NR511 Comprehensive Midterm Study Guide Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common -Dx made clinically, -May have HTN\tachy -Labs are not -Surgical; preoperative -F\U with surgeon
between 10-30yrs; but based primarily on proportional to pain\ diagnostic and care, NPO, correction of -Ambulation after
can occur at any age; H&P exam symptoms nonspecific fluid\electrolyte surgery
rare in infants and older - Classic presentation -When lying flat, may -Women should have imbalances -Adv diet when
adults includes acute onset of flex R knee to relieve urine human -Avoid narcotics bowel sounds
-men more at risk mild to severe colicky, tension in abd muscle chorionic -Atb with 3rd gen return
- Diets low in fiber, high epigastric, or -Pain with palpation in gonadotrophin to r\o cephalosporin; -Return to hosp
in fat, refined sugars, & periumbilical pain abd, diffuse in early ectopic pregnancy Ex:ampicillin, gentamycin, with s\s of infection
other carbs at increased - Pain is vague at first stages. Localized to - +Rovsing’s Sign- flagyl -Avoid heavy lifting
risk. then localizes within RLQ later deep palpation & for at least 2 wks
- Obstruction of 24hrs to RLQ -Positive for rebound release in LLQ causes
appendix is cause of - Pain exacerbated by pain; ask pt to cough rebound pain in RLQ
majority of appendicitis walking\coughing to localize pain - +Psoas Sign- lift R
- contributing factors: - Men may feel location leg against gentle
Intra-abdominal radiated pain in testes -Sudden cessation of pressure causes pain
tumors, positive family - Abd muscle rigidity, pain means - +Obturator Sign-
hx N\V, anorexia perforation and is ER flex R hip & knee and
- Recent roundworm - Mildly elevated temp slowly rotate
infection or viral GI 99-100F common internally causes pain
infection - If RLQ accompanied - +McBurney’s Sign-
by shaking chills, pain with pressure
perforation should be applied to point
suspected between umbilicus &
- Older adults may ilium
present with - x-ray\CT helpful
weakness, anorexia, when paired with
abd distention, mild positive H&P findings
pain leading to delayed
dx and increased
morbidity.
Celiac disease ** Mostly diagnosed in Many asymptomatic. Muscle wasting Serologic testing for lifelong adherence to a teaching related to
(autoimmune adulthood. May complain of (anemia), reduces anti-tTG IgA antibody strict gluten-free diet. gluten free diet.
disorder caused by an diarrhea,gas, subcutaneous fat, Some people with
immunologic A family member with dyspepsia, wt loss. ataxia, & peripheral Total IgA (2% of pts Referral to a dietician to celiac disease have
response to gluten) celiac disease or Atypical symptoms: neuropathy (vitamin have IgA deficiency help. vitamin or nutrient
dermatitis herpetiformis fatigue, B12 deficiencies) and will falsely test deficiencies that do
bone or joint pain, osteoporosis or negative) Some pts may need not cause them to
Type 1 diabetes arthritis, osteopenia (bone treatment with feel ill, such as
osteoporosis, or loss) duodenal biopsies immunomodulating anemia due to iron
, NR511 Comprehensive Midterm Study Guide Worksheet
Down syndrome or osteopenia (bone loss) hypothyroidism agents. deficiency or bone
Turner syndrome liver and biliary tract Test for nutritional loss due to vitamin
disorders Pts with dermatitis deficiencies D deficiency.
Autoimmune thyroid (transaminitis, fatty herpetiformis found associated with However, these
disease liver, primary to have signs of celiac malabsorption of C.D. deficiencies can
sclerosing cholangitis, disease on intestinal (hemoglobin, iron, cause problems
Microscopic colitis depression or anxiety biopsy. folate, vit B12, over the long term.
(lymphocytic or peripheral neuropathy Calcium, and Vitamin Untreated
collagenous colitis) seizures or migraines D.) celiac/developing
missed menstrual certain types of
Addison's disease periods gastrointestinal
infertility or recurrent cancer. This risk can
miscarriage be reduced by
canker sores inside the eating a gluten-free
mouth diet.
dermatitis
herpetiformis (itchy
skin rash)
Cholelithiasis is the formation of Patient complaint of Right side involuntary Mild elevation of a. Initial management-- Nonsurgical
gallstones and is found indigestion, nausea, guarding of WBC up to 15, 000 begins with definitive intervention: weight
in 90% of patients with vomiting (after abdominal muscles, Abdominal Xray: diagnosis. When loss, avoidance of
cholecystitis. consuming meal high Positive Murphy's Quick, noninvasive, asymptomatic (normally fatty foods to
--Risk factors--2 types of in fat), and pain in RUG sign, possible palpable reliable, and cost- an incidental finding while decrease attacks,
stones (cholesterol and or epigastrium that gallbladder, Low effective means of exploring another alternative birth
pigmented) may radiate to the grade fever between identifying the problem) require no control for persons
a. Cholesterol (most middle of the back, 99-101 degrees. presence of further treatment except taking oral
common form): female, infrascapular area or Possible jaundice cholelithiasis. teaching s/sx of contraceptives,
obesity, pregnancy, right shoulder. from common bile "gallbladder attack". menopausal women
increased age, drug- duct edema and Nonsurgical candidate can taking estrogen
induced (oral diminished bowel be treated with dissolution informed about
contraceptives and sounds. therapy or lithotripsy. alternative sources
clofibrates: cholesterol Acute includes hydration of phytoestrogens
lowering agent), cystic (IV fluids), antibiotics, (soy products).
fibrosis, rapid weight analgesics, GI rest.
loss, spinal cord injury, b. Treatment of choice for
Ileal disease with Acute cholecystitis is early
extensive resection, surgical intervention after
Diabetes mellitus, sickle stabilization. Poor surgical
cell anemia. risk may benefit from
b. Pigmented: hemolytic cholecystectomy
diseases, increasing age, operatively or
hyperalimentation percutaneously.
, NR511 Comprehensive Midterm Study Guide Worksheet
(artificial supply of
nutrients, typically IV),
cirrhosis, biliary stasis,
chronic biliary
infections.
Crohn’s ** Ages 15-25 of onset and Mild-Four or fewer Tenderness in LLQ or Stool analysis to r/o Glucocorticoids, there is Pt educated on
then again at 50-80. loose bowel across entire abd with bacterial, fungal, or no cure for CD and disease process,
Familial tendency, movements per day, guarding and abd parasitic infection for treatment is aimed at diet and lifestyle
smoker can have small distension. DRE cause of diarrhea. suppressing inflammation changes. Stress
Carcinoma less common amounts of blood and performed to look for CBC to check for and symptomatic relief of reduction, adequate
in patients with CD due mucus in the stool, anal and perianal anemia, eval for complications. Initially rest to decrease
to treatment sometimes and cramping in the inflammation, rectal hypocalcemia, vit D oral prednisone 40-60 bowel motility and
colectomy rectum. Moderate-4-6 tenderness, and blood deficiency., mg/d, tapered over 2-4 promote healing.
loose bowel in stool. S/Sx of hypoalbuminemia, months, then can have Low residue diet
movements per day peritonitis and ileus and steatorrhea. LFT daily maintenance dose of when obstructive sx
containing more blood may be found to screen for primary 5-10mg/d. Sulfasalazine present such as
and mucus and other depending on severity sclerosis cholangitis, for mild to moderate CD canned fruits,
sx such as tachycardia, of crohns. Tender and other liver 500 mg BID, increased to vegetables and
weight loss, fever, mild mass in RLQ, anal problems assoc with 3-4 g/d. Clinical white bread
edema. Severe- fissure, perianal IBD. Check fluid and improvement in 3-4 wks,
frequent bloody bowel fissure, edematous electrolytes. May and then tapered to 2-3
movements (6-10), pale skin tags. Extra have elevated WBC g/d for 3-6 months, this
abd pain and intestinal finding may count and sed rate medication interferes with
tenderness, sx of be episcleritis, and prolonged folid acid absorption and
anemia, hypovolemia, erythema nodosum, prothrombin time. patient must take
impaired nutrition. nondeforming Barium upper GI supplements.
Most common sx are peripheral arthritis, series, colonoscopy, Metronidazole effective in
abd and axial arthropathy and CT to determine tx perianal disease and in
cramping/tenderness, bowel wall thickening controlling crohns colitis,
fever, anorexia, wt or abscess formation other ABT’s such as Cipro,
loss, spasm, flatulence, Ampicillin, and
RLQ pain or mass Tetracycline effective in
controlling CD ileitis, and
ileocolitis.
Immunosuppressive meds
when unresponsive to
other treatments.
Diverticulitis ** -Uncommon under -25% develop -LLQ abd tenderness -Abd x-ray can reveal -Asymptomatic cases -Increase fiber in
40yrs; risk rises after symptoms with possible Firm, free air, ileus, managed with high fiber diet to avoid
-Rare in pediatric; equal -LLQ abd pain, worsens fixed mass may be obstruction diet or fiber supplement constipation and
in men\women after eating identified in area of -Barium studies show with psyllium straining
-More common in -Pain sometimes diverticula sinus tracts, fistulas, -Mild symptoms managed -H2O intake of at
, NR511 Comprehensive Midterm Study Guide Worksheet
developed countries relieved with BM or -May have rebound obstruction outpatient with clear least 8\8oz glasses
-High in low fiber, high flatus tenderness with -Colonoscopy to r\o liquid diet and rest to promote bowel
fat\red meat diets -BM may alternate guarding\rigidity Ca, but less sensitive -Atb should not be regularity
-Obesity, chronic between diarrhea\ -Tender rectal exam; than barium for routinely used but can be -Bulk-forming
constipation, h\o constipation stool usually + for diverticula with diverticula abscess laxative may be
diverticulitis,& number -May present with occult blood -CT with contrast culture needed Ex:psyllium,
of diverticula which bleeding w\o pain or -Amoxicillin\clavulanate K FiberCon,
occur in sigmoid colon. discomfort (or) flagyl with bactrim Metamucil
-Fever, chills, tachy; -Symptoms usually subside
LLQ with anorexia, N\V quickly and diet can be
-Fistula may form advanced slowly
causing dysuria, -Pain managed with
pneumaturia, fecaluria antispasmotics Ex; Levsin,
Bentyl, BuSpar
-Avoid morphine
-NG for ileus or intractable
N\V
-Pt can be D\C’d from
hosp once able to
maintain adequate
nutrition\ hydration if
acute phase resolved
-Colon resection may be
necessary if no
improvement or
deterioration after 72hrs
of treatment
GERD ** -Can occur at any age -Heartburn; mild to -H&P usually normal -Usually Hx alone -8wk trial of PPI; weight -Weight loss, med
-Risk increases with age, severe -May be + for occult diagnoses loss, avoiding triggers compliance and
then decreases after -Regurgitation, water blood in stool -May manifest with -If unresponsive to once avoidance of
69yrs brash, dysphagia, sour atypical symptoms daily dosing; can increase triggers
-Prevalence equal taste in AM, belching, such as adult-onset to twice daily; if no relief -Small frequent
across gender, ethnic, coughing, odynophagia asthma, chronic EGD needed meals; main meal
cultural (painful swallow), cough, chronic -PPI and H2-RA should not mid-day, avoid
-Obesity, alcohol, hoarseness or laryngitis, sore throat, be taken together eating 4hrs before
caffeinated beverages, wheezing at night noncardiac chest pain -Pt’s on long term therapy bed, avoid straining,
chocolate, fruit, decaf -Substernal\ -If pt fails to respond should be re-eval’d q6mos sleep with HOB
coffee, fatty foods, retrosternal pain to 4-8wks PPI, EGD is elevated, smoking
onions, peppermint\ -Worsens if reclined ordered cessation, stress
spearmint, tomato after eating, eating -EGD warranted over mgmt
products large meals, empiric treatment
Anticholinergics, beta- constrictive clothing when heartburn &
