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NSG 320 (mcp) > Gastrointestinal (GI): Gastritis, GERD, PUD > Flashcards

Gastrointestinal (GI): Gastritis, GERD, PUD Flashcards

1
Q

What is Gastritis?

A

Inflammation of the mucosal lining of the stomach

- May involve part or all of the stomach

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2
Q

What are the 2 Categories of Gastritis?

A
  1. Acute Gastritis
    - Occurs after exposure to local irritants or other causes
  2. Chronic Gastritis
    - Chronic exposure to irritants or pathogen
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3
Q

Differentiate the Pathophysiology for Acute and Chronic Gastritis
(What happens initially–Acute–versus what can result–Chronic)

A

Acute Gastritis:

  • Thickened & reddened mucous membrane with prominent rugae
    • Bleeding can result if the muscle layer is involved

Chronic Gastritis:

  • Patchy diffuse inflammation of stomach’s mucosal lining
    • Stomach walls & lining will thin and atrophy
    • ↓ Parietal cell function → ↓ stomach acid
    • ↓ IF production → B12 absorption stops
      - Leads to Pernicious anemia
    • Results in intestinal metaplasia → Gastric Cancer
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4
Q

Causes of Gastritis (5)

A
  1. NSAIDs
  2. ETOH
  3. H. Pylori
  4. Severe illness
  5. Autoimmune disorders
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5
Q

What is the most common cause of Acute gastritis?

3 other causes of Acute or Chronic:

A

MOST COMMON → NSAIDs

- Other causes: severe illness

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6
Q

What is the most common cause of Chronic gastritis?

2nd leading cause of chronic?

A

MOST COMMON → H. Pylori

2nd leading → NSAIDs

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7
Q

Acute Gastritis S/S (7)

A
  1. Epigastric pain & cramping
  2. Abdominal tenderness
  3. Indigestion
  4. Anorexia
  5. N/V
  6. Hematemesis
  7. Melena (partially digested food in stool)
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8
Q

Chronic Gastritis is often _______ until ulceration occurs.

When might you see Epigastric discomfort?

A

Often ASYMPTOMATIC

Epigastric discomfort AFTER a meal

Other S/S:
1. N/V

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9
Q

How can we prevent Gastritis? (3)

What should we reduce consumption of? (7)

A
  1. Balanced Diet
  2. Exercise
  3. Stress management

Reduce consumption of

  1. Caffeine
  2. Spicy food
  3. Chocolate
  4. ETOH
  5. Tobacco
  6. Aspirin
  7. NSAIDS
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10
Q

Interventions of Acute Gastritis are mainly ____.

Name the 3 Interventions mentioned.

A

SUPPORTIVE

  1. Fluids (for dehydration)
  2. Blood products (if bleeding)
  3. Nutritional changes – Bland foods
    - “BRAT” diet: bananas, rice, applesauce, toast
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11
Q

The main intervention for Chronic gastritis is …

Name some medications we may administer and why.

A

REMOVE THE CAUSE!

Medications:

  1. PPIs (b/c decreased stomach acid)
  2. Mucosal barriers (Sucralfate; same as above)
  3. IM B12 Injections (Tx pernicious anemia)
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12
Q

What is Gastroesophageal Reflux Disease (GERD)

What might be the only visible sign that GERD is happening?

A

⧫ Backward flow of stomach contents into the esophagus, possibly due to increased abdominal pressure or reduced emptying of the stomach (occurs w/ age and diabetes)

⧫ Highly acidic & irritating contents cause inflammation in the esophagus causes excessive relaxation of the lower esophageal sphincter (LES)
→ Hyperemia** may be only visible sign of GERD
→ Erosion

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13
Q

Risk Factors of GERD (7)

Name some foods that can cause GERD (4)

A
  1. Pregnancy
  2. Obesity
  3. Smoking
  4. Large meals
  5. Types of foods
    • Spicy food
    • Citrus foods
    • carbonated beverages
    • Fatty meats
  6. Hiatal hernia
  7. Any tubes put down the throat (feeding/breathing tube)
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14
Q

What are the complications associated with GERD? (8)

A
  1. Barrett’s Epithelium (precancerous cells)
  2. Esophageal stricture
  3. Asthma
  4. Laryngitis
  5. Dental Decay
  6. Aspiration pneumonia
  7. Bleeding
  8. Cardiac disease
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15
Q

GERD Assessment:

What are the 3 important assessments we should perform related to GERD?

A
  1. Pain assessment
  2. Respiratory assessment
  3. Swallow assessment!
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16
Q

GERD Assessment:

S/S

A
  1. Dyspepsia/Indigestion/Regurgitation
    - fullness, nausea, belching, flatulence
  2. Bitter taste
  3. “Water brash” may occur in response (reflexive saliva)
  4. Heartburn
  5. Morning Hoarseness
  6. Painful swallowing
  7. Dysphagia
  8. Asthma
  9. Pneumonia
    • Crackles in lungs?
      - Wheezing?
    • Coughing?
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17
Q

GERD Assessment:
Describe the pain associated with GERD.
What can it mimic?

What are some questions we should ask to differentiate the location of pain?

A

Heartburn → CAN MIMIC CARDIAC PAIN (MI)
Pain may radiate to the neck or jaw

What is this pain in relation to eating, sleeping, activity?

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18
Q

GERD Assessment:
What Causes Discomfort to worsen?

When might discomfort occur in relation to a meal?

A

Discomfort worsens with

  1. bending over
  2. lying down

May occur for 20 mins-2 hours AFTER a meal

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19
Q

How do we mainly Diagnosis GERD?

A

Mainly based on SYMPTOMS and HOW THEY RESPOND TO TREATMENT (PPIs)

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20
Q

Name 5 other diagnostic tests for GERD.

Which one is the most definitive test to diagnose GERD?

A
  1. **pH exam **
  2. Barium Swallow Study (Esophagus)
  3. Upper endoscopy (EGD)*** MOST DEFINITIVE
  4. Esophageal Manometry
  5. Gastric emptying test
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21
Q

4 Main Interventions for GERD:

A
  1. Nutrition
  2. Lifestyle adjustments
  3. Medications
  4. EDUCATION!!!!!!!!!!!
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22
Q

GERD Interventions: Nutrition

What foods should be avoided?

A

Avoid irritating foods

  1. Caffeine
  2. Chocolate
  3. Fried food
  4. Fatty food
  5. Citrus
  6. Peppermint
  7. Spicy foods
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23
Q

GERD Interventions: Nutrition

What should they do in relation to meals?

A
  1. Eat small portions/small meals more frequently
  2. Avoid eating before bedtime
  3. Avoid bending over
  4. Sit upright for 30 min after a meal
24
Q 
GERD Interventions: Lifestyle Adjustments  
what should they stop or reduce?
What should they wear?
What should they be evaluated for?
How should they sleep?
A
  1. Stop Smoking & Reduce Alcohol intake
  2. Weight loss
  3. Evaluation for obstructive sleep apnea
  4. Wear Loose clothes

Sleeping:

  1. Elevate HOB 6-12 inches
  2. Sleep on right side
25
Q

GERD Interventions: Medications

What medications contribute to LED relaxation + GERD?
Can they be avoided?

A

Can’t ALWAYS be avoided; BALANCE!

  1. Nitrates
  2. NSAIDs (suggest Tylenol instead)
  3. Oral contraceptives
  4. CCB’s
  5. Sedatives (should be reduced)
26
Q

GERD Interventions: Medications

What meds do we use to treat GERD?

A

Meds that reduce stomach acid!

  1. Antacids
  2. H2 antagonists
  3. PPIs
27
Q

What is the standard surgical approach for GERD?

A

Nissen fundoplication

28
Q

What is Peptic Ulcer Disease (PUD)?

A

Mucosal Lesion of the stomach or duodenum

“PUD” occurs with impairment of mucosal defenses → Acid and pepsin are able to destroy the epithelium tissue of the stomach and duodenum

29
Q

What is the most common cause of PUD?

What else is this associated with?

A

H. Pylori

Chronic gastritis

30
Q

Other causes/risk factors of PUD (8)

A
  1. NSAIDs
  2. Gastritis
  3. Medications
    - Corticosteroids
    - Theophylline
  4. Excessive ETOH intake
  5. Smoking
  6. Caffeine
  7. Radiation therapy
  8. Stress
31
Q

What are the 3 Types of Peptic Ulcers?

A
  1. Gastric Ulcers
  2. Duodenal Ulcers
  3. Stress Ulcers
32
Q

Types of Peptic Ulcers: Gastric Ulcers

A

DELAYED Stomach emptying, normal acid secretion, increased diffusion of gastric acid into stomach tissue

33
Q

Types of Peptic Ulcers: Duodenal Ulcers

A

INCREASED stomach emptying, increased secretion of gastric acid, and normal diffusion of acid into the stomach tissue. (top portion of small intestine)

34
Q

Types of Peptic Ulcers: Stress Ulcers
Occur after…..

What can they result in?

A
  • Occur after medical crisis or trauma*
    1. Sepsis
    2. Head Injury
    3. Burns
    4. NPO for surgery

MAY CAUSE BLEEDING (Increase death)

  • Related to long hospital stays
  • Increased mortality and morbidity
35
Q

What do we do to prevent Stress PUD in the hospital?

A

GIVE PROPHYLACTIC PPIs!

- Especially if also taking corticosteroids

36
Q

PUD + Patient History (5)

What do we want to ask about GI symptoms?

A
  1. Risk Factors?
  2. Medications?
  3. What aggravates it?
  4. Past surgeries?
  5. GI symptoms?
    - Relationship of GI symptoms to eating & sleep
    - Changes in GI symptoms
37
Q

PUD + Assessment:

Why is it important to take Vital signs in relation to Abdominal pain?

A

Risk for BLEEDING!

Can result in peritonitis!

38
Q

PUD + Assessment:
General S/S (7)
Bowel sounds early and late in disease?

A

Most ulcers are BENIGN and don’t cause Sxs

  1. INDIGESTION (Dyspepsia)
  2. Sharp, burning pain
  3. Abdominal fullness
  4. Epigastric tenderness
  5. Appetite changes
  6. Bowel sounds
    - Hyperactive bowel sounds (early)
    - Hypoactive bowel sounds (late)
  7. N/V
39
Q 
PUD + Assessment: Gastric vs Duodenal Ulcers
Location of pain?
Relation to food?
Relation to sleep?
Bleeding?
A 
Gastric 
Pain → Upper epigastrium (and left)
Food → Aggravates it; occurs 30-60 min after meal
Sleep → pain at night 
Bleeding → Hematemesis 
Duodenal 
Pain → Lower epigastrium (and right)
Food → Doesn't Aggrave it; occurs 1.5-3 hrs after meal
Sleep → Pain in the middle of night 
Bleeding → Melena
40
Q

PUD + Diagnostics:

Gold Standard for Diagnosis?

A

Esophagogastroduodenoscopy (EGD) **

- Camera sent down thru stomach to intestines

41
Q

PUD + Diagnostics:
3 Tests for H. pylori:

2 Tests for bleeding?

A

H. pylori:

  1. Urea Breath test
  2. Stool Antigen test
  3. Serum Antibody test

Bleeding:
Hemoglobin and hematocrit
Fecal Occult test

42
Q

PUD + Interventions:

A
  1. Drug Therapy
  2. Nutrition
  3. CAM
  4. Managing Complications
43
Q

PUD + Interventions: Drug Therapy
Goals (4)

Name the drug therapies utilized: (2)

A
  1. Provide pain relief
  2. Eliminate H. pylori
  3. Heal ulcers
  4. Prevent reoccurrence

Drug therapies:

  1. Triple Therapy: PPI + 2 antibiotics
  2. Quadruple therapy: Triple therapy + Pepto-Bismol
44
Q

PUD + Interventions: Nutrition

A
  1. Avoid irritating foods
  2. Bland foods (acute)
    - bananas, rice, applesauce, toast, eggs
  3. Avoid bedtime snacks
  4. Avoid ETOH
  5. Avoid smoking
45
Q

What are the 3 Complications associated with PUD?

A
  • Chronic & difficult to treat disease*
    1. Hemorrhage
    2. Perforation
    3. Pyloric Obstruction
46
Q

PUD + Complications: Hemorrhage

Differentiate S/S of a lower and upper GI Hemorrhage:

A

UPPER GI:

  1. Hematemesis
    - Bright red
    - Coffee ground (been there longer, coagulated)

LOWER GI:

  1. Melena
    - Dark tarry stool (Digested blood)
47
Q

PUD + Complications: Hemorrhage
Key intervention & Tests:
(NOT management)

A 
Early detection + 
Patient education (stool inspection, HR, weakness)
  1. Vital signs (identify bleeding)
    • Tachycardia
    • Trending down BP (hypotension)
  2. Hemoccult test for suspicious stool
  3. HH
48
Q

PUD + Complications: Hemorrhage Management
What’s most important to protect?

Positioning if hematemesis is occurring?

What do we need to prepare them for?

A
  1. Airway protection!!
    - may need to intubate
  2. Positioning
    - On side initially instead of elevating
  3. Oxygen
  4. IV Access for Volume replacement
  5. Blood transfusion
  6. Prepare patient for medical intervention
  7. Acid suppression
49
Q

PUD + Complications: Hemorrhage Management

Why do we want to suppress acid? How do we do this?

A

To prevent re-bleeding

  1. IV Protonix
  2. IV Ocreotide
50
Q

What are the 2 Surgical treatments to stop a hemorrhage?

A
  1. Esophagogastroduodenoscopy (EGD) **
  2. Interventional Radiological (IR) procedure
    • Catheter-directed embolization of artery
51
Q

PUD + Complications: Hemorrhage Management

3 ways to stop a bleed with an Esophagogastroduodenoscopy:

A

IV sedation

  1. Inject chemicals into the bleeding site to stop it
  2. Treat bleed with a heat source
  3. Apply band or clip** most common
52
Q

PUD + Complications: Hemorrhage Management

If interventions to stop the hemorrhage with an EGD doesn’t work, what else can we do?

A

Interventional Radiological procedures

Catheter-directed embolization of the artery that’s bleeding

53
Q

PUD + Complications: Perforation
What can perforation result in?

Describe the S/S of a perforation:

A

EMERGENCY
Allows contents of GI system to leak into the peritoneal cavity → PERITONITIS

Sudden, sharp mid -epigastric pain that radiates through the abdomen

54
Q

PUD + Complications: Perforation

What is the key S/S of Peritonitis?

A

TENDER, RIGID, BOARDLIKE ABDOMEN

Rebound tenderness

55
Q

PUD + Complications: Perforation

Interventions?

A

SUPPORT AND GET TO SURGERY

NSG 320 (mcp) (24 decks)

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