NR 507 Week 8 Final Exam Study Guide Review

st o Proton-pump inhibitors – 1 thing in the morning. Give it 6 weeks then do endoscopy if symptoms persist. o R/O Cardiac Cause of symptoms  Risk factors for esophageal stricture o GERD: backflow  inflammation C irritations  scar formation  narrowing o Esophagitis: inflammation d/t infection, meds, C autoimmune patho o Ingestion of Caustic Substances: swallowing strong acids/bases  scar tissue from healing process o Radiation: radiation-induced scar tissue o NOTE: Spicy food C family hx of stricture are NOT direct risk factors.  Hiatal hernia treatment - reduce reflux C pressure on the stomach o Lifestyle Modifications  Weight loss  Small, frequent meals  Upright 2-3 hours after eating  Elevate HOB  Avoid Trigger Foods  Fatty foods, chocolate, ca^eine, alcohol, spicy foods, peppermint, acidic foods (tomatoes, citrus)  Stop Smoking  Avoid Tight Clothing  Avoid Heavy Lifting o Meds  Antacids, H2 Receptor Blockers, PPIs, Prokinetic Agents o Surgery  Hernia repair  Pathophysiology of appendicitis o Obstruction  buildup of mucus, bacteria, other debris  inflammation C increased pressure  appendix swells C fills with pus  compromised blood flow  ischemia C necrosis  perforation, peritonitis, abscess formation  Symptoms of appendicitis o ABD pain HALLMARK  Starts umbilical  moves to RLǪ  Dull, vague  sharp, intense  McBurney’s Point  Rosving’s Sign - Palpation of LLǪ causes pain at McBurney’s point o N/V o More extensive than erosion o May cause significant bleeding o PERFORATION o Breach thru entire thickness of GI wall o Contents leak into abdominal cavity o Severe complication, requires immediate medical attention o Sudden, severe ABD pain, board-like rigidity of ABD  Risk factors for PUD o H. pylori (KEY contributor) o NSAID use o Smoking o Acute pancreatitis o Excessive alcohol intake o Obesity o COPD o Age > 65 years o Genetic Predisposition o Stress o Bloody diarrhea HALLMARK o Purulent mucus in stool o ABD pain – crampy, LLǪ concentration o Tenemus – persistent feeling of needing to empty bowels even when little or no stool is present o Anemia o Colon CA o Wt. loss o Fatigue o Fever o Loss of appetite o Toxic Megacolon – complications: bowel perforation, sepsis, C shock, medical emergency o Intermittent periods of remission and exacerbation  Pathophysiology of Crohn’s disease o Illeum is most common location, often spares Rectum o Immune system attacks the entire wall of the GI tract in scattered patches o Genetics + gut bacteria + environment trigger an abnormal immune response  chronic inflammation in ANY PART of the GI tract (mouth to anus)  Patchy damage (skip lesions/Cobblestone lesions)  Full- thickness inflammation (transmural inflammation)  thicken bowel, strictures, fistulas, abscesses.  Treatment of Crohn’s disease (goal to suppress immune systems) o Diet  AVOID FODMAPs – hard-to-digest carbohydrates C sugars o Pharmacological  Aminosalicylates – decrease inflammation  Help maintain remission C precent flares/exac.  SULFASALAZINE C OLSALAZINE  Antimicrobial – prevent/treat infection  Ciprofloxacin C