GERD, Gastritis, PUD, Dumping Syndrome Flashcards by Anonymous 1

Backward flow (reflux) of stomach contents into the
esophagus resulting to inflammatory changes of the
esophageal mucosa

GERD

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Hallmark of GERD: ? (acute symptoms of inflammation)

Reflux Esophagitis

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GERD Causes:
Inappropriate relaxation of the ?
Gastric volume or ? is elevated
Delayed ?

Lower Esophageal Sphincter/ Decrease LES
Intra-abdominal pressure
Gastric Emptying

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GERD CM: substernal or retro- sternal burning sensation
- pain radiate to the neck, jaw, back (mimic ANGINA or
MI

Heartburn/Pyrosis

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GERD CM: warm fluid traveling up the throat (sour or bitter taste)
- danger for aspiration (note for crackles in the lungs)

Regurgitation

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GERD CM: “water brash”

Hypersalivation

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GERD CM: Difficulty of swallowing

Dysphagia

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GERD CM: Painful swallowing

Odynophagia

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GERD CM: change of the normal squamous cell epithelium to columnar epithelium

Barrett’s Epithelium

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GERD CM: Chronic ? especially at ? (due to position)

Cough
Night

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GERD CM:
? belching
? gas
? after eating

Eructation
Gas
Bloating

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GERD DT: Most accurate method

24 hour ambulatory pH monitoring

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GERD DT: small catheter is placed through the nose into the distal esophagus, pH is continuously monitored & recorded)

24 hour ambulatory pH monitoring

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GERD DT: Endoscopy

Esophagogastroduodenoscopy

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GERD DT: “motility testing”

Esophageal Manometry

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GERD DT: water-filled catheters are inserted via the client’s nose or mouth & slowly withdrawn while measurements of LES pressure & peristalsis are recorded); not specific enough to establish a diagnosis of GERD

Esophageal Manometry

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GERD Management: Avoid foods containing

Caffeine, Cocoa, Alcohol, High in Calorie (Fatty food)

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GERD Management: Restrict spicy & acidic foods ?

Orange Juice, Tomatoes

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GERD Management: ? beverages increases pressure in the stomach

Carbonated

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GERD Management: sleep in the ? position to minimize the nighttime episodes of reflux

Left Lateral (Side-lying)

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GERD Management: Small frequent meals

4-6 meals a day

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GERD Management: Remain in upright position for atleast ? after eating

1-2 hrs

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GERD Management: Elevate hob ? inches using wooden blocks or foam wedge

8-12 inches

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GERD Management: Do not wear ?

Constrictive clothing

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GERD Management: Chew ? and follow with ? right after

Antacids Water

GERD Pharmacotherapy: neutralizes HCL & deactivating pepsin

Antacids

GERD Pharmacotherapy: Antacids

Aluminum Hydroxide Magnesium Hydroxide Maalox Mylanta

GERD Pharmacotherapy: Decreases acid production of parietal cells

H2 Receptor Blockers

GERD Pharmacotherapy: H2 Receptor Blockers

Famotidine Ranitidine (Zantac) Cimetidine (Tagamet) Nizatidine

GERD Pharmacotherapy: main treatment for GERD

Proton Pump Inhibitors

GERD Pharmacotherapy: inhibition of proton pump of the parietal cell thereby decreases acid secretion

PPI

GERD Pharmacotherapy: PPI

Omeprazole, Lansoprazole, Rabeprazole, Pantropazole, Esomeprazole

GERD Pharmacotherapy: Increases gastric emptying

Metoclopramide

GERD Pharmacotherapy: the physician applies radiofrequency energy through needles placed near gastroesophageal junction inhibiting the vagus nerve thus reducing the discomfort of the client. It will reshape the ring of muscles in the lower esophagus.

Endoscopic Therapy (Stettra Procedure)

is an inflammation of the gastric mucosa, is classified as either acute or chronic

Gastritis

Gastritis Cause: It usually stems from ingestion of a ?, ?, or ? substance

Corrosive Erosive Infectious

Gastritis Cause: ? and ?, chemotherapeutic drugs, steroids, acute alcoholism and food poisoning (typically caused by Staphylococcus organisms) are common causes.

Aspirin NSAIDs

Gastritis Cause: Food substances including excessive amounts of tea, carbonated drinks and pepper can precipitate acute gastritis. Foods with a rough texture or those eaten at an extremely ? can also damage the stomach mucosa

Tea, Carbonated Drinks, Pepper Rough Texture High Temperature

Gastritis CM: ? discomfort Feeling of ?, early Severe ? Sometimes ? is the only manifestation

Epigastric Fullness, Satiety N&V GI Bleeding

Gastritis CM

Belching Flatulence Cramping Hematemesis

Gastritis CM: When contaminated food is the cause of gastritis, ? usually develops within ? of ingestion

Diarrhea 5 hours

Gastritis Pharmacotherapy: Anti – emetic drugs like Inj. ? or Tab, ? are frequently effective in vomiting.

Perinorm Domperidone

Gastritis Pharmacotherapy: ?, ? are effective to reduce the pain.

Antacids H2 Blockers

Gastritis Pharmacotherapy: If ingestion of NSAIDs is a problem, a ? may be prescribed to protect the stomach mucosa and inhibit gastric acid secretion.

Prostaglandin E1 (PGE1) Analog

Chronic Gastritis: which causes a reddened, edematous mucosa with small erosions and hemorrhages

Superficial Gastritis

Chronic Gastritis: which occurs in all layers of the stomach, develops frequently in association with gastric ulcer and gastric cancer, and is invariably present in pernicious anemia; it is characterized by a decreased number of parietal and chief cells.

Atrophic Gastritis

Chronic Gastritis: which produces a dull and nodular mucosa with irregular, thickened, or nodular rugae; hemorrhages occur frequently

Hypertrophic Gastritis

Chronic Gastritis Cause: Infection with ? or ? may lead to chronic gastritis.

Helicobacter Pylori Gastric Surgery (Gastro-Jejunostomy)

Chronic Gastritis Complications

Bleeding Pernicious Anemia Gastric Cancer

Mucosa: release hydrochloric acid along with intrinsic factor

Parietal Cells

Mucosa: release pepsinogen which mixes with hydrochloric acid and becomes PEPSIN

Chief Cells

Mucosa: release gastrin

G-cells

Defense System: coats the gastric layer and protects the cells from acids

Bicarbonate (HCO3)

Defense System: regulates perfusion to stomach, causes stomach cells to release mucous rich in bicarb, controls acid amounts via the parietal cells

Prostaglandin

PUD Cause: 90% of duodenal ulcers and up to 80% of gastric ulcers are caused by ?

H. pylori

PUD Cause: they work to decrease the production of prostaglandins

Long tern NSAIDs

PUD Cause: tumor formation that causes increased release of gastrin which increases stomach acid production.

Zollinger-Ellison Syndrome

PUD DT: ? indicates bleeding, ? in stool specimen

Decrease Hgb/Hct Occult Blood Test (Guiac Test)

PUD DT: patient will ingest a urea tablet and if h. pylori is present it will break down urea into ammonia and carbon dioxide. Breath samples will be analyzed for abnormally high carbon dioxide levels.

Urea Breath Test

PUD DT: normal gastric acidity in gastric ulcer (increase in duodenal ulcer)

Gastric Analysis

PUD CM: ? and ? pain described as burning, dull, or ? pain

Indigestion, Epigastric Gnawing

PUD CM: Food makes pain worst (pain ? after eating)

Gastric Ulcer 1-2 hours

PUD CM: Weight loss

Gastric Ulcers

PUD CM: Severe: vomit blood more common

Gastric Ulcer

PUD CM: Pain happens when stomach empty… food makes it BETTER (pain ? after eating)

Duodenal Ulcer 3-4 hours

PUD CM: Wake in middle of night with pain

Duodenal Ulcer

PUD CM: Weight normal

Duodenal Ulcer

Severe: tarry, dark stool from GI bleeding

Duodenal Ulcer

PUD Pharmacotherapy: Antibiotics for H. pylori infection

Metronidazole (Flagyl) Tetracycline Pepto-bismol

PUD Pharmacotherapy: Anticholinergics (decrease gastric juice secretion)

Probanthine, Pirenzepine

PUD Surgery: distal end of the stomach is removed, and the remainder is anastomosed to the duodenum

Gastroduodenostomy (Billroth I)

PUD Surgery: removal of the antrum and distal portion of the stomach and duodenum with anastomosis of the remaining portion of the stomach to the jejunum

Gastrojejunostomy (Billroth II)

PUD Surgery: Transection of vagus nerve that eliminates the acid-secreting stimulus to gastric cells & causing a decrease gastric acid secretion

Vagotomy

PUD Surgery: removal of 75% - 85% of the stomach

Subtotal Gastrectomy

PUD Surgery: removal of the antrum of the stomach to eliminate the gastric phase of digestion

Antrectomy

PUD Surgery: creating a passage between the body of the stomach & the jejunum to permit neutralization of gastric acid by regurgitation of alkaline duodenal contents into the stomach

Gastroenterostomy

PUD Surgery: removal of the entire stomach with a loop of jejunum anastomosed to the esophagus

Esophagojejunostomy (Total Gastrectomy)

PUD Post-operative: Measure drainage accurately to determine necessity for ? replacement; notify physician if there is no drainage. Anticipate frank, red bleeding for ? ; Do not manipulate the tube and ensure its ?

Fluid and Electrolyte 12-24 hrs Patency

PUD Post-operative: Place client in ? or ? position to promote chest expansion; Teach client to ? high upper abdominal incision before turning, coughing, and deep breathing

Mid - High Fowlers Splint

PUD Post-operative: After removal of NG tube, provide ? with gradual introduction of small amounts of ? at frequent intervals; Monitor weight daily. Assess for ?; if present, instruct client to eat ? at a slower pace

Clear liquids Bland foods Regurgitation Smaller amounts of food