inflammation, infection, or a symptom of disease, side effect of medicine- mouth
Stomatitis
Small white painful ulcers, on the inner cheek, lips, tongue, pharyns
Can last several days to 2 weeks- usually heals w/o a scar
Canker sore
Cheesy white plaque that looks like milk curds when rubbed off
Candidiasis- thrush (moniliasis)
Risk factors for Herpes simplex 1
Diabetes, antibiotic therapy, immunosupression- Opportunistic- may appear up to 20 days after exposure, treat with Acyclovir (antifungal)
Cold sores, fever blisters, recur but will only last a few days, infectious, can be contagious, provoked by stress, fever, run down, no cure
Herpes simplex 1
Pts with _____ can tolerate solids more easily than liquids- teach "double-swallow) technique- 1 inhale, 2 put food in pharyns and swallow, 3 exhale, 4 swallow again
pharyngeal weakness
esophageal weakness is also called
Cardiospasm or aperistalsis
s/s of esophageal weakness
gradual onset of dysphagia for both fluids and solids, loss of weight, substernal chest pain, regurgitation of esophageal contents onto pillow at night, progresses slowly-usually in the distal end- usually 40 years of age and over
condition where the lining of the esophageal mucosa is altered, associated with GERD that is left untreated- can lead to precancerous cells in esophagus
Barrett's esophagus
Mucosal laceration at the gastroEsophageal junction- occurs in about 10% of cases, typically follows vomit, 90% of bleeding stops on it's own
mallory- Weiss Tear
Causes of narrowing of the lumen of the esophagus
ingestion of corrosive substances, reflux esophagitis, prolonged NGT, irritation of the esophageal walls lead to formation of a stricture that the esophageal lumen and leads to dysphagia
esophageal cancer affects more ____ and more ----
men and african americans ages 50-60
Primary s/s of esopheageal cancer
difficulty swallowing
_____ when you don't secrete enough intrinsic factor, therefore you have trouble absorbing enough B12 leading to pernicious anemia
Chronic gastritis type A- autoimmune gastritis
s/s of chronic gastritis
may be asymptomatic except s/s of anemia, weakness, sore tongue, numbness, tingling- Treated with B12 injections
Affects lower end of the stomach, antrum, and pylorus, near the duodenum- Freq. Assoc. with H. pylori, S/s poor appetite, heartburn after eating, belching, sour taste,
epigastric discomfort, anorexia, heartburn after eating, belching sour taste in mouth, nausea and vomiting, intolerance of some foods, may have vitamin deficiency
Risk factors for peptic ulcer disease
excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking and familial tendency-
Choledococholithotomy
incision of the common bile duct to remove stones
Which ulcer is associated w/ extensive burns?
Curlings- normally around 72 hours after
What is the most prominant sign of inflammatory bowel disease?
Intermittent pain
peripheral veins used for ____
Short term- very irritating to veins- soultion is weaker
Which dietary modification is utilized for a pt dx w/ acute pancreatitis?
Elimination of coffee- high- carb, low fat, low protein diet should be implimented
An iliostomy resivior should be emptied...
Every 2-4 hours
Reddened circumscribed lesion that ulcerates and becomes crusted- primary lesion of syphilis
Chancre
What does TPN contain?
animno acids, fats, vitamins, electrolytes, trace elements, and water
What is a protrusion of the intestine through a weakened area in the abdominal wall?
Hernia
Diet modification for a pt dx w/ IBS
low residue diet
When should you use TPN
Unable to tolerate liquids in GI tracts
Enteral feedings
disorders of GI tract
Surgical pts, trauma, healing
poor nutrition
weight loss
physician decides
Which mouth condition is associated w/ HIV
Kaposis sarcoma
The presence of mucus and pus in stools suggest which condition?
inflammatory colitis
The primary source of microorganisms for cath-related infections are the skin and...
cath hub
Which surgical procedure for obesity utilizes a prosthetic device to restrict oral intake?
Gastric banding
To ensure patency of central venous line ports, diluted heparin flushes are used in which situation?
Daily-when not in use
A pt being treated for diverticulosis should...
drink at least 8-10 glasses of H20 daily
Fat soluable vitamins and fatty acids, glycerol absorbed into____
lymph in lacteals
Dysphagia
difficulty swallowing
odynaphagia
Pain on swallowing
dyspepsia
indigestion
What is the most common type of complain of a pt w/ pancreatitis?
severe, radiating abdominal pain
symptom of GERD which is characterized by burning sensation in the esophagus
Post operatively, a pt with a radical neck dissection should be placed in which position
fowlers
causes of dysphagia
pharyngeal muscle weakness
esophageal disorders
Enzymes and secretions in the stomach
hydrocloric acid, pepsin, intrinsic factor
dysphagia- tolerate solids better than liquids
Achalasia
Following acute gallbladder inflammation a pt should avoid which food
Cheese, eggs, cream and fried foods
Which type of diarrhea is caused by increased production and secretion of H20, electrolytes by intestinal mucosa into intestinal lumen
Secretory
S/s of Achalasia (cardiospasm, aperistalisis)
Gradual onset of dysphagia
Weight loss
Substernal chest pain
regurgitation of esophageal content
little or no food in stomach
Rebound hypoglycemia is a complication of parental nutrition caused by____
feedings stopped too abruptly
most common cause of diarrhea
contaminated food
causes of esophageal strictures
Ingestion of corrosive substances
Reflux esophagitis
Prolonged NGT
When irrigating a colostomy the nurse lubricates the cath and inserts into the stoma no more than ____ inches
3
A nontunneled cath can be used for no more than _____
30 days
Transmural thickening usualy is an early pathologic sign of _____
chron's later results in deep, penetrating granulomas
Typical s/s of appendicitis
Nausea, pain in RLQ
Rebound tenderness, or pain felt when pressure to abdomen is released
Low-grade fever
S/s of esophageal cancer
Dysphagia- prime symptom
foul breath
full feeling
Causes of acute gastritis
injury of the protective mucosal barrier by drugs, chemicals
alcohol,
steroids-prednisone
bacterial infections
NSAIDs
extreme stress
excess coffee, tea, pepper, spices
severe trauma
The most common s/s of esophageal disease
dysphagia
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
Peptic ulcer disease
Risk factors for PUD
excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking and familial tendency
Manifestations of PUD
dull gnawing pain or burning in the mid-epigastrium; heartburn and vomiting may occur
A sharply defined break or ulceration in the protectice mucosal lining of the lower esophagus, stomach or duodenum which may involve submucosa and muscular layers- may expose the submucosal layers to gastric acid secretions and pepsin and cause autodigestion
Peptic ulcer
____ ulcers extend throught he muscularis mucosa and damage blood vessels, causing bleeding or may lead to perforation of the GIT wall
True
Pain, buringin and gnawing pain in the high left epigastric region
Gastric acid secreted in parietal cells of fundus of the stomach
Peptic ulcer
Predisposing factors for Peptic ulcers
excessive use of asprin, non-steroidal anti-inflammatory drugs (NSAIDs) cigarette smoking, genetic, dietary, severe stress, alcohol abuse, infection, caffeine, chemotherapy drugs
Increased back diffusion of gastric acid into the tissues/mucosa of the stomach causes
histamine release, inflammatory reactions, tissue damage, bleeding and ulcerations in the gastric wall
The most common site for peptic ulcer formation is in the
duodenum
____ ulcers are associated with weight loss, burning left epigastric area, food frequently aggraves pain, no pain at bedtime
Gastric
____ ulcers- right epigastric pain at bedtime,
burning, cramping, mid epigastric pain
pain 2-4 hours after a meal, eating decreases pain, weight gain, melena in elderly, Stress/Drug induced
Duodenal Ulcers
Disorder of altered intestinal motility in which the colon does not contract in a normal pattern, hereditary tendency- s/s gas, bloating, constipation, diarrhea,
IBS
Cluster of symptoms that occur despite the avsence of a disease process (motility disorder primarily affecting colon)- fluctuating instestinal motility
IBS
metabolic disorder- inability to metabolize peptides (protein)
Celiac disease
Bacterial infection of intestines (protein malabsorption and other nutrients)
Tropical spruce
Frequent loose, bulky, foul, fatty stools, gray in color, float-
perforation, abcess of appendix, peritonitis, severe pain, temp 100
Presence of puches of mucosa and submucos that protrudes or herniate through the circular muscles of the intestinal wall- most common in the sigmoid colon
Diverticulosis
Inflammation of the peritoneum and abdominal cavity from trauma, ischemia, tumor perforation, leakage of organ contents into pertoneal cavity- Complication of bacterial infection from perforated pepptic ulcer, ruptured appendix, also complication of CAPD
Peritonitis
A disease that causes inflammation in the small intestine, but it may affect any part of the GI tract
Chron's disease- IBD
S/S of Chron's
Crampy Abd. pain, distention, tenderness in lower quadrents of the abdomen, esp. R/ side Hx of chronic diarrhea and fatigue, also skin lesions, inflammation of the eyes and abnormalities with liver, arthritis
S/S: patho/etiology: epithelial lining of colon is shed, multiple ulcerations exact cause unknown; triggered poss. Infection, allergy, emotional stress- generally starts in the rectum, as a rule no healthy tissue appears between inflammed areas
ulcerative colitis
A collection of pus in the perianal area
Anorectal Abscess
S/Sx of anorectal Abscess
Pain, redness and swelling of the area, drainage and fever
Inflammation of the liver from exposure to infectious microorganism, hepatotoxic chemicals or drugs
hepatitis
s/s of hepatitis
fatigue, abdominal tenderness, color of skin and eyes, vleeding- prolonged prothrombin- vital signs- low grade fever
Liver cells are infiltrated with fat and WBCs, then replaced with fibrotic tissue changing obstruction of hepatic blood flow and normal liver function- Decr. absorp.and utilization of fat soluble vitamins such as ADEK
Hepatitis
_____ hepatitis can lead to cirrhosis, chronic hepatitis or even death
Viral
Type __ viral hepatitis- contaminated food, water, milk, through feces incubation period- 3-7 weeks
Type __ hepatitis-blood transfusions, needle sticks, a cause of acute and chronic hepatitis/world- incubation period 1 week- months
C
Type __ hepatitis- a coinfection with HBV- transmitted
Type D
Type __ hepatitis- usuallyu contaminated water, similar to HAV seen in poor contries, inadequate sanitation, incubation period 2-9 weeks
E
Chronic, progressive disease characterized by inflammation, fibrosis, and degeneration of liver parenchymal cells
Cirrhosis
S/S of Chronic liver failure
malaise, anorexia, indigestion, nausea, weight loss, diarrhea or constipation, and dull aching RUQ pain. Liver may be enlarged, firm, and tender. Bruising of the skin, bleeding gums, anemia, and maybe jaundice (known and icterus) may have sever pruritus
pathophys of liver failure
dilated blood vessels in the esophagus, develops from portal HTN (pressure rises in the portal vein from blocked blood flow in the liver) -DX- endoscopy
S/S of acute pancreatitis
usually intense pain, rigid abdomen, pain in midline below sternum, pain radiating to spine, shoulders, low back, low-grade fever, dry mucous membranes, tachycardia, if biliary, nausea, vomiting, jaundice- increased amylase, liver enzymes and bilirubin
A progressive inflammatory disorder with destruction of the pancreas. Cells are replaced by fibrous tissue, and pressure within the pancrease increases.
chronic pancreatitis
Etiology of chronic pancreatitis
alcohol consumption, gallstones blocking the pancreatic duct, trauma to the abdomen, or infection
A progressive disease, irreversible, normal pancreatic tissue is replaced by connective tissue, enzyme production decreases, pancreas becomes small and hardened- usual age 45-60, then live 25 years
Chronic pancreatitis
Functions of the liver
Carbohydrate metabolism
Amino Acid metabolism
Lipid metabolism
Synthesis of Plasma Proteins
Phagocytosis by Kapffer Cells
Synthesizes albumin
Formation of Bilirubin
Storage of minerals, iron and Copper, stores vitamins A,D,E,K