Final Exam Concept Guide
Know the Etiology, Signs/Symptoms, Diagnosis/Diagnostics, Clinical Manifestation, Risks,
Treatment and Complications for the following:
▪ Gastritis
Gastritis – inflammation of the stomach lining
Acute Gastritis – (just acquired) ingestion of toxins, alcohol, aspirin or other irritating substances
Chronic- 2 months to become chronic
Triggers of Gastritis: Alcohol, caffeine, autoimmune disease, viral or bacteria Chronic
Gastritis: H Pylori is always a factor
H Pylori goes very deep in the lining of the stomach and It causes persistent inflammation
S/S: N/V – Anorexia- postcranial discomfort
Post Cranial Discomfort- after eating- goes away and come back 1-2 hrs
Gastritis- hematemesis- blood in the vomit- coffee brown color
Treatment: Treat H pylori treat GERD, change lifestyle, PPI
▪ Peptic Ulcer Disease
Inflammation and ulceration in the stomach (acid and pepsin) Gastric:
stomach location
Duodenal: duodenal location PUD
is a complication of Gastritis
PUD is caused by aspirin, H pylori, Nsaids, Stress, Smoking S/S
Gastric N/V Anorexia Chest discomfort, asymptotic, Dyspepsia
Duodenal – normal weight
Biggest complication of PUD- GI bleeding due to Ulcer perforation- hole in the lining and bleed
It is life-threatening if it keep bleeding (Anemic, electrolytes imbalance (losing volume) Duodenal
– Blood in the stool – black and tarry
Bleeding profusely-frank with cloth
Hematemesis- Bleeding in vomiting
Treatment: Cortery of perforation, treatment of H. pylori, PPI, Cessation of smoking
▪ Ulcerative Colitis and Crohn’s the difference in the complications Complication in
UC Malnutrition – dehydration, increased risk factor of colon cancer 7-10 yrs, rarely in
megacolon
Complication of Chron- Fistulas, perianal fissures, abscesses. The risk of colorectal cancer
▪ Bowel Obstruction Manifestations
Obstructions in the jejunal area: Vomiting, dehydration, electrolyte depletion Obstructions of the
distal portion of the small bowl or ileum, dehydration to hypovolemic schock
Obstructions of the colon: Massive gas distention
Blockage of the colon by a tumor is the most common cause of colonic obstruction and perforation of
the bowel wall adjacent to the tumor.
▪ What percentage of the pancreas is dedicated to endocrine functions?
Only 5%
▪ Pancreatic Cancer
Pancreatic Cancer – 2% of all cancers
Ranked 4th among death in all malignancies Risk
Factors; cigarette smoking, obesity
S/S; head: Jaundice, malabsorption, weight loss tail: Abd pain, nausea’
▪ Hepatic Encephalopathy is due to?
Hepatic encephalopathy is a decline in brain function due to severe liver disease
,Hepatic encephalopathy is usually precipitated by certain well-defined clinical developments, including
hypokalemia, hyponatremia, alkalosis, hypoxia, hypercarbia, infection, use of sedatives, GI hemorrhage,
protein meal gorging, renal failure, and constipation. In some patients, progressive liver failure leads to
chronic encephalopathy without other exacerbating factors.
Hepatic encephalopathy is graded 1 to 4:
• Grade 1: Confusion, subtle behavioral changes, no flap
• Grade 2: Drowsy, clear behavioral changes, flap present
• Grade 3: Stuporous but can follow commands, marked confusion, slurred speech, flap present
• Grade 4: Coma, no flap
▪ Gastroesophageal Varices Management
- Initial treatment: Fluid resuscitation to stop bleeding Large bore
- intravenous lines are placed
- Admin of parenteral vitamin K and plasma, platelet infusion if thrombocytopenia is present
- Octreotide acetate (synthetic analog) no more vasopressin 3-5 days Metoclopramide and B
- blockers
- Esophagogastroduodenoscopy EGD to determine site of bleeding
▪ Difference between Diverticulosis and Diverticulitis
Diverticulosis (diverticular disease) presence of diverticula in the colon.
Diverticula are acquired herniations of the mucosa and submucosa through the muscular coat of the colon
Diverticulosis The presence of one or more diverticula vs diverticulitis inflammation of one or more
diverticula
▪ Kidney Disease- Assessment-CVA
Pain associated with intrarenal disorders are assessed by palpating or light percussion over the
costovertebral angle (CVA) posteriorly and is recorded as CVA tenderness. Pain is transmitted to the
spinal cord between T10 and L1
▪ Kidney Cancer signs and symptoms
Benign renal neoplasm: S/S Hematuria and flank pain Some may
be asymptomatic until large
Renal cell carcinoma: Metastatic disease
Risk factors: smoking, obesity and hypertension S/S
CVA tenderness, hematuria, palpable mass
▪ Dialysis- Benefits and Risks
▪ Filter blood and rid the waist
Dialysis is the only therapeutic option for those with ESRD unable to obtain transplant Each
treatment of dialysis remove about 2/3 of the total body urea content
Dialysis maintain volume status
Prevent and treat acid-base and electrolyte disturbances Prevent
and treat uremia
Support nutritional needs.
Prevent and treat infection
Orevent and treat anemia
Improve quality of life
Lower mortalty and morbidity rates
Control pains
VS
RISKS
Electrolytes imbalance (potassium and sodium) -need to check hyper or hypo
, Low blood pressure (have to check vitals before and after) Risk
for infection
Long-term mobidity Life
threatening
Cardiovascular disease remained the most common cause of death in ESRD patient
▪ Acute Kidney Injury- Three phases- Prodromal- Oliguric- Postoliguric
Prodomal Phase
- Normal or declining urine output
- Serum blood urea nitrogen (BUN) and creatine levels rise
Oliguric phase (10-14 days) range from 1 day to 8 weeks
- Oliguria – Small abnormal amount of urine
- Edema, Hypertension, Hypervolemia
- Distended neck veins, weight gain
- Crackles, possibly heart faily
- WBC and RBC in urine
- Protein in urine
- Hyperkalemka
- Volume overload
- Azotemia and uremia
- Metabolic acidosis
Postoliguric phase (5% recover)
- Fluid volume deficit
- Labs begin to normalize
- Polyuria – sodium waste
▪
▪ Acute Tubular Necrosis and the causes of Acute Tubular Necrosis
ATN is the result of tubular cell injury
- Ischemia: Exposure to nephrotoxic substances
- ½ of all cases of AKI
Nephrotoxins leading cause of ATN (aminoaglycosides, NSAIDS, amphotericin B, cisplatin, tetracycline.
CI- AKI or Contrast-induced nephropathy
▪ Cystitis- signs and symptoms
(inflammation of the bladder) no fever or flank pain If fever is present – Might be infection (UTI)
Confusion
Cloudy urine
Frequency
Urgency
Dysuria
Intrarenal Kidney Injury- Toxic causes of
Box 28.1
Types of A cu t e K i d n e y Inj ury
Prerenal
• • Absolute decrease in circulating volume
o • Hemorrhage
o • Dehydration
o • Burns
• • Relative decrease in circulating volume
Know the Etiology, Signs/Symptoms, Diagnosis/Diagnostics, Clinical Manifestation, Risks,
Treatment and Complications for the following:
▪ Gastritis
Gastritis – inflammation of the stomach lining
Acute Gastritis – (just acquired) ingestion of toxins, alcohol, aspirin or other irritating substances
Chronic- 2 months to become chronic
Triggers of Gastritis: Alcohol, caffeine, autoimmune disease, viral or bacteria Chronic
Gastritis: H Pylori is always a factor
H Pylori goes very deep in the lining of the stomach and It causes persistent inflammation
S/S: N/V – Anorexia- postcranial discomfort
Post Cranial Discomfort- after eating- goes away and come back 1-2 hrs
Gastritis- hematemesis- blood in the vomit- coffee brown color
Treatment: Treat H pylori treat GERD, change lifestyle, PPI
▪ Peptic Ulcer Disease
Inflammation and ulceration in the stomach (acid and pepsin) Gastric:
stomach location
Duodenal: duodenal location PUD
is a complication of Gastritis
PUD is caused by aspirin, H pylori, Nsaids, Stress, Smoking S/S
Gastric N/V Anorexia Chest discomfort, asymptotic, Dyspepsia
Duodenal – normal weight
Biggest complication of PUD- GI bleeding due to Ulcer perforation- hole in the lining and bleed
It is life-threatening if it keep bleeding (Anemic, electrolytes imbalance (losing volume) Duodenal
– Blood in the stool – black and tarry
Bleeding profusely-frank with cloth
Hematemesis- Bleeding in vomiting
Treatment: Cortery of perforation, treatment of H. pylori, PPI, Cessation of smoking
▪ Ulcerative Colitis and Crohn’s the difference in the complications Complication in
UC Malnutrition – dehydration, increased risk factor of colon cancer 7-10 yrs, rarely in
megacolon
Complication of Chron- Fistulas, perianal fissures, abscesses. The risk of colorectal cancer
▪ Bowel Obstruction Manifestations
Obstructions in the jejunal area: Vomiting, dehydration, electrolyte depletion Obstructions of the
distal portion of the small bowl or ileum, dehydration to hypovolemic schock
Obstructions of the colon: Massive gas distention
Blockage of the colon by a tumor is the most common cause of colonic obstruction and perforation of
the bowel wall adjacent to the tumor.
▪ What percentage of the pancreas is dedicated to endocrine functions?
Only 5%
▪ Pancreatic Cancer
Pancreatic Cancer – 2% of all cancers
Ranked 4th among death in all malignancies Risk
Factors; cigarette smoking, obesity
S/S; head: Jaundice, malabsorption, weight loss tail: Abd pain, nausea’
▪ Hepatic Encephalopathy is due to?
Hepatic encephalopathy is a decline in brain function due to severe liver disease
,Hepatic encephalopathy is usually precipitated by certain well-defined clinical developments, including
hypokalemia, hyponatremia, alkalosis, hypoxia, hypercarbia, infection, use of sedatives, GI hemorrhage,
protein meal gorging, renal failure, and constipation. In some patients, progressive liver failure leads to
chronic encephalopathy without other exacerbating factors.
Hepatic encephalopathy is graded 1 to 4:
• Grade 1: Confusion, subtle behavioral changes, no flap
• Grade 2: Drowsy, clear behavioral changes, flap present
• Grade 3: Stuporous but can follow commands, marked confusion, slurred speech, flap present
• Grade 4: Coma, no flap
▪ Gastroesophageal Varices Management
- Initial treatment: Fluid resuscitation to stop bleeding Large bore
- intravenous lines are placed
- Admin of parenteral vitamin K and plasma, platelet infusion if thrombocytopenia is present
- Octreotide acetate (synthetic analog) no more vasopressin 3-5 days Metoclopramide and B
- blockers
- Esophagogastroduodenoscopy EGD to determine site of bleeding
▪ Difference between Diverticulosis and Diverticulitis
Diverticulosis (diverticular disease) presence of diverticula in the colon.
Diverticula are acquired herniations of the mucosa and submucosa through the muscular coat of the colon
Diverticulosis The presence of one or more diverticula vs diverticulitis inflammation of one or more
diverticula
▪ Kidney Disease- Assessment-CVA
Pain associated with intrarenal disorders are assessed by palpating or light percussion over the
costovertebral angle (CVA) posteriorly and is recorded as CVA tenderness. Pain is transmitted to the
spinal cord between T10 and L1
▪ Kidney Cancer signs and symptoms
Benign renal neoplasm: S/S Hematuria and flank pain Some may
be asymptomatic until large
Renal cell carcinoma: Metastatic disease
Risk factors: smoking, obesity and hypertension S/S
CVA tenderness, hematuria, palpable mass
▪ Dialysis- Benefits and Risks
▪ Filter blood and rid the waist
Dialysis is the only therapeutic option for those with ESRD unable to obtain transplant Each
treatment of dialysis remove about 2/3 of the total body urea content
Dialysis maintain volume status
Prevent and treat acid-base and electrolyte disturbances Prevent
and treat uremia
Support nutritional needs.
Prevent and treat infection
Orevent and treat anemia
Improve quality of life
Lower mortalty and morbidity rates
Control pains
VS
RISKS
Electrolytes imbalance (potassium and sodium) -need to check hyper or hypo
, Low blood pressure (have to check vitals before and after) Risk
for infection
Long-term mobidity Life
threatening
Cardiovascular disease remained the most common cause of death in ESRD patient
▪ Acute Kidney Injury- Three phases- Prodromal- Oliguric- Postoliguric
Prodomal Phase
- Normal or declining urine output
- Serum blood urea nitrogen (BUN) and creatine levels rise
Oliguric phase (10-14 days) range from 1 day to 8 weeks
- Oliguria – Small abnormal amount of urine
- Edema, Hypertension, Hypervolemia
- Distended neck veins, weight gain
- Crackles, possibly heart faily
- WBC and RBC in urine
- Protein in urine
- Hyperkalemka
- Volume overload
- Azotemia and uremia
- Metabolic acidosis
Postoliguric phase (5% recover)
- Fluid volume deficit
- Labs begin to normalize
- Polyuria – sodium waste
▪
▪ Acute Tubular Necrosis and the causes of Acute Tubular Necrosis
ATN is the result of tubular cell injury
- Ischemia: Exposure to nephrotoxic substances
- ½ of all cases of AKI
Nephrotoxins leading cause of ATN (aminoaglycosides, NSAIDS, amphotericin B, cisplatin, tetracycline.
CI- AKI or Contrast-induced nephropathy
▪ Cystitis- signs and symptoms
(inflammation of the bladder) no fever or flank pain If fever is present – Might be infection (UTI)
Confusion
Cloudy urine
Frequency
Urgency
Dysuria
Intrarenal Kidney Injury- Toxic causes of
Box 28.1
Types of A cu t e K i d n e y Inj ury
Prerenal
• • Absolute decrease in circulating volume
o • Hemorrhage
o • Dehydration
o • Burns
• • Relative decrease in circulating volume
