Disorders Of Stomach And Upper Small Intestine Flashcards by Brina Quintanilla Reyes

What is peptic ulcer disease?

Condition characterized by erosion of gi mucuous from the digestive action of HCI acid and Pepsin

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What are the 2 types of peptic ulcers?

Acute vs chronic

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What is acute peptic ulcer (3)

Superficial Erosion
Minimal inflammation

Short duration
- resolved quickly when cause is identified and removed

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What is chronic peptic ulcer disease? (2)

Muscular wall erosion with formation of fibrous tissues

More common than acute erosions

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Chronic can be in two locations, which are?

Gastric and duodenal

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Chronic gastric ulcer is ?(5)
What are risk factors (4)

Superficial
Pain 1-2 hours post meals with foods
Peak age 50-60 ( women )
Increased obstruction
Increased mortality

Risk factors are
- h.pyloric, medications, smoking, bile reflux

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Chronic duodenal ulcers is?(6)
What are risk factors (4)

80% of all ulcers
Deep
Pain 2-4 hours post meals
Pain decrease with food
Peak 35-50 men
Associated with stress and chronic disease

Risk factors
- h. Pylori, ETOH( alcohol), smoking, increase HCL acid

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H. Pylori is a major risk factor why?
% gastric
% duodenal
How is it transmitted?
Mainly found in who?
Life span?
What does it produce?

80%
90%
Oral or oral / fecal to oral
African Americans & Hispanic
Long
Urease

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What are the 3 overall risk factors for peptic ulcers?

H. pylori
Medications
Life styles

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Medications induced injury such as? (3)

NSAIDS
Corticosteroids/anticoagulants

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Life styles factors for peptic ulcers are? (5)

Alcohol
Smoking
Caffeine
Psychological distress
Stress related muscoal disease in upper gi bleed

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What are diagnostic studies for peptic ulcers?(5)
(3)(3)(3)(3)(1)

Endoscopy
- direct visualization
- obtain specimens for h.pylori ( urease )
- monitor toward healing

Noninvasive h. Pylori : serology, stool, breathe test

Barium contrast, high fasting serum gastric levels, secretin stimulation

Labs : CBC, liver enzymes, serum amylase

Stool- blood

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Treatment goals of peptic ulcers are?

Decreased gastric acidity and en goes muscoal defense mechanism

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What is conservative care for peptic ulcer? (6)

Adequate rest
No smoking/alcohol
Stress management
Dietary modifications
Pain mangement ( NO NSAIDS/ASPIRN!! ( unless with PPI, H2 recotor, misoprostol )
Endoscopy evaluation follow up 3-6 months

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Drug therapy for peptic ulcers (5)

PPI
Antibiotic therapy
( peptiod bismuth )Bismuth alone or combined with tetracycline & Metronizadole
Cytoprotective drug therapy

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Antibiotic therapy for the?
Do for how long ( days?)
If allergic use what?

H. Pylori 14 days of PCN ( if allergic, use metronidazole )

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Cytoprotective drug therapy
What is the drug?
Helps how?
Works best in?
Bonds with?

Sucralfate
Protects esophagus, stomach and duodenum

Low ph; 1-3 hours before and after antacid

Cimetidine, digoxin, warfarin, phenytoin and tetracycline

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What are the 3 complications of drug therapy?
Is it emergent? Yes or no

Hemorrhage
Perforation
Gastric outline obstruction
Emergent !!

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Out of the 3, what is most common?
What is the most lethal?

Hemorrhage
Perforation

Why is perforation so lethal from the drug therapy complication?
Causing?
Intensity will amount to?

GI contents will spill into the peripheral cavity
Causing
Suddenly severe abdominal pain; going to the back and shoulders with no relief of food or antacids

Bowl sounds become absent ; nausea and vomiting
Respiratory shallow
Pulse increase & weak

Intensity will amount to duration of spillage

Perforation; the belly will be rigidly like and that is?
Rigid, board like abdomen
We need surgery!!

Peritinistisis

If perforation isn’t untreated you will get what within 6-12 hours?

Bacterial peritonitis

Your immediate focus with perforation in peptic ulcer is to?

Stop the spillage and restore blood volume

What will we do for perforation? (5)

NGT for aspiration and gastric suppression
IV fluids and blood
Central line

Small - self sealing
Large - surgery & closure

Gastric outlet obstruction, what is going to happen for peptic ulcer patients?

Stomach fills and dilated causing discomfort and pain ; worse at end of day and may be visibility dilated Belching and vomiting ( protective ) may provide some relief ; constiplayion & anorexia

Gastric outlet obstruction manifestations ? (4)

Edema Inflammation Pylorospams Scar tissue obstruction in distal stomach & duodenum

Treatment of gastric outlet obstruction? (4)

Decompress with NGI PPI or H2 Pain management Fluid and electrolytes replacement Surgery & ballon dilation

Nursing management for peptic ulcers are? (2)

Ulcerogenic drugs Teach to report gastric distress symptoms to HCP

Acute care for peptic ulcers are? (7)

NPO NGT IV FLUIDS monitor for shock Gastric content analysis : check ph, blood or bile Monitor labs Manage pain & anxiety ; restful environment

Gerontologic considerations PUD (4)

increase morbidity & mortality Frequent use of NSAIDS ( arthritis) First symptom may be GI bleed or decrease HCT Treatment plan is similar with emphasis in teaching and preventing

Upper GI blessing Hemaremesis What is it?

Bloody vomits Coffee ground contact with HCI acid ; digested blood

Upper gi bleed Melena means?

Black Tarry stools

What is occult?

A guaiac test that detects blood in gastric secretions, vomitus and stool

What causes blood stools? (4)

Black licorice Bleeding ulcers Pepto bismol Mallory weiss tear

What else causes upper gi bleeding ? (4)

Stomach & Duondeal - PUD ( most common ? - stress related mucosal disease - physiologic stress ulcers

For upper GI bleed, you have an increase risk of? (5)

Being critically Ill Coagulopathy Liver disease Organ failure Renal replacement therapy

GI bleeding for esophageal origin? (3)

Chronic esophagitis Mallory weiss tear Esophageal varices

Diagnostic studies for UPPER GI bleeding? (4)

Endoscopy Angiopgraohy Labs ( CBC, BUN ) vomitus and stool - gross or occult blood

Emergency assessment for massive gi bleed is? (3)

Greater than 1500ml blood loss 25% intravascular volume (80-85% spontaneously ) Shock ( tachy, weak pulse, hypotension, cool extremities, prolonged capillary refill, apprehension ) Monitor urine hourly

Emergency assessment and management (5)

Hemodynamic monitoring Oxygen administration Monitor for perforation & Peritonitis Administer IV fluids Blood/blood product transfusion

What is the first like emergency management? In order to determine ?

Endoscopic therapy 24 hours to determine treatment and surgery

Goal for endoscopic therapy is to? (5)

Coagulate or thrombose bleed - clips or bands ( compres vessel ) - thermal ablation ( cauterized ) - injection ( ephinoehrine or alcohol ) - sclerotherapy

Surgical therapy requires more than how much Ml or blood ?

2000

Drug therapy for emergency? (3)

Antacids Ppi Iv Bolus then infusion

Nursing assessment for gi bleeding ? (4)

Manage physical needs Assess LOC & VS Determine histiry Labs

Health promotion of gI bleeding? (6)

Identify risk Avoid GI toxic drugs (NSAIDS) Avoid gastric irritants ( smoking, alcohol, OTC ) Test for occult blood Varies : avoid pressure ( severe coughing and sneezing ) Blood dyscrasias - teach about disease drugs and risk of gi bleeding

Acute care You also want to put them on clear liquids, and lavage of 50-100 ml ? True or false

True