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Gastrointestinal and Bowel Disorders: Symptoms, Diagnosis, and Treatment, Exams of Nursing

A comprehensive overview of various gastrointestinal and bowel disorders, including acute gastroenteritis (age), irritable bowel syndrome (ibs), inflammatory bowel disease (ibd), diverticulosis, and colorectal cancer. It covers the common symptoms, diagnostic criteria, and treatment approaches for these conditions. The document delves into the etiology, pathophysiology, and management strategies for each disorder, equipping healthcare professionals with the necessary knowledge to effectively identify, evaluate, and manage patients presenting with gastrointestinal and bowel-related complaints. Additionally, the document addresses the role of advanced practice registered nurses (aprns) in the care of these patients, highlighting their scope of practice and the importance of appropriate referrals to gastroenterologists when necessary.

Typology: Exams

2023/2024

Available from 09/19/2024

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vincent-prince 🇺🇸

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CHAMBERLAIN NR 511 PHARMACOLOGY

MIDTERM EXAM (420 QUESTIONS AND

ANSWERS)2024 UPDATED AND GRADED A+

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 What is the most common viral pathogen causing AGE in pediatrics? - answer Rotavirus. This has been greatly reduced since the introduction of the rotavirus vaccine. T or F: Stool studies are indicated in the absence of bloody diarrhea or systemic disease - answer False T or F: A CBC will help distinguish between viral and bacterial AGE - answer False When are stool studies warranted? - answer Severe or prolonged diarrhea, a fever > 38.5ºC, bloody stools or stools that test positive for leukocytes or occult blood. What are common pathogens involved in Traveler's Diarrhea? - answer Shigella, Campylobacter, and E. coli.

What should the clinician do if the patient develops diarrhea after initiation of completion of antibiotic therapy? - answer Test for C. diff. What are some DDx of AGE, particularly in patients with persistent or chronic diarrhea and severe abdominal pain? - answer IBS, IBD, ischemic bowel disease, partial bowel obstruction, small bowel diverticulosis. What are some red flag symptoms that may indicate the need for hospitalization? - answer Hypovolemia, dehydration, abnormal electrolytes, decreased renal function, bloody 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. T or F: IBS is a disorder of bowel function in the absence of an atomic abnormality. - answer True What are common symptoms of IBS? - answer Changes in bowel habits such as diarrhea (IBS-D), constipation (IBS-C), abdominal pain, bloating, rectal urgency with diarrhea. What are some extra-intestinal (outside the intestines) symptoms of IBS? - answer Sexual dysfunction, loss of libido, dyspareunia, muscle aches and

pains, fatigue, fibromyalgia, headaches, back pain, urinary urgency, urinary hesitation, or bladder spasms. T or F: IBS results in serious medical consequences - answer False, prognosis for IBS is excellent. T or F: IBS is a risk factor for IBD (Crohn's and UC) and colon cancer. - answer False What are the two most common types of bowel disorders under the Inflammatory Bowel Disease (IBD) umbrella? - answer Ulcerative Colitis (UC) and Crohn's Disease In which part of the bowel is UC most commonly manifested? - answer Rectosigmoid T or F: UC extends into the small intestine. - answer False, UC is not present outside of the colon. T or F: Crohn's Disease can be present anywhere from mouth to anus. - answer True 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.

  1. Relief of pain with defecation
  2. Heightened sensation in bowel activity
  3. 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 are the 4 main points of IBS treatment? - answer 1. Diet
  4. Education
  5. Pharmacological therapy
  6. Supportive interventions: i.e.reduce stress

T of F: There is proven treatment for IBS - answer False At what severity are pharmacological measures taken in patients with IBS? Mild, moderate, or severe? - answer Moderate to severe What is the first-line treatment for IBS-C? - answer 1. High fiber diet and hydration

  1. Exercise
  2. Bulking agents T of F: Stimulant laxatives can be used as long as is needed to treat IBS-D when first-line treatment fails. - answer False. Not for long-term use. What stimulant laxatives can be used for IBD-D on a short-term basis? And if these fail? - answer 1. Lactulose, magnesium hydroxide.
  3. Linzess (linaclotide), Trulance (plecanatide), or Amitiza (lubiprostone) 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
  4. Rectal bleeding
  5. Leukocytosis
  6. 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

  1. 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.
  2. 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
  3. Fever
  4. Anorexia and weight loss
  5. Flatulence
  6. RLQ pain or mass What are the possible components of the stool that show up in patients with Crohn's? - answer 1. Blood
  7. Mucus
  8. Pus

T of F: Periods of stress can exacerbate Crohn's symptoms - answer True T or F: Fatty, spicy, and dairy foods are well tolerated in patients with Crohn's Disease - answer False, they are usually poorly tolerated. T of R: Crohn's is characterized by periods of acute exacerbation alternating with complete remission. - answer True What is history of antibiotic use important when a patient presents with diarrhea? - answer Because antibiotics disrupt the normal balance of bacteria in the GI tract which in turn affects digestion. What are the most common presenting symptoms of ulcerative colitis (UC)? - answer 1. Rectal bleeding

  1. Abdominal cramping
  2. 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

  1. Guarding
  2. Abdominal distention
  3. 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
  4. Colonoscopy
  5. Barium enema with small bowel follow-through
  6. 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. If 5-ASA drugs fail to help treat IBD, what is the next line of drug therapy? - answer Corticosteroid therapies such as prednisone or hydrocortisone and are very effective in reducing inflammation. If corticosteroid therapy fails to help treat IBD, what is the next line of drugs? - answer Immunomodulators such as Azathioprine, Methotrexate, and 6-mercaptopurine (6-MP). Note: These drugs cause bone marrow suppression which increased the risk of infection.

What medications are often use for moderate to severe IBD? - answer Anti-TNF therapy or "Biologics" including Remicade (infliximab), Humira (adalimumab), and Entyvio (vedolizumab). What disease is present when inflammatory changes within diverticula mucosa of the intestines arises? - answer Diverticular Disease What does diverticular disease, or diverticulosis, look like upon examination of the bowels? - answer Small outpouchings or sacs in the wall of the colon are present, usually at the location of weakened areas of the bowel wall where arterial vessels perforate the colon. T of F: Diverticulosis is typically asymptomatic until the diverticula become inflamed and/or bleed. - answer True Although diverticula con occur anywhere in the intestines, where is the most common place for them to arise? - answer Descending and sigmoid colon 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

  1. Fever
  2. Change in bowel habits (usually diarrhea)
  3. 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

  1. 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.
  11. Laxatives & stool softeners if diet changes aren't sufficient
  12. Miralax: gentle but safe laxative that is safe for long-term use How is opioid-induced constipation (OIC) treated pharmacologically? - answer Movantik or Relistor

If you are at high risk for colorectal cancer based on family history, when should you start screenings? - answer BEFORE age 50 and/or be screened more often What makes a person at high risk for colorectal cancer? - answer 1. Personal history of CC or adenomatous polyps

  1. Personal history of IBD including ulcerative colitis or Crohn's Disease.
  2. Strong family history of colon cancer or polyps
  3. A known family history of hereditary colorectal cancer syndromes such as familial adenomatous polyposis or Lynch Syndrome (hereditary nonpolyposis colorectal cancer). At what age should a colonoscopy begin to be a routine part of a physical exam? - answer 50 years old T of F: African Americans are more likely to develop colon cancer at an early age and should consider colonoscopy screening at age 40. - answer True What are some red flag symptoms of colorectal cancer? - answer 1. Unintentional weight loss
  4. Rectal bleeding
  5. Diffuse lower abdominal pain
  6. New onset of severe diarrhea or constipation
  7. Early satiety
  8. Loss of appetite What are two possible functions of the appendix? - answer 1. "Safe house" for gut flora/bacteria
  9. 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
  1. Fecalith or "poop rock"
  2. Undigested seeds
  3. Pinworm infection
  4. 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
  1. Fever
  2. 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
  3. Subphrenic abcess What treatment is usually performed when appendicitis is present? - answer Appendectomy + Antibiotics Describe acute pancreatitis in one sentence... - answer Acute pancreatitis is the sudden inflammation and hemorrhaging of the pancreas due to destruction by its own digestive enzymes, also called auto digestion.

What are the main endocrine functions of the pancreas? - answer Alpha and beta cells secret hormones into the bloodstream, namely glucagon and insulin, respectively. What are the endocrine functions fo the pancreas? - answer Acinar cells secrete digestive enzymes which are secreted into the duodenum which help break down carbohydrates, lipids, and proteins. How does the pancreas protect itself from its own enzymes? - answer By producing inactive forms of enzymes called proenzymes, known more specifically as zymogens. These zymogens are activated by proteases. Where is zymogen stored to keep it away from sensitive tissues? - answer In vesicles called zymogen granules. These are stored with protease inhibitors to prevent accidental activating for the zymogen. How are zymogens used to digest food? - answer They are secreted into the pancreatic duct and enter the duodenum where they are activated by the protease trypsin. What is trypsinogen? How, when, and to what is it converted? - answer Trypsinogen is a zymogen made by the pancreas. It is activated by enteropepidase which is produced in the duodenum. The active form of the enzyme is called trypsin. What is the results of trypsinogen and other zymogens becoming active prematurely? - answer Acute Pancreatitis Acute pancreatitis may be a result from what two physical circumstances? - answer 1. Injury to the acinar cells

  1. Impaired secretion of proenzymes What are the leading causes of impaired secretion of proenzymes from the pancreas? - answer 1. Alcohol abuse
  2. Gallstones How does alcohol induce acute pancreatitis? - answer 1. Alcohol increases zymogen secretion from acinar cells. Simultaneously, it decreases fluid and bicarbonate in the ducts of the pancreas. This results

in thick pancreatic juices that can form a protein plug in the pancreatic ducts and therefore cause a blockage.

  1. Backed up pancreatic juices increase pressure and may distend ducts. Membrane trafficking* becomes chaotic. Zymogen granules may fuse with lysosomes. This brings trypsinogen into contact with lysosomal digestive enzymes. Trypsinogen then converts to trypsinogen which starts a cascade of enzyme activation resulting in AUTODIGESTION of the pancreas = acute pancreatic.
  2. It stimulates release of cytokines which attracts a strong immune reaction. Neutrophils arrive and release superoxide and proteases which contributes to the problem.
  3. High alcohol consumption and oxidative metabolism of alcohol produces reactive oxygen species which may overwhelm cellular defenses. *Membrane trafficking is the process by which proteins and other macromolecules are distributed throughout the cell, and released to or internalised from the extracellular space. Membrane trafficking uses membrane-bound vesicles as transport intermediaries. How do gallstones cause acute pancreatitis? - answer They can become lodged in the Sphincter of Oddi which is the opening of the of the common bile duct into the duodenum. This results in much the same results as alcohol induced acute pancreatitis (because of the plug) Fill out the acronym "I GET SMASHED" in order to show the varied causes of acute pancreatitis. - answer I: idiopathic G: gallstones E: ethanol abuse T: trauma (i.e. knife wound, not just a punch) S: steroids M: mumps virus A: autoimmune diseases S: scorpion stings H: hypertriglyceridemia and hypercalcemia E: endoscopic retrogrande cholangiopancreatography (ERCP). D: drugs --> sulfa, reverse transcriptase inhibitors and protease inhibitors.

What happens to the pancreas as a whole after the inflammatory response and proteases ravaging the tissues? - answer This causes blood vessels to leak and rupture causing edema which results in the swelling of the capsule of the pancreas. What happens when lipases are activated in the pancreas as a result of the inflammatory process? - answer They can destroy the fat surrounding the pancreas known as the peripancreatic fat. As the autodigestion and bleeding occur in the pancreas, what is the end result? - answer Liquification of pancreatic tissues known as: liquefactive hemorrhagic necrosis. One complication of acute pancreatitis is a pseudocyst. How does this occur and what are the symptoms? How is it best diagnosed? How is this problematic? - answer This occurs when fibrous tissue surrounds liquefactive necrotic tissue which fills with pancreatic juice. Symptoms: abdominal pain, loss of appetite, palpable mass, serum amylase/lipase/bilirubin elevation. CT scan for imaging As pseudocysts grow they may rupture releasing enzymes into the abdominal cavity causing massive inflammation. They can become infected, often by E. coli, which turns the pseudocyst into an abscess. How is a pancreatic pseudocyst distinguished from a pancreatic abscess since they present similarly in symptoms and imaging? - answer 1. High fever and WBC count since it is an infection What secondary complication results from damaged blood vessels as a result of acute pancreatitis? - answer Hemorrhage --> hypovolemic shock How does acute pancreatitis affect the body's ability to clot? - answer It affects the systemic activation of coagulation factors which may result in disseminated intravascular coagulation (DIC). How does acute pancreatitis affect the body's respiratory system? - answer May lead to acute respiratory distress syndrome (ARDS) where massive pancreatic inflammation leads to leaky blood vessels throughout

the body making it harder to breath. #1 killer in patients with acute pancreatitis. What are some general symptoms of acute pancreatitis? What about distinctive signs? - answer 1. N/V, epigastric pain radiating to the back

  1. Hypocalcemia as a result of fat necrosis
  2. Bruising around the umbilicus (Cullen's sign)
  3. Bruising along the flanks (Grey Turner's sign) 3 & 4 happen as a result of necrosis induced hemorrhaging spreads to the soft tissues of those body areas What are the diagnostic features of acute pancreatitis? - answer 1. Pain in epigastric region which may radiate to the back
  4. Labs: Amylase and lipase, the latter being more specific to the pancreas.
  5. CT scan: inflammation, necrosis, pseudocyst
  6. Ultrasound: not definitive, but can locate gallstones if they are suspected. How is acute pancreatitis treated? - answer It can't be cured, per se. Treatment consists of pain management, hydration, electrolyte management, bowel rest. Treat complications with oxygen (ischemia of tissue) and antibiotics for infection such as in an abscess. What is the most common reason for cholecystitis? - answer When a gallstone becomes lodged in the cystic duct. The small intestine secretes ________________ into the blood when food is present in order to instruct the ___________ to secrete ________ to help digest food. - answer 1. cholecystokinin
  7. gallbladder
  8. bile Pain resulting from acute cholecystitis usually starts in the ____________ region and shifts to the ____________ as the gallbladder becomes ____________. - answer 1. midepigastric
  9. right upper quadrant
  10. infection

What is the main subjective s/s of acute cholecystitis? - answer Nausea & vomiting which can last a long time. How does the gall bladder become inflamed? - answer Since there a is a stone stuck in the cystic duct, the bile cannot escape the gallbladder. The bile becomes an irritant to the gallbladder mucosa which in turn secretes mucus and enzymes. These enzymes cause the walls of the gallbladder to become inflamed and pressure to rise. Where does pain caused from cholecystitis radiate? - answer Right scapula, shoulders Bacteria eventually make their way through the gall bladder wall and into the _____________ causing _____________. This results in ____________ tenderness. - answer 1. peritoneum

  1. peritonitis
  2. rebound ____________ sign can help with the diagnosis of cholecystitis and is performed by applying pressure at the subcostal region of the right upper quadrant on inspiration. - answer Murphy's What would blood work show in a patient with cholecystitis? What is the condition called? - answer 1. Elevated neutrophils
  3. Neutrophilic leukocytosis What is the most common resolution of cholecystitis? - answer The gallstone leaves the cystic duct falling back into the gallbladder. How is blood flow to the gallbladder affected in cholecystitis? What is the result? - answer If the stone remains lodged in place, pressure continues to increase in the gallbladder until it expands and pushes on the vessels that supply its blood. This causes ischemia to the organ which leads to gangrenous cell death. Rupture is possible. What complications might arise upon gallbladder rupture? - answer Bacteria from the gallbladder can be expelled and infect the circulatory system leading to sepsis. This is grounds for cholecystectomy.

What complications arise if a gallstone becomes lodged in the common bile duct? - answer Bile backs up into the gallbladder and the liver. The pressure builds and causes bile to force its way through the cells that form the bile duct walls and allow it to enter the blood stream --> conjugated bilirubin --> jaundice. What markers in the blood can be used to assist in the diagnosis of cholecystitis? - answer ALT or alkaline phosphatase. This enzyme is found in high amounts in the cells of the bile ducts of the liver. The increased pressure of the bile in the ducts can cause the cells to rupture, releasing their ALP into the blood. What non-invasive diagnostic test can be used for cholecystitis? What are some of its findings? - answer 1. Ultrasound

  1. Gallbladder wall thickness, sludge, and distention of gallbladder of bile duct. *This test can also elicit the Sonographic Murphy's Sign. What is a more sensitive diagnostic tools can be used for cholecystitis? - answer 1. Cholescintigraphy (HIDA scan) - radio-labeled marker. When duct is blocked, the gallbladder can't be seen.
  2. Endoscopic Retrograde Cholangiopancreatography (ERCP) - Dye is used and then viewed with a fluoroscope.
  3. Magnetic Resonance Cholangiopancreatography (MRCP) What are three main treatment components of cholecystitis? Surgery? - answer 1. Intravenous fluids
  4. Pain management
  5. Antibiotics Surgery: cholecystectomy or Lap Chole (laparoscopic approach) What are some ototoxic drugs? - answer Aminoglycosides, antibiotics, aspirin, and quinine. How is sensorineural hearing loss defined? - answer Caused by a defect of the inner ear such as a lesion in the organ of Corti or in the central pathways, including CN 8 and auditory cortex. _____________ is age related hearing loss and is a form of sensorineural hearing loss. - answer presbycusis

What type of hearing loss involves the outer and middle ear to the level of the oval window that may results from a variety of structural abnormalities?

  • answer Conductive hearing loss T or F: Sensorineural hearing loss is usually irreversible. - answer True T or F: Conductive hearing is often reversible. - answer True T or F: Presbycusis produces a typical low-frequency loss that is bilaterally symmetrical. - answer False, it's high-frequency loss. T or F: In additional to hearing loss, an acoustic tumor will mostly like produce neurological changes such a s facial weakness and tingling, loss of taste and dysphagia. - answer True The _______ test used a vibrating 512-Hz (or higher) turning fork placed midline on the patient's skull. - answer Weber Using the Weber test, in sensorineural loss, the sound in the ________________ is louder. - answer unaffected (or less affected) ear Using the Weber test, in conductive loss, the sound is ________ in the affected ear. - answer Louder The ________ test places a vibrating tuning fork on the mastoid process. When the sound ______ ______ , the fork is promptly placed over the external auditory meatus. - answer 1. Rinne
  1. fades away Using the Rinne test, normally, via air conduction the sound can be heard for _____ times as long as in bone conduction. - answer two Using the Rinne test, in _________________ loss, the ratio of air conduction to bone conduction remains the same or normal (2:1). - answer sensorineural Using the Rinne test, in ________________ loss, the ratio of air conduction to bone conduction is closer to 1:1, or even _____________. - answer 1. conduction
  1. reversed In __________ test, a vibrating tuning fork is placed over the mastoid process of the patient and then the examiner and the results are compared.
  • answer Schwabach Using the Schwaback test, in _________________ loss, the patient's bone conduction is present for a shorter time than the examiner's. - answer sensorineural Using the Schwaback test, in _________________ loss, the patient's bone conduction persists for al longer time than the examiner's. - answer conductive Differential diagnosis for sensorineural hearing loss... - answer 1. Ototoxicity
  1. Exposure to loud noises
  2. Autoimmune issue
  3. Acoustic neuroma
  4. Ménière's disease Differential diagnosis for conductive hearing loss... - answer 1. Cerumen accumulation or impaction (ceruminosis)
  5. Foreign body in the external canal
  6. Otitis externa
  7. Chroic otitis media
  8. Middle ear effusion
  9. Otosclerosis
  10. Vascular anomaly
  11. Cholesteatoma ____________ hearing loss is gradual and progressive, high frequency loss, and deterioration of the cochlea. - answer Sensorineural *This deals with the inner ear and its components T or F: Genetics can influence sensorineural hearing loss - answer True T or F: Sensorineural hearing loss can be corrected - answer False, but it can be stabilized and even prevented.

How is sensorineural hearing loss treated? - answer There's no proven treatment, but hearing aids and cochlear implants (for profound loss) can aide. T or F: Most type of conductive hearing loss are irreversible. - answer False, most are reversible. What are some possible causes of tympanic membrane (TM) rupture? - answer Impact, pressure change injury such as in an airplane of an explosive. Acute infection of the middle ear may cause a relative ischemia in drum concurrent with increased pressure in the middle ear space. What does this lead to? - answer Tear or rupture of the tympanic membrane. What are the signs and symptoms of a perforated tympanic membrane? - answer 1. Sharp ear pain which resides quickly

  1. Drainage from the canal, tinnitus, possible hearing loss
  2. Healing is spontaneous most of the time, but surgery is sometimes necessary. _______________ is scarring after the tympanic membrane has ruptured and healed. What might this scarring be caused from? - answer Otosclerosis. AOM or tympanovstomy tubes that are expelled. __________ ___________ is a common condition found in the outpatient setting that presents with inflammation of the auditory canal, benign and self-limiting but painful. - answer Otitis externa What is a medical emergency that can result from otitis externa? - answer Osteomyelitis of the skull What are the most common causative agents of otitis externa? - answer Gram-negative rods such as pseudomonas as well as fungi. What are the s/s of otitis externa? - answer 1. Painful and itchy
  3. Possible conductive hearing loss
  4. Red, swollen and purulent discharge.
  5. Painful auricle
  6. May be difficult to visualize the TM with excessive edema

How is otitis externa treated? - answer Antibacterial ear drops with or w/o corticosteroids. No class is better than another. Consider cost, availability, and convenience. If the TM cannot be visualized in otitis externa _______________ drops much be used when treating. _______________ is the antibiotic class of choice. - answer 1. non-ototoxic

  1. Fluoroquinolone Uncomplicated acute otitis externa common resolves after ________ days of topical treatment. - answer 7-10 days At what point are systemic antibiotics needed for acute otitis externa treatment? What do these antibiotics need to cover? - answer 1. With refractory cases or auricle cellulitis
  2. Pseudomonas and s. aureus. What is the purpose of the eustachian tube? - answer 1. Connects the middle ear to the nasopharynx
  3. Protects middle ear
  4. Equalizes pressure
  5. Drains secretions What are some causes of a dysfunctional eustachian tube? - answer 1. Allergic rhinitis
  6. Sinusitis
  7. URI
  8. Adenoids
  9. Pregnancy
  10. Pressure changes from airplanes or scuba diving What are common symptoms of eustachian tube disorder (ETD)? - answer 1. Decreased or muffled hearing
  11. Fullness in ears
  12. Inability to "pop" ears with barometric pressure changes
  13. Tinnitis or disequilibrium
  14. Concern for ear infection or cerumen impaction

What is the differential diagnosis for eustachian tube disorder (ETD)? - answer 1. Acute, serous, or chronic otitis media

  1. Otitis externa
  2. Cerumen impaction
  3. Viral myringitis
  4. Cholesteatoma
  5. Otosclerosis What may be encountered on physical exam of patient with eustachian tube disorder (ETD)? - answer 1. Tympanic membrane appears retracted or "sucked in".
  6. Possible effusion What does pneumatic otoscopy show in eustachian tube disorder (ETD)? - answer 1. Immobile tympanic membrane Weber and Rinne tests in patients with eustachian tube disorder (ETD) will show ___________ hearing loss on the affected side. - answer Conductive The key to treating eustachian tube disorder (ETD) is to treat the ___________ problem! - answer Underlying...cold, AOM, AR, T o F: Holding nose and blowing out is an effective way to help clear and equalize the eustachian tube. - answer False, may cause tympanic membrane perforation. Sometimes tympanostomy tubes are placed to relieve pressure. ____________ is the sensation of wound without an exogenous sound source. What causes this sensation? - answer 1. Tinnitis
  7. Poorly understood, might be from chronic noise exposure that may damage the cilia and auditory hair cells or spontaneous activity in individual auditory nerve fibers. What are some associated conditions of tinnitus? - answer 1. Age and hearing loss
  8. Infection
  9. Metabolic disorders
  10. Autoimmune disorders
  11. Trauma