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CERTIFICATION REVIEW
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The FDA is the Federal
Regulatory agency responsible for controlling the safety and effectiveness
of drugs, devices, and instrumentation.
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The CDC has formulated a set
of general guidelines for the prevention and control of nosocomial
(hospital-acquired) infections.
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OSHA is the federal regulatory
agency responsible for enforcing safety and health regulations in the
workplace.
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The EPA is the federal agency
that approves products for the disinfectant registration after review of
labeling and supporting data submitted by manufacturers.
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With the enactment of the new
Safe Medical Devices Act, health care facilities are now required to report
device-related injuries and illness to the Food and Drug Administration
(FDA) and to the manufacturer.
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For laser procedures, the
optical density of the protective eyewear used is determined by the
wavelength of the laser being used.
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The objective of
decontamination in the endoscopy setting is to prevent drying of secretions
and to remove large numbers of organic material and microorganisms.
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Manual cleaning is a
prerequisite to manual or automatic reprocessing with any chemical sterilant/disinfectant.
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Reusable sterilant/disinfectants
must be tested at least each day of use to determine that they are above
their minimum effective concentration (MEC).
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Flexible GI endoscopes are
classified as semi critical devices and require high-level disinfection
using FDA-cleared solutions such as 2% glutaraldehyde, 6% hydrogen peroxide,
or peracetic acid.
 | Achalasia is the
failure of the LES to relax. Manometry findings include a hypertensive
sphincter, no sphincter relaxation, and aperistalsis. |
| Diffuse esophageal
spasm (DES) is diagnosed by simultaneous contractions in more than 10%
of wet swallows, along with intermittent normal peristalsis. It may
also be associated with dysphagia and chest pain. |
| Nutcracker
esophagus is characterized by esophageal contractions that are normal in
sequence, but hypertensive in contractile amplitude. Chest pain and
dysphagia are common complaints. |
| Motility describes
the peristaltic activity and manometry measures pressure. |
| Scleroderma is a
connective tissue disorder characterized by a progressive thickening and
induration of the dermis. Manometry will show reduced contractions,
aperistalsis in the distal esophageal body, and low to absent LES
pressure. |
| Manometry is
indicated for preoperative assessment of peristaltic function in
patients being considered for antireflux surgery. |
| Simultaneous
contractions of the esophagus occur at the same time throughout the
esophageal body. |
| Retrograde
contractions of the esophagus are those that progress from the distal to
the proximal esophagus. |
| Esophageal motility
is abnormal in approximately 805 of patients with diabetic neuropathy. |
| Ambulatory
esophageal pH monitoring is useful in determining the amount of
esophageal reflux in patients with GERD symptoms who are unresponsive to
medical therapy. |
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Liver cells have the ability
to regenerate themselves within 3 weeks.
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It is possible for the liver
to function even with damage to 90% of its mass, but liver removal or total
destruction leads to death within about 10 hours.
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The liver is divided into a
right and a left lobe by the falciform ligament. This ligament also
attaches the liver to the abdominal wall and to the diaphragm.
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The right lobe of the liver is
six times larger than the left.
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The hepatic lobule is the
functioning unit of the liver. Each lobule consists of a hexagon row of
hepatic cells called hepatocytes.
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The hepatocyte secretes bile
into the bile canaliculi and also performs a number of metabolic functions.
Each lobule has a hepatic artery, a portal vein, and a bile duct, which are
known as the portal triad.
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As much as 1500 ml of blood
enters the liver each minute, making the liver one of the most vascular
organs in the body. The portal vein supplies about 75% of this blood,
bringing in about 50% of the oxygen supply to the liver and bringing in
nutrients that are absorbed from the GI system. The hepatic artery supplies
25% of the blood flow and supplies the other 50% of the oxygen to the liver.
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Digested fat is converted in
the intestines to triglycerides, cholesterol, phospholipids, and
lipoproteins. These substances are then taken up by the liver and
hydrolyzed to glycerol and fatty acids, through a process known as
ketogenesis.
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High concentrations of
riboflavin (vitamin B2) are found in the liver, as are nicotine acid and
pyridoxine. Also found in the liver are small amounts of vitamin C, most of
the body’s vitamin D stores, vitamin E, and vitamin K. Vitamin E is
excreted in bile, which is required for vitamin K absorption. Ninety-five
percent of vitamin A stores are also concentrated in the liver.
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Ammonia is normally produced
by the breakdown of protein in the bowel, and in healthy individuals it is
metabolized by the liver to form urea. In patients with portal
hypertension, the blood cannot pass into the liver and the ammonia enters
the systemic circulation and flows to the brain.
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Gilbert syndrome is a
relatively common and benign congenital (probably hereditary) disorder found
more frequently in males. The disorder is characterized by a mild,
fluctuating increase in serum bilirubin. There is no treatment necessary.
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Intrahepatic biliary dysplasia
(IHBD), also known as alagille syndrome, is a unique, autosomal-dominant
liver disease that appears in approximately 1 in 100,000 live births.
| Stimulant
cathartics act by producing local irritation or by stimulating
Auerbach’s plexus, thus resulting in increased intestinal activity. |
| In the liver,
carbohydrates are metabolized to Glycogen. |
| The primary
physiological function of the Kupffer cells is phagocytosis of harmful
substances. |
| Chronic skin
lesions, increased hair growth, mild liver disease, and a lack of
neuropsychiatric manifestations are characteristic of porphyria cutanea
tarda. |
| In adults, the
approximate length of the esophagus is 25cm. |
| The progressive
circular muscle contraction initiated by esophageal distention is known
as secondary peristalsis. |
| Hemolytic
reactions to blood transfusions usually occur with in the first 30
minutes of the transfusion. |
| The tonicity of
body fluids refer to the effective osmotic pressure equivalent. |
| Hypotonic
solutions, (e.g. NaCl in water 0.45%), unless they are balanced with
sufficient numbers of electrolytes, can flood the red blood cells,
causing them to burst, a condition known as hemolysis. |
| Prostaglandin is a
group of naturally occurring, chemically related, long-chain hydroxyl
fatty acids that stimulate contractibility of smooth muscles and have
the ability to lower blood pressure, regulate acid secretion of the
stomach, regulate body temperature and platelet aggregation, and control
inflammation and vascular permeability; they also affect the action of
certain hormones. |
| Variable is a
measured concept or construct; a characteristic or attribute of a person
or object that takes on different values within the population under
study. |
| Variability is a
concept concerned with how spread out or dispersed the data values are
about the mean; the degree to which subjects in a sample vary from one
another with respect to some critical attribute. |
| Outcome
identification is an actual or potential health exhibited by an
individual through the process of clinical reasoning and judgement
functions that nurses by virtue of their education and experience are
capable and licensed to treat independently. |
| Lesser omentum is
a layer of visceral peritoneum that attaches the lesser curvature of the
stomach to the underside of the liver. |
Boerhaave’s
syndrome: Catastrophic event in
which the lower thoracic esophagus is completely torn away from the gastric
cardia.
Borborygmi:
Rumbling noises caused by the propulsion
of gas through the intestines.
Auerbach’s plexus:
The part of the enteric plexus that is within the muscularis. Also called
the myenteric plexus.
Curling’s ulcer:
A stress ulcer that appears in patients with serious burn injuries.
Cushing’s ulcer:
A stress ulcer that appears in
patients with intracranial trauma.
G cell:
A cell type located in the pyloric glands of
the stomach; G cells secrete gastrin.
Modified Whipple’s
procedure: Pylorus-preserving
pancreaticoduodenectomy.
Duct of Santorini:
The minor pancreatic duct, draining a part of the head of the pancreas into
the minor duodenal papilla.
Meissner’s plexus:
The part of the enteric plexus
that is situated in the submucosa. Also called the submucosal plexus.
Edrophonium
chloride: Tensilon; a
cholinesterase inhibitor that is administered by IV bolus in a provocative
test designed to reproduce noncardiac chest pain caused by esophageal
dysmotility.
Hydrogen breath
test: A measure of the amount of
hydrogen expelled in the breath after ingestion of a carbohydrate drink;
used to detect carbohydrate malabsorption, abnormal gastrointestinal transit
time, or bacterial overgrowth in the small bowel.
Highly selective
vagotomy: Surgical procedure
interrupting the nerve fibers to the antrum but preserving the innervation
of the pyloric region.
Standard deviation:
An average-size spread among
values in a set around the average value in the set; how far away the
numbers in a list are from their average.
Structural
standard: A standard concerned
with the environment in which care is provided.
Tenia coli:
Three thickened flat bands, about
one-sixth shorter than the colon, formed by the longitudinal fibers in the
muscular tunic of the colon and extending from the root of the vermiform
appendix to the rectum, where they spread out and form a continuous layer
encircling the tube.
Qualitative:
Pertains to describing or analyzing
qualities, attributes or characteristics.
Scope of practice:
A statement of the dimensions of
a professional practice that outlines the functions of individuals in that
profession.
Process improvement:
A systematic approach to the way work is designed and performance is
measured, assessed, and improved.
Parietal cell:
A cell type located in the parietal glands of the stomach and that sectretes
hydrochloric acid and intrinsic factor. Also known as oxyntic cells.
Lamina propria:
The connective tissue coat of a
mucous membrane.
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