Exam 3: GI content Flashcards
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What is primary stomatitis
inflammation of the oral mucosa
What are the s/s of primary stomatitis and the complications
painful ulceration (s) place pt at risk for bleeding and infection
What is the treatment for primary stomatitis
topical analgesic application (lidocaine) to opioids or antifungal medications
What is secondary stomatitis
Candidiasis –> painful infection caused by the fungus candida albicans
Treatment for secondary stomatits
treat with nystatin swish and spit
Oral tumors/oral cancers signs
bleeding from mouth, poor appetite, difficult swallowing, weight loss, thick or absent saliva, pain, lump in cheek
What cancer is related to HPV
oropharyngeal cancer
What is GERD
occurs as a result of regurgitation–backward flow of stomach contents into esophagus
–> obesity and H. pylori may also contribute to reflux
Hiatal hernia will ________ risk for GERD
increase
GERD complications
ulceration, hemorrhage, adenocarcinoma
S/S GERD
heartburn
regurgitation
water brash
frequent belching
nocturnal cough, wheezing, hoarseness
dysphagia or odynophagia (difficulty swallowing)
What are alarm symptoms of GERD
dysphagia, odynophagia, anemia, bleeding, weight loss
Diagnostic testing for GERD
pH monoitoring–> below 4
Endoscopy
Biopsy to r/o cancer
Manometry: sphincter and muscle function
Barium swallow: hiatal hernia
What surgical procedure do we use for GERD when there is a hiatal hernia
laparoscopic Nissen Fundoplication
What is the stretta procedure with GERD
The procedure uses radio frequency energy to reshape the lower esophageal sphincter (LES) muscle ring. This strengthens the sphincter, which helps restore the natural barrier that prevents stomach acid from entering the esophagus
What are the different types of hiatal hernias
sliding: type l
paraesophageal or rolling: type ll through lV
What is the diagnostic test for a hiatal hernia
barium swallow study with fluoroscopy is the most specific –> EGD may be performed for sliding hernias
What are 2 complications of rolling hernias
obstruction and/or strangulation
What diet do we want for hiatal hernias
high carb, low protein, and increased fluid intake
When we place an NG tube for a hiatal hernia what is the normal coloration
drainage bloody then green within 8 hours
What is dyspepsia
describe symptoms such as pain, discomfort, fullness, nausea, burning, belching
Gastritis is commonly caused by
H. pylori
NSAID use
Local irritation from radiation
autoimmune causes
How do we treat acute gastritis
remove causative agent, NPO –advance diet, antacids, H2 receptor antagonists, PPI, monitor for bleeding
How do we treat chronic gastritis
treat H. pylori, diet, meds, possibly B-12 injections to treat anemia due to lack of intrinsic factors produced by the stomach lining
What conditions favor gastric ulcer
normal gastric acid secretion and delayed stomach emptying with increased diffusion of gastric acid back into stomach tissues
What conditions favor duodenal ulcers
normal diffusion of acid back into stomach tissue with increased secretion of gastric acid and increased stomach emptying
What is the triple H pylori treatment modality
clarithromycin, amoxicillin, and a PPI all given twice daily for 14 days
(metronidazole can be used instead of amoxicillin)
What is the bismuth quadtruple therapy for H pylori
bismuth subsalicylate, metronidazole, tetracycline, and PPI give for 14 days
PUD complications
hemorrhage, perforation, intractable pain and obstruction
How do we diagnose a GI bleed
nuclear medicine –> bleeding scan
What is a perforation
erosion of ulcer through wall of stomach or duodenum –> gastric secretions spill into the abd cavity resulting in peritonitis
S/S of a perforation
abdominal pain, rebound tenderness, rigid abdomen (board-like), decreased BS and VS changes
What are the classifications of irritable bowel syndrome
D: diarrhea
C: constipation
A: alternating
M: mix
What do labs look like with irritable bowel syndrome
usually normal, increased exhaled hydrogen
Health teaching with irritable bowel
30 to 40 grams of fiber daily
promote normal bowel function
Drug therapy for irritable bowel
C:
D:
C: lubiprostone, linaclotide
D: olosetron (serotonin antagonist)
What do we monitor for with irritable bowel
obstruction or ischemic colitis
Diverticulitis is
perforation and peritonitis
S/S of diverticulitis
LLQ pain, low grade fever, N/V
common cause of lower GI bleeding (bright blood)
Chrons disease vs UC
chrons: skip lesions, abd pain in RLQ and diarrhea –> steatorrhea
UC: abd pain and bloody diarrhea –> electrolyte imbalance
Extraintestinal symptoms of IBD
arthritis, skin rashes
Chrons is most often in
terminal ileus
What color stoma is a medical emergency
dark red, dusky colored stoma
With stoma care we must monitor for
s/s of ischemia, unusual bleeding, seperation, retraction, prolapse, skin rash
What do we clean the stoma with
tap water
What are hemorrhoids
masses of dilated blood vessels
What is the difference between internal and external hemorrhoids
There are two types of hemorrhoids: Internal hemorrhoids, which are located inside the rectum and often less painful than external hemorrhoids. External hemorrhoids, which are found under the skin around the anus and are generally more painful
With an anorectal surgery what is our main priority to monitor for
hypotension and dizziness
Cholelithioasis
stone formation
Cholecystitis
acute or chronic inflammation
Risk factors for gallbladder issues
female, fluffy, fertile, fatty meals
S/S of acute gallbladder issues
RUQ abd pain, positive murphys signs, jaundice, fever
Charcot’s triad for gallbladder
acute obstructive cholangitis
fever w/ chills, abd pain, jaundice
What diets do we want with gallbladder issues
high fiber, low fat diet
Acute pancreatitis
severe condition
rapid onset (hours/days)
can become necrotic
Chronic pancreatitis
ongoing and fibrotic
progressive and permanent
gallstones or excessive alc association
What are the main findings in terms of labs for pancreatitis
increased amylase, lipase, and bili
amylase in urine
s/s of pancreatitis
tachy, fever, stabbing pain that worsens with eating and radiates to the back, hypotension, jaundice, decreased BS, grey turners and cullens signs
What type of aggressive fluid do we give to pancreatitis patients
LR
Hep vaccines are for
HAV and HBV
HAV specific recommendations
proper handwashing
avoid contaminated food or water
HCV specific recommendations
avoid IV drug use or sharing needles
Viral hepatitis stages
pre-icteric: profound anorexia, malaise, nausea and vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or right upper quadrant abdominal pain
icteric: Jaundice (yellowing of the skin and whites of the eyes) develops. Other symptoms may subside. Anorexia, nausea and vomiting may worsen
post-icteric: subsiding symptoms, energy levels increase
Normal ALT
4 to 36
Normal AST
8 to 33
Normal ALK phosphate
4.5 to 13
Normal bili
less than 1.0
elevated is greater than 2.5
HCV curative therapy
ledipasvir (harvoni)
sofosbuvir (epclusa)
INterferon vs ribavirin side effects for HCV
interferon: flu like, depression, hair thin, diarrhea, insomnia
ribavirin: anemia, anorexia, cough, rash, pruritis, dyspnea
Chronic HBV primary treatment
peginterferon alpha 2a (pagasys) subcut for 48 weeks–minimum
interferon alfa-2b (intron A) subcut injection
A patient has been diagnosed with hepatitis A . Which of the following assessment findings would the nurse anticipate?
A) dark stools
B) weight gain
C) malaise
D) LUQ pain
C: malaise
Which finding confirms that the patient is in the icteric phase of hepatitis
C: jaundice
mechanical obstruction
blocked by problems outside the intestine (adhesion, fibrous band, chrons, tumors)
Non-mechanical obstruction
paralytic ileus or adynamic ileus
What is a strangulation obstruction a result of
tumor, hernias, fecal impactions, strictures, intussusception (bowel telescoping on itself), volvulus (twisting), fibrosis, vascular disorder, and adhesion
With mechanical obstruction _______ peristalsis and secretions
increased
Causes of paralytic ileus
intestinal handling
electrolyte imbalances (hypokalemia)
peritonitis
vascular insufficiency (ischemia)
S/s of non mechanical obstruction
singultus (hiccups)
constant, diffuse discomfort
abdominal distention
decreased to absent bowel sounds (borboygmi-peristalsis waves visible)
vomiting
Small bowel obstruction
pain accompanied by visible peristalsis waves in upper and middle abdomen
upper or epigastric abdominal distention
N/V
ostipation
severe fluid and electrolyte imbalance (low sodium, cl, K)
Small bowel obstruction is associated with metabolic
alkalosis (if high)
Large bowel obstruction is associated with metabolic
acidosis
Large bowel obstruction
lower abdominal cramping and distention
no or minimal vomiting
obstipation
no major electrolyte imbalance
What medication do we give for a paralytic ileus
alvimopan
