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Chronic Rehab > GI Part 2 > Flashcards

GI Part 2 Flashcards

1
Q

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

A

endoscopic procedure

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2
Q

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

A

Nissen fundoplication

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3
Q

when may clear liquids be given

A

Following surgery and after peristalsis is re-established

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4
Q

what may you develop after GERD surgery

A

gas bloat syndrome (cannot eructate)

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5
Q

what should you avoid eating after GERD surgery

A

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

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6
Q

what are the three most common abdominal hernias

A

umbilical, incisional, femoral

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7
Q

Protrusion of stomach through the esophagus

A

hiatal hernia

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8
Q

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

A

GERD

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9
Q

surgical method of fixing a hernia

A

Lap Nissen Fundoplication-

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10
Q

post op hernia patient is at risk for what

A

risk for bleeding, infection and respiratory complications

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11
Q

what is a hiatal hernia also known as

A

Known as diaphragmatic hernia

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12
Q

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

A

sliding hernia

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13
Q

hernias are classified as either

A

rolling or sliding

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14
Q

these hernias generally moves into and out of the thorax

A

sliding hernia

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15
Q

what can cause sliding hernias

A

weakening in the esophageal hiatus

Congenital weaknesses, trauma, obesity or surgery

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16
Q

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

A

rolling hernia

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17
Q

what can cause rolling hernias

A

improper anchorage of the stomach

or previous esophageal surgeries.

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18
Q

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

A

increase with age and are more common in women

occurs in 20% of adults

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19
Q

nonsurgical management of hernias is similar to what

A

GERD

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

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20
Q

what are the major stomach disorders

A

Gastritis, Peptic ulcer disease, gastric cancer

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21
Q

inflammation of the gastric mucosa

can be erosive or nonerosive

A

gastritis

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22
Q

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

A

pernicious anemia

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23
Q

gastritis increases your risk for what

A

cancer

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24
Q

onset of what can commonly result in gastritis

A

H. pylori

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25
Q

what else can result in gastritis

A

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

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26
Q

what do you treat H pylori with

A

bismuth, amoxicillin and Flagyl

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27
Q

how do you treat gastritis

A

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

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28
Q

Mucosal lesion of the stomach or duodenum

A

peptic ulcer disease

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29
Q

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

A

PUD

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30
Q

three main types of ulcers

A

Gastric
Duodenal
Stress

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31
Q

Peptic ulceration

Mucosal lining erosion

A

Esophageal
Gastric
Duodenal

32
Q

Peptic ulceration

Hypersecretion

A

HCl
Pepsin
pH of 2 to 5

33
Q

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

A

esophageal ulcer

34
Q

Results from a breakdown of gastric mucosal barrier

A

gastric ulcer

35
Q

Results from hypersecretion of acid

A

Duodenal ulcer

36
Q

Results from trauma, burns, major surgery

A

stress ulcer

37
Q

conditions favoring the development of gastric ulcers

A

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

38
Q

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

A

gastric mucosa

39
Q

increase the barrier’s resistance to ulceration by producing mucous

A

prostaglandins

40
Q

if there is a break in the mucosal barrier

A

HCL acid damages the epithelium

41
Q

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

A

gastric ulcers

42
Q

What drug can be given to improve emptying

A

Reglan or metclopramide

43
Q

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

A

gastric ulcers

44
Q

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

A

duodenal ulcers

45
Q

caused by increased secretion of gastric acid and increased stomach emptying

A

duodenal ulcers

46
Q

what stimulates acid secretion

A

Protein rich meals, calcium and vagal excitation

47
Q

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

A

hypersecretion

48
Q

many patients with duodenal ulcers also have what

A

H. pylori infection

49
Q

H pylori produces what

A

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

50
Q

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

A

stress ulcers

51
Q

what are stress ulcers associated with

A

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

52
Q

what is the principle manifestation of stress ulcers

A

bleeding

53
Q

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

A

stress ulcers

54
Q

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

A

hemorrhages

55
Q

bleeding at or above the duodenojejunal junction

A

Hematemesis

56
Q

Smaller amounts of bleeding

stool may appear black

A

melena

57
Q

severe pain will ensue

A

perforation

58
Q

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

A

surgical emergency

59
Q

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

A

pyloric obstruction

60
Q

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

A

perforation

61
Q

what can follow perforation

A

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

62
Q

abdominal bloating, nausea and vomiting

A

gastric outlet obstruction

63
Q

what may you go into as a result from pyloric obstruction

A

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

64
Q

what may result from the vommiting

A

hypokalemia

65
Q

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

A

intractable disease

66
Q

what causes intractable diseases

A

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

67
Q

what drugs stimulate HCL acid production

A

Theophylline, corticosteroids and caffeine

68
Q

discomfort around the epigastrium, sharp, burning or gnawing

A

dyspepsia

69
Q

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

A

gastric dyspepsia

70
Q

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

A

duodenal dyspepsia

71
Q

testing for ulcers

A

EGD and H pylori testing

72
Q

goal of nursing diagnoses associated with ulcers

A

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

73
Q

potential nursing diagnoses with ulcers

A 
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
74
Q

reduce gastric acid secretions

A

hyposecretory drugs

75
Q

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

A

Antisecretory agents

76
Q

block histamine-stimulated gastric secretions, “dine” ending

A

H2 receptor antagonists-

77
Q

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

A

prostaglandin analogues

Chronic Rehab (18 decks)

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