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Questions and Answers
What characterizes peptic ulcer disease?
What characterizes peptic ulcer disease?
What is hematemesis indicative of?
What is hematemesis indicative of?
Which condition is associated with prolonged irritation of the stomach?
Which condition is associated with prolonged irritation of the stomach?
What is a hernia characterized by?
What is a hernia characterized by?
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What does melena refer to?
What does melena refer to?
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Which of the following is most likely a complication of untreated gastroesophageal reflux disease (GERD)?
Which of the following is most likely a complication of untreated gastroesophageal reflux disease (GERD)?
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Which statement accurately describes diverticulum?
Which statement accurately describes diverticulum?
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What might sudden pain relief indicate in the context of appendicitis?
What might sudden pain relief indicate in the context of appendicitis?
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What is a typical symptom of bowel obstruction?
What is a typical symptom of bowel obstruction?
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Which area is commonly associated with rebound pain in appendicitis?
Which area is commonly associated with rebound pain in appendicitis?
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Study Notes
Hernia
- A protrusion of abdominal contents through a weakened abdominal muscle.
- Pathophysiology: Intestines protrude through abdominal opening; this can be reducible or incarcerated. Strangulation occurs when blood flow to the intestines is affected.
- Causes: Straining, lifting heavy objects, sudden twists/pulls, muscle strain, weight gain, chronic coughs, and previous abdominal surgery.
- Types: Inguinal (indirect and direct), femoral, umbilical, and ventral/incisional. Aging is a factor.
Risk Factors
- Obesity, smoking, excessive wound tension, malnutrition, pregnancy, and immunosuppressive agents.
Signs and Symptoms
- Bulge, swelling, abdominal distention, nausea, vomiting, pain, and fever, tachycardia.
- Strangulation can lead to additional symptoms.
Irritable Bowel Syndrome (IBS)
- Pathophysiology: Unknown cause, abdominal pain, and altered bowel habits can occur.
- Subtypes: Constipation-dominant, diarrhea-dominant, mixed, and unclassified.
- Factors: Gastrointestinal motility, visceral hypersensitivity, intestinal inflammation, post-infectious, bacterial overgrowth, food sensitivity, carbohydrate malabsorption, gluten sensitivity, genetics, and psychosocial factors.
Signs/Symptoms of IBS
- Abdominal pain and altered bowel habits.
Nursing Interventions (IBS)
- Assessments: Vitals, pain levels, I&O, surgical site, and deep breathing, early ambulation, pain medications, ice packs, and clear liquid diet.
- Teaching: Discourage coughing, heavy lifting, and observe incisions for infection.
Diverticulitis
- Pathophysiology: Outpouching of intestinal wall inflamed or infected.
- Symptoms: Pain, fever, leukocytosis, palpable mass, increased flatulence, anorexia, abdominal bloating, diarrhea, or constipation, or stools with blood/mucous. Potential perforation or peritonitis in advanced cases.
- Older adults may show mental status changes.
- Complications: Perforation, microperforation, abscess formation, fistula, bowel obstruction, and bleeding.
- Nursing Management: Assess vitals (fever, tachycardia, and serum potassium levels), I&O, pain, mental status, and administer IV fluids, antibiotics, and consider a nasogastric tube for low intermittent suction.
Appendicitis
- Pathophysiology: Opening to the appendix becomes blocked. Inflammation progresses, typically developing severe pain in RLQ, (McBurney's point).
- Symptoms: Periumbilical pain, anorexia, nausea, vomiting, RLQ pain (becoming severe). Rebound tenderness at McBurney's point.
- Complications: Rupture and sepsis. Increased WBC count (10,000-18,000 or >20,000 in perforated cases) might accompany symptoms.
- Sudden pain relief may indicate rupture.
- Nursing Management: Assess vitals, I&O, pain, rebound tenderness, WBC count, and differential. Administer IV fluids, antibiotics. NPO status.
Bowel/Intestinal Obstruction
- Blockage of food/liquid passage through the small or large intestine.
- Symptoms: Pain, loud bowel sounds (borborygmi), vomiting, distention, hypovolemia, and electrolyte imbalances.
- Treatment: Antibiotics, IV fluids, decrease abdominal distention, and other interventions.
Hiatal Hernia
- Stomach portion protrudes upward through the esophageal lining.
- Risk Factors: Residing in western countries- unnatural sitting positions used for defecating and lack of dietary fiber, obesity, pregnancy, and smoking.
- Types: Sliding (GEJ disruption), and paraesophageal (rolling).
- Symptoms: Heartburn, regurgitation, chest pain, dysphagia, belching.
Gastroesophageal Reflux Disease (GERD)
- Relaxation of the lower esophageal sphincter (LES).
- Symptoms: Heartburn, severe atypical chest pain, painful swallowing, hemorrhage, dental caries.
- Complications: Barrett's epithelium (increased malignancy risk); strictures; progressive dysphagia.
Gastritis
- Prolonged stomach irritation.
- Causes: H. pylori, alcohol, NSAIDs, Crohn's disease, tuberculosis, and bile reflux.
- Symptoms: Epigastric pain, nausea, vomiting, weight loss, decreased appetite, altered stool color, dehydration, and GI bleeding.
- Treatments: Triple (or quadruple) therapy, proton pump inhibitors.
Gastroenteritis
- Caused by virus, bacteria, or parasite.
- Symptoms: Diarrhea, nausea, vomiting, anorexia, abdominal distention, poor skin turgor, dehydration, and hyperactive bowel sounds.
- Treatment: Oral and IV rehydration, and medications (loperamide, bismuth subsalicylate).
Peptic Ulcer Disease
- Break in the lining of the stomach or duodenum (submucosa).
- Types: Gastric and duodenal.
- Symptoms: Burning epigastric pain, often worsened by fasting, alleviated by food or antacids, and possible presence of bleeding (hematemesis or melena).
- Complications: Perforation, obstruction, and possible GI hemorrhage.
Gastrointestinal Bleeding
- Hematemesis (bright red) or coffee ground emesis, and/or melena.
- Can occur from peptic ulcers/diseases.
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