GI Part 2 Flashcards by Christina Stafstrom

spongy material in LES to tighten it Stretta procedure- radiofrequency energy through needles to inhibit the vagus nerve

endoscopic procedure

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Surgeon wraps and sutures the gastric fundus around the esophagus which anchors the LES area below the diaphragm and reinforces the high pressure area

Nissen fundoplication

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when may clear liquids be given

Following surgery and after peristalsis is re-established

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what may you develop after GERD surgery

gas bloat syndrome (cannot eructate)

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what should you avoid eating after GERD surgery

Avoid eating high fat foods, chewing gum, drinking with a straw or drinking carbonated beverages

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what are the three most common abdominal hernias

umbilical, incisional, femoral

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Protrusion of stomach through the esophagus

hiatal hernia

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the symptoms and nonsurgical methods of a hernia are similar to what?

GERD

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surgical method of fixing a hernia

Lap Nissen Fundoplication-

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post op hernia patient is at risk for what

risk for bleeding, infection and respiratory complications

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what is a hiatal hernia also known as

Known as diaphragmatic hernia

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are the most common type of hernia and account for 90% of the total number of hiatal hernias.

sliding hernia

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hernias are classified as either

rolling or sliding

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these hernias generally moves into and out of the thorax

sliding hernia

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what can cause sliding hernias

weakening in the esophageal hiatus

Congenital weaknesses, trauma, obesity or surgery

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gastroesophageal junction remains in normal location but the fundus rolls through the esophageal hiatus and into the thorax beside the esophagus

rolling hernia

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what can cause rolling hernias

improper anchorage of the stomach

or previous esophageal surgeries.

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when do hiatal hernias increase and who are they more common in

increase with age and are more common in women

occurs in 20% of adults

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nonsurgical management of hernias is similar to what

GERD

Include drug therapy, diet therapy, lifestyle modifications and client education

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what are the major stomach disorders

Gastritis, Peptic ulcer disease, gastric cancer

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inflammation of the gastric mucosa

can be erosive or nonerosive

gastritis

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With progressive disease, stomach lining thins, parietal cell functioning becomes compromised and the patient will develop

pernicious anemia

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gastritis increases your risk for what

cancer

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onset of what can commonly result in gastritis

H. pylori

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what else can result in gastritis

Other pathogens implicated are CMV (in HIV patients), staph, strep, E.coli or salmonella NSAIDS, Ingestion of corrosive substances, and radiation

what do you treat H pylori with

bismuth, amoxicillin and Flagyl

how do you treat gastritis

Treat symptomatically Remove causative agents Treat with H2 receptor antagonists to block gastric secretions Antacids as buffers May need B12 Instruct patient about medications that exacerbate the problem such as steroids, NSAIDS, ASA, erythromycin and chemotherapeutic agents

Mucosal lesion of the stomach or duodenum

peptic ulcer disease

gastric mucosal defenses become impaired and they can no longer protect the epithelium from acid and pepsin

PUD

three main types of ulcers

Gastric Duodenal Stress

Peptic ulceration | Mucosal lining erosion

Esophageal Gastric Duodenal

Peptic ulceration | Hypersecretion

HCl Pepsin pH of 2 to 5

Results from reflux of acidic gastric secretions into esophagus due to an incompetent cardiac sphincter

esophageal ulcer

Results from a breakdown of gastric mucosal barrier

gastric ulcer

Results from hypersecretion of acid

Duodenal ulcer

Results from trauma, burns, major surgery

stress ulcer

conditions favoring the development of gastric ulcers

delayed stomach emptying and increased diffusion of gastric acid back into the stomach tissue

is protected by mucous and bicarbonate that maintain a normal pH on the gastric tissue and protects it from acid

gastric mucosa

increase the barrier’s resistance to ulceration by producing mucous

prostaglandins

if there is a break in the mucosal barrier

HCL acid damages the epithelium

result from back-diffusion of acid or dysfunction of the pyloric sphincter

gastric ulcers

What drug can be given to improve emptying

Reglan or metclopramide

are deep and penetrating and usually are in the lesser curvature of the stomach, near the pylorus

gastric ulcers

Deep lesions that penetrate through the mucosa and submucosa into the muscle layer. The floor of the ulcer consists of a necrotic area on granulation tissue and surrounded by fibrosis

duodenal ulcers

caused by increased secretion of gastric acid and increased stomach emptying

duodenal ulcers

what stimulates acid secretion

Protein rich meals, calcium and vagal excitation

rapid emptying of food from stomach reduces the buffering effect of food and delivers a large acid bolus to the duodenum

hypersecretion

many patients with duodenal ulcers also have what

H. pylori infection

H pylori produces what

produces urease changes urea to ammonia, H+ ions released contribute to damage

Acute gastric mucosal lesions occurring after and acute medical crisis or trauma

stress ulcers

what are stress ulcers associated with

head injury, major surgery, burns, respiratory failure, shock and sepsis

what is the principle manifestation of stress ulcers

bleeding

Usually elevated HCL acid levels and hospital stay longer than 11 days

stress ulcers

15-25% of patients with PUD develop these, most serious complication

hemorrhages

bleeding at or above the duodenojejunal junction

Hematemesis

Smaller amounts of bleeding | stool may appear black

melena

severe pain will ensue

perforation

Abdomen is tender, rigid, and board like and the client will assume the knee-chest position to decrease abdominal wall tension-

surgical emergency

caused by scarring, edema, inflammation or a combination of these

pyloric obstruction

Sudden, sharp pain in midepigastric region and spread over the abdomen Amount of pain correlates with the amount and type of GI contents spilled

perforation

what can follow perforation

Chemical peritonitis, bacterial septicemia and hypovolemic shock follow then paralytic ileus and possible death

abdominal bloating, nausea and vomiting

gastric outlet obstruction

what may you go into as a result from pyloric obstruction

metabolic alkalosis from loss of large quantities of acid gastric juice (H+ and Cl-)

what may result from the vommiting

hypokalemia

Disease may recur throughout life, stressors, inability to adhere to therapy, no longer responds to management

intractable disease

what causes intractable diseases

NSAID use, drugs that stimulate HCL production, H pylori infection,

what drugs stimulate HCL acid production

Theophylline, corticosteroids and caffeine

discomfort around the epigastrium, sharp, burning or gnawing

dyspepsia

occurs in upper epigastrium with localization to the left of the midline and may be relieved by food

gastric dyspepsia

located to the right of the epigastrium, occurs 90 min to 3 hours after eating and awaken at night, may be aggravated by spicy foods, onions, alcohol, caffeine and ASA, NSAIDS

duodenal dyspepsia

testing for ulcers

EGD and H pylori testing

goal of nursing diagnoses associated with ulcers

decrease pain, heal ulcers, eradicate h-pylori, prevent recurrence

potential nursing diagnoses with ulcers

``` Increase bleeding and perforation of stomach Risk of pyloric obstruction Risk of anemia Pain and heartburn Increased risk for aspiration Anxiety/fear related to disease prognosis Imbalance nutrition and weight changes Knowledge deficit ```

reduce gastric acid secretions

hyposecretory drugs

proton pump inhibitors, “zole” ending, suppress H, K-ATP ase enzyme system of gastric acid production, can be given IV or PO

Antisecretory agents

block histamine-stimulated gastric secretions, “dine” ending

H2 receptor antagonists-

reduce gastric acid secretion and enhance gastric mucosal resistance to tissue injury, Misoprostol (Cytotec) helps prevent NSAID induced ulcers, does cause uterine contraction and can not be given to pregnant women

prostaglandin analogues