GI and gallbladder Flashcards
cholelithiasis
calculi in the gallbladder
gallstones composition (pigment: 25%, cholesterol: 75%)
biliary colic with obstruction of cystic duct
stone may retreat or pass
cholelithiasis diagnosis
ultrasonography, cholecystography, endoscopic retrograde cholangiopancreatography, PCT, MRI, blood test, X-ray
cholelithiasis treatment
ERCP and PTC (removal of stones) and extracorporeal lithotripsy to dissolve stones
NG tube
nutrition: low fat
avoid alcohol, gas forming foods, fried foods
drug therapy: antibiotics, lipid/cholesterol lowering drugs, antispasmodics, analgesics
cholecystectomy
surgical procedure to remove the gallbladder
cholelithiasis post procedure care
assess, monitor vitals, O2 sat, skin care, biliary drainage, t-tub or NG tube, pain control, I&O, encourage activity
low fat diet, ideal weight, limit pregnancies
report fever, jaundice, pruritus, dark urine, pale stools
dumping syndrome
food rapidly enters jejunum, vasomotor disturbances within 10-30 minutes after eating
vertigo, tachycardia, syncope, sweating pallor, palpitation, d/n, weak
dumping syndrome patient teaching
small frequent meals, avoid drinking with meals
HIGH PROTEIN, HIGH FAT, LOW CARB, LOW FIBER (dry diet)
antispasmodics
lying down after meals
GERD
Backflow of gastric contents into the esophagus
incompetent LES and inflamed esophageal mucosa
mucus and saliva are protective factors
GERD risk factors
unknown cause
pressure zones, weight gain, obesity, pregnancy, lying flat, spicy food, high fat foods, caffeine, carbonation, chocolate, chewing tobacco, elderly
NSAIDs and stress increase gastric acid
clinical manifestations of GERD
dyspepsia
pain after activities/meals, supine position, radiates to the back of neck or jaw (confused with angina), walking
esophageal spasm/odynophagia
intermittent dysphagia
acid regurgitation
water brash
eructation
distended abdomen
GERD diagnosis
barium swallow, esophagoscopy, esophageal biopsy, cytology, gastric secretions, acid tests
medical management of GERD
mild- antacids, work in 30 minutes to increase gastric pH, avoid mg antacids
persistent- histamine receptor antagonists, reduce gastric secretions, take 1 hr before or after antacid
severe- cholinergic drugs (reglan) increases LES pressure and gastric emptying, taken before meals
PPIs (nexium) suppress gastric secretions
Gerd nursing interventions
eat small frequent meals slowly
chew to create saliva
avoid extremely hot or cold foods
don’t drink 2-3 hours before bed
elevate HOB 30º
avoid tobacco, fatty foods, chocolate, caffeine
no strenuous activities after meals
bowel obstruction
impairment of forward flow of intestinal contents
high mortality rate if not treated within 24 hours
partial or complete
mechanical (blockage) or nonmechanical (paralytic ileus)
etiology of bowel obstruction
adhesions (most common), tumors, hernias, fecal impaction, strictures, narrowed blood vessels, intussusception, volvulus, ileus
bowel obstruction assessment
hiccups, last BM, fever, ribbon like stools, tachycardia, bowel sounds may be absent or decreased or increased, a mass
bowel obstruction clinical manifestations
abdominal cramps, fever, nausea with vomiting (may be orange or brown with fecal odor), hiccups, obstipation, partial obstruction, fluid and electrolyte imbalance
diagnosis for bowel obstruction
CBC, BUN and electrolytes, elevated amylase if pancreas affected, ABG abnormal, abdominal X-rays, CT scan, colonoscopy
bowel obstruction treatment
nonmechanical obstruction (NG tube)
mechanical obstruction (NG tube and removal of obstruction)
fluid and electrolyte replacement
pain management (avoid opioids)
antibiotics
surgery
surgical options for bowel obstructions
laparotomy if the cause is unknown (to find cause), adhesions removed, bowel resection
ulcerative colitis
starts at rectum and works way up, continuous, not deep, just first layer
inflamed mucosal lining of colon or rectum
unknown etiology
tobacco protects against development of UC (risk for Crohn’s)
LOW FIBER, LOW RESIDUE, LOW FAT DIET, high protein and calories
ulcerative colitis signs and symptoms
many loose stools with pus, blood, or mucous (10-20 liquid stools per day)
dehydration
intermittent tenesmus (straining)
metabolic acidosis or alkalosis
fistulas from exertion
toxic megacolon
crohn’s disease
deeper, not continuous, some lesions
inflammatory disease of the small intestine or beginning of colon
flares and remissions
healthy tissue interspersed with diseased tissue
crohn’s signs and symptoms
steatorrhea from malabsorption (frequent fatty stools, 5-6 per day)
loss of appetite
periumbilical pain
low grade fever
increased WBC
urgency, straining
ileostomy preoperative
psychological prep
bowel prep (neomycin)
cleaning enema
discuss post op incentive spirometry and breathing exercises
refer counseling
permanent ileostomy
terminal ileum brought out through the abdominal wall
brought into intra-abdominal pouch
drained with catheter
emptied every 2 hrs in the first 2 weeks
ileoanal anastomosis
colon and rectum removed
J pouch
colon removed leaving rectal sphincter
billroth 1
a gastroduodenostomy and involves resection of the lower portion of the stomach. offers a lower cure rate than the billroth 2
