N3661 - Exam 2 (Med Surg - D. Cleary) Questions With
Complete Solutions
Billroth I vs Billroth II
What is it for?
*PEPTIC ULCER DISEASE*
I: gastroduodenostomy, remove bottom of stomach, attach to
duodenum
II: gastrojejunostomy, remove bottom of stomach, attach to
jejunum
,What is cor pulmonale?
Describe the process
right sided heart failure resulting from pulmonary arterial
hypertension
emphysema=damaged alveoli → arteriole vasoconstricts to bad
alveoli to divert blood → too many damaged alveoli with
emphysema → pressure buildup in lung blood flow → pressure
backup to RIGHT ventricle → right sided HF
A patient with a total gastrectomy can expect to have injections
of what the remainder of their life?
vit B12
(no stomach = no parietal cells = no intrinsic factor being made
= not being converted to vit b12 = pernicious anemia [low
RBCs])
What is Nissen Fundoplication?
surgical management of GERD, wrap portion of stomach around
LES to increase pressure
,How can you determine the difference between duodenal and
gastric ulcers in regards to pain?
g: pain occurs immediately after eating
d: pain occurs 2-3 hours after meal, may get relief from antacid
Treatment of peptic ulcer disease aka PUD (3)
antibiotics for H. pylori
PPIs
diet modification
(H2 blockers sometimes)
What is a vagotomy and when is it done?
done if tx for PUD unsuccessful
severing of vagus nerve (CN 10) to stomach
Regarding PUD, perforation vs penetration
perforation: emergency, erosion of ulcer through to peritoneal
cavity w/o warning
penetration: erosion of ulcer through to adjacent structures (ie:
pancreas)
Patient with PUD experiences sudden, severe upper abdomen
pain with N/V. What do you suspect?
penetration
return to surgery and irrigate abdominal cavity d/t peritonitis
Patient with PUD experiences epigastric pain not relieved by
medications that were effective before. What do you suspect?
perforation
, emergency!
S/S of PUD perforation (4)
rigid abdomen
tachycardia ( & hypotension indicating shock)
pain in right shoulder
rebound tenderness
S/S stomach cancer
pain relieved by antacids (early s/s)
weight loss
indigestion
pain above umbilicus
bloating post meals
If patient has stomach cancer, what lymph nodes will likely be
swollen?
Sister Mary Joseph Nodes around umbilicus
What is gastric outlet obstruction?
Following a gastrectomy, what the nurse education pt on
regarding meals?
6 meals/day
no fluids w/ meals (prevent dumping syndrome)
diet LOW in carbs and sugar
What is gastric outlet obstruction?
area distal to pyloric sphincter becomes scarred and stenosed
contents struggle to leave stomach
Complete Solutions
Billroth I vs Billroth II
What is it for?
*PEPTIC ULCER DISEASE*
I: gastroduodenostomy, remove bottom of stomach, attach to
duodenum
II: gastrojejunostomy, remove bottom of stomach, attach to
jejunum
,What is cor pulmonale?
Describe the process
right sided heart failure resulting from pulmonary arterial
hypertension
emphysema=damaged alveoli → arteriole vasoconstricts to bad
alveoli to divert blood → too many damaged alveoli with
emphysema → pressure buildup in lung blood flow → pressure
backup to RIGHT ventricle → right sided HF
A patient with a total gastrectomy can expect to have injections
of what the remainder of their life?
vit B12
(no stomach = no parietal cells = no intrinsic factor being made
= not being converted to vit b12 = pernicious anemia [low
RBCs])
What is Nissen Fundoplication?
surgical management of GERD, wrap portion of stomach around
LES to increase pressure
,How can you determine the difference between duodenal and
gastric ulcers in regards to pain?
g: pain occurs immediately after eating
d: pain occurs 2-3 hours after meal, may get relief from antacid
Treatment of peptic ulcer disease aka PUD (3)
antibiotics for H. pylori
PPIs
diet modification
(H2 blockers sometimes)
What is a vagotomy and when is it done?
done if tx for PUD unsuccessful
severing of vagus nerve (CN 10) to stomach
Regarding PUD, perforation vs penetration
perforation: emergency, erosion of ulcer through to peritoneal
cavity w/o warning
penetration: erosion of ulcer through to adjacent structures (ie:
pancreas)
Patient with PUD experiences sudden, severe upper abdomen
pain with N/V. What do you suspect?
penetration
return to surgery and irrigate abdominal cavity d/t peritonitis
Patient with PUD experiences epigastric pain not relieved by
medications that were effective before. What do you suspect?
perforation
, emergency!
S/S of PUD perforation (4)
rigid abdomen
tachycardia ( & hypotension indicating shock)
pain in right shoulder
rebound tenderness
S/S stomach cancer
pain relieved by antacids (early s/s)
weight loss
indigestion
pain above umbilicus
bloating post meals
If patient has stomach cancer, what lymph nodes will likely be
swollen?
Sister Mary Joseph Nodes around umbilicus
What is gastric outlet obstruction?
Following a gastrectomy, what the nurse education pt on
regarding meals?
6 meals/day
no fluids w/ meals (prevent dumping syndrome)
diet LOW in carbs and sugar
What is gastric outlet obstruction?
area distal to pyloric sphincter becomes scarred and stenosed
contents struggle to leave stomach
