Chapter 46: Upper Gastrointestinal Problems Flashcards
term that describes hot, bitter, or sour liquid coming into the throat or mouth
regurgitation
diseases such as __________________________ and other irritating risk factors, such as ____________, ______________, and ____________________ may lead to development of gastritis
autoimmune gastritis, endoscopy, NG tube, psychologic stress
(gastric, duodenal) ulcers more likely to cause obstruction
gastric
nine drugs that decrease lower esophageal sphincter (LES) pressure (five classes and four specific) (GERD and hiatal hernias)
anticholinergics, beta-adrenergic blockers, calcium channel blockers, nitrates, antidepressants
diazepam, morphine sulfate, progesterone, theophylline
emergency management of upper GI bleeding: patient will need these three lab studies
CBC, clotting studies, type and crossmatch
peptic ulcer disease teaching: report any of the following three things
increased nausea or vomiting
increased epigastric pain
bloody emesis or tarry stools
risk factors for NSAID-induced gastritis include being (male, female), this age group, history of _____________, ____________________ therapy, low-dose ______________, ________________ drugs, and _____________ diseases
female, >60 years, peptic ulcer disease, anticoagulant, aspirin, corticosteroid, chronic
five patients at increased risk for stress-related mucosal disease (SRMD)
critically ill, coagulopathy, liver disease, organ failure, renal replacement therapy
goal for managing upper GI bleeding with endoscopy
coagulate or thrombose bleed
severing of the vagus nerve; decreases gastric acid secretion
vagotomy
conservative management of hiatal hernias focuses on reducing _____________________
intraabdominal pressure
guaiac test that detects blood in gastric secretions, comitus, or stool
occult
in treating/managing perforation, notify _______, take frequent ______________, place on absolute _______ status, ________ management, insert __________ for aspiration and gastric decompression, give IV _______ and __________, and give the drug _____________________
HCP, vital signs, NPO, pain, NG tube, fluids, blood, broad spectrum antibiotics
GERD: avoid these three things
alcohol, caffeine, smoking
after history and physical, gold standard of diagnosing GERD
upper GI endoscopy (with biopsy)
to assess for dehydration and fluid and electrolyte balance in a patient with nausea and vomiting, monitor _____________ and ____________, ___________, and assess for dehydration ___________
intake, output, vital signs, manifestations
these three lab tests can be done to help diagnose peptic ulcer disease
CBC, liver enzymes, serum amylase
emesis with fecal odor (feces) and bile indicates this
obstruction below pylorus (hallmark sign of bowel obstruction)
laboratory tests for upper GI bleeding include CBC for ______________ and ____________; _______ for GI tract bacteria breakdown protein
hemoglobin, hematocrit, BUN
two factors that can contribute to hiatal hernias
structural changes (weakening of muscles in diaphragm around esophagogastric opening)
increased intraabdominal pressure (from obesity, pregnancy, ascites, tumors, intense physical exertion, heavy lifting)
the gerontologic population has an increased _____________ and ______________ with peptic ulcer disease
morbidity, mortality
peptic ulcer disease teaching: __________ can be related to PUD; learn and use management strategies
stress
supportive care for acute gastritis involves _______, _______ status, ___________, _______________ drugs, and monitoring for ___________
rest, NPO, IV fluids, antiemetic, dehydration
endoscopic therapy for upper GI bleeding: these are used to compress the vessel
clips or bands
type of oral cancer that starts in the mouth
oral cavity cancer
regurgitation occurs when the ___________________________ didn’t close all the way
lower esophageal sphincter
emergency management of upper GI bleeding: watch for this in the older adult
fluid overload
risk factors for this location of oral cancer include tobacco and alcohol use, chronic irritation, and syphilis
tongue
condition characterized by esophageal metaplasia of cells that increases risk for cancer
Barrett’s esophagus
this type of peptic ulcer penetrates the mucosa only
erosion
four other diagnostic studies for GERD (other than history, physical, upper GI endoscopy, biopsy)
esophagram (barium swallow)
motility (manometry) studies
pH monitoring
radionuclide studies
four lifestyle factors that increase risk for peptic ulcer disease
alcohol, smoking, caffeine, psychologic distress
lifestyle modifications for chronic gastritis include avoiding ___________, eating ___ (small, large) meals per day of nonirritating food, and adhering to __________________
smoking, 6, small, prescribed drugs
swelling of esophagus due to infiltration of eosinophils
eosinophilic esophagitis
GERD is typically diagnosed via __________ and ____________ and response to ___________ and __________ therapies
history, physical, behavioral, drug
to prevent aspiration in a patient with nausea and vomiting who cannot manage self-care, place in one of these two positions
semi-Fowler’s
side-lying
manifestations of perforation include sudden, severe abdominal _________ that radiates to ______ and ___________; no relief with _______ or ____________; __________, _____________ abdomen; bowel sounds _________; _________ and ________________; respirations _____________; pulse ___________ and ________
pain, back, shoulders, food, antacids, rigid, boardlike, absent, nausea, vomiting, shallow, increased, weak
most accurate procedure (gold standard) to determine presence and location of ulcer
endoscopy
surgical method for hiatal hernias involving closure of the hiatal defect
herniorrhaphy
risk of dumping syndrome is reduced with _______ after eating
rest
manifestations of this location of oral cancer include an indurated, painless ulcer
lip
manifestations include anorexia, nausea, vomiting, epigastric tenderness, hemorrhage
acute gastritis
two complementary therapies that may help nausea and vomiting
acupressure, acupuncture
two most common causes of upper gastrointestinal bleeding from stomach and duodenal origin
H. pylori, NSAIDs (cause peptic ulcer disease)
two treatments for esophageal strictures
dilation with bougies or balloons using endoscopy or fluoroscopy
surgical excision
factors involved in pathogenesis of GERD include impaired __________________ motility, delayed ________________, small intestine reflux of _______, defective ____________ defense, ____________ dysfunction (decreased pressure), and reflux of _______________
esophageal, gastric emptying, bile, mucosal, lower esophageal sphincter (LES), gastric contents
surgical method for hiatal hernias involving excision of the hernia sac
herniotomy
precancerous lesion due to smoking that becomes hyperkeratosis; characterized by white patch on mouth mucosa or tongue
leukoplakia
when taking PPIs and corticosteroids for eosinophilic esophagitis, monitor for this disease
candidiasis
four causes of obstruction in distal stomach and duodenum (complication of peptic ulcer disease)
edema, inflammation, pylorospasm, scar tissue
physical/objective assessment for upper GI bleeding includes these five things
- LOC
- frequent VS
- skin color
- capillary refill (shock)
- abdomen (distention, guarding, peristalsis)
six factors (foods, substances other than drugs) that decrease lower esophageal sphincter (LES) pressure (increase irritation) (GERD)
alcohol, chocolate, fatty foods, nicotine, peppermint/spearmint, tea/coffee (caffeine)
acid reflux into the mouth may lead to _______________
dental erosion
these three food items may be given to patients with nausea and vomiting
dry toast, crackers, gelatin
endoscopic therapy for GERD in which a biopsy is obtained to determine presence of any cancer
endoscopic mucosal resection (EMR)
treatment for large perforations
surgery for closure; suctioning of peritoneal cavity
risk factors for this location of oral cancer include constant overexposure to the sun, ruddy and fair complexion, recurrent herpetic lesions, pipe stem irrigation, syphilis, and immunosuppression
lip
risk factors for this location of oral cancer include poor oral hygiene, tobacco usage (pipe and cigar smoking, snuff, chewing tobacco), chronic alcohol use, chronic irritation (jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants), HPV
oral cavity
postoperative complication of gastric surgery in which uncontrolled high carbohydrate bolus enters small intestine causing excess insulin and resulting in hypoglycemia 2 hours after eating
postprandial hypoglycemia (variant of dumping syndrome)
partial gastrectomy with removal of the distal 2/3 of the stomach and anatomosis of the gastric stump to the duodenum
gastroduodenostomy or Billroth I
type of oral cancer that develops in the part of the throat just behind the mouth
oropharyngeal cancer
two diagnostic studies for eosinophilic esophagitis
endoscopy with biopsy
allergy testing
type of hiatal hernia in which the junction of the stomach and esophagus is above the diaphragm, and a part of the stomach slides through the hiatal opening in the diaphragm when supine
sliding
prolonged nausea/vomiting can cause _____________________ imbalances, __________ or ___________, decreased __________ volume, and ______________ failure
fluid and electrolyte, acidosis, alkalosis (more common), plasma, circulatory (along with renal failure)
those infected with this strain of Helicobacter pylori are more likely to have peptic ulcer disease
CagA-positive strain
peptic ulcer disease teaching: follow _____________ drug therapy to prevent relapse, including antisecretory and antibiotic drugs
prescribed
treatment/nursing management for gastric outlet obstruction includes decompression/suction with ___________ with __________ per policy; monitoring _________ and __________; ________________ patient; one of two drugs: ________ or _______________; _______ management; __________________ replacement; ____________ or ___________ dilation
NG tube, irrigation, intake, output, repositioning, PPI, H2 blocker, pain, fluid and electrolyte, surgery, balloon
first sign of GERD/hiatal hernias in gerontologic population may be severe: ___________________ or _________________
esophageal bleeding, aspiration
sense of a lump in the throat
globus sensation
pain with (gastric, duodenal) ulcers worsens with food
gastric
gastric outlet obstruction: if gastric residual is <_____ mL after clamped for ___________ (time period), begin oral intake and progress to solids
200 mL, 8-12 hours
first symptom of peptic ulcer disease in gerontologic population may be one of these two
GI bleed, decreased Hct
management of severe acute gastritis includes placing NG tube to monitor for ____________ and perform __________ to empty stomach
bleeding, lavage
aspiration from GERD may lead to these three respiratory conditions
asthma, chronic bronchitis, pneumonia
pain management for peptic ulcer disease avoids use of _________ or _________ for 4-6 weeks unless administered with one of the drugs _____________, __________________, or _______________
NSAIDs, ASA, PPI, H2 blocker, misoprostol
type of peptic ulcer disease characterized by superficial erosion (into submucosa) and minimal inflammation
acute
duodenal ulcers manifest as _____________ or _______________ pain in _________________ region or ______; occurs ___________ (time period) after meals
burning, cramplike, midepigastric, back, 2-5 hours
precancerous lesion that often progresses to squamous cell carcinoma; characterized by red velvety patch on mouth or tongue
erythroplakia
five food triggers for eosinophilic esophagitis
milk, eggs, wheat, rye, beef
three manifestations of esophageal strictures
dysphagia, regurgitation, weight loss
gastric ulcers are more prevalent in this age/sex group
females >50 years
duodenal ulcers have highest incidence in this age group
35-45 years
most lethal complication of peptic ulcer disease
perforation
four conservative care methods for peptic ulcer disease
adequate rest
avoid smoking/alcohol/caffeine
stress management
dietary modifications
primary tool used for diagnosing source of upper gastrointestinal bleeding
endoscopy
GERD: stay in __________ position _________ after meals; avoid _______ clothing at waist or ______________ after eating; avoid ______ and eating ________ (time period) before bedtime
upright, 2-3 hours, tight, bending over, milk, 3 hours
two diet risk factors for gastritis
alcohol
spicy, irritating foods
manifestations of this location of oral cancer include leukoplakia, erythroplakia, ulcers, sore spot, rough area, pain, dysphagia, lump or thickening in area, sore throat or feeling that something is stuck, difficulty chewing and speaking (later signs)
oral cavity
postoperative complication of gastric surgery in which bile reflux causes damage to gastric mucosa, chronic gastritis, and peptic ulcer disease
bile reflux gastritis
identify ___________, ______________, and ____________ of emesis upon assessment
source, timing, characteristics
the patient with persistent vomiting, possible bowel obstruction, or paralytic ileus may need this
NG tube
mortality of (gastric, duodenal) ulcers is greater than the other
gastric
another term for heartburn (burning, tight sensation felt intermittently beneath lower sternum and spreading upward to throat or jaw)
pyrosis
term for pain or discomfort centered in upper abdomen (mainly in or around the midline)
dyspepsia
as diet progresses in patient with nausea and vomiting, give _________ diet with ________ carbohydrates and ________ fat
bland, high, low
manifestations of this gastric surgery postoperative complication include weakness, sweating, palpitations, dizziness, cramping, borborygmi, and defecation urge
dumping syndrome
medication-induced peptic ulcer disease occurs most often with this medication; higher risk for peptic ulcer disease when combined with at least one of these two medications
NSAIDs
corticosteroids, anticoagulants
transmission of Helicobacter pylori occurs with these two methods
oral-oral, fecal-oral
peptic ulcer disease teaching: avoid foods that cause _______________, such as _________ foods
epigastric distress, acidic
highest incidence of stomach cancer is in these four ethnic groups
Asian Americans, Pacific Islanders, Blacks, Hispanics
peptic ulcer disease teaching: avoid ______ drugs unless approved by HCP, including __________ and _____________
OTC, aspirin, NSAIDs
a massive GI bleed is >_______ mL blood loss or ____% intravascular volume
1500; 25
two ethnic groups in which Helicobacter pylori is most prevalent
Hispanic, Black
endoscopic therapy for upper GI bleeding: one of these two substances is injected into the site
epinephrine, alcohol
manifestations include heartburn, dysphagia, food impaction of esophagus, nausea, vomiting, weight loss
eosinophilic esophagitis
peptic ulcer disease teaching: do not _________________ brands of PPIs, antacids, or H2 receptor blockers bought OTC without checking with HCP; can lead to harmful side effects
interchange
health promotion for upper GI bleeding: avoid these three gastric irritants
smoking, alcohol, OTC medications
diagnosis of gastritis is based on ______________, including history of _______ or _________ use; ________________ with _________, ____________ testing, lab test ______, _________________ in stool, __________________ to parietal cells, and __________________
symptoms, drug, alcohol, endoscopy, biopsy, H. pylori, CBC, occult blood, antibodies, intrinsic factor
clinical manifestations and diagnostic studies of hiatal hernia are similar to those of ________
GERD
two treatment goals for peptic ulcer disease
decreased gastric acidity
enhanced mucosal defense mechanisms
manifestations of this gastric surgery postoperative complication include sweating, weakness, confusion, palpitations, tachycardia, anxiety
postprandial hypoglycemia
three risk factors for gastric ulcers
Helicobacter pylori
NSAIDs
bile reflux
antireflux surgery reduces reflux and enhances LES function and is reserved for these two patients
complications
persistent severe symptoms
postoperative complication of gastric surgery in which gastric chyme enters small intestine as large hypertonic bolus; pulls fluid into bowel lumen causing decreased plasma volume, distention of bowel lumen, and rapid transit within 15-30 minutes of eating
dumping syndrome
type of peptic ulcer disease characterized by erosion of muscular wall with formation of fibrous tissue
chronic
three risk factors for GERD other than food and drugs
obesity, smoking, hiatal hernia
pain with (gastric, duodenal) ulcers improves with food
duodenal
surgical method for hiatal hernias involving attachment of the stomach below the diaphragm to prevent re-herniation
gastropexy
three noninvasive methods that test for Helicobacter pylori
serology, stool, breath test
most common risk factor for duodenal ulcers
Helicobacter pylori
health promotion for upper GI bleeding: avoid __________ drugs
GI toxic (ex. NSAIDs, corticosteroids)
four susceptible areas of GI tract in developing peptic ulcer disease (PUD)
lower esophagus
stomach
duodenum
post-op gastrojejunal anastomosis
peptic ulcer disease teaching: avoid _______________, which promotes ulcer development and delays ulcer healing
cigarettes/smoking
emesis with bright red blood indicates this
active bleeding due to Mallory-Weiss tear, varices, ulcers, or cancer (above stomach)
complication of peptic ulcer disease in which stomach fills and dilates causing discomfort and pain that is worse at the end of the day; may be visibly dilated
gastric outlet obstruction
decreased BP; cool, clammy skin; increased HR; decreased LOC; slow capillary refill, and decreased urine output (<0.5 mL/kg/hr) indicate this (in a patient with acute GI bleed)
hypovolemic shock
pathogen risk factor for gastritis
H. pylori
two environmental risk factors for gastritis
radiation, smoking
when clear liquids are started in patients with nausea and vomiting, have patients drink _________ amounts (_______ mL) every ________ minutes with fluids at ___________________
small, 5-15, 15-20, room temperature
disease characterized by erosion of GI mucosa from HCl acid and pepsin
peptic ulcer disease (PUD)
in gastric outlet obstruction, belching and vomiting (make symptoms worse, provide relief); constipation and anorexia also occur
provide relief
term for narrowing of esophagus
esophageal stricture
emesis with coffee-ground color indicates this
gastric bleeding (blood mixes with HCl acid)
two treatments for eosinophilic esophagitis
avoid known/identified allergens
drug therapy: PPIs, corticosteroids
five environmental triggers for eosinophilic esophagitis
pollen, mold, cat, dog, dust mite allergens
manifestations include abdominal pain, abdominal rigidity, hematemesis, melena, nausea
acute GI bleed
surgery for GERD and hiatal hernias in which the fundus of the stomach is wrapped around the lower part of the esophagus to reinforce and repair defective barrier
laparoscopic fundoplication
manifestations of this location of oral cancer include ulcer or area of thickening, soreness, or pain; limited area movement; increased saliva, slurred speech, dysphagia, toothache, earache (later signs)
tongue
chronic syndrome of mucosal damage due to reflux of stomach acid into lower esophagus
gastroesophageal reflux disease (GERD)
most common area of stomach in which gastric ulcers occur
antrum (lower part of stomach)
health promotion for upper GI bleeding: avoid this to avoid bleeding varices
pressure (such as severe coughing, sneezing)
if perforation is untreated, ___________________ occurs in 6-12 hours
bacterial peritonitis
emergency management assessment of upper GI bleeding: assess/monitor these eight things
airway, breathing, circulation, ECG, vital signs, LOC, abdomen (bowel sounds), intake and output
partial gastrectomy with removal of the distal 1/2 of the stomach and anastomosis of the gastric stump to the jejunum
gastrojejunostomy or Billroth II
surgical therapy is done if bleeding continues despite efforts and more than _________ mL of blood is transfused or _______ occurs
2000, shock
subjective assessment for upper GI bleed includes history of these four things along with one other thing
history of
1. previous bleeds
2. blood transfusions
3. transfusion reactions
4. illnesses/drugs that may contribute to bleeding
religious preference that prohibits blood transfusion
peptic ulcer disease teaching: reduce or stop ___________ use
alcohol
two treatments for all locations of oral cancer
surgery, radiation
first-line management of upper GI bleeding that is done within 24 hours to determine treatment or need for surgery
endoscopy
six patient conditions at high risk for duodenal ulcers
COPD, cirrhosis, pancreatitis, hyperparathyroidism, Zollinger-Ellison syndrome, chronic renal failure/chronic kidney disease
type of hiatal hernia in which the fundus and greater curvature of the stomach roll up through the diaphragm, forming a pocket alongside the esophagus
paraesophageal or rolling
partially digested emesis indicates one of these two things
gastric outlet obstruction
delayed gastric emptying
incidence and mortality rates of oral cancer are highest in this group
black men
mucosal damage in the GI tract associated with serious illness or physiologic stress
stress-related mucosal disease (SRMD)
enzyme made by Helicobacter pylori bacteria that activates the immune response and release of cytokines, leading to increased gastric secretion and tissue damage, leading to peptic ulcer disease
urease
a patient who has a LINX reflux management system cannot have this medical test
MRI
GERD: head of bed increased on _______ inch blocks
4-6
diagnostic study for peptic ulcer disease that directly visualizes the mucosal lining of the stomach; ulcers or tumors can be directly seen, and biopsies can be taken
esophagogastroduodenoscopy (EGD)
type of hiatal hernia that can strangle the stomach or have its blood supply cut off; is a medical emergency
paraesophageal or rolling
many antiemetic drugs act in the _____________________ via the ______________________ to block neurochemicals that trigger nausea and vomiting
central nervous system (CNS), chemoreceptor trigger zone (CTZ)
highest incidence of esophageal cancer is in this group
non-Hispanic white men
peptic ulcer disease teaching: frequent use of _____________ for arthritis in gerontologic population can increase incidence
NSAIDs
acute care management of upper GI bleeding: NG tube management: place in proper __________ and assess aspirate for ________
position, blood
do not perform endoscopy when ________________ is present and if concerned that ___________ may occur
inflammation, perforation
diagnostic test used to diagnose source of upper gastrointestinal bleeding when endoscopy cannot be done or when bleeding persists after endoscopy
angiography
(gastric, duodenal) ulcers are more common than the other
duodenal
endoscopic therapy for upper GI bleeding: this is used to cauterize the bleed
thermal ablation
(gastric, duodenal) ulcers cause more bleeding episodes than the other
duodenal
three methods used to treat varices
ligation, sclerotherapy, balloon tamponade
two medications that can cause medication-induced esophagitis
NSAIDS, potassium
esophageal bleeding can be caused by these three things
chronic esophagitis, Mallory-Weiss tear, esophageal varices
three tests for peptic ulcer disease (other than gold standard and noninvasive H. pylori tests)
barium contrast, high fasting serum gastrin levels, secretin stimulation
immediate focus of treatment for perforation includes stopping ____________ and restoring _________________
spillage, blood volume
esophageal strictures occur most often from _________ but can also occur from ___________ ingestion, ______________, _____________, or ______________
GERD, chemical, radiation, surgery, trauma
GERD: ________ diet and _________ meals with ________ in between meals
low-fat, small, fluids
health promotion for upper GI bleeding: teach about these three things if patient has blood dyscrasia
disease, drugs, risk of GI bleeding
repeated esophagitis/ulcerations may lead to these three things
scar tissue, stricture, dysphagia
management for acute or chronic gastritis involves identifying ______________
cause
option for GERD patients who have symptoms despite maximum medical management; a ring of titanium beads with magnets are implanted into LES to prevent reflux by keeping it closed when not eating or drinking
LINX reflux management system
gastric content analysis for peptic ulcer disease involves checking _____ and for ________ or _______
pH, blood, bile
most common complication of peptic ulcer disease
hemorrhage (GI bleeding)
two drinks other than water that may be tolerated in patients with nausea and vomiting
flat sodas at room temperature
warm tea
to prevent stomach distention in patient with nausea and vomiting, tell patient to eat food _________ and in ___________ amounts
slowly, small
surgical enlargement of the pyloric sphincter to promote the easy passage of contents from the stomach
pyloroplasty
patient with GERD may report respiratory symptoms such as these three
wheezing, coughing, dyspnea
peptic ulcer disease: allow _______________ (time period) for healing
3-6 months
surgical management of hiatal hernias focuses on these three things
reduce hernia
optimize LES pressure
prevent movement of gastroesophageal junction
GERD: _______ weight
lose
emergency management of upper GI bleeding: patient will require __________________ IV access for fluids, PPIs, and blood
two large bore
emergency management/assessment of upper GI bleed involves hourly _____________________ monitoring, ____________________ monitoring, ___________ administration, assessing for ____________ and _____________, administering IV ________, and __________________________________
urine output, hemodynamic, oxygen, perforation, peritonitis, fluids, blood/blood product transfusions
treatment for small perforations
self-sealing; monitor for obstruction
dumping syndrome lasts about/less than ________
1 hour
resection of the lower esophagus, removal of the stomach, and anastomosis of the esophagus to the jejunum
gastrectomy
emesis with bile indicates this
obstruction below ampulla of Vater (small opening that enters into duodenum)
term for black, tarry stools from upper GI source
melena
gastric ulcers manifest as ____________ pain __________ (time period) after meals with complaint of __________ or ____________ pain
epigastric, 1-2 hours, burning, gaseous
endoscopic therapy for GERD that uses heat energy to create lesions to thicken LES
radiofrequency ablation
acute care for peptic ulcer disease includes placing on _______ status, placing __________, giving __________, checking ___________, monitoring for _________, ________ and __________ management, and adequate _______
NPO, NG tube, IV fluids, vital signs, shock, pain, anxiety, rest
manifestations may be ASYMPTOMATIC or may include anorexia, nausea, vomiting, epigastric tenderness, hemorrhage, and pernicious anemia
chronic gastritis
acute care management of upper GI bleeding: when lavage is used, instill _______ mL at a time into the stomach, then drain
50-100
two complementary herbs that may help nausea and vomiting
ginger, peppermint
manifestations of this gastric surgery postoperative complication include epigastric distress temporarily relieved with vomiting
bile reflux gastritis
when caring for a patient with nausea and vomiting in acute care, keep patient _____ and give ___________ until ______ intake is tolerated
NPO, IV fluids, oral
seven complications of hiatal hernias
GERD, esophagitis, ulcers, hemorrhage, stenosis, strangulation, aspiration
complication of peptic ulcer disease in which GI contents spill into peritoneal cavity
perforation
