Developing Your WIDS/IntraLearn Course

1
GI JEOPARDY!
2
Upper GI Problems
Lower GI Problems
A P
GI Tests
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25
25
25
50
50
50
50
75
75
75
75
100
100
100
100
150
150
150
150
200
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200
3
A P 25 pts

Name 3 physical factors and 1 psychological
factor which can affect the function of the GI
tract. (Be specific).
A
4
Answer AP 25 pts

• Mobility
• Diet
• Fat / Fiber / Spices
• ETOH / caffeine
• Medication
• ASA / NSAIDS / APAP
• Antacids / Antibiotics
• Smoking
• Stress / Anxiety

5
A 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
6
Answer AP 50 pts

• 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

7
A P 75 pts

• This substance is needed for Vitamin B12
  absorption in the small intestine.
• (Name the substance and where it is made).

A
8
Answer AP 75 pts

• What is
• Intrinsic Factor
• (which is made in
• the stomach)?

9
A P 100 pts

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

A
10
Answer AP 100 pts

• 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.

11
A 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
12
Answer AP 150 pts

• What is the liver?
• If damaged / diseased can
• lead to
• bilirubin / ammonia levels
• glucose levels
• Bleeding problems
• cholesterol levels
• Drug toxicity

13
A 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
14
Answer AP 200 pts

• What is the pancreas?
• Enzymes it produces
• Amylase ? carbohydrates
• Lipase ? fat
• Trypsin / Peptidase ? proteins
• Bicarbonate ?neutralizes stomach acids

15
GI Tests 25 pts

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

A
16
Answer GI Tests 25 pts

• What is rebound tenderness?
• Remember
• Auscultate 1st (2-5 mins in each quadrant),
• then palpate or irrigate NG
• Palpate most painful area last!!

17
GI Tests 50 pts

• This test looks for hidden blood in the stool.

A
18
Answer GI Tests 50 pts

• What is a Guaiac / Hemoccult test?
• Should be done on a yearly basis, starting at
  
• age 50, to screen for colorectal cancer!!

19
GI Tests 75 pts

• This 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
20
Answer GI Tests 75 pts

• 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 test
• Monitor for bleeding / perforation / infection
  after test

21
GI Tests 100 pts

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

A
22
Answer GI Tests 100 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

23
GI Tests 150 pts

• This 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
24
Answer GI Tests 150 pts

• What is an EGD?
• (Esophagogastroduodenoscopy)
• Direct visualization of upper GI tract
• Looking for
• GERD / Ulcers / Hiatal Hernia
• Bx / 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

25
GI Tests 200 pts

• This 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
26
Answer GI Tests 200 pts

• What is an Abdominal Ultrasound?
• Notes Gallstones / Obstructions / Masses
• Appendicitis / Liver enlargement

27
Upper GI Probs 25 pts

• Risk factors include
• 5 Fs Female, Fat, 40, Fertile, Family
• Sedentary lifestyle
• High fat diet
• Trauma / infection to area.
• (Name disease process 2 common S/S).

A
28
Answer UGI Probs 25 pts

• What 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, restlessness
• Obstruction (D/T stones in bile duct)
• Jaundice / White, clay-colored stools
• Bleeding problems
• Pancreatitis / Hepatitis

29
Upper GI Probs 50 pts

• 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
30
Answer UGI Probs 50 pts

• What is GERD?(Gastroesophageal Reflux
  Disease)
• Causes
• Weakened LES
• Delayed gastric emptying
• Impaired esophageal motility
• Hiatal Hernia
• S/S (esp after eating irritating foods)
• Pyrosis (heartburn)
• Regurgitation (sour liquid coming up throat)
• Sore throat / hoarseness / lump in throat
• Post meal N/V fullness
• Resp S/S (wheezing / cough / SOB) due to
  aspiration

31
Upper GI Probs 75 pts

• What type of medications can be used to treat
  GERD?
• (Name 3 categories of medications and an
  example of each).

A
32
Answer UGI probs 75 pts

• Antacids
• Maalox / Mylanta
• Histamine (H2) Blockers
• Zantac / Pepcid / Axid / Tagamet
• Proton Pump Inhibitors
• Prilosec / Nexium / Protonix / Aciphex /
  Prevacid
• Other meds
• Antiulcer meds Carafate / Gaviscon
• Prokinetic agents Reglan
• Cholinergic agents Urecholine
• Surgical tx when diet / meds fail, HH,
  complications
• Nissen Fundoplication

33
Upper GI Probs100 pts

• This disease process is caused by
• Irritating foods / caffeine
• Smoking / ETOH
• Medications (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
34
Answer UGI Probs 100 pts

• What is Gastritis?
• Tx options
• Rest stomach
• Treat nausea / pain
• Change diet ?BLAND
• Medications Antacids, H2 blockers, PPI
• Antibiotics
• Vit B12 (chronic gastritis)

35
Upper GI Probs 150 pts

• .

• 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
36
Answer UGI probs 150 pts

• What is an ERCP?
• (Endoscopic Retrograde CholangioPancreatography)
• Important
• Monitor for pancreatitis after procedure
• (due to manipulation of common bile duct)

37
Upper GI Probs 200 pts

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

A
38
Answer UGI probs 200 pts

• Medical Tx for GB disease
• Tx S/S pain, nausea, infection, fluids / lytes
• Stone removal / duct dilatation
• Low fat diet
• Surgical Tx for GB disease
• Lap vs Open Cholecystectomy
• Routine post-op care
• Drains T-tubeto keep duct open
• Right shoulder pain D/T CO2 movement

39
Lower GI Probs 25 pts

• 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
40
Answer LGI Probs 25 pts

• 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

41
Lower GI Probs 50 pts

• 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
42
Answer LGI Probs 50 pts

• What is an Appendicitis?
• S/S Periumbilical / RLQ pain
• Rebound tenderness
• Muscle guarding
• Anorexia / N/V / fever
• Tx Control pain (ice / no heat,
• limit narcotics until dx made)
• Confirm dx (Ultrasound / CT scan)
• Prompt surgical removal

43
Lower GI Probs 75 pts

• 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
44
Answer LGI Probs 75 pts

• What is peritonitis?
• Can be caused by
• Perforation of internal abd organ
• (appendix / bowel / diverticuli / ulcer)
• Can lead to ?Sepsis ?Shock
• ?Organ failure ? Death!
• Requires Prompt recognition / tx!!
• Need to support ABCs 1st,
• then investigate / tx the cause.

45
Lower GI Probs 100 pts

• How does tx of diverticulosis differ from tx of
  diverticulitis?

A
46
Answer LGI Probs 100 pts

• Tx of Diverticulosis
• Increase fiber / fluids (no nuts, seeds,
  popcorn)
• Bulk laxatives
• Anticholinergics short term use
• Wt loss
• Decrease intra-abd pressure
• Tx of Diverticulitis Acute situation!!
• Bowel rest NPO / IV fluids
• Bed rest
• IV antibiotics
• ? Surgery needed in 30 of cases

47
Lower GI Probs 150 pts

• Where do intestinal obstructions occur most often
  and why?
• (Name location and
• 2 mechanical causes
• 2 non-mechanical causes).

A
48
Answer LGI Probs 150 pts

• Small Intestine
• (23 feet of narrow bowel)
• Mechanical causes
• Adhesions / scar tissue
• Hernias
• Neoplasms / tumors
• Twisted bowel
• Non-mechanical causes
• Lack of nerve stimuli
• Lack of blood flow (emboli / ischemia)
• Paralytic ileus / Immobility
• Electrolyte imbalance (low K levels)
• Infection

49
Lower GI Probs 200 pts

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

A
50
Answer LGI Probs 200 pts

• S/S N/V (esp with SBO)
• Abdominal pain / distention
• Tympanic or absent bowel sounds
• No flatus or BM
• Medical tx Surgical tx
• Support ABCs!! Bowel rx / anastomosis
• Thorough 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 balance
• IV fluids / NPO / IO
• Ambulate