GI Flashcards
What is LES?
Lower esophageal sphincter - a ring of muscle that forms a valve at the lower end of the esophagus where it joins the stomach
What is Achalasia and its S/Sx?
Spasm of the LES and dilation of lower esophagus
S/Sx: dysphagia, pain, aspiration
What is nutcracker esophagus and S/Sx?
excessive contractions in the smooth muscle of the esophagus and the stomach
S/Sx: dysphagia, chest pain, odynophagia (painful swallowing)
What is the medication treatment for achalasia & nutcracker esophagus?
Nitrates: NTG SL
Calcium channel blockers: Verapamil (relaxes esophagus/stomach muscles)
What are the diagnostics used for achalasia & nutcracker esophagus?
Barium swallow (esophagogram), CT, endoscopy, manometry
What is the treatment and nursing intervention for Achalasia and nutcracker esophagus?
treatment: pneumatic dilation, surgery, meds/botox
nursing intervention: education (eat slowly and have fluids w/meals, assess for complications after procedures/surgeries)
What is a hiatal hernia?
part of the stomach bulging into the chest
Explain assessment and S/Sx of sliding hiatal hernias?
pyrosis, dyspepsia, regurgitation, dysphagia, belching, nausea, bloating
Explain assessment and S/Sx of paraesophagael hernias?
feeling of fullness and breathlessness after eating, feeling of suffocation, chest pain (mimics angina), worsening of symptoms in recumbent position
What are the diagnostics of hiatal hernias?
barium swallow with flouroscopy, EGD, chest CT scan
What is the surgical intervention for hiatial hernia?
Nissen Fundoplication Surgery
What are the nursing interventions for hiatal hernia?
- frequent small feedings
- educate pt not to recline for 1 hour post meal
- educate to elevate HOB
What are the post-op interventions for nissen fundoplication surgery?
- NG tube care
- monitor for complications e.g. abdominal bloat syndrome, anastomatic leak
- diet/meds
What age group is most commonly affected by GERD?
middle to older adults
What is the pathophysiology of GERD?
Can occur from: incompetent LES and hiatial hernia’s
What are the S/Sx of GERD?
- dyspepsia (indigestion/heartburn)
- dysphagia
- pyrosis (burning sensation in ES)
- odynophagis (painful swallowing)
- reflus
- esophagitis
- eructation
- water brash (hypersalivation)
- N/V, weight loss
What are the complications of GERD?
- esophageal strictures
- barrett’s esophagus
- bronchospasm
- aspiration
What factors exacerbate GERD?
- recumbent position
- large meals
- alcohol
- caffeine
- nicotine
- mint
- carbonated/acidic food & bev
What is the diagnostic tool used for GERD?
endoscopy
What is the medication treatment for GERD?
PPI: give before meals
H2 blockers: dont give at same time as PPI
Antacids: PRN
Prokinetic agents: GI stimulants
Anti-gas
What is the bed positioning for GERD?
Elevate HOB
What are the symptoms of esophageal cancer?
dysphagia (first with solids, then liquids), reflux, weight loss, mass sensation in throat, painful swallowing, substernal pain or fullness, regurgitation of undigested food, hiccups, halitosis, complete obstruction
What are the diagnostics for esophageal cancer?
Barium swallow, EGD, CT, PET (to look for mets), endoscopic US (to detect spread to lymph)
What is the treatment for esophageal cancer?
Early detection can be cured, however it is often detected late.
- Symptom management
- surgery
- radiation, chemo
How long after chemo/radiation is esophagectomy performed?
5-6
What are the nursing interventions pre-op esophagectomy?
nutrition management: need high protein/calories to increase weight. PEG or JT may be used 2-3 weeks prior to surgery
pt education: possible chest tube, NGT, TN, gastric intubation, neck/ab incisions
What position prevents reflux?
Fowlers
What are the post-op priorities for esophagectomy?
respiratory (usually intubated), cardiac (hypotension), wound/drain management, NGT care, slow reintroduction of feeds
What are the post op complications for esophagectomy?
atelectasis, Pulmonary edema, pain, infection, anastomatic leak, bleeding, aspiration, wound/drain management, nutrition, dysrythmias, DVT
What is gastritis?
Inflammation of gastric mucosa (stomach lining), disruption of protective layer. Damage occurs through HCL acid, pepsin
What are the risk factors for gastritis?
alcohol, smoking, NSAIDS, ASA, corticosteroids, physiological stress, H pylori infection
What are the S/Sx of gastritis?
pain, N/V, upper GI bleed
What are the diagnostics for gastritis?
endoscopy, anti-H pylori antibodies (IgG), H+H
What is the treatment for gastritis?
treat H pylori, PPI, eliminate causative factors
What is the treatment for H Pylori?
10-14 day course of Triple therapy: Amoxicillin, Clarithromycin (Biaxin), PPI OR
Quadruple therapy: PPI, tetracycline, metronidazole (flagyl), bismuth
Chronic gastritis causes which vitamin deficiency?
B12 deficiency and iron malabsorption
What is peptic ulcer disease?
Complete erosion of GI mucosa
What are the three types of peptic ulcers?
gastric, duodenal, stress
What are the notable features of gastric ulcers?
-pain aggravated by food
-associated with NSAIDS
-pain left of the midline/upper epigastrium
What are the notable features of duodenal ulcers?
- pain between meals
-relieved with food/antacids
-pain right of epigastrium
What is the etiology of stress ulcers?
transient ischemia associated with hypotension, burns, trauma etc
What are the risk factors for peptic ulcer disease?
-NSAIDS, ASA, corticosteroids
-H Pylori
-ETOH
-Tobacco
-not food associated
-zollinger-ellison syndrome
What are the complications of peptic ulcer disease?
GI bleed, perforation, gastric outlet obstruction
What are the diagnostics for peptic ulcer disease?
-endoscopy
-biopsy
-H pylori IgG, CBC, CMP, Amylase Lipase
What is the treatment for peptic ulcer disease?
PPI, sucralfate, H pylori therapy, lifestyle modification, surgery (rare)
What are the S/Sx of upper GI bleed due to peptic ulcer disease?
upper GI bleed is LIFE THREATENING (6-10% mortality)
-hematemesis, coffee ground emesis, melena, syncope, anemia
What is the management for upper GI bleed?
-vitals, labs (CBC, CMP, ABG, PT/INR, aPTT)
-hemodynamic stabilisation, fluid replacement, transfusions
-CVP monitoring, H+H every 6h
-UO, O2, PPI’s, prep for endoscopy and surgery
Explain the peptic ulcer disease complication: Perforation?
Spillage of GI contents into peritoneum
What are the S/Sx of PUD complication perforation?
-sudden sever pain radiating to shoulder
- board-like abdomen
- absence of bowel sounds
What can PUD perforation lead to?
perforation is a surgical emergency to prevent Bacterial peritonitis
What is the post-op care for PUD perforation?
-broad spectrum antibiotics
-NPO, NGT (to decompress)
-incision/drain management
-IV fluids/FBC/electrolytes
-pain
-prevent complications
Explain the PUD complication: gastric outlet obstruction?
Inflammation/edema of pylorus
What is the treatment for gastric outlet obstruction?
NGT, replace fluids/electrolytes, surgery may be needed
What are the three surgerys used to treat PUD?
-Billroth I (gastroduodenostomy)
-Billroth II (gastrojejunostomy)
-Vagotomy
What is Billroth I?
Gastroduodenostomy: partial gastrectomy with anastomosis to duodenum
What is Billroth II?
Partial gastrectomy with anastomosis to jejunum
What is a vagotomy?
Severing of branches of vagus nerve (cutting the branch of the vagus nerve that tells stomach to secrete gastric acid)
What is the post-op management for gastric resection?
-pain, atelectasis risk, PNA
-abdominal distension, leaks, ileus
What are the risk factors for gastric cancer?
Diet: smoked, salted, pickled foods, diet low in fruit & veg
Lifestyle: smoking
Other: chronic inflammation of stomach, H. pylori infection, pernicious anemia, genetics, gastric ulcers, previous gastrectomy
What is the diagnostics and treatment for gastric cancer?
EGD w/biopsy, CT
Possible surgery (billroth I/II) or chemo (palliative)
What is dumping syndrome?
A complication of gastric surgery: chyme entry to intestine not controlled
(food moves from stomach to small bowel too quickly after eating)
Hyperosmolar bolus enters intestine: large fluid shift results in hypotension and diarrhea
What is postprandial hypoglycemia?
“reactive” hypoglycemia: bolus of carbs result in insulin surge post meal (blood sugar drops after meal)
What is barretts esophagus
inflammation causing cellular alteration in esophageal lining, precancerous
