Gastrointestinal and Hepatobiliary Disorders Review

A comprehensive set of question-and-answer flashcards covering esophageal, gastric, intestinal, hepatobiliary, pancreatic, and peritoneal disorders, their clinical manifestations, diagnostics, management, and key nursing considerations.

What is the primary physiologic problem in gastroesophageal reflux disease (GERD)?

Incompetent lower esophageal sphincter allows excessive back-flow of gastric or duodenal contents into the esophagus.

Name four hallmark clinical manifestations of GERD.

Pyrosis (burning), dyspepsia, dysphagia, and hypersalivation/esophagitis.

Which diagnostic studies confirm GERD?

Endoscopy or barium swallow and 12-36-hour ambulatory esophageal pH monitoring.

List the main drug classes used to treat GERD.

Antacids, H2-receptor antagonists, proton-pump inhibitors (PPIs), and prokinetic agents.

What surgical procedure is commonly performed for refractory GERD?

Nissen fundoplication—wrapping the gastric fundus around the lower esophagus to strengthen the sphincter.

Define Barrett's esophagus.

Metaplastic change of the esophageal lining from squamous to columnar cells, often due to chronic GERD; precursor to esophageal cancer.

Differentiate the two types of hiatal hernia.

Sliding: GE junction and stomach slide upward; Paraesophageal: part or all of stomach herniates beside the esophagus.

State two typical symptoms of a hiatal hernia.

Heartburn and regurgitation (may also include dysphagia or chest fullness).

Give two lifestyle teaching points for a patient with either GERD or hiatal hernia.

Eat low-fat meals, avoid lying down or wearing tight clothes after eating; elevate head of bed 6-8 inches.

List three common causes of acute or chronic gastritis.

Irritating foods/ETOH, NSAID or aspirin overuse, Helicobacter pylori infection (others: bile reflux, radiation, caustic ingestion).

Name four key symptoms of gastritis.

Abdominal discomfort, nausea/vomiting, heartburn after eating, vitamin B12 deficiency.

Which bacteria is strongly associated with peptic ulcer disease (PUD)?

Helicobacter pylori.

When does duodenal ulcer pain usually occur relative to meals?

2–3 hours after eating and is relieved by food.

State one classic difference between gastric and duodenal ulcer bleeding patterns.

Gastric ulcer—hematemesis more common; Duodenal ulcer—melena more common.

List the four major drug groups for PUD therapy.

H2 blockers, proton-pump inhibitors, antibiotics for H. pylori, and antacids/cytoprotective agents (e.g., sucralfate).

Describe Dumping syndrome in one sentence.

A group of vasomotor and GI symptoms (nausea, cramping, diarrhea, tachycardia, dizziness) occurring ~30 min after meals due to rapid gastric emptying following gastric surgery.

Give two dietary strategies to prevent Dumping syndrome.

Lie down after meals and consume small, dry, low-carbohydrate meals while avoiding fluids with meals.

Differentiate diverticulosis from diverticulitis.

Diverticulosis: multiple non-inflamed outpouchings; Diverticulitis: inflammation/infection of diverticula with pain and possible complications.

What diet is recommended in uncomplicated diverticulosis?

Soft, high-fiber foods with adequate fluids.

Which analgesic is contraindicated in diverticulitis and why?

Morphine; it can increase intraluminal pressure and worsen symptoms.

Describe the pathologic pattern of Crohn’s disease.

Transmural inflammation anywhere in the GI tract (most often ileum/colon) with thickening, scarring, fistulas, ‘cobblestone’ lesions.

State three common manifestations of Crohn’s disease.

Crampy post-prandial pain, semisolid diarrhea possibly with mucus/pus, weight loss.

How does ulcerative colitis differ from Crohn’s in location and depth?

UC affects mucosal/submucosal layers of colon/rectum only; Crohn’s is transmural and can involve entire GI tract.

What stool pattern is typical in ulcerative colitis?

Frequent (10–20/day) liquid stools with blood and mucus.

Name the first-line drug class for mild-to-moderate IBD flare.

Salicylate compounds such as mesalamine (5-ASA).

What surgical procedure provides a permanent cure for ulcerative colitis?

Total proctocolectomy with permanent ileostomy.

Identify the classic pain location in appendicitis.

Right lower quadrant (McBurney’s point) after vague periumbilical pain.

What is Rovsing’s sign?

Palpation of the left lower quadrant causes pain in the right lower quadrant—suggestive of appendicitis.

Post-appendectomy, why is the patient placed in high-Fowler’s position?

Reduces tension on incision and abdominal organs, decreasing pain.

List two common symptoms of external hemorrhoids.

Severe anal pain and bright-red bleeding with defecation.

Give two conservative measures to relieve hemorrhoid discomfort.

Warm sitz baths and a high-residue diet with increased fluid to avoid straining.

Which four lobes comprise the liver?

Right, left, caudate, and quadrate lobes.

What are the hallmark signs of the icteric stage of viral hepatitis?

Jaundice, dark urine, pale stool, pruritus, and enlarged tender liver.

State the primary transmission route for Hepatitis A and its typical outcome.

Fecal–oral transmission; usually mild and self-limiting with complete recovery.

Name three major types of cirrhosis and their usual causes.

Laennec’s (alcohol), biliary (bile duct disease), post-hepatic/post-necrotic (viral hepatitis or toxins).

Why is dietary protein restricted in late-stage cirrhosis?

To decrease ammonia production and reduce risk of hepatic encephalopathy.

Define portal hypertension.

Elevated pressure within the portal venous system caused by resistance to blood flow through the liver.

State two major complications of portal hypertension.

Ascites and development/rupture of esophageal or rectal varices.

What emergency device controls bleeding esophageal varices and what must be kept at bedside?

Sengstaken-Blakemore tube; keep scissors to cut the tube if respiratory distress occurs.

Explain how lactulose treats hepatic encephalopathy.

It acidifies the colon, traps ammonia in the gut, and acts as a laxative to eliminate ammonia.

Give two classic signs of hepatic encephalopathy on physical exam.

Asterixis (flapping tremor) and fetor hepaticus (sweet, fecal breath odor).

List four risk factors for gallstone formation (cholelithiasis).

Obesity, female sex/multiple pregnancies, rapid weight loss, and diabetes mellitus (others: high-estrogen therapy, Native American ancestry).

What is Murphy’s sign?

Inspiratory arrest due to pain when palpating the right upper quadrant during deep inspiration—suggestive of cholecystitis.

Which imaging study is the diagnostic test of choice for gallstones?

Ultrasonography of the gallbladder.

Name the minimally invasive surgery most commonly used for gallbladder removal.

Laparoscopic cholecystectomy.

State two common causes of acute pancreatitis.

Alcohol abuse and gallstone obstruction of the common bile duct.

Identify Cullen’s and Turner’s signs in pancreatitis.

Cullen’s: bluish discoloration around umbilicus; Turner’s: bluish discoloration of flanks—both indicate internal hemorrhage.

Which serum enzymes are markedly elevated in acute pancreatitis?

Amylase and lipase.

What is the primary pain medication used in acute pancreatitis?

Morphine sulfate.

Why are oral foods withheld during acute pancreatitis?

To suppress pancreatic stimulation and enzyme secretion, allowing the pancreas to rest.

Describe the typical stool in chronic pancreatitis and its cause.

Frequent, frothy, foul-smelling steatorrhea due to fat malabsorption from enzyme deficiency.

Which surgery drains the pancreatic duct into the jejunum for chronic pancreatitis pain relief?

Pancreatic jejunostomy (Roux-en-Y).

List three common causes of secondary peritonitis.

Perforated ulcer, ruptured appendix, or bowel perforation (also diverticulitis, abdominal trauma, PD infection).

What patient position relieves peritonitis pain and why?

Side-lying with knees flexed; reduces tension on inflamed peritoneal surfaces.

Which electrolyte abnormalities are anticipated in severe peritonitis?

Decreased potassium, sodium, and chloride levels due to third-spacing and GI losses.