gi jeopardy! gi jeopardy!. 25 a & p gi tests upper gi problems lower gi problems 50 75 50 25 75...

GIJEOPARDY!

GIJEOPARDY!

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Lower GI Problems

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A

Name 3 physical factors and 1 psychological factor which can affect the function of the GI tract. (Be specific).

A & P:A & P: 25 pts 25 pts

Answer: A&P 25 ptsAnswer: A&P 25 ptsMobilityDiet:

Fat / Fiber / Spices ETOH / caffeine

Medication:ASA / NSAIDS / APAPAntacids / Antibiotics

SmokingStress / Anxiety

A & P: 50 ptsA & P: 50 pts

Part 1: This structure prevents reflux

/ regurgitation of stomach secretions into the esophagus.

Part 2: This structure prevents

aspiration of fluids / solids into the trachea. A

Answer: A&P 50 Answer: A&P 50 ptspts

What is the LES (Lower Esophageal Sphincter)? Remains contracted most of the time Relaxes for swallowing / belching / vomiting

What is the epiglottis? Opens breathing / talking Closes eating / drinking

A & P: 75 ptsA & P: 75 pts

This substance is needed for Vitamin B12 absorption in the small intestine.

(Name the substance and where it is made).

A


What isIntrinsic Factor

(which is made in the stomach)?

A & P: 100 ptsA & P: 100 pts

This is where digestion is completed and most absorption takes place.

A


What is the small intestine?

23 feet for absorption

Inflammation / disease or removal of part of the bowel will result in less absorption of essential nutrients / calories.

A & P: 150 ptsA & P: 150 pts

This organ:

Regulates glucose(by storing / breaking down glycogen);

Stores nutrients (vitamins, minerals, proteins);

Makes essential nutrients (clotting factors, transferrin, proteins, bile);

Breaks down substances / wastes. (cholesterol, RBC, protein, meds) A


What is the liver?If damaged / diseased can

lead to: bilirubin / ammonia levels glucose levelsBleeding problems cholesterol levelsDrug toxicity

A & P: 200 ptsA & P: 200 pts

This organ supports the GI system by releasing many enzymes needed to promote digestion of carbohydrates, fats, and proteins.(Name the organ and 3 enzymes it produces). A

Answer: A&P 200 Answer: A&P 200 ptsptsWhat is the pancreas?

Enzymes it produces:Amylase carbohydrates

Lipase fat Trypsin / Peptidase proteins

Bicarbonate neutralizes stomach acids

GI Tests: 25 ptsGI Tests: 25 pts

A

This physical assessment technique is done to localize the area of pain in the abdomen.

Answer: GI Tests 25 Answer: GI Tests 25 ptspts What is rebound tenderness?

Remember:Auscultate 1st (2-5 mins in each quadrant),

then palpate or irrigate NG

Palpate most painful area last!!

http://www.doctorsecrets.com/your-surgery/appendicitis-picture.gif


This test looks for hidden blood in the stool.

A

Answer: GI Tests 50 Answer: GI Tests 50 ptspts

What is a Guaiac / Hemoccult test?

**Should be done on a yearly basis, starting at age 50, to screen for colorectal cancer!!

GI Tests: 75 ptsGI Tests: 75 ptsThis invasive procedure requires:

Informed consent;

Clear liquids day prior / NPO after midnoc;Laxatives / enemas before;IV conscious sedation.

A flexible tube with a lighted scope is inserted into the large intestine during this procedure.

A

Answer: GI Tests 75 Answer: GI Tests 75 ptspts What is a colonscopy?

Direct visualization of colon

(polyps, diverticuli, masses)

Gold standard for Colon Cancer screening / dx

(done q 10 years & prn based on findings)

Expect cramping / flatus after testMonitor for bleeding / perforation /

infection after test


This test requires:NPO 8-12 hrs before;Ingestion of liquid barium;Laxatives / fluids after.

A

Answer: GI Tests 100 Answer: GI Tests 100 pts pts What is an UGI Series / Barium Swallow? (SBFT: Small Bowel Follow Through)

Looking for: strictures / masses / hernias Stools will be white after the test

FYI:

LGI Series (Lower GI Series) / Barium Enema

Looking for polyps, lesions, diverticuli Requires laxatives / enemas before

GI Tests: 150 ptsGI Tests: 150 ptsThis invasive procedure requires:

Informed consent;

NPO status;IV conscious sedation;Lidocaine spray to numb the throat.

A flexible lighted scope is passed through the esophagus, stomach and into the duodenum during this procedure. A

Answer: GI Tests 150 Answer: GI Tests 150 ptspts What is an EGD?

(Esophagogastroduodenoscopy)Direct visualization of upper GI tractLooking for:

GERD / Ulcers / Hiatal HerniaBx / cautery / removal

After test: Protect airway

NPO until gag reflex returns and pt is awake HOB elevated / side-lying position

Monitor for bleeding / perforation / infection

GI Tests: 200 ptsGI Tests: 200 ptsThis noninvasive procedure requires:

NPO 2-6 hrs before test;No smoking 8-12 hrs before test.

It is usually the 1st test done to visualize the size / shape / integrity of internal organs of the abdomen.

A

Answer: GI Tests 200 Answer: GI Tests 200 ptspts

What is an Abdominal Ultrasound?

Notes: Gallstones / Obstructions / Masses Appendicitis / Liver enlargement

Upper GI Probs: 25 Upper GI Probs: 25 ptspts

A

Risk factors include:5 F’s: Female, Fat, 40, Fertile, Family;Sedentary lifestyle;High fat diet;Trauma / infection to area.

(Name disease process & 2 common S/S).

Answer: UGI Probs 25 Answer: UGI Probs 25 ptsptsWhat is Gall Bladder Disease?

(Cholelithiasis: gallstones)(Cholecystitis: inflammation of GB)

S/S: Indigestion / N/V / heartburn & flatulence

(esp after high fat meal) RUQ pain (biliary colic) radiation to shoulder /

back (Demerol: drug of choice to decrease spasms)

Tachycardia, diaphoresis, fever, restlessnessObstruction (D/T stones in bile duct):

Jaundice / White, clay-colored stools Bleeding problems Pancreatitis / Hepatitis


This syndrome is treated with:

Dietary changes No spices, citrus, fatty foods,

No caffeine, ETOH

Lifestyle changes Small freq meals

No bedtime snacks Bed up on blocks

Wt loss / No smoking

Meds Antacids / H2 blockers / PPI.

(Name syndrome, 2 causes and 2 S/S).A

Answer: UGI Probs 50 Answer: UGI Probs 50 ptspts

What is GERD?(Gastroesophageal Reflux Disease)

Causes:

Weakened LES

Delayed gastric emptyingImpaired esophageal motilityHiatal Hernia

S/S (esp after eating irritating foods):Pyrosis (heartburn)

Regurgitation (sour liquid coming up throat)Sore throat / hoarseness / lump in throatPost meal N/V & fullnessResp S/S (wheezing / cough / SOB) due to aspiration


What type of medications can be used to treat GERD?

(Name 3 categories of medications and an example of each).

A

Answer: UGI probs 75 Answer: UGI probs 75 ptspts

Antacids:Maalox / Mylanta

Histamine (H2) Blockers:Zantac / Pepcid / Axid / Tagamet

Proton Pump Inhibitors:Prilosec / Nexium / Protonix / Aciphex /

PrevacidOther meds:

Antiulcer meds: Carafate / GavisconProkinetic agents: ReglanCholinergic agents: Urecholine

Surgical tx: when diet / meds fail, HH, complications Nissen Fundoplication

Upper GI Probs:100 Upper GI Probs:100 ptspts

This disease process is caused by:Irritating foods / caffeine Smoking / ETOHMedications (ASA / NSAIDS / steroids)Bacteria (H. Pylori)

which can lead to GI bleeding / ulcers, anemia and gastric cancer if not treated.

(Name disease and 2 tx options). A

Answer: UGI Probs 100 Answer: UGI Probs 100 pts pts

What is Gastritis?

Tx options:Rest stomach

Treat nausea / painChange diet BLANDMedications: Antacids, H2 blockers, PPI

Antibiotics Vit B12 (chronic gastritis)

Upper GI Probs: 150 Upper GI Probs: 150 ptspts. This invasive procedure includes the insertion of a lighted scope into the esophagus, stomach and duodenum and back up into the common bile duct to retrieve stones or material causing obstruction and / or place stents.

A

Answer: UGI probs 150 Answer: UGI probs 150 ptspts What is an ERCP? (Endoscopic Retrograde CholangioPancreatography)

Important: **Monitor for pancreatitis after procedure

(due to manipulation of common bile duct)


Describe the medical and surgical treatment options for a client with GB disease.

A

Answer: UGI probs 200 Answer: UGI probs 200 ptsptsMedical Tx for GB disease:

Tx S/S: pain, nausea, infection, fluids / lytes

Stone removal / duct dilatationLow fat diet

Surgical Tx for GB disease:Lap vs Open Cholecystectomy

Routine post-op careDrains: T-tube—to keep duct openRight shoulder pain: D/T CO2

movement

Lower GI Probs: 25 Lower GI Probs: 25 ptspts

Part 1: These are out-pouchings of the large

intestine (sigmoid colon) caused by age and / or lack of fiber and fluid in the diet.

Part 2:These are excess growths that project into the bowel (sigmoid colon) and are often seen and removed during a routine colonoscopy. A

Answer: LGI Probs 25 Answer: LGI Probs 25 ptspts

What are diverticuli? Usually asymptomatic until inflamed

(diverticulitis) which can lead to increased pain, fever, bleeding, obstruction &/or perforation.

What are polyps? Usually asymptomatic / benign All polyps are considered abnormal

(a risk factor for colon cancer) and removed

Lower GI Probs: 50 Lower GI Probs: 50 ptspts This disease process occurs more often in teenage males and is caused by a blockage / build up of stool, lymph tissue or foreign material.

(Name disease & 2 common S/S).

A

Answer: LGI Probs 50 Answer: LGI Probs 50 ptsptsWhat is an Appendicitis?

S/S: Periumbilical / RLQ pain

Rebound tendernessMuscle guardingAnorexia / N/V / fever

Tx: Control pain (ice / no heat,

limit narcotics until dx made) Confirm dx (Ultrasound / CT scan) Prompt surgical removal


The S/S of this problem include:Rigid / board-like abdomen;Abdominal distention;Abd pain / tenderness;Absence of bowel sounds;Tachycardia / tachypnea;Fever / diaphoresis.

A

Answer: LGI Probs 75 Answer: LGI Probs 75 ptspts What is peritonitis?

Can be caused by:Perforation of internal abd organ(appendix / bowel / diverticuli /

ulcer)

Can lead to Sepsis ShockOrgan failure Death!

Requires: Prompt recognition / tx!!**Need to support ABC’s 1st,

then investigate / tx the cause.

Lower GI Probs: 100 Lower GI Probs: 100 ptspts How does tx of

diverticulosis differ from tx of diverticulitis?

A


Tx of Diverticulosis:

Increase fiber / fluids (no nuts, seeds, popcorn)

Bulk laxativesAnticholinergics: short term useWt lossDecrease intra-abd pressure

Tx of Diverticulitis: Acute situation!!Bowel rest: NPO / IV fluids

Bed restIV antibiotics? Surgery: needed in 30% of cases


Where do intestinal obstructions occur most often and why?

(Name location and2 mechanical causes &2 non-mechanical causes).

A


Small Intestine(23 feet of narrow bowel)

Mechanical causes:Adhesions / scar tissue

HerniasNeoplasms / tumorsTwisted bowel

Non-mechanical causes:

Lack of nerve stimuli

Lack of blood flow (emboli / ischemia)Paralytic ileus / ImmobilityElectrolyte imbalance (low K+ levels)

Infection


Name three common S/S of a bowel obstruction and how they are treated:medically vs surgically.

A

Answer: LGI Probs 200 Answer: LGI Probs 200 ptsptsS/S: N/V (esp with SBO)

Abdominal pain / distentionTympanic or absent bowel soundsNo flatus or BM

Medical tx: Surgical tx:Support ABC’s!! Bowel rx / anastomosisThorough GI assessment: Bowel rx / ostomy

BS / N/V / pain / firmness Stoma: beefy red / moist

Decompress bowel: edematous

NG to LIS / NG management shrinks as it heals

Maintain fluid / electrolyte balanceIV fluids / NPO / I&O

Ambulate

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