (words are hard)
Ammonia (NH3) levels in the body- 15-110mcg/dL (Galen labs)
above 110mcg would be considered high
Dumping syndrome is commonly seen after ________ procedures.
a)appendectomy
b)intestinal biopsy
c)colonoscopy
d)gastric bypass
d) gastric bypass