Diagnosis and Treatment of Gastrointestinal Disorders: Age, IBS, UC, and Crohn's Disease, Exams of Nursing

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Chamberlain NR 511 Midterm EXAM 2024-2025 UPDATE ACTUAL EXAM ALL

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What are common causes of N/V associated with gastritis? - answer>>Alcohol, NSAIDs, ASA, ABX, and illicit substances What is the most common cause of nausea and vomiting? - answer>>Acute Gastroenteritis (AGE) What are some manifestations of AGE? - answer>>Nausea, vomiting, and diarrhea, fever, abdominal pain. May also include fatigue, malaise, anorexia, tenesmus and borborygmus. How is the severity of AGE gauged? - answer>>Dehydration secondary to profuse watery diarrhea, fever greater than 101ºF (38.3ºC), vomiting, or dysentery. What are important parts of a patient's history when AGE is suspected? - answer>>Travel, dining locations, ABX history.. What happens to the pH of the stomach when antacids are taken and how does this affect bacteria? - answer>>High pH can make it easier for bacteria to survive and cause and infection. How does motility of the GI tract affect bacteria colonization? - answer>>Small bowel stasis as a result of obstruction, diverticulitis, or blind loop syndrome frequently develop an overgrowth of bacteria within the stagnant segment.

Which immunoglobulin may protect the GI tract against invading organisms? - answer>>IgA...may also help protect against a future attack by the same pathogen. Onset of N/V begin within 6 hours after exposure. Is this bacterial or viral? - answer>>Bacterial: time frame suggests food poisoning resulting from the ingestion of a preformed toxin such as that of Bacillus cereus. What two indications are highly suggestive of viral AGE? - answer>>Incubation periods greater than 14 hours and the initial symptom of vomiting. If a patient presents with AGE and reports bloody stools, what can be understood about the reason for blood in the stool/ - answer>>Mucosal damage and inflammatory process secondary to invasive pathogens. What do frothy stools and flatus suggest? - answer>>Malabsorption problem. Patients with prolonged AGE illness who are malnourished may present with edema. What is the reason? - answer>>Hypoalbuminemia T or F: Chronic diarrhea usually has a noninfectious etiology. - answer>>True T or F: Acute diarrhea usually is caused by infectious agents or toxins - answer>>True What is the most common viral pathogen causing AGE in adults? - answer>>Norovirus

stool/rectal bleeding, weight loss, severe abdominal pain, prolonged symptoms greater than 1 week, pregnancy, advanced age, history of hospitalization or antibiotic use in the last 3- 6 months. What is the usual course of treatment for AGE? - answer>>Only supportive treatment is initiated since AGE is usually self-limiting and resolves within 1 week after onset of symptoms. How such patients with evidence of dehydration be treated initially? - answer>>Fluid repletion and nutrition. Sports drinks aren't as effective as specific electrolyte replenishing drinks. At what point should a patient be referred to the hospital for dehydration? - answer>>Signs of hypovolemia such as hypotension, tachycardia, pallor, and poor skin turgor. T of F: Empiric antimicrobial therapy is recommended for patients with severe diarrhea suspected form traveling. - answer>>True. Bactrim, Ciprofloxacin, Norfloxacin, Floxacin. T or F: Antibiotic prophylaxis for patients traveling to high-risk areas is appropriate. - answer>>True How effective is antibiotic prophylaxis for patients traveling to high-risk areas? - answer>>90% effective What does antibiotic prophylaxis treatment consist of? - answer>>Bactrim, Ciprofloxacin, Norfloxacin, or Floxacin given once daily until 2 days after returning home.

What is an appropriate symptomatic treatment for patients < 65 years or age with moderate to severe diarrhea? - answer>>Two-day course of Loperamide (Imodium) What is an appropriate symptomatic treatment for patients < 65 years or age with significant vomiting? - answer>>Two-day course of Zofran or Phenergan. What is the best way to prevent AGE? - answer>>Hand washing. T or F: Kids can attend daycare with infectious diarrhea as long as they're separated from other children. - answer>>False! Not until the diarrhea has stopped. If pain is present in the right lower quadrant, what might be the etiology related to bowel disorders? - answer>>IBD, IBS, Infectious Colitis, and Constipation If pain is present in the left lower quadrant, what might be the etiology related to bowel disorders? - answer>>Diverticulitis, IBS, IBD, Constipation, and Infectious Colitis. If pain is present in the left upper quadrant, what might be the etiology related to bowel disorders? - answer>>Stomach ulcers, pancreatitis, and gastritis. If pain is present in the right upper quadrant, what might be the etiology related to bowel disorders? - answer>>Gall bladder, hepatitis, and pancreatitis.

In Crohn's Disease there is a characteristic segmental presentation of the diseased bowel, separated by normal areas of mucosa. What are these areas referred to as? - answer>>Skipped lesions What is one characteristic of Crohn's that differentiates it from UC related to the bowel tissues themselves? - answer>>Crohn's affects the tissue to a deeper level and can affect any or all layers of the bowel. What is the theory behind the etiology of IBD? - answer>>An initiating factor such as a virus, allergic, or bacterial process occurs and inflames the intestine. Subsequently, those with a certain genetic predisposition may produce antibodies that chronically attack the intestine (autoimmune). Sometimes other relatives are found to also have IBD demonstrating a genetic component. Describe IBS as it pertains to its effect on the bowels... - answer>>Disordered sensation or abnormal function of the small or large intestine. What is the most consistent characteristics of IBS? - answer>>Alteration in bowel habits alternating. Abdominal pain is also common. Painless diarrhea may occur. What are the three most common areas of abdominal tenderness for patients with suspected IBS? - answer>>LLQ, umbilicus, or epigastrium.

T or F: The physical exam for patients with suspected IBS is usually abnormal - answer>>False: It's usually normal because there is no anatomical abnormality behind this condition. T or F: Digital rectal exams are usually normal in patients with suspected IBS but may exacerbate symptoms. - answer>>True T or F: Extensive testing such as thyroid testing, abdominal imaging, and stool studies are indicated in patients with suspected IBS - answer>>False: Start with basic labs such as CBC and ESR, although elevated ESR and leukocytosis is typically seen with IBD, not IBS. T or F: Colonoscopy and barium enema are abnormal in a patient with suspected IBS - answer>>False: Those tests would be normal because there is no anatomical abnormality behind this condition. What are 4 main points of diagnosis for patients with suspected IBS? - answer>>1. Reveal an increase in bowel symptoms with the onset of pain.

2. Relief of pain with defecation
3. Heightened sensation in bowel activity
4. Sense of incomplete defecation T or F: Symptoms of IBS are accompanied by fever and/or bleeding. - answer>>False What is the first step to treating a newly diagnosed IBS patient? - answer>>Determine whether they are IBS-D, IBS-C, or IBS-M

What medication can be used to help with abdominal pain/spasms due to IBS? - answer>>Antispasmodics: Bentyl (dicyclomine) or Levisn (hyoscyamine) T of F: Patients with IBS and comorbid BPH or glaucoma, especially in the elderly, should avoid anticholinergics to treat abdominal pain. - answer>>True T or F: Tricyclics antidepressants and SSRIs have shown to have favorable outcomes in patients with IBS - answer>>True T or F: APRNs should not be managing patients with IBS and should immediately refer to a gastroenterologist - answer>>False. APRNs can manage IBS with the conservative treatment. If these fail, they should then be referred. What symptoms are shared by ulcerative colitis (UC) and Crohn's under the Inflammatory Bowel Disease umbrella? - answer>>1. Fever

2. Rectal bleeding
3. Leukocytosis
4. Cramping abdominal pain/diarrhea T or F: Cross-sectional imaging and/or colonoscopy can usually detect signs of IBD. - answer>>True

Crohn's Disease represents an abnormality in intestinal immune response. What is the result of this abnormality with regard to the bowel tissue and subsequent complications? - answer>>1. Causes fibrosis which thickens the bowel wall

2. Narrows the lumen of the bowel leading to obstructions, fistulas, and ulcerations. T or F: Patients with Crohn's are at higher risk than the general population for developing colon cancer. - answer>>True What is the supposed etiology of ulcerative colitis (UC) and what tissue does it affect? - answer>>An inflammatory response of unknown origin that occurs in the thinner mucosa of the rectum and sigmoid colon resulting in tissue damage. What type of tissue damage occurs ulcerative colitis (UC)? - answer>>1. Ulcers form in the eroded tissue.
3. Abscesses form in the crypts which become necrotic and ulcerated. What happens to the mucosa in ulcerative colitis (UC)? - answer>>It becomes edematous and thickened, narrowing the lumen of the colon. T of F: There is a higher risk of perforation of the colon in patients with UC - answer>>True What are the most common presenting symptoms of Crohn's Disease? - answer>>1. Abdominal cramping
4. Fever

3. Urge to defecate What is characteristic of stool in patients with UC? - answer>>Watery diarrhea with blood and mucus T or F: Fecal leukocytes are almost always present in the presence of ulcerative colitis. - answer>>True How many bowel movements do patients with mild UC report on a daily basis? - answer>>Up to 4 loose BMs associated with abdominal cramps that are relieved with defecation. How many bowel movements do patients with moderate UC report on a daily basis? - answer>>4-6 loose BMs that contain more blood and mucus. How many bowel movements do patients with severe UC report on a daily basis? - answer>>6- 10 loose BMs per day, abdominal tenderness, and symptoms of anemia, hypovolemia, and impaired nutrition. What might a physical exam reveal on a patient with suspected Crohn's Disease? - answer>>RLQ tenderness which often presents as appendicitis, RLQ mass may be palpated, 50% of individuals have perianal involvement consisting of anal or perianal fissures. What is the severity of Crohn's based on? - answer>>Level of inflammation and intestinal lumen obstruction caused by fibrosis.

What might a physical exam reveal on a patient with suspected ulcerative colitis? - answer>>1. Tenderness in the LLQ or across the entire abdomen

2. Guarding
3. Abdominal distention
4. In severe cases s/s of peritonitis may be seen if perforation is a complication. What is an important first step when considering ulcerative colitis as a diagnosis? - answer>>Excluding an infectious cause for the colitis What tests are used to differentiate UC from CD? - answer>>1. Sigmoidoscopy
5. Colonoscopy
6. Barium enema with small bowel follow-through
7. CT T or F: IBD treatment can be very complex and in generally managed by a gastroenterologist. - answer>>True What medication has been used with some success for the last 50 years in the treatment of UC but not in Crohn's? - answer>>5-aminosalicyclic acid agents (5-ASA). T or F: Antidiarrheals should be used for acute UC and toxic megacolon. - answer>>False, but they can be used for sparingly outside of these conditions for IBD keeping in mind that constipation may result.

How does diverticulosis differ from diverticulitis? - answer>>The latter occurs when the former becomes inflamed and subsequently has the potential to rupture Where does acute diverticulitis usually show up during an abdominal exam? - answer>>LLQ abdominal pain and tenderness If a perforation of a diverticula occurs and is not isolated, signs and symptoms of _________________ may be present. - answer>>Peritonitis...think rebound tenderness! What are common signs and symptoms of diverticulitis? - answer>>1. LLQ pain/tenderness

2. Fever
3. Change in bowel habits (usually diarrhea)
4. N/V T or F: Occult blood can usually be found in the presence of diverticulitis. - answer>>True When testing for diverticulitis, what blood tests should be ordered and what would they show?

• answer>>1. CBC: can show mild to moderate leukocytosis

2. H&H: may be low with associated rectal bleeding. T or F: Abdominal x-rays should be obtained on all patients with suspected diverticulitis. Why or why not? - answer>>True: to look for free air (indicating perforation), ileus, or obstruction.

Which clinical test is very sensitive and accurate for definitive diagnosis of diverticulitis? - answer>>CT scan with oral and IV contrast If evidence of diverticulitis is found on x-ray, what would be the next step? - answer>>Treat empirically, do NOT wait for confirmation with CT. What is the medication of choice for treatment of diverticulitis? - answer>>10-14 days of Metronidazole 500mg TID + Ciprofloxacin 500mg BID —OR— Bactrim DS 160/800mg BID Common causes of constipation? - answer>>1. Idiopathic

2. Narcotics
3. Tricyclics antidepressants
4. Iron supplements
5. Anticholinergics
6. Antidiarrheals
7. Antipsychotics
8. Calcium supplements
9. Can be a symptom of colorectal cancer How is constipation treated? - answer>>1. Increase intake of fluids and high fiber foods: vegetables, fruits, prunes, whole grain breads and high fiber cereal, bran (may cause gas)
10. Bulking agents: psyllium and methylcellulose. Bulk in the stool stimulates the natural contractions of the large intestine. They're softer and easier to pass.

3. Diffuse lower abdominal pain
4. New onset of severe diarrhea or constipation
5. Early satiety
6. Loss of appetite What are two possible functions of the appendix? - answer>>1. "Safe house" for gut flora/bacteria
7. Immune system role What percentage of the populations experiences appendicitis at some point in their life? - answer>>10% T or F: Appendectomy is the most common surgery of the abdomen. - answer>>True What is the most common cause of appendicitis and what contributes to this cause? - answer>>Obstruction
8. Fecalith or "poop rock"
9. Undigested seeds
10. Pinworm infection
11. Lymphoid hyperplasia in adolescence which happens as a natural part of development of when a viral (including vaccinations) infection is present.

How does the appendix become inflamed and what nerves does it affect? - answer>>Mucus is continually produced by intestinal tissue. When the appendix becomes blocked, that production continues and enlarges the appendix due to the obstruction. As it inflames, it pushes on the visceral nerve fibers causing abdominal pain. In appendicitis, what causes a spike in WBC count upon testing the blood? - answer>>Normal gut bacterium including E. coli and Bacteroids fragilis multiply and causes the immune system to respond. How physical signs can be assessed for in order to make a diagnosis of appendicitis? - answer>>1. RLQ pain --> McBurney's Point

2. Fever
3. N/V What is the pathology of appendicitis from onset to peritonitis? - answer>>Increasing inflammation causes blood vessels to become compressed --> ischemia of the appendiceal tissue --> tissues necrosis --> bacterial invasion of appendiceal tissue and pus formation--> appendiceal tissue rupture --> peritonitis with rebound tenderness What are two possible complications of a ruptured appendix beyond peritonitis? - answer>>1. Periappendiceal abcess
4. Subphrenic abcess What treatment is usually performed when appendicitis is present? - answer>>Appendectomy + Antibiotics