Lecture 5.1 - GI Flashcards
What kind of TPN is better for patients on fluid restrictions?
Those with higher percentages (10-30%) of fat emulsion provide large numbers of calories in relatively small amounts of fluid.
Note that fat emulsions are contraindicated in patients with hyperlipidemia.
What are the two kind of parenteral nutrition administration?
Peripheral and Central
–> PPN contains fewer nutrients and is less hypertonic (800mmol/L). Still poses risk for phlebitis or fluid overload.
What is refeeding syndrome?
Fluid retention and low phosphate, Mg, K.
Can occur any time a malnourished pt starts aggressive nutritional support.
What is Barrett’s esophagus?
When the normal squamous epithelium of the esophagus becomes replaced with columnar epithelium from the stomach.
Associated with repeated episodes of GERD.
What are the clinical manifestations of GERD?
Hx of heartburn, regurgitation, dyspnea or coughing.
What are some complications of GERD?
–> Esophagitis
–>Barrett’s esophagus.
Repeated esophagitis might lead to…
Scar tissue formation (esophageal stricture) that may result in dysphagia.
What is the purpose of diagnostic studied for GERD? What diagnostic studied are used?
TO determine the cause, such a a hiatal hernia.
–> Barium swallow
–> Endoscopy
–> Biopsy
–> pH tests
How can GERD be managed?
Lifestyle modifications
–> Avoid diet and medication factors that exacerbate (high fat, milk, spicy). High protein, low fat.
–> Avoid meals before bed.
–> Avoid smoking
Medication:
–> PPI, H2-blockers, antacids
What is the difference between a sliding and rolling esophageal hernia?
A sliding hernia involves the stomach sliding partially above the diaphragm into the thoracic cavity
A rolling hernia involves the esophagogastric junction remaining in normal position, but fundus rolls up through diaphragm forming a pocket beside the esophagus.
What is achalasia?
Absence of peristalsis in the lower 2/3rds of the esophagus.
What is gastritis?
Inflammation of the gastric mucosa
May be:
–> Acute/Chronic
–> Diffuse/Localized
Which medications can cause gastritis?
ASA, corticosteroids, NSAIDs
Which dietary factors can cause gastritis?
Alcohol and spicy food
Which microorganisms can cause gastritis?
–> H. pylori (Acquired in Childhood)
–> Species of salmonella
–> Species of staphylococcus
What are the three subtypes of gastritis?
1 - autoimmune (body and fundus)
2 - Diffuse antral (Antrum)
3 - Multifocal (diffuse throughout)
Anorexia, N&V, epigastric tenderness, and a feeling of fullness are associated with what condition?
Acute gastritis.
Chronic gastritis has similar manifestations, but may also be accompanied with a loss of intrinsic factor –> B12 deficiency –> Pernicious anemia
What stomach condition should you be aware of in those with chronic alcoholism?
Hemorrhage is commonly associated
Chronic gastritis –> B12 deficiency
What diagnostic studies are used to diagnose acute gastritis?
–> Hx of drugs and alcohol
–> Endoscopy w biopsy for definitive diagnosis
Breath, urine, serum (gold standard), stool and biopsy tests are available to test for H. Pylori.
–> CBC for anemia (B12/hemorrhage)
–> Stools for occult blood
How is acute gastritis managed?
Eliminating cause and preventing future exacerbation is main goal
Plan of Care
–> bed rest
–> NPO
–> IV Fluids + antiemetics
For severe acute gastritis an NG tube may be placed to keep stomach empty and free from noxious stimuli. Check VS frequently or hemorrhage is considered likely.
How is chronic gastritis treated?
Focus is on evaluating and eliminating specific cause.
Plan of Care:
–> Antibiotics (if indicated)
–> Cobalamin if necessary. Discussion about future supplementation
Future plan:
–> six small meals a day followed by antacid
–> Smoking cessation
–> Monitor Ca if taking calcium rich antacids
What is Zofran?
Ondansetron
–>52 blocker (antiemetic)
What should you be aware of for patients with excessive vomiting?
HypoK
What is gravol?
Dimenhydrinate
–>Antihistamine for &V
What is Stemetil?
Prochlorperazine
–> D2 blocker that also has anticholinergic and antihistaminic effects - used as antiemetic and antisecretory in gastritis
Upper GI bleeds are more common in which demographic?
Older women –> Most likely d/t NSAID use to treat arthritic pain
A massive GI bleed is considered how much blood?
1500 ml
Most upper GI bleeds originate where?
50% are in stomach and duodenal origin
What is melena?
Black tarry stool with foul acidic smell - associated with upper GI bleed
What percentages of upper GI bleeds spontaneously resolve? What must we do to ensure treatment for those that do not?
80-85% resolve spontaneously
Perform bowel assessment, integ/resp/CDV and frequent VS to monitor.
Basically a H2T for perfusion and signs of major hemorrhage.
A rigid abdomen is a hallmark of which condition?
Peritonitis
What diagnostic studies must be done for an upper GI bleed?
Serum for CBC, lytes, BGL, clotting factors (PTT,PT/INR), ABGs, T&C in anticipation for transfusion.
Urinalysis for blood in urine.
What is the purpose of a type and hold test?
To determine blood type and antibodies
What is the purpose of a type and cross test?
To determine how many units of blood should be prepared.
What diagnostic studies can be used to determine the etiology of acute abdominal pain?
A complete history and physical examination including rectal and pelvic exams.
–> CBC
–> Urinalysis
–> X-ray
–> ECG
Consider pregnancy test for anatomical females.
What are the overall goals to establish during the planning phase for a patient with acute abd pain?
1 - Resolution of the underlying process
2 - Relief of pain
3 - Freedom from complications
4 - Normal nutritional status
What goals should be established in the planning phase with a patient with acute infectious diarrhea?
1 - Not transmit microorganism
2 - Cease having diarrhea and resume normal bowel patterns
3 - Have normal fluid, lute, and acid-base balance
4 - Normal nutritional intake
5 - Have no perianal breakdown
What goals should be established in the planning phase for a patient with constipation?
1 - Increase dietary intake of fiber and fluids
2 - Have passage of soft, formed stools
3 - Not have any complications such as bleeding hemorrhoids.
What are the goals established during the planning phase for a patient with fecal incontinence?
1 - Have normal bowel control
2 - Maintain perianal skin integrity
3 - Not suffer any self-esteem issues resulting from problems with bowel control
What interventions should be considered for a patient with acute abdominal pain?
–> Need for pre and postoperative care
–> Potential nasogastric tube
–> Need for ambulatory and home care.
Bowel inflammation, peritonitis, obstruction and inflammation can lead to which major complications?
Septic and hypovolemic shock
Which bowel sounds are considered hyperactive, hypoactive, and absent?
Normal bowel sounds should be between 5-30 a minute. Anything out of this range is abnormal
Listen for a full 3 minutes to determine if sounds are absent.
