Gastrointestinal Disorders Chapt 45 Flashcards
What is Parotitis
inflammation of the parotid gland. It is the most common inflammatory condition of the salivary glands
Inflammation to the Parotid may be due to
Mumps (epidemic parotitis)
Who is at high risk for bacterial parotitis
people who are older, acutely ill, or debilitated with decreased salivary flow from general dehyration or medications are at high risk
What organism causes bacterial parotitis
Staphylococcus Aureus (travels from the mouth through the salivary ducts)
What are the symptoms of Parotitis
fever, chills, and other systemic signs associated with infection. The glands swell and become tense and tender. The patient feels pain in the ear and swollen glands interfere with swallowing. Swelling increases rapidly and skin becomes red and shiny
What is the medical management for parotitis
adequate nutritional and fluid intake, good oral hygiene, and discontinuing medications (ex. tranquilizers, diuretic agents) that can diminish salivation.
Pharmacological treatment for parotitis
antibiotics are necessary for bacterial parotitis, and analgesics may be prescribed for pain.
Other treatments parotitis
the gland may need to be drained by a surgical procedure known as parotidectomy. This procedure may be necessary to treat chronic parotitis.
Sialadenitis
Inflammation of the salivary glands
What causes Sialadenitis?
dehydration, radiation therapy, stress, malnutrition, salivary gland calculi, or improper oral hygiene.
What bacteria causes Sialadenitis?
the inflammation is caused by S. Aureus. In hospitalized patients, the infecting organism may be methicillin-resistant S. Aureus (MRSA)
Symptoms of Sialadenitis
pain, swelling, and purulent discharge
Treatment for Sialadenitis
antibiotics, massage, warm compresses, and sialagogues (substances that trigger saliva flow like hard candy or lemon juice)
what causes chronic sialadenitis
decreased salivary flow
Treatment for recurrent sialadenitis
surgical drainage or excision of the gland and its duct
where does Salivary Calculus (Sialolithiasis) usually occur?
in the submandibular gland
What tests are needed to confirm the diagnosis of salivary calculus
salivary gland ultrasonography or sialography may be required to demonstrate obstruction of the duct
What forms salivary calculi
calcium phosphate
Symptoms of Sialolithiasis
calculi within the salivary gland may cause no symptoms
a calculus that obstructs the gland’s duct causes swelling and sudden, local, and often colicky pain, which is abruptly relieved by a gush of saliva
Treatment of Sialolithiasis
the calculus can be extracted. Sometimes enlargement of the ductal orifice permits the stone to pass spontaneously. Occasionally lithotripsy (a procedure that uses shockwaves to disintegrate the stone may be used.
Lithotripsy preparation and side effects
Requires no anesthesia, sedation, or analgesia
May cause local hemorrhage and swelling
Neoplasms (tumors or growths) risk factors
exposure to radiation to the head and neck, older age, and specific carcinogens introduced in specific work environments.
Symptoms for a benign tumor (Neoplasm)
most patients with a benign growth present with painless swelling of the glands
Symptoms for a malignant tumor (Neoplasm)
patients tend to have neurologic symptoms (weakness or numbness) and persistent facial pain.
How is diagnosis made (Neoplasm)
diagnosis is based on the health history, physical exam, and the results of fine-needle aspiration biopsy.
early stage salivary gland tumors treatment
usually curable with surgery alone.
complications from surgery of salivary gland tumors
facial nerve dysfunction, and Frey syndrome
What is Frey syndrome
involves facial sweating and flushing in the general location of the removed parotid gland that occurs while eating.
Treatment for Frey Syndrome
Botulinum toxin type A injections
treatment for a malignant tumor (Neoplasm)
Radiation may be needed following surgery, chemotherapy may be considered in late stages. Recurrent tumors are more aggressive than initial tumors.
What is Achalasia
absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing
When does achalasia occur?
progresses slowly most common in people 40 or older
Clinical manifestations of achalasia
dysphagia of solids and liquids
Symptoms of achalasia as it progresses
food is commonly regurgitated spontaneously or intentionally by the patient to relieve discomfort
the patient may report non-cardiac chest pain or epigastric pain and pyrosis (heartburn)
How is Achalasia diagnosed?
x-ray, CT scan, barium swallow, and endoscopy
what confirms the diagnosis of achalasia?
manometry- peristalsis, contraction amplitudes, and esophageal pressure is measured
Management of Achalasia
pt is instructed to eat slowly and to drink fluids with meals
oral calcium channel blockers and nitrates have been used to decrease esophageal pressure and improve swallowing
injections of botulinum toxin into quadrants of the esophagus via endoscopy has been helpful b/c it inhibits the contraction of smooth muscle
What is Hiatal Hernia?
the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax.
Does hiatal hernia occur most often in women or men?
women
What are the two types of hiatal hernias
sliding (type I) or paraesophageal
What is a paraesophageal hernia?
when all or part of the stomach pushes through the diaphragm beside the esophagus
How are paraesophageal hernias classified?
Type II, III, or IV
Type IV has the greatest herniation, with other intra-abdominal viscera such as the colon spleen, or small bowel evidencing displacement into the chest along with the stomach
What type of hernia is most common? paraesophageal or sliding?
95% of patients with esophageal hiatal hernia have sliding hernias
clinical manifestations of sliding hernia
pyrosis, regurgitation, and dysphagia, but many patients are asymptomatic.
The patient may present with vague symptoms of intermittent epigastric pain or fullness after eating.
commonly associated with GERD
hemorrhage, obstruction and strangulation can occur with any type of hernia
Assessment and diagnostic findings of hiatal hernias
confirmed by x-ray, barium swallow, esophagogastroduodenoscopy (EGD), esophageal manometry, or chest CT scan
Management of hiatal hernia
frequent small feedings that can pass easily through the esophagus, sit up for 1 hour after eating,
When is surgery indicated for patients with a hiatal hernia?
when patients are symptomatic
postoperative care for a hiatal hernia
the patient will slowly move from a liquid diet to solids, the nurse will monitor nausea and vomiting, nutritional intake, and weight.
What is Gastroesophageal Reflux Disease (GERD)
backflow of gastric or duodenal contents into the esophagus that causes troublesome symptoms and or mucosal injury to the esophagus.
Clinical Manifestations of GERD
pyrosis, dyspepsia, regurgitation, dysphagia, or odynophagia, hypersalivation, and esophagitis. The symptoms may mimic those of a heart attack
how do you diagnose GERD
endoscopy or barium swallow.
Ambulatory 12-36 hour esophageal pH monitoring to evaluate the degree of acid reflux
Management of GERD
a low-fat diet, avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages: avoid eating or drinking 2 hours before bedtime; maintain normal body weight
avoid tight-fitting clothes
elevate the head of the bed at least 30 degrees
surgical intervention may be necessary
what is Barrett Esophagus (BE)?
A condition in which the lining of the esophageal mucosa is altered.
Clinical Manifestations of BE
pt complains of symptoms of GERD, frequent heartburn. Pt may also complain of symptoms related to peptic ulcers or esophageal stricture or both.
How do you diagnose BE?
EGD and Biopsies are performed
Management of BE
Tx is individualized for each patient surveillance with biopsies use of proton pump inhibitors endoscopic resection radiofrequency ablation and consideration of metal stents
Cancer of the esophagus pathophysiology
Esophageal cancer can be of two cell types: adenocarcinoma, and squamous cell carcinoma. Risk factors for esophageal cancer include chronic esophageal irritation or GERD
Cancer of the esophagus has been associated with ingestion of ___ and the use of ___
alcohol, tobacco
What are the risk factors for squamous cell carcinoma
chronic ingestion of hot liquids or foods, nutritional deficiencies, poor oral hygiene, exposure to nitrosamines in the environment or food, cigarette smoking, or chronic alcohol exposure, and some esophageal medical conditions such as caustic injury
Clinical Manifestations for cancer of the esophagus
many patients have an advanced ulcerated lesion of the esophagus before symptoms are manifested. Symptoms include dysphagia, sensation of a mass in the throat, painful swallowing, substernal pain or fullness, regurgitation of undigested food with halitosis, and hiccups.
How is esophageal cancer diagnosed?
EGD with biopsy and brushings. PET scan can help detect metastasis
Medical management of esophageal cancer
If detected at an early state treatment goals may be directed toward a cure
If detected in late stages relief of symptoms is the only tx
treatments include surgical resection of the esophagus, radiation, and chemotherapy
Preoperative Nursing Management (esophageal cancer)
directed towards improving the patients nutritional and physical status in preparation for surgery, radiation, or chemotherapy
