Cyndi - Week 1 - Exam 1 Flashcards
what is achalasia?
lower esophageal sphincter can’t relax and aperistalsis of the lower espohagus
what are the causes/risk factors of achalasia? (4)
– Nerve degeneration of inhibitory neurons
– Esophageal dilation due to accumulation of
food and fluid
– Hypertrophy (bigger esophagus)
– Unknown cause
is achalasia common?
no, not common
what are the clinical manifestations of achalasia? (7)
- substernal chest pain (need to rule out MI w/ 12 lead EKG)
- dysphagia
- coughing (trying to move the food or get it out - could go into lungs → aspiration)
- regurgitation of food (esp. when lying down)
- weight loss
- weakness
- poor skin turgor
what are the 6 possible complications of achalasia?
- Megaesophagus
- GERD
- Chest pain
- Nocturnal regurgitation (laying down after eating, wake up and vomit)
- Aspiration (new crackles, get chest xray)
- Halitosis (bad breath)
what are the 3 diagnostic tests used for achalasia?
- upper GI barium xray
- espohageal manometry
- esphoagogastroduodenoscopy (EGD)
what is important pre-assessment for a patient who is to undergo a EGD?
- NPO for 8 hours
- signed consent
- sedation education (possible risks - perforation)
- NPO after procedure
what are 4 things to include in achalasia patient education?
- dietary adjustments (small meals, small sips b/t meals)
- meds (relax muscle → anticholinergics)
- elevate HOB after eating/at night
- procedural teaching
what side is the patient positioned during a EGD and why?
on the left side; considered the “recovery side”; least likely to vomit.
what 3 types of pharm treatments are used in achalasia?
- anticholinergics
- smooth muscle relaxants before meals
- botulism injection to lower esophageal sphincter (short term fix)
what 3 invasive treatments are used in achalasia?
- dilation of LES
- surgery (Heller myotomy)
- POEM (peroral endoscopic mytomy)
what is gastritis?
inflammation of mucosa d/t breakdown in protective barriers
what are the risk factors for gastritis?
- meds (aspirin, NSAIDs)
- alcohol use
- H. pylori
- radiation exposure
- physiological stress conditions (↑ acid)
what are the clinical manifestations of gastritis?
- heartburn
- epigastric pain
- nausea
- anorexia
what are the diagnostic tests of gastritis?
EGD, H. pylori test, biopsy, CBC (intrinsic factor), guaic stool
what is the treatment for gastritis?
- Eliminate cause, if known (H. pylori)
- NG tube for bowel rest
- PPIs
- H2 blockers
- antacids
- antibiotics for H. pylori infection
what are the possible complications for gastritis?
- ulcer
- hemorrhage
- ↑ risk of stomach cancer
what is GERD?
gastroesophageal reflux disease - reflux of gastric contents into the esophagus d./t LES incompetence; may include a gastroparesis component also.
what are the risk factors for GERD?
- foods (spicy, acidic, coffee, tea, too much food)
- medications
- obesity
- smoking
- hiatal hernia
- abd pressure
what are the s/sx of GERD?
- heartburn
- dyspepsia (indigestion)
- regurgitation
- pain (dyspepsia)
- may have respiratory symptoms (coughing, aspiration, wheezing)
what are the diagnostic tests used for GERD?
- endoscopy
- biopsy
- pH monitoring (tests how much acid is produced)
- manometry
- upper GI barium study
what are the possible complications from GERD?
- esophagitis
- barret’s esophagitis (cells change with inflammation)
- respiratory compromise
what are the treatment options for GERD?
- medications (PPI, H2 blockers, others)
- lifestyle changes (weight loss, diet)
- surgery
- magnet (lynx system)
what is a hiatal hernia?
herniation of stomach above diaphragm
- weakened diaphragm around esophagus
what are the risk factors of hiatal hernias?
age, gender, abd pressure, meds
what are the two different types of hiatal hernias
sliding and rolling
what are the characteristics of a sliding hiatal hernia?
- most common
- stomach slides above diaphragm and back down
- epigastric pain and vomiting
- not emergent
what are the characteristics of rolling hiatal hernias?
– Fundus of stomach rolls through diaphragm and stays
– Forms a pocket next to esophagus – risk for strangulation → necrosis → infection → EMERGENT
- projectile vomiting
what are the diagnostic tests for hiatal hernias?
- upper GI barium study
- EGD
what are the clinical manifestations of hiatal hernias?
- CHEST PAIN/PRESSURE
- heartburn
- dyspepsia
- regurgitation
- pain
what are the complications of hiatal hernias?
- GERD
- strangulation
- esophagitis
- hemorrhage
- ulcer
- regurgitation with aspiration
what is the conservative treatment for hiatal hernia?
- similar to GERD (prevent problems with gastric reflux)
PPIs, H2 receptor blockers, lifestyle changes
what are the surgery options for hiatal hernia?
Nissen or Toupet fundoplication
how does a peptic ulcer occur?
balance of stomach protective and aggressive mechanisms lost
an increase in which aggressive factors could contribute to an ulcer formation?
- ↑ acid secretion
- ↑ pepsin secretion
- ↑ H. pylori infection
a decrease in which protective factors could contribute to an ulcer formation?
- ↓ mucus
- ↓ bicarbonate secretion
- ↓ gastric mucosa blood flow
what is a peptic ulcer?
excavation formed in wall of stomach or duodenum
what are characteristics of peptic ulcers?
- Extends into the mucularis layer (blood/nerves)
- Acute
- Chronic
- Scarring caused by repeated episodes (doesn’t stretch/absorb)
- Stomach vs duodenal location (more common in duodenum)
what are the diagnostic tests used for peptic ulcers?
- Upper GI endoscopy with biopsy
- Barium tests
- Labs (CBC [HnH])
- H. Pylori tests
what are the risk factors for peptic ulcers?
- Similar to GERD, gastritis, H. pylori, stress, alcohol, smoking, medication
- Duodenal 80% of ulcers, near pyloric sphincter
- Genetic predisposition (often lifestyle)
- NSAIDS and H. pylori together = high risk
what are the s/sx of peptic ulcers?
• Pain –burning, gnawing • Pain – Stomach • Shortly after meals – Duodenal • 2‐3 hours after eating • Nocturnal pain more likely • Dyspepsia • Hematemesis (bloody vomit) • Melena (bloody stools)
what is the POC for a patient with a peptic ulcer?
• NPO • IVF • NG tube for bowel rest • Medications • Pt education – ID cause and eliminate – Avoid foods that irritate (spicy/acidic) – Smoking, alcohol, stress, etc. • Possible blood transfusion
what are complications of peptic ulcers?
hemorrhage, perforation, gastric outlet obstruction
what medications are given for ulcers?
ones that decrease acidity, enhance mucosa (antacids, PPIs, sucralfate, H2 blockers, prokinetic agents, ATB)
what do antacids do?
neutralizes stomach acid
what does sucralfate do?
viscous substance augments stomach’s protective lining
what do H2 receptor blockers do? (ranitidine)
blocks histamine receptors on the cells of the stomach lining, decreasing stomach acid production
what do PPIs do? (pantoprazole)
decreases stomach acid production by inhibiting active enzymes (a building block for H+ ions) in some parietal cells
what do prokinetic agents do? (metoclopramide)
increases gastric emptying
what are antibiotics used for regarding H. pylori?
eradicates the bacteria
what surgical treatments are there for ulcers?
• Partial gastrectomy –Billroth I (gastroduodenostomy) –Billroth II (gastrojejunostomy) • Vagotomy • Pyloroplasty
what is an upper GI bleed?
the presence of bleeding in the esophagus, stomach, duodenum urgent focus on finding the source!
what are characteristics of a GI bleed?
site and type of blood vessel
what are the causes of an upper GI bleed?
gastritis, ulcer, cancer, meds, other
UGI bleeds can be chronic or acute. Whats the difference?
• Chronic ‐ insidious; difficult to detect
– May occur intermittently
• Acute ‐ sudden or massive onset
T/F: Any disorder that involves bleeding can develop into hypovolemic shock, and requires primary hemodynamic stabilization
TRUTH
what are the diagnostic tests used for UGI bleeds?
- Labs – frequent H & H (Q 4‐6 hours) – monitor trends
- Upper endoscopy ( may need to be emergent)
- Guaiac stool for presence of occult blood
- Frequent VS to monitor trends
what are the s/sx of UGI bleeds?
• Fatigue, low energy, especially with chronic bleed
• Pain
• Dyspepsia
• Hematemesis – coffee ground, or red?
• Melena
• If sudden or massive, may have anxiety, restlessness, change in LOC,
tachycardia, dyspnea, tachypnea, cool, clammy skin, nausea
(signs of shock)
what assessments should occur for a pt with UGI bleed?
Monitor for s/s hypovolemia/shock or perforation!
• FrequentVS, H&H, LOC, and oxygenation status
• Multiple large bore IVs (18 gauge or central line)
• NG tube
• Fluid replacement
• Blood transfusion if needed
what txs are used for UGI bleed?
Medications:
• PPI or H2 blocker IVP or infusion
• Octreotide (Sandostatin) IV infusion
• Chronic will need PPI, Sucralfate, iron supplement
Endoscopy
– Thermal probe, Laser , Scleral therapy
Surgery to repair the site of bleeding if unable to control
what are the NIs for gastric surgery?
- Monitor for bleeding
- Watch for s/s of decreased peristalsis
- Post‐prandial hypoglycemia
what patient teaching is needed for gastric surgery?
- Pernicious anemia long term complication
- Dumping syndrome
- S/s, dietary changes, meds to delay gastric emptying
what are the complications of gastric surgery?
• 20% Dumping syndrome; pernicious or iron deficient anemia, postprandial hypoglycemia, bile reflux
