NR 507 Week 8 Final Exam Master Study Guide

NR507 Final Exam Master Study Guide FINAL EXAM QUICK MAPS GI: inflammation, obstruction, bleeding, and liver failure GERD = weak LES -> acid exposure -> esophagitis Appendicitis = lumen obstruction -> bacterial overgrowth -> ischemia/perforation risk PUD = acid/pepsin injury > mucosal defense, usually H. pylori or NSAIDs IBD = inappropriate immune inflammation of bowel; UC mucosa/colon, Crohn transmural/skip lesions Cirrhosis = fibrosis -> portal HTN + low albumin -> ascites and encephalopathy Endocrine: read the feedback loop Primary gland failure = pituitary hormone rises to compensate, example high TSH in hypothyroidism Overactive target gland = pituitary hormone suppressed, example low TSH in hyperthyroidism Cortisol excess = catabolism + glucose elevation + immune suppression Parathyroid hormone raises calcium and lowers phosphate Neuro: location explains symptoms CNS demyelination = MS, scattered CNS deficits Peripheral demyelination = GBS, ascending weakness/areflexia NMJ transmission problem = myasthenia gravis, fatigable weakness Cerebral blood flow interruption = TIA/stroke symptoms NR507 Final Exam Master Study Guide Signs and symptoms: • Heartburn, regurgitation, chest discomfort, dysphagia • Many sliding hernias are asymptomatic Diagnostics/labs: • Endoscopy, barium swallow, or imaging may identify hernia if symptoms warrant Treatment/management: • Lifestyle measures and acid suppression for reflux symptoms • Surgical repair/fundoplication for large paraesophageal hernia, obstruction, strangulation risk, bleeding, or refractory GERD Exam pearl: Sliding hiatal hernia commonly causes GERD. Paraesophageal hernia is more concerning for strangulation/obstruction. Pathophysiology of appendicitis Pathophysiology: Appendicitis usually begins with obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia, tumor, or foreign body. Mucus continues to be secreted into a closed space, intraluminal pressure rises, venous outflow is impaired, bacteria multiply, ischemia develops, and the appendix can perforate. Signs and symptoms: • Early vague periumbilical pain from visceral nerve irritation • Pain migrates to right lower quadrant as parietal peritoneum becomes inflamed • Anorexia, nausea/vomiting, low-grade fever • McBurney point tenderness, rebound, guarding, positive Rovsing/psoas/obturator signs may occur Diagnostics/labs: • CBC: leukocytosis with neutrophilia • CRP may be elevated • Urinalysis helps rule out urinary causes but mild pyuria can occur from irritation • Pregnancy test in reproductive age patients • CT abdomen/pelvis commonly used in adults; ultrasound often used first in children/pregnancy Treatment/management: • Appendectomy is definitive for many patients • Antibiotics and IV fluids; nonoperative antibiotics may be considered in selected uncomplicated cases • Perforation/abscess may require drainage plus antibiotics before or with surgery Exam pearl: Periumbilical pain that migrates to RLQ is classic because visceral pain becomes localized parietal peritoneal pain. Risks for appendectomy in adults Pathophysiology: Risk comes from the condition and the surgery. Delayed appendicitis increases perforation and abscess risk. Adult surgical risk is higher with comorbidities and complicated disease. Signs and symptoms: • Older age, obesity, diabetes, immunosuppression, pregnancy, anticoagulation, cardiovascular/pulmonary disease • Perforated appendicitis, abscess, sepsis, delayed presentation Diagnostics/labs: • Pre-op labs, imaging, pregnancy testing when relevant, anesthesia assessment NR507 Final Exam Master Study Guide Signs and symptoms: • Epigastric pain worse with eating, nausea, early satiety • Occult bleeding or melena Diagnostics/labs: • Endoscopy with biopsy when indicated