Exam 3: Stomach disorders, Non-inflammatory intestinal problems Flashcards
Chronic Gastritis: Type A (non-erosive) etiology
- Inflammation of the gastric glands, fundus & body of the stomach
- Autoimmune link
Chronic Gastritis: Type B etiology
- Involves the glands of the antrum, may also involve the entire stomach
- Caused by H. pylori infection
Chronic Gastritis: Atrophic etiology
- Affects all layers of the stomach, decreases number of cells
- Older adults
- Toxins, H. pylori, autoimmune
Pathogenesis of peptic ulcer: most common cause and second most common
Most common cause
- Infection with H. pylori (HP) is the most common cause of gastric and duodenal ulcers
- Additional factors must be involved: 50% harbor HP, but only 10% develop PUD
Second most common cause
- NSAIDs
Peptic ulcer diagnostics
- serologic testing (testing for H. pylori antibodies)
- Breath test (screening tool) (swallowing a capsule, liquid, or pudding that contains urea with special carbon. Patient exhales and sepecial carbon atom found= bacterium is present)
- EGD (esophagogastroduodenoscopy)
Management of GI bleeding
- Serial H and H
- # 1 priority: Obtain and monitor vital signs closely
- Oxygen
- Fluid and blood replacement
- Large bore NG tube
- Lavage (with room temperature solution and 200-300 mL)
- EGD
- Acid suppression
Gastric cancer treatment
- Surgical resection (Gastrectomy
- Chemotherapy
- Radiation
Gastric cancer complications
- Dumping syndrome
- Alkaline reflux gastropathy
- Afferent loop syndrome
Dumping syndrome: Early symptoms (30 min after meal)
- Vasomotor response
- Vertigo, tachycardia, syncope, sweating, palpitations
Dumping syndrome: Late symptoms (90 min to 3 hours)
- Excessive release of insulin
- Dizziness, lightheadedness, diaphoresis, confusion
Irritable Bowel Syndrome Types: IBS-D symptoms
Primary symptom is diarrhea
Irritable Bowel Syndrome Types: IBS-C symptoms
Primary symptom is constipation
Irritable Bowel Syndrome Types: IBS-M symptoms
Mixture of diarrhea and constipation
Irritable Bowel Syndrome Types: IBS-A symptoms
Alternates between constipation and diarrhea
Irritable Bowel Syndrome assessment
- Fatigue, malaise, abdominal pain, changes in bowel pattern or consistency of stools, passage of mucus
- Nausea, belching, gas, bloating, anorexia
- Assess location, intensity and quality of pain
Irritable Bowel syndrome diagnostic
Hydrogen breath test
- NPO for 12 hours
- Ask for allergy to sucrose
- clear water but that’s it
- breath test before they give you sucrose and then wait an hour to do another test
Caused by - absorption of a dairy product
- caffeinated beverages
Irritable Bowel Syndrome medications: For IBS-C
- psyllium (Metamucil) (cause to have a BM)
- linaclotide (Linzess)
- lubiprostone (Amitiza)(only used in women) (take it with food and water, increases fluids in intestines)
Irritable Bowel Syndrome medications: For IBS-D
- loperamide (Imodium)
- psyllium (Metamucil) (formed stool)
- alosetron (Lotrenex) (only approved for woman) (post market analysis- had bad effects. Decreases motility, severe constipation, perforation and death. Not first choice. Treatment for 6 months before taking this.) report any Constipation
Irritable Bowel Syndrome medications: General
- rifaximin (Xifaxan) (control affects of inflammation, antibiotic)
- darifenacin (Enablex) (same as above)
- amitriptyline (Elavil)
- Complementary therapies
Probiotics, Accupuncture, moxibustion (Acu-Moxa)
Colorectal cancer risk factors
- Age >50 yr
- Genetic predisposition, personal/family history of cancer
- Familial adenomatous polyposis (FAP)
- Hereditary nonpolyposis colorectal cancer (HNPCC)
- Infection
- Helicobacter pylori, Streptococcus bovis, HPV
- Smoking, heavy ETOH, lack of exercise, high fat, low fiber diet
- Inflammatory bowel disease
Colorectal cancer symptoms
- Rectal bleeding, anemia, change in stool consistency/shape
- Fatigue, abdominal fullness, vague abdominal pain, unintentional weight loss
Colorectal cancer; Stage 1
tumor invades up to muscle layer
Colorectal cancer: Stage 2
tumor invades up to other organs or perforates peritoneum
Colorectal cancer: Stage 3
any level of tumor invasion, up to 4 regional lymph nodes
Colorectal cancer: Stage 4
any level of tumor invasion; many lymph nodes affected with distant metastasis
Colorectal cancer: Treatment
Chemotherapy
FOLFOX
- FOL: leucovorin (LV) (folinic acid) (increase the effectiveness of 5-FU)
- F: 5-fluorouracil (5-FU) (only in system for short time),
- OX: oxaliplatin (Eloxatin)
Antiangiogenesis
- Bevacizumab (Avastin)
Epidermal growth factor receptor inhibitor (EGFRI)
- cetuximab (Erbitux)
- panitumumab (Vectibix)
Colostomy types: Ascending
- done for right sided tumors
Colostomy Types: Transverse (double-barreled)
- intestinal obstruction or perforation
- The proximal one, closes to the small intestine: drains feces
- The distal stoma drains mucus
Colostomy types: Descending
- Done for left sided tumors
Colostomy types: Sigmoid
- Done for rectal tumors
Colostomy care
- Pink, moist, blood flow is present, not blue
- Goal for assessment, skin around stoma is very fragile because the acidity of the drainage can leak around it
- Soap and water to wash the drainage off.
- Don’t let bag get completely full
Abdominal trauma: Liver
Most common organ injured in penetrating trauma
2nd most common in blunt trauma
Abdominal trauma: Liver assessment
Inspection for ecchymosis
Abdominal CT scan
Grade I - VI
Abdominal trauma: Liver Treatment and nursing interventions
Treatment
- Stable: non-operative management
- Unstable- surgical repair
Nursing interventions
- Monitor for signs of hemorrhage
- Monitor response to treatment
Abdominal trauma: Spleen
Most common organ injured in blunt trauma
Abdominal trauma: Spleen assessment
- Abdominal CT scan
- Grade I - V
Abdominal trauma: Spleen Treatment and nursing interventions
Treatament
Stable: Medical management
Unstable: Surgical intervention
Nursing interventions
Monitor for signs of hemorrhage
Abdominal trauma: Intestinal injuries diagnostics
FAST, CT scan of abdomen or DPL
- Free fluid
- Free air
- Mesenteric hematoma
- FAST (Focused assessment sonogram for trauma) looking for type of blood or perforation that is occurring
- DPL (Peritoneal lavage) looking for blood
Abdominal perfusion pressure (APP) calculation and normal range
- APP= MAP-IAP
- Should be maintained at more than 50-60 mmHg to
maintain adequate perfusion.
