Med Surg: Completion of GI lecture Flashcards
What are abnormal secretion of peptic ulcer disease?
Mucosal lesions of the stomach or duodenum as a result of impaired gastric mucosal defenses
What are the types of abnormal secretion of peptic ulcer disease?
Gastric ulcer
Duodenal ulcer
Stress ulcer
What are stress ulcers?
Acute gastric mucosa lesions occuring after an acute medical crisis or trauma
Associated with head injury major surgery, respiratory failure, shock and sepsis
Prinicpal manifestation: bleeding caused by gastric erosion
What are the complications of ulcers?
Hemorrhage: hematemisis, decrease CO or oxygenate tissue, tarry stools, CBC
Perforation: surgical emergency, abdomen ditended, rigid sepsis, bacterial invastoin
Pyloric stenosis: emesis, stomach cant empty, NG tube until obstruction relieved or surgery
What are clinical manifestations of ulcers?
Epigastric tenderness
dyspepsia
pain: sharp, burning or snawing
sensation of abdominal pressure or of fullness even without palpated distention
What are the 4 primary goals of drug therapy?
provide pain relief
eradicate H. pylori infection
heal ulcerations
prevent recurrence
What are the classifications of Drugs in PUD?
Pain: usually not analgesia by symptom control
Same as for GERD
- H2 receoptor antagonists
- Proton pump inhibitors
- Antacids
Mucosal Barrier Fortifiers: creases a protective coat, sucralfate
Drugs to eradicate H. Pyloris: triple therapy, PPI, 2 antibodies (flagyl, tetracycline or amoxicillin)
What is diet therapy?
Exclude foods that cause discomfort
A bland, nonirritating diet, may help relive symptoms: avoid spicy food, increase gastric acid secretion
Avoid bedtime snacks: ulcers that feel better with eating may eat before bed
Avoid alcohol and tobacco: break down wall
What are complication and risks for GI bleeding?
Endoscopic therapy can assist in achieving hemostasis
Prevent hypovolemic shock-fluid replacement
Nasogastric tube and lavage: for significant bleeding
Endoscopic IR procedures to quickly stop bleeding: cauterize and achieve hemostasis
Follow with acid suppression drugs: PPI
Perforation: fluid replacement and antibiotics, keep NPO
Pyloric obstruction r/t edema and spasm: risk for aspiration, IV therapy, watch for metabolic alkalosis
What is surgical management for GI bleeding?
Vagotomy eliminates acid-secreting stimulus to gastric cells and decreases the reponse of parietal cells
Pyloroplasty facilitates emptying of stomach contents
Gastric resection: partial or total gastrectomy, depend on significance
What is postoperative care of GI bleeding?
Monitor the nasogastric tube
Monitor for postop complications: dumping syndrome, gastric reflux, dietary deficiencies
What is inflammatory bowel disease: ulcerative colitis?
Characterized by remissions and exacerbations
muscosal lining of the colon or rectum is most often affected
loose stools containing blood and mucous
thickening of the colon wall can result
What is the assessment of ulverative colitis?
Clinical manifestations: feel urge, no stool, colic pain, relieved by defecation, anorexia because dont want pain, weight loss, more bleeding because mucosal lining
Lab assessment: blood studies, inflammation markers, nutirion
Diagnostic assessment: CT, colonoscopy
Interventions: limit diarrhea, assess number stools, eliminate foods that cause problems, try lactose free diet, rest at acute exacerbations
What is drug therapy for ulverative colitis?
aminosalicylates: inhibit protaglandins, help decrease pain and heal, not immediate and take time
glucocorticoids: exacerbations to decrease inflammation, mask infection signs
immunosuppressive drugs
antidirrheal drugs: slowing peristalsis
What is inflammatory bowel diease: chrons?
Inflammatory disease
All layers of bowel involved
“Skip” lesions
Bowel fistulas: abdominal openings that shouldnt be there, tunnel to another organ and drain fecal matter
Malabsorption of bitamin and nutrients: supplementation
Cancer of the small bowel and colon develop may develop with long term disease
