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MED SURG > TOPIC 7 - GI system > Flashcards

TOPIC 7 - GI system Flashcards

1
Q

GI diseases

A

GERD, hiatal hernia, peptic ulcer disease, gastritis, gastroenteritis, inflammatory bowel disease (crohns and colitis), diverticulitis, IBS, intestinal or bowel obstruction, bowel surgery, ostomies, bariatric surgery

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2
Q

symptoms of GERD

A

heart burn, burning, tight sensation under lower sternum, spreading towards throat or jaw, felt intermittently

chest pain can mimic angina, relieved with antacids

resp : wheezing, coughing, dyspnea, nocturnal discomfort

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3
Q

predisposing factors of GERD

A

incompetent lower esophageal sphincter
decreased LES pressure
increased intraabdominal pressure
hiatal hernia

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4
Q

GERD complications

A

Barretts esophagus
esophageal varices
esophageal ulcers
respiratory (from irritation of upper airway) : cough, bronchospasm, laryngospasm

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5
Q

diagnostic tests

A

upper GI endoscopy
ambulatory esophageal pH monitoring
radionuclide tests

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6
Q

meds

A

PPIs, H2R blockers, acid protective, pro kinetic drugs, antacids

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7
Q

PPIs

A

promote esophageal healing
ex : omeprazole
s/e : headache

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8
Q

H2R blockers

A

decrease secretion of HCl
reduce symptoms and promote esophageal healing
ex : famotidine
uncommon s/e

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9
Q

acid protective

A

cytoprotective properties
ex : sucralfate

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10
Q

prokinetic drugs

A

promote gastric emptying
reduce risk of reflux
ex: metoclopramide

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11
Q

antacids

A

quick but short lived relief
neutralize HCl
taken 1-3 hours after meals
ex : maalox, mylanta

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12
Q

interventions for GERD

A

elevate HOB 30 degrees
do not lie down for 2-3 hours after eating
avoid smoking, alcohol, acidic foods
stress reduction
weight reduction
small, frequent meals

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13
Q

surgical therapy for …

A

patients with med intolerance, barretts meaplasia, esophageal stricture and stenosis, chronic esophagitis, failure of conservative therapy

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14
Q

nissen fundoplication

A

treat more than 1 clinical condition

fundus of stomach is wrapped around distal esophagus and sutured to itself

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15
Q

hiatal hernia - sliding

A

stomach slides through hiatal opening in diaphragm when patient is supine, goes into abdominal cavity when patient is standing upright

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16
Q

hiatal hernia - rolling

A

fundus and greater curvature of stomach stomach roll up through diaphragm, forming a pocket alongside the esophagus
Paraoesophageal junction remains in normal position
Acute paraoesophageal hernia is a medical emergency

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17
Q

complications of hiatal hernia

A

GERD, esophagitis, hemorrhage, stenosis, ulcerations of herniated portion

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18
Q

diagnostics

A

esophagogram (show protrusion of mucosa)
endoscopy (visualize lower esophagus)

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19
Q

surgical therapy

A

gastropexy : anti-reflux procedure, attachment of stomach sub-diaphragmatically
herniotomy : reduction of herniated stomach, excision of hernia sac
herniorrhaphy : closure of hiatal defect

20
Q

first indication in geriatric population

A

esophageal bleeding or respiratory complications

21
Q

invasive imaging for diagnostics patient prep

A

NPO, bowel prep, take normal meds, IV access for sedation, cardiac monitor, labs: electrolytes and CBC,
monitor LOC, RR, O2, vitals

risk for perforation

22
Q

causes of peptic ulcer disease

A

Hydrochloric acid & pepsin
Helicobacter Pylori
Medications (aspirin, NSAIDS, corticosteroids, anticoagulants, SSRIs)
Lifestyle (excessive ETOH, coffee, smoking, stress)

23
Q

peptic ulcer disease :

A

erosion of GI mucosa from action of HCl, affecting lower esophagus, stomach, and duodenum

24
Q

acute peptic ulcer disease

A

superficial erosion, minimal inflammation, short duration, resolves when cause treated

25
Q

chronic peptic ulcer disease

A

erodes through the muscular wall, present continuously for years or intermittent through life, most common type of ulcers

26
Q

diagnostic studies for peptic ulcer disease

A

endoscopy with biopsy,

invasive tests (endoscopic procedure or biopsy),

noninvasive (urea breath test),

stool antigen test,

serum or whole blood antibody test (IgG - wont distinguish between past and current infection)

barium contrast study (patients who cant undergo endoscopy, not for superficial ulcers, diagnose gastric outlet obstruction)

gastric analysis (content for acidity and volume, NG tube, analyze for HCl)

labs (CBC, liver enzymes, serum amalyse, stool exam)

27
Q

meds for peptic ulcer

A

PPIs
H2R blockers
Antibiotics
Antacids
Anticholinergics
Cytoprotective therapy

28
Q

antibiotics for peptic ulcer

A

Eradicates H. pylori infection
No single agent has been effective in eliminating H. pylori
Prescribed concurrently with a PPI for 7 to 14 days

29
Q

complications of ulcers

A

hemorrhage (hematemesis, melena, EGD, type and screen, PRBC give and hold, IV access, O2)
perforation (sudden, sharp, epigastric pain, peritonitis, rebound tender, rigid)
gastric outlet obstruction (edema, inflammation, pain worse at end of day, burping, constipation)

30
Q

surgical interventions and complications

A

partial gastrectomy, vagotomy, pylorplasty

dumping syndrome, posprandial hypoglycemia, bile reflux gastritis

31
Q

gastritis

A

Breakdown of the normal mucosal barrier
Causes: Drugs, Diet, Microorganisms, Environment, diseases, and other factors
Nausea, vomiting, anorexia, epigastric tenderness, feeling of fullness, gi bleed
Chronic Management: remove causes, manage symptoms, treat pernicious anemia for stomach tissue atrophies

32
Q

gastroenteritis

A

Inflammation of the mucosal lining
Causes: bacterial, viral, food contamination Table 42-1, Harding et al…
Sudden diarrhea, nausea, vomiting, fever, abdominal cramping
Self-limiting
Management: fluids replacement, antipyretics

33
Q

foods that trigger exacerbations

A

Lactose intolerance
High-fat foods
Cold foods
High-fiber foods

34
Q

goals of treatment of IBD

A

Rest the bowel
Control inflammation
Combat infection
Correct malnutrition
Alleviate stress
Relieve symptoms
Improve quality of life

35
Q

nutritional therapy during acute exacerbations

A

regular diet not tolerated
liquid enteral feedings (high calorie, lactose free, easily absorbed, low fiber)

36
Q

goal of drug treatment

A

induce and maintain remission

37
Q

meds

A

Aminosalicylates
Antimicrobials
Corticosteroids
Immunosuppressants
Biologic and targeted therapy

38
Q

bowel obstruction causes

A

mechanical : tumor, adhesion, stricture

vascular : interference of blood supply

39
Q

bowel obstruction assessment

A

vomiting, abdominal distention, hyperactive proximal to blockage, colicky type pain, fluid/electrolyte imbalance

40
Q

barium enema only used after what is ruled out

A

perforation

41
Q

bowel obstruction complications

A

infection, ischemia-infaraction, perforation, severe dehydration, electrolyte imbalance

42
Q

bowel obstruction treatment

A

NG tube - decompression
surgery - ileostomy or colostomy

43
Q

bowel obstruction interventions

A

NPO, IV fluids, abdominal assessment, I+O, monitor CBC,BMP, pain meds, anti-emetics, oral care

44
Q

purpose of bariatric surgeries

A

decrease client weight as safely as possible, decrease risks of obesity related diseases

45
Q

who should adjust NG tube placement

A

only provider

MED SURG (30 decks)

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