Patho - GI system

What is the correct sequence of abdominal assessment?

Assess (look), auscultate, percuss (Tap), palpate (push)

Why should you palpate last during abdominal assessment

To avoid increasing pain before the other assessments are complete

What are normal bowel sounds called, and how many per minute are normal?

Borborygmus: 5-30 sounds per minute and per quadrant

What causes paralytic ileus

Anesthesia (often after surgery)

How do you know that paralytic ileus has been resolved?

Return of bowel sounds or passage of gas (flatus)

Which postoperative patient should you observe most closely for paralytic ileus?

A patient who is on postoperative day 1 following gallbladder surgery

Where is the ileum/what is it a part of?

It is in the RLQ of the abdomen and is a part of the large intestines

What are the signs of dehydration?

Poor skin turgor, low urine output, capillary refill >2 seconds, dry mucus membranes.

What is normal urine specific gravity?

1.000 - 1.030

What are the classic symptoms of appendicitis

RLQ tenderness, fever, leukocytosis > 10,000, nausea, vomiting

Where is McBurney’s point located? What disease is it associated with?

RLQ - Appendicitis

What is rebound tenderness?

Increased pain when pressure is released from palpation at McBurney’s point

What characterizes Crohn’s disease?

Granulomatous lesions, “cobblestone” mucosa, and patchy areas of inflammation

What characterizes ulcerative colitis?

Continuous ulceration through the colon; no “good spots”

What are the common symptoms of Crohn’s and Ulcerative Colitis?

Diarrhea, rectal bleeding, nausea, and weight loss

What is diverticulitis?

Inflammation of diverticula in the colon

Symptoms of diverticulitis?

LLQ pain, fever, nausea, vomiting, leukocytosis

Common dietary causes?

Hard-to-digest foods such as seeds, corn, and popcorn

Treat/prevention of diverticulosis?

Increase fiber, physical activity, and water intake

Who is at risk for gallbladder disease?

Female, fat, fair, and forty

Classic symptoms of acute cholecystitis?

RUQ pain with Murphy’s sign

What is Murphy’s sign?

Pain on palpation under ribs

What causes jaundice in gallbladder?

A blocked bile duct causes bile buildup in the blood

What is occult blood?

Hidden blood in stool; detected with the Hemoccult test

What does dark (melena) stool indicate?

Upper GI bleed

Bright red stool indicates?

Lower GI bleed

What lab values confirm pancreatitis?

Elevated amylase and lipase

Common causes of pancreatitis?

Alcohol abuse and gallstones

What are the symptoms of acute pancreatitis?

LUQ/midline pain, fever, nausea, vomiting, leukocytosis, jaundice

What process occurs in acute pancreatitis?

Autodigestion of pancreatic tissue

Who is at the highest risk for chronic pancreatitis?

A person who drinks 6-8 alcoholic drinks a night

Major causes of cirrhosis?

Alcohol and Tylenol 

What are the late signs of cirrhosis?

Liver failure and portal hypertension

What is hepatic encephalopathy caused by?

Accumulation of neurotoxins like ammonia (NH3) in the brain

What are the early signs of hepatic encephalopathy?

CLARI and asterixis (hand tremors)

What is fetor hepaticus?

“Breath of death” - ammonia odor on breath

What is portal hypertension?

Increased pressure in portal circulation → splenomegaly, ascites, varices 

What causes ascites?

Too much blood in the veins

What is the treatment for ascites?

Paracentesis (drainage of fluid)

What happens if too much fluid is removed from an Ascites?

Hypovolemia, dehydration, or shock

What is the best treatment for constipation?

Increase fiber, fluid, and exercise

What are the major causes of mechanical bowel obstruction?

Postoperative adhesions

What are the signs of bowel obstruction?

Abdominal distention, vomiting, constipation, high-pitched bowel sounds early, then silenced later

What causes hepatitis?

Viral infection - inflammation of the liver

Which hepatitis types have vaccines?

A and B

How is hepatitis A transmitted?

Fecal-oral route: contaminated food/water, and poor hygiene

How is hepatitis B transmitted?

blood and body fluids

How is hepatitis C transmitted?

Sex and shared needles

What condition may result from acetaminophen overdose?

Acute fulminant hepatitis

What is the first sign of colon cancer?

Change in bowl habits

Why is colorectal cancer dangerous?

Most cases are advanced before symptoms appear

What is in each quadrant of the stomach?

Bowel sounds are?

Waves of peristalsis (movement)

Where is the appendix?

RLQ

What is Cholelithiasis?

Gallstones

Cholecystitis is?

Inflammation/disease of the gallbladder

Portal Hypertension does what to the spleen?

It will cause it to swell, and it may burst

What are esophageal varices?

Dilated veins in the lower esophagus caused by increased pressure in the portal venous system (portal hypertension)

What is colic?

pain that comes and goes in waves

What is Gastritis?

Inflammation of the stomach

What causes gastritis?

stress, alcohol, spicy food, aspirin, and NSAIDS

What are some NSAIDS?

Aspirin, Motrin, Advil

What is Helicobacter pylori? 

bacteria linked to ulcer formation and linked to stomach cancer