Gastrointestinal Disorders & Duodenal Ulcers Flashcards
1
Q
Inflammation of gastric mucosa
A
Gastritis
2
Q
Non-erosive gastritis
A
H. Pylori
3
Q
Erosive gastritis
A
NSAID, ETOH use
4
Q
Is stress related gastritis erosive or non-erosive?
A
Non-erosive
5
Q
Onset of gastritis
A
Rapid (acute)
6
Q
Manifestations of gastritis
A
- Abdominal discomfort
- Dyspepsia (indigestion)
- Nausea/vomiting/anorexia
- Blood in vomit or black tarry stool
- Fatigue
- Burning sensation in stomach
- Intolerance to spicy or fatty foods
7
Q
Erosive may cause…
A
Bleeding
8
Q
Diagnostics for gastritis (2) (Which is gold standard?)
A
Identification of causative factors
- EGD (gold standard)
- H-pylori
9
Q
Risk with EGD
A
Perforation
10
Q
Treatment for gastritis
A
- Triple therapy (H. Pylori)
- NGT and IV fluids
- Antacids
- H2 blockers
- Proton pump inhibitors
- Vitamin B12
- Diet/lifestyle changes (for chronic) (avoid spicy)
- Gastric resection (extreme case)
11
Q
What is triple therapy?
A
PPI and 2 antibiotics for 14 days
12
Q
Nursing role/Interventions for gastritis
A
- Pain management
- Anxiety reduction
- Optimize nutritional status (intake & output) (treat pain so pt can eat food)
- Fluid balance
- Monitor/assess for hemorrhage
13
Q
What do we not want to give for pain with gastritis?
A
No NSAIDs
14
Q
What are we monitoring and assessing for hemorrhage?
A
- Quantity of loss
- Color
- Correction of loss
- S/S associated with hypovolemic shock
Decrease BP, urine output
Increase HR/RR, Hgb/CBC
15
Q
S/S associated with hypovolemic shock
A
Low BP
Tachypnea
16
Q
1 PRBC is how many mL
A
350 mL
17
Q
Where can a peptic ulcer form?
A
- Mucosal wall of the stomach
- Pylorus
- Duodenum
- Esophagus
18
Q
Excavation
A
Hollowed out area
19
Q
This looks like a little hole
A
Peptic ulcer
20
Q
Peptic ulcers are associated with..
A
- H. Pylori
- NSAID and ASA use
(synergistic affect between H. Pylori and NSAIDs) - Excess secretion of HCL (stress may be a factor)
- Type O blood type
- Chronic kidney or lung disease
- Older adults
21
Q
Most duodenal ulcers occur in…
A
The first portion of the duodenum
22
Q
Deep, sharply demarcated lesions that penetrate through the mucosa and submucosa
A
Duodenal ulcers
23
Q
Use what to treat duodenal ulcers?
A
Wait for response to PPI
Then, Scope
24
Q
Increased stress =
A
Increased gastric acid secretion
25
Acute gastric mucosa lesions occurring after an acute medical crisis or trauma
Stress ulcers
26
What type of ulcer is associated with head injury, major surgery, burns, respiratory failure, shock, and sepsis?
Stress ulcer
27
Principal manifestation of stress ulcer
Bleeding caused by gastric erosion
28
What is key for stress ulcers?
Prevention
29
What do we use for prevention of stress ulcers?
- Proton pump inhibitors (Omeprazole)
- H2 antagonists
30
Peptic ulcer disease types
- Gastric ulcers
- Duodenal ulcers
- Stress/drug induced ulcers
31
What type of ulcer is this?
- Weight loss
- Burning left epigastric area
- Food frequently aggravates pain
- No pain during sleep
Gastric ulcer
32
Duodenal ulcer signs
- Epigastric pain at HS
- Burning, cramping, mid epigastric pain
- Pain 2-4 hours after meal (eating decreases pain)
- Weight gain
- Nausea/vomiting
33
Stress/drug induced ulcer signs
Asymptomatic
34
PUD diagnosis
- EGD
- Abdominal films (looking for "free air")
- H. Pylori
- CBC
35
PUD H. pylori test
Breath test or serum (blood) antibodies
36
PUD CBC test
- Assessment for bleeding
- Stool testing for occult blood
37
PUD abdominal films
- Looking for "free air"
(indicates perforation)
38
PUD medical treatment goals
- Pain relief
- Decrease/remove H. Pylori
- Heal ulcerations
- Reduce chance of reoccurrence
39
Diet wise, what do we want to avoid for PUDs? What DO we want?
Avoid coffee, caffeine, smoking
We want small, frequent meals
40
What meds do we want for PUD?
H2 blockers
Proton pump inhibitors
41
How to we get rid of H. pylori?
Antibiotics/anti-infective care are only option
10-14 days triple therapy
42
PUD complications
- Hemorrhage
- Perforation
- Penetration
- Peritonitis
42
How do we heal ulcerations and reduce chance of reoccurrence?
Holistic care
43
Erosion eats through blood vessels
Hemorrhage
44
Hemorrhage manifestations
- Bleeding
- Hypovolemia and shock
45
Types of bleeding
- Hematemesis
- Melena
- Coffee ground (emesis)
46
Lab values for hemorrhage
Hct
Hgb
Type and screens - need a blood transfusion
47
Hemorrhage nursing responsibilities
- Insert large bore IV catheter
- Quickly determine amount of blood lost
- Monitor H and H, Coags, Type and Screen
- Insert NG tube
- Administer lavage
- Foley
- Monitor VS and administer oxygen
- Position patient to prevent hypotension/prevent aspiration
48
Lavage
Washing out of body cavity
- Can be room temp or iced
49
Large bore IV catheter for PUD
Saline, LR, blood products
50
Erosion through the ulcer directly into peritoneum
Perforation
51
Two types of peritonitis
Bacterial and chemical
52
Would you rather have perforation of stomach or colon?
Stomach
53
Erosion through the gastric serosa into adjacent structures
Penetration
54
Where does penetration take place?
Pancreas, biliary tract, gastro-hepatic
55
What are two abdominal catastrophes that require immediate surgery?
Perforation and penetration
56
Manifestations of perforation and penetration
- Sudden, severe upper abdominal pain (may be referred to right shoulder or back)
- Vomiting and collapse
- Tender, board like abdomen
- Hypotension, tachycardia
- Shock
57
Late signs of peritonitis
Hypotension and tachycardia
58
Peritonitis manifestations
- Fever
- Abdominal pain
- Paralytic ileus
- Decreased or absent bowel sounds
- Abdominal distention
59
Peritonitis treatment
Antibiotics
60
5th most common cancer diagnosis worldwide
Gastric cancer
61
Where is gastric cancer most common?
East Asia
62
How do we identify gastric cancer?
Screening programs
63
Who is at a higher risk for gastric cancer?
Smokers
64
90% of gastric cancer identifies as...
Adenocarcinomas
65
How do adenocarcinomas start?
Arise from the mucous producing cells in the inner most lining of the stomach
66
What occurs early in gastric cancer?
Lymph node involvement and metastasis
67
Clinical manifestations of gastric cancer
- Pain relieved by antacids
- Dyspepsia
- Weight loss
- Pain in abdomen above umbilicus
- Decreased appetite
- Bloating, nausea, vomiting
68
Advanced stages of gastric cancer produce symptoms similar to...
PUD
69
Gold standard for diagnostics of gastric cancer
EGD for biopsy and cytologic washings
70
Diagnostics of gastric cancer
- EGD
- Barium X-Ray of upper GI tract
- Endoscopic Ultrasound
- CT scan
- CBC
- Tumor markers
71
Management of gastric cancer
- Surgery (total gastrectomy, radical partial gastrectomy)
- Chemo & radiation
72
Nursing care for gastric cancer
- Promotion of nutrition
- Pain management
- Psychosocial & anxiety support
73
Medication for pain management of gastric cancer
Analgesics
