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
What is the treatment for gastritis?
PPI H2 Receptor Blockers Sucralfate Metronidazole, amoxicillin, tetracycline (combo 2) Acute requires GI rest Gastric Lavage
What is a hiatal hernia?
Part of the stomach protrudes through the esophageal hiatus of the diaphragm and enters the thoracic cavity
Incidence increases with age
What are the symptoms of hiatal hernia?
Typically asymptomatic
Diagnosed with barium swallow study or endoscopy
When symptoms do occur it presents like GERD
Increased pain may be present when there is increased abdominal pressure or the hernia becomes incarcerated.
What is the treatment for a hiatal hernia?
Symptom management same as GERD
If becomes incarcerated, surgical repair
Nissen fundoplication
What is needed for a successful bariatric surgery?
Pay attention to dietary changes and teach the patient about nutritional needs post op.
Patient needs a nutrition consult and Psych evaluation prior to surgery to make sure they are prepared for the life long changes that will occur.
Good support system
What is the nursing care for abdominal surgery?
May need to be NPO longer before surgery and have a bowel prep No lifting Splint incision Delayed healing with obesity May need to be on liquids longer post op Loose clothing Pain meds and constipation
What are the advantages of laparoscopic bariatric procedures?
Small incision Minimally invasive Less pain Better cosmetic appearance Less risk of infection Shorter length of stay Lower mortality rate Fewer complications Requires expertise
Describe a gastric bypass.
- laparoscopic
Stomach resection-divided and separated, leaves 1 ounce stomach. Stomach left in place, but is
not functional.
Also malabsorption_bypass portion of the bowel and goes to small intestine
Small pouch-small portions of food
Limits ability to absorb calories
Hormone changes: Ghrelin, GLP-1_dec hunger and improves diabetic control
Hospital stay: longest track record of safety & success. Greatest effect on diabetes, cholesterol
and heartburn. Highest weight loss: 65-80%
Complication rate 3.2% (low) but highest rate. Risk for ulcers-poor choice for smokers, unable to
take anti-inflammatory (nsaids)
Higher incidence of vitamin and mineral def
Describe a sleeve gastrectomy.
(Laparoscopic)
Creates high pressure narrow sleeves. Half of abd is resected and removed-no bypass. Food is
absorbed normally.
Restrictive only-not malabsoprtive
Hormonal changes: removes ghrelin cells. Diminished hunger
Short hospital stay
Able to take NSAIDS
Few vitamin deficiencies
Avg weight loss 60-70%
Complications 2.6%
Not reversible, has a leak rate out of stapled abdomen, unproven durability beyond 5 years
Describe a lap band.
Creates small pouch, no malabsorption, pressure of band appears to diminish hunger Fluid can be added/withdrawn from the band-adjustable. Low complication rate Short hospital stay Can take NSAIDS Few vitamin deficiencies Can be removed Restrictive diet More office follow-up, q month x12 Weight loss is less predictable, more gradual 40%-50% weight loss, highly variable Not good for very obese (>BMI 50)
