Med Surg II Exam 1

Med Surg II Exam 1 Structures of the Lower GI tract Duodenum High alkaline, breakdown of cholesterol Pancreas releases breakdown enzymes Liver and biliary systems produce bile, metabolizes protein carbs and fats, vitamins and cholesterol are stored, detoxification of bacteria Jejunum and ileum absorbs dietary folic acid (jejunum) Ileum- increase of lymphoid cells Main areas of obstruction Cecum and appendix appendix exits from the cecum, there's no job for the appendix Colon 4.9 ft long, reabsorbs liquid, most bacteria Rectum and anus control of feces Small Intestine Folic acid produces RBCs, enhances appetite, Foods ▪ Beans, banana, dark green leafy, shellfish and liver Cobalamin Iron Fat-soluble vitamins Hormones and neurotransmitters Absorption of fat, carbohydrates, and proteins Diet for swallowing disorders Mechanical soft Include bread, hot cereal, ready-to-eat cereal soaked in milk, canned fruit, soft cooked vegetables, juice, scrambled eggs, ground meat, cooked beans, cooked peas, cottage cheese, yogurt without fruit, custards, puddings, cream soups and noodles. Acute Abdomen Epidemiology Very common with many causes Elderly Etiology Medical or surgical Pathophysiology Inflammation ▪ Infectious or chemical Obstruction ▪ Of the small or large bowel may be due to mechanical causes or paralysis of intestinal muscles and may be partial or complete. Vascular Assessment with clinical manifestations Pain assessment ▪ Origins ▪ Location ▪ Radiation ▪ Character of the abdominal pain Inspection ▪ Cullen’s sign: blush periumbilical discoloration, can occur with intra- abdominal bleeding ▪ Grey Turner or Fox signs: should be sought in the flank and inguinal area, respectively. ▪ Borborygmi: gurgling, slashing sound normally heard over large intestine. Vital signs Abdomen Diagnostic tests CT of abdomen and pelvis CBC, BMP Liver function test AST, ALT, albumin(low) and bilirubin will be evaluated to indicate any cirrhosis or hepatitis Appendicitis Pathophysiology The function of the appendix is not completely known, but it does regularly fill with and empty digested food. If untreated, necrosis, gangrene, and perforation follow. Obstruction of the appendix. Assessment with clinical manifestations Periumbilical pain Nauseous Low- grade fever Rovsing’s sign (Rebound tenderness- more pain after pressure is released) Pain in the RLQ