Gastrointestinal System Flashcards
Reflux, regurgitation and back-flow of gastric acid
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GERD
Most common symptom of GERD
Heartburn / Pyrosis
Symptom of Gerd - 2B
Belching / Bloating
Symptom of Gerd - 2R
Regurgitation / Reflux
Symptom of Gerd - 2D
Dyspepsia / Dysphagia
Diagnostic Test for GERD
Esophageal pH monitoring
Normal PH level of acid in stomach
2-3
Most important Diagnostic test for GERD
Barium Swallow
Effect of Relaxation of LES on pressure
Decreased pressure
Long-standing untreated precancerous GERD
Barrett’s esophagus
Complication of GERD that results to stricture and ulceration
Esophagitis
Adenocarcinoma / cancerous GERD
Esophageal cancer
Surgical procedure for GERD
Anti-reflux surgery (Nissen and Toupet fundoplication)
Normal value for Esophageal PH monitoring
Below 7.35`
Antireflux surgery: One suture/complete
Nissen Fundoplication
Antireflux surgery: Two suture/Partial
Toupet
GERD Pharmacological Mnemonic
PAPA Proton Pump Inhibitor Antacid Prokinetics Anti-histamine
Primary meds for hyperacidity
PPI & anti-histamine
Indicated for quick/short-lived relief of mild, intermittent heartburn
Antacid
Increases LES pressure & Improve gastric emptying & regurgitation
Prokinetics
Examples of anti-histamines for GERD
Cimetidine / Ranitidine
Examples of PPI for GERD
Omeprazole / Lanzoprazole / Rabeprazole
Examples of Prokinetics for GERD
Metoclopramide / Baclofen / Cisapride
Nursing Management for Antacids & anti-ulcer meds
Report signs of GI bleeding
like black stool, tarry stool, and abdominal pain
Imbalanced Nutrition interventions for GERD
Non-irritating foods
Avoid reflux-inducing foods
Acute Pain interventions for GERD
SFF
Eat slowly
Avoid eating 2-3 hours before sleep
Give fluid in between meals
Protrusion/ enlargement/ pushing upward of stomach and gastric mucosa in the lower thoracic cavity or esophageal hiatus
Hiatal Hernia
Type of Hiatal Hernia: GEJ protrude/move upward with intact diaphragm
Type 1: Sliding / Esophageal Hernia
Most common
Type of Hiatal Hernia: GEJ no movement with Non-intact diaphragm
Type 2: PARAESOPHAGEAL or Diaphragmatic Hernia
Symptom of Hiatal Hernia
HERNIA Heartburn Epigastric pain Regurgitation Nocturnal heartburn Indigestion After eating - Dysphagia, Belching, Fullness
Diagnostic test for Hiatal Hernia
Barium Swallow
Xray
Upper GI series
Hiatal Hernia Pharmacological Mnemonic
APA
Anti-histamine
Proton Pump Inhibitor
Antacid
Surgical procedures for Hiatal Hernia
Herniotomy
Herniorrhaphy
Anti-reflux procedure
Gastropexy
Hiatal Hernia surgery: To open & excise
Herniotomy
Hiatal Hernia surgery: To repair the hernia sac
Herniorrhaphy
correct twisting/ torsion of stomach,
prevent restriction of blood flow, reduce hernia,
increase LES pressure
Gastropexy
Absent or ineffective peristalsis of the distal esophagus
Esophageal Atresia
Esophagus failed to relax, narrows, strictures, dilates, incomplete relax, obstructs, decrease emptying (food content causes dilation proximal to the obstructed area)
Esophageal Atresia
Risk factor of Esophageal Atresia
Idiopathic
Age
Stages of Esophageal Atresia
Early & advanced
Stages of Esophageal Atresia: tapering or NARROWING of lower esophagus
Early
Stages of Esophageal Atresia: DILATED tortuous esophagus (food and fluid) or megaesophagus (enlargement of lower esophagus)
advanced
Symptom of Esophageal Atresia
Dysphagia (most common/primary) Sensation globus Substernal chest pain - after meal Heartburn (pyrosis) **Halitosis (foul smelling breath)
Complications of Esophageal Atresia
Aspiration (gastric content)
Pulmonary complication
Esophagitis
Confirmatory Diagnostic test of Esophageal Atresia
Manometry
- measures esophageal pressure
Nursing intervention for Esophageal Atresia
Elevated HOB while sleeping
Semi-soft diet
Drink fluids during meals
Esophageal Atresia Meds
Botulinum toxin
Calcium channel blocker (Nifedipine)/ Nitrates ( ISDN or Isordil only)
Indication of Botox for Esophageal Atresia
endoscopically to inhibit contraction of smooth muscles, therefore relaxes the smooth muscles
Surgical procedure for Esophageal Atresia: endoscopic procedure using balloon to stretch the narrowed esophagus
Pneumatic dilatation (surgical reparation)
N.I for Pneumatic dilatation
watch out for perforation - fever, abdominal tenderness
Surgical procedure for Esophageal Atresia: cuts/ separate esophageal muscle fibers to relieve stricture, allow food to pass
Esophagomyotomy (Heller myotomy)
UGIB: profuse, bright red blood
Arterial Bleeding
UGIB: blood in stomach for some time
Coffee-ground vomitus
UGIB: black tarry stool, upper GI bleeding (slow or prolong)
Melena
UGIB: blood loss > 1.5L
Massive UGIH (Upper Gastrointestinal Hemorrhage)
WORST manifestation in GI bleeding
Perforation/ Peritonitis
Absence of bowel sounds
Normal Pulse Pressure
+3
Primary tool to diagnose source/location of UGIB, 1st line management
Endoscopy
N.I for UGIB: best measure for vital perfusion
Measure urine output
N.I for UGIB: fluid volume status,
hemodynamic monitoring
- SYSTEMIC fluid status of body
Central Venous Pressure line
N.I for UGIB: Which IVF to give and why?
Lactated Ringers
- contains sodium, potassium, magnesium, chloride
- corrects overall electrolyte imbalance
N.I for UGIB: What kind of needle for IVF and why?
Large bore needle
- used for high fluid volume rescucitation
Normal CVP line value
0-8 mmHg
Gastric Lavage: Vasoconstricting effect
Cold
Gastric Lavage: Vasodilating effect
Hot
Important N.I for Gastric lavage
Withhold feeding if there’s presence of blood
Inflammation of gastric and stomach mucosa
Gastritis
Diagnostic test for gastritis
Endoscopy
1 minute ultra rapid urease test (breath test) for detecting
H. pylori (>200)