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NSG 2200 > Digestion > Flashcards

Digestion Flashcards

1
Q

Peptic Ulcer Facts

A
  • Effects 1% of total adult population
  • Rare in the 19th century
  • 4 million recurrences each year
  • No identifiable racial, ethnic or cultural patterns have been found
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2
Q

Etiology of Peptic Ulcers

A

*Genetic Factors:gastric and duodenal ulcers occur 2-3 times more often where there is a family history of ulcers
*Environmental- smoking, alcohol, coffee. NSAIDS
8Infection- H. pylori

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3
Q

Peptic Ulcer Disease:

A
  • Effects mucosa and deeper structures of the UGI tract
  • Auto digestion of GI lining
  • Esophagus, stomach, duodenum or jejunum
  • Refers to gastric and duodenal ulcers
  • Acute (superficial erosion, mild inflammation)
  • Chronic (erode into muscle)
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4
Q

Peptic ulcers may lead to:

A
  • bleeding

* Perforation or other emergencies

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5
Q

Gastric Ulcers

A
  • Normal lo low secretion of HCL
  • > 50 years old
  • Higher mortality rate
  • NSAIDS, ASA, steroids
  • Alcohol, chronic gastritis, reflux, smoking
  • Frequently completely asymtomatic
  • Pain– epigastric location near midline and may radiate around costal border to back
  • Occurs 1-2 hours after meals
  • May be relieved or worsened by food or antacid
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6
Q

Duondenal Ulcers

A
  • Most common peptic ulcer
  • 34-35 years old, men
  • Associated with high HCL secretion
  • May be asymptomatic
  • Pain– epigastric location near midline may radiate around costal border to back
  • Described as gnawing, burning, aching
  • Occurs 2-4 hours after meals
  • Usually relieved by food or antacids
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7
Q

Diagnostic Tests for PUD

A

*Endoscopic exam- definitive test for ulcers
*UGI not always accurate
*Biopsy specimen via endoscopy as well as gastric analysis for pH and H. Pylori
*H. Pylori tests
CBC- Anemia?

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8
Q

Collaborative Care: Conservative Therapy: Objectives

A
  • Rest, diet modifications, drug therapy, stop smoking/drinking, stop NSAIDS/ASA, long term follow up
  • Takes 3-9 weeks usually
  • Pain stops after 3-6 days
  • Drugs: GERD meds
  • Diet 6 small meals, avoid irritating foods
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9
Q

Complications:

A
  • Acute Exacerbation: NG, fluid and electrolyte replacement, endoscopy. 5 yr follow-up
  • Perforation
  • Gastric outlet obstruction
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10
Q

Histamine Receptor Antagonists

A
  • Vary in potency and cost
  • Inhibit HCL secretion by binding to the histamine H2 receptor
  • Tagamet, Zantac, Pepcid
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11
Q

Antacids

A
  • Weak base that neutralize free hydroch acid to prevent irritation and promote mucosal healing
  • Rake 1-3 hours after meals and at bedtime
  • Magnesium hydroxide- laxative effect
  • Aluminum hydroxide- constipation
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12
Q

Sucralfate (Carafate)

A
  • Coats and acts as sealant against acid irritation
  • neither inhibits or neutralizes gastric acid
  • 30-60 minutes before meal and at bedtime
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13
Q

H. Pylori drug treatment: most common

A
  • bismuth subsalicylate (Pepto-Bismol)
  • metronidazole (Flagyl)
  • tetracyline
  • pantoprazole (Protonix) or omeprazole (Prilosec)
  • Prilosec
  • Amoxicillin
  • Clarithromycin
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14
Q

Treatment-H. Pylori eradication rate

A

*H2 blockers alone- no effect
*Omeprazole- no effect
*Bismuth and amoxicillin- 44% (197)
*Bismuth and metronidazole- 55% (118)
*Omeprazole and amoxicillin- 58% (433)
*Bismuth, metronidazole and amoxicillin-73% (130)
Bismuth, metronidazole and tetracycline- 94% (434)

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15
Q

Diet:

A
  • Role of diet has changed over 40 yr.- milk based therapy was used but had no effect on healing just symtoms
  • Amino acids and calcium in milk increase acid secretion
  • No special diet
  • Restrict foods that cause discomfort, small frequent meals 6X a day
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16
Q

Collaborative Care

A

Surgey:

  • Vagotomy
  • Billroth I
  • Billroth II
  • Pyloroplasty
  • Total Gastrectomy
17
Q

Vagotomy

A

reduces acid production by decreasing cholinergic stimulation of the parietal cells

18
Q

Post-op Care Gastric Surgery

A
  • Promote Pulmonary Ventilation- turn, breathe deeply, cough at least every two hours- splint or support incision during coughing
  • Provide comfort
  • Measure n/g drainage, monitor for blood in drainage, DO NOT irrigate or reposition n/g tube,monitor for distention
  • Monitor weight
  • Report signs of Dumping Syndrome (weakness, faintness, palpitation, diaphoresis, nausea, and diarrhea)
  • Avoid stress
  • Elevate head when lying
  • Slow progression with food
19
Q

Complication of Gastric Surgery

A
  • Bleeding
  • Duodenal Stump Leakage
  • Dumping syndrome
  • Postprandial Hypoglycemia
  • Bile reflux gastritis
  • Malabsorption
20
Q

Duodenal Stump Leakage

A
  • Any anastomosis sites are at risk for leakage in early post-op
  • Monitor for classic peritonitis symptoms such as: severe abdominal pain, rigidity and fever
  • WBC increase
  • Surgical drainage and closure are necessary
21
Q

Dumping Syndrome

A
  • Vasomotor & gastrointestinal symtoms
  • Pathophysiology not understood
  • Theory: rapid entry of hypertonic food directly into jejunum leads to fluid being pulled into jjejunum decreasing blood volume.
  • Prevention: moderate fat, moderate protein, limited carbohydrates and limit fiber. No simple sugars, no fluids with meal. Lying down on left side 20-30 minutes after eating delays emptying
22
Q

Dumping Syndrome Symptoms:

A
  • weakness
  • dizziness
  • diaphoresis/pallor
  • feeling of dullness or discomfort
  • nausea
  • diarrhea
  • onset of symptoms is 5-30 minutes after eating and last for 20-60 minutes
23
Q

Malabsortion

A
  • after gastric surgery, malabsorption of fat may occur from decreased pancreatic enzymes and increase upper GI motility
  • steatorrhea
  • diarrhea
  • weight loss
  • deficiencies in fat soluble vits
24
Q

Vitamin B12 Deficiency

A
  • Gastrectomy results in partial or total loss of intrinsic factor tat is secreted by parietal cells of stomach
  • Needs intrinsic factor for B12 absorption in terminal ileum
  • Pernicious anemia- deficiency of B12 monthly lifelong injections
25
Q

Morbid Obesity: Etiology

A
  • Genetic/biological factors
  • Environmental factors
  • Psychosocial factors
26
Q

Health risk factors

A
  • CV
  • Resp.
  • DM
  • MS
  • GI/liver
  • Cancer
27
Q

Conservative Collaborative Care

A
  • Nursing diagnoses: Imbalance nutrition, skin integrity, breathing pattern, self esteem, health maintenance
  • Planning: changing eating patterns, activity, weight reduction, minimize or prevent health problems
28
Q

Collaborative Care:

A
  • Nutrition
  • Exercise
  • Behavior modification
  • Support groups
  • Drug therapy
  • appetite suppressing drugs
  • nutrient absorption-blocking drugs
29
Q

Surgeries: Restrictive

A
  • Lap band
  • Vertical banded gastroplasty
  • Gastric sleeve

NSG 2200 (4 decks)

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