gastric cancer

Question 1

risk factors for gastric cancer

Answer 1

diet 
chronic inflammation wi H. pylori infection 
pernicious anemia 
smoking 
achlorhydria 
gastric ulcers 
previous subtotal gastrectomy 
genetics

Question 2

manifestations of gastric cancer

Answer 2

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

Question 3

diet that increases risk for gastric cancer

Answer 3

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

Question 4

genetic risk factors for gastric cancer

Answer 4

type a blood group
pernicious anemia
BRACA 2 gene

Question 5

surgeries for gastric cancer

Answer 5

endoscopic resection

sub total gastrectomy (lower part of stomach) some time duodenum

Question 6

total gastrectomy

Answer 6

removes entire stomach, near by lymph nodes, omentum, remove pancreas, intestines, and other near by organs

Question 7

nis total gastrectomy

Answer 7

end of esophagus is attached to small intestine, eat small amounts frequently

Question 8

medical management of gastric cancer

Answer 8

cure could be achieved if the tumor is localized 
5-flourourical 
mitomycin
doxorubicin 
cisplatin

Question 9

when there is a total gastrectomy what connects to the pancreas

Answer 9

piece of a small intestine

Question 10

promoting optimal nutrition

Answer 10

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

Question 11

other ways to support nutrition

Answer 11

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

Question 12

nis for gastric retention

Answer 12

npo, ng with low pressure suction

Question 13

bile reflux

Answer 13

agents that bind with bile acid (cholestyramine)

Question 14

malabsorption of vitamins and minerals

Answer 14

supplement iron

give b12 because of lack of intrinsic factor in stomach wall

Question 15

what is dumping syndrome

Answer 15

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

Question 16

nis for steatorrhea

Answer 16

reduce fat intake and administer loperamide

Question 17

why high fiber diet for dumping syndrome?

Answer 17

slows movement of bowels by bulking bowel movements (monitor for gas pain)

Question 18

early dumping syndrome

Answer 18

30-60 minutes
releases glucose modulating hormones
vasomotor palpitations, tachycardia, flushing, hypotension, perspiration, syncope
gi symptoms- abdominal pain, borborygmi, bloating, nausea

Question 19

late dumping syndrome

Answer 19

60-180 minutes
autonomic, andrengeric response, tremors, perspiration, aggression
neuroglycopenic- fatigue, weakness, confusion, hunger, syncope

Question 20

patho of early dumping syndrome

Answer 20

insulin, glucagon, rapid release of nutrients in jejunum

Question 21

patho of late dumping syndrome

Answer 21

impaired gastric volume capacity- rapid absorption of glucose and exaggerated insulin release

Question 22

dietary self management for syndrome

Answer 22

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

Question 23

whats a whipple or pancreaticoduodenoctomy

Answer 23

remove head of the pancreas, part of small intestine, gallbladder and part of the bile duct, stomach and intestines are still reconnected

Question 24

post op whipple what is the client at risk for

Answer 24

high risk for infection and bleeding

client may have nausea and vomiting due to delayed stomach emptying or dumping syndrome

Question 25

exocrine cells

Answer 25

release fluids into the pancreatic ducts

Question 26

endocrine cells

Answer 26

release hormones and insulin, controls blood sugar

Question 27

major complications of a whipple procedure include

Answer 27

hemorrhage
hypovolemic shock
hepatorenal failure

Question 28

nutritional complications during whipple procedure

Answer 28

gastroparesis 
dumping syndrome 
fat mal-absorption 
diabetes 
nutrient deficiences