41 - Upper GI Problems Flashcards
patients w GI problems are likely to have…
- malnutrition fr impaired nutritional intake
- altered fluid
- electrolyte imbalance
- pH imbalance
- difficulty w eating drinking talking
- sleep problems
- fatigue
- aspiration
most common manifestations of GI disease
n/v
NG tubes
used for decompression
may before persistent vomiting, bowel obstruction, paralytic ileus,
severe vomiting needs….
IV fluid therapy w electrolytes + glucose replacement
oral candidiasis aka
moniliasis or thrush
oral candidiasis/thrush
etiology
candida albicans
-prolonged high dose of abx or corticosteroid therapy
-sore mouth, yeasty halitosis, milk curds on tongue
oral candidiasis/thrush
tx
- miconazole buccal tablets (Oravig)
- nystatin or amphotericin B as oral suspension or buccal tabs
- good oral hygiene
is GERD a disease?
NO, it is a symptom
GERD
chronic symptom of mucosal damage caused by reflux of stomach acid into lower esophagus
most common upper GI problem
gerd
GERD s/s
heartburn (pyrosis) + regurgitation
complications of GERD are due to direct local effects of _______ on the esophageal mucosa
- gastric HCl + pepsin secretins fr stomach
- proteolytic enzymes like trypsin ) buile fr intestines if present
one of the main factors that cause GERD
incompetent LES
-may be due to certain foods, drugs, obesity
pyrosis
heartburn
-tight burning feeling in chest
severe pyrosis/heartburn occurs more than ___/wk, and is assoc w ______
occurs more than 2x/week
- assoc w dysphagia
- if occurs at night, wakes the person fr sleep
unlike angina, GERD related chest pain is relieved w ____
antacids
dyspepsia
pain/discomfort centered in the upper abdomen
–usually midline
resp complications of GERD
wheezing, coughing, dyspnea
- bronchospasm
- laryngospasm
- cricholaryngeal spasms
common complications of GERD
- esophagitis>esophageal ulcers
- Barrett’s esophagus
Barrett’s esophagus
esophageal metaplasia
- flat epithelial cells turn columnar
- incr risk in 60+, male, white, obese
metaplasia
reversible change fr one type of cell to another type due to abnormal stimulus
-precancerous
complications fr aspirations
irritated the airway, may cause
- asthma
- chronic bronchitis
- pneumonia
endoscopy for GERD
to assess
- LES competence
- degree of inflammation
- potential scarring
- potential strictures
lifestyle mods for GERD
- head of bed is raised
- should not be supine 2-3 hrs after a meal
GERD
drugs
PPI: more effective than H2 w healing
-decr bone density + kidney issues + low B12 + low Mg
H2: also reduce sympt + promote healing
GERD
diet
- avoid fatty food, choc, peppermint, acid, alcohol, soda, wine, OJ
- avoid milk or late night snacking before bedtime
fundoplication
common laparoscopic antireflux surgery
-reserved for pt w complications, med intolerance, BE, or persistent sympt
Peptic Ulcer Disease
erosion of GI mucosa fr digestive action of HCl + pepsin
-any part of GI tract
Acute PUD vs Chronic PUD
A- superficial erosion, minml inflammation
C-erodes thru muscular wall, w formatio of fibrous tissue
—-more common than acute
PUD only develops in an ___ environment
acidic
is excess HCl necessary for peptic ulcer dvlpt?
no, but HCl is needed to activate pepsinogen into pepsin
major risk factor of PUD
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
risk factors for PUD
- cagA H Pylori (most common)
- ETOH
- ASA + NSAIDS (2nd most common)
- irritating food
- caffeine
- smoking
NSAID on PUD
- inhibit prostaglandin synth
- incr gastric acid secretion
- reduce integrity of mucosal barrier
- pt taking corticosteroids or anticoag are at higher risk
Gastric vs Duodenal
lesion
G-superficial, smooth
D-penetrating assoc w deformity of duodenal bulb
Gastric vs Duodenal
location of lesion
G-mostly ANTRUM, but maybe body or funduc
D- first 1-2 in of D
Gastric vs Duodenal
INCIDENCE
G-more in women, peak age 50-60
-incr risk of cancer
D-more in men, peak age 35-45
–more common than G
Gastric vs Duodenal
pain mealtime
G-pain 1-2hr AFTER meal
—–food aggravates
D-2-5hr AFTER meal
—–food/antacid relieves pain
duodenal ulcer is often assoc w high HCl. those at high risk incl
- H Pylori (most common cause)
- COPD
- cirrhosis
- pancreatitis
- hyperparathyroidism
- CKD
- Zollinger syndrome
zollinger syndrome
rare condition w severe peptic ulcer + HCl hypersecretion
____ ulcers are more likely to cause obstruction
GASTRIC ulcers
main risk factors for gastric ulcers
- h pylori
- nsaids
- bile reflux
gold standard for h pylori Dx
biopsy of antral mucosa w resting for urease
-rapid urease testing
-antibody test are NOT accurate
most accurate procedure to determine presence + location of ulcer
endoscopy
how long does pain relief + healing usually take in ambulatory care?
with rest,
pain is gone 3-6 days
healing may take 3-9 wks
PUD
treatment
- supportive (rest)
- NPO
- NG tube for perforation or gastric outlet obstruction
- Abx PPI H2 Sucralfate
- surgery
- lifestyle changes
3 major complications of PUD
1 hemorrhage (upper GI bleeding) 2 perforation (most lethal) 3 gastric outlet obstruction
nursing action for perforation
- notify dr
- take VS q15-30min
- stop all feeding + drugs
- start abx
- surgery if does not self seal
Gastritis
inflammation of gastric mucosa
- breakdown of normal gastric mucosal barrier that normally protects fr HCl + pepsin
- acute or chronic
Gastritis
risk factors
- drugs: ASA, corticostrds, iron supplmt, nsaids, digitalis
- diet: etoh, spicy/irritating food, caffeine
- microbes
- smoking, radiation
- stress
Acute gastritis
typically caused by irritant or infection
- tx is to remove cause
- often self limiting
- etoh can lead to hemorrhage
Chronic gastritis
- bacterial infection like H Pylori which damages the stomach
- may lose parietal cells>low intrinsic factor>low cobalamin absorption
Gastritis
s/s
- anorexia
- n/v
- epigastric tenderness
- feeling of fullness
Gastritis
diagnosis
- endoscopy
- pt hx
- CBC for chronic gastritis
Gastritis
tx
- supportive tx
- NPO + NG
- Drugs
- lifestyle changes
Gastritis
- 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
