NUR 631 Exam 2 100% Correct!!

What are examples of things that can cause visceral pain? -ANSWER Intestine, biliary tree, liver disease What are examples of things that can cause parietal pain? -ANSWER Appendicitis, peritonitis What are examples of things that can cause referred pain? -ANSWER Cholecystitis What are examples of things that can cause colicky pain? -ANSWER Renal stones What is the order in which you should perform an abdominal physical exam? -ANSWER 1. inspection 2. auscultation 3. percussion 4. palpation What diagnosis would you consider for a 30 year old with heart burn, early satiety, burping and generalized abdominal pain? -ANSWER Dyspepsia related to gastritis What diagnosis would you consider for a 50 YEAR OLD SMOKER with heart burn and abdominal pain? -ANSWER Colon cancer How high is the bilirubin level when the patient is starting to develop physical jaundice? -ANSWER 2.5 or higher ______________ bilirubin is unconjugated, which means that it has not been metabolized by the liver or made into a water soluble form of bilirubin -ANSWER Indirect bilirubin ________________ is processed bilirubin that is water soluble -ANSWER Direct bilirubin What are some of the causes of elevated indirect bilirubin levels? -ANSWER - hemolysis - heart failure - Gilbert syndrome - neonates - hyperthyroidism - chronic hepatitis & advanced liver cirrhosis What are some of the causes of elevated direct bilirubin levels? -ANSWER - choledocholithiasis - tumors - AIDS - acute/chronic pancreatitis - viral hepatitis - alcoholic hepaitits - biliary tree cholangitis - sepsis - TPN - postoperative cholestasis - sickle cell disease - pregnancy - end stage liver disease What does a history of fever, chills and RUQ pain indicate? -ANSWER Acute cholangitis What does RUQ pain with a history of anorexia, malaise and myalgias indicate? -ANSWER Viral hepatitis What is the terminology for when the gallbladder is so distended that you can palpate it? -ANSWER Courvoiser Sign What is the terminology for inspiratory arrest that occurs when you are putting pressure on the RUQ due to inflammed gallbladder? -ANSWER Murphey's Sign Which liver enzyme is specific for hepatocytes? -ANSWER ALT Which liver enzyme is more specific to alcohol, statins and tylenol use? -ANSWER AST If the ratio of AST to ALT is 2 to 1, what does this indicate? -ANSWER Liver damage due to alcohol, statins or tylenol If the ratio of ALT is twice as high as AST, what does this indicate? -ANSWER Viral hepatitis What is the normal range for ALT and AST? -ANSWER 30-40 What does an elevated ALT, AST and Alk Phos indicate? -ANSWER Gallbladder obstruction What are the signs and symptoms in a patient that has MILD melena? -ANSWER Resting tachycardia What are the signs and symptoms in a patient that has melena with a blood volume loss of at least 15%? -ANSWER Orthostatic hypotension What are the signs and symptoms of a patient that has melena with a blood volume loss of at least 40%? -ANSWER Supine hypotension + abdominal pain What type of anemia would someone with melena have? -ANSWER Iron deficiency anemia What is the gold standard diagnostic test for a patient with Melena? -ANSWER Endoscopy What are the leading causes for dysphagia? -ANSWER Alzheimer disease + stroke This type of dysphagia is due to a tumor that is obstructing the passage of food -ANSWER Mechanical dysphagia This type of dysphagia is due to a neurological deficit resulting in the inability to swallow -ANSWER Functional dysphagia What is the gold standard diagnostic test for dysphagia? -ANSWER Video fluoroscopic swallow study IF a patient over the age of 50 comes in with dysphagia, what would you assume? -ANSWER Esophegeal cancer If a patient comes in with SUDDEN dysphagia, what would you assume? -ANSWER Patient had a stroke What is the term used to describe the chronic immunological disease that manifests in intestinal inflammation? -ANSWER Inflammatory Bowel Disease What is the term used to describe a clinical syndrome of uncertain etiology characterized by lower abdominal pain and alternating diarrhea and/or constipation -ANSWER Irritable Bowel Syndrome What is the term used to describe the disease process in which the MUCOSAL surface of the colon and rectum erodes resulting in bloody diarrhea? -ANSWER Ulcerative Colitis What is the term used to describe the disease process in which ALL layers of the bowel wall have tissue damage characterized by skip (cobblestone) lesions in both the small and large intestine? -ANSWER Chron's Disease What are the signs and symptoms of Ulcerative colitis? -ANSWER - Diarrhea - 4-10 bowel movements a day - small and large amounts of blood and mucus in the stool - abdominal pain and tenderness - impaired nutrition, anemia and hypovolemia What are the signs and symptoms of Crohn's disease? -ANSWER - insidious gradual onset - diarrhea - bloody stool intermittently - steatorrhea - abdominal cramping - FEVER - weight loss, anorexia Which type of anemia can occur in patients with ulcerative colitis? -ANSWER Macrocytic anemia from poor absorption of folate What level of severity is the patient with Ulcerative Colitis that has 4 or less diarrhea a day without any systemic symptoms? -ANSWER Mild disease What level of severity is the patient with Ulcerative Colitis that has 4 or more diarrheas a day + systemic symptoms? -ANSWER Moderate disease What level of severity is the patient with Ulcerative Colitis that has 6-10 diarrhea's a day with systemic symptoms? -ANSWER Severe disease What level of severity is a patient with Ulcerative Colitis that is having 10 or more bloody stools a day? -ANSWER Fulminant disease Which medications should be avoided during an acute phase of ulcerative colitis? -ANSWER Imodium or lomotil What are the medications that can be used to treat Ulcerative Colitis? -ANSWER 1st line is ASA THERAPY- Mesalamine (oral or rectal) Topical or systetmic steroids Immunomodulating Drugs - Azathioprine - Methotrexate - Infliximab - Adalimumab When would you hospitalize a patient with Ulcerative Colitis? -ANSWER 10 + bloody stools a day Fever Tachycardia Using the Crohn's Disease activity index calculator, what does a score less than 150 indicate? -ANSWER Remission Using the Crohn's Disease activity index calculator, what does a score between 150-220 indicate? -ANSWER MILD Disease Using the Crohn's Disease activity index calculator, what does a score of 220- 450 indicate? -ANSWER MODERATE-SEVERE disease Using the Crohn's Disease activity index calculator, what does a score greater than 450 indicate? -ANSWER Severe fulminant disease What are the treatment options for a patient with Mild Crohn's disease? -ANSWER - Budenoside - Sulfasalazine (mild colitis) - Mesalamine (mild ileitis) - Oral prednisone for 1-2 weeks and taper What are the treatment options for a patient with Moderate- Severe Crohn's disease? -ANSWER - Steroids to achieve remisison - Azathioprine - Cyclosporine - Infliximab What are the treatment options for a patient with severe disease? -ANSWER Ileostomy surgery How often do you need to perform colon cancer screening in a patient with UC? -ANSWER Every 7-8 years How often do you need to perform a colon cancer screening for a patient with CD? -ANSWER Every 10 years What are the criteria for diagnosing Irritable Bowel Syndrome? -ANSWER Abdominal pain or discomfort that is relieved by defecation or has been associated with the change/frequency of stool for 3 months AND Defecation with patterns of constipation AND 2 OR MORE OF THE FOLLOWING - altered stool frequency - altered stool form - an altered sensory act of defecation - passage of mucus - varying degrees of bloating and abdominal distention How can you manage IBS? -ANSWER Antidiarrheal medications during periods of diarrhea High fiber diet Anticholinergics Antispasmodics Antidepressants What are the symptoms of IBS? -ANSWER Bloating Cramping Diarrhea Nausea Constipation Abdominal pain Gas Incomplete bowel movements Fatigue What are the signs and symptoms of bowel obstructions? -ANSWER Sudden onset of colicky abdominal pain Nausea/vomiting Diarrhea early/ constipation late Signs of dehydration Abdominal distention Bowel sounds may be high pitched/ hyperactive or totally absent Mass may be palpable What are the diagnostic tests that can be performed to identify a bowel obstruction? -ANSWER Abdominal xray films will reveal air-fluid levels in the bowel What is the treatment plan for a patient with a bowel obstruction? -ANSWER Hospitalize the patient and refer them immediately Laparotomy for a patient with a complete bowel obstruction IV hydration and electrolyte replacement D/C all medications that decrease intestinal motility Placement of NG tube to decompress When should you refer a patient with a bowel obstruction? -ANSWER ALL PATIENTS WITH A BOWEL OBSTRUCTION SHOULD BE REFERRED TO A SURGEON What do we call a mass of dilated and torturous veins that represent prolapsed submucosal tissue? -ANSWER Hemorrhoid What are the signs/symptoms of a hemorrhoid? -ANSWER Abrupt pain that is associated with a perianal lump Intense pain after defecation or straining Pruritis External hemorrhoids: not visible at rest but will portrude when standing or with the valsalva maneuver Internal hemorrhoids most often present with rectal bleeding What are the treatment options for hemorrhoids? -ANSWER - oral analgesics - sitz baths - bulk- forming laxative - increase fiber intake slowly from 25-35 - topical hydrocortisone cream (anusol and proctofoam) -surgical excision What are the symptoms of colorectal cancer? -ANSWER Usually asymptomatic however the patient may report a change in bowel habit, stool caliber or blood streaks in stools Late symptoms include weight loss and anorexia What is the management of colorectal cancer? -ANSWER Surgical resection Chemotherapy based on staging Radiation What are the screening recommendations for the average risk person for colorectal cancer? -ANSWER Beginning at age 50 through 75 For African Americans begin screening at 45 years Perform colonoscopy every 10 years What are the screening recommendations for high risk people with a family history of colorectal cancer before age 60? -ANSWER Colonoscopy every 5 years starting at age 40 or 10 years younger at age of diagnosis of youngest affected relative What is the terminology for a fungal infection of the skin? -ANSWER Dermatophytosis What is the terminology for a fungal infection of the nails? -ANSWER Onchomycosis What is the terminology for a fungal infection of the hair? -ANSWER Trichomyosis (mainly arm hairs) What are the risk factors for developing a dermophytosis? -ANSWER Warm