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Med Surg > 41 - Upper GI Problems > Flashcards

41 - Upper GI Problems Flashcards

1
Q

patients w GI problems are likely to have…

A
  • malnutrition fr impaired nutritional intake
  • altered fluid
  • electrolyte imbalance
  • pH imbalance
  • difficulty w eating drinking talking
  • sleep problems
  • fatigue
  • aspiration
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2
Q

most common manifestations of GI disease

A

n/v

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3
Q

NG tubes

A

used for decompression

may before persistent vomiting, bowel obstruction, paralytic ileus,

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4
Q

severe vomiting needs….

A

IV fluid therapy w electrolytes + glucose replacement

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5
Q

oral candidiasis aka

A

moniliasis or thrush

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6
Q

oral candidiasis/thrush

etiology

A

candida albicans
-prolonged high dose of abx or corticosteroid therapy

-sore mouth, yeasty halitosis, milk curds on tongue

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7
Q

oral candidiasis/thrush

tx

A
  • miconazole buccal tablets (Oravig)
  • nystatin or amphotericin B as oral suspension or buccal tabs
  • good oral hygiene
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8
Q

is GERD a disease?

A

NO, it is a symptom

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9
Q

GERD

A

chronic symptom of mucosal damage caused by reflux of stomach acid into lower esophagus

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10
Q

most common upper GI problem

A

gerd

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11
Q

GERD s/s

A

heartburn (pyrosis) + regurgitation

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12
Q

complications of GERD are due to direct local effects of _______ on the esophageal mucosa

A
  • gastric HCl + pepsin secretins fr stomach

- proteolytic enzymes like trypsin ) buile fr intestines if present

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13
Q

one of the main factors that cause GERD

A

incompetent LES

-may be due to certain foods, drugs, obesity

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14
Q

pyrosis

A

heartburn

-tight burning feeling in chest

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15
Q

severe pyrosis/heartburn occurs more than ___/wk, and is assoc w ______

A

occurs more than 2x/week

  • assoc w dysphagia
  • if occurs at night, wakes the person fr sleep
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16
Q

unlike angina, GERD related chest pain is relieved w ____

A

antacids

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17
Q

dyspepsia

A

pain/discomfort centered in the upper abdomen

–usually midline

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18
Q

resp complications of GERD

A

wheezing, coughing, dyspnea

  • bronchospasm
  • laryngospasm
  • cricholaryngeal spasms
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19
Q

common complications of GERD

A
  • esophagitis>esophageal ulcers

- Barrett’s esophagus

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20
Q

Barrett’s esophagus

A

esophageal metaplasia

  • flat epithelial cells turn columnar
  • incr risk in 60+, male, white, obese
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21
Q

metaplasia

A

reversible change fr one type of cell to another type due to abnormal stimulus
-precancerous

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22
Q

complications fr aspirations

A

irritated the airway, may cause

  • asthma
  • chronic bronchitis
  • pneumonia
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23
Q

endoscopy for GERD

A

to assess

  • LES competence
  • degree of inflammation
  • potential scarring
  • potential strictures
24
Q

lifestyle mods for GERD

A
  • head of bed is raised

- should not be supine 2-3 hrs after a meal

25
Q

GERD

drugs

A

PPI: more effective than H2 w healing
-decr bone density + kidney issues + low B12 + low Mg

H2: also reduce sympt + promote healing

26
Q

GERD

diet

A
  • avoid fatty food, choc, peppermint, acid, alcohol, soda, wine, OJ
  • avoid milk or late night snacking before bedtime
27
Q

fundoplication

A

common laparoscopic antireflux surgery

-reserved for pt w complications, med intolerance, BE, or persistent sympt

28
Q

Peptic Ulcer Disease

A

erosion of GI mucosa fr digestive action of HCl + pepsin

-any part of GI tract

29
Q

Acute PUD vs Chronic PUD

A

A- superficial erosion, minml inflammation

C-erodes thru muscular wall, w formatio of fibrous tissue
—-more common than acute

30
Q

PUD only develops in an ___ environment

A

acidic

31
Q

is excess HCl necessary for peptic ulcer dvlpt?

A

no, but HCl is needed to activate pepsinogen into pepsin

32
Q

major risk factor of PUD

A

CagA pos strain of H Pylori

  • survives in gastric epithelial cells in mucosal layer
  • makes UREASE which metabs urea-producing ammonium chloride + other damaging chems
33
Q

risk factors for PUD

A
  • cagA H Pylori (most common)
  • ETOH
  • ASA + NSAIDS (2nd most common)
  • irritating food
  • caffeine
  • smoking
34
Q

NSAID on PUD

A
  • inhibit prostaglandin synth
  • incr gastric acid secretion
  • reduce integrity of mucosal barrier
  • pt taking corticosteroids or anticoag are at higher risk
35
Q

Gastric vs Duodenal

lesion

A

G-superficial, smooth

D-penetrating assoc w deformity of duodenal bulb

36
Q

Gastric vs Duodenal

location of lesion

A

G-mostly ANTRUM, but maybe body or funduc

D- first 1-2 in of D

37
Q

Gastric vs Duodenal

INCIDENCE

A

G-more in women, peak age 50-60
-incr risk of cancer

D-more in men, peak age 35-45
–more common than G

38
Q

Gastric vs Duodenal

pain mealtime

A

G-pain 1-2hr AFTER meal
—–food aggravates

D-2-5hr AFTER meal
—–food/antacid relieves pain

39
Q

duodenal ulcer is often assoc w high HCl. those at high risk incl

A
  • H Pylori (most common cause)
  • COPD
  • cirrhosis
  • pancreatitis
  • hyperparathyroidism
  • CKD
  • Zollinger syndrome
40
Q

zollinger syndrome

A

rare condition w severe peptic ulcer + HCl hypersecretion

41
Q

____ ulcers are more likely to cause obstruction

A

GASTRIC ulcers

42
Q

main risk factors for gastric ulcers

A
  • h pylori
  • nsaids
  • bile reflux
43
Q

gold standard for h pylori Dx

A

biopsy of antral mucosa w resting for urease
-rapid urease testing

-antibody test are NOT accurate

44
Q

most accurate procedure to determine presence + location of ulcer

A

endoscopy

45
Q

how long does pain relief + healing usually take in ambulatory care?

A

with rest,
pain is gone 3-6 days
healing may take 3-9 wks

46
Q

PUD

treatment

A
  • supportive (rest)
  • NPO
  • NG tube for perforation or gastric outlet obstruction
  • Abx PPI H2 Sucralfate
  • surgery
  • lifestyle changes
47
Q

3 major complications of PUD

A 
1 hemorrhage (upper GI bleeding)
2 perforation (most lethal)
3 gastric outlet obstruction
48
Q

nursing action for perforation

A
  • notify dr
  • take VS q15-30min
  • stop all feeding + drugs
  • start abx
  • surgery if does not self seal
49
Q

Gastritis

A

inflammation of gastric mucosa

  • breakdown of normal gastric mucosal barrier that normally protects fr HCl + pepsin
  • acute or chronic
50
Q

Gastritis

risk factors

A
  • drugs: ASA, corticostrds, iron supplmt, nsaids, digitalis
  • diet: etoh, spicy/irritating food, caffeine
  • microbes
  • smoking, radiation
  • stress
51
Q

Acute gastritis

A

typically caused by irritant or infection

  • tx is to remove cause
  • often self limiting
  • etoh can lead to hemorrhage
52
Q

Chronic gastritis

A
  • bacterial infection like H Pylori which damages the stomach
  • may lose parietal cells>low intrinsic factor>low cobalamin absorption
53
Q

Gastritis

s/s

A
  • anorexia
  • n/v
  • epigastric tenderness
  • feeling of fullness
54
Q

Gastritis

diagnosis

A
  • endoscopy
  • pt hx
  • CBC for chronic gastritis
55
Q

Gastritis

tx

A
  • supportive tx
  • NPO + NG
  • Drugs
  • lifestyle changes
56
Q

Gastritis

A
  • monitor for dehydration (can occur rapidly in acute)
  • NPO + IV if vomiting
  • NG tube to monitor bleed, lavage precipitating agent, keep stomach empty + free of noxious stimuli

Med Surg (18 decks)

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