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ACI I > GI System > Flashcards

GI System Flashcards

1
Q

Order of a GI assessment

A

Inspection, auscultation, percussion, palpation

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2
Q

What is part of the GI system’s function?

A
  • Immune function (70% of body’s immune tissue)
  • bacteria, mucus, enzymes, IgA, acids, hormones, emetic response
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3
Q

GI diagnostics

A
  • Fecal analysis –> presence of bacteria, blood, fat
  • Imaging
  • Endoscopy
  • Blood tests –> amylase (carb breakdown), lipase (fat breakdown)
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4
Q

Factors that contribute to obesity

Five

A
  • Biology –> increased # and size of adipocytes, rate of hormone/peptide synthesis
  • Genetics –> FTO (fat mass and obesity-associated) gene
  • Eating habits –> comfort, pleasure, security
  • Access to food
  • Socioeconomic status
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5
Q

GI Hormones/peptides

A
  • Ghrelin –> hunger drive
  • Leptin –> appetite suppressant, metabolism
  • Insulin –> BG regulation
  • Peptide YY –> ileu, & colon, satiety
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6
Q

Risk factors for obesity

A

DM, HTN, heart disease, stroke

and more

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7
Q

Treatment options for obesity

A
  • Nutritional therapy
  • Exercise
  • Behavioral modification
  • Support groups
  • Surgical intervention
  • Medications
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8
Q

Criteria for bariatric surgery

think of My 600lb Life

A
  • Failed at traditional weight loss
  • BMI >= 40 (or 35 if 1+ weight-related complications)
  • Understands risks and benefits
  • Psychiatric/social stability
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9
Q

Two categories of bariatric surgeries

A
  • Restrictive
  • Malabsorptive & restrictive combination
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10
Q

Adjustable Gastric Banding

A
  • Restrictive
  • Adjustable band connected to access port is placed @ top of stomach to create pouch
  • Reduces stomach size
  • Digestion remains normal
  • Slower weight loss compared to other methods
  • Reversible and adjustable
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11
Q

Vertical Sleeve Gastrectomy

A
  • Restrictive
  • Vertical excision of stomach (80% removed)
  • Non-reversible
  • Fewer food restrictions than other options
  • Reduces amount of ghrelin produced
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12
Q

Roux-En-Y Gastric Bypass

A
  • Restrictive & Malabsorptive
  • Surgical creation of pouch @ top of stomach, rerouting of intestine to pouch (bypasses rest of stomach)
  • Most weight loss out of all options
  • More effective than others at reversing obesity-associated health problems
  • Low complication rate
  • Greater risk for nutritional deficiencies

pouch only 20-30mL capacity

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13
Q

Pre-Op nursing management

for bariatric surgery patients

A
  • Team approach
  • Use/provide bariatric equipment
  • Private room
  • Plan for co-morbidities
  • Prep pt for post-op care
  • Check personal biases
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14
Q

Post-Op nursing management

for bariatric surgery patients

A
  • Pain control
  • Skin/wound care
  • NG tube care
  • TCDB Q2H
  • Diabetes management
  • Early ambulation
  • Discharge planning
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15
Q

GERD etiology

A
  • Incompetent lower esophageal sphincter
  • Impaired esophageal motility
  • Obesity
  • Hiatal hernia
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16
Q

Symptoms of GERD

A
  • Heartburn/dyspepsia
  • Hypersalivation
  • Non-cardiac chest pain

often made worse by laying flat, consuming dairy

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17
Q

Diagnostics for GERD

A
  • H&P
  • Barium swallow study
  • Upper endoscopy
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18
Q

Complications of GERD

A
  • Esophagitis –> common, related to inflammation
  • Barrett’s esophagus –> metaplasia, pre-cancerous, routine follow-ups required
  • Respiratory complications –> cough, bronchospasm, dental erosion, aspiration pneumonia

metaplasia is the replacement of normal squamous epithelium with columnar epithelium

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19
Q

Treatments for GERD

A
  • Lifestyle modifications –> weight loss, reduce alcohol, stop smoking
  • Nutritional therapy –> avoid certain foods, over-distending stomach, late night snacks
  • Drug therapy –> PPIs, H2 inhibitors, antacids, prokinetics
  • Laparoscopic fundoplication –> for patients with persistent S&S or complications; reinforces weak lower esophageal sphincter
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20
Q

Nursing considerations for GERD

A
  • HOB >30 degrees, greater for 2-3hrs after eating
  • Drug therapy
  • Prevent resp complications
  • NG care, accurate I/Os post-op
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21
Q

Peptic ulcer disease patho/etiology

A
  • mucosal layer impaired, allows HCL acid and pepsin to freely enter mucosa and injure lining
  • causes increased inflammation, histamine, acid, and pepsin production
  • compensatory increase in blood flow w/ mucosal damage
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22
Q

Factors associated w/ mucosal damage

A
  • H. pylori –> survives in acidic enviro, produces urease
  • Medications –> NSAIDs, corticosteroids
  • Lifestyle –> ETOH, smoking, stress
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23
Q

Diagnostics fo PUD

A
  • H&P
  • Biopsy
  • H. pylori testing
  • Barium study
  • CBC (infection, bleeding)
  • Liver enzymes
  • Occult blood test
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24
Q

Treatments for PUD

A
  • Meds –> H2 inhibitors, PPIs, abx
  • Triple therapy for H. pylori –> PPi, amox, clarith
  • Lifestyle changes
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25
Complications of PUD
- Hemorrhage --> erosion through blood vessel (often w/ duodenal ulcers) - Perforation --> erosion through serosal surface and gastric/duodenal content leaks into peritoneum - Gastric outlet obstruction --> ulcers in antrum/pyloric areas, narrowing of pylorus, projectile vomiting common
26
Treatment for acute exacerbations/complications of PUD
- NPO - NGT - Pain control - IV fluids/electrolytes - Blood transfusion
27
Upper GI bleed etiology
- Sudden or insidious onset - Severity depends on arterial or venous - Location varies - Can be difficult to identify cause ## Footnote massive hemorrhage = 1500mL
28
Possible causes of upper GI bleeds
- Drugs - PUD - Esophageal/stomach cancer - Esophageal varices - Mallory Weiss tear
29
S&S of upper GI bleed
- Fatigue/weakness - SOB - Pallor - Vomiting blood - Abdominal pain - Positive ortho VS
30
Assessments for upper GI bleed
- VS/ortho VS - Labs --> CBC - Abdominal distension - Monitor for hypovolemic shock ( LOC, BP/HR)
31
Nursing considerations for upper GI bleed
- Serious GI bleeding can destabilize vital signs (BP might tank rapidly) - IV access is critical for fluid resus, potential transfusion - NPO/NGT - O2 therapy - PPI - Accurate I/Os - Potential for endoscopy, surgery
32
Inflammatory Bowel Disease (IBD)
- Crohn's and Ulcerative Colitis (UC) - Genetic predisposition - Chronic and recurrent inflammations of GIT - remissions and exacerbations common
33
Crohn's S&S
- cramping, diarrhea - fever - weight loss (r/t malabsorption) - anywhere in GIT - skip lesions (cobblestone appearance) - entire thickness of bowel wall - ulcerations, strictures, abscesses, fistulas - perforation possible
34
Ulcerative colitis S&S
- bloody diarrhea - urgency, cramping - continuous areas of inflammation - starts distal and spreads upwards - inflammation, edema, thickening - destructive to epithelium - cured w/ colectomy | limited to colon & continuous
35
IBD Dx
- H&P - endoscopy - stool specimen - CBC/chem
36
Goals of IBD treatment
- control inflammation, infection - correct malnutrition - relieve symptoms - improve quality of life
37
IBD management
- stop smoking - psychotherapy - rest gut, high cal, low res, protein, vitamins - anti-inflammatories, immunosuppressants, biologics, pain - surgery ## Footnote TPN may be needed short term; avoid NSAIDs
38
Intestinal obstruction
- small or large intestines - partial or complete - can be mechanical or non-mechanical
39
Mechanical obstruction
- most common (90%) - physical blockage - can be caused by surgical adhesions (50-60%)
40
Non-mechanical obstruction
- "functional" obstruction - muscle wall transiently impaired - can be caused by abd surgery, trauma, infx, etc.
41
Small intestine obstruction
- rapid onset - pain is colicky, can be frequent or intermittent - vomiting (projectile) is frequent - bowel movements still occur in beginning stages
42
Large intestine obstruction
- gradual onset - low-grade pain, persistent, w/ cramping - vomiting is uncommon - obstipation (severe constipation)
43
Diagnosis of bowel obstructions
- H&P - imaging - endoscopy - blood work
44
Treatment of bowel obstructions
- can be conservative - NPO w/ NGT - IVF w/ strict I/Os - pain management - monitor/replace fluids & electrolytes (F&E) - TPN considered - surgical intervention (may be urgent)
45
Nursing considerations for bowel obstructions
- pain - F&E (labs) - strict I/Os - abd assessment - post-op care - NGT care
46
Colorectal cancer (CRC)
- no single risk factor - highest risk w/ 1st deg. relative or IBD - Kras gene (cell division regulation) mutation
47
S&S of CRC
- early --> no symptoms or non-specific - advanced --> abd tenderness/mass(es), hepatomegaly, ascites, bloody stools, anemia - can be right (diarrhea) or left-sided (bowel obstruction) - can lead to obstruction, bleeding, perf, peritonitis, fistula(s)
48
CRC diagnostics
- fecal occult tests - colonoscopy screening (beginning @ age 45, removal of polyps) - biopsy - CBC, LFTs - CT, MRI
49
CRC treatment
- varies based on staging (TNM) - surgical intervention --> tumor resection, exploration to determine metastasis, lymph node removal, restore bowel function, prevent complications - chemotherapy (pre/post surgery, or palliative) - radiation (adjunct or palliative)
50
Ostomy
- surgically created permanent or temporary opening (stoma) in abdominal wall for elimination of body waste - colostomy --> rectum removed, colon attached to stoma - ileostomy --> colon & rectum removed, ileum attached to stoma - total procto-colectomy --> removal of colon, rectum, & anus
51
Nursing considerations for CRC
- psychological prep/emotional support - monitor stoma/incision(s) - monitor bowel function - ostomy care/education - diet education
52
Gastric cancer causes
- heredity (1-3%) --> CDH1 mutation - enviro --> H. pylori - behavioral --> tobacco, diet (smoked, salty, spicy foods)
53
Gastric cancer S&S
- anemia - fatigue/weakness - poor appetite, weight loss, dysphagia, early satiety - abdominal pain - bloody stools - ascites
54
Gastric cancer diagnostics
- H&P - Endo (best tool) - bloodwork - tumor markers (CEA) - CT
55
Gastric cancer treatments
- surgery (1st choice) --> Billroth I or II, total gastrectomy - nutritional support - radiation or chemo
56
Nursing considerations
- pain control - adequate nutrition - emotional support (d/t poor prognosis) - education - post-op care
57
Liver functions
- filters toxins - stores glucose, fats, vitamins, minerals - produces bile - synthesizes albumin, cholesterol, coag factors
58
Hepatitis A
- fecal-oral transmission via contaminated food/water - small outbreaks r/t poor hygiene & crowding - generally self-limiting - no chronic carriers d/t antibodies - HAV vaccine and hand hygiene best prevention
59
Hepatitis B
- highly infections - transmitted via blood/bodily fluids - chronic carriers are infectious for life - high incidence in asian populations - vaccine best prevention - HBV needed for HDV
60
Hepatitis C
- >4mil in US (most chronic and unaware) - blood transmission - several genotypes - no vaccine available - high risk for cirrhosis, cancer, death - leading cause of liver transplants
61
Pathophysiology of hepatitis
- inflammatory process - acute phase is most infectious - liver cells may regenerate after acute infection resolution - chronic develops over 30-40 years - chronic destruction may lead to fibrosis, cirrhosis, liver failure
62
S&S of acute hepatitis
- often no symptoms or non-specific - fatigue, fever, myalgia - anorexia, N/V, weight loss - RUQ discomfort, hepatomegaly - may have jaundice, dark urine
63
S&S of chronic hepatitis
- malaise, fatigue, myalgias - hepatomegaly, elevated LFTs - ascites, general edema - anemia - asterixis - spider angiomas - potentially esophageal varices
64
Testing for hepatitis
- at risk individuals should be tested (anyone born in 40s-70s) - negative antibody = no disease, positive = have/had virus - viral load can be tested - cure is possible with new therapies, many of which have less side effects
65
Hepatitis treatments
- goal is to eradicate virus, reduce viral load, decrease progression, reduce need for transplant - individualized based on severity, genotype, co-morbidities - give Hep A&B vaxxes --> 90% cure rate - nutrition guidance supplementation - relapses are common --> manage
66
Hepatitis complications
- chronic HBV, HCV - cirrhosis - liver failure, liver cancer (HCV) - portal HTN - cogulopathies - fulminant hepatic failure --> rapid demise, often d/t drugs, hepatic encephalopathy (ammonia)
67
Liver transplants
- HCV leading indicator - 17k waiting --> 1.7k die waiting - 8000 performed annually - rigorous screening of donors - split liver transplant possible - 5-year survival plan (80%) --> HCV lower & w/ higher recurrence of infection - live liver transplants becoming more common
68
Cholelithiasis pathophysiology
- bile supersaturated w/ cholesterol, bile salts, & calcium forming crystals d/t bile stasis, over excretion of cholesterol - stones form slowly in gallbladder or biliary duct system - risk factors include ethnicity, age, gender, genetics, certain conditions (crohn's, obesity, sickle cell, TPN use)
69
Cholelithiasis S&S
- variable, often no symptoms - movement of stones that lodge in ducts --> more symptoms - stone in cystic duct causes GB distension, severe cramping, and RUQ pain - stone in common bile duct d/t bile refluxing into liver & causing jaundice, pain, hepatic damage - cholecystits, infection lead to leukocytosis, fever
70
Cholelithiasis Dx
- ultrasound 95% accurate in detecting gallstones - MRI, CT, ERCP
71
Cholelithiasis treatment
- lap chole (treatment of choice) - ERCP for visualization or stone removal
72
Post-op care for lap chole
- monitor for bleeding - prep for D/C (often day of) - avoid carbonated beverages - mild shoulder pain up to 1 week - encourage walking - monitor incisions - can return to work in 1 week

ACI I (2 decks)

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