Gastric and Duodenal Disorders Flashcards
What are the 3 most commonly seen Gastric and Duodenal Disorders?
Peptic Ulcer Disease (PUD)
Dumping Syndrome
Cholelithiasis
GI bleeding is one of the most serious complications of ulcers and this is caused by an ulcer eroding down into a blood vessel. This is a major complication related to what gastrointestinal disorder?
Peptic Ulcer Disease (PUD)
Vomiting fresh bright blood
Passing bloody or tarry black stools
These are the clinical manifestations of what gastrointestinal disorder?
Peptic Ulcer Disease
When a patient with peptic ulcer disease is vomiting fresh bright blood or passing fresh bright blood in stools what does that mean?
When the nurse sees a patient vomiting fresh bright blood the nurse will know that there is new bleeding going on in the upper GI tract.
When the nurse sees a patient passing bright blood in the stools the nurse will know that the bleeding is lower down in the GI tract.
When a patient with peptic ulcer disease is passing a tarry black stool what does that mean?
If the stool is tarry black, the blood has been in there a while and is probably coming from a bleed that is occurring up higher in the GI tract.
_________ is a very serious complication that occurs if a peptic ulcer erodes through the entire wall of the stomach and opens into the abdominal cavity. This will cause all of the stomach acids and the contents spill into the abdominal cavity.
Perforation
Sometimes people are not healthy enough for surgery so we have the following procedures for treatment:
Oral bile acids are given to decrease cholesterol production and lowers the content of bile so it facilitates disillusion of the gallstones. This makes them dissolve. takes quite a while for this to happen-like months; we need to know that it can be treated medically.
cholecystectomy
What is the first sign to the nurse that peptic ulcer perforation has occurred?
1st sign of perforation is sudden intense steady abdominal pain
Study Tip: Think about all those highly acidic gastric contents leaking into the peritoneal cavity this will cause the patient to have a sudden onset of extreme abdominal pain.
Why will the patient with the gastric ulcer have weight loss. Why?
Because the food makes the pain worse so patient avoids eating. There will be burning in the left epigastric area. The ulcer would be located left of the midline. There is no pain at bedtime with this type of ulcer.
How can a nurse tell the difference between the patient with a duodenal ulcer and a gastric ulcer?
The timing of the symptoms. A GASTRIC ulcer would give epigastric pain DURING the meal, as gastric acid production is increased because of food entering the stomach. Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes tightly to concentrate the stomach contents, therefore acid is not reaching the duodenum. DUODENAL ulcer pain would manifest mostly 2–3 hours AFTER the meal when the stomach begins to release digested food and acid into the duodenum.
Highly acidic gastric contents leak into the peritoneal cavity after a _________ caused by a peptic ulcer this will cause the patient to have a sudden onset of extreme abdominal pain, any movement makes the pain worse and their stomach will become rigid, hard, and board-like.
perforation
Study Tip: If you see these manifestations you need to think that there is a perforation from an ulcer and emergency surgery is usually the treatment for this complication.
Weight gain
Pain at Hour of Sleep in the High Epigastric area
Burning cramping and mid Epigastric pain
Pain 2-4 hrs after a meal
Eating decreases pain
Melena seen in the elderly
These are the signs and symptoms of what type of ulcer?
Duodenal Ulcer
Study Tip: Melena is black tarry stools
Stress or drug induced ulcers are _________.
Asymptomatic
Weight loss
Burning Pain in the Left Epigastric area
Eating food makes pain worse
No pain at their hour of sleep
These are the signs and symptoms of what type of ulcer?
Gastric Ulcer
Why will the patient with the duodenal ulcer have weight gain? Where will their pain be located?
With duodenal ulcers they will have right epigastric pain at HS that is where the duodenum is pain is decreased by eating and they have weight gain; they have an ulcer in the duodenum and there is gastric secretions (rest and digest) there are gastric secretions being excreted and they drip into the duodenum and they are landing on that duodenal ulcer causing pain; so they will eat because it will help neutralize some of those secretions to make them less acidic to make it less painful so people with a duodenal ulcer will show a weight gain.
Eliminate foods that cause the symptoms. The diet will be highly individualized. These are the nursing interventions for what gastrointestinal disorder?
Peptic Ulcer Disease
Study Tip: The food that causes problems with some people will not be the same for others.
_________ react with gastric acid and neutralize the acid. This therapeutic classification of medication inactivates pepsid and enhances mucosal protection but does NOT coat the ulcer crater or protect it from acid and pepsid. What medication has this mode of action?
Antacids / Mucosal Protective Medications
There is really NO evidence that bland or soft diets ________ gastric acids or promote healing but they can just say to ______ alcohol, coffee and other beverages that contain caffeine because they can further erode the mucosal lining.
Reduce
Avoid
________ medication is used to treat peptic ulcer disease and GERD. This medication should be taken on a regular schedule NOT PRN so some are ordered to be taken 7x a day. These medications are taken 1 hour before and 3 hours after each meal and at bedtime.
What medication has this nursing intervention?
Antacids / Mucosal Protective Medications
_______ can decrease the exacerbation of symptoms of peptic ulcer disease.
Weight loss
If this medication is given in tablets they need to be chewed thoroughly and followed with water. With the liquid form of the medication there is some prep and they do have to be shaken they do settle out.
What medication has this nursing intervention?
Antacids / Mucosal Protective Medications
What are the 4 most common therapeutic classifications of medications that are used to treat Peptic Ulcer Disease?
H2 antagonists
Proton pump inhibitors
Anti-infectives
Bismuth
Study Tip: Bismuth is the stuff that is in Pepto-Bismol.
These medications can interact with other medications so we have to allow an hour between antacids administrations and any other medications. This is really important to remember because people will be combining these medications with over the counter meds and they are going to be taking them so they really need to know that.
What medication has this nursing intervention?
Antacids / Mucosal Protective Medications
________ medication coats the stomach with a protective barrier against acid and pepsid.
Sulcralfate (Carafate)
This medication can interfere with the action of Karophate or Sucralfate and the nurse will want to administer these medications an hour apart from each other.
What medication has this nursing intervention?
Antacids / Mucosal Protective Medications
IMPORTANT: Look at everything that the patient is on so that we can schedule these meds to be given away from the other times of medications so we don’t cause any interactions.
Aluminum carbonate gel (Basaljel)
Aluminum hydroxide gel (Amphojel, Alu-Cap, Dialume): slow acting;
Bismuth subsalicylate (Pepto-Bismol)
Calcium carbonate (Tums)-can cause constipation which is a common side effect; if they are administered with milk or milk products or foods high in vit D it can cause REMEMBER:milk alkali syndrome: headache, urinary frequency, so we would want to stay away from that
Magnesium hydroxide (Milk of magnesia, MOM)
Misoprostol (Cytotec)
CHECK
This medication should be taken on an empty stomach, at least an hour apart from other antacids and it can cause constipation. It may also interfere with the absorption of Coumadin, Dilantin, Digoxin, and so those should be administered 2 hours apart.
What medication has this nursing intervention?
Sulcralfate (Carafate)
__________ is something that occurs to someone after they have had one of the GI surgical procedures to treat ulcers.
Dumping syndrome
Study Tip:
Ex. Vagotomy with antrectomy removing part of the stomach
Vagotomy with pyloroplasty
Parietal cell vagotomy (aka superselective or proximal gastric vagotomy)
Bilroth II
Very rapid onset. This medication promotes flatulence. This can cause systemic alkalosis. What medication has this nursing intervention?
Sodium Bicarbonate
Study Tip: This is baking soda it is IMPORTANT!
POST VAGOTOMY: the vagus nerve helps to regulates GI motility so if we cut the vagus nerve we can have some issues; ________ is most likely to happen after they have surgery that removes part or all of your stomach or it has been bypassed; also called rapid gastric emptying.
Dumping Syndrome
What bacteria that is known to cause ulcers? What therapeutic classification of medication treats this cause?
Helicobacter Pylori
If your patient eats something and they experience symptoms of this disorder soon after eating, or it can occur 1-3 hours after eating, but it is the most common and disabling post prandial syndrome observed after surgery for peptic ulcer disease. What is this GI disorder called?
Dumping Syndrome
Study Tip: it can be separated into early (right after eating) and late (1-3 hours after)
These are pretty old medications and a lot of them are available generically and are pretty cheap. What therapeutic classification of medication has this nursing intervention?
Antimicrobials
Symptoms are believed to be the result of rapid gastric emptying so you have all these stomach contents that are all of a sudden being dumped into the bowels; so the small bowel gets rapidly distended; the patient has an increase in the frequency of contractions and this causes diarrhea; this can also happen with rapid tube feedings if we haven’t given a person a chance to get used to it we can cause dumping even with healthy people giving them rapid tube feedings into the duodenum; they can be very unpleasant.
What GI disorder has these symptoms?
Dumping syndrome
Name the 4 medications that are given in conjunction with Bismuth or Pepto-Bismol that it usually cures the ulcers and people never have a problem again.
Amoxicillin (Amoxil)
Clarithromycin (Biaxin)
Metronidazole (Flagyl)
Tetracycline (Achromycin)
s/sx: weakness dizziness diaphoresis epigastric fullness tachycardia abdominal cramping What GI disorder has these symptoms?
Dumping syndrome
Vagotomy with antrectomy removing part of the stomach
Vagotomy with pyloroplasty
Parietal cell vagotomy (aka superselective or proximal gastric vagotomy)
Bilroth II
These are the surgical interventions to treat what GI disorder?
Ulcers
Study Tip: FYI > Not testable and this shows what each test does. You might see that these procedures have been done on a patient in the hospital.
Foods that are causes this disorder:
high carbs
high fluid
We regulate the types of food that people can eat; have them lie flat after they eat; they will not want to take a walk right after eating
What GI disorder has these nursing interventions?
Dumping syndrome
The nurse might have heard of the 5 F’s which are the people that are most likely to get this disease.
What GI disorder has these symptoms?
Cholecystitis
Weakness Dizziness Diaphoresis Epigastric fullness Tachycardia Abdominal cramping Self limited What GI disorder has these side effects?
Dumping syndrome
Study Tip: Occurs 15 mins after eating
_______is the irritation of the gallbladder.
cholelithiasis is actually gall stones.
Cholecystitis
NO FLUIDS WITH MEALS
NO SALT
NO HIGH CARBS EX. NO BREAD/POTATOES
What GI disorder has these nursing interventions?
Dumping syndrome
Symptoms: fever leukocytosis > elevated wbc count jaundice > the gallbladder and the liver are very close together and it there are gallstones or irritations that can obstruct the duct this will cause bile to build up. nausea/vomiting abdominal pain in the RUQ or epigastric What GI disorder has these symptoms?
Cholecystitis
_________ can cause bile to back up, can cause pancreatitis, if it is blocking and not allowing the digestive enzymes from the pancreas to enter into the duodenum
Cholelithiasis
Fever Leukocytosis Jaundice Nausea Vomiting Fat ingestion intolerance Feeling of fullness Abdominal dissension Abdominal pain > Right upper quadrant or Epigastric. May radiate to the back. Increased pain with a deep breath What GI disorder has these symptoms?
Cholecystitis
_________ are formed in the gallbladder, by accumulation of biological components > it could be cholesterol (which these are) or pigment stones which are small or dark and made of bilirubin and calcium.
Gallstones
The cystic duct leaving the gallbladder to join the hepatic duct to form the common bile duct; then you have the pancreas on the posterior side of the common bile duct and there is a pancreatic duct that is joining the common bile duct as it goes into the duodenum where a lot of the digestion takes place; so you can see how a stone in the gallbladder can get into that common bile duct or even into the pancreatic duct and cause blockages. What is this GI disorder called?
Cholelithiasis
REMEMBER
the pain can radiate to the back
deep breathing can make it worse
bad digestion intolerance > we can’t get the digestive enzymes in there to work so fat isn’t digested and this causes a feeling of abdominal fullness and abdominal distention
This can be acute or chronic
This is almost always associated with gall stones.
What GI disorder has these symptoms?
Cholecystitis
lab test: white blood cell count to look for infection,
ultrasound of the gallbladder will show the wall to be thickened
What GI disorder has these symptoms?
Cholelithiasis
The 5 F’s: Fair- someone with light skin, light hair, light eyes Flatulent Forty Female Fat What GI disorder has these symptoms?
Cholecystitis
Choledocholithiasis leads to jaundice, obstruction of the outlet of the pancreatic system and can lead to _________.
pancreatitis
Gallstones can occur anywhere in the biliary tree including the gallbladder and the common bile duct, when the duct becomes obstructed it is called _____________.
Choledocholithiasis
s/sx: pain in the upper abdominal region, suddenly increases, radiate to the back, it is rarely felt in the lower region of the stomach, n/v can occur.
What GI disorder has these symptoms?
Cholelithiasis
