Exam #3 Upper and Lower GI Pt.1 Flashcards
Stomatitis
- Inflammation in the oral cavity
- Painful, red ulcerations
- Ex: Canker sore, cold sore, herpes
Causes:
- Recent infections
- Nutrition changes
- Oral hygiene
- Trauma
- Stress
Stomatitis S/S & Interventions
- Dysphagia
- Blisters
- Drooling, pain, swelling
- Fever
- Red patches
Interventions:
- Oral hygiene, clotrimazole, nyastin, chlorhexidine, cool or cold liquids, high protein, vit c
Meds: Viscous lidocaine, aluminum hydroxide
Leukoplakia
- Thickened, white, firmly attached patches on the oral mucosa that cannot be easily scraped off
Erythroplakia
- Percutaneous, appear red, velvety mucosal lesions on the floor of mouth, tongue and palate
Sialadenitis
- A salivary gland infection: Causes inflammation
Causes: bacteria, viruses, salivary stone/ blockage, chronic inflammation, ionizing radiation to head/ neck
Treatment: offering fluids every hour, moist heat, massage, NSAIDS, Antibiotics
- If untreated an abscess can develop
GERD Risk Factors
- GERD is when the acid from the stomach comes all the way up to the esophagus.
Risk: - Certain meds
- Smoking
- Alcohol
- Pregnancy
- Obesity
- Hiatal hernia
GERD S/S
- Dyspepsia
- Morning hoarseness
- Coughing, wheezing at night
- Difficult, painful when swallowing
- Worse pain when laying down
- Abdominal fullness, nausea, flatulence
- Pain can mimic cardiac pain ( epigastric )
GERD Interventions
- Antacids, histamine blockers, PPI
- Diet; small, frequent meals, limit fried and fatty foods
- Surgery
- Sitting upright for at least 1 hour after eating!!!
GERD Complications
- Adult onset asthma
- Esophagitis ( Inflammation of the esophagus )
- Stricture ( Narrowing of the esophagus )
- Barrett’s Esophagus ( pre-cancerous changes to the esophagus )
- Regurgitation of acid into lungs
- Ulcers / bleeding
Barrett Esophagus
Reversible changes of the esophageal mucosa to columnar type because of chronic exposure to gastric secretions
- Wider opening
- Metaplasia can become dysplasia
- Complication of GERD
S/S:
- Often asymptomatic
- Heartburn, regurgitation
Treatment:
- Aggressive medications and surgery treatment of GERD
- Biopsies
Hiatal Hernia
Herniation of the stomach through the esophageal hiatus of the diaphragm
- Diagnosis: By barium swallow study with fluoroscopy
Hiatal Hernia S/S
- Some asymtomatic
- Some GERD symptoms like heartburn
- Epigastric distress
- Sour / acidic taste in throat
- Symptoms increase after a meal / laying down
Hiatal Hernia Treatment
- PPI/ antacids
- Less fatty, fried foods
- Lifestyle changes
- Laparoscopic Nissen Fundolplication ( LNF ) stomach fundus is wrapped around the distal esophagus. The wrap anchors the lower esophagus below the diaphragm
Esophageal Tumors
S/S: Dysphagia, weight loss, heartburn, dry cough
Treatment: Small, frequent meal, high cal, high protein diet, no fatty foods, monitor weight
Surgical: Esophagectomy
Esophageal Perforation
- Tear/ rupture creates hole through the esophageal layers
Causes: Foreign body, trauma, infection, forceful vomiting
S/S: PAIN, crepitus, systemic infection/ sepsis, hematemesis ( Mallory Weiss Tear ) … tear in the mucosal layer at the junction of the esophagus and stomach
Treatment: NPO, stent, surgery
Gastritis
-Inflammation of the lining of the stomach
- Can be acute / chronic
Causes:
- H. Pylori, NSAIDS, Alcohol, Caffeine and Coffee, Cigarette smoking
S/S:
- N/V, abdominal pain
Diagnosis:
- EGD via endoscope
Interventions:
- Limit foods and spices that causes distress, avoid alcohol, caffeine, H2 Receptors, PPI, Antacids, Vit B12
Peptic Ulcer Disease
- Increased gastric acid secretion or a weakened mucosal barrier leads to mucosal erosion or ulceration
Causes: - H.Pylori, NSAID, Smoking, Alcohol use, drug use, high stress
S/S: - Epigastric tenderness/ pain, rigid board like abdomen with rebound tenderness and pain, dyspepsia, heartburn, sharp pain
Diagnosis: - Testing for H.Pylori, stool antigen test
Complications: - Hemorrhage
- Perforation
- Pyloric obstruction
- Intractable disease
Interventions: - Triple Therapy:
PPI, Metronidiazole and tetracyline or clafithromycin and amoxicllin for 10-14 day - Quadruple Therapy: PPI, 2 antibiotics and bismuth therapy
- Bland diet, stress reduction, smoking cessation
Antibiotics:
Amoxicillian, Bismuth, Clarithromycin, Metronidazole, Tetracyline, Tinidazole
- Eradification of H.Pylori
- Combo of 2-3 antibiotics for 14 days
- N/V/D is common
- Take full course
H2 Receptor Antaganists:
Ranitidine, Cimedtidine
MOA:Block H2 receptors, suppression of gastric acid.
Uses: GERD, Ulcers, acid indigestion
Comp: Cimetidine, Ranitidine, dont take with antacids
Cont: High risk for COPD, decrease dose in kidney disease
Education: Monitor for occult GI bleed, avoid alcohol, increase fiber
Proton Pump Inihibitors ( PPI )
Omeprazole
MOA: Block the gastric proton pump
Uses: GERD- Limit treatment to 4-8 weeks
Comp: Headache, N/V/D
Inter: Digoxin, decreased effects with clopidogrel
Education: Do not crush, break, chew, take in morning on empty stomach, treats ulcers for 4-6 weeks, monitor for coffee ground emesis
Mucosal Protectant
Sucralfate
MOA: Protective barrier that adheres to an ulcer.
Uses: Duodenal ulcers
Comp: Absorbed and eliminated in feces, can cause constipation
Cont: Caution in CKD. DM
Education: Take 1 hour prior to meals, dissolve in water
Antacids
Aluminum Hydroxide, Mag, Calcium Carbonate
MOA: Neutralize/ reduce acidity of gastric acid
Comp: Al and Calcium = Constipation, mag = diarrhea
Education: Drink at least 8 ounces of water, NO MILK, take all meds at least one hour prior before antacid
Gastric Cancer Risk Factors
- Age
- Diet
- Atrophic gastris
- H.Pylori
Gastric Cancer S/S
- May be asymptomatic if early stage
- Abdominal discomfort
- Anemia is present in advanced stage
( Macrocytic, Microcytic anemia )
