Gastroenterology Quiz on Gastric Conditions
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Questions and Answers

What is a common diagnostic test to evaluate gastric bleeding?

  • MRI
  • Gastroscopy (correct)
  • CT scan
  • Ultrasound

    • Gastric bleeding can be caused by an ulcer perforation.

    True

    What surgical procedures are often performed for gastric conditions?

    Subtotal or total gastrectomy

    Signs of gastric bleeding include ______, hematemesis, and melena.

    <p>occult blood in stool</p> Signup and view all the answers

    Which of the following is a symptom of appendicitis?

    <p>Severe abdominal pain in the right lower quadrant</p> Signup and view all the answers

    Match the signs/symptoms with their corresponding conditions:

    <p>Occult blood in stool = Gastric bleeding Severe abdominal pain = Appendicitis Hypovolemic shock = Gastric bleeding complications Localized tenderness at McBurney's point = Appendicitis</p> Signup and view all the answers

    NPO status is recommended to treat hypovolemic shock.

    <p>True</p> Signup and view all the answers

    What is the most common cause of blood loss into the stomach or intestine?

    <p>Gastric bleeding</p> Signup and view all the answers

    What is a common symptom associated with peptic ulcers?

    <p>Heartburn</p> Signup and view all the answers

    The majority of gastric cancer cases are diagnosed at an early stage.

    <p>False</p> Signup and view all the answers

    Name one therapeutic measure used to treat peptic ulcers.

    <p>Proton pump inhibitors</p> Signup and view all the answers

    The H.pylori infection is associated with increased risk of _______.

    <p>gastric cancer</p> Signup and view all the answers

    Match each diagnostic test to its purpose:

    <p>Urea breath test = Detect H.pylori infection Biopsy = Assess malignant lesions Upper GI series = Examine gastrointestinal structure EGDS = Visualize upper digestive tract</p> Signup and view all the answers

    Which of the following is NOT a complication of peptic ulcers?

    <p>Kidney stones</p> Signup and view all the answers

    Belching is caused by the decrease in air swallowing.

    <p>False</p> Signup and view all the answers

    Identify one lifestyle change that can help manage symptoms of peptic ulcers.

    <p>Avoiding smoking</p> Signup and view all the answers

    What position should a patient be placed in to relieve abdominal pain and tension before surgery for appendicitis?

    <p>Upright position</p> Signup and view all the answers

    Heat should be applied to the right lower quadrant to alleviate pain and prevent rupture of the appendix.

    <p>False</p> Signup and view all the answers

    What is the primary causative organism associated with secondary peritonitis due to trauma?

    <p>E. Coli</p> Signup and view all the answers

    The classic sign of peritonitis includes pain that increases with _____ and rebound tenderness.

    <p>movement</p> Signup and view all the answers

    Match the type of peritonitis with its description:

    <p>Primary Peritonitis = Occurs mainly in young females due to pathogenic bacteria Secondary Peritonitis = Caused by appendicitis and other abdominal issues</p> Signup and view all the answers

    What is a common nursing diagnosis related to gastric pain?

    <p>Pain related to the effect of gastric acid secretion on damaged tissue</p> Signup and view all the answers

    Administering antacids can potentially cause side effects such as diarrhea or constipation.

    <p>True</p> Signup and view all the answers

    Which of the following is NOT a diagnostic test for peritonitis?

    <p>Chest x-ray</p> Signup and view all the answers

    What lifestyle adjustments should a patient consider to help reduce anxiety related to gastric disease?

    <p>Identify stressors and involve family in decision-making regarding care.</p> Signup and view all the answers

    Fluid replacement is a critical component in the management of peritonitis.

    <p>True</p> Signup and view all the answers

    List one potential sign of paralytic ileus associated with peritonitis.

    <p>Abdominal distention</p> Signup and view all the answers

    Regularly spaced meals should be encouraged in a _____ atmosphere.

    <p>relaxing</p> Signup and view all the answers

    Match the nursing interventions with their goals:

    <p>Administer medication as prescribed = Relief of pain Avoid caffeine-containing foods = Relief of pain Identify stressors = Reduction of anxiety Encourage family participation = Reduction of anxiety</p> Signup and view all the answers

    What condition is characterized by multiple diverticula present without inflammation?

    <p>Diverticulosis</p> Signup and view all the answers

    Diverticulitis is caused by bacteria trapped in a diverticulum.

    <p>True</p> Signup and view all the answers

    What is the most common symptom of diverticulitis?

    <p>Crampy pain</p> Signup and view all the answers

    Increasing dietary ______ can help prevent constipation.

    <p>fiber</p> Signup and view all the answers

    Match the following conditions with their characteristics:

    <p>Diverticulitis = Inflammation and infection of diverticula Crohn's Disease = Can affect any part of the GI tract Ulcerative Colitis = Inflammatory disease of the colon and rectum Diverticulosis = Presence of diverticula without inflammation</p> Signup and view all the answers

    Which test may show irregular narrowing of the colon?

    <p>Barium enema</p> Signup and view all the answers

    Chronic constipation is a known risk factor for developing diverticulosis.

    <p>True</p> Signup and view all the answers

    What can be a severe treatment measure for diverticulitis?

    <p>Administration of IV antibiotics</p> Signup and view all the answers

    Which of the following is a common symptom of Ulcerative Colitis?

    <p>Bloody diarrhea</p> Signup and view all the answers

    Ulcerative Colitis affects individuals equally among all ethnic groups.

    <p>False</p> Signup and view all the answers

    Name two complications associated with Ulcerative Colitis.

    <p>Anemia and bowel obstruction</p> Signup and view all the answers

    Patients with Ulcerative Colitis should avoid _____ foods, as they may exacerbate diarrhea.

    <p>cold</p> Signup and view all the answers

    Which diagnostic evaluation is NOT typically used for Ulcerative Colitis?

    <p>MRI</p> Signup and view all the answers

    Match the following treatments for Inflammatory Bowel Disorders with their purpose:

    <p>High-protein diets = Meet nutritional needs Antidiarrheal medications = Reduce colonic peristalsis Intravenous therapy = Correct fluid imbalance Antibiotics = Treat secondary infections</p> Signup and view all the answers

    What type of surgery involves the removal of nearly all of the colon?

    <p>Subtotal colectomy</p> Signup and view all the answers

    Laxatives are recommended during the acute stages of Ulcerative Colitis.

    <p>False</p> Signup and view all the answers

    Study Notes

    Management of Peptic Ulcer Disease

    • A peptic ulcer is an excavation in the mucosal lining of the esophagus, stomach, pylorus, or duodenum caused by erosion of a circumscribed area of the mucous membrane.
    • Types of peptic ulcers include esophageal ulcers, gastric ulcers, and duodenal ulcers. Esophageal ulcers form in the esophagus, gastric ulcers in the stomach, and duodenal ulcers in the duodenum (the upper part of the small intestine).

    Pathophysiology of Peptic Ulcer

    • Acid secretion is regulated by endocrine, neural, and paracrine factors.
    • Mucosal defenses, including mucosa, tunica muscularis, serosa, secrete bicarbonate to maintain pH. Mucus is primarily water (95%) and glycoprotein (5%).
    • H. pylori affects the stomach lining by producing urease, influencing neutral gastric acid, and creating toxic effects on mucosal epithelial cells.
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) irritate the mucosa and inhibit the production of prostaglandins, which normally protect the mucosa.

    Causes and Risk Factors

    • Helicobacter pylori infection
    • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    • Zollinger-Ellison syndrome (gastrinoma)
    • Severe stress (e.g., surgery, trauma, head injury, burns)
    • Cigarette smoking
    • Excessive alcohol intake
    • Aging

    Pain

    • Pain/discomfort is sharply localized in the midepigastrium.
    • Heartburn (substernal burning) may occur.
    • Pain may radiate to the back if a duodenal ulcer is involved.
    • Pain is usually worse when the stomach is empty, typically 30 minutes to 2 hours after meals. Pain may wake the patient in the early morning hours (12 midnight - 3 AM). Pain is usually less prominent when the patient first awakens as gastric secretions are lowest at that time.
    • Pain can occur in cycles (clusters) lasting days to weeks.
    • Pain relief is often achieved by food or antacids, within 5-10 minutes if effective.

    Nausea and Vomiting

    • Reflex vomiting occurs in 10-20% of patients with peptic ulcers; it is often associated with ulcer pain or duodenal obstruction, sometimes occurring just after evening meals.

    Belching

    • Belching is caused by excessive air swallowing.

    Heartburn (Pyrosis)

    • Heartburn is a burning sensation in the lower esophagus and just below the sternum.

    Duodenal vs. Gastric Ulcer

    Feature Duodenal Ulcer Gastric Ulcer
    Age 30-60 years old Over 50
    Pathophysiology Hypersecretion of stomach acid Normal or hyposecretion of stomach acid
    Pain Location Epigastric area 2-3 hours after meals; pain relieved by food Mid-epigastric area, ½ - 1 hour after meals; pain increases with food
    Vomiting Uncommon Common - can reduce pain
    Melena Common Uncommon

    Diagnostic Tests

    • For H. pylori: Urea breath test, stool test, biopsy
    • For peptic ulcers: Upper GI series (barium swallow), Upper gastrointestinal X-ray (GI X-ray), Esophago-gastro-duodeno-scopy (EGDS), gastric secretory studies (used to identify Zollinger-Ellison syndrome).

    Peptic Ulcer Complications

    • Hemorrhage: Bleeding can lead to shock
    • Perforation: Ulcer can rupture causing peritonitis
    • Pyloric obstruction: Blockage of the pylorus, leading to dehydration
    • Intractability: Inability to control illness; can cause incapacitation, needing surgery

    Therapeutic Measures

    • Antibiotics (e.g., amoxicillin, clarithromycin)
    • Proton pump inhibitors (PPIs) to reduce acid secretion
    • Histamine antagonists to inhibit histamine action on gastric cells
    • Antacids to neutralize stomach acid
    • Bland diet (soft food, avoid spicy foods)
    • Avoid irritants (e.g., smoking, caffeine, alcohol, trigger foods)

    Gastric Cancer

    • Gastric cancer is a malignant lesion in the stomach, more common in men than women.
    • H. pylori is implicated in gastric cancer development.
    • Other factors associated with gastric cancer development include pernicious anemia, exposure to occupational substances like lead.
    • A poor prognosis is common due to metastasis often present at diagnosis.

    Signs and Symptoms

    • Detected late; presenting symptoms are easily confused with peptic ulcers; they include indigestion, anorexia (loss of appetite), pain, weight loss, nausea, vomiting, and anemia. Later stages may lead to involvement of other organs like the liver.

    Diagnostic Tests for Gastric Cancer/Disorders

    • X-ray studies
    • Gastroscopy
    • Gastric fluid analysis using a nasogastric tube

    Therapeutic Measures for Gastric Cancer/Disorders

    • Medical treatment isn't effective; surgery (subtotal or total gastrectomy) is often needed.
    • Potential surgical complications include hemorrhage, acute gastric distension, and nutritional issues

    Gastric Bleeding

    • Bleeding may result from ulcer perforation, tumors, or gastric surgery.
    • Causes include blood loss into the stomach and intestines.
    • Signs/Symptoms: occult blood in stool, hematemesis (vomiting blood), and melena (black, tarry stool)
    • Diagnostics: hypovolemic shock, endoscopy, low hemoglobin/hematocrit
    • Treatment: stopping blood loss, treating hypovolemic shock with NPO (nothing by mouth), IV fluids, oxygen therapy, nasogastric tube, removal or ligation of bleeding area, medications to reduce gastric acid.
    • Complication: hypovolemic shock

    Disorders of the Lower GI Tract

    • Includes appendicitis, peritonitis, diverticulitis, Crohn's and ulcerative colitis

    Appendicitis

    • Inflammation of the appendix, commonly due to infection.
    • Often requires surgery.
    • Usually occurs in young adults but can happen at any age.
    • Appendix is a small, finger-like organ (approx 10 cm/4 inches).
    • Obstruction of the appendix (narrow lumen) is common, often caused by fecalith (hardened feces) or foreign body.
    • Signs and symptoms include progressively severe abdominal pain (initially periumbilical, then migrating to the right lower quadrant); localized tenderness (McBurney's point), loss of appetite, slight to moderate fever, mild changes in bowel habits (constipation), nausea, and vomiting.

    Appendicitis: Diagnosis

    • Physical examination (focus on pain location and rebound tenderness).
    • Blood tests (elevated white blood cell count).
    • Urinalysis.
    • Careful history to rule out other causes.

    Appendicitis: Complications

    • Perforation (severe pain, elevated temperature):     - Abscess formation (collection of pus)     - Peritonitis (inflammation of the abdominal lining)

    Appendicitis: Treatment and Management

    • Palliative preoperative care:     - Comfortable position to relieve pain and tension (upright position usually).     - Nothing by mouth to decrease peristalsis and allow the stomach to empty before surgery.     - Ice packs applied to the right lower quadrant.     - Monitor vital signs frequently to track infection progression.     - Administer antibiotics when acute appendicitis is diagnosed.
    • Operative care (simple appendectomy): If acute appendicitis is confirmed. Increased operative urgency required if perforation is suspected and generalized peritonitis has developed.

    Peritonitis

    • Inflammation of the abdominal lining (peritoneal cavity).
    • Etiology:     - Bacterial infections (e.g., E. coli, Proteus, Pseudomonas)     - Trauma     - Extension of inflammation from other organs (e.g., inflamed kidney)     - Appendicitis     - Perforated ulcers     - Diverticulitis     - Bowel perforation

    Types of Peritonitis

    • Primary peritonitis: Typically affecting young women, can result from pathogenic bacteria (e.g., streptococci, gonococci) entering the fallopian tubes.
    • Secondary peritonitis: Related to appendicitis, peptic ulceration, biliary tract disease, colonic inflammation, or from trauma.

    Peritonitis: Common Signs

    • Increasing pain with movement
    • Rebound tenderness
    • Signs of paralytic ileus (abdominal distention and absent bowel sounds/activity)
    • Abdominal rigidity and tenderness

    Peritonitis: Diagnostic Tests

    • Blood studies (elevated WBC count)
    • Urine analysis (may show urinary tract problems)
    • Peritoneal aspiration to check for blood, pus, bile, bacteria, amylase, etc., in the peritoneal fluid.
    • Cultures of peritoneal fluid
    • Abdominal X-rays

    Peritonitis: Management

    • Fluid, colloid, and electrolyte replacement to counteract dehydration and imbalances.
    • Nasogastric tube (NGT) intubation and suction to empty stomach contents
    • Oxygen therapy
    • Antibiotics
    • Surgery (directed toward excision - e.g., appendicitis or inflamed bowel; resection with optional anastomosis - for intestines; repair for perforation or drainage for abscesses)

    Diverticulosis and Diverticulitis

    • Diverticulosis: Multiple outpouchings (diverticula) in the colon; usually asymptomatic
    • Diverticulitis: Inflammation and infection of diverticula, common with trapped bacteria

    Diverticulosis and Diverticulitis: Signs and Symptoms

    • Usually asymptomatic until diverticulitis occurs.
    • Symptoms may include:     - Abdominal cramping/pain
    • Worsening symptoms associated with:     - Fever, nausea, vomiting     - Weakness; anemia, leading possibly to peritonitis

    Diverticulitis: Diagnostic Tests

    • Colonoscopy: can show irregular colon narrowing and thickened walls.
    • Barium enema: may show irregularities.
    • Stool examination: Possible for occult blood.
    • Abdominal x-ray to identify perforated diverticula.

    Diverticulitis: Treatment

    • Prevention (increasing dietary fiber intake)
    • In severe instances: intravenous antibiotics, pain control, and nasogastric tube
    • May involve NPO (nothing by mouth) until nausea and vomiting subside

    Crohn's Disease

    • Inflammatory bowel disease (IBD) affecting any part of the GI tract but commonly the terminal ileum or the large intestine.
    • Inflammation extends through the intestinal mucosa and causes abscesses, fistulas (abnormal connections), and fissures (unnatural tracts/ulcers).

    Ulcerative Colitis

    • Inflammatory bowel disease affecting the colon and rectum mucosa. Submucosal inflammation occurs less often.

    Ulcerative Colitis: Etiology and Incidence

    • Unknown (idiopathic).
    • Possible factors:     - Emotional response altering blood supply and causing mucosal ulceration.     - Unidentified organisms causing pathology     - Infection, stress, allergy, autoimmunity.
    • Most common in young adulthood and middle age.

    Ulcerative Colitis: Clinical Manifestations

    • Bloody diarrhea, tenesmus (straining), urgency, and cramping.
    • Multiple crypt abscesses often form, which may become necrotic and lead to ulceration.
    • May be associated with weight loss, fever, dehydration, hypokalemia, anorexia, nausea, vomiting, and iron-deficiency anemia/cachexia (extreme weight loss).

    Ulcerative Colitis: Diagnostic Evaluation

    • Stool exam to rule out bacillary or ameobic dysentery.
    • Sigmoidoscopy
    • Barium enema and x-ray (careful to avoid laxatives in acute cases, as they can exacerbate and cause toxic megacolon).
    • Review of patient's history to understand patterns of fatigue, overwork, and other emotional stressors.
    • Assessing food habits (e.g. milk intolerance).
    • Careful clinical evaluation to rule out diverticulitis, cancer, etc.

    Ulcerative Colitis: Complications

    • Skin ulcers
    • Bowel obstruction
    • Malnutrition
    • Anemia
    • Abscess formation
    • Anal fistulas
    • Electrolyte imbalance
    • Bleeding/hemorrhage
    • Malignancy (e.g., colon cancer)
    • Peritonitis

    Ulcerative Colitis: Medical Management

    • High-protein diets with supplements (vitamins and iron) are recommended to meet nutritional needs.
    • Correct fluid and electrolyte imbalances (often caused by dehydration) via intravenous therapy
    • Avoid foods that worsen diarrhea
    • Avoid smoking/cold foods (intestinal motility is increased by both)

    Ulcerative Colitis: Surgical Management

    • Surgical management may include segmental colectomy with anastomosis, subtotal colectomy with ileorectal anastomosis, and total colectomy.

    Nursing Process for Patients with Gastric Disorders

    • Assessment:     - Pain history (character, degree, relation to meals, relief by antacids).     - Nausea/Vomiting (color, if blood is present).     - Melena     - Food habits, smoking, stress level     - Weight loss, anorexia     - Family history of gastric disease.     - Vital signs for anemia indicators     - Physical examination (palpating for abdominal tenderness)
    • Nursing Diagnoses:     - Pain related to gastric acid effects on damaged tissue.     - Anxiety related to coping with an acute disease.
    • Planning and Implementation: Setting goals to address pain and anxiety.
    • Interventions: Administer pain medication, encourage relaxation techniques, ensure regular nutrition in a calming environment and address patient concerns and anxiety.
    • Evaluation: Patient outcome concerning pain and anxiety resolution

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    Management of Patient with Peptic Ulcer Disease PDF

    Description

    Test your knowledge on gastric conditions including gastric bleeding, ulcers, and appendicitis. This quiz covers diagnostic tests, symptoms, and treatment options related to digestive health. Assess your understanding of common gastrointestinal issues and their management strategies.

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