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
2
Q
8th cause of death in men
A
Oral Cancer from tobacco use
3
Q
Oral Cancer:
Squamous cell>
A
sores in mouth, leukoplakia(white patches)
4
Q
Can be a protective mechanism(ANS)
A
Vomiting
5
Q
Antiemetics works in the
A
brain and vagus nerve
6
Q
First line antiemetic for radiation/chemo
A
Zofran
7
Q
Dopamine antagonist for post-op and motion sickness
A
Reglan
8
Q
Med sometimes given for chemo related n/v
A
glucocorticosteroids
9
Q
Neurokinin 1 receptor antogonist
A
Emend
10
Q
Tropane alkaloid and anticholinergic drug used to treat motion sickness and post-op n/v
A
Scopolamine
11
Q
What fluid & electrolyte problems would occur with prolonged nausea & vomiting?
A
Dehydration
K+ & Na+ loss
Metabolic alkalosis
Aspiration
12
Q
Type of IV fluid that can help pts with stomach virus
A
NS (2 liters)
13
Q
Black, tarry stool indicative of GI bleeding
A
Melena
14
Q
Color of bile emesis
A
Green
15
Q
GI test:
Measures PH of stomach contents
A
Gastric analysis
16
Q
Vitamin that helps form RBC’s and hemoglobin
A
Vit B12
17
Q
Types of emesis
A
Coffee ground emesis
bile emesis
hematemesis
melena
18
Q
Prepping for GI tests
A
Clear liquids, high fiber
NPO the night before
No meds
No smoking for 24hrs prior
19
Q
Nursing Diagnosis for the following:
Dehydration
K+ & Na+ loss
Metabolic alkalosis
Aspiration
A
Fluid volume deficit
20
Q
Type of illness related to GERD, smoking, or Barrett’s
A
Esophageal Cancer
21
Q
Esophageal Disorder:
High mortality
Risk increases >age 70
Squamous cell, adenocarcinoma
Symptom= Dysphagia
A
Esophageal Cancer
22
Q
Esophageal Disorder:
long term GERD that changes cells=RISK
Risks – tobacco, age, male, low fiber
A
Barrett’s Esophagus
23
Q
Treatment for Barrett’s:
A
remove/replace esophagus, chemo, radiation
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)
25
Syndrome with many causes:
hiatal hernia, incompetent LES, decreased clearance of esophagus/stomach
Gastro-esophageal Reflux Disease (GERD)
26
Symptoms: Heartburn (Pyrosis)
respiratory: cough, sneeze
gastric symptoms
Gastro-esophageal Reflux Disease (GERD)
27
Burning sensation in the esophagus (medical term for heartburn)
Pyrosis
28
Treatments for GERD:
elevate HOB
no smoking,
antacids, H2 blockers, cholinergics, proton pump inhibitors, small meals/ no caffeine
Weight loss
29
Surgery for GERD:
Nissen fundoplication
30
Inflammation of gastric mucosa
Gastritis
31
Acute Gastritis is due to
A break in mucosa barrier
32
Superficial ulcerations in gastritis may occur which can lead to
hemorrhage.
33
Factors that may injure gastric mucosa:
Diet:
ETOH, spicy foods
34
Factors that may injure gastric mucosa:
meds:
NSAIDS, ASA
35
EtOH stands for
ethyl alcohol
36
PH level of stomach
1-2.5
37
Chemical that stimulates mucus in the stomach
prostaglandin
38
Major cause of Chronic gastritis
H. pylori
39
Intrinsic factor is a
natural substance normally found in the stomach
40
A lack of intrinsic factor leads to
pernicious anemia and vitamin B12 deficiency,
41
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
42
A condition that occurs when your stomach lining becomes inflamed
Chronic gastritis
43
Treatment for chronic gastritis
Treat the cause, non-steroid meds, avoid alcohol, spicy foods
44
Chronic gastritis ABC
Autoimmune
Bacterial (helicobacter)
Chemical
45
Number 1 cause of GI bleeding
Bleeding ulcers
46
Stool occult test
Guaiac test
47
Occult
hidden
48
Number 1 cause of ulcers
H. pylori
49
Bacteria that attacks the stomach lining
H. pylori
50
Accounts for almost 80% of gastric and 95% of duodenal ulcers
H. pylori
51
GERD pack is
A combo of meds taken for 2 weeks to treat GERD
52
Frank blood
Bright red blood
53
The passage of fresh blood through the anus path, usually in or with stools
Hematochezia
54
H. pylori
Helicobacter pylori
55
H. pylori is diagnosed with
Biopsy; breath & stool tests
56
A sudden inflammation or swelling in the lining of the stomach.
Acute gastritis
57
What is treatment to remove H. pylori?
Antibiotics> 2-3 weeks
Bismuth salts
PPI
58
PPI
Proton pump inhibitors
59
PPI meds
omeprazole, protonix, pantoprazole
60
Erosion of the mucosa anywhere in the GI tract: esophagus, stomach, duodenum, jejunum
Peptic ulcer
61
PUD
Peptic Ulcer Disease
62
Most common type of peptic ulcer. Makes up 80% of ulcers
gastric & duodenal
63
LES
Lower esophageal sphincter
64
Ulcers of the antrum of stomach, commonly seen in ages 50-60
increased with LES problems, stress ulcers
Gastric ulcers
65
Type of ulcer where pain increases 1-2 hr after meals or food
Gastric ulcer
66
Type of ulcer:
age 35-45, PAIN 2-4h AFTER, pain relief with food, antacids,
Duodenal ulcer
67
Type of ulcer that may cause weight gain from trying to get relief
Duodenal ulcer
68
Diagnosing ulcers
Endoscopy preferred
Biopsy
Barium study (Upper GI)
69
Treatment that could be done for ulcers during endoscopy
Cauterization
70
Can pts eat after an endoscopy?
No food or drink until gag reflex returns
71
Medications for ulcers
2-3 antibiotics>
proton pump inhibitors
bismuth salts
H2 blockers or PPI
72
H2 blockers or PPI are used alone to treat
NSAID-induced and other ulcers not associated with h pylori
73
Treatments for ulcers
Stress Reduction & Rest
Smoking Cessation
Dietary Modifications
Meds
Surgery
74
Surgical Management of ulcers:
recommended for
intractable ulcers as a last resort
75
Surgical procedures to treat ulcers include:
vagotomy, with or without pyloroplasty
Billroth I & Billroth II procedures
76
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
77
a surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
Vagotomy
78
An operation to widen the pylorus, the opening between your stomach and your small intestine.
Pyloroplasty
79
an operation in which the pylorus is removed and the distal stomach is anastomosed directly to the duodenum
Billroth I
80
gastroduodenostomy
Billroth I
81
reconstruction surgery, in which a loop of jejunum is mobilized and anastomosed to the gastric remnant;
Billroth II
82
gastrojejunostomy
Billroth II
83
Second most common cancer in the world
Stomach cancer
84
Populations at highest risk for stomach cancer
men, Hispanic, African American, Asian American
85
Lifestyles and conditions with highest risk for stomach cancer
Family history, tobacco, pernicious anemia, H pylori, diet high in smoked/cured meats
86
Less than 30% of people with this condition live past 5 yr if it spread at diagnosis
Stomach cancer
87
Vitamin deficiency anemia; a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate
Pernicious anemia
88
Condition that progresses & causes perforation, bleeding & spreads to liver, bone & peritoneal tissue
Stomach Cancer
89
Symptoms of stomach cancer are usually none until late, which are
“heartburn”, anorexia, Weight loss
90
Treatment for stomach cancer
Subtotal or total gastrectomy
91
Diagnostic test for stomach cancer
Esophagogastroduodenoscopy (EGD)
92
Subtotal Gastrectomy:
Billroth I is also called a
gastroduodenostomy
93
Subtotal Gastrectomy:
Billroth II is also called
gastrojejunostomy
94
a surgical procedure that creates an anastomosis between the stomach and the jejunum
gastrojejunostomy
95
anastomosis between the stomach and the duodenum
gastroduodenostomy
96
A protein that helps your intestines absorb vitamin B12.
Intrinsic factor
97
Endoscopy to duodenum
EGD
98
Connection or opening between 2 things
anastomosis
99
If there is loss of intrinsic factor, patient may need
Vit B12 shots for life
100
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
101
Meds to decrease stomach acid:
H2Receptor Blockers
Proton Pump Inhibitors (PPI)
102
Meds to decrease pH & acid:
Antacids
103
Aluminum antacids cause what side effects?
Constipation
104
Magnesium antacids cause what side effects?
Diarrhea
105
H2 receptor blocker meds
Pepcid and Tagamet
106
Cells that secrete intrinsic factor
Parietal cells
107
Surgery option for morbidly obese patients with BMI >40
Bariatric
108
Can banding and bypass surgeries be combined?
Yes
109
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
110
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
111
Is gastric band reversible?
Yes
112
Adjustable forms of gastric weight-loss surgery
gastric band and stapling
113
Complications of stomach surgery include
volume increased motility
dumping syndrome
hyperosmolarity to bowels
ANS (weakness, dizziness, cramps, and palpitations)
malnutrition
pernicious anemia
anastomosis leak
114
Hyperosmolar is
when fluid is drawn into an area (the lumen) which can cause hyperglycemia
115
bypass patients special info on diet
no more than 60cc to 90cc per meal to start…
116
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
117
Lying down after meals helps to reduce transit time of food but can also cause
Acid reflux
118
Number 1 complication of ulcers
hemorrhage
119
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
120
Signs and symptoms of stomach perforation
severe abd pain, shoulder pain, no bowel sounds n/v
121
How long after initial perforation will peritonitis begin?
6-12hrs
122
Sign of peritonitis
Board-like abdomen
123
Pyloric Obstruction aka
gastric outlet obstruction
124
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
125
Signs and symptoms of pyloric obstruction
Projectile vomiting, weight loss, dehydration
126
Stomach enters chest through esophageal hiatus opening
Hiatal Hernia
127
Condition that is sometimes an incidental finding
hiatal hernia
128
Symptoms of hiatal hernia
Heartburn
Regurgitation
Dysphagia
129
Diagnosing hiatal hernia
X-ray: seen on routine chest x-ray
Barium swallow
Fluoroscopy
130
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
131
rare disorder that causes tumors of pancreas and duodenum and ulcers in stomach and duodenum
Zollinger-Ellison Syndrome
132
Tumors are cancerous in 50% of these cases
Zollinger-Ellison Syndrome
133
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
134
S/S of Zollinger-Ellison Syndrome
peptic ulcers
135
Diagnosing Zollinger-Ellison Syndrome
Diagnosis made thru blood test measuring levels of gastrin and HCL.
136
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
137
Stress ulcer in neuro disease that causes overstimulation of vagus nerve
Cushing's ulcer
138
Stress ulcer related to burns that occurs 72hrs after injury
Curling's ulcer
139
Treatment for stress ulcer is
Prevention!! H2 blockers, volume, watch for bleeding
140
Treatments for diarrhea:
Treat underlying cause
hydration
141
Treatments for constipation
Treat underlying cause
stool softener
hydrate
clear the obstruction
142
Both Crohn's and ulcerative colitis can cause
Diarrhea
143
Crohn's can cause diarrhea and
constipation
144
Findings in obstruction
Obstruction may cause necrosis
145
S/S of obstruction
Crampy, wavelike colicky pain
146
Protrusion through a weak portion of the abdominal wall. Can occur anywhere, primarily in the abdominal cavity.
Hernia
147
A weakness in the walls occurs, which may be:
Congenital
Acquired
Hernia
148
Herniation occurs when there is an INCREASE in intra-abdominal pressure due to
Surgical weakness, coughing, straining, lifting heavy weight
149
Occurs when there’s a weakness or opening in your lower abdominal wall that allows abdominal tissue to push through.
An inguinal hernia
150
Surgery is done to treat hernias when
they become strangulated or bothersome
151
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
152
Condition when multiple UNINFLAMMED diverticula are present. Fecal matter can get trapped
Diverticulosis
153
An outpouching of a hollow (or a fluid-filled) structure in the body.
Diverticulum
154
an INFLAMMATION of the diverticula.
Diverticulitis
155
plural form of diverticulum
diverticula
156
Patho – bacteria multiply in the “pocket” causing infection & pain
Diverticulitis
157
Medications for Diverticulosis
Bulk forming agents:
Metamucil: fiber
Miralax: laxative
Stool Softeners: Colace
Softener with cathartic: Peri-colace
158
Burst diverticulitis =
High mortality rate
159
Treatments for diverticulitis
Surgery with anastamosis or colostomy may be done
Antibiotics, rest, IV, NPO
May be given TPN, JP drains
160
Inflammation of the appendix, that prevents mucus/stool from passing into the cecum
Appendicitis
161
If untreated, appendix can:
rupture &
Gangrene
Ischemia
Peritonitis
162
Appendicitis most frequently occurs in
males ages 10-30
163
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
164
Diagnosing appendicitis
CAT scan & ultrasound, WBC
165
A ‘+’ PSOAS sign
guarding of abdomen.
166
Appendicitis: Withhold narcotic analgesics until positive diagnosis is made because
It masks symptoms
167
Prevention of appendix perforation:
No enemas or laxatives.
No cathartics.
No heat pads (causes engorgement)
168
Appendicitis:
No perforation =
same day surgery or 23hr
169
Appendicitis medications:
Antipyretics / Analgesics / antibiotics
170
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.
171
Contamination of Abd Cavity
Peritonitis
172
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
173
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
174
Intestinal blockage can lead to
DISTENTION
PRESSURE
F & E loss
SHOCK & DEATH
175
Occurs when part of the intestine loops around and folds over itself
Volvulus
176
Types of intestinal obstruction
Volvulus
Intussusception
Causes:
IBD
TUMORS
FECAL IMPACTIONS
PARALYTIC ILEUS
Adhesions
177
85% of intestinal obstructions OCCUR HERE
Small bowel
178
Adhesions most common cause of
Small bowel obstruction
179
Small bowel obstruction can cause
Dehydration & metabolic alkalosis develops (n/v)
Necrosis> eventual rupture of the bowel is possible
180
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!
181
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!
182
Purpose of second lumen on salem sump
to let air into stomach
183
a one-lumen nasogastric tube
The Levin tube
184
Most common NG tube
Salem sump
185
a double-lumen balloon-tipped rubber tube used for the purpose of decompression in treating intestinal obstruction
A Miller–Abbott NG tube
186
What is the Miller-Abbott tube used for?
Intestinal suction
Decompression
Bowel dilation
187
a long, single-lumen intestinal tube with a sealed, mercury-filled rubber bag tip; used to decompress or stent the small intestine.
Cantor tube
188
Surgical interventions for large bowel obstruction:
Cecostomy
Colostomy
Ileostomy
189
Why are barium studies contraindicated in large bowel obstruction?
because of perforation risk. CT and x-ray can diagnose
190
MEDICAL MANAGEMENT of hemorrhoids:
stool softeners
anti-inflammatory creams
high fiber diet
increase fluids and activity
191
SURGICAL MANAGEMENT of hemorrhoids:
laser surgery-good for external! (Quick, painless)
Photocoagulation
Injection of sclerosing solutions to dry and remove
192
Infrared light used to treat hemorrhoids
Photocoagulation
193
Second most common type of internal cancer in the US.
COLORECTAL CANCER
194
If patient has IBS or polyps, screening for this disease is done younger than 50
COLORECTAL CANCER
195
Liver metastasis is common with
Colorectal cancer
196
Exact cause of colorectal cancer is
Unknown
197
S/S of colorectal cancer
*Change in bowel habits – most common.
*Blood in stool
Unexplained:
Anemia
Anorexia
Wt Loss
Fatigue
198
95% of colorectal tumors are this type (arising from the epithelial lining of the intestine)
adenocarcinoma
199
Colorectal cancer may start out as benign polyp, then becoming
malignant
200
Colorectal cancer S/S:
right sided lesions
Dull abdominal pain & melena
201
Colorectal cancer S/S:
left sided lesions
Abdominal pain & cramping
Narrowing stools
Constipation
Distention
Bright red blood in stool
202
Colorectal cancer S/S:
rectal lesions
Tenesmus (ineffective, painful straining)
Rectal pain
Feeling of incomplete evacuation after BM
Alternating constipation & diarrhea
Bloody stools.
203
Crohn's/ulcerative colitis commonly occurs in ages
15y-35y
204
Common sites for Crohn's/ulcerative colitis:
Distal Ileum & colon
205
Crohn's/ ulcerative colitis is 2x’s more common in
smokers
206
Bowel becomes fibrotic & lumen narrows with this disease that causes vomiting and starts as small ulcerations
Crohn's/ ulcerative colitis
207
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.
208
Fistulas, fissures & abscesses form with
Crohn's/ ulcerative colitis
209
RLQ pain & diarrhea unrelieved by defecation
Crohn's/ ulcerative colitis
210
Narrowing of intestinal lumen causing crampy abdominal pain
Crohn's/ ulcerative colitis
211
Patient limits eating to avoid pain with these condtions causing malnutrition
Crohn's/ ulcerative colitis
212
indicating the constriction of the intestine
String sign-
213
ASCA: + antibody=
Crohn’s
214
pANCA:+ associated with
UC
215
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
216
elevated ESR =
inflammation
217
Inflammatory disease of mucosal & submucosal layers of the colon & rectum only
Ulcerative Colitis
218
Ulcerative Colitis: Highest incidence in these populations
Caucasians & people of Jewish Heritage
219
Signs and Symptoms of Ulcerative Colitis
Diarrhea ( 10+ bloody/mucus stools/d, LLQ pain)
No steatorrhea
anorexia, vomiting, wt.loss, hypocalcemia
220
Ulcerative Colitis:
The only cure is
surgery: colostomy or ileostomy
221
Ulcerative Colitis:
10-15% develop
Ca of the Colon
222
Ulcerative Colitis:
Nursing management
Control diarrhea
Prevent or minimize complications> meds
Promote low residue diet
Knowledge about disease & meds
Weights
Stress management
