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Med/Surg > Disorders of the GI System: Upper and Lower > Flashcards

Disorders of the GI System: Upper and Lower Flashcards

1
Q

Types of Stomatitis:

A

Herpetic
Fungal: candida
Nutritional deficiency (B vitamins, folate,iron)
Chemical: chemo, alcohol, tobacco

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2
Q

8th cause of death in men

A

Oral Cancer from tobacco use

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3
Q

Oral Cancer:

Squamous cell>

A

sores in mouth, leukoplakia(white patches)

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4
Q

Can be a protective mechanism(ANS)

A

Vomiting

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5
Q

Antiemetics works in the

A

brain and vagus nerve

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6
Q

First line antiemetic for radiation/chemo

A

Zofran

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7
Q

Dopamine antagonist for post-op and motion sickness

A

Reglan

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8
Q

Med sometimes given for chemo related n/v

A

glucocorticosteroids

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9
Q

Neurokinin 1 receptor antogonist

A

Emend

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10
Q

Tropane alkaloid and anticholinergic drug used to treat motion sickness and post-op n/v

A

Scopolamine

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11
Q

What fluid & electrolyte problems would occur with prolonged nausea & vomiting?

A

Dehydration
K+ & Na+ loss
Metabolic alkalosis
Aspiration

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12
Q

Type of IV fluid that can help pts with stomach virus

A

NS (2 liters)

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13
Q

Black, tarry stool indicative of GI bleeding

A

Melena

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14
Q

Color of bile emesis

A

Green

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15
Q

GI test:

Measures PH of stomach contents

A

Gastric analysis

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16
Q

Vitamin that helps form RBC’s and hemoglobin

A

Vit B12

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17
Q

Types of emesis

A

Coffee ground emesis
bile emesis
hematemesis
melena

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18
Q

Prepping for GI tests

A

Clear liquids, high fiber
NPO the night before
No meds
No smoking for 24hrs prior

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19
Q

Nursing Diagnosis for the following:

Dehydration
K+ & Na+ loss
Metabolic alkalosis
Aspiration

A

Fluid volume deficit

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20
Q

Type of illness related to GERD, smoking, or Barrett’s

A

Esophageal Cancer

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21
Q

Esophageal Disorder:

High mortality
Risk increases >age 70
Squamous cell, adenocarcinoma
Symptom= Dysphagia

A

Esophageal Cancer

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22
Q

Esophageal Disorder:

long term GERD that changes cells=RISK
Risks – tobacco, age, male, low fiber

A

Barrett’s Esophagus

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23
Q

Treatment for Barrett’s:

A

remove/replace esophagus, chemo, radiation

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24
Q

A syndrome of:
any condition that is caused by reflux of stomach contents into the lower esophagus (lower esophageal sphincter (LES)

A

Gastro-esophageal Reflux Disease (GERD)

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25
Q

Syndrome with many causes:
hiatal hernia, incompetent LES, decreased clearance of esophagus/stomach

A

Gastro-esophageal Reflux Disease (GERD)

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26
Q

Symptoms: Heartburn (Pyrosis)
respiratory: cough, sneeze
gastric symptoms

A

Gastro-esophageal Reflux Disease (GERD)

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27
Q

Burning sensation in the esophagus (medical term for heartburn)

A

Pyrosis

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28
Q

Treatments for GERD:

A

elevate HOB
no smoking,
antacids, H2 blockers, cholinergics, proton pump inhibitors, small meals/ no caffeine
Weight loss

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29
Q

Surgery for GERD:

A

Nissen fundoplication

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30
Q

Inflammation of gastric mucosa

A

Gastritis

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31
Q

Acute Gastritis is due to

A

A break in mucosa barrier

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32
Q

Superficial ulcerations in gastritis may occur which can lead to

A

hemorrhage.

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33
Q

Factors that may injure gastric mucosa:

Diet:

A

ETOH, spicy foods

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34
Q

Factors that may injure gastric mucosa:

meds:

A

NSAIDS, ASA

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35
Q

EtOH stands for

A

ethyl alcohol

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36
Q

PH level of stomach

A

1-2.5

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37
Q

Chemical that stimulates mucus in the stomach

A

prostaglandin

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38
Q

Major cause of Chronic gastritis

A

H. pylori

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39
Q

Intrinsic factor is a

A

natural substance normally found in the stomach

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40
Q

A lack of intrinsic factor leads to

A

pernicious anemia and vitamin B12 deficiency,

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41
Q

Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate.

A

pernicious anemia

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42
Q

A condition that occurs when your stomach lining becomes inflamed

A

Chronic gastritis

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43
Q

Treatment for chronic gastritis

A

Treat the cause, non-steroid meds, avoid alcohol, spicy foods

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44
Q

Chronic gastritis ABC

A

Autoimmune
Bacterial (helicobacter)
Chemical

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45
Q

Number 1 cause of GI bleeding

A

Bleeding ulcers

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46
Q

Stool occult test

A

Guaiac test

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47
Q

Occult

A

hidden

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48
Q

Number 1 cause of ulcers

A

H. pylori

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49
Q

Bacteria that attacks the stomach lining

A

H. pylori

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50
Q

Accounts for almost 80% of gastric and 95% of duodenal ulcers

A

H. pylori

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51
Q

GERD pack is

A

A combo of meds taken for 2 weeks to treat GERD

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52
Q

Frank blood

A

Bright red blood

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53
Q

The passage of fresh blood through the anus path, usually in or with stools

A

Hematochezia

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54
Q

H. pylori

A

Helicobacter pylori

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55
Q

H. pylori is diagnosed with

A

Biopsy; breath & stool tests

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56
Q

A sudden inflammation or swelling in the lining of the stomach.

A

Acute gastritis

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57
Q

What is treatment to remove H. pylori?

A

Antibiotics> 2-3 weeks
Bismuth salts
PPI

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58
Q

PPI

A

Proton pump inhibitors

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59
Q

PPI meds

A

omeprazole, protonix, pantoprazole

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60
Q

Erosion of the mucosa anywhere in the GI tract: esophagus, stomach, duodenum, jejunum

A

Peptic ulcer

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61
Q

PUD

A

Peptic Ulcer Disease

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62
Q

Most common type of peptic ulcer. Makes up 80% of ulcers

A

gastric & duodenal

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63
Q

LES

A

Lower esophageal sphincter

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64
Q

Ulcers of the antrum of stomach, commonly seen in ages 50-60
increased with LES problems, stress ulcers

A

Gastric ulcers

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65
Q

Type of ulcer where pain increases 1-2 hr after meals or food

A

Gastric ulcer

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66
Q

Type of ulcer:
age 35-45, PAIN 2-4h AFTER, pain relief with food, antacids,

A

Duodenal ulcer

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67
Q

Type of ulcer that may cause weight gain from trying to get relief

A

Duodenal ulcer

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68
Q

Diagnosing ulcers

A

Endoscopy preferred
Biopsy
Barium study (Upper GI)

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69
Q

Treatment that could be done for ulcers during endoscopy

A

Cauterization

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70
Q

Can pts eat after an endoscopy?

A

No food or drink until gag reflex returns

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71
Q

Medications for ulcers

A

2-3 antibiotics>
proton pump inhibitors
bismuth salts
H2 blockers or PPI

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72
Q

H2 blockers or PPI are used alone to treat

A

NSAID-induced and other ulcers not associated with h pylori

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73
Q

Treatments for ulcers

A

Stress Reduction & Rest
Smoking Cessation
Dietary Modifications
Meds
Surgery

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74
Q

Surgical Management of ulcers:

recommended for

A

intractable ulcers as a last resort

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75
Q

Surgical procedures to treat ulcers include:

A

vagotomy, with or without pyloroplasty
Billroth I & Billroth II procedures

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76
Q

Gastrectomy that includes removing the part of your stomach with cancer, nearby lymph nodes, and possibly parts of other organs near the tumor

A

Subtotal gastrectomy

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77
Q

a surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion

A

Vagotomy

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78
Q

An operation to widen the pylorus, the opening between your stomach and your small intestine.

A

Pyloroplasty

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79
Q

an operation in which the pylorus is removed and the distal stomach is anastomosed directly to the duodenum

A

Billroth I

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80
Q

gastroduodenostomy

A

Billroth I

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81
Q

reconstruction surgery, in which a loop of jejunum is mobilized and anastomosed to the gastric remnant;

A

Billroth II

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82
Q

gastrojejunostomy

A

Billroth II

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83
Q

Second most common cancer in the world

A

Stomach cancer

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84
Q

Populations at highest risk for stomach cancer

A

men, Hispanic, African American, Asian American

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85
Q

Lifestyles and conditions with highest risk for stomach cancer

A

Family history, tobacco, pernicious anemia, H pylori, diet high in smoked/cured meats

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86
Q

Less than 30% of people with this condition live past 5 yr if it spread at diagnosis

A

Stomach cancer

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87
Q

Vitamin deficiency anemia; a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate

A

Pernicious anemia

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88
Q

Condition that progresses & causes perforation, bleeding & spreads to liver, bone & peritoneal tissue

A

Stomach Cancer

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89
Q

Symptoms of stomach cancer are usually none until late, which are

A

“heartburn”, anorexia, Weight loss

90
Q

Treatment for stomach cancer

A

Subtotal or total gastrectomy

91
Q

Diagnostic test for stomach cancer

A

Esophagogastroduodenoscopy (EGD)

92
Q

Subtotal Gastrectomy:

Billroth I is also called a

A

gastroduodenostomy

93
Q

Subtotal Gastrectomy:

Billroth II is also called

A

gastrojejunostomy

94
Q

a surgical procedure that creates an anastomosis between the stomach and the jejunum

A

gastrojejunostomy

95
Q

anastomosis between the stomach and the duodenum

A

gastroduodenostomy

96
Q

A protein that helps your intestines absorb vitamin B12.

A

Intrinsic factor

97
Q

Endoscopy to duodenum

98
Q

Connection or opening between 2 things

A

anastomosis

99
Q

If there is loss of intrinsic factor, patient may need

A

Vit B12 shots for life

100
Q

Nursing care of post subtotal gastrectomy

A

Assess abdomen
Semi-Fowler position
Monitor/treat for I&O
NG tube to decompress stomach
NPO > clear > soft foods

101
Q

Meds to decrease stomach acid:

A

H2Receptor Blockers
Proton Pump Inhibitors (PPI)

102
Q

Meds to decrease pH & acid:

103
Q

Aluminum antacids cause what side effects?

A

Constipation

104
Q

Magnesium antacids cause what side effects?

105
Q

H2 receptor blocker meds

A

Pepcid and Tagamet

106
Q

Cells that secrete intrinsic factor

A

Parietal cells

107
Q

Surgery option for morbidly obese patients with BMI >40

108
Q

Can banding and bypass surgeries be combined?

109
Q

Surgery where about 80-90% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana

A

Vertical sleeve gastrectomy

110
Q

A type of weight-loss surgery that involves creating a small pouch from the stomach and connecting the newly created pouch directly to the small intestine

A

roux en y bypass

111
Q

Is gastric band reversible?

112
Q

Adjustable forms of gastric weight-loss surgery

A

gastric band and stapling

113
Q

Complications of stomach surgery include

A

volume increased motility
dumping syndrome
hyperosmolarity to bowels
ANS (weakness, dizziness, cramps, and palpitations)
malnutrition
pernicious anemia
anastomosis leak

114
Q

Hyperosmolar is

A

when fluid is drawn into an area (the lumen) which can cause hyperglycemia

115
Q

bypass patients special info on diet

A

no more than 60cc to 90cc per meal to start…

116
Q

Dumping syndrome treatment

A

Reduce meal size:
NO FLUIDS WITH MEALS- between only
LOW CARB- LOW FAT
PROTEIN: good quality, low fat
Rest lying down after meals
NO CONCENTRATED SWEETS

117
Q

Lying down after meals helps to reduce transit time of food but can also cause

A

Acid reflux

118
Q

Number 1 complication of ulcers

A

hemorrhage

119
Q

Interventions for hemorrhaging ulcers

A

Oxygen
IV line for infusion of saline, LR, or FFP, PRBC
CBC
Inserting NGT
O2 therapy, vital signs
Saline lavage
Treating hemorrhagic shock
Inserting Foley catheter and strict I&O’s

120
Q

Signs and symptoms of stomach perforation

A

severe abd pain, shoulder pain, no bowel sounds n/v

121
Q

How long after initial perforation will peritonitis begin?

122
Q

Sign of peritonitis

A

Board-like abdomen

123
Q

Pyloric Obstruction aka

A

gastric outlet obstruction

124
Q

Occurs when area distal pyloric sphincter becomes scarred and stenosed from spasm. Edema or scar tissue that forms when ulcer alternately heals & breaks down

A

Pyloric Obstruction

125
Q

Signs and symptoms of pyloric obstruction

A

Projectile vomiting, weight loss, dehydration

126
Q

Stomach enters chest through esophageal hiatus opening

A

Hiatal Hernia

127
Q

Condition that is sometimes an incidental finding

A

hiatal hernia

128
Q

Symptoms of hiatal hernia

A

Heartburn
Regurgitation
Dysphagia

129
Q

Diagnosing hiatal hernia

A

X-ray: seen on routine chest x-ray
Barium swallow
Fluoroscopy

130
Q

Management of hiatal hernia

A

Small frequent high fiber feedings
Do not eat right before bed
Elevate head of bed: blocks under bed
Weight loss
Do not bend at the waist
Nissen fundoplication

131
Q

rare disorder that causes tumors of pancreas and duodenum and ulcers in stomach and duodenum

A

Zollinger-Ellison Syndrome

132
Q

Tumors are cancerous in 50% of these cases

A

Zollinger-Ellison Syndrome

133
Q

Condition where gastrin secretions cause stomach produce too much acid, which in turn causes peptic ulcers.
These ulcers less responsive to treatment.

A

Zollinger-Ellison Syndrome

134
Q

S/S of Zollinger-Ellison Syndrome

A

peptic ulcers

135
Q

Diagnosing Zollinger-Ellison Syndrome

A

Diagnosis made thru blood test measuring levels of gastrin and HCL.

136
Q

A form of erosive gastritis with ischemia of gastric mucosa & bleeding that occurs in acute stress due to shifting of blood away from GI to other parts of body

A

True stress ulcers

137
Q

Stress ulcer in neuro disease that causes overstimulation of vagus nerve

A

Cushing’s ulcer

138
Q

Stress ulcer related to burns that occurs 72hrs after injury

A

Curling’s ulcer

139
Q

Treatment for stress ulcer is

A

Prevention!! H2 blockers, volume, watch for bleeding

140
Q

Treatments for diarrhea:

A

Treat underlying cause
hydration

141
Q

Treatments for constipation

A

Treat underlying cause
stool softener
hydrate
clear the obstruction

142
Q

Both Crohn’s and ulcerative colitis can cause

143
Q

Crohn’s can cause diarrhea and

A

constipation

144
Q

Findings in obstruction

A

Obstruction may cause necrosis

145
Q

S/S of obstruction

A

Crampy, wavelike colicky pain

146
Q

Protrusion through a weak portion of the abdominal wall. Can occur anywhere, primarily in the abdominal cavity.

147
Q

A weakness in the walls occurs, which may be:
Congenital
Acquired

148
Q

Herniation occurs when there is an INCREASE in intra-abdominal pressure due to

A

Surgical weakness, coughing, straining, lifting heavy weight

149
Q

Occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through.

A

An inguinal hernia

150
Q

Surgery is done to treat hernias when

A

they become strangulated or bothersome

151
Q

Most important nursing interventions for hernia

A

Discourage coughing; continue turning & deep breathing

Assist to splint incision site when coughing or sneezing.

Check bladder distention (especially w/ inguinal) (could cause urethral pressure)
Avoid strenuous physical activities (heavy lifting – more than 5lbs, pulling, pushing) for ~ 6 weeks.
Review correct body mechanics.
Report any difficulty with urination

152
Q

Condition when multiple UNINFLAMMED diverticula are present. Fecal matter can get trapped

A

Diverticulosis

153
Q

An outpouching of a hollow (or a fluid-filled) structure in the body.

A

Diverticulum

154
Q

an INFLAMMATION of the diverticula.

A

Diverticulitis

155
Q

plural form of diverticulum

A

diverticula

156
Q

Patho – bacteria multiply in the “pocket” causing infection & pain

A

Diverticulitis

157
Q

Medications for Diverticulosis

A

Bulk forming agents:
Metamucil: fiber

Miralax: laxative

Stool Softeners: Colace
Softener with cathartic: Peri-colace

158
Q

Burst diverticulitis =

A

High mortality rate

159
Q

Treatments for diverticulitis

A

Surgery with anastamosis or colostomy may be done
Antibiotics, rest, IV, NPO
May be given TPN, JP drains

160
Q

Inflammation of the appendix, that prevents mucus/stool from passing into the cecum

A

Appendicitis

161
Q

If untreated, appendix can:

A

rupture &
Gangrene
Ischemia
Peritonitis

162
Q

Appendicitis most frequently occurs in

A

males ages 10-30

163
Q

S/S of appendicitis

A

Localized tenderness at McBurney’s Point
Rebound tenderness
Fever, N/V
pain relief in fetal position
immediate pain relief could be a rupture

164
Q

Diagnosing appendicitis

A

CAT scan & ultrasound, WBC

165
Q

A ‘+’ PSOAS sign

A

guarding of abdomen.

166
Q

Appendicitis: Withhold narcotic analgesics until positive diagnosis is made because

A

It masks symptoms

167
Q

Prevention of appendix perforation:

A

No enemas or laxatives.
No cathartics.
No heat pads (causes engorgement)

168
Q

Appendicitis:

No perforation =

A

same day surgery or 23hr

169
Q

Appendicitis medications:

A

Antipyretics / Analgesics / antibiotics

170
Q

Appendicitis nursing care:

A

Monitor JP if used> ruptured
Monitor & maintain patency of NG Tube: with perforated
Semi-fowlers or right side lying to facilitate drainage.

171
Q

Contamination of Abd Cavity

A

Peritonitis

172
Q

S/S of peritonitis

A

Severe abdominal pain over involved area
Abdominal rigidity (“board like”)
Rebound tenderness
Anorexia , N/V
Elevated TPR & BP (T=103F) ˄WBC
Upward displacement of diaphragm
Fluid & Electrolyte shift into abdominal cavity, resulting in dehydration.
Decreased BS

173
Q

Treatment for peritonitis

A

Maintain F/E balance
Decrease GI distention: Maintain NPO/NG tube
Antibiotics: Imipenem, Zosyn, Flagyl
02 therapy (may be anemic & distended abd affects breathing)
Monitor VS for??
I&O
Maintain semi-fowlers position
Monitor for bowel sounds & flatus

174
Q

Intestinal blockage can lead to

A

DISTENTION
PRESSURE
F & E loss
SHOCK & DEATH

175
Q

Occurs when part of the intestine loops around and folds over itself

176
Q

Types of intestinal obstruction

A

Volvulus
Intussusception
Causes:
IBD
TUMORS
FECAL IMPACTIONS
PARALYTIC ILEUS
Adhesions

177
Q

85% of intestinal obstructions OCCUR HERE

A

Small bowel

178
Q

Adhesions most common cause of

A

Small bowel obstruction

179
Q

Small bowel obstruction can cause

A

Dehydration & metabolic alkalosis develops (n/v)
Necrosis> eventual rupture of the bowel is possible

180
Q

S/S of SBO

A

Crampy pain
No flatus or fecal matter
Vomiting
Dry mucous membranes> dehydration
Rigid, board-like abdomen
Absent bowel sounds distal to obstruction> proximal to obstruction are high pitched!

181
Q

Nursing interventions for SBO

A

Decompress with NGT – monitor drainage
Maintain IVF: LR or NS
Assess:
Vital Signs for hypotension/fluid deficit/I&O
Bowel sounds ? Peritonitis?
Pain – Semi-fowlers position/type/quality
Stool & flatus
May be surgical candidate!

182
Q

Purpose of second lumen on salem sump

A

to let air into stomach

183
Q

a one-lumen nasogastric tube

A

The Levin tube

184
Q

Most common NG tube

A

Salem sump

185
Q

a double-lumen balloon-tipped rubber tube used for the purpose of decompression in treating intestinal obstruction

A

A Miller–Abbott NG tube

186
Q

What is the Miller-Abbott tube used for?

A

Intestinal suction
Decompression
Bowel dilation

187
Q

a long, single-lumen intestinal tube with a sealed, mercury-filled rubber bag tip; used to decompress or stent the small intestine.

A

Cantor tube

188
Q

Surgical interventions for large bowel obstruction:

A

Cecostomy
Colostomy
Ileostomy

189
Q

Why are barium studies contraindicated in large bowel obstruction?

A

because of perforation risk. CT and x-ray can diagnose

190
Q

MEDICAL MANAGEMENT of hemorrhoids:

A

stool softeners
anti-inflammatory creams
high fiber diet
increase fluids and activity

191
Q

SURGICAL MANAGEMENT of hemorrhoids:

A

laser surgery-good for external! (Quick, painless)
Photocoagulation
Injection of sclerosing solutions to dry and remove

192
Q

Infrared light used to treat hemorrhoids

A

Photocoagulation

193
Q

Second most common type of internal cancer in the US.

A

COLORECTAL CANCER

194
Q

If patient has IBS or polyps, screening for this disease is done younger than 50

A

COLORECTAL CANCER

195
Q

Liver metastasis is common with

A

Colorectal cancer

196
Q

Exact cause of colorectal cancer is

197
Q

S/S of colorectal cancer

A

*Change in bowel habits – most common.
*Blood in stool
Unexplained:
Anemia
Anorexia
Wt Loss
Fatigue

198
Q

95% of colorectal tumors are this type (arising from the epithelial lining of the intestine)

A

adenocarcinoma

199
Q

Colorectal cancer may start out as benign polyp, then becoming

200
Q

Colorectal cancer S/S:

right sided lesions

A

Dull abdominal pain & melena

201
Q

Colorectal cancer S/S:

left sided lesions

A

Abdominal pain & cramping
Narrowing stools
Constipation
Distention
Bright red blood in stool

202
Q

Colorectal cancer S/S:

rectal lesions

A

Tenesmus (ineffective, painful straining)
Rectal pain
Feeling of incomplete evacuation after BM
Alternating constipation & diarrhea
Bloody stools.

203
Q

Crohn’s/ulcerative colitis commonly occurs in ages

204
Q

Common sites for Crohn’s/ulcerative colitis:

A

Distal Ileum & colon

205
Q

Crohn’s/ ulcerative colitis is 2x’s more common in

206
Q

Bowel becomes fibrotic & lumen narrows with this disease that causes vomiting and starts as small ulcerations

A

Crohn’s/ ulcerative colitis

207
Q

Difference between Crohn’s and ulcerative colitis

A

Ulcerative colitis causes inflammation of the colonic mucosa, the innermost part of a person’s intestinal tract. By contrast, Crohn’s disease can affect any portion of the intestinal tract, including, but not limited to, the colonic mucosa.

208
Q

Fistulas, fissures & abscesses form with

A

Crohn’s/ ulcerative colitis

209
Q

RLQ pain & diarrhea unrelieved by defecation

A

Crohn’s/ ulcerative colitis

210
Q

Narrowing of intestinal lumen causing crampy abdominal pain

A

Crohn’s/ ulcerative colitis

211
Q

Patient limits eating to avoid pain with these condtions causing malnutrition

A

Crohn’s/ ulcerative colitis

212
Q

indicating the constriction of the intestine

A

String sign-

213
Q

ASCA: + antibody=

214
Q

pANCA:+ associated with

215
Q

Complications of Crohn’s

A

Intestinal stricture or obstruction
Perianal disease
Fluid & electrolyte imbalance
Fistulas- enterocutaneous most common
Abscess formation
High risk for CA of the colon
Fissures around anus

216
Q

elevated ESR =

A

inflammation

217
Q

Inflammatory disease of mucosal & submucosal layers of the colon & rectum only

A

Ulcerative Colitis

218
Q

Ulcerative Colitis: Highest incidence in these populations

A

Caucasians & people of Jewish Heritage

219
Q

Signs and Symptoms of Ulcerative Colitis

A

Diarrhea ( 10+ bloody/mucus stools/d, LLQ pain)
No steatorrhea
anorexia, vomiting, wt.loss, hypocalcemia

220
Q

Ulcerative Colitis:

The only cure is

A

surgery: colostomy or ileostomy

221
Q

Ulcerative Colitis:

10-15% develop

A

Ca of the Colon

222
Q

Ulcerative Colitis:

Nursing management

A

Control diarrhea
Prevent or minimize complications> meds
Promote low residue diet
Knowledge about disease & meds
Weights
Stress management

Med/Surg (17 decks)

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