Exam #4 Additional GI Flashcards
What is Roux-en-Y bypass?
Gastric bypass surgery. A small pouch created by stapling - causing pt to feel full fast. Small section of small intestine attached to pouch to allow food to bypass lower stomach and duodenum
What is a vertical banded gastroplasty?
Small pouch made with a staple line and mesh band placed around the pouch. Band slows food flow from the stomach pouch, causing feeling of fullness
What are some complications of a vertical band gastroplasty?
Erosion of tissue around the band and vomiting from overeating
What are the 2 types of hiatal hernias?
Sliding and rolling
What is a sliding hiatal hernia?
Stomach slides up into the thoracic cavity through the diaphragm when a pt is supine then goes back into the abdominal cavity when pt is upright
What is a rolling hiatal hernia?
Only 1% are this type, part of the stomach moves through the diaphragm and sits alongside the esophagus
When does a hiatal hernia become a life-threatening emergency and what is this condition called?
Can cause twisting of the intestines or stomach which is called a volvulus
What is a Nissen Fundiplication?
The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce heartburn due to acid reflex
When is the Nissen Fundiplication performed?
If the pt experiences: severe heartburn; Severe inflammation of the esophagus due to the blackflow of gastric fluids (reflex); Narrowing of the esophagus due to acid damage (esophageal stricture); Chronic inflammation of the lungs (pneumonia) due to frequent breathing in (aspiration) of gastric fluids; Para-esophageal hernia
What is a para-esophageal hernia?
A hiatal hernia that raises the risk of the stomach getting stuck in the chest or twisting on itself
What causes esophageal varices?
Portal hypertension
What can cause esophageal varices to burst and cause severe bleeding?
These vein walls are thin and can rupture easily by coughing, vomiting, lifting, or straining
What is portal hypertension?
Persistent elevation in the BP in the portal circulation of the abdomen. Liver damage causes the blockage of blood flow in the portal vein. This increased resistance causes the vein in the walls of the esophagus to dilate
Sucralfate (Carafate) can heal an active ulcer, but what CAN’T it do?
Prevent a new ulcer from forming
What part of the stomach is removed in either Bilroth surgery, proximal or distal?
Distal
Name 2 major complications of gastric surgeries?
Nutritional problems and Dumping syndrome
What are some nutritional problems associated with gastric surgeries?
B12 & folic acid deficiencies (due to lack of intrinsic factor) and inadequate absorption of food
What is the treatment for nutritional problems associated with gastric surgeries?
NPO for 24-48hrs after surgery; IV fluids, possibly TPN if NPO for extended period; Introduce food slowly (clear liquids to start)
Those with pernicious anemia must have what type of injections for the rest of their lives?
B12 injections. Start out daily, then weekly, then monthly for life
In dumping syndrome what causes symptoms 5-30 minutes after eating and what are the symptoms?
Hypovolemia. Causes dizziness, tachycardia, fainting, sweating, nausea, diarrhea, and abdominal cramping. Also causes blood sugar to rise and pancreas responds by releasing insulin which could cause a hypoglycemic reaction an hour or 2 later
What happens in dumping syndrome?
Rapid entry of food into the jejunum without mixing with digestive juices. Food draws in fluid from the blood volume to dilute the high concentrations of sugar and electrolytes. The rapid shift is what causes the symptoms 5-30 min after eating
What is the treatment for dumping syndrome?
Eat small, frequent meals high in protein and low in fat and CHO; Avoid drinking fluids for 1hr before, with, or 2hrs after a meal to prevent the rapid gastric emptying; Lie down after a meal to slow gastric emptying
What is a perforated ulcer?
Gastroduodenal contents spill into peritoneal cavity which can result in peritonitis, septicemia, and hypovolemic shock
What is the action of dicyclomine (Bentyl) and what does it treat?
It relieves spasms of the muscles in the stomach and intestines by blocking the actions of certain chemicals in the body. Used to treat functional bowel or irritable bowel syndrome
What is the action of tegaserod (Zelnorm)?
Increases the action of a chemical called serotonin in the intestines. This speeds the movement of stools through the bowels
What is tegaserod (Zelnorm) used to treat?
For chronic constipation associated with irritable bowel syndrome in those 55 and younger. Pulled from the market in 2007 but still used in emergencies now.
What is the man-made protein involved in the immune system and what disease process is it used for?
Interferon used for hepatitis
What is the action of interferon?
Stimulates immune cells to destroy the cells that have become infected with viruses or cancer
What kind of pain is felt in acute pancreatitis?
Quite intense and steady, in the upper abdomen and radiates to the pt’s back ( major symptom)
Name some other symptoms, besides pain, that are associated with acute pancreatitis.
N/V, abdominal swelling are common symptoms. Often they will have a slight fever, with an increased HR and low BP
What occurs in pancreatitis?
Enzymes become prematurely activated so that they actually begin their digestive functions within the pancreas. The pancreas begins to digest itself which results in bleeding caused by the digested blood vessels. Other active pancreatic chemicals cause blood vessels to leak fluid into the abdominal cavity. The activated enzymes also gain access to the bloodstream through leaky, eroded blood vessels, and begin circulating throughout the body
What occurs in shock ( a complication of acute pancreatitis)?
The BP is too low to get adequate circulation to critical organs. Without this, organs are deprived of oxygen, nutrients, and waste removal and may not function well
What are some possible serious outcomes of shock associated with acute pancreatitis?
Kidney, respiratory, and heart failure
What can occur even if shock doesn’t occur in acute pancreatitis?
Circulating pancreatic enzymes and related toxins can cause damage to the hear, lungs, kidneys, lining of the GI tract, liver, eyes, bones, and skin
What can occur as the result of blocked blood flow due to pancreatic enzymes creating blood clots?
The supply of oxygen is further decreased to various organs and additional damage done
What are some other complications of acute pancreatitis?
Pancreatic necrosis, abscess, and pseudocyst formation
What is pancreatic necrosis and what other risks are associated with it?
Occurs when a significant portion of the pancreas is permanently damaged during an acute attack. Increased risk of death and an increased chance of pancreatic infection
What is a pancreatic abscess?
A local collection of pus that may develop several weeks after the illness subsides
What is a pancreatic pseudocyst?
Occurs when dead pancreatic tissue, blood, WBCs, enzymes, and fluid leaked from the circulatory system accumulate. Causes recurrent abdominal pain and also presses on the GI tract, causing disruption of function
When are pancreatic pseudocysts life threatening?
When they become infected (abscess) and rupture
What is DIC?
Generalized bleeding can occur as a result of clotting factors that are consumed at excessive rate
What is a test performed primarily to diagnose or monitor diseases of the pancreas and also some digestive tract problems?
Amylase
What is amylase?
An enzyme that helps digest glycogen and starch
Where in the body is amylase produced?
Mainly in the salivary glands and pancreas
What occurs with amylase when the pancreas is diseased or inflamed?
It escapes into the blood
What is a test that is performed to evaluate pancreatic function?
Lipase
What is lipase?
An enzyme secreted by the pancreas into the small intestines. It starts the breakdown of triglycerides into fatty acids
What occurs with lipase in a damaged pancreas?
It appears in the blood
What is chronic pancreatitis?
Swelling (inflammation) of the pancreas that leads to scarring and loss of function
Where is the pancreas located and what hormones are produced by it?
Located behind that stomach and produces chemicals needed to digest food. It produces the hormones insulin and glucagon.
What occurs in chronic pancreatitis?
Because of the inflammation and scarring of pancreatic tissue it is unable to produce the right amount of enzymes needed to digest fat. It also interferes with insulin production leading to diabetes
Alcoholism and alcohol abuse most often cause chronic pancreatitis, what are some other causes?
Genetics, chronic blockage of the pancreatic duct, injury, hyperlipidemia, and hyperparathyroidism
Does chronic pancreatitis occur more often in men or women?
Men because alcohol-use disorders are more common in men
List some s/s of chronic pancreatitis.
Abdominal pain, digestive problems, fatty stools, N/V, pale and clay-colored stools, and unintentional weight loss
What might relieve the abdominal pain of pancreatitis?
Sitting up and leaning forward
What might the symptoms of chronic pancreatitis mimic?
Pancreatic cancer
Describe the abdominal pain of chronic pancreatitis.
Greatest in the upper abdomen; May last from hours to days; Eventually may be continuous; May be worsened by drinking, eating or drinking alcohol; May radiate to the back
What drug group is ranitidine (Zantac) in?
Histamine-2 blockers
What is the action of ranitidine (Zantac)?
Works by reducing the amount of acid your stomach produces
What does ranitidine (Zantac) treat?
Used to treat and prevent ulcers in the stomach and intestines; Zollinger-Ellison syndrome (condition in which the stomach produces too much acid); GERD (acid backs up from the stomach into the esophagus, causing heartburn)
What is the action of omeprazole (Prilosec)?
Decreases the amount of acid produced in the stomach
What is omeprazole (Prilosec) given together with to treat gastric ulcers caused by an infection with H. pylori?
An antibiotic
What is omeprazole (Prilosec) used to treat?
Symptoms of GERD and other conditions caused by excess stomach acid; Used to promote healing of erosive esohagitis
What is erosive esophagitis?
Damage to your esophagus caused by stomach acid
What is the primary class of drugs used for gastric acid suppression?
The proton pump inhibitors, omeprazole, lansoprazole, pantoprazole, and rabeprazole
What drug class is used for maintenance of gastric acid suppression after treated with the proton pump inhibitors?
H-2 receptor blocking agents, cimetidine, famotidine, nizatidine, and rantidine
When is sucralfate indicated in the treatment of gastric ulcers?
For patients in whom other classes of drugs are not indicated, or those whose gastric ulcers are caused by NSAIDs rather than H. pylori infections
What is the action of sucralfate?
Acts by forming a protective coating over the ulcerate lesion
When should you not use tegaserod (Zelnorm)?
Allergy, hx of stroke or heart attack, untreated or uncontrolled angina (chest pain), high BP, high cholesterol or triglycerides, diabetes, depression or anxiety, smokers, are older than 55 years, are overweight, and have a hx of suicidal thoughts or actions
Who gets hiatal hernias?
Women, > 60 years old, obese, and pregnant
What are the s/s of hiatal hernias?
None, pain, heartburn, fullness, and reflux
What are some therapeutic interventions for hiatal hernias?
Antacids (Tums, Mylanta), H2 receptor antagonists (Zantac, tagamet); Small meals; No reclining 1hr after eating; Raise HOB 6-12in; No bedtime snacks, spicy foods, alcohol, caffeine, smoking
Why don’t you want to eat spicy foods, drink alcohol or caffeine, and smoking with a hiatal hernia?
These things relax the cardiac sphincter
What do you need to assess after a pt has a Nissen Fundiplication?
Assess for dysphagia which is indicative of repair being too tight
What is the pathophysiology of GERD?
Gastric secretions reflux into esophagus; Esophagus damaged; Lower esophageal sphincter does not close tightly
What are the s/s of GERD?
Heartburn, regurgitation, dysphagia, and bleeding
What are some complications of GERD?
Aspiration, scar tissue, and Barrett’s esophagus
What is Barrett’s esophagus and what must be done?
Pre-cancerous cells. Must have endoscopy q6mos if cell changes are detected
How is GERD diagnosed?
Barium swallow and Esophgoscopy
What are some therapeutic interventions for GERD?
Lifestyle changes, Fundoplication and medications
What medications are given for GERD?
Antacids (Tums, Mylanta), H2 receptor antagonists (Zantac, Axid, Pepcid) and Proton Pump Inhibitors (Prevacid, Protonix, Prilosec, Nexium)
What do proton pump inhibitors (PPIs) do?
Block gastric acid secretion
What do H2 blockers do?
Decrease gastric acid secretion by blocking histamine receptors on the gastric parietal cells
List a few nursing diagnoses for GERD.
Acute pain; Sleep pattern, disturbed; Risk for aspiration
What are some purposes of gastrointestinal intubation?
Decompresses the stomach, lavage the stomach, dx GI disorders, administer meds and feeding, to treat an obstruction, to compress a bleeding site, and to aspirate gastric contents for analysis
What are some s/s of cholelithiasis?
May have none or minimal symptoms and may be acute or chronic. Epigastric distress, acute symptoms, biliary colic and jaundice
What is epigastric distress?
Fullness, abdominal distention, vague URQ pain
When might epigastric distress occur in cholelithiasis?
Distress may occur after eating a fatty meal
When will acute symptoms occur in cholelithiasis?
With an obstruction and inflammation or infection
Why does jaundice develop in cholelithiasis?
Develops due to blockage of the common bile duct
What are the acute symptoms of cholelithiasis?
Fever, palpable abdominal mass, severe right abdominal pain that radiates to the back or right shoulder, and N/V
What is biliary colic?
Episodes of severe pain usually associated with N/V
When does biliary colic usually occur?
Several hours after a heavy meal
What is the medical management of cholelithiasis?
Cholecystectomy, Laparoscopic cholecystectomy, dietary management, meds (ursodeoxycholic acid and chenodeoxycholic acid) and nonsurgical removal (by instrumentation and intracorporeal or extracorporeal lithotripsy)
What are they nonsurgical techniques for removing gallstones?
T-tube to remove stone; Removal of stone with basket to catheter threaded through T-tube tract; ERCP endoscope inserted into duodenum; Papillotome inserted into common bile duct; Enlarging opening of sphincter of Oddi; Retrieval and removal of stone with basket inserted through endoscope
What assessments need done after gallbladder surgery?
Pt hx; Knowledge and teaching needs; Respiratory status; Nutritional status; Monitor for potential bleeding; GI symptoms
What GI symptoms do you need to assess for after laparoscopic gallbladder surgery?
Loss of appetite, vomiting, pain, distention, fever, potential infection or disruption of GI tract
List some nursing diagnoses after gallbladder surgery.
Acute pain; Impaired gas exchange; Impaired skin integrity; Imbalanced nutrition; Deficient knowledge
What are some potential complications with gallbladder surgery?
Bleeding; GI symptoms; Atelectasis, thrombophlebitis
List some post-op interventions related to gallbladder surgery.
Low Fowler’s position; May have NG; NPO until bowel sounds return, then a soft, low-fat, high-carb diet; Care of biliary drainage system; Administer analgesics; TCDB is encouraged; Ambulation
What signs do you teach the patient to report after gallbladder surgery?
Changes in color of stool or urine, fever, unrelieved or increased pain, N/V, and redness/edema/signs of infection at incision site
Define Diverticulosis
Multiple diverticula without inflammation
Define Diverticulum
Sac-like herniations of the lining of the bowel that extend through a defect in the muscle layer
Where do diverticulum occur?
Anywhere in the intestines but are most common in the sigmoid colon
Define Diverticulitis
Infection and inflammation of diverticula
What are the risk factors with Diverticular disease?
Increased with age and associated with a low-fiber diet
How is Diverticular disease diagnosed?
By colonoscopy
What are some potential complications with Diverticulum disease?
Perforation, peritonitis, abscess formation, and bleeding
How do you maintain normal elimination pattern with diverticulum disease?
Fluid intake of at least 2L/day; Soft foods with increased fiber, such as cooked vegetables; Individualized exercise program; Bulk laxatives (psyllium) and stool softeners
