Gastric Duodenal Ulcers Flashcards
gastritis
inflammation of the gastric mucosa
can gastritis be acute or chronic
both
acute gastritis
- onset
rapid
acute gastritis
- example
over consumption of alcohol
chronic gastritis
- example
H pylori
is acute gastritis always need meds
no most times it is self limiting and can heal in 2 days
gastritis
- non erosive cause
helicobacter pylori
gastritis
- erosive cause
NSAIDS/ ASA/ Steroids
alcohol
radiation therapy
erosive
ulcerative
bleeding
eating away
how do NSAIDS cause erosion
inhibits production of mucosa
gastritis
- manifesations
abdominal discomfort
dyspepsia
N/V
anorexia (way the body to heal itself)
fatigue (from anemia, chronic)
erosive may casue
bleeding
bleeding in vomit apperence
coffee ground (old)
bleeding in stool old/upper GI
black/tarry
bleeding in stool new/lower Gi
bright red
gastritis care is
supportive
before EGD we would do what and why
CBC
- noninvasive/inexpensive way to see if bleeding
would we give these patients NSAID or aspirin
NO
preparation for EGD
NPO
lidocaine spray
conscious sedation
if we are prepping for EGD and it is an emergency and no time to become NPO what do we do
NG tube, check by pulling back and then low intermittent suction
if we chose to start the NG on low intermittent suction just by a pull back, would we administer meds or fluids through this
no, we would wait until X RAY to put things down the NG tube
if H pylori is noticed what would our pharm treatment be
PPI and 2 antibiotics for 10-14 days
gastritis IV fluids
isotonic
gastritis meds
antacids
H2 blockers
PPI
chronic gastritis might need what vitamin
B12
chronic gastritis diet changes
no spicy foods
gastritis labs
CBC (bleeding)
type/screen/cross
INR/PT/PTT (clotting)
1 unit of blood is how many mL
350
what would we assess for fluid overload or depletion
mucous membranes
urine output
pulses
JVD
turgor
mental status
what would we assess for for bleeding
decrease BP
urine output
increase HR RR
hemoglobin
mental status
anxiety
what else should we know besides bleeding
estimate the quantity of loss
and color
peptic ulcer disease is more common where
duodenum
peptic ulcer definition
excavation (hallowed out area) that forms in the mucosal wall of the stomach
peptic ulcer causes
H pylori
NSAID
ASA
excess secretion of HCL
Type O blood
chronic kidney/lung disease
older adults
stress ulcer occurs after
acute medical crisis or trauma
- head injury
- major surgery
- burns
- respiratory failure
- shock
- sepsis
what is key with stress ulcers
prevention
gastric ulcer
- weight
loss
gastric ulcer
- burning location
left epigastric area
gastric ulcer
- food related to pain
food aggravates pain
gastric ulcer
- pain at hour of sleep
no pain
duodenal ulcers
- pain at hour of sleep
epigastric pain at hour of sleep
duodenal ulcers
- pain type and location
burning, cramping, mid epigastric area
duodenal ulcers
- food and pain
food decreases pain but it will flare up 2-4 hours after eating
duodenal ulcers
- weight
gain
duodenal ulcers
- N/V?
yes
stress/ drug induced ulcers
asymptomatic
what is the main thing we use to diagnosis
EGD
when can a patient eat after a EGD
positive cough and gag, able to eat
abdominal films are used for
ruling out peritonitis
H pylori is diagnosed by
breath test or serum antibodies
PUD goals
pain relief
how do PUD get pain relief
change diet
PUD new diet rules
avoid coffee, caffeine, stop smoking
PUD meal regimen
small frequent meals
meds for PUD
H2 blockers
PPi
H pylori med regimen
10-14 days of triple therapy
- PPI and 2 antibiotics
what is a PUD complication
hemorrhage
- erosin through blood vessel
how will bleeding look like
hematemesis
melena
coffee grounds
lab values for bleeding
CBC
INR/PT/PTT
type screen and cross (urgent bc it takes 45 mins to get results
if there is hemorrhage what do you want for IV
2 large bore
if someone is bleeding what might we give them
isotonic solutions
PRBC
platlets
fresh frozen plasma
what should we monitor if we think bleeding is happening
H and H and coagulants
what should we stop if we think bleeding is happening
stop meds that contribute
- ASA, heparin, warfarin
what might we do for gastric bleeding after we administer an NG tube
gastric lavage
why would we do a gastric lavage with room temp or ice water
vasoconstrict blood vessels
hemorrhage HOB
head of the bed is up to decrease aspiration
PUD complications
perforation
penetration
perforation
erosion through the ulcer directly into peritoneum
penetration
erosion through the gastric serosa into adjacent structures
what are both perforation and penetration
abdominal catastrophes and require immediate surgery
perforation and penetration
- slow or fast onset of pain
acute/fast onset of pain
perforation and penetration
- where is the pain location in the abdominal
upper
perforation and penetration
- tender or nontender
tender
perforation and penetration
- rigid or not rigid
rigid
perforation and penetration
- will the patient be protecting
yes
perforation and penetration
- other signs and symptoms
N/V/D/C
perforation and penetration
- bowel sounds
initial hyperactive and then hypoactive and then absent
- the reason the bowels slow is to minimize bacteria spread
perforation and penetration
- late signs
hypotension
tachycardia
shock
perforation and penetration
- distention or flat
distention
perforation and penetration
- fever or no fever
fever
* elderly might not have a fever
perforation and penetration
- treatment
antibiotics
gastric cancer
- signs and symptoms
few symptoms in early stages
gastric cancer
- pain
relieved by antacids
gastric cancer
- worst case surgical management
total gastrectomy
radical partial gastrectomy
gastric cancer
- gastrectomy issues
absorption of vitamins and minerals
