chapt 46 management of patients with gastric and duodenal disorders Flashcards
Gastritis is characterized by a disruption of the __ barrier that normally protects the stomach tissue from __ juices. The impaired mucosal barrier allows corrosive HCI, __, and other irritating agents to come in contact with the gastric mucosa, resulting in inflammation. In acute gastritis, this inflammation is usually transient and self-limiting in nature. In chronic gastritis persistent or repeated insults lead to chronic inflammatory changes and eventually __ of the gastric tissue
mucosal
digestive juices
pepsin
atrophy
gastritis affects mostly
A. men
B. Women
C. Both equally
both equally
gastritis may be __ lasting several hours to a few days, or __ resulting from repeated exposure to irritating agents or recurring episodes of acute gastritis
acute
chronic
Acute gastritis may be classified as __ or __
erosive or non-erosive
The __ form of acute gastritis is most often caused by local irritants such as aspirin, and other nonsteroidal anti-inflammatory drugs, alcohol consumption, and gastric radiation therapy.
erosive
The __ form of acute gastritis is most often caused by an infection with Helicobacter Pylori (H-Pylori)
non-erosive
A more severe form of acute gastritis is caused by the ingestion of strong __ or alkali, which may cause the __ to become gangrenous or to perforate.
acid
mucosa
Acute gastritis may also develop in acute illnesses, especially when the patient has had major traumatic injuries; burns, severe infection, hepatic, kidney, or respiratory failure, or major surgery. This type of acute gastritis is often referred to as __ __ gastritis
stress-related gastritis
Acute gastritis may have __ onset of symptoms
Complaints of __ discomfort, headache, lassitude, nausea, anorexia, vomiting, and hiccuping lasting from a few hours to a few days
rapid
abdominal
erosive gastritis may cause bleeding which may manifest as blood in vomit, or as __(black tarry stools) or __ (bright red bloody stools).
melena
hematochezia
The patient with chronic gastritis may be __.
complaints of anorexia, heartburn after eating, belching, a sour taste in the mouth, or nausea and vomiting.
May have mild epigastric discomfort, intolerance to spicy or fatty foods, or pain relieved by __
may not be able to absorb vitamin __, and usually having evidence of malabsorption of this vitamin may lead to pernicious anemia.
asymptomatic
eating
B12
Gastritis is sometimes associated with achlorhydria or hypochlorhydria or with high acid levels.
upper gastrointestinal __ series and upper __ are useful
Biopsy with histologic examination are performed
serologic testing for antibodies to the _ __ antigen and a breath test may be performed
A __ may be drawn to assess for anemia as a result of hemorrhage or pernicious anemia
x-ray, endoscopy
H. Pylori
CBC
if the patient has ingested __ or alkalis, emergency measures may be necessary
offer supportive therapy to the patient and family during treatment and after the ingested acid or alkali has been neutralized or diluted.
assess __ to determine whether ingestion may have been intentional
acids
Mood
provide __ and __ support for patients with acute gastritis
help patient __ symptoms
avoid foods and fluids by mouth for hours or days until acute symptoms subside, thus allowing the gastric mucosa to heal
offer ice chips and __ liquids when symptoms subside
Discourage __ beverages, alcohol, and cigarette smoking
physical and emotional
manage
clear
alcoholic
Monitor daily intake and output for dehydration minimal intake of __ L per day and urine output of __mL/kg per hour
- 5 L
0. 5 mL
assess electrolyte values every __ hours for fluid imbalance
24 hours
Be alert for indicators of __ gastritis (hematemesis, tachycardia, hypotension) and notify the physician. Assess vital signs as the patient’s condition warrants.
hemorrhagic
Assess all __ for the presence of frank or occult bleeding
stools
Instruct the patient to avoid foods and beverages that may __ the gastric mucosa
irritate
Instruct the patient in the correct use of __ to relieve chronic gastritis
medications
peptic ulcer disease mainly occurs in the gastroduodenal mucosa b/c this tissue cannot withstand the digestive action of gastric acid and pepsin. the erosion is caused by the increased concentration of acid-pepsin (HCI) or by decreased resistance of the mucosa. A damaged mucosa cannot secrete enough mucus to act as a barrier against HCI. The use of __ inhibits the secretion of mucus that protects the mucosa. Patients with duodenal ulcers secrete more acid than normal, whereas patients with gastric ulcers tend to secrete normal or decreased levels of acid. damage to the gastroduodenal mucosa results in decreased resistance to bacteria, and this infection from _ __ bacteria may occur.
NSAIDs
H. Pylori
Symptoms of an ulcer may last days, weeks, or months and may subside only to reappear without cause. Many patients have __ ulcers
asymptomatic
Dull, gnawing pain and a __ sensation in the midepigastrium or in the back are characteristic signs of PUD
burning
Pain associated with gastric ulcers most commonly occurs __ after eating, whereas the pain associated with duodenal ulcers most commonly occurs __ to __ hours after meals
immediately
2 to 3 hours
pain that is relieved by eating or taking an antiacid us characteristic of __ ulcers
duodenal
awakening with pain during the night is reported by approximately __% to __ % of patients with duodenal ulcers; only __% to __% of patients with gastric ulcers voice this complaint.
50% to 80%
30% to 40%
upper __ is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions
endoscopy
H. Pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by __ or rapid urease test of the biopsy specimen
biopsy
The patient who has a bleeding ulcer may require periodic __ to determine the extent of blood loss and whether or not blood transfusions are advisable
CBCs
__ secretory studies are of value in diagnosis ZES and achlorhydria
gastric
the goal of treatment for PUD is to eradicate _ __ and manage gastric acidity with methods such as __, lifestyle changes, and surgical intervention
H. Pylori
medications
the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and sometimes __ salts that suppress or eradicate H. Pylori
bismuth
patients with peptic ulcers should avoid extremes of temperatures in __ and beverages and overstimulation from the consumption of __, coffee, and other caffeinated beverages.
food
alcohol
Most gastric cancers are adenocarcinomas. They can occur anywhere in the stomach. Gastric cancer is a more common diagnosis among __ adults, with the mean age of diagnosis at __ years.
older
69 years
Who has the highest incidence of gastric cancer? men or women
men
Hispanic Americans, African Americans, and Asian/pacific islanders are at __ risk of developing gastric cancer than caucasian Americans.
increased
other factors related to the incidence of gastric cancer include chronic inflammation of the __, H. Pylori infection, pernicious anemia, smoking, achlorhydria, gastric ulcers, previous subtotal gastrectomy, and genetics.
stomach
Prognosis is generally __ because most patients have __ (liver, pancreas, and esophagus or duodenum) at the time of diagnosis.
poor
metastases
Prognosis is generally __ because most patients have __ of the (liver, pancreas, and esophagus or duodenum) at the time of diagnosis.
poor
metastases
Prognosis is generally __ because most patients have __ of the (liver, pancreas, and esophagus or duodenum) at the time of diagnosis. metastasis via the lymphatic system to the peritoneal cavity occurs later in the disease.
poor
metastases
Early stages: symptoms may be __ or may resemble those of patients with benign ulcers (ex pain relieved with antacids).
absent
Progressive stages: symptoms include dyspepsia, early satiety, weight loss, abdominal pain just above the umbilicus, loss or decrease in appetite, __ after meals, nausea, and vomiting, and symptoms similar to those of peptic ulcer disease.
bloating
Esophagogastroduodenoscopy (EGD) for biopsy and washing cytology is the diagnostic study of __
choice
advanced gastric cancer may be palpable as a __; ascites and hepatosplenomegaly may be apparent if there is metastasis to the liver
mass
palpable lymph nodes around the umbilicus are a sign of __ cancer
GI
confusion, agitation, and restlessness may be the only symptoms seen in __ adult patients, who may have no gastric symptoms until their tumors are well advanced
older
Treatment of gastric cancer is, radiation therapy, and __ therapy
surgery, chemotherapy
(gastric cancer) encourage small frequent feedings of nonirritating foods to decrease gastric irritation, encourage fluid consumption __ meals rather than with meals
between
facilitate tissue repair by ensuring food supplements are high in calories and Vitamins __ and __ and iron
A and C
administer parenteral vitamin __ indefinitely if a total gastrectomy is performed.
B12
__ syndrome may occur as a result of any surgical procedure that involves the removal of a significant portion of the stomach or includes resection or removal of the pylorus.
dumping
