NR 511 MIDTERM STUDY GUIDE 1 – WEEK 2&3
TOPICS WITH ANSWERS
Week 2
1. Identify the most common type of pathogen responsible for acute
gastroenteritis
Gastroenteritis, also known as enteritis or gastroenterocolitis, is defined as an
inflammation of the stomach and intestine that manifests as anorexia, nausea,
vomiting, and diarrhea. Acute gastroenteritis results most often from an infectious
agent. The most common mode of transmission for acute infectious gastroenteritis
is the fecal–oral route from contaminated food or water. Person-to-person transfer
of the disease is more common within the hospital setting and within day-care
centers where there are larger groups of people capable of transmitting the
disease. Bacterial pathogens account for 30% to 80% of acute gastroenteritis
cases and are an important cause of morbidity in tropical areas and in travelers to
areas of high risk for the pathogens (traveler’s diarrhea). Page 526
2. Recognize that assessing for prior antibiotic use is a critical part of the
history in patients presenting with diarrhea
Some medications, such as antibiotics, can induce diarrhea by disrupting the
normal balance of bacteria. Probiotics have been studied in the treatment of
diarrhea. A systematic review of 63 probiotic studies of adults and children
revealed that the duration of antibiotic-associated diarrhea was shortened by a
mean of 25 hours with probiotics and hydration therapy. Page 512-513.
3. Describe the difference between Irritable Bowel Disease (IBS) and
Inflammatory Bowel Disorder (IBD)
Normal bowel function is regulated by segmental contractions that limit the
movement of bowel contents through the colon. An increase in these contractions
causes constipation, and a decrease in the contractions results in frequent stooling
or diarrhea. Studies have confirmed alterations in colonic activity during periods
of emotional stress, in which motility is decreased or inhibited with depression and
increased with feelings of hostility and anger. Up to one-third of patients with IBS
develop the disorder after bacterial gastroenteritis. It appears that patients with
increased life stressors are more prone to developing IBS postinfection. See #4.
Page 577-578.
4. Discuss two common Inflammatory Bowel Diseases
,Inflammatory bowel disease (IBD) is the term used to describe a chronic
immunological disease that manifests in intestinal inflammation. The two most
common IBDs are ulcerative colitis (UC) and Crohn’s disease (CD). UC involves
only the mucosal surface of the colon, which ultimately results in friability,
erosions, and bleeding. It occurs most often in the rectosigmoid area but can
involve the entire colon. CD is also known as regional enteritis because of the
characteristic segmental presentation of the diseased bowel, which is clearly
separated by areas of normal mucosa, often referred to as “skipped lesions.” CD
can involve all or any layer of the bowel wall and any portion of the
gastrointestinal (GI) tract from the mouth to the anus. UC is more common in
males, and CD is more common in females. Page 570-571.
5. Discuss the diagnosis of diverticulitis, risk factors, and treatments
Diverticular disease is the term used to describe the inflammatory changes that
occur within the diverticular mucosa of the intestine (diverticulitis), as well as the
asymptomatic, uninflamed outpouchings called diverticulosis. Although there is no
known cause for diverticular disease, a low-fiber diet has been implicated because
it causes increased intraluminal pressures within the colon, which lead to mucosal
herniation through the weaker areas in the bowel wall. Other factors believed to
contribute to the formation of diverticula include hypertrophy of the segments of
the circular muscle of the colon, chronic constipation and straining, irregular and
uncoordinated bowel contractions, obesity, and weakness of the bowel muscle
brought on by aging. Risk factors are directly related to the suspected causes of
the disease: older than age 40, low-fiber diet, previous diverticulitis, and the
number of diverticula present within the colon. Diverticula occur most often in the
left lower quadrant (LLQ); a right lower quadrant presentation is a rare
condition, with a higher incidence in Asian populations. Patients with
diverticulosis characteristically present with pain in the LLQ of the abdomen.
When the diverticula have become inflamed, there are the usual signs and
symptoms of infection—fever, chills, and tachycardia. A physical exam reveals
tenderness in the LLQ of the abdomen, and—if the patient can tolerate more
vigorous examination—a firm, fixed mass may be identified in the area of the
diverticuli. Initial laboratory testing can show mild to moderate leukocytosis,
depending on whether the patient presents with diverticulitis or with a more
advanced inflammatory process such as peritoneal abscess. The white blood cell
(WBC) count is usually normal in patients with diverticulosis. Hemoglobin and
hematocrit may be low if there is associated rectal bleeding. Patients with signs
suggestive of peritonitis should have a blood culture to assess for bacteremia. An
incidental finding of uncomplicated diverticulosis requires no further intervention
and can be managed with a high-fiber diet or daily fiber supplementation with
, psyllium. Treatment of a patient presenting with mild symptoms can often be
managed on an outpatient basis with rest, oral antibiotics, and a clear liquid diet.
Initial antibiotic therapy varies with the extent of the inflammatory process and
can include metronidazole (Flagyl) 500 mg by mouth three times daily with
ciprofloxacin (Cipro) 500 mg by mouth twice daily, or
trimethoprim/sulfamethoxazole (Bactrim DS) 160/800 mg by mouth twice daily for
7 to 10 days. The symptoms usually subside quickly; then the diet can be advanced
to soft, low roughage and next to high fiber as tolerated. Pain due to spasms can
be managed with antispasmodics such as hyoscyamine (Levsin) 0.125 mg every 4
hours, dicyclomine (Bentyl) 20 to 40 mg four times daily, buspirone (BuSpar) 15 to
30 mg/day, and/or meperidine (Demerol) 100 to 150 mg/day in divided doses. To
evaluate or diagnose diverticular disease, all patients will require colonoscopy at
some point during their disease process; therefore, referral to a gastroenterologist
is indicated for symptoms that do not respond to treatment after 6 months. Patients
diagnosed with diverticular disease will need to make modifications in their diets
with an emphasis on increasing the amount of dietary fiber. The goal of diet
therapy is to avoid constipation and straining during bowel movements, which can
further increase intraluminal pressures and cause complications. Patients should
also be instructed to drink at least ten 8-ounce glasses of water a day to have
regular, soft bowel movements. Pages 584-586
6. Identify the significance of Barrett’s esophagus
As the erosion heals, the body replaces the normal squamous epithelium with
metaplastic columnar epithelium (Barrett’s epithelium) containing goblet and
columnar cells. This new epithelium is more resistant to acid and, therefore,
supports esophageal healing. Barrett’s epithelium is a premalignant tissue,
however, and presents a 40-fold increased risk for the development of esophageal
adenocarcinoma. Fibrosis and scarring also accompany the healing process,
leading to esophageal strictures. Page 523.
7. Discuss the diagnosis of GERD, risk factors, and treatments
Esophageal reflux is the backward flow of stomach or duodenal contents into the
esophagus without associated retching or vomiting. Gastroesophageal reflux
disease (GERD) is a syndrome that results from esophageal reflux; the
characteristic symptoms are caused by repeated exposure of the esophageal
mucosa to the deleterious effects of gastrointestinal contents and the gradual
breakdown of the mucosal barrier. The primary cause of GERD is the
inappropriate, spontaneous, transient relaxation of the lower esophageal sphincter
(LES) to an unknown stimulus. Obesity is also a risk factor for GERD. A number
TOPICS WITH ANSWERS
Week 2
1. Identify the most common type of pathogen responsible for acute
gastroenteritis
Gastroenteritis, also known as enteritis or gastroenterocolitis, is defined as an
inflammation of the stomach and intestine that manifests as anorexia, nausea,
vomiting, and diarrhea. Acute gastroenteritis results most often from an infectious
agent. The most common mode of transmission for acute infectious gastroenteritis
is the fecal–oral route from contaminated food or water. Person-to-person transfer
of the disease is more common within the hospital setting and within day-care
centers where there are larger groups of people capable of transmitting the
disease. Bacterial pathogens account for 30% to 80% of acute gastroenteritis
cases and are an important cause of morbidity in tropical areas and in travelers to
areas of high risk for the pathogens (traveler’s diarrhea). Page 526
2. Recognize that assessing for prior antibiotic use is a critical part of the
history in patients presenting with diarrhea
Some medications, such as antibiotics, can induce diarrhea by disrupting the
normal balance of bacteria. Probiotics have been studied in the treatment of
diarrhea. A systematic review of 63 probiotic studies of adults and children
revealed that the duration of antibiotic-associated diarrhea was shortened by a
mean of 25 hours with probiotics and hydration therapy. Page 512-513.
3. Describe the difference between Irritable Bowel Disease (IBS) and
Inflammatory Bowel Disorder (IBD)
Normal bowel function is regulated by segmental contractions that limit the
movement of bowel contents through the colon. An increase in these contractions
causes constipation, and a decrease in the contractions results in frequent stooling
or diarrhea. Studies have confirmed alterations in colonic activity during periods
of emotional stress, in which motility is decreased or inhibited with depression and
increased with feelings of hostility and anger. Up to one-third of patients with IBS
develop the disorder after bacterial gastroenteritis. It appears that patients with
increased life stressors are more prone to developing IBS postinfection. See #4.
Page 577-578.
4. Discuss two common Inflammatory Bowel Diseases
,Inflammatory bowel disease (IBD) is the term used to describe a chronic
immunological disease that manifests in intestinal inflammation. The two most
common IBDs are ulcerative colitis (UC) and Crohn’s disease (CD). UC involves
only the mucosal surface of the colon, which ultimately results in friability,
erosions, and bleeding. It occurs most often in the rectosigmoid area but can
involve the entire colon. CD is also known as regional enteritis because of the
characteristic segmental presentation of the diseased bowel, which is clearly
separated by areas of normal mucosa, often referred to as “skipped lesions.” CD
can involve all or any layer of the bowel wall and any portion of the
gastrointestinal (GI) tract from the mouth to the anus. UC is more common in
males, and CD is more common in females. Page 570-571.
5. Discuss the diagnosis of diverticulitis, risk factors, and treatments
Diverticular disease is the term used to describe the inflammatory changes that
occur within the diverticular mucosa of the intestine (diverticulitis), as well as the
asymptomatic, uninflamed outpouchings called diverticulosis. Although there is no
known cause for diverticular disease, a low-fiber diet has been implicated because
it causes increased intraluminal pressures within the colon, which lead to mucosal
herniation through the weaker areas in the bowel wall. Other factors believed to
contribute to the formation of diverticula include hypertrophy of the segments of
the circular muscle of the colon, chronic constipation and straining, irregular and
uncoordinated bowel contractions, obesity, and weakness of the bowel muscle
brought on by aging. Risk factors are directly related to the suspected causes of
the disease: older than age 40, low-fiber diet, previous diverticulitis, and the
number of diverticula present within the colon. Diverticula occur most often in the
left lower quadrant (LLQ); a right lower quadrant presentation is a rare
condition, with a higher incidence in Asian populations. Patients with
diverticulosis characteristically present with pain in the LLQ of the abdomen.
When the diverticula have become inflamed, there are the usual signs and
symptoms of infection—fever, chills, and tachycardia. A physical exam reveals
tenderness in the LLQ of the abdomen, and—if the patient can tolerate more
vigorous examination—a firm, fixed mass may be identified in the area of the
diverticuli. Initial laboratory testing can show mild to moderate leukocytosis,
depending on whether the patient presents with diverticulitis or with a more
advanced inflammatory process such as peritoneal abscess. The white blood cell
(WBC) count is usually normal in patients with diverticulosis. Hemoglobin and
hematocrit may be low if there is associated rectal bleeding. Patients with signs
suggestive of peritonitis should have a blood culture to assess for bacteremia. An
incidental finding of uncomplicated diverticulosis requires no further intervention
and can be managed with a high-fiber diet or daily fiber supplementation with
, psyllium. Treatment of a patient presenting with mild symptoms can often be
managed on an outpatient basis with rest, oral antibiotics, and a clear liquid diet.
Initial antibiotic therapy varies with the extent of the inflammatory process and
can include metronidazole (Flagyl) 500 mg by mouth three times daily with
ciprofloxacin (Cipro) 500 mg by mouth twice daily, or
trimethoprim/sulfamethoxazole (Bactrim DS) 160/800 mg by mouth twice daily for
7 to 10 days. The symptoms usually subside quickly; then the diet can be advanced
to soft, low roughage and next to high fiber as tolerated. Pain due to spasms can
be managed with antispasmodics such as hyoscyamine (Levsin) 0.125 mg every 4
hours, dicyclomine (Bentyl) 20 to 40 mg four times daily, buspirone (BuSpar) 15 to
30 mg/day, and/or meperidine (Demerol) 100 to 150 mg/day in divided doses. To
evaluate or diagnose diverticular disease, all patients will require colonoscopy at
some point during their disease process; therefore, referral to a gastroenterologist
is indicated for symptoms that do not respond to treatment after 6 months. Patients
diagnosed with diverticular disease will need to make modifications in their diets
with an emphasis on increasing the amount of dietary fiber. The goal of diet
therapy is to avoid constipation and straining during bowel movements, which can
further increase intraluminal pressures and cause complications. Patients should
also be instructed to drink at least ten 8-ounce glasses of water a day to have
regular, soft bowel movements. Pages 584-586
6. Identify the significance of Barrett’s esophagus
As the erosion heals, the body replaces the normal squamous epithelium with
metaplastic columnar epithelium (Barrett’s epithelium) containing goblet and
columnar cells. This new epithelium is more resistant to acid and, therefore,
supports esophageal healing. Barrett’s epithelium is a premalignant tissue,
however, and presents a 40-fold increased risk for the development of esophageal
adenocarcinoma. Fibrosis and scarring also accompany the healing process,
leading to esophageal strictures. Page 523.
7. Discuss the diagnosis of GERD, risk factors, and treatments
Esophageal reflux is the backward flow of stomach or duodenal contents into the
esophagus without associated retching or vomiting. Gastroesophageal reflux
disease (GERD) is a syndrome that results from esophageal reflux; the
characteristic symptoms are caused by repeated exposure of the esophageal
mucosa to the deleterious effects of gastrointestinal contents and the gradual
breakdown of the mucosal barrier. The primary cause of GERD is the
inappropriate, spontaneous, transient relaxation of the lower esophageal sphincter
(LES) to an unknown stimulus. Obesity is also a risk factor for GERD. A number
