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Med-Surg > Peptic Ulcers & GER/GERD > Flashcards

Peptic Ulcers & GER/GERD Flashcards

1
Q

What are peptic ulcers ?

A

erosion of the GI mucosa due to the digestive action of HCl acid and pepsin
- acute or chronic

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2
Q

What are acute peptic ulcers ?

A
  • superficial erosion
  • minimal inflammation
  • short duration
  • resolves quickly when cause is identified and removed
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3
Q

What are chronic peptic ulcers ?

A
  • long duration
  • eroding through the muscular wall with the formation of fibrous tissue
  • present continuously for many months or intermittently throughout the person’s lifetime
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4
Q

What are some risk factors for Peptic Ulcers ?

A
  • Acid environment (increase in acid causes inflammation and histamine release which causes more secretion of acid and pepsin)
  • H. pylori bacterial infection
  • Medical-induced injury: NSAIDS & Aspirin
  • Lifestyle: alcohol, coffee psychologic stress, smoking
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5
Q

What are the 2 types of peptic ulcers ?

A

gastric & duodenal
- mortality is greater in gastric because they tend to affect those over 50 yrs

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6
Q

What are some characteristics of gastric ulcers ?

A
  • greater in women
  • peak age is 50-60 yrs
  • increase mortality
  • more common in people of lower socioeconomic status
  • increased with smoking, drug use (aspirin, NSAIDS), H.pylori, and alcohol use
  • increased with incompetent pyloric sphincter and bile reflux
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7
Q

What are some characteristics of Duodenal ulcers ?

A
  • greater in men but increasing in women (especially postmenopausal)
  • peak age is 35-45 hrs
  • associated with psychological stress
  • increased with smoking, drug use and alcohol use
  • associated with other disease (COPD, pulmonary disease, pancreatic disease, hyperparathyroidism, Zollinger-Ellison’s, chronic renal failure)
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8
Q

What are some clinical manifestations of gastric ulcers ?

A
  • pain in left epigastrum, back and upper abdomen
  • “burning & gaseous” pain
  • 1 to 2 hours after a meal
  • if ulcer is through the mucosa the pain is worse when eating
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9
Q

What are some clinical manifestations of duodenal ulcers ?

A
  • mid-epigastric pain, beneath xiphoid process, or back pain
  • “burning or cramplike” pain
  • 2-5 hrs after a meal
  • food may relieve pain
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10
Q

Why does the pain occur hours after a meal in duodenal ulcers ?

A

food moving from the stomach to the duodenum takes a few hours so when it finally reaches the duodenum then that is when acid is secreted again to further digest the food which irritates the ulcers here
- food makes pain lessen because it helps neutralize the acid

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11
Q

What are some diagnostic studies for Peptic ulcers ?

A
  • endoscopy with or without biopsy
  • test for H. pylori (breathing test or biopsy)
  • barium contrast studies (only if endoscopy isn’t possible)
  • gastric analysis
  • Labs: CBC, liver enzyme studies and stool examination (looking for problems that could cause complications)
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12
Q

What is some nursing care for an Endoscopy ?

A
  • before procedure: NPO for 6-12 hrs
  • after procedure: NPO until gag reflex returns (1-2 hours)
  • monitor for pain, bleeding, unusual difficult swallowing, elevated temperature
  • minor throat discomfort: lozenges, saline gargle
  • bed rest until fully alert
  • inform pt that they may experience some bloating, belching and flatulence
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13
Q

What are some symptoms of hemorrhage with peptic ulcers ?

A

most common: due to erosion
- change in vital signs (if lots of blood loss)
- bleeding per stool or NG output
- lower RBC count

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14
Q

What are some symptoms of perforation ?

A

EMERGENCY
- in large duodenal ulcers or those on lesser curvature of stomach
- acute pain
- rigid/board-like abdomen
- elevated WBCs
- may need antibiotic and go into surgery

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15
Q

What is gastric outlet obstruction ?

A

sudden onset of narrowing of pylorus due to edema, inflammation or scar tissue
- S&S: increased gastric residual, vomiting, constipation

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16
Q

What is the tx for hemorrhage of ulcers ?

A
  • NG tube to suction for 1-2 days
  • IV fluids and electrolytes (blood transfusion if needed)
  • careful I/O monitoring
  • endoscopy
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17
Q

What is the tx for perforation ?

A
  • notify provider immediately
  • NG tube to suction
  • antibiotics
  • IV fluids: usually lactated ringer’s
  • prepare for emergency surgery
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18
Q

What is the tx for gastric outlet obstruction ?

A
  • NG tube to suction
  • fluid and electrolytes
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19
Q

What is the function of antacids with PUD ?

A

increase gastric PH by neutralizing acid
- Tums, Mylanta, Maalox

20
Q

What is the function of Histamine Receptor Blockers with PUD ?

A

decreases HCl acid secretion by blocking action of histamine on H2 receptors
- Famotidine (Pepcid)
- side effects: N,V,D, constipation, HA, thrombocytopenia

21
Q

What is the function of Proton Pump Inhibitors ?

A

decreased HCl acid secretion by blocking enzyme that is important for the secretion of HCl acid
- Esomeprazole/Nexium & Pantoprazole (protonix)

22
Q

What is the function of Sucralfate for ulcers ?

A

provides a physically protective coating
- used primarily in addition with other meds
- interacts with digoxin, warfarin, and dilantin
- can cause mild constipation

23
Q

What is the function of Misoprostol/Cytotec for ulcers ?

A

Synthetic Prostaglandin: decreases acid secretion in the parietal cells of the stomach and provides some physical protection
- for gastric ulcers
- used primarily in addition with other meds
- may be used if Aspirin and/or NSAIDS can’t be discontinued
- contraindicated in pregnancy

24
Q

What is the difference between the Bilroth 1 and 2 ?

A

in both the bottom/distal portion of the stomach is resected
- 1: the stomach is joined to the duodenum
- 2: stomach bypasses the duodenum and is joined to the jejunum

25
Q

What is a vagotomy ?

A

cut of the vagus nerve which reduces acid production
- Truncal Vagotomy: cut main trunk of vagus nerve which significantly reduces stomach acid production but can cause other complications
- Selective: specific branch of vagus nerve that reduces acid production but preserves other gastric functions

26
Q

What is dumping syndrome ?

A

associated with meals having a hyperosmolar composition (food is moving too quickly through the small intestine)
- causes a spike in insulin
- S&S: generalized weakness, sweating palpation, and dizziness

27
Q

What is Postprandial Hypoglycemia ?

A

a bolus of fluid high in carbohydrate goes into the small intestine causing excessive amounts of insulin into circulation
- S&S: sweating, weakness, mental confusion, palpation, tachycardia, and anxiety

28
Q

What is Bile Reflux Gastritis ?

A

prolonged contact of bile causes damage to gastric mucosa
- administration of Questran relieves irritation
- bile is the problem now and it can more easily reflux up into the stomach

29
Q

What is some Post-Op care for pt’s of gastric surgery ?

A
  • risk for pernicious anemia
  • maintain NG tube until fluids can be tolerated (IV fluids before then)
  • careful GI assessment and incision care
  • small portions of fluid and food daily (small frequent meals)
  • low carbohydrates
  • restricted sugar with meals
  • moderate amounts of protein and fat
  • 30 mins of rest after each meal
30
Q

What are some gerontologic considerations for PUD ?

A

increased in patients greater then 60 yrs
- increased use of NSAIDS for overall pain
- first manifestation may be frank gastric bleeding or decreased hematocrit
- tx is similar to younger adults
- emphasis on prevention of both gastric and peptic ulcers

31
Q

What is GERD ?

A

mucosal damage caused by reflux (backflow) of stomach acid into the esophagus, causing irritation / esophagitis

32
Q

What is GER ?

A

the transfer of gastric contents into the esophagus
- peak is in 4 month infants and generally resolves spontaneously around 12 months of age as their esophageal sphincter grows stronger
- becomes GERD when complications occur

33
Q

What are some predisposing conditions to GER/GERD ?

A
  • incompetent lower esophageal sphincter (certain meds & foods exacerbate this)
    • Foods: caffeine, chocolate, peppermints
    • Meds: anticholinergics
  • decreased esophageal clearance
  • increased intraabdominal pressure (obesity, Hhiatal hernia)
34
Q

What are some S&S of GERD in adults ?

A
  • heartburn/pyrosis (more than twice a week, especially in older adults needs to be evaluated further)
  • dyspepsia: pain/discomfort in upper abdomen that is usually midline
  • coughing/wheezing
  • dyspnea
  • posteating bloating
  • belching
  • early satiety
  • regurgitation
  • hypersalivation
  • N/V
  • feeling of lump in throat or food stopping
  • dysphagia
  • sore throat
35
Q

What are some S&S of GER in infants ?

A
  • spitting up, vomiting
  • crying/irritable with arching of back
  • weight loss, failure to thrive
  • gagging, choking at end of feedings
  • respiratory problems (aspiration)
  • apnea or ALTE (apparent life-threatening event)
36
Q

What are some S&S of GER in children ?

A
  • heartburn
  • abdominal pain
  • non cardiac chest pain
  • chronic cough
  • dysphagia
  • nocturnal asthma
  • recurrent pneumonia
37
Q

What are some complications of GER/GERD ?

A
  • esophagitis (irritation of lining of the esophagus)
  • esophageal strictures (resulting from scar tissue) which can lead to dysphasia
  • Barrett’s esophagus (precancerous lesions)
  • bronchitis
  • aspiration (pnemonia)
  • bronchospasms
  • laryngospasma
  • ulceration of esophagus
  • upper GI bleeding
  • dental erosion
38
Q

What are some diagnostic test of GER/GERD ?

A
  • history of symptoms
  • barium swallow
  • endoscopy
  • esophageal biopsy
  • gastric secretions/24 hr pH study
  • scintiscan (child eats and different pics are taken at various times over 4 hr or even days later) aka a gastric emptying study
39
Q

What are some potential complications of a Endoscopy ?

A
  • perforation of the esophagus, stomach and duodenum
  • bleeding from a biopsy site
  • pulmonary aspiration of gastric contents
  • over sedation from medication during test
  • hypotension induces by the sedative medication
  • local IV phlebitic reaction to the injection of sclerosing sedative medication
40
Q

What are some modifications of GER for infants ?

A
  • infants who are growing with no respiratory complications do not need modifications
  • change to soy formula
  • frequent burping
  • smaller more frequent feedings
  • thicken feeding with rice cereal
  • weight monitoring
41
Q

What are some GER/GERD lifestyle changes ?

A
  • small, frequent meals (4-6 per day)
  • drink adequate fluids w meals to aide food passage
  • eat slowly and chew well to add saliva to the food
  • avoid extremely hot or cold foods, spies, fats, alcohol, coffee, chocolate, and citrus
  • avoid eating and drinking for 3 hrs before retiring to prevent nocturnal reflux
  • elevate HOB
  • lose weight, if overweight, to decrease the gastroesophageal pressure gradient
  • avoid tobacco and salicylates
42
Q

What is the purpose of Histamine 2 Receptor Antagonists with GER/GERD ?

A

decreases gastric acid secretion by inhibiting the H2 receptors
- Famotidine (Pepcid), Ranitidine (Zantac) , Nixatidine (Axid)
- side effects: N,V,D, constipation, HA, thrombodytopenia

43
Q

What is the purpose of Proton Pump Inhibitors (PPIs) with GER/GERD ?

A

decrease stomach HCl acid secretions by inhibiting the proton pump mechanism responsible for secreting H ions
- Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix)
- take before 1st meal of the day
- side effects: N,V,D, constipation, low bone density, predisposition of GI infections like C.Diff so report diarrhea to provider

44
Q

What is the purpose of Gastrointestinal Stimulants with GER/GERD ?

A

stimulates the smooth muscle of the GI tract and increases the rate of gastric emptying
- Metoclopramide (Reglan)
- side effects: sedation, dry mouth diarrhea,

45
Q

What is the purpose of Antiacids with GER/GERD ?

A

neutralizes the acid secretions and promotes gastric mucosal defense mechanism
- Gaviscon, Mylanta, Tums
- take 30 mins before 1-3 hrs after a meal to provide temporary relief
- only med that can’t be given to kids

46
Q

What is Nissen Fundoplication ?

A

where the top part of the stomach (fundus) is wrapped around the lower esophagus and sutured in place to make the sphincter stronger and tighter

47
Q

What is some Post-Op care after surgery for GERD ?

A
  • deep breathing, control N/V and pain
  • start on liquid diet and slowly advance to soft, then solids
  • side effects: difficulty swallowing, bloating, and increased flatulence
  • complications: general anesthetic complications, bleeding, tearing of the esophagus slippage of the wrap

Med-Surg (16 decks)

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