NR 283 Exam Review 3
PATHOPHYSIOLOGY
Gastrointestinal
GI bleeding
a. Upper GI bleeding: esophagus, stomach, duodenum
b. Lower GI bleeding: jejenum, ileum, colon, rectum
Hematemesis: bloody vomit (from esophagus)
Hematochezia: bright-red blood (colon, rectum “hemmoroid”)
Melena: burgundy color (old blood; jejunum)
Occult bleeding: hidden bleeding (blood cells present in feces)
Hiatal Hernia:
part of the stomach protrudes through the opening (hiatus) in the diaphragm into the
thoracic cavity
Cause: too much pressure (repetitively) on stomach muscles; coughing, vomiting, straining
during BM
a. Sliding: ususally when pt is in supine position; common
b. Paraesophogeal/Rolling: due to weak or enlarged hiatus in diaphragm; leads to ulceration
s/s: heartburn “pyrosis”, frequent belching, discomfort when laying down, substernal pain
radiating to shoulder & jaw
Gastritis: Acute vs. Chronic, Signs and Symptoms
Inflammation of stomach
Acute
-characteristics: red & edematous, ulcerated & bleeding
-s/s: anorexia, nausea, vomiting, hematemesis (bleeding in stomach), epigastric pain, cramps,
fever/headache, diarrhea
Chronic
-characteristics: atrophy of mucosa of stomach, loss of intrinsic factor for absorbing B12
-s/s: vague; mild epigastric discomfort, intolerance for spicy/fatty foods
Pts w chronic g. at risk for peptic ulcers & gastric carcinoma
Peptic Ulcer Disease:
Cause: common- H. pylori infection or vasoconstrictions by stress smoking, shock, circulatory
impairment in elderly, scar tissue, severe anemia
s/s: epigastric burning, localizing pain, stomach emptying, heartburn, nausea, vomiting, weight
loss
location: proximal duodenal, antrum of stomach,
, Cholelithiasis: “gallstone”
cause: formation of gallstones
s/s: radiating pain, nausea/vomiting, jaundice
Hepatitis: Types, transmission, Signs and Symptoms
Hep A infectious Oral/fecal; contaminated
water/shellfish/anal intercourse
Hep B chronic Blood/body fluids; exposed to
infected blood/body secretions
(mother to baby)
Hep C chronic Blood/body fluids; post transf,
IV drug use
s/s: liver- inflammation, necrosis, edematous & tender
Hepatic Encephalopathy: Cause and diagnosis
decline in brain function that occurs as a result of severe liver disease
cause: buildup of toxins in blood when liver fails
s/s: difficulty thinking, personality changes, poor concentration, confusion, musty or sweet
breath, seizures, shaky hands, slow movements
Cirrhosis: Signs and Symptoms, Complications
destruction of liver cells leading to liver failure
cause: alcoholic liver disease, biliary (immune disorder), postnecrotic (chronic hep, long term
exposure to toxic materials), metabolic storage disorders
s/s: initial- fatigue, anorexia, weight loss, anemia, diarrhea, dull aching pain in RUQ; advanced-
ascites, peripheral edema, increased bruising, jaundice, encephalopathy, esophageal may
rupture, hemorrhage, circulatory shock,
Stages (alcoholic liver disease):
-Initial—fatty liver (asymptomatic; reversible)
-Second—alcoholic hepatitis (inflammation, cell necrosis, fibrous tissue formation; irreversible)
Third—end stage cirrhosis (fibrotic tissue replaces norm tissue; little remaining function)
Esophageal varices: Causes, Signs and Symptoms, complications
Abnormal, enlarged veins in the esophagus
Cause: when normal blood flow is blocked by a clot/scar tissue in the liver; cirrhosis
s/s: hematemesis, melena, lightheaded, jaundice, ecchymosis, ascites
complications: hemorrhaging, hypovolemic shock, death
Crohn’s disease: “skip lesions”
commonly in ileum (sm. Intest.); inflammatory bowel disease
cause: unknown
s/s: diarrhea w/ cramping, stool soft/semiformed, melena present if ulcers erode,
pain/tenderness in RLQ, anorexia, weight loss, anemia, fatigue
PATHOPHYSIOLOGY
Gastrointestinal
GI bleeding
a. Upper GI bleeding: esophagus, stomach, duodenum
b. Lower GI bleeding: jejenum, ileum, colon, rectum
Hematemesis: bloody vomit (from esophagus)
Hematochezia: bright-red blood (colon, rectum “hemmoroid”)
Melena: burgundy color (old blood; jejunum)
Occult bleeding: hidden bleeding (blood cells present in feces)
Hiatal Hernia:
part of the stomach protrudes through the opening (hiatus) in the diaphragm into the
thoracic cavity
Cause: too much pressure (repetitively) on stomach muscles; coughing, vomiting, straining
during BM
a. Sliding: ususally when pt is in supine position; common
b. Paraesophogeal/Rolling: due to weak or enlarged hiatus in diaphragm; leads to ulceration
s/s: heartburn “pyrosis”, frequent belching, discomfort when laying down, substernal pain
radiating to shoulder & jaw
Gastritis: Acute vs. Chronic, Signs and Symptoms
Inflammation of stomach
Acute
-characteristics: red & edematous, ulcerated & bleeding
-s/s: anorexia, nausea, vomiting, hematemesis (bleeding in stomach), epigastric pain, cramps,
fever/headache, diarrhea
Chronic
-characteristics: atrophy of mucosa of stomach, loss of intrinsic factor for absorbing B12
-s/s: vague; mild epigastric discomfort, intolerance for spicy/fatty foods
Pts w chronic g. at risk for peptic ulcers & gastric carcinoma
Peptic Ulcer Disease:
Cause: common- H. pylori infection or vasoconstrictions by stress smoking, shock, circulatory
impairment in elderly, scar tissue, severe anemia
s/s: epigastric burning, localizing pain, stomach emptying, heartburn, nausea, vomiting, weight
loss
location: proximal duodenal, antrum of stomach,
, Cholelithiasis: “gallstone”
cause: formation of gallstones
s/s: radiating pain, nausea/vomiting, jaundice
Hepatitis: Types, transmission, Signs and Symptoms
Hep A infectious Oral/fecal; contaminated
water/shellfish/anal intercourse
Hep B chronic Blood/body fluids; exposed to
infected blood/body secretions
(mother to baby)
Hep C chronic Blood/body fluids; post transf,
IV drug use
s/s: liver- inflammation, necrosis, edematous & tender
Hepatic Encephalopathy: Cause and diagnosis
decline in brain function that occurs as a result of severe liver disease
cause: buildup of toxins in blood when liver fails
s/s: difficulty thinking, personality changes, poor concentration, confusion, musty or sweet
breath, seizures, shaky hands, slow movements
Cirrhosis: Signs and Symptoms, Complications
destruction of liver cells leading to liver failure
cause: alcoholic liver disease, biliary (immune disorder), postnecrotic (chronic hep, long term
exposure to toxic materials), metabolic storage disorders
s/s: initial- fatigue, anorexia, weight loss, anemia, diarrhea, dull aching pain in RUQ; advanced-
ascites, peripheral edema, increased bruising, jaundice, encephalopathy, esophageal may
rupture, hemorrhage, circulatory shock,
Stages (alcoholic liver disease):
-Initial—fatty liver (asymptomatic; reversible)
-Second—alcoholic hepatitis (inflammation, cell necrosis, fibrous tissue formation; irreversible)
Third—end stage cirrhosis (fibrotic tissue replaces norm tissue; little remaining function)
Esophageal varices: Causes, Signs and Symptoms, complications
Abnormal, enlarged veins in the esophagus
Cause: when normal blood flow is blocked by a clot/scar tissue in the liver; cirrhosis
s/s: hematemesis, melena, lightheaded, jaundice, ecchymosis, ascites
complications: hemorrhaging, hypovolemic shock, death
Crohn’s disease: “skip lesions”
commonly in ileum (sm. Intest.); inflammatory bowel disease
cause: unknown
s/s: diarrhea w/ cramping, stool soft/semiformed, melena present if ulcers erode,
pain/tenderness in RLQ, anorexia, weight loss, anemia, fatigue
