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Jean Inman_ Domain II Part II - Questions with Explanations of Answers
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Jean Inman_ Domain II Part II - Questions with Explanations of Answers

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  • June 16, 2024
  • 15
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

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  • jean inman domain ii part ii questions with exp

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Jean Inman: Domain II Part II
GI Ulcer - ✅✅--Eroded mucosal lesion
-Tx: Antacids, antibiotics if d/t *H. Pylori*

-Drug therapy: Cimetidine, Ranitidine...H2 blocker; prevents binding of histamine to
receptor, decreases acid secretion

-Diet: as tolerated, well-balanced, avoid late night snacks.

-Omit gastric irritants: Cayenne + Black pepper, large amounts of chili powder,
excess caffeine or etoh

Hiatal Hernia - ✅✅--Protrusion of the stomach above the diaphram into the chest
-Diet: *Small* frequent bland feedings, avoid late night snacks, caffeine, chili powder
and black pepper

Dumping Syndrome - ✅✅--*Follows a gastrectomy* (Billroth I, II)
-S/s: Cramps/full feeling, rapid pulse, weakness, perspiration, dizziness

-When rapidly hydrolyzed, CHO enters jejunum, water is drawn into GI
osmotically...casuses decrease in in vascular fluid compartment and peripheral
vascular resistance....BP drops....could cause reactive hypoglycemia....

Billroth I - ✅✅--Also known as gastroduodenostomy
-Attaches remaining stomach to duodenum

Billroth II - ✅✅--Also known as gastrojejunostomy
-Attaches it to the jejunum. When food bypasses the duodenum, the secretion of
secretin and pancreozymin by the duodenum is reduced. These hormones normally
stimulate hte pancreas, so now little pancreas secretion.

-*Calcium and iron absorption are adversly affected*

Considerations in Billroth I and II - ✅✅-*Anemia*
-B12 deficiency - lack of instrinsic factor and bacteral overgrowth in loop being
bypassed interfere w/ B12 abs....pernicious anemia dx using "Schilling Test"

, -Folate deficiency - needs B12 to transport inside the cell, also d.t poor folate intake
and low serum iron


*Diet*

-Small frequent, dry feedings
-Fluid only before or after meals
-Restrict hypertonic concentrated sweets...50-60% complex CHO...Lactose may be
poorly tolerated
-Protein at each meal
-Moderate fat
-B12 injections may be needed

Gastroparesis - ✅✅ --Delayed gastric emptying...could be d/t surgery, DM (high BG
detrimental to gastric nerves), viral infections, obstruction

-Prokinetics such as erythromycin, metoclopramid increase stomach contractility

-Diet: small frequent meals, pureed food, avoid high fiber, avoid high fat (liquid fat
may be better tolerated)

-Bezoar formation may be d/t undigested food or meds...tx includes enzyme or
endoscoptic therapy

Tropical sprue - ✅✅--Bacterial, viral, parasitic infection
-Chronic GI distress, intestinal lesions, may also effect stomach

-Diarrhea, malnutrition, deficiencies of B12 and folate d/t decreased HCl and intrinsic
factor

-Tx: antibiotics, high calories, high protein, B12 injections, oral folate supps

Celiac disease, gluten induced enteropathy (non-tropical sprue) - ✅✅ --Gluten
refers to large stoarge proteins (*Prolamins*: gliadin in wheat, secalin in rye, hordein
in barley, avenin in oats)

-Rxn to gliadin affects jejunum and ileum (proximal intestine)

-Malabsorption...leads to loss of fat soluble vitamins, macrocytic anemia, weight loss,
diarrhea, steatorrhea, iron deficiency anemia

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