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NRSG 102: Med Surg 1 > Exam 2: Chapter 46 - Gastritis and Peptic Ulcers > Flashcards

Exam 2: Chapter 46 - Gastritis and Peptic Ulcers Flashcards

1
Q

What is Gastritis

A

Inflammation of the gastric or stomach mucosa

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2
Q

Acute Gastritis may be classified as

A

erosive or nonerosive

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3
Q

Erosive form of acute gastritis is most often caused by

A

local irritants sucha s aspirin and other nonsteroidal anti-inflammatory drugs, alcohol consumption, and gastric radiation therapy

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4
Q

Nonerosive Form of Acute Gastritis is most often caused by

A

an infection with H. Pylori.

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5
Q

Acute gastritis may also develop in acute illnesses, espeically when patient has had

A

traumatic injuries burns severe infection hepatic, kidney, or respiratory failure major surgery This is known as stress-related gastritis

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6
Q

Chronic H. Pylori gastritis is implicated in the development of

A

peptic ulcers, gastric adenocarcinoma (cancer), and gastric mucosa-associated lymphoid tissue lymphoma. Also associated with Hashimoto Thyroiditis, Addison Disease, and Graves Disease

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7
Q

Gastritis is characterized by a

A

disruption of the mucosal barrier that normally protects the stomach tissue from digestive juices (HCl and Pepsin)

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8
Q

Impaired mucosal barrier allows

A

corrosive HCl, Pepsin, and other irritating agents to co me in contant with the gastric mucosa, resulting in inflammation

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9
Q

In acutue gastritis, the inflammation causes the gastric mucosa to become

A

Edematous and hyperemic (congested with fluid and blood) and to undergo superficial erosion.

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10
Q

Patient with acute gastritis may have a rapid onset of symptoms, such as

A

epigastric pain or discomfort indigestion anorexia hiccups nausea/vomitting

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11
Q

Erosive gastritis may cause

A

bleeding, which may manifest as blood in vomit or melena (black, tarry stools) or hematochezia (bright, red, bloody stools)

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12
Q

Patient with chronic gastritis may complain of

A

fatigue, pyrosis (burning senstion in the stomach and esophagus that moves up to the mouth; heartburn), belching, sour taste, early satiety, anorexia, nausea/vomiting

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13
Q

Patients with chronic gastritis may not be able to absorb

A

vitamin B12, because of diminished production of intrinsic factor by the stomachs parietal cells due to atrophy, which may lead to pernicious anemia.

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14
Q

Definitive diagnosis of gastritis is determined by a

A

endoscopy and histologic examination obtained by biopsy. CBC may be drawn for anemia as a result of hemorrhage or pernicious anemia. H-Pylori test as well.

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15
Q

When too many NSAIDS consumed, what happens to the mucosal layer?

A

It is no longer produced and allows HCl and Pepsin to eat away at it and break it down

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16
Q

What has the ability to eat through the stomach?

A

HCl acid

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17
Q

Recovery time from acute gastritis?

A

Gastric mucosa is capable of repairing itself after 1 day.

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18
Q

Acute Medical Management of Gastritis

A

Refrain from alcohol and food until symptoms subside If due to strong acid, treatment to neutralize the agent

Supporitive therapy includes NG intubation, antacids and IV Fluids

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19
Q

Gastritis: Perforation

A

Can be severe whre it can cause a hole through the stomach.

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20
Q

How is Perforation treated?

A

EGD performed. Will look inside the stomach adn see what they can remove. Can remove part of stomach, removing amount of HCl secreted

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21
Q

What happens if patient has Peritonitis

A

Surgery. HCl Acid is causing damag to organs and causing inflammation. Stomach can become rigid and board like

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22
Q

Chronic gastritis is managed by modifying the

A

patients diet, promoting rest, reducing stress, recommending voidance of alcohol and NSAIDs, and initating medications that include antacids, H2 Blockers and PPI

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23
Q

Why are antibiotics given for Gastritis?

A

To assist with eradicating H. Pylori

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24
Q

Why are H2 Receptor Antagonists given for Gastritis?

A

Decreases amount of HCl produced by stomach by blocking action of histamine on histamine receptors of parietel cells in the stomach

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25
Q

Why are Proton Pump Inhibitors given for Gastritis?

A

DEcreases gastric secreation by slowing ATPase pump

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26
Q

Gastritis Nursing Management: Reducing Anxiety

A

Uses a calm approach to assess the patient and to answer all questions as completely as possible

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27
Q

Gastritis Nursing Management: Promoting Optimal Nutrition

A

For acute, the patient should take no food or fluids by mouth, possibly for a few days.

If IV Therapy necessary, nurse monitors I/O along with electrolyte values

Caffeinated beverages discouraged because its a nervous system stimulant that increases gastric activity and pepsin secretion

Introduce clear fluids and solid foods as prescribed.

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28
Q

Gastritis Nursing Management: Promiting Fluid Balance

A

Minimal fluid intake of 1.5 L.

If NPO, IV Fluids must be 3 L / day.

Monitor I/O, Electrolyte Imbalance, and Hemorrhage

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29
Q

Gastritis Nursing Management: Relieving Pain

A

Instruct to avoid foods and beverages that may irritate the gastric mucosa as well as correct use of medications to relieve chronic gastritis

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30
Q

What is a peptic ulcer?

A

A excavation (hollowed-out area) that forms in the mucosa of the stomach, in the pylorus, in the duodenum, or in the esophagus

31
Q

Peptic ulcers are more likely to occur in which location

A

the duodenum that in the stomach.

32
Q

Chronic gastric ulcers tend to occur in

A

the lesser curvature of the stomach, near the pylorus

33
Q

Esophagela ulcers occur as a result of

A

backward flow of HCl from the stomach into the esophagus

34
Q

Older adults are more prone to peptic ulcers due

A

to higher rates of NSAID use and H. Pylori Infections

35
Q

Most peptic ulcers result from

A

infection with gram-negative bacteria H. Pylori, which is acquired thorough ingestion of food and water

36
Q

People with what blood type are more prone to peptic ulcers?

A

O

37
Q

Deep peptic ulcer can also be called a

A

tissue injury, which kicks in a immune response

38
Q

A complication with peptic ulcers will be

A

Peritonitis

39
Q

Risk factors of peptic ulcers include

A

excessive secretion of stomch acid, dietary factors, chronic use of NSAIDs, alcohol , smoking, and familial tendency

40
Q

The use of NSAIDs inhibits

A

prostaglandin ynthesis, which is associated wiht a disruption of the normally protective mucosal barrier

41
Q

ZES is suspected when

A

a patient has several peptic ulcers or an ulcer that is resistant to standard medical therapy

42
Q

Stress ulcer is the term given to

A

the acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events such as burns, shock, sepsis, and multiple organ dysfunction syndrome

43
Q

Stress ulcers most common in those who are

A

ventilator dependent after trauma or surgery

44
Q

Types of ulcers from stressful conditions?

A

Curling Ulcers

Cushing Ulcers

45
Q

Curling ulcer frequency observed about

A

72 hours after extensive burn injuries and often involvess the antrum of the stomach or the duodenum

46
Q

Cushing ulcer common in patients with

A

traumatic head injury, stroke, brain tumor, or follow intracranial surgery

Thought to be caused by increased intracranial pressure, which results in overstimulation of vagal nerve and increased secretion of HCl

47
Q

Patient with an ulcer complains of

A

dull, gnawing pain or a burning sensation in the midepigastrium or the back

48
Q

Gastric Ulcers pain

A

Pain occurs immediately after eating.

49
Q

Duodenal Ulcer Pain

A

Duodenal ulcers most commonly occur 2-3 hours after a meal

50
Q

What ulcer may wake you up at night?

A

Duodenal

51
Q

What type of ulcer will cause you to express relief of pain after eating

A

patients with duodenal ulcers

52
Q

Duodenal Ulcer information

A

Most Common. Include weight gain and food may decrease pain beause you may coat the ulceer

53
Q

Peptic Ulcer Manifestations include

A

a dull gnawing pin or burning in the midepigastrium; heartburn and vomiting may occur

54
Q

Peptic Ulcer Diagnostic Findings

A

Endoscopy that may reveal lesions.

Serologic Testing for Antibodies aagainst the H. Pylori Antigen

Stool Antigen Test

Urea Breath Test

55
Q

Peptic Ulcer treatments

A

Medications, Lifestyle changes and occasionally surgery

56
Q

Most common used therapy for peptic ulcers is a

A

combination of antibiotics, PPI, and sometimes bismuth salts.

Typically prescribed for 10-14 days and may include triple therapy with two antibiotics or quadruple therapy with two antibiotics plus a PPI and Bismuth Salts

57
Q

H2 Blocks and PPI inhibitors that reduce gastric acid secretion are used to

A

treat ulcers not associated with H. Pylori Infection

58
Q

Pt is advised to avoid using

A

Aspirin and other NSAIDs

59
Q

Peptic Ulcers: smoking Cessation

A

Decreases secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum and delayed healing of peptic ulcers

60
Q

Peptic Ulcers: Dietary Modification

A

Avoid oversecretion of acid and hypermotility in the GI tract. Avoid extremes of temperture in food and beverages and the overstimulation from consumption of alcohol, coffee, and other caffeinated beverages

61
Q

Peptic Ulcers: Surgery recommended for those with

A

intractable ulcers that have not healed after 12-16 weeks,

life-threatening hemorrhage

perforation, or obstruction

And for those with ZES that is unresponsive to medications

Surgical procedures include vagotomy, w/ or w/o pyloroplasty, and Antrectomy

62
Q

What is a Vagotomy?

A

Severing of the vagus nerve.

Decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin. May be performed via an open surgical approach or laparoscopy.

63
Q

What is a Truncal Vagotomy

A

Severs the right and left vaus nerves at they enter the stomach

Most commonly used to decrease acid secretions

64
Q

What is Selective Vagotomy

A

Severs vagal innervation to the stomach but maintains innervations to the rest of the abdominal organs

65
Q

What is Pyloroplasty

A

Longitudinal incision is made into the pylorus and transversely sutured closed to enarge the outlet and relax the muscle.

May be performed with Truncal and Selective Vagotomies

66
Q

What is a Billroth I (Gastroduodenostomy)

A

Removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus.

REmaining segment is anastomosed to the duodenum. May be performed with Truncal Vagotomy

67
Q

What is a BillRoth II (Gastrojejunostomy)

A

Removal of lower portion (antrum) of stomach with anastomosis to jejunum.

Duodenal stump remains and is oversewn

68
Q

What is Transcatheter Arterial Embolization (TAE)

A

An interventional radiologic procedure in which a catheter is placed percutaneously into an artery and is advanced under use of fluroscopy to teh site of the bleeding peptic ulcer

Embolic agent is then delivered via the catheter, which selectively occludes blood flow to the bleeding vessels and thus stops bleeding of the peptic ulcer

69
Q

Peptic Ulcer: What is Perforation

A

The erosion of the ulcer thorugh the gastric serosa into teh peritoneal cavity without warning.

70
Q

Peptic Ulcer: What is Penetration

A

The erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or omentum.

71
Q

How does Gastric Outlet Obsturction Occcur?

A

When the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down

72
Q

Peptic Ulcer: Blood Pressre and HEart rate during Hemorrhage?

A

Increased heart rate and decreased blood pressure

73
Q

Peptic Ulcer: Hemorrhage, what should you do with oxygen?

A

SHould administer oxygen . They are rapidly breathing because theyre trying to get oxygen throughout their body

NRSG 102: Med Surg 1 (52 decks)

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