GI Flashcards
What is Diverticular Disease?
Diverticula=small outpouchings of the colon that occur in rows. “Fingerlike”, mostly in sigmoid
Inc with age
Cause: low fiber, refined diet
What causes diverticula?
Formed when increased pressure in the bowel causes herniation of the bowel mucosa through the colon wall.
Bowel lumen narrowed due to hypertrophy of muscular tissue.
Define diverticula, diverticulosis and diverticulitis.
Diverticula: the actual finger like outpouches
Diverticulosis: indicates the actual presence of diverticula
Diverticulitis: inflammation in and around diverticular sac.
What are the manifestations of diverticular disease?
Pain, left sided, mild to severe, steady or cramping
Constipation vs inc defecation
N,V, low grade fever
Distended abd, mass in LLQ
What are the complications of diverticular disease?
Abscess
Peritonitis
Hemorrhage
Bowel obstruction
What are the diagnostic tests performed for diverticular disease?
Barium enema X-rays=free air Flexible sigmoidoscopy Colonoscopy CT scan-abscesses, inflammation Labs: Guaiac, WBC
What are the treatments for diverticular disease? (meds and diet)
Meds: metronidazole, ciprofloxacin, trimethoprim-sulfamethoxazole, rifaximin
Acute=IV antibiotics: cefoxitin, Piperacillin-tazobactum
IV fluids, NPO, TPN, surgery (peritonitis/abscess)
***Diet-high fiber, avoid seeds (AFTER bowel rest is completed)
What is a bowel obstruction and what can cause it?
Result of something blocking part of the intestine (mechanical obstruction) or a failure of the intestine to work properly (paralytic ileus).
Causes: Diverticulosis, UC, Crohns, Colon Cancer
What is the nursing care for bowel obstruction?
NPO CT scan, abd scan NGT to suction Bowel rest Surgery if unresolved by the above Monitor for infection, perforation, jaundice
When is Total Parenteral Nutrition used and how do you calculate it?
Used for longer term bowel rest
Must administer through CVAD
Monitor labs daily if inpt
Check glucose q 6 hrs
Calculate requirements for water (30 to 40 mL/kg/day), energy (30 to 45 kcal/kg/day, depending on energy expenditure), amino acids (1.0 to 2.0 g/kg/day, depending on the degree of catabolism), essential fatty acids, vitamins, and minerals.
Use a central venous catheter, with strict sterile technique for insertion and maintenance.
Monitor patients closely for complications (eg, related to central venous access, glucose levels, electrolyte and mineral levels, hepatic or gallbladder effects, volume, or lipid emulsions).
What is GERD?
A weak LES allows backward movement of gastric contents into the esophagus
Results in mucosal injury in the esophagus
Increase occurrence with age
May also be a result of pyloric stenosis or a motility disorder
What are the symptoms of GERD?
Burning sensation in esophagus, AKA Pyrosis
Regurgitation and sour tasting secretions
Dysphagia
Odynophagia
Chest pain
Chronic cough
Hoarseness
Explain the nursing management of GERD.
TEACH! Lifestyle modifications
Eat low-fat, high-fiber diet
Avoid irritants such as spicy or acidic foods, alcohol, caffeine, and tobacco
Do not eat or drink 2 hours before bed
Elevate the HOB
Weight loss
Give medications as prescribed
If no improvement, prepare for surgical repair
Fundoplication—wrapping a portion of the gastric fundus around the sphincter of the esophagus
What are some medications for GERD?
Antacids
H2 receptor antagonists
Proton pump inhibitors, or PPI
What is peptic ulcer disease?
Effects 5-10% of population
May result in duodenal or gastric ulcers
Results from Helicobacter pylori, or H-Pylori, infection
Excessive secretion of hydrochloric acid diminishes the protective effects of mucus secretion
What are common risk factors of PUD?
Altered gastric acid and serum gastrin levels
Tobacco and alcohol use
Over use of Aspirin, NSAIDs, and Corticosteriods
Genetic predisposition
May be psychosomatic (seen with chronic anxiety)
H Pylori
What are assessment findings and symptoms for PUD?
Burning or aching pain—occurs 2-3hrs after meal Pain is relieved by eating Heartburn, nausea, or vomiting GI bleed (may be slow or rapid loss) Coffee ground emesis Epigastric tenderness Older adult -Chest pain -Dysphagia -Weight loss -Anemia
What are the complications of PUD?
Upper GI bleed – erosion of the blood vessels
Obstruction-edema surrounds the ulcer
Perforated stomach
Gastric contents enter the peritoneum causing inflammation
infection
What is the nursing management for PUD?
Diagnose with Endoscopy, urea breath test, fecal test for h pylori
Medication management
Monitor for complication
Smoking cessation
Regular meals
Avoid excess milk or creams as they are acid stimulants
Stress management and coping techniques
What are the medications for PUD?
PPIs H2 Receptor blockers Abx (combo of metronidazole, amoxicillin, tetracycline) Sucralfate Bismuth Antacids
What is Gastritis?
Inflammation of the stomach
May be associated with chronic use of NSAIDs, corticosteroids, aspirin, alcohol, and caffeine
Acute vs Chronic
Page 1105 chart 55-2 comparison
Acute is more common, usually related to something ingested
Chronic is seen more with Age
-Common in people who smoke or consume alcohol
-Irreversible changes in the gastric mucosa
-May be contributed to H pylori bacteria
What are the acute symptoms of gastritis?
Mild heartburn Vomiting Bleeding Hematemesis Sharp pain anorexia
What are the chronic symptoms of gastritis?
Heavy feeling after meals
Ulcer like epigastric pain (unrelieved by antacids)
Fatigue
Anemia
What is the diagnosis for gastritis?
Urea breath test
Endoscopy
Monitoring lab values… Hgb, Hct, RBC, B12
