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Essentials of Pathophysiology (NUR 2063) – Exam 2 blueprint 1
GI disorders
Dysphagia Difficulty swallowing
o Causes Nero disease: Parkinson’s, dementias, muscular dystrophy, Huntington’s, ALS, MN,
Guillain Barre Syndrome. Other: Congenital issues/cerebral palsy, Esophageal stenosis,
esophageal diverticula, tumors, stroke, achalasia
Vomiting – why and consequences Why: protect against substance, reverse peristalsis, increase
intracranial pressure, severe pain. Consequences: lead to fluid, electrolyte, pH imbalance, aspiration
o Emesis types and why the emesis would be a problem Hematemesis: blood in vomit (protein),
Yellow/green: presence of bile. Deep brown: fecal matter. Undigested food
o Treatment of vomiting disorders Antiemetic med., fluid replacement, correct electrolyte
imbalance, restore acid-base
Esophageal disorders
o Hiatal hernia Stomach section protrudes through diaphragm
Causes: Weakening of diaphragm muscle, trauma, congenital defects. Manifestation:
Indigestion; heartburn; frequent belching; nausea; chest pain; strictures; dysphagia; and
soft abdominal mass. diagnosis: H & P; barium swallow; upper GI Xrays; EGD, treatment:
eat small meals, sleep elevated, antacid
o GERD
Causes: Certain foods: chocolate, caffeine, carbonated beverages, citrus fruit, tomatoes,
spicy or fatty foods, peppermint , Alcohol consumption; nicotine, Hiatal hernia, Obesity;
pregnancy, Certain medications – such as corticosteroids; beta blockers; calcium-channel
blockers; anticholinergics, NG intubation, Delayed gastric emptying
Manifestations: Heartburn, Epigastric pain, Dysphagia, Dry cough, Laryngitis
Pharyngitis, Food regurgitation, Sensation of lump in throat
Diagnosis: H & P; barium swallow; EGD; esophageal pH monitoring
Treatments: Avoid triggers; avoid restrictive clothing, Eat small frequent meals; high
Fowler’s positioning, Weight loss; stress reduction; Antacids; acid reducing agent;
mucosal barrier agents, Herbal therapies (licorice, chamomile), Surgery
Complications: Esophagitis; strictures; ulcerations; esophageal cancer; chronic
pulmonary disease
o Gastritis/gastroenteritis
Acute: Can be mild, transient irritation or can be severe ulceration with hemorrhage,
Usually develops suddenly, Likely to also have nausea & epigastric pain
Chronic: Develops gradually
May be asymptomatic but usually accompanied by dull epigastric pain and a sensation of
fullness after minimal intake
Complications: peptic ulcer; gastric cancer; hemorrhage
H. pylori: Most common cause of chronic gastritis
Bacteria embeds in mucous layer; activates toxins & enzymes that cause inflammation
Genetic vulnerability & lifestyle behaviors (smoking, stress) may increase susceptible
Other causes: Organisms through food/water contamination, LT NSAID use, Excess
alcohol use, Severe stress, Autoimmune conditions
Manifestations of GI bleeding: Indigestion; heart burn, Epigastric pain; abdominal
cramping, N/V; anorexia, Fever; malaise, Hematemesis, Dark, tarry stools = ulceration &
bleeding
, Essentials of Pathophysiology (NUR 2063) – Exam 2 blueprint 2
GI tract disorders
o Peptic ulcer disease
Duodenal: Most commonly associated with excess acid or H.pylori infections, Typically
present with epigastric pain relieved by food
Gastric: Less frequent; more deadly, typically associated with malignancy and NSAIDs,
Pain worsens with food
Symptoms:
Curling’s ulcer from what: associated with burns
Cushing’s ulcer from what: associated with head injuries
Complications of ulcers: GI hemorrhage; obstruction; perforation; peritonitis
Manifestations: Epigastric or abdominal pain, Abdominal cramping, Heartburn;
indigestion, N/V
Diagnosis: same as gastritis
Treatment: Same as for gastritis, Surgical repair may be necessary for perforated or
bleeding ulcers, Prevention is crucial – may need prophylactic medications (ex: acid-
reducers) for at-risk clients
o Gallbladder disorders
Cholelithiasis: Gallbladder stones
Cholecystitis: Inflammation or infection in the biliary system caused by calculi
Manifestations: Biliary colic; abdominal distension; N/V; jaundice; fever; leukocytosis
Diagnosis: H & P; abdominal Xray; gallbladder US; laparoscopy
Treatments: Low-fat diet, medications to dissolve calculi, Antibiotic therapy, NG tube
with intermittent sxn, Lithotripsy, Choledochostomy, Laparoscopic surgery
o Liver disorders
Hepatitis – infectious: A, B, C, D, E vs. noninfectious: Giant cell hepatitis, Ischemic
hepatitis, Non-alcoholic fatty liver hepatitis, Autoimmune hepatitis, Toxic & drug-induced
hepatitis, Alcoholic hepatitis
Transmission of viral hepatitis: If it’s a Vowel, it comes from the Bowel. All others are
blood
Define: acute: Proceeds through 4 stages—asymptomatic stage then 3 symptomatic
stages chronic: Characterized by continued liver disease > 6 months, Symptom severity
and disease progression vary by degree of liver damage, Can quickly deteriorate with
declining liver integrity fulminant: Uncommon, rapidly progressing form that can quickly
lead to
Liver failure, hepatic encephalopathy, or death within 3 wks
Diagnosis: H & P, Serum hepatitis profile, Liver enzymes, Clotting studies, Liver
biopsy, Abdominal US
treatment for viral hepatitis: treat with interferon & antiviral mediations
Cirrhosis
Common causes: Hep C and chronic alcohol abuse most common cause in U.S.
Hepatitis and all factors that can lead to hepatitis
What happens to liver: Leads to fibrosis, nodule formation, impaired blood flow,
and bile obstruction liver failure
Manifestations: Portal hypertension, Varicosities, Bleeding –slow or severe,
Muscle wasting, Bile accumulation, Clay-colored stools, Dark urine, Ulcers/GI
bleeding, Encephalopathy, Spontaneous bacterial peritonitis
, Essentials of Pathophysiology (NUR 2063) – Exam 2 blueprint 3
Diagnosis & treatments: H & P; liver biopsy; abdominal Xray; liver enzymes; EGD;
clotting studies; stool exam for occult blood
Hepatic encephalopathy:
o Pancreatitis
Causes: Cholelithiasis, Alcohol abuse, Biliary dysfunction, Hepatotoxic drugs, Metabolic
disorders, Trauma, Renal failure, Endocrine disorders, Pancreatic tumors, Penetrating
peptic ulcer
What happens to the pancreas in the disorder? pancreatic enzymes to leak into the
pancreatic tissue and initiate autodigestion - -results in edema, vascular damage,
hemorrhage & necrosis
Acute pancreatitis importance & complications: Acute respiratory distress syndrome
(ARDS), DM, Infection, Septic or hypovolemic shock, Disseminated intravascular
coagulation (DIC), Renal failure, Malnutrition, Pancreatic cancer
Pseudocyst – pancreatic fluids & necrotic debris accumulate & eventually rupture,
Abscess
Manifestations: Upper abdominal pain that radiates to the back, worsens after
eating, somewhat relieved by leaning forward or pulling knees to chest, N/V
Mild jaundice, Low-grade fever, BP and pulse changes
Chronic pancreatitis manifestations: Upper abdominal pain, Indigestion, Losing weight
without trying, Steatorrhea, Constipation, Flatulence
Pancreatitis diagnosis: H & P, Serum amylase & lipase, Serum calcium level, CBC, Liver
enzymes, Serum bilirubin level, ABG, Stool analysis (lipid & trypsin levels), Abdominal
Xray, CT/MRI, Abdominal US, ERCP (endoscopic retrograde cholangiopancreatography)
treatment: Rest pancreas by fasting; administer IV nutrition; gradually advance diet from
clears as tolerated to low fat, Pancreatic enzyme supplements when diet resumed
Maintain hydration with IVF, NG to intermittent suction, Antiemetic agents, Pain
management, Antacids/acid-reducing agents, Anticholinergic meds, Antibiotics, Insulin
Bowel disorders
o Diarrhea – acute: Often d/t bacterial or viral infections, Certain medications such as antibiotics,
antacids, laxatives, usually self-limiting depending on cause
o Chronic: Lasts longer than 4 weeks
o Causes: Inflammatory bowel diseases, Malabsorption syndromes, Endocrine disorders,
Chemo/radiation
Manifestations: If small bowel: Large and loose, provoked by eating, Usually
accompanied with pain in right lower quadrant, If large bowel: Stools are small and
frequent, Frequently accompanied by pain and cramping in the left lower quadrant,
Acute diarrhea is generally infectious, Accompanied by cramping, fever, chills, N/V
Blood (may be frank, occult, or melena), pus, or mucus may be present
Bowel sounds may be hyperactive, Fluid, electrolyte and pH imbalances, Metabolic
alkalosis
Diagnosis/Bristol stool chart: H & P, include usual bowel habits and complete Bristol
Stool chart, Stool analysis –include cultures & occult blood, CBC, Blood chemistry
ABG, Abdominal US
Treatment: Fasting for acute diarrhea with infection, Antidiarrheal agents maybe or not
Antibiotics may be needed, Anticholinergics, Antispasmodic agents, Clear liquid diet until
diarrhea subsides, then advance diet as tolerated. Dietary fiber to manage chronic
diarrhea, maintain hydration and correct electrolyte and pH imbalance, Meticulous skin
care in presence of incontinence
