NR 576 FINAL EXAM REVIEW QUESTIONS AND ANSWERS
ELABORATIONS!!
Assessing for prior antibiotic use is a critical part of the history in patients with
presenting with _______________ due to_________________
Answers :Diarrhea/CDiff
Irritable bowel syndrome
Answers :disorder of the bowel function not from anatomic abnormality--
constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large
bowel
NOT associated with serious medical conditions, IBD, CA
Inflammatory bowel disorder
Answers :chronic immunologic disease that manifests in intestinal inflammation
Ulcerative colitis
crohn's disease
Two common inflammatory bowel diseases
Answers :Ulcerative colitis-mucosal surface of the colon is inflamed and
ultimately results in frability, erosions, and bleeding--most common in recto-
sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall and can
involve all or any layer of the bowel wall and any portion of the GI tract from the
mouth to the anus--skipped lesions, pain in LLQ
Diverticulitis
,Answers :Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free
air=perforation; patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
Identify the significance of Barrett's esophagus
Answers :After repeated exposure to gastric contents, inflammation of the
esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar
epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
Diagnosis of GERD
Answers :made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
,Risks of GERD
Answers :Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
Treatments of GERD
Answers :Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of
the bed elevated.
Medications for GERD
Answers :antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI
(pantoprazole 40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
Differential diagnosis of acute abd pain
Answers :Acute appendicitis
Acute pancreatitis
Acute cholecystitis
Acute appendicitis
, Answers :Inflammation of the vermiform appendix; due to obstruction or infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
Acute pancreatitis
Answers :Sudden inflammation and hemorrhaging of the pancreas due to
destruction by its own digestive enzymes
1. Autodigestion
Most of the time mild, but can be severe
Pancreas
Long skinny gland, length of dollar bill
Located in upper abdomen
Behind the stomach
Endocrine
Alpha/beta cells produce insulin & glucagon that are secreted into the blood
stream
Exocrine
Leading causes:
ELABORATIONS!!
Assessing for prior antibiotic use is a critical part of the history in patients with
presenting with _______________ due to_________________
Answers :Diarrhea/CDiff
Irritable bowel syndrome
Answers :disorder of the bowel function not from anatomic abnormality--
constipation, diarrhea, bloating, urgency w/diarrhea
+s/s--result from disordered sensations or abnormal function of the small and large
bowel
NOT associated with serious medical conditions, IBD, CA
Inflammatory bowel disorder
Answers :chronic immunologic disease that manifests in intestinal inflammation
Ulcerative colitis
crohn's disease
Two common inflammatory bowel diseases
Answers :Ulcerative colitis-mucosal surface of the colon is inflamed and
ultimately results in frability, erosions, and bleeding--most common in recto-
sigmoid colon. Can involve entire colon, pain in RLQ
Crohns disease-inflammation extends deeper into the intestional wall and can
involve all or any layer of the bowel wall and any portion of the GI tract from the
mouth to the anus--skipped lesions, pain in LLQ
Diverticulitis
,Answers :Symptoms: LLQ pain/tenderness, fever, N/V/D
Need imagining especially if perforation or peritonitis is suspected--free
air=perforation; patient may have ileus, small or large bowel obstruction
Can use plain x-ray
CT or Barium enema are preferred
CT with contrast is more sensitive and accurate
Identify the significance of Barrett's esophagus
Answers :After repeated exposure to gastric contents, inflammation of the
esophageal mucosa becomes chronic
Blood flow increases, erosion occurs
As erosion heals, normal squamous epithelium replaced with metaplastic columnar
epithelium containing goblet and columnar cells.
More resistant to acid and supports esophageal healing
Premalignant tissue
40-fold frisk for developing esophageal adenocarcinma
Fibrosis and scarring during healing of erosions; leads to strictures
Diagnosis of GERD
Answers :made on history alone: sensitivity of 80%
if symptoms are unclear/patient does not respond to 4 weeks of empiric tx
made by ambulatory esophageal pH monitoring
pH <4 above the lower esophageal sphincter correlates with symptoms = GERD
EDG with biopsy-Barrett's esohagus
Normal results in 50% of symptomatic patients
,Risks of GERD
Answers :Obesity
Increase after age 50
Equal across gender, ethnic, and cultural groups
Treatments of GERD
Answers :Small frequent meals-main meal in midday
Avoid trigger foods
No bedtime snacks: no eating <4 hours prior to bed
Eliminate caffeine, stop smoking, avoid tight fitting clothing, sleep with head of
the bed elevated.
Medications for GERD
Answers :antacids or OTC H2 (Tagamet, zantac, axid)
Rx-strength H2 (ranitidine 150mg BID, famotidine 20mg BID) or PPI
(pantoprazole 40mg daily, omeprazole 20mg daily)
PPI (Omeprazole 40mg daily)
Surgery (fundoplication)
Differential diagnosis of acute abd pain
Answers :Acute appendicitis
Acute pancreatitis
Acute cholecystitis
Acute appendicitis
, Answers :Inflammation of the vermiform appendix; due to obstruction or infection
Most common surgical emergency of the abdomen
Hollow tube - most common cause is obstruction of appendix
Fecaltih - hard lump of fecal matter
Undigested seeds
Pinworm infections
Lymphoid follicle growth/lymphoid hyperplasia Symptoms
4. Symptoms
Nausea/vomiting
RLQ pain
Guarding
Acute pancreatitis
Answers :Sudden inflammation and hemorrhaging of the pancreas due to
destruction by its own digestive enzymes
1. Autodigestion
Most of the time mild, but can be severe
Pancreas
Long skinny gland, length of dollar bill
Located in upper abdomen
Behind the stomach
Endocrine
Alpha/beta cells produce insulin & glucagon that are secreted into the blood
stream
Exocrine
Leading causes:
