exam 3 - GI disorders

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giep
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77100
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exam 3 - GI disorders
Updated:
2011-04-03 20:16:02
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nurse
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GI disorders
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  1. acute inflammation of the veriform appendix (the blind pouch attached to the cecum of the colon)
    appendicitis
  2. what is the initial manifestation of appendicitis
    abd pain in epigastric or periumbilical area
  3. is mcburney's point an early or late sign of appendicitis?
    late
  4. what are s/s of perforation
    • rebound tenderness
    • increase pain with coughing
    • relief of pain w/ fetal position
    • wbc >20,000

    *no perforation wbc 10-18000
  5. other s/s of appendicitis
    nv, anorexia
  6. where is mcburney's point located?
    RL quadrant
  7. causes of appendicitis
    • obstruction of opening of appendix by fecaliths,
    • malig tumors,
    • worms,
    • other infections,
    • unknown
  8. pathophysiology of appendicitis
    • blocked lumen>
    • infection (as bacterial invades pancreas walls)>
    • increased internal pressure>
    • decreased blood flow>
    • PAIN
  9. appendicitis w/ perforation has increased risk for what?
    peritonitis
  10. appendicitis:
    nonsurgical interventions
    • NPO
    • iv fluids
    • semi-fowler position
    • analgesics
    • no laxatives or enemas
    • no heat
  11. why would someone suspected of having an appendicitis be put in a semi-fowler's position
    • decrease pain
    • prevent infected fluids from going up
    • keep abd fluid localized
  12. what is done to rule out appendicitis
    • laparoscopy
    • laparotomy
  13. surgical management of appendicitis
    appendectomy
  14. post op care of appendectomy
    • vs
    • deep breathe
    • ambulation
    • pain management
    • bs
    • lbm
    • gas
    • nv
    • ABX!!!!!
  15. this is a life-threataening acute inflammation of visceral/parietal peritoneum and endothelial lining of abd cavity or peritoneum
    peritonitis

    *contaminated by bacteria > walling off (a localized area)> inflamm reaction
  16. peritonitis:
    if walling off fails what happens???
    massive inflammation and contamination
  17. what are some causes of peritonitis
    • bacteria
    • chemicals
    • perforating tumors
    • leakage/contamination during surgery
    • infected CAPD catheter
    • perforation (appendicitis, diverticulitis, peptic ulcer disease)
    • external penetrating wound
    • gangrenous gall bladder
    • bowel bostruciton
    • peritoneal dialysis
  18. why might diffuse peritonitis occur?
    if theres a delay in diagnosis or treatment
  19. what can DIFFUSE PERISTALSIS do to the peristalsis
    slows or stops it

    *potential for septicemia
  20. DIFFUSE PERITONITIS may increase abd presure and distention. this increases the risk for what??
    risk for resp problems

    *bigger and bigger stomach pushes diaphragm up decreasing deep breathing
  21. what can third spacing into the peritoneal cavity result in?
    loss of circulatory volume

    *increase risk for hypovolemic shock and kidney failure
  22. how does third spacing happen in peritonitis?
    infection continues therefore shunting extra blood to that area continues

    fluid shifts from the extracellular fluid compartment into the peritoneal cavity, connective tissue, and GI tract
  23. cardinal signs of of peritonitis
    • abdominal pain
    • tenderness

    ***start thinking peritonitis
  24. other manifestations of peritonitis
    • rigid, boardlike abd
    • abd pain
    • distended abd
    • fever
    • tachycardia
    • dehydration
    • low urine ouput
    • hiccups
    • compromised resp status
    • nv
  25. dx of peritonitis
    • increased wbc
    • blood cultures
    • PD fluid
    • xray - dilation, edema, and inflammation of small and large intestine
  26. nonsurgical management of peritonitis
    • iv fluids
    • broad spectrum ABX
    • daily wt monitored
    • fluid volume assessed
    • ng suction - rid of fluid
    • NPO status
    • o2
    • pain managment

    *avoid resp issues by decompression of stomach
  27. surgical management of peritonitis
    exploratory laparotomy
  28. peritonitis
    post op care
    • semi fowlers position
    • wound care:
    • care of incisions and drains
    • peritoneal irrigation
    • IV fluid replacement
  29. inflammation of the gastrointestinal tract
    gastroenteritis
  30. increase int he frequency and water content of stools or vomiting results form this condition
    gastroenteritis - inflamm of mucous membranes of stomachand intestinal track
  31. which part of the GI tract does gastroenteritis mainly affect
    small bowel
  32. the gastroenteritis the same as food poisoning?
    no!!

    *differens from food poisoning with regard to transmission in the body, incubation time, and effect on immunity
  33. gastroenteritis:
    bacterial form
    • Campylobacter*
    • Shigella
    • Escherichia coli*

    *2 forms of travellers diarrhea
  34. gastroenteritis:
    viral form
    norwalk virus

    *cruise ship
  35. gastroenteritis occurs in epidemic outbreaks where?
    • asia
    • africa
    • latin america

    *most common cause of morbidity and morality
  36. manifestations of GASTROENTERITIS
    • myalgia
    • headache
    • malaise
    • dehydration
    • abd cramps
    • nv
    • foul smelling stool
    • bloody stool

    *depends on causative organism; varies based on incubation time, trasmission, effects
  37. what's important to know about gastroenteritis
    it's self limiting unless complications occur
  38. nursing interventions for gastroenteritis
    • WASH HANDS!!!!
    • stool culture
    • fluid replacement
    • nutrtion therapy
    • skin care
    • health teaching
    • drug therapy:
    • anticholinergics and antiemetics are not routinely given
    • abx if bacterial
  39. dysenteries affect the ____ bowel while gastroenteritis affects the ____ bowel
    • large
    • small
  40. name the 3 round worms
    • 1. enterobiasis "pinworms"
    • 2. trichinosis
    • 3. hook worms
  41. pinworms are aka
    enterobiasis
  42. how is enterobiasis transmitted
    oral intake contaminated food or drink
  43. name some manifestation of pinworms or "enterobiasis"
    • perianal itching esp at night
    • vaginitis
    • vague GI sx: abd pain, nvd
  44. how is the enterobiasis dx
    eggs from perianal
  45. how is enterobiasis treated??
    • handwashing!!
    • hygiene
    • drug therapy
  46. what is the most common helminthic infection in the US
    enterbiasis "pinworm"
  47. the incidence of this type of roundworm infection is low in the US, but many mild or asymp cases go undx
    Trichinosis
  48. Trichinosis is caused by what?
    Trichinella spiralis
  49. where does Trichinella spiralis live?
    intestine of humans, pigs, bears, rats
  50. how is trichinosis transmitted?
    eating undercooked pork or pork products
  51. manifestations of trichinosis

    *wk 1, 2, 3, recovery
    • first week parasite invades gut:
    • diarrhea
    • abd pain
    • nausea
    • vomiting

    • second week larvae invade muscle:
    • hypersensitivity rxn w/ fever
    • edema of face, around eyes
    • subconjunctival hemorrhage

    • 2-3 weeks after infection:
    • myositis
    • myalgia
    • muscle wkness - low back pain neck, jaw , biceps

    • recovery can last several months:
    • fague muscle pain
    • malaise
  52. how is a trichimosis infection dx?
    • hx
    • wbc - elevated 2 wks after meat consumption
    • muscle biopsy - shows larvae

    *worms are rarely seen in feces
  53. what meds are used to treat trichomosis
    • vermox
    • high dose corticosteroids
  54. what's different about hook worms in terms of how they enter the body?
    they enter thru the SKIN

    *infection occurs when larvae penetrate thru the skin
  55. how long are hook worms infective outside the body?
    1 wek in moist soil
  56. how does the hook worm make its way around the body?
    travels to lungs (alveoli) thru bloodstream
  57. how does the hook worm make its way to the GI tract
    when they enter the alveoli > cilia carry the organism up the resp treat > pharynx > mouth > swallowed > enters GI tract
  58. what are early sx of hook worm disease
    itchy, red, reaised, blister-like infalmmation of skin
  59. infection of hookworm in the GI tract manifestations
    • no sx
    • anorexia
    • diarrhea
    • mild abd pain
    • epigastric discomfort
    • bleeding - when worms suck blood at sites in GI tract
    • anemia - if blood loss is severe
  60. this infection infects quarter of the world's population mainly in the tropics
    hook worms
  61. how is hookworm infection dx
    • eggs in feces
    • occult blood in stool
    • anemia
  62. what's the difference in dx between trichinosis and hookworms?
    • trichinosis - larvae in muscle not feces
    • hookworms - eggs in feces
  63. how to treat a hookworm infection
    • iron therapy for anemia
    • high protein diet
    • meds
  64. how bad are tapeworm infections
    • no sx
    • gi upset:
    • nd, abd pain
  65. how is tapeworm infection dx
    laboratory examination of eggs found in stool
  66. what can cause a tapeworm infection
    • consumption of undercooked:
    • beef
    • raw fish
    • contaminated food or water
    • accidental swallow of infecgted lice or fleas from dogs or COCKROACH
  67. how is tapeworm infection treated
  68. meds
  69. how to prevent tapeworm infection
    • handwashing!!!!!!
    • food prep
    • food storage

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