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  1. herniation
    -a weakness in the abdominal muscle through which a segment of the bowel or other abdominal structure protrudes
  2. indirect inguinal hernia
    sac formed from the peritoneum that contains a portion of the intestine or omentum. hernia pushes downward at an angle into the inguinal canal

    in males the hernia may descend into the scrotum
  3. direct inguinal hernia
    passes through a weak point in the abdominal wall
  4. femoral hernia
    protrudes through the femoral ring. a plug of fat in the femoral canal enlarges and eventually pulls from the peritoneum and often urinary bladder into the sac
  5. umbilical hernia
    congenital or acquired.

    congenital umbilical hernia appear at infancy

    acquired umbilical hernia directly result from increased intra abdominal pressure-most commonly in obese people
  6. incisional or ventral hernia
    occur at the site of a previous surgical incision

    these result from inadequate healing of the incision, which is usually caused by post op wound infections, inadequate nutrition and obesity
  7. reducible hernia
    when the contents of the sac can be replaced into the abdominal cavity by gentle pressure
  8. irreducible hernia
    cannot be replaced into abdominal cavity.

    required immediate surgical evaluation
  9. strangulated hernia
    when the blood supply of the herniated segment of the bowel is cut off by pressure from the hernial ring

    ischemia and obstruction of the bowel loop

    leads to necrosis of the bowl or bowel perfusion

    signs: nausea, vomiting, pain, fever, tachycardia, abdominal distention
  10. truss
    a pad made with firm material that is held in place over the hernia with a belt to help keep the abdominal contents from protruding into the hernial sac
  11. hernioplasty
    reinforcing the weakened outside abdominal muscle wall with a mesh patch
  12. hemorrhoids
    unnaturally swollen or distended veins in the anorectal region. May be internal or external. With repeated elevation of intro abdominal pressure the distended veins separated from the smooth muscle and prolapse.
  13. internal hemorrhoids
    cannot be seen on inspection, lies above the anal sphincter
  14. external hemorrhoids
    lie below the anal sphincter and can be seen on inspection
  15. prolapsed hemorrhoids
    can become thrombosed or inflamed, they can also bleed
  16. non surgical management
    • -tucks-alcohol based pad
    • -cold packs
    • -sitz bath
    • -topical lidocaine, dibucaine ointment
    • -hdrocortisone for itching
    • -cleanse the anal area
    • -stool softeners
    • -oral analgesics
  17. appendicitis
    • acute inflammation of the vermiform appendix-blind pouch attached to the cecum of the colon located in the right iliac region
    • -when infected the lumen is blocked and enlarges impending blood flow
    • -gangene from hypoxia or perforation can occur 24 hours
    • -adjacent organs may wall off the area and an abscess develops

    -mcburneys  point

  18. what is the most common cause of acute inflammation in the right lower quad
    acute appendicitis
  19. lab data
    elevation of WBC 10,000-18,000 with a shift to the left

    -WBC count of 20,000 or greater may indicate a perforated appendix
  20. assessment of classic appendicitis
    • -epigastric or periumbilical pain
    • -n&v
    • -anorexia
    • -pain is in the right lower quad between the anteriaor iliac crest and umbilicus
    • -increases with coughing or movement-perforation
    • -relieved with flexion of the right hip/knees-perforation
    • -remp usually normal or slight elevation
    • -moderate elevation of WBC
    • -appendix can be malpositioned
    • -shift to the left-increased of immature cells
  21. when are you at risk for perforation
    rare in 24 hours but rises after 48 hrs
  22. nonsurgical management
    • -iv fluids
    • -NPO
    • -semi fowlers postion
    • -analgesics
    • -antiobiotics
    never administer laxatives or enemas, it can cause perforation
  24. fecalith
    hard stony mass of feces, calcium phosphate-risch mucus and inorganic salts
  25. appendectomy
    removal of the inflamed appendix by one of several surgical approaches
  26. laparoscopy
    a minimally invasive surgical procedure with one or more small incisions near the umbilicus through which a small endoscope is placed
  27. laparoscopic appendectomy
    • -npo
    • -iv fluids
    • -semi fowlers
    • -opiod analgesics
    • -no laxatives
    • -no heat
    • -minimally invasive
    • -small incisions
    • -removal of appendix
    • -3 weeks to heal
  28. laparotomy
    open surgical approach with a larger abdominal incision for complicated or atypical appendicitis or peritonitis
  29. peritonitis
    life threatening acute inflammation of the visceral/parietal peritoneum and endothelial lining of the abdominal cavity

    primary peritonitis is rate and indicated the peritoneum is infected via the bloodstream

    KEY FEATURES: rigid board like abdomen, abdominal pain referred to shoulder or chest), distended abdomen, nausea, anorexia, vomiting, diminished bowel sounds, inability to pass flatus or feces, rebound tenderness in abdomen, high fever, tachycardia, dehydration, decreased urine output, hiccups, possible compromise in respiratory status, FLUID SHIFT FROM ECF TO THE PERITONEAL CAVITY, THIRD SPACING, HYPOVOLEMIA, INSUFFICIENT CIRCULATING VOLUME CAN LEAD TO RENAL FAILURE, PERISTALSIS SLOWS OR STOPS, BOWEL BECOMES DISTENDED WITH GAS AND FLUID, FLUID ACCUMULATES 7-8 LITERS DAILY, TOXINS CAN ENTER THE BLOOD STREAM, SEPTICEMIA (BACTERIAL INVASION), RESPIRATORY COMPROMISE, DEATH
  30. ascities
    3rd spacing thin with large belly filled with fluid
  31. septicemia
    bacterial invasion of the blood
  32. gastroenteritis
    increase in the frequency and water content of stools and or vomiting as a result of inflammation of the mucous membranes of the stomach and intestinal tract
  33. intestinal obstruction
    mechanical or non mechanical
  34. mechanical obstruction
    the bowel is physically blocked by problems outside the intestine, in the bowel wall, or in the intestinal lumen

    -adhesions, hernias, tumors, or impactions
  35. nonmechanical onstruction/paralytic ileus
    does not involve physical obstruction in or outside the intestine. peristalsis is decreased or absent as a result of neuromuscular disturbances, resulting in slowing of the movement or a backup of intestinal contents
  36. what is a sign or obstructions and peritonitis?
  37. strangulated obstruction
    obstruction with compromised blood flow, the risk for peritonitis is greatly increased
  38. most common site for obstruction
    ileum in the small intestine
  39. intussusception
    bowel folds back into itself
  40. volvulus
    • -twisting of the intestine
    • -bowel dies and extends
  41. physical assessment for mechanical obstruction
    • -mild abdominal cramping
    • -sporadic
    • -localized with strangulation
    • -obstipation (no passage)
    • -diarrhea (partial)
    • -ribbon like stools
    • -borborygmi (high pitched bowel sounds)
  42. physical assessment for non mechanical obstruction
    • -consistent diffuse pain
    • -pain is severe
    • -associated with tissue infarction
    • -handling of the bowel during surgery
  43. what do you need to turn off when listening to bowel sounds?
    suction on pump
  44. cholecystitis
    • inflammation of the gall bladder
    • -acute or chronic (acute is most common)
  45. 2 types of acute cholecystitis
    calculous and acalculous cholecystitis
  46. most common type of acute cholecystitis
    calculous cholecystitis-chemical irritation and inflammation result from gallstones that obstruct the cystic duct, gallbladder neck or common bile duct
  47. cholelithiasis
  48. choledocholithiasis
    obstruction in the common bile duct
  49. acalculous cholecystitis
    • inflammation without the presence of gallstones typically associated with biliary stasis caused by any condition that affects the regular filling or emptying of the gall bladder
    • -kinking of the GB neck
  50. chronic cholecystitis
    • -repeated episodes
    • -becomes fibrotic and contracted
    • -pancreatitis and cholangitis can occur
  51. cholangitis
    bile duct inflammation
  52. jaundice
    yellow discoloration of the skin and mucous membranes
  53. icterus
    yellow discoloration of the sclerae
  54. steatorrhea
    fat floaty poop
  55. GI symptoms
    • flatulence
    • pain triggered by high fat diet
    • dyspepsia (indigestion)
    • eructation (belching)
    • anorexia
    • nausea and vomiting
    • feeling full
    • rebound tenderness
    • fever
    • jaundice
    • anorexia
    • pain may radiate to right shoulder or scapula
  56. biliary colic
    obstruction of the cystic duct of the gallbladder or movement of one or more stones
  57. cholecystectomy
    surgical removal of the gallbladder
  58. blumbergs sign
    • -MD only
    • -deep palpation
    • -quickly releases
    • -guarding and rigidity and rebound tenderness
    • -under right rib cage
  59. diagnostics
    • -alkaline phosphatase
    • -ast
    • -ldh
    • -direct bilirubin-conjugated water soluble
    • -indirect bilirubin- unconjugated fat soluble
    • -wbc shift to left (inflammation)
    • -ultraonography
    • -abdominal x ray
    • -ercp-endoscopic retrograde cholangiopancreatography
    • -mrcp-magnetic resonacnce cholangiopancreatography
  60. interventions
    • low fat diet
    • fat soluble vitamins a,d,e,k, and bile salts
    • opiod analgesia (may cause sphincter spasm)
    • DEMEROL is not used because it breaks down into toxic metabolite that can cause seizures
    • anticholengerics (antinausea meds)
  61. ESWL
    • extracorporeal shock wave lithotripsy
    • non invasive
    • shock waves that help break up stones
  62. percutaneous transhepatic biliary catheter
    catheter by liver into biliary duct to retrieve bile blocked by stones
  63. t tube
    drains bile into bag
  64. endoscopy/esophagogastroduodenoscopy
    • exam of the esophagus, stomach and duodenum
    • avoid nsaids, asa, anticoagulants
    • fiberoptic scope
    • npo 6-8 hrs prior
    • versed and fentanyl
    • atropine to dry secretions
    • local spray anesthetic to inactivate gag reflex
    • bite block
    • post procedure: frequent vs, npo until gag reflex returns, monitor for perforation, hoarse or soar throat
  65. colonoscopy
    • begin at 50 yo
    • examines entire large bowel
    • tissue biopsy
    • liquid diet 12-24 hours prior
    • npo 4-6 hours prior
    • bowel prep (golytely)
    • bowel generally clears in 4-5 hours
    • may need laxatives and cleansing enemas
    • versed and opiate
    • instill air into bowel
    • takes 30-60 mins
    • lay on left side post of to fart out gas
  66. virtual colonoscopy
    • noninvasive
    • multidimensional
    • bowel prep
    • dietary restrictions
Card Set:
2013-03-10 20:42:36

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