Disorders of the GI System: Upper and Lower Flashcards
Types of Stomatitis:
Herpetic
Fungal: candida
Nutritional deficiency (B vitamins, folate,iron)
Chemical: chemo, alcohol, tobacco
8th cause of death in men
Oral Cancer from tobacco use
Oral Cancer:
Squamous cell>
sores in mouth, leukoplakia(white patches)
Can be a protective mechanism(ANS)
Vomiting
Antiemetics works in the
brain and vagus nerve
First line antiemetic for radiation/chemo
Zofran
Dopamine antagonist for post-op and motion sickness
Reglan
Med sometimes given for chemo related n/v
glucocorticosteroids
Neurokinin 1 receptor antogonist
Emend
Tropane alkaloid and anticholinergic drug used to treat motion sickness and post-op n/v
Scopolamine
What fluid & electrolyte problems would occur with prolonged nausea & vomiting?
Dehydration
K+ & Na+ loss
Metabolic alkalosis
Aspiration
Type of IV fluid that can help pts with stomach virus
NS (2 liters)
Black, tarry stool indicative of GI bleeding
Melena
Color of bile emesis
Green
GI test:
Measures PH of stomach contents
Gastric analysis
Vitamin that helps form RBC’s and hemoglobin
Vit B12
Types of emesis
Coffee ground emesis
bile emesis
hematemesis
melena
Prepping for GI tests
Clear liquids, high fiber
NPO the night before
No meds
No smoking for 24hrs prior
Nursing Diagnosis for the following:
Dehydration
K+ & Na+ loss
Metabolic alkalosis
Aspiration
Fluid volume deficit
Type of illness related to GERD, smoking, or Barrett’s
Esophageal Cancer
Esophageal Disorder:
High mortality
Risk increases >age 70
Squamous cell, adenocarcinoma
Symptom= Dysphagia
Esophageal Cancer
Esophageal Disorder:
long term GERD that changes cells=RISK
Risks – tobacco, age, male, low fiber
Barrett’s Esophagus
Treatment for Barrett’s:
remove/replace esophagus, chemo, radiation
A syndrome of:
any condition that is caused by reflux of stomach contents into the lower esophagus (lower esophageal sphincter (LES)
Gastro-esophageal Reflux Disease (GERD)
Syndrome with many causes:
hiatal hernia, incompetent LES, decreased clearance of esophagus/stomach
Gastro-esophageal Reflux Disease (GERD)
Symptoms: Heartburn (Pyrosis)
respiratory: cough, sneeze
gastric symptoms
Gastro-esophageal Reflux Disease (GERD)
Burning sensation in the esophagus (medical term for heartburn)
Pyrosis
Treatments for GERD:
elevate HOB
no smoking,
antacids, H2 blockers, cholinergics, proton pump inhibitors, small meals/ no caffeine
Weight loss
Surgery for GERD:
Nissen fundoplication
Inflammation of gastric mucosa
Gastritis
Acute Gastritis is due to
A break in mucosa barrier
Superficial ulcerations in gastritis may occur which can lead to
hemorrhage.
Factors that may injure gastric mucosa:
Diet:
ETOH, spicy foods
Factors that may injure gastric mucosa:
meds:
NSAIDS, ASA
EtOH stands for
ethyl alcohol
PH level of stomach
1-2.5
Chemical that stimulates mucus in the stomach
prostaglandin
Major cause of Chronic gastritis
H. pylori
Intrinsic factor is a
natural substance normally found in the stomach
A lack of intrinsic factor leads to
pernicious anemia and vitamin B12 deficiency,
Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate.
pernicious anemia
A condition that occurs when your stomach lining becomes inflamed
Chronic gastritis
Treatment for chronic gastritis
Treat the cause, non-steroid meds, avoid alcohol, spicy foods
Chronic gastritis ABC
Autoimmune
Bacterial (helicobacter)
Chemical
Number 1 cause of GI bleeding
Bleeding ulcers
Stool occult test
Guaiac test
Occult
hidden
Number 1 cause of ulcers
H. pylori
Bacteria that attacks the stomach lining
H. pylori
Accounts for almost 80% of gastric and 95% of duodenal ulcers
H. pylori
GERD pack is
A combo of meds taken for 2 weeks to treat GERD
Frank blood
Bright red blood
The passage of fresh blood through the anus path, usually in or with stools
Hematochezia
H. pylori
Helicobacter pylori
H. pylori is diagnosed with
Biopsy; breath & stool tests
A sudden inflammation or swelling in the lining of the stomach.
Acute gastritis
What is treatment to remove H. pylori?
Antibiotics> 2-3 weeks
Bismuth salts
PPI
PPI
Proton pump inhibitors
PPI meds
omeprazole, protonix, pantoprazole
Erosion of the mucosa anywhere in the GI tract: esophagus, stomach, duodenum, jejunum
Peptic ulcer
PUD
Peptic Ulcer Disease
Most common type of peptic ulcer. Makes up 80% of ulcers
gastric & duodenal
LES
Lower esophageal sphincter
Ulcers of the antrum of stomach, commonly seen in ages 50-60
increased with LES problems, stress ulcers
Gastric ulcers
Type of ulcer where pain increases 1-2 hr after meals or food
Gastric ulcer
Type of ulcer:
age 35-45, PAIN 2-4h AFTER, pain relief with food, antacids,
Duodenal ulcer
Type of ulcer that may cause weight gain from trying to get relief
Duodenal ulcer
Diagnosing ulcers
Endoscopy preferred
Biopsy
Barium study (Upper GI)
Treatment that could be done for ulcers during endoscopy
Cauterization
Can pts eat after an endoscopy?
No food or drink until gag reflex returns
Medications for ulcers
2-3 antibiotics>
proton pump inhibitors
bismuth salts
H2 blockers or PPI
H2 blockers or PPI are used alone to treat
NSAID-induced and other ulcers not associated with h pylori
Treatments for ulcers
Stress Reduction & Rest
Smoking Cessation
Dietary Modifications
Meds
Surgery
Surgical Management of ulcers:
recommended for
intractable ulcers as a last resort
Surgical procedures to treat ulcers include:
vagotomy, with or without pyloroplasty
Billroth I & Billroth II procedures
Gastrectomy that includes removing the part of your stomach with cancer, nearby lymph nodes, and possibly parts of other organs near the tumor
Subtotal gastrectomy
a surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
Vagotomy
An operation to widen the pylorus, the opening between your stomach and your small intestine.
Pyloroplasty
an operation in which the pylorus is removed and the distal stomach is anastomosed directly to the duodenum
Billroth I
gastroduodenostomy
Billroth I
reconstruction surgery, in which a loop of jejunum is mobilized and anastomosed to the gastric remnant;
Billroth II
gastrojejunostomy
Billroth II
Second most common cancer in the world
Stomach cancer
Populations at highest risk for stomach cancer
men, Hispanic, African American, Asian American
Lifestyles and conditions with highest risk for stomach cancer
Family history, tobacco, pernicious anemia, H pylori, diet high in smoked/cured meats
Less than 30% of people with this condition live past 5 yr if it spread at diagnosis
Stomach cancer
Vitamin deficiency anemia; a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate
Pernicious anemia
Condition that progresses & causes perforation, bleeding & spreads to liver, bone & peritoneal tissue
Stomach Cancer
Symptoms of stomach cancer are usually none until late, which are
“heartburn”, anorexia, Weight loss
Treatment for stomach cancer
Subtotal or total gastrectomy
Diagnostic test for stomach cancer
Esophagogastroduodenoscopy (EGD)
Subtotal Gastrectomy:
Billroth I is also called a
gastroduodenostomy
Subtotal Gastrectomy:
Billroth II is also called
gastrojejunostomy
a surgical procedure that creates an anastomosis between the stomach and the jejunum
gastrojejunostomy
anastomosis between the stomach and the duodenum
gastroduodenostomy
A protein that helps your intestines absorb vitamin B12.
Intrinsic factor
Endoscopy to duodenum
EGD
Connection or opening between 2 things
anastomosis
If there is loss of intrinsic factor, patient may need
Vit B12 shots for life
Nursing care of post subtotal gastrectomy
Assess abdomen
Semi-Fowler position
Monitor/treat for I&O
NG tube to decompress stomach
NPO > clear > soft foods
Meds to decrease stomach acid:
H2Receptor Blockers
Proton Pump Inhibitors (PPI)
Meds to decrease pH & acid:
Antacids
Aluminum antacids cause what side effects?
Constipation
Magnesium antacids cause what side effects?
Diarrhea
H2 receptor blocker meds
Pepcid and Tagamet
Cells that secrete intrinsic factor
Parietal cells
Surgery option for morbidly obese patients with BMI >40
Bariatric
Can banding and bypass surgeries be combined?
Yes
Surgery where about 80-90% of the stomach is removed, leaving a tube-shaped stomach about the size and shape of a banana
Vertical sleeve gastrectomy
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
roux en y bypass
Is gastric band reversible?
Yes
Adjustable forms of gastric weight-loss surgery
gastric band and stapling
Complications of stomach surgery include
volume increased motility
dumping syndrome
hyperosmolarity to bowels
ANS (weakness, dizziness, cramps, and palpitations)
malnutrition
pernicious anemia
anastomosis leak
Hyperosmolar is
when fluid is drawn into an area (the lumen) which can cause hyperglycemia
bypass patients special info on diet
no more than 60cc to 90cc per meal to start…
Dumping syndrome treatment
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
Lying down after meals helps to reduce transit time of food but can also cause
Acid reflux
Number 1 complication of ulcers
hemorrhage
Interventions for hemorrhaging ulcers
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
Signs and symptoms of stomach perforation
severe abd pain, shoulder pain, no bowel sounds n/v
How long after initial perforation will peritonitis begin?
6-12hrs
Sign of peritonitis
Board-like abdomen
Pyloric Obstruction aka
gastric outlet obstruction
Occurs when area distal pyloric sphincter becomes scarred and stenosed from spasm. Edema or scar tissue that forms when ulcer alternately heals & breaks down
Pyloric Obstruction
Signs and symptoms of pyloric obstruction
Projectile vomiting, weight loss, dehydration
Stomach enters chest through esophageal hiatus opening
Hiatal Hernia
Condition that is sometimes an incidental finding
hiatal hernia
Symptoms of hiatal hernia
Heartburn
Regurgitation
Dysphagia
Diagnosing hiatal hernia
X-ray: seen on routine chest x-ray
Barium swallow
Fluoroscopy
Management of hiatal hernia
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
rare disorder that causes tumors of pancreas and duodenum and ulcers in stomach and duodenum
Zollinger-Ellison Syndrome
Tumors are cancerous in 50% of these cases
Zollinger-Ellison Syndrome
Condition where gastrin secretions cause stomach produce too much acid, which in turn causes peptic ulcers.
These ulcers less responsive to treatment.
Zollinger-Ellison Syndrome
S/S of Zollinger-Ellison Syndrome
peptic ulcers
Diagnosing Zollinger-Ellison Syndrome
Diagnosis made thru blood test measuring levels of gastrin and HCL.
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
True stress ulcers
Stress ulcer in neuro disease that causes overstimulation of vagus nerve
Cushing’s ulcer
Stress ulcer related to burns that occurs 72hrs after injury
Curling’s ulcer
Treatment for stress ulcer is
Prevention!! H2 blockers, volume, watch for bleeding
Treatments for diarrhea:
Treat underlying cause
hydration
Treatments for constipation
Treat underlying cause
stool softener
hydrate
clear the obstruction
Both Crohn’s and ulcerative colitis can cause
Diarrhea
Crohn’s can cause diarrhea and
constipation
Findings in obstruction
Obstruction may cause necrosis
S/S of obstruction
Crampy, wavelike colicky pain
Protrusion through a weak portion of the abdominal wall. Can occur anywhere, primarily in the abdominal cavity.
Hernia
A weakness in the walls occurs, which may be:
Congenital
Acquired
Hernia
Herniation occurs when there is an INCREASE in intra-abdominal pressure due to
Surgical weakness, coughing, straining, lifting heavy weight
Occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through.
An inguinal hernia
Surgery is done to treat hernias when
they become strangulated or bothersome
Most important nursing interventions for hernia
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
Condition when multiple UNINFLAMMED diverticula are present. Fecal matter can get trapped
Diverticulosis
An outpouching of a hollow (or a fluid-filled) structure in the body.
Diverticulum
an INFLAMMATION of the diverticula.
Diverticulitis
plural form of diverticulum
diverticula
Patho – bacteria multiply in the “pocket” causing infection & pain
Diverticulitis
Medications for Diverticulosis
Bulk forming agents:
Metamucil: fiber
Miralax: laxative
Stool Softeners: Colace
Softener with cathartic: Peri-colace
Burst diverticulitis =
High mortality rate
Treatments for diverticulitis
Surgery with anastamosis or colostomy may be done
Antibiotics, rest, IV, NPO
May be given TPN, JP drains
Inflammation of the appendix, that prevents mucus/stool from passing into the cecum
Appendicitis
If untreated, appendix can:
rupture &
Gangrene
Ischemia
Peritonitis
Appendicitis most frequently occurs in
males ages 10-30
S/S of appendicitis
Localized tenderness at McBurney’s Point
Rebound tenderness
Fever, N/V
pain relief in fetal position
immediate pain relief could be a rupture
Diagnosing appendicitis
CAT scan & ultrasound, WBC
A ‘+’ PSOAS sign
guarding of abdomen.
Appendicitis: Withhold narcotic analgesics until positive diagnosis is made because
It masks symptoms
Prevention of appendix perforation:
No enemas or laxatives.
No cathartics.
No heat pads (causes engorgement)
Appendicitis:
No perforation =
same day surgery or 23hr
Appendicitis medications:
Antipyretics / Analgesics / antibiotics
Appendicitis nursing care:
Monitor JP if used> ruptured
Monitor & maintain patency of NG Tube: with perforated
Semi-fowlers or right side lying to facilitate drainage.
Contamination of Abd Cavity
Peritonitis
S/S of peritonitis
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
Treatment for peritonitis
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
Intestinal blockage can lead to
DISTENTION
PRESSURE
F & E loss
SHOCK & DEATH
Occurs when part of the intestine loops around and folds over itself
Volvulus
Types of intestinal obstruction
Volvulus
Intussusception
Causes:
IBD
TUMORS
FECAL IMPACTIONS
PARALYTIC ILEUS
Adhesions
85% of intestinal obstructions OCCUR HERE
Small bowel
Adhesions most common cause of
Small bowel obstruction
Small bowel obstruction can cause
Dehydration & metabolic alkalosis develops (n/v)
Necrosis> eventual rupture of the bowel is possible
S/S of SBO
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!
Nursing interventions for SBO
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!
Purpose of second lumen on salem sump
to let air into stomach
a one-lumen nasogastric tube
The Levin tube
Most common NG tube
Salem sump
a double-lumen balloon-tipped rubber tube used for the purpose of decompression in treating intestinal obstruction
A Miller–Abbott NG tube
What is the Miller-Abbott tube used for?
Intestinal suction
Decompression
Bowel dilation
a long, single-lumen intestinal tube with a sealed, mercury-filled rubber bag tip; used to decompress or stent the small intestine.
Cantor tube
Surgical interventions for large bowel obstruction:
Cecostomy
Colostomy
Ileostomy
Why are barium studies contraindicated in large bowel obstruction?
because of perforation risk. CT and x-ray can diagnose
MEDICAL MANAGEMENT of hemorrhoids:
stool softeners
anti-inflammatory creams
high fiber diet
increase fluids and activity
SURGICAL MANAGEMENT of hemorrhoids:
laser surgery-good for external! (Quick, painless)
Photocoagulation
Injection of sclerosing solutions to dry and remove
Infrared light used to treat hemorrhoids
Photocoagulation
Second most common type of internal cancer in the US.
COLORECTAL CANCER
If patient has IBS or polyps, screening for this disease is done younger than 50
COLORECTAL CANCER
Liver metastasis is common with
Colorectal cancer
Exact cause of colorectal cancer is
Unknown
S/S of colorectal cancer
*Change in bowel habits – most common.
*Blood in stool
Unexplained:
Anemia
Anorexia
Wt Loss
Fatigue
95% of colorectal tumors are this type (arising from the epithelial lining of the intestine)
adenocarcinoma
Colorectal cancer may start out as benign polyp, then becoming
malignant
Colorectal cancer S/S:
right sided lesions
Dull abdominal pain & melena
Colorectal cancer S/S:
left sided lesions
Abdominal pain & cramping
Narrowing stools
Constipation
Distention
Bright red blood in stool
Colorectal cancer S/S:
rectal lesions
Tenesmus (ineffective, painful straining)
Rectal pain
Feeling of incomplete evacuation after BM
Alternating constipation & diarrhea
Bloody stools.
Crohn’s/ulcerative colitis commonly occurs in ages
15y-35y
Common sites for Crohn’s/ulcerative colitis:
Distal Ileum & colon
Crohn’s/ ulcerative colitis is 2x’s more common in
smokers
Bowel becomes fibrotic & lumen narrows with this disease that causes vomiting and starts as small ulcerations
Crohn’s/ ulcerative colitis
Difference between Crohn’s and ulcerative colitis
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.
Fistulas, fissures & abscesses form with
Crohn’s/ ulcerative colitis
RLQ pain & diarrhea unrelieved by defecation
Crohn’s/ ulcerative colitis
Narrowing of intestinal lumen causing crampy abdominal pain
Crohn’s/ ulcerative colitis
Patient limits eating to avoid pain with these condtions causing malnutrition
Crohn’s/ ulcerative colitis
indicating the constriction of the intestine
String sign-
ASCA: + antibody=
Crohn’s
pANCA:+ associated with
UC
Complications of Crohn’s
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
elevated ESR =
inflammation
Inflammatory disease of mucosal & submucosal layers of the colon & rectum only
Ulcerative Colitis
Ulcerative Colitis: Highest incidence in these populations
Caucasians & people of Jewish Heritage
Signs and Symptoms of Ulcerative Colitis
Diarrhea ( 10+ bloody/mucus stools/d, LLQ pain)
No steatorrhea
anorexia, vomiting, wt.loss, hypocalcemia
Ulcerative Colitis:
The only cure is
surgery: colostomy or ileostomy
Ulcerative Colitis:
10-15% develop
Ca of the Colon
Ulcerative Colitis:
Nursing management
Control diarrhea
Prevent or minimize complications> meds
Promote low residue diet
Knowledge about disease & meds
Weights
Stress management
