NR 283 Exam Review 3 PATHOPHYSIOLOGY| WITH RATIONALES

NR 283 Exam Review 3 PATHOPHYSIOLOGY Gastrointestinal • GI bleeding a. Upper GI bleeding: esophagus, stomach, duodenum b. Lower GI bleeding: jejenum, ileum, colon, rectum Hematemesis: bloody vomit (from esophagus) Hematochezia: bright-red blood (colon, rectum “hemmoroid”) Melena: burgundy color (old blood; jejunum) Occult bleeding: hidden bleeding (blood cells present in feces) Hiatal Hernia: • part of the stomach protrudes through the opening (hiatus) in the diaphragm into the thoracic cavity • Cause: too much pressure (repetitively) on stomach muscles; coughing, vomiting, straining during BM a. Sliding: ususally when pt is in supine position; common b. Paraesophogeal/Rolling: due to weak or enlarged hiatus in diaphragm; leads to ulceration • s/s: heartburn “pyrosis”, frequent belching, discomfort when laying down, substernal pain radiating to shoulder & jaw Gastritis: Acute vs. Chronic, Signs and Symptoms • Inflammation of stomach • Acute -characteristics: red & edematous, ulcerated & bleeding -s/s: anorexia, nausea, vomiting, hematemesis (bleeding in stomach), epigastric pain, cramps, fever/headache, diarrhea • Chronic -characteristics: atrophy of mucosa of stomach, loss of intrinsic factor for absorbing B12 -s/s: vague; mild epigastric discomfort, intolerance for spicy/fatty foods Pts w chronic g. at risk for peptic ulcers & gastric carcinoma Peptic Ulcer Disease: • Cause: common- H. pylori infection or vasoconstrictions by stress smoking, shock, circulatory impairment in elderly, scar tissue, severe anemia • s/s: epigastric burning, localizing pain, stomach emptying, heartburn, nausea, vomiting, weight loss • location: proximal duodenal, antrum of stomach, Cholelithiasis: “gallstone” • cause: formation of gallstones • s/s: radiating pain, nausea/vomiting, jaundice Hepatitis: Types, transmission, Signs and Symptoms Hep A infectious Oral/fecal; contaminated water/shellfish/anal intercourse Hep B chronic Blood/body fluids; exposed to infected blood/body secretions (mother to baby) Hep C chronic Blood/body fluids; post transf, IV drug use • s/s: liver- inflammation, necrosis, edematous & tender Hepatic Encephalopathy: Cause and diagnosis • decline in brain function that occurs as a result of severe liver disease • cause: buildup of toxins in blood when liver fails • s/s: difficulty thinking, personality changes, poor concentration, confusion, musty or sweet breath, seizures, shaky hands, slow movements Cirrhosis: Signs and Symptoms, Complications • destruction of liver cells leading to liver failure • cause: alcoholic liver disease, biliary (immune disorder), postnecrotic (chronic hep, long term exposure to toxic materials), metabolic storage disorders • s/s: initial- fatigue, anorexia, weight loss, anemia, diarrhea, dull aching pain in RUQ; advanced- ascites, peripheral edema, increased bruising, jaundice, encephalopathy, esophageal may rupture, hemorrhage, circulatory shock, • Stages (alcoholic liver disease): -Initial—fatty liver (asymptomatic; reversible) -Second—alcoholic hepatitis (inflammation, cell necrosis, fibrous tissue formation; irreversible) Third—end stage cirrhosis (fibrotic tissue replaces norm tissue; little remaining function) Esophageal varices: Causes, Signs and Symptoms, complications • Abnormal, enlarged veins in the esophagus • Cause: when normal blood flow is blocked by a clot/scar tissue in the liver; cirrhosis • s/s: hematemesis, melena, lightheaded, jaundice, ecchymosis, ascites • complications: hemorrhaging, hypovolemic shock, death Crohn’s disease: “skip lesions” • commonly in ileum (sm. Intest.); inflammatory bowel disease • cause: unknown