TOPIC 7 - GI system Flashcards
GI diseases
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
symptoms of GERD
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
predisposing factors of GERD
incompetent lower esophageal sphincter
decreased LES pressure
increased intraabdominal pressure
hiatal hernia
GERD complications
Barretts esophagus
esophageal varices
esophageal ulcers
respiratory (from irritation of upper airway) : cough, bronchospasm, laryngospasm
diagnostic tests
upper GI endoscopy
ambulatory esophageal pH monitoring
radionuclide tests
meds
PPIs, H2R blockers, acid protective, pro kinetic drugs, antacids
PPIs
promote esophageal healing
ex : omeprazole
s/e : headache
H2R blockers
decrease secretion of HCl
reduce symptoms and promote esophageal healing
ex : famotidine
uncommon s/e
acid protective
cytoprotective properties
ex : sucralfate
prokinetic drugs
promote gastric emptying
reduce risk of reflux
ex: metoclopramide
antacids
quick but short lived relief
neutralize HCl
taken 1-3 hours after meals
ex : maalox, mylanta
interventions for GERD
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
surgical therapy for …
patients with med intolerance, barretts meaplasia, esophageal stricture and stenosis, chronic esophagitis, failure of conservative therapy
nissen fundoplication
treat more than 1 clinical condition
fundus of stomach is wrapped around distal esophagus and sutured to itself
hiatal hernia - sliding
stomach slides through hiatal opening in diaphragm when patient is supine, goes into abdominal cavity when patient is standing upright
hiatal hernia - rolling
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
complications of hiatal hernia
GERD, esophagitis, hemorrhage, stenosis, ulcerations of herniated portion
diagnostics
esophagogram (show protrusion of mucosa)
endoscopy (visualize lower esophagus)
surgical therapy
gastropexy : anti-reflux procedure, attachment of stomach sub-diaphragmatically
herniotomy : reduction of herniated stomach, excision of hernia sac
herniorrhaphy : closure of hiatal defect
first indication in geriatric population
esophageal bleeding or respiratory complications
invasive imaging for diagnostics patient prep
NPO, bowel prep, take normal meds, IV access for sedation, cardiac monitor, labs: electrolytes and CBC,
monitor LOC, RR, O2, vitals
risk for perforation
causes of peptic ulcer disease
Hydrochloric acid & pepsin
Helicobacter Pylori
Medications (aspirin, NSAIDS, corticosteroids, anticoagulants, SSRIs)
Lifestyle (excessive ETOH, coffee, smoking, stress)
peptic ulcer disease :
erosion of GI mucosa from action of HCl, affecting lower esophagus, stomach, and duodenum
acute peptic ulcer disease
superficial erosion, minimal inflammation, short duration, resolves when cause treated
chronic peptic ulcer disease
erodes through the muscular wall, present continuously for years or intermittent through life, most common type of ulcers
diagnostic studies for peptic ulcer disease
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)
meds for peptic ulcer
PPIs
H2R blockers
Antibiotics
Antacids
Anticholinergics
Cytoprotective therapy
antibiotics for peptic ulcer
Eradicates H. pylori infection
No single agent has been effective in eliminating H. pylori
Prescribed concurrently with a PPI for 7 to 14 days
complications of ulcers
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)
surgical interventions and complications
partial gastrectomy, vagotomy, pylorplasty
dumping syndrome, posprandial hypoglycemia, bile reflux gastritis
gastritis
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
gastroenteritis
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
foods that trigger exacerbations
Lactose intolerance
High-fat foods
Cold foods
High-fiber foods
goals of treatment of IBD
Rest the bowel
Control inflammation
Combat infection
Correct malnutrition
Alleviate stress
Relieve symptoms
Improve quality of life
nutritional therapy during acute exacerbations
regular diet not tolerated
liquid enteral feedings (high calorie, lactose free, easily absorbed, low fiber)
goal of drug treatment
induce and maintain remission
meds
Aminosalicylates
Antimicrobials
Corticosteroids
Immunosuppressants
Biologic and targeted therapy
bowel obstruction causes
mechanical : tumor, adhesion, stricture
vascular : interference of blood supply
bowel obstruction assessment
vomiting, abdominal distention, hyperactive proximal to blockage, colicky type pain, fluid/electrolyte imbalance
barium enema only used after what is ruled out
perforation
bowel obstruction complications
infection, ischemia-infaraction, perforation, severe dehydration, electrolyte imbalance
bowel obstruction treatment
NG tube - decompression
surgery - ileostomy or colostomy
bowel obstruction interventions
NPO, IV fluids, abdominal assessment, I+O, monitor CBC,BMP, pain meds, anti-emetics, oral care
purpose of bariatric surgeries
decrease client weight as safely as possible, decrease risks of obesity related diseases
who should adjust NG tube placement
only provider
