GI Flashcards
important function large intestine
absorption of water and electrolytes
liver function
- remove bacteria , toxins
- manufacture, store, transfrom, and excrete a lot of substances involved in metabolism
biliary tract
bilirubin is from HGB breakdown
pancreas
- insulin (endocrine)
- amylase, lipase (exocrine), for fat metabolism
peds GI
Increased risk of dehydration due to: greater percentage body weight is water, greater body surface area and increased fluid intake relative to size, infant kidneys less able to concentrate urine
-Gastric acid concentration is low until school age
-Faster basal metabolic rates
-Decreased ability to digest fats first 4 -5 months
-Immature liver function – reduces vitamin/mineral uptake
Loss of fluid->elevated temp sooner than an adult
-Lower acid concentration in stomach alters medication absorption and ability to kill GI pathogens.
-Children need more nutrients-proteins, minerals, vitamins, calories to support higher basal metabolic rate but the immature liver function – reduces vitamin/mineral uptake
- decreased ability to absorb fats.
geri GI
- Dry mouth due to decreased saliva production and effects of many of their meds and gingival atrophy
- Decreased gastric motility->delayed emptying
- Decrease in HCl acid->food intolerances, malabsorption, B12 absorption
- Decreased colonic transit time->constipation
- Decreased absorption of nutrients such as dextrose, fats, calcium, and iron
- Dehydration, diuretics-> Lasix
- Older adults may be at risk for decreased food intake due to transportation issues, economic constraints, immobility……
checking rebound tenderness
You first gently palpate over the painful site, pushing in slowly and firmly then quickly withdraw—pain on withdrawal may indicate peritoneal inflammation
blood-amylase
Amylase-dx of pancreatitis peaks early 24 hr then down to normal 48-72hr
lipase
Lipase-Dx of pancreatitis but it stays elevated longer,
CEA
- carcinoembryonic antigen (test)
- cancer marker, protein found or increased in level in certain cancers
- cancer of the large intestine (colon and rectal cancer). It may also be present in people with cancer of the pancreas, breast, ovary, or lung.
stool test
-Occult blood, ova and parasites, -fecal fat: increased fat is found in the stools of patients with Crohn’s disease, malabsorption, cystic fibrosis, and pancreatic disease.
basal secretion test
measures HCL and pepsin
gastric acid stimulation test
-similar to basal secretion test except a drug is given to stimulate secretions and additional specimens are taken at intervals
Upper GI radiologic study
- X-ray allowing examination of esophagus after swallowing barium. The series follows barium through the esophagus, stomach, and small intestine and used to diagnose esophageal strictures, varices, polyps, tumors, hiatal hernia, foreign bodies, and peptic ulcers
- NPO, contrast
Lower GI radiologic study
Similar to upper GI but uses barium enema to identify polyps, tumors and other lesions of the colon. Requires client to retain barium so may not be diagnostic procedure of choice for older adult.
-bowel prep, empty area- complete
abdominal ultrasound
diagnostic procedure for cholelithasis. Can be used for diagnosis of appy, acute cholecystitis and other changes in abdominal organs
- no prep
endoscopy and EGD (esophagastroduodenoscopy)
direct visualization through lighted fiberoptic instrument of esophagus, stomach, duodenum, colon. With the aid of fluoroscopy and X-rays can also visualize the pancreas and biliary tree.
virtual colonoscopy
combines CT or MRI with sophisticated computer software program to produce images of the colon and rectum. Less invasive than normal colonoscopy. Good for assessing polyps larger than 1 cm but cannot obtain a biopsy.
-is done with a CT or MRI. Air is introduced into the colon to better visualize structures. 2D and 3D views are obtained to visualize the colon.
liver biopsy
Dg fibrosis, cirrhosis, and neoplasms (hepatic tissue)
Liver function tests
- r/t Dg hepatic disease
- ALP (alkaline phosphatase), AST (aspartate aminotrasnferase), ALT (alanine aminotransferase)
nurse interventions for radiographic studies
- NPO after midnight
- laxative night before
- discourage smoking
- hold all meds
- aftercare: fluids, enema, monitor stools
ERCP
- endoscopic retrograde cholangiopancreattography
- (use of side viewing flexible endoscope to view pancreatic, hepatic and common bile ducts, biliary tree) Has biopsy forceps and cytology brushes on the endoscope
- combo with biopsy and cytologic studies
- major complication: perforation
capsule endoscopy
Capsule: allows visualization of small intestines and sends data to a recorder that is worn around the waist, Takes 8 hrs, pt can move about
Nissen fundoplication -GERD
Reduce reflux of gastric contents by enhancing integrity of LES
- Most performed laparoscopically
- *Fundus of stomach is wrapped around lower portion of esophagus
Stretta procedure GERD
-catheter is positioned and site is treated with radiofrequency energy
NI:-Monitored for complaints of chest pain
Clear liquids for 24 hours
Advance to soft diet for 2 weeks
Liquid medications
Nausea and vomiting: Must contact physician
No NSAIDs for 10 days following procedure
CTZ
Chemoreceptor trigger zone (CTZ)
Responds to chemical stimuli of drugs and toxins
Located in the fourth ventricle
Site of action of drugs used to induce vomiting
Plays a role in vomiting due to labyrinthine stimulation
Vomiting can be a protective mechanism
regurgitation
- Partially digested food slowly brought up into stomach
- Effortless return of food or gastric contents from stomach into esophagus or mouth
- Described as hot, bitter, or sour liquid coming into the mouth or throat
projectile vomit
Forceful expulsion of stomach contents without nausea
nutritional therapy for NV
Clear liquids started first
5 to 15 ml fluid every 15 to 20 minutes
Room-temp carbonated beverages without carbonation okay
Warm tea
Use Gatorade, broth with caution because of high salt intake
herniation
Herniation of portion of the stomach into esophagus through an opening or hiatus in diaphragm
Also referred to as diaphragmatic hernia and esophageal hernia
Most common abnormality found of x-ray of upper GI
More common in older adults and in women
sliding herniation
Stomach slides into thoracic cavity when supine, goes back into abdominal cavity when standing upright
- 95% of cases
- r/t GERD
paraesophageal or rolling
Esophageal junction remains in place, but fundus and greater curvature of stomach roll up through diaphragm
Diagnostic tests-PUD
Most often used
Allows for direct viewing of mucosa
Determines degree of ulcer healing after treatment
During procedure, tissue specimens can be obtained to identify H. pylori and rule out gastric cancer Tests for H. pylori
Noninvasive tests
Serum or whole blood antibody tests
Immunoglobin G (IgG)
90% to 95% sensitive
Will not distinguish between active or recently treated disease Urea breath test
Urea is by product of metabolism of H. pylori
Can determine active infection
Stool antigen test
Not as accurate as breath test
Invasive tests
Endoscopic procedure
Biopsy of stomach
Barium contrast studies
Widely used
Not accurate for shallow, superficial ulcers
Used in diagnosis of gastric outlet obstruction
Rapid urease testX-ray studies
Ineffective in distinguishing a peptic ulcer from a malignant tumor
Do not show degree of healing like that of endoscope
PUD-Billroth I
- Gastroduodenostomy
- part of distal portion of stomach, including antrum is removed. Remaining stomach is anastamosed to duodenum.
PUD-Billroth II
- Gastrojejunostomy
- Partial gastrectomy with removal of distal 2/3 stomach and anastomosis of gastric stump to jejunum
Vagotomy
Severing of vagus nerve
Done in conjunction with gastrectomy
Gastrectomy
removal of entire stomach
pyloroplasty
Surgical enlargement of pyloric sphincter
Commonly done after vagotomy
↓ Gastric motility and gastric emptying
If accompanying vagotomy, ↑gastric emptying
PUD-post op complications
Dumping syndrome
Postprandial hypoglycemia
Bile reflux gastritis (cont’d)
dumping syndrome
33% to 50% of patients experience after surgery
Direct result of surgical removal of a large portion of stomach and pyloric sphincter
↓ Ability of stomach to control amount of gastric chyme entering small intestine
Occurs at end of meal or 15 to 30 minutes after eating
Symptoms include
Weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate
Last no longer than an hour
Postprandial hypoglycemia
Postprandial hypoglycemia
Variant of dumping syndrome
Result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine
↑ Blood sugar
Release of excessive amounts of insulin into circulation
Secondary hypoglycemia occurs with symptoms ~2 hours after meals
Symptoms include sweating, weakness, mental confusion, palpitations, tachycardia and anxiety
When symptoms occur, immediate ingestion of sugared fluids or candy relieves symptoms
bile reflux gastritis
Bile reflux gastritis (cont’d)
Continuous epigastric distress that ↑ after meals
Administration of cholestyramine (Questran) relieves irritation
Aluminum hydroxide antacids also used
PUD post op nutrition
-Start as soon as immediate postoperative period is successfully passed
-Patient should be advised to reduce drinking fluid (4 oz) with meals
-Diet should consist of :
Small, dry feedings daily
Low in carbohydrates
Restrict sugar with meals
Moderate amounts of protein and fat
30 minutes of rest after each meal
hypertrophic pyloric stenosis (HPS)
Pyloric muscle becomes thickened obstructing the gastric outlet
Higher incidence in males, Caucasians and those with family history
Incidence overall: 3 in 1000 live births
HPS SS
projectile vomiting in otherwise healthy, hungry infant, weight loss, dehydration, olive-shaped tumor to R of umbilicus, metabolic alkalosis (prolonged vomiting)
HPS Tx
surgical -> pyloromyotomy (Fredet-Ramstedt procedure) or laparoscopic
HPS NC
Post op the focus is on SLOW introduction of fluids and foods, though I have read one recent journal article recommending fluids be introduced more quickly if tolerated. Usual course is 5 ml, then 10ml, then 30 ml q 1 hour and for a hungry infant, this is difficult
IBS criteria
-Rome II criteria- abd discomfort at least 12 wks in past yr: relieved with defecation or onset associated with a change in stool appearance change
