Chapter 55

Question 1

Causes of acute gastritis?

Answer 1

NSAID, alcohol, radiation, smoking, stress, infection of H.pylori, staph, strep, e.coli, salmonella

Question 2

Difference in origins between Type A chronic and Type B chronic

Answer 2

Type A is genetic, autosomal pattern , presence of antibodies to parietal cells and intrinsic factor

Question 3

Causes of local irritation in chronic Type B?

Answer 3

Caffeine, ETOH, Radiation, smoking

Question 4

Bacteria most often associated with chronic gastritis?

Answer 4

helicobacter pylori

Question 5

Features of acute gastritis?

Answer 5

rapid onset
nausea, vomiting
hematemesis (vomit blood)
gastric hemorrhage 
dyspepsia
anorexia

Question 6

Features of chronic gastritis?

Answer 6

vague reports of epigastric pain that is related to foods
anorexia
nausea vomiting 
intolerance of fatty or spicey foods
pernicious anemia

Question 7

What is pernicious anemia?

Answer 7

deficiency of vitamin B12

Question 8

Interventions for chronic gastritis?

Answer 8

eliminate the disease 
eliminate H. pylori 
H2 agonist
antacids
proton pump inhibitors

Question 9

Name the H2 agonists

Answer 9

famotidine

nizatidine

Question 10

What class of medds is used as a buffering agent?

Answer 10

antacids, magnesium hydroxide, aluminum hydroxide, simethicone

Question 11

Name the proton pump inhibitors

Answer 11

omeprazole

pantoprazole

Question 12

Whats does H2 agonist do?

Answer 12

block gastric secretions

Question 13

What does proton pump inhibitors do?

Answer 13

suppress gastric acid secretions

Question 14

Hematemesis?

Answer 14

vomiting bright red blood or coffee-ground blood

Question 15

What does hematemesis indicate?

Answer 15

bleeding above the duodenojejunal junction, referred to as an upper GI bleed

Question 16

what is melena?

Answer 16

dark tarry stool

Question 17

symptoms of a hemorrhage due to ulcers

Answer 17

Vomits bright red or coffee-ground blood, black tarry stool

Question 18

What is a perforated ulcer?

Answer 18

entire thickness of stomach or duodenum is worn away

Question 19

Symptoms of perforation

Answer 19

sudden sharp pain starts at the mid-epigastric region and spreads over entire abdomen, patient may be in fetal position

Question 20

Danger of perforation?

Answer 20

leakage into the peritoneal cavity causing bacterial septicemia and hypovolemic shock

Question 21

Where does a pyloric obstruction occur?

Answer 21

at the pylorus, the gastric outlet

Question 22

What causes a pyloric obstruction?

Answer 22

caused by scarring, edema, inflammation

Question 23

What are the symptoms of pyloric obstruction?

Answer 23

bloating, vomiting, hyochloremic alkalosis, hypokalemia

Question 24

When would intractability occur and what are the features?

Answer 24

intractability develops from complications of ulcers, stress, non-compliant with treatment, symptoms interfere with ADLs, recurrent pain and discomfort despite treatment

Question 25

Physical assessment findings when a patient has a perforation

Answer 25

rigid, broad like abdomen with rebound tenderness and pain

Question 26

What is dyspepsia?

Answer 26

sharp, burning, gnawing pain, fullness or hunger

Question 27

Where does general gastric ulcer pain occur?

Answer 27

upper epigastrium, left of midline

Question 28

What aggravates a gastric ulcer?

Answer 28

food

Question 29

Where is duodenal ulcer pain located?

Answer 29

located to right or below epigastrium

Question 30

Generally, what are the symptoms of ulcers?

Answer 30

``` discomfort/pain/heartburn melena vomiting fluid status orthostatic vitals dizzy low hgb and hct ```

Question 31

What aggravates a duodenal ulcer?

Answer 31

not food, food relieves it

Question 32

Patient teaching for antacids

Answer 32

- give 2 hours after meals and at bedtime - do not give within 1-2 hours of other meds (affects absorption) - assess patient for renal disease

Question 33

Patient teaching for H2 antagonists

Answer 33

give single dose at bedtime for GI ulcers, PUD, and heartburn

Question 34

Patient teaching for Mucosal Barriers

Answer 34

- give 1 hour before and 2 hours after meals - do not give within 30min of giving antacids - do not take aspirin with this - stools may be black - may cause constipation

Question 35

Patient teaching for Proton Pump Inhibitors

Answer 35

- do not crush, take whole | - may cause weakening of bones

Question 36

Patient teaching for antimicrobials

Answer 36

- take with food

Question 37

Steps when patient has a GI bleed?

Answer 37

- ABCs - Oxygen - Start 2 large bore IVs monitor vitals, HCT, O2 sats

Question 38

What causes ACUTE GASTRIC DILATION?

Answer 38

clogged NG tube

Question 39

Symptoms of ACUTE GASTRIC DILATION?

Answer 39

``` abdominal distension epigastric pain tachycardia hypotension fullness/ hiccups ```

Question 40

what is a total gastrectomy?

Answer 40

Total gastrectomy – growth removed in the proximal upper third of stomach

Question 41

syndrome associated with a total gastrectomy?

Answer 41

DUMPING SYNDROME

Question 42

Cause of early dumping syndrome?

Answer 42

rapid emptying of food contents into the small intestine causing fluid shift to the gut causing abdominal distension

Question 43

Cause of late dumping syndrome?

Answer 43

rapid increase of insulin production

Question 44

Diet for dumping syndrome?

Answer 44

- high fat and protein, low carb diet (atkins) - No milk, sweets, or sugars - Low roughage

Question 45

Other interventions for dumping syndrome?

Answer 45

- decrease meal size - no fluids during meals - HOB 45 degrees (Semi-recumbent) eating, flat after eating - Sedatives/antispasmodics to delay gastric emptying

Question 46

What is a subtotal gastrectomy?

Answer 46

removal of tumor located in the mid-portion distal part of the stomach

Question 47

Syndrome associated with subtotal gastrectomy?

Answer 47

Alkaline reflux gastropathy

Question 48

Symptoms of Alkaline reflux gastropathy?

Answer 48

- Early satiety - Abdominal discomfort - Vomiting - Atrophic glossitis - Pernicious anemia

Question 49

What is Atrophic glossitis?

Answer 49

tongue is shiny, smooth, and beefy due to vitamin B12 deficiency

Question 50

What is Pernicious anemia?

Answer 50

decrease in red blood cells when the body can't absorb enough vitamin B-12

Question 51

Labs associated with alkaline reflux syndrome?

Answer 51

``` Low B12 Folic acid Iron Calcium Vitamin D ```

Question 52

Management for alkaline reflux syndrome?

Answer 52

ALL THAT SHIT BITCH