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Adult Health Pt 2 > Gastric/Duodenal Disorders > Flashcards

Gastric/Duodenal Disorders Flashcards

1
Q

What is gastritis?

A

inflammation of the stomach mucosa

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2
Q

Acute Gastritis

A
  • viral/bacterial infections
  • food (spicy, contaminated)
  • lasts hours to days
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3
Q

Chronic Gastritis

A
  • long term
  • most common cause-H. Pylori
  • result of frequent acute attacks or continuing exposure to irritating agents
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4
Q

What is a common cause of peptic ulcers?

A

H. Pylori

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5
Q

Treatment for H. Pylori Bacteria

A
  • 10-14 days of double antibiotic therapy
  • proton pump inhibitor (long term)
  • bismuth salt (Pepto-Bismol)
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6
Q

S/S of Gastritis

A
  • abdominal pain/cramping
  • headache
  • bloating
  • lack of energy
  • N/V
  • anorexia
  • chronic belching/hiccupping
  • indigestion
  • sour taste in mouth
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7
Q

Acute Treatment for Gastritis

A
  • NPO for 24 hours w/ fluids
  • avoid alcohol while symptoms persist
  • bland soft diet
  • medication
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8
Q

Chronic Gastritis Treatment

A
  • dietary modifications
  • rest/stress reduction
  • avoid alcohol, smoking, NSAIDs
  • Tx for H. Pylori
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9
Q

Antibiotics for Gastritis

A
  • Amoxil (penicillin-based)
  • Flagyl (metronidazole)
  • Biaxin
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10
Q

H2 Antagonist for Gastritis

A
  • Zantac (ranitidine)

- Pepcid (famotidine)

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11
Q

Proton Pump Inhibitors for Gastritis

A
  • Prilosec (omeprazole)
  • Protonix (pantoprazole)
  • Nexium (esomeprazole)
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12
Q

Peptic Ulcer Disease (PUD)

A

A hollowed out area that forms in the mucosa of the:

  • stomach (Gastric)
  • intestines (most common) (Duodenal)
  • esophagus
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13
Q

Duodenal PUD

A
  • increase HCI
  • weight gain
  • pain 1-2 hrs after eating/during night
  • food helps pain
  • little to no vomiting
  • hemorrhage unlikely
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14
Q

Gastric PUD

A
  • normal to decreased HCI
  • weight loss
  • pain 1/2-1 hrs after eating/rarely at night
  • food makes worse
  • vomiting common and may help pain
  • hemorrhage common (hematemesis)
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15
Q

Risk Factors for Duodenal PUD

A
  • H. Pylori
  • alcohol
  • smoking
  • stress
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16
Q

Risk Factors for Gastric PUD

A
  • H. Pylori
  • gastritis
  • alcohol
  • smoking
  • stress
  • NSAIDs
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17
Q

S/S of PUD

A
  • may lasts weeks-months
  • dull knowing pain
  • burning in mid-epigastric area/back
  • food may help
  • heartburn
  • vomiting
  • diarrhea/constipation
  • melena
  • hematemesis
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18
Q

How is PUD diagnosed?

A
  • endoscopy

- barium swallow

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19
Q

Endoscopy

A
  • direct visualization of ulceration w/ or w/o bleeding
  • “bleeders” can be cauterized
  • biopsy
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20
Q

Pre-procedure for Endoscopy

A
  • consent
  • gown
  • remove dentures
  • NPO
  • patent IV
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21
Q

Intra-Procedure for Endoscopy

A
  • conscious sedation (Propofol)
  • short acting meds that caused decreased LOC and loss of memory
  • monitor for hypotension and respiratory depression
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22
Q

Post-procedure for Endoscopy

A
  • continuous pulse ox x 12 hours
  • assess neuro status q 2 hours then q 4
  • vital signs q 4 hours
  • assess for S/S of perforated esophagus
  • NPO until gag reflex returns
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23
Q

What to do for Hematemesis?

A
  • ensure patent airway
  • patent IV
  • NG tube
  • determine cause
24
Q

NG tubes for Hematemesis

A
  • remove blood from stomach

- iced saline lavage/saline lavage

25
Q

Saline Lavage

A

instillation and aspiration of iced saline solution through a NG tube to empty the stomach of blood and to slow the bleeding at its source

26
Q

Lifestyle Management

A
  • stop meds causing ulcers
  • rest
  • stress reduction
  • smoking/alcohol cessation
  • dietary modifications
27
Q

Dietary Modifications for Ulcers

A
  • avoid spicy, fried foods
  • limit milk/dairy
  • avoid alcohol and caffeine
  • eat 3 regular meals a day
28
Q

What is the most common complication of ulcers?

A

hemorrhage

29
Q

S/S of Hemorrhage

A
  • hematemesis-bright red or coffee ground color
  • melena-bright red or dark, tarry color
  • n/v
  • dizziness, confusion
  • hypotension
  • tachycardia
  • tachypnea
  • cool, pale skin
  • oliguria
30
Q

What should you monitor for Hemorrhage?

A
  • hemoglobin-F:12-16/M: 14-18
  • hematocrit-F:37-47/M:40-52
  • stools for occult blood
31
Q

Perforation

A

erosion of the ulcer through the wall of the stomach into the peritoneal cavity

32
Q

S/S of Perforation

A
  • sudden “knife-like” abdominal pain
  • tender, rigid abdomen
  • sudden vomiting
  • hypotension, tachycardia
  • extreme diaphoresis
33
Q

Penetration

A

erosion of the ulcer through the wall of the stomach into adjacent structures/organs (pancreas)

34
Q

S/S of Penetration

A

-back/epigastric pain not relieved by previous methods

35
Q

What is the main complication of perforated ulcers?

A

peritonitis

36
Q

Peritonitis

A

inflammation of the peritoneum; lining of the abdominal cavity and the organs w/in

37
Q

S/S of Peritonitis

A
  • n/v
  • abdominal pain
  • bloating
  • fever
  • often no flatulence or stool
38
Q

Treatment for Peritonitis

A
  • surgery to close perforation
  • lavage to clean gastric/intestinal contents from abdominal cavity
  • NG tube
  • antibiotics
39
Q

Nursing Care Post-perforation

A
  • monitor vitals/labs
  • administer antibiotics
  • assess for return of bowel sounds
  • ambulation day 1 post-op
  • educate: cough, deep breathing, splinting, meds, lifestyle changes
40
Q

Pyloric Obstruction (Gastric Outlet Obstruction)

A

gastric emptying is impeded by a narrowing of the area of the stomach just below the pyloric sphincter

41
Q

What is most often the cause of Pyloric Obstruction?

A

Scarring from multiple episodes of exacerbation and healing of peptic ulcer

42
Q

S/S of Pyloric Obstruction

A
  • n/v
  • constipation
  • feeling full all of the time
  • anorexia w/ weight loss
43
Q

Treatment for Pyloric Obstruction

A
  • NG tube/IV fluids/NPO
  • balloon dilation
  • surgery: severing of vagus nerve; antrectomy
44
Q

What classifies you as morbidly obese?

A

weight more than 2x ideal body weight or BMI > 30

45
Q

Morbid Obesity causes risks for what?

A
  • diabetes
  • heart disease
  • stroke/HTN
  • gallbladder disease
  • musculoskeletal probs
  • sleep apnea
  • COPD
  • depression
  • suicidal thoughts
46
Q

Treatment for Morbid Obesity

A
  • dietary restrictions
  • exercise
  • behavioral modifications
  • treat depression
  • meds
  • encourage fluid intake
  • assess for extreme weight loss
47
Q

What is considered after failure of non-surgical treatment for morbid obesity?

A

Bariatric Surgery

48
Q

Pre-Counseling for Bariatric Surgery

A
  • 6-12 months
  • lifestyle/dietary modifications
  • side effects
  • support system
49
Q

Criteria for Bariatric Surgery

A
  • BMI: > 40 no comorbidities, > 35 w/ comorbidities
  • unsuccessful hx of weight loss
  • assurance patient will adhere to treatments and follow ups
50
Q

Exclusions for Bariatric Surgery

A
  • reversible conditions causing obesity
  • drug/alcohol abuse in last year
  • psychiatric illness
  • inability to learn, understand, follow directions
51
Q

Gastric By-Pass Surgery

A
  • can be done laparoscopically
  • stomach is divided into smaller upper pouch that is stapled closed and a larger lower pouch is rerouted to upper pouch
  • inpatient 2-3 days
52
Q

Gastric Banding (Lap Band)

A
  • can be done laparoscopically
  • silicone band placed around the upper portion of the stomach
  • new narrowed portion slows movement of food leaving person feeling fuller longer
  • band can be loosened or tightened
  • typically new stomach will hold about 1 oz
53
Q

Gastric Sleeve

A
  • approx. 80% of stomach is removed
  • thin vertical sleeve of stomach is created using stapling device
  • does not require rerouting
  • inpatient 2-3 days
54
Q

Complications of Bariatric Surgery

A
  • atelectasis/pneumonia
  • hemorrhage
  • DVT/PE
  • bowel obstructions
  • incisional hernia
  • infection/leakage
55
Q

Complications SPECIFIC to Bariatric Surgery

A
  • chronic n/v
  • dumping syndrome
  • changes in bowel function
56
Q

Dumping Syndrome

A

food is emptied too quickly from the stomach into the small intestine not allowing time for dilution of fats/carbohydrates

57
Q

S/S of Dumping Syndrome

A
  • diarrhea
  • abdominal cramps
  • vomiting
  • fatigue
  • dizziness
  • diaphoresis

Adult Health Pt 2 (8 decks)

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