Disorders Of The upper and lower GI Tract Flashcards
Symptoms of GERD
Heartburn (most common)
Respiratory symptoms (coughing, sore throat, dyspnea)
Hoarseness, chocking, feeling lump in throat, regurgitation, early satisfy, bloating, nausea, vomiting
What is GERD?
Reflux to gastric contents into lower esophagus
Acidic gastric secretions cause irritation and inflammation
Complications of GERD
Esophagitis Ulceration Stricture Dysphagia Barrette's esophagus Risks associated to acids
Diagnostic tests for GERD
Barium swallow Endoscopy Motility studies PH level is esophagus Radionuclide tests
Collaborative care for GERD
Lifestyle changes Elevate head of bed Avoid tight clothing Smaller more frequent meals Stop smoking Avoid alcohol Stress and weight management OTC drug management Surgery
What is a hiatal hernia?
Herniation of portion of stomach into esophagus through an opening in the diaphragm
Cause unknown
What are the two types of hiatal hernia?
Sliding (moves in and out of thoracic cavity)
Paraesophageal or rolling (fundus and greater curvature of the stomach roll up through diaphragm and form a pocket alongside the esophagus)
What are the symptoms of hiatal hernia?
Similar to those of GERD
Reflux and discomfort are associated with position - bending down laying on the right side and is relieved by turning or standing up
May be asymptomatic
What are the complications of a hiatal hernia?
GERD Hemorrhage from erosion Esophageal stenosis Tracheal aspiration of gastric contents Ulceration of herniation part of the stomach
The diagnostic studies for hiatal hernia?
Similar to those of GER D Barium swallow Endoscopy Motility study Esophageal pressure studies PH level in esophagus
Is the collaborative care for hiatal hernia?
Lifestyle change Elevate head of bed Avoid tight clothing Smaller more frequent meals Stop smoking and drinking alcohol Weight and stress management Over the counter drug therapy
What is esophageal cancer?
Rare malignant neoplasm in the Esophagus in the western society
rates are high in parts of Asia
Five-year survival rate is less than 10%
Adenocarcinomas are the most common type
Incident increases with age and cause unknown
Risk factors for esophageal cancer
Barrett's esophagus Smoker Exposure to asbestos and metals Swallowing lye Poor diet Achalasia - abnormal motility in lower esophagus
What are the clinical manifestations of esophageal cancer?
Not detected until tumor is advanced Early symptoms are unrecognizable Progressive dysphagia is common Pain develops late Weight loss, regurgitation, hoarseness, and cough
What are complications of esophageal cancer?
Hemorrhage
Esophageal perforation with fistula formation
Esophageal obstruction
Liver and lungs are common site for metastasis
What are diagnostic studies done for esophageal cancer?
History and physical examination Barium swallow with fluoroscopy Endoscopy with biopsy Endoscopic ultrasound Bronchoscopy CT, MRI
What is the collaborative care for esophageal cancer?
Depends on the stage, location, and metastasis
Prognosis is poor
can try surgery, radiation, and palliative therapy
Family needs a lot of psychological support
What is gastritis?
Inflammation of the gastric mucosal
And be acute or chronic
Most common problems affecting the stomach
Cause is unknown
The risk factors for gastritis?
Drugs
Diet such as spicy food and binge drinking
Environmental such as smoking and radiation
Microorganism
Autoimmune response
Bacterial, viral, and fungal infections
Different diseases
What are the symptoms for acute gastritis?
Anorexia, nausea, and vomiting
Epigastric tenderness
Feeling of fullness
Hemorrhage - maybe the only symptom common with ETOH abuse
Important to note that acute gastritis is self-limiting, last hours to a few days, and usually has complete mucosal healing
What are the diagnostic studies done for gastritis?
Endoscopic exam with biopsy, this is done to look for H pylori
Urine and stool sample
Gastric analysis
Serum immunoglobulin
Urea breath test
If Acute - important to explore history of drugs and alcohol
If chronic - delayed or missed due to nonspecific symptoms, explore history of drugs and alcohol
What is the collaborative care for acute gastritis?
Caring for nausea and vomiting, may insert NG tube
Vitals if hemorrhage is suspected
Drug therapy
Focuses on evaluating and eliminating original cause
What is the collaborative care for chronic gastritis?
Identify and eliminate specific cause
Determine whether cobalamin deficiency anemia is suspected
Teaching family to help patients stop what is causing it
Cancer incidence is higher with this disease
What is peptic ulcer disease?
Can be acute or chronic, depending on the degree and duration of the mucosal lining affected
Acute peptic ulcers are short duration and resolve quickly once the causes removed
Chronic ulcer can be present continuously or intermittently throughout a persons life
erode through the muscle wall and fibrous tissue is formed as a try to heal
Are four times as common as the acute ones
treatment of all types of ulcers are similar
What are the symptoms of peptic ulcer disease?
Usually asymptomatic
First symptom may be hemorrhage or perforation
When pain does occur for a duodenal ulcer it is described as burning or cramping, usually felt just below the xiphoid process or in the back, occurs up to four hours after meal, and can occur intermittently over time
When paying does occur related to a gastric ulcer it is usually described as a burning or gaseous, felt high in the epigastric region, and two hours after the meal
What are the diagnostic studies for peptic ulcer disease?
History and physical examination Presents a black tarry stool or coffee ground emesis Epigastric tenderness Nausea and vomiting Endoscopy Serum immunoglobulin urea breath test Urine and stool specimen Serum analysis CBC to determine anemia
What is the collaborative care for peptic ulcer disease?
Medication Health teaching Nutritional therapy Avoid ETOH, coffee, and carbonated drinks Stop smoking Avoid OTC unless approved by Dr. Adequate physical and psychological rest What to do if pain and/or discomfort, nausea, and blood in the stool occur
What are major complications of peptic ulcer disease?
Hemorrhage
Perforation, which is a sudden onset of severe abdominal pain and rigidity, no bowel sounds, shallow and rapid respirations, peritonitis will occur in 6 to 12 hours if not treated
Gastric outlet obstruction in, occurs when ulcer blocks any part of the pylorus, pain is really by belching or projectile vomiting, loud peristalsis is audible and visual
What is the collaborative care for perforation with peptic ulcer disease?
Immediate focus is to stop spillage of gastric content into the peritoneal cavity
Make patient NPO status and prepare for immediate surgery
What is the collaborative care for gastric outlet obstruction with peptic ulcer disease?
Decompress the stomach, correct fluid and electrolyte and balances, and improve health status
Monitor vital signs and strict ins and outs
repositioning patient from side to side
Non-surgical option for pyloric obstruction is to undergo a series of balloon dilations
What is the collaborative care for peptic ulcer disease?
Surgery
Pre and Postoperative care
Avoid postoperative complications
What is irritable bowel syndrome?
Characterized by intermittent and recurring abdominal pain associated with alteration involve function
Affects 13 to 20% of Canadians and is most common reason for workplace absence
Symptoms of irritable bowel syndrome?
Diarrhea or constipation Abdominal distention Excessive flatulence bloating Urge to defecate Sense of incomplete bowel evacuation
What are the risk factors for irritable bowel syndrome?
Stress
Psychological factors
Food Intolerances
What are the diagnostic studies done for irritable bowel syndrome?
Very thorough history and physical examination
Rule out other causes
A collaborative care done for irritable bowel syndrome?
Diet therapy, at least 30 g of fiber daily, avoid gas producing foods, avoid lactose if it is the cause
Treatments for constipation, stress management, and antidepressant
What is abdominal trauma?
Most often due to blunt trauma, or other penetrating injuries
Injuries can be severe and life-threatening, laceration to liver, arterial tears, ruptured spleen, and bladder, intestines, or stomach injuries
Complications can also be severe and life-threatening such as sepsis on peritonitis
What are the symptoms of abdominal trauma?
Guarding and splinting of the abdomen
Hard, distended abdomen
Absent bowel sounds
Contusion, abrasions, bruising over flanks or abdomen
Severe abdominal pain
Hematemesis, hematuria, or signs of hypovolemic shock
What are the diagnostic studies done for abdominal trauma,?
CBC Urinalysis X-rays CT Abdominal ultrasound
What is the collaborative care for abdominal trauma?
Repair the damage
Emergency management focuses on airway, fluid replacement, gastric decompression, and prevention of hypovolemic shock
What is appendicitis?
Inflammation of the appendix
Most common cause is occlusion of appendiceal lumen or hyper active growth of the tissue
What are the symptoms of appendicitis?
Persistent, continuous periumbilical pain followed by anorexia, nausea, and vomiting
Pain eventually shift to right lower quadrant and localized at McBurney’s point
What are the diagnostic studies done for appendicitis?
History And physical examination
Palpation of abdomen
Differential wbc’s
Urinalysis
What is the treatment for appendicitis?
Appendectomy
What is the collaborative care done for appendicitis?
Teach people to seek medical attention if they have abdominal pain
If appendicitis is suspected patient should become NPO
Patient is usually discharged on day two if there is no peritonitis
Teach patient symptoms of infection
Cannot lift things more than 10 pounds for three weeks
What is peritonitis?
Results from a localized or generalized inflammatory process of the peritoneum
May be acute or chronic
Maybe primary or secondary
What are the symptoms of peritonitis?
Abdominal pain is most common symptom
Universal find is tenderness over the involved area
Rebound tenderness, muscular rigidity, basil, abdominal distention or ascites
Fever, tachypnea, tachycardia, nausea and vomiting
Altered bowel habits may be present
What are complications of peritonitis?
Hypovolemic shock Septicemia Intra-abdominal abscess formation Paralytic ileus Organ failure
What are the diagnostic studies done for peritonitis?
CBC Peritoneal aspiration Abdominal x-ray which may show evidence of paralytic ileus Urinalysis and CT scan Peritonealscopy
The collaborative care done for peritonitis?
Identify and eliminate it cause
Minor cases can be managed non-surgically
Monitor for sepsis and increased pain
What Is gastroenteritis?
Inflammation of the mucosa of the stomach and the small intestine, usually related to bacterial or viral infection
Usually runs its course with no significant adverse effects
What are the symptoms of gastroenteritis?
Nausea and vomiting, abdominal distention and cramping
Fever
Blood or mucus in the stool
Self limiting
Older clients are at risk for dehydration
Collaborative care for gastroenteritis?
NPO until no longer vomiting
Iv fluid replacement
Accurate ins and outs
Medical asepsis and infection control precautions
Antibiotics depending on causative organism
Teach patient infection control management related to food preparation and handling
What is Ulcerative colitis?
Chronic inflammatory bowel disease
May occur at any age but peaks between 15 and 25 years of age and again between 60 and 80 years of age
Equally affects both sexes
More common in Jewish and upper-middle-class urban population
What are the symptoms of ulcerative colitis?
Intermittent exacerbations over many years
Bloody diarrhea
Abdominal pain
Systemic symptoms such as fever, malaise, and anorexia
Mucousy or bloody stool
Anemia, weight loss, tachycardia, dehydration
What are the complications of ulcerative colitis?
Intestinal issues such as hemorrhage, structures, perforation, toxic megacolon, colorectal cancer
Extra intestinal issues… (Not focusing on this for this test)
What are the diagnostic studies done for ulcerative colitis?
History and physical examination Bloodwork Stool samples for blood, pus, and mucus Stool for C&S. To determine for infectious agents Sigmoidoscopy and colonoscopy Barium enema
What is the collaborative care for ulcerative Colitis?
Rest the bowels Control inflammation Combat infection Correct malnutrition Alleviate stress Provide symptom relief by using drug therapy Most do not need surgical intervention
What is Crohn’s disease?
A chronic nonspecific inflammatory bowel disorder of unknown origin that can affect any part of the G.I. tract from the mouth to the anus
Most often occurs between 15 and 30 years of age
Slightly higher incidence in women
Unpredictable periods of recurrence in remission
What are the symptoms of Crohn’s disease?
Are dependent on anatomic location, extent of disease process, and complications
Onset is insidious with nonspecific complaints
Diarrhea, nonbloody
Fatigue, abdominal pain, weight loss, and fever
Are the complications of Crohn’s disease?
Scar tissue related to inflammation
Extraintestinal complication similar to colitis
What are the diagnostic studies done for Crohn’s disease?
History and physical examination CBC Serum chemistry Testing for stool occult blood Barium enema Sigmoidoscopy Colonoscopy
Is the collaborative care for Crohn’s disease?
Control the inflammatory process Symptom Management Correct metabolic and nutritional problems Promote healing Drug and nutritional therapy Surgical therapy only one severe
What is intestinal obstruction?
Partial or complete obstruction of the intestine
Requires immediate treatment
Cause can be mechanical or nonmechanical
Is potentially life-threatening
What are the symptoms of intestinal obstructions?
Vomiting feces
pain
Abdominal distention
High-pitched bowel sounds
The diagnostic studies done for intestinal obstructions?
History and physical examination
Abdominal x-rays
Barium enema
CBC, electrolytes, amylase, and BUN
Collaborative care for intestinal obstructions
Relief of obstruction
Resolution of pain
Normal fluid and electrolyte status
Adequate nutrition
It is diverticular disease?
There are two forms of diverticular disease the first one is diverticulosis and the second one diverticulitis
It is a common G.I. disorder with 5% of adults affected by age 40 and 60% by 885
Affects men and women equally but men have a higher rate of complications
Cause of diverticulitis is related to retention of stool and bacteria in the diverticulum
Inflammation spreads to the surrounding tissue causing edema, abscesses, and perforation
What are the symptoms up for diverticulosis?
Majority of clans have no symptoms
Crampy abdominal pain in left lower quadrant which is alleviated by passing of gas or having a bowel movement
alternative constipation and diarrhea
What are the symptoms for diverticulitis?
Domino pain but is localize over the involved area of the colon
Fever, chills, nausea, anorexia, increased WBCs
Please note that older clients maybe afebrile, have normal WBC, and little to no abdominal tenderness
Complications for diverticulitis?
Perforation
Bowel obstruction
Ureteral obstruction
bleeding
What are the diagnostic studies done for diverticular disease?
CT with oral contrast
CBC, urinalysis, and fecal occult blood testing
colonoscopy
The collaborative care for diverticulitis?
Allow the colon to rest and the inflammation to subside
What is the collaborative care for diverticulosis?
Prevent progression to diverticulitis
Is the collaborative care for diverticular disease?
Fiber and balk laxatives for non-complicated diverticular disease
Acute phase the patient should be given IV fluids, bedrest, and monitor for signs and symptoms of peritonitis
Oral fluids once acute phase is over
Stool softeners and antibiotics upon discharge
