NR511 Midterm Study Guide
Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common -Dx made -May have HTN\ -Labs are not -Surgical; preoperative -F\U with surgeon
between 10-30yrs; but clinically, based tachy proportional to diagnostic and care, NPO, correction -Ambulation after
can occur at any age; primarily on H&P pain\symptoms nonspecific of fluid\electrolyte surgery
rare in infants and exam -When lying flat, may -Women should have imbalances -Adv diet when
older adults - Classic presentation flex R knee to relieve urine human -Avoid narcotics bowel sounds
-men more at risk includes acute onset tension in abd chorionic -Atb with 3rd gen return
- Diets low in fiber, high of mild to severe muscle gonadotrophin to r\o cephalosporin; Ex: -Return to hosp
in fat, refined sugars, & colicky, epigastric, or -Pain with palpation in ectopic pregnancy ampicillin, gentamycin, with s\s of infection
other carbs at periumbilical pain abd, diffuse in early - +Rovsing’s Sign- flagyl -Avoid heavy lifting
increased risk. - Pain is vague at stages. Localized to deep palpation & for at least 2 wks
- Obstruction of first then localizes RLQ later release in LLQ
appendix is cause of within 24hrs to RLQ -Positive for rebound causes rebound pain
majority of appendicitis - Pain exacerbated by pain; ask pt to cough in RLQ
- contributing factors: walking\coughing to localize pain - +Psoas Sign- lift R
Intra-abdominal - Men may feel location leg against gentle
tumors, positive radiated pain in -Sudden cessation of pressure causes pain
family hx testes pain means - +Obturator Sign-
- Recent roundworm - Abd muscle perforation and is ER flex R hip & knee and
infection or viral GI rigidity, N\V, slowly rotate
infection anorexia internally causes pain
- Mildly elevated - +McBurney’s Sign-
temp 99-100F pain with pressure
common applied to point
- If RLQ accompanied between umbilicus &
by shaking chills, ilium
perforation should - x-ray\CT helpful
be suspected when paired with
- Older adults may positive H&P findings
present with
weakness, anorexia,
abd distention, mild
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 strict gluten-free diet. gluten free diet.
disorder caused by an diarrhea, gas, subcutaneous fat, antibody Some people with
immunologic A family member with dyspepsia, wt loss. ataxia, & peripheral Referral to a dietician celiac disease have
response to gluten) celiac disease or Atypical symptoms: neuropathy (vitamin Total IgA (2% of to help. vitamin or nutrient
dermatitis herpetiformis fatigue, B12 deficiencies) pts have IgA deficiencies that do
bone or joint osteoporosis or deficiency and will Some pts may need not cause them to
Type 1 diabetes pain, arthritis, osteopenia (bone falsely test treatment with feel ill, such as
osteoporosis, or loss) negative) immunomodulating anemia due to iron
duodenal biopsies
, NR511 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
disorders Pts with dermatitis deficiencies vitamin D
Autoimmune thyroid (transaminitis, fatty herpetiformis found associated with deficiency.
disease liver, primary to have signs of celiac malabsorption of C.D. However, these
sclerosing cholangitis, disease on intestinal (hemoglobin, iron, deficiencies can
Microscopic colitis depression or anxiety biopsy. folate, vit B12, cause problems
(lymphocytic or peripheral neuropathy Calcium, and Vitamin over the long term.
collagenous colitis) seizures or migraines D.) Untreated
missed menstrual celiac/developing
Addison's disease periods certain types of
infertility or recurrent gastrointestinal
miscarriage cancer. This risk
canker sores inside can be reduced by
the mouth eating a gluten-free
dermatitis diet.
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 sign, possible palpable reliable, and cost- an incidental finding while decrease attacks,
stones (cholesterol and RUG or epigastrium gallbladder, Low effective means of exploring another alternative birth
pigmented) that may radiate to grade fever between identifying the problem) require no control for persons
a. Cholesterol (most the middle of the 99-101 degrees. presence of further treatment except taking oral
common form): female, back, infrascapular Possible jaundice cholelithiasis. teaching s/sx of contraceptives,
obesity, pregnancy, area or 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 informed about
contraceptives and sounds. dissolution therapy or alternative sources
clofibrates: cholesterol lithotripsy. Acute includes of phytoestrogens
lowering agent), cystic hydration (IV fluids), (soy products).
fibrosis, rapid weight antibiotics, analgesics, GI
loss, spinal cord injury, rest.
Ileal disease with b. Treatment of choice for
extensive resection, Acute cholecystitis is early
Diabetes mellitus, surgical intervention after
sickle cell anemia. stabilization. Poor surgical
b. Pigmented: hemolytic risk may benefit from
diseases, increasing cholecystectomy
age, hyperalimentation operatively or
percutaneously.
, NR511 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, mass in RLQ, anal problems assoc with 3-4 g/d. Clinical white bread
mild edema. Severe- fissure, perianal IBD. Check fluid and improvement in 3-4 wks,
frequent bloody fissure, edematous electrolytes. May and then tapered to 2-3
bowel movements (6- pale skin tags. Extra have elevated WBC g/d for 3-6 months, this
10), abd pain and intestinal finding may count and sed rate medication interferes
tenderness, sx of be episcleritis, and prolonged with folid acid absorption
anemia, hypovolemia, erythema nodosum, prothrombin time. and 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 -Asymptomatic cases -Increase fiber in
40yrs; risk rises after symptoms with possible Firm, reveal 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 Midterm Study Guide
Worksheet
developed countries relieved with BM -May have rebound obstruction outpatient with clear least 8\8oz
-High in low fiber, or flatus tenderness with -Colonoscopy to r\o liquid diet and rest glasses to
high fat\red meat -BM may alternate guarding\rigidity Ca, but less sensitive -Atb should not be promote bowel
diets between -Tender rectal exam; than barium for routinely used but can be regularity
-Obesity, chronic diarrhea\ stool usually + for diverticula with diverticula abscess -Bulk-forming
constipation, h\o constipation occult blood -CT with contrast culture laxative may be
diverticulitis, & number -May present with -Amoxicillin\clavulanate K needed Ex:
of diverticula which bleeding w\o pain or (or) flagyl with bactrim psyllium, FiberCon,
occur in sigmoid colon. discomfort -Symptoms usually subside Metamucil
-Fever, chills, tachy; quickly and diet can be
LLQ with anorexia, N\ advanced slowly
V -Pain managed with
-Fistula may form antispasmotics Ex; Levsin,
causing dysuria, Bentyl, BuSpar
pneumaturia, fecaluria -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 loss, med
-Risk increases with age, severe -May be + for diagnoses weight loss, avoiding compliance and
then decreases after -Regurgitation, water occult blood in -May manifest with triggers avoidance of
69yrs brash, dysphagia, sour stool atypical symptoms -If unresponsive to once triggers
-Prevalence equal taste in AM, belching, such as adult-onset daily dosing; can increase -Small frequent
across gender, ethnic, coughing, asthma, chronic to twice daily; if no relief meals; main meal
cultural odynophagia (painful cough, chronic EGD needed mid-day, avoid
-Obesity, alcohol, swallow), hoarseness laryngitis, sore throat, -PPI and H2-RA should not eating 4hrs before
caffeinated beverages, or wheezing at night noncardiac chest pain be taken together bed, avoid
chocolate, fruit, decaf -Substernal\ -If pt fails to respond -Pt’s on long term therapy straining, sleep with
coffee, fatty foods, retrosternal pain to 4-8wks PPI, EGD should be re-eval’d HOB elevated,
onions, peppermint\ -Worsens if reclined is ordered q6mos smoking cessation,
spearmint, tomato after eating, eating -EGD warranted over stress mgmt
products large meals, empiric treatment
Anticholinergics, beta- constrictive clothing when heartburn &
Worksheet
Disease Risk Subjective Finding Objective Findings Diagnostics Treatment Education
GI DISORDERS
Appendicitis -Most common -Dx made -May have HTN\ -Labs are not -Surgical; preoperative -F\U with surgeon
between 10-30yrs; but clinically, based tachy proportional to diagnostic and care, NPO, correction -Ambulation after
can occur at any age; primarily on H&P pain\symptoms nonspecific of fluid\electrolyte surgery
rare in infants and exam -When lying flat, may -Women should have imbalances -Adv diet when
older adults - Classic presentation flex R knee to relieve urine human -Avoid narcotics bowel sounds
-men more at risk includes acute onset tension in abd chorionic -Atb with 3rd gen return
- Diets low in fiber, high of mild to severe muscle gonadotrophin to r\o cephalosporin; Ex: -Return to hosp
in fat, refined sugars, & colicky, epigastric, or -Pain with palpation in ectopic pregnancy ampicillin, gentamycin, with s\s of infection
other carbs at periumbilical pain abd, diffuse in early - +Rovsing’s Sign- flagyl -Avoid heavy lifting
increased risk. - Pain is vague at stages. Localized to deep palpation & for at least 2 wks
- Obstruction of first then localizes RLQ later release in LLQ
appendix is cause of within 24hrs to RLQ -Positive for rebound causes rebound pain
majority of appendicitis - Pain exacerbated by pain; ask pt to cough in RLQ
- contributing factors: walking\coughing to localize pain - +Psoas Sign- lift R
Intra-abdominal - Men may feel location leg against gentle
tumors, positive radiated pain in -Sudden cessation of pressure causes pain
family hx testes pain means - +Obturator Sign-
- Recent roundworm - Abd muscle perforation and is ER flex R hip & knee and
infection or viral GI rigidity, N\V, slowly rotate
infection anorexia internally causes pain
- Mildly elevated - +McBurney’s Sign-
temp 99-100F pain with pressure
common applied to point
- If RLQ accompanied between umbilicus &
by shaking chills, ilium
perforation should - x-ray\CT helpful
be suspected when paired with
- Older adults may positive H&P findings
present with
weakness, anorexia,
abd distention, mild
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 strict gluten-free diet. gluten free diet.
disorder caused by an diarrhea, gas, subcutaneous fat, antibody Some people with
immunologic A family member with dyspepsia, wt loss. ataxia, & peripheral Referral to a dietician celiac disease have
response to gluten) celiac disease or Atypical symptoms: neuropathy (vitamin Total IgA (2% of to help. vitamin or nutrient
dermatitis herpetiformis fatigue, B12 deficiencies) pts have IgA deficiencies that do
bone or joint osteoporosis or deficiency and will Some pts may need not cause them to
Type 1 diabetes pain, arthritis, osteopenia (bone falsely test treatment with feel ill, such as
osteoporosis, or loss) negative) immunomodulating anemia due to iron
duodenal biopsies
, NR511 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
disorders Pts with dermatitis deficiencies vitamin D
Autoimmune thyroid (transaminitis, fatty herpetiformis found associated with deficiency.
disease liver, primary to have signs of celiac malabsorption of C.D. However, these
sclerosing cholangitis, disease on intestinal (hemoglobin, iron, deficiencies can
Microscopic colitis depression or anxiety biopsy. folate, vit B12, cause problems
(lymphocytic or peripheral neuropathy Calcium, and Vitamin over the long term.
collagenous colitis) seizures or migraines D.) Untreated
missed menstrual celiac/developing
Addison's disease periods certain types of
infertility or recurrent gastrointestinal
miscarriage cancer. This risk
canker sores inside can be reduced by
the mouth eating a gluten-free
dermatitis diet.
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 sign, possible palpable reliable, and cost- an incidental finding while decrease attacks,
stones (cholesterol and RUG or epigastrium gallbladder, Low effective means of exploring another alternative birth
pigmented) that may radiate to grade fever between identifying the problem) require no control for persons
a. Cholesterol (most the middle of the 99-101 degrees. presence of further treatment except taking oral
common form): female, back, infrascapular Possible jaundice cholelithiasis. teaching s/sx of contraceptives,
obesity, pregnancy, area or 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 informed about
contraceptives and sounds. dissolution therapy or alternative sources
clofibrates: cholesterol lithotripsy. Acute includes of phytoestrogens
lowering agent), cystic hydration (IV fluids), (soy products).
fibrosis, rapid weight antibiotics, analgesics, GI
loss, spinal cord injury, rest.
Ileal disease with b. Treatment of choice for
extensive resection, Acute cholecystitis is early
Diabetes mellitus, surgical intervention after
sickle cell anemia. stabilization. Poor surgical
b. Pigmented: hemolytic risk may benefit from
diseases, increasing cholecystectomy
age, hyperalimentation operatively or
percutaneously.
, NR511 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, mass in RLQ, anal problems assoc with 3-4 g/d. Clinical white bread
mild edema. Severe- fissure, perianal IBD. Check fluid and improvement in 3-4 wks,
frequent bloody fissure, edematous electrolytes. May and then tapered to 2-3
bowel movements (6- pale skin tags. Extra have elevated WBC g/d for 3-6 months, this
10), abd pain and intestinal finding may count and sed rate medication interferes
tenderness, sx of be episcleritis, and prolonged with folid acid absorption
anemia, hypovolemia, erythema nodosum, prothrombin time. and 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 -Asymptomatic cases -Increase fiber in
40yrs; risk rises after symptoms with possible Firm, reveal 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 Midterm Study Guide
Worksheet
developed countries relieved with BM -May have rebound obstruction outpatient with clear least 8\8oz
-High in low fiber, or flatus tenderness with -Colonoscopy to r\o liquid diet and rest glasses to
high fat\red meat -BM may alternate guarding\rigidity Ca, but less sensitive -Atb should not be promote bowel
diets between -Tender rectal exam; than barium for routinely used but can be regularity
-Obesity, chronic diarrhea\ stool usually + for diverticula with diverticula abscess -Bulk-forming
constipation, h\o constipation occult blood -CT with contrast culture laxative may be
diverticulitis, & number -May present with -Amoxicillin\clavulanate K needed Ex:
of diverticula which bleeding w\o pain or (or) flagyl with bactrim psyllium, FiberCon,
occur in sigmoid colon. discomfort -Symptoms usually subside Metamucil
-Fever, chills, tachy; quickly and diet can be
LLQ with anorexia, N\ advanced slowly
V -Pain managed with
-Fistula may form antispasmotics Ex; Levsin,
causing dysuria, Bentyl, BuSpar
pneumaturia, fecaluria -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 loss, med
-Risk increases with age, severe -May be + for diagnoses weight loss, avoiding compliance and
then decreases after -Regurgitation, water occult blood in -May manifest with triggers avoidance of
69yrs brash, dysphagia, sour stool atypical symptoms -If unresponsive to once triggers
-Prevalence equal taste in AM, belching, such as adult-onset daily dosing; can increase -Small frequent
across gender, ethnic, coughing, asthma, chronic to twice daily; if no relief meals; main meal
cultural odynophagia (painful cough, chronic EGD needed mid-day, avoid
-Obesity, alcohol, swallow), hoarseness laryngitis, sore throat, -PPI and H2-RA should not eating 4hrs before
caffeinated beverages, or wheezing at night noncardiac chest pain be taken together bed, avoid
chocolate, fruit, decaf -Substernal\ -If pt fails to respond -Pt’s on long term therapy straining, sleep with
coffee, fatty foods, retrosternal pain to 4-8wks PPI, EGD should be re-eval’d HOB elevated,
onions, peppermint\ -Worsens if reclined is ordered q6mos smoking cessation,
spearmint, tomato after eating, eating -EGD warranted over stress mgmt
products large meals, empiric treatment
Anticholinergics, beta- constrictive clothing when heartburn &
