GI Flashcards
what is considered upper abdominal issues
- GERD
- peptic ulcers
- gastritis
- gastroparesis
- gallstones
what is considered lower abdominal issues
- celiac disease
- diverticular disease
- IBS
- inflammatory bowel disease
symptoms of upper GI issue
- bleeding
- anemia
- early satiety
- unexplained weight loss >10%
- progressive dysphagia
- odynophagia (pain or discomfort when swallowing)
- persistent vomiting
what does C-reactive protein tell you
inflammation
causes of gastritis
- H.pylori
- excessive smoking or drinking
- prolonged NSAID use
- cocaine
- weakened stomach lining (i.e. pernicious anemia)
most important system to check although it is GI issues
cardiac first - pulses, cap refill, O2 sat monitor
isolation precaution for gastritis
contact precautions
how often to take I/Os for at risk pt
q1hr
how often to check weight for at risk pt
q4hr
what type of IV fluid to give for gastritis
D5W w/ 0.9NS + 20KCl
nurse teaching for gastritis
- perianal hygiene
- food prep practices
- vaccines
- continued ORT (oral rehydration therapy) at home
what type of acid/base issue might vomiting and diarrhea lead to
hyperchloremic acidosis from loss of sodium bicarbonate
minimum of fluids for maintenance & how much fluid intake we should have per day
125-150mLs /hr
should have 2-3L per day
most common causes of appendicitis & age range for getting it
- infection from stomach migrated to appendix
- obstruction of stool
most common in teenage years
why is abx &IV fluids typically given to someone with appendicitis
prophylactic prevention in case it ruptures
IV fluids to avoid dehydration
what is GI bleed pt at risk for
- hemorrhage
- hypovolemic shock
- aspiration
what’s the treatment for GI bleed
- blood transfusion
- NG tube for gastric lavage
- stop bleed
- meds: epinephrine, vasopressin
- meds: octreotide
- PPI: pantoprazole
why give vasopressin (ADH) for GI bleed
it constricts the GI blood vessels to slow bleed
what is a sign of a massive GI bleed
foul smelling, marron or purple color jelly stool
what can hyperperistalsis indicate
intestine issue such as obstruction
teaching for fluoroscopic x-rays
- enemas need to be given
- NPO for 8 hrs at least
- lost of fluids & laxatives to expel the contrast
what position should the pt be in for endoscopy
left side with head bend forward
how does ERCP (endoscopic retrograde cholangiopancreatography) work
endoscopy into duodenum & inject contrast dye into common bile ducts to see gallstones, tumor, or biopsy
how does capsule endoscopy work
pt swallows small camera to see small bowel that wasn’t seen in regular endoscopy
contraindications for barium swallow
pregnancy - since barium has radiation
perforation of esophagus or intestines
blockage or severe constipation
severe issues with swallowing
sensitivities
how does barium affect stool color
white or light color until clears
preparation for colonoscopy
clear liquids the day before
Golytely night before (may cause ab cramping) - osmotic laxative to cleanse
when is colonoscopy recommended
pts over age 50
how is gastric contents analyzed
NG tube and see contents
gerontological considerations
- stomach produces less acid - less protection when taking NSAIDs
- muscles can slow leading to acid reflux or constipation
S/S of diverticulitis
- gas, bloated, cramps, constipation
- if inflamed: pain, cramps, fever, vomiting
what is Barrett’s esophagus
if GERD is untreated and the acid affect the esophagus and leading to cancer
S/S of gastritis
- N&V
- abd pain, cramps
- indigestion, uncomfortable between meals or at night
- hiccups
- loss of appetite
- black tarry stools
treatment for gastritis
- avoid gluten & dairy
- avoid hot & spicy foods
- take antacids prn
- abx w/ acid blocking drug for H.pylori
- vitB12 shots for pernicious anemia
S/S of appendicitis
- LRQ pain that radiates from naval
- pain that worsens with movement
- N&V
- loss of appetite
- fever
- constipation or diarrhea
- flatulence or bloating
where is McBurney’s Point for appendicitis
abd wall between navel and LLQ that causes pain in LRQ
when do appendix typically burst from appendicitis
24-72 hrs
what is Rovsing’s sign for appendicitis
palpation of LLQ that leads to pain in LRQ
Testing for appendicitis
- CBC (especially neutrophils 2,500-7,000)
- CT, ultrasound
- c-reactive protein for inflammation
laparotomy vs. laparoscopy
laparotomy is small incision in abdomen
laparoscopy is inserting a small scope in
what position to place patient after appendix sx
high-fowler’s to decrease tension in abdomen
what is octreotide used for
decrease HCl & decrease splanchnic blood flow
IV bolus up to 5-6 days after bleed
MOA of PPI pantoprazole
inhibits pump that secretes HCl acid
neutralizing effect lasts longer than antiacids
can take up to 4 days before effect is seen
list HH2 receptor antagonist drugs
ranitidine
cimetidine
famotidine
nizatidine
-“tidine”
MOA of ranitidine
inhibit histamine at H2 receptors to decrease parietal cell acid secretion
when should pts take pantoprazole
before meals
when should pts take ranitidine
with or after meals
before sleep
use HH2 receptor antagonists cautiously in which pts
kidney dx pts
what is small intestine adhesions
fibrous tissue that form after sx from extreme inflammation
can lead to GI obstruction
what is small intestine volvulus
twisting of intestines that can lead to obstruction
what is small intestine intussusception
“telescoping” of one segment into the next section that can lead to obstruction
stricture of colon means
narrowing of colon caused by scarring of inflammation
causes of GI obstruction
- small intestine adhesion, volvulus, intussusception
- birth defect
- tumors
- hernias
- IBS (i.e. Crohn’s)
- swallowed objects in children
what can ileus lead to
gastroenteritis, appendicitis
electrolyte imbalances
what is pseudo-obstruction
obstruction due to muscle or nerve issue
causes of pseudo-obstruction
Parkinson’s, MS
Hirschsprung’s dx - lack of nerves in large intestine
diabetes
hypothyroidism
symptoms of obstruction
- severe bloating
- pain
- decreased appetite
- N&V
- constipation (complete) or diarrhea (partial block)
treatment for obstruction
- IV fluids
- NG suction
- surgery - colostomy, ileostomy, partial bowel removal
DC teaching after obstruction sx
- eat small meals throughout day
- take sips of clear liquids throughout day
- add new foods back to diet slowly
- if constipation or discomfort avoid solid foods & clear liquid only
- limit exercise for 4-6wks
- ileostomy or colostomy care
list 3
antiemetics
ondansetron
metoclopramide
dimenhydrinate
what type of foods should pts with ileostomy restrict
- fiber
- soda, nuts, peppers
- limit smoking
- dairy
change in pain when someone with duodenal ulcer vs. gastric ulcer ingests food
decrease in pain for duodenal ulcer
increase in pain for gastric ulcer
use of magnesium hydroxide
known as “milk of magnesia”
increases GI motility
how does vomiting and diarrhea affect electrolytes
decrease in electrolytes so should be monitored closely
what happens to the enzymes that the pancreas typically releases when the pt has pancreatitis
increase in enzymes due to poor modulation
what foods should a pt with colostomy eat
yogurt
crackers
toast
to prevent flatus and odor
what foods can a pt with celiac dx eat and not eat
don’t eat gluten
eat more fiber foods - beans, nuts, fruits, veg
main symptom to look out for when a pt is taking metoclopramide
extrapyramidal symptoms i.e. ataxia
main symptom to look out for when a pt is taking ondansetron
monitor ECG for QT prolongation
main symptoms of dramamine (dimenhydrinate)
drowsiness, dry mouth, blurred vision
how should antiacids be taken
with a full glass of water when acid levels are highest so 1-3hrs post meal and before bedtime
how does changes in CEA (carcinoembryonic antigen) level change with cancer
increases with cancer
Hgb level for pt with colorectal cancer
decrease due to intestinal bleed
foods to eat vs. not eat to avoid dumping syndrome post gastrectomy
eat more protein
eat less carbs or sugary foods & fluids
why would cirrhosis lead to bleeding of the esophageal varices
increased portal vein pressure that leads to enlarged veins of the esophagus
what type of foods should a pt with pancreatitis consume and not consume
low fat
high protein diet
prolonged use of PPI can lead to what
fractures especially in elderly
pneumonia or C.diff
list some antiacids
- aluminum hydroxide
- magnesium hydroxide
- calcium carbonate
- sodium bicarbonate
what does metoclopramide do
antiemetic
increased motility of stomach and esophagus
which antibiotics can eliminate H. pylori
- metronidazole
- amoxicillin
- clarithromycin
- tetracycline
what is sucralfate used for
coats ulcer and protects it
prevents H. pylori from binding to mucosal wall
inhibits acid
expected effects of taking sucralfate
black stool
when to take sucralfate
1 hr before meals or bedtime
what drug not to take & adverse effect of sucralfate
don’t take with aspirin, NSAIDs
may cause constipation
