gastric cancer Flashcards
risk factors for gastric cancer
diet chronic inflammation wi H. pylori infection pernicious anemia smoking achlorhydria gastric ulcers previous subtotal gastrectomy genetics
manifestations of gastric cancer
pain *relieved* by antacids dyspepsia early safety weight loss abdominal pain loss or decrease in appetite bloating, nausea, vomiting after meals dx of disease is usually late
diet that increases risk for gastric cancer
high salt consumption high nitrate consumption smoked salt and cured foods poor refrigeration diet low in vit a and c smoking and heavy etoh consumption
genetic risk factors for gastric cancer
type a blood group
pernicious anemia
BRACA 2 gene
surgeries for gastric cancer
endoscopic resection
sub total gastrectomy (lower part of stomach) some time duodenum
total gastrectomy
removes entire stomach, near by lymph nodes, omentum, remove pancreas, intestines, and other near by organs
nis total gastrectomy
end of esophagus is attached to small intestine, eat small amounts frequently
medical management of gastric cancer
cure could be achieved if the tumor is localized 5-flourourical mitomycin doxorubicin cisplatin
when there is a total gastrectomy what connects to the pancreas
piece of a small intestine
promoting optimal nutrition
encourage patient to eat small frequent meals, high in calories, vit a and c, iron enhances tissue repair
provided parental nutrition before surgery
j tube may be inserted post op
other ways to support nutrition
small frequent non irritating foods
a c and iron
diet edu for potential dumping syndrome
six small feedings low in carbs, sugar, fluids between not with meals
nis for gastric retention
npo, ng with low pressure suction
bile reflux
agents that bind with bile acid (cholestyramine)
malabsorption of vitamins and minerals
supplement iron
give b12 because of lack of intrinsic factor in stomach wall
what is dumping syndrome
rapid passing of food into jejunum and drawing of fluid caused by hypertonic intestinal contents
vasomotor and gi symptoms with reactive hypoglycemia
high fiber high protein
avoid carbs and sugar intake
nis for steatorrhea
reduce fat intake and administer loperamide
why high fiber diet for dumping syndrome?
slows movement of bowels by bulking bowel movements (monitor for gas pain)
early dumping syndrome
30-60 minutes
releases glucose modulating hormones
vasomotor palpitations, tachycardia, flushing, hypotension, perspiration, syncope
gi symptoms- abdominal pain, borborygmi, bloating, nausea
late dumping syndrome
60-180 minutes
autonomic, andrengeric response, tremors, perspiration, aggression
neuroglycopenic- fatigue, weakness, confusion, hunger, syncope
patho of early dumping syndrome
insulin, glucagon, rapid release of nutrients in jejunum
patho of late dumping syndrome
impaired gastric volume capacity- rapid absorption of glucose and exaggerated insulin release
dietary self management for syndrome
semi fowlers for 20-30 minutes after meal
take antispasmotics as prescribed
avoid fluids with meals or 30 minutes after
dry items high protein high fiber
eat fat as tolerated but keep carbs intake low and avoid concentrated carbohydrates
small frequent meals
dietary supplements, vitamins, medium chain triglycerides, b12 injections
whats a whipple or pancreaticoduodenoctomy
remove head of the pancreas, part of small intestine, gallbladder and part of the bile duct, stomach and intestines are still reconnected
post op whipple what is the client at risk for
high risk for infection and bleeding
client may have nausea and vomiting due to delayed stomach emptying or dumping syndrome
