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Adult Health 2 > Upper and Lower GI Disorders > Flashcards

Upper and Lower GI Disorders Flashcards

1
Q

reflex of gastric contents into lower esophagus

A

gastroesophageal reflux disease (GERD)

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2
Q

What contributes to GERD sxs

A
  • impaired esophageal motility
  • defective mucosal defense
  • LES dysfunction
  • delayed gastric emptying
  • reflux of gastric contents
  • small intestine reflux of bile
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3
Q

Risk factors of GERD

A
  • hiatal hernia
  • incompetent LES (one of primary causes)
  • decreased gastric emptying
  • obesity
  • pregnancy
  • smoking, caffeine, and alcohol
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4
Q

clinical manifestations of GERD

A
  • heartburn (most common sx)
  • dyspepsia
  • hyper salivation
  • regurgitation
  • coughing, wheezing, dyspnea
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5
Q

complications of GERD

A
  • esophagitis

- Barrett’s esophagus (precancerous lesion)

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6
Q

diagnostic tests for GERD

A
  • description of sxs
  • reaction to GERD tx
  • EGD (for complications)
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7
Q

collaborative care for GERD

A
  • increased HOB 2-3 hours after eating
  • high protein, low fat diet
  • small frequent meals
  • avoid chocolate, peppermint, caffeine, tomatoes, orange juice, and alcohol
  • avoid late-night snacks or meals
  • smoking cessation and weight reduction
  • avoid tight clothing
  • drug therapy
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8
Q

drugs used for GERD

A
  • proton pump inhibits (PPI): esomeprazole (Nexium)

- H2 blockers: famotidine (Pepcid)

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9
Q

herniation of part of the stomach into esophagus through diaphragm

A

hiatal hernia

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10
Q

2 type of hiatal hernias

A
  • sliding: esophagogastric junction above diaphragm when supine; most common
  • paraesophageal or rolling: fundus and greater curvature of stomach pass through diaphragm on one side
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11
Q

which type of hiatal hernia is a medical emergency

A

paraesophageal or rolling hernia: section of stomach above diaphragm can become strangulated (low blood flow)

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12
Q

risk factors for hiatal hernia

A
  • obesity
  • pregnancy
  • physical overexertion or heavy lifting
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13
Q

clinical manifestations of hiatal hernia

A
  • asymptomatic or sxs similar to GERD
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14
Q

complications of hiatal hernia

A
  • GERD
  • ulcerations
  • strangulation
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15
Q

diagnostic tests for hiatal hernia

A

EGD

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16
Q

collaborative care for hiatal hernia

A
  • avoid lifting and straining (keep intraabdominal pressure low)
  • similar to GERD (lift HOB, diet, avoid smoking/tight clothes)
  • medication
  • surgery (if medication not effective)
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17
Q

types of surgery for hiatal hernia

A
  • herniorrhaphy (closure of defect)
  • herniotomy (excision of the hernia sac
  • Nissen fundoplication (upper part of stomach wrapped around LES to strengthen sphincter)
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18
Q

types of UGI bleeding

A
  • hematemesis (bright red or coffee ground vomit)
  • melena (black tarry stool)
  • occult bleeding (bleeding somewhere but is undetectable to naked eye)
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19
Q

where is the bleeding for bright red vomit

A

in esophagus or acute upper GI tract

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20
Q

what causes melena and coffee ground vomit

A

blood has been digested

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21
Q

common causes of UGI bleeding

A
  • esophagus (esophagitis, esophageal varices, Mallory Weiss tear)
  • stomach and duodenum (PUD, gastric cancer, stress ulcers)
  • drug-induced (ASA, NSAIDs, corticosteroids)
  • systemic disease (liver disease, leukemia, thrombocytopenia)
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22
Q

assessment and management of UGI bleeding

A
  • monitor BP and HR q 15-30 minutes
  • assess signs of shock
  • ABD exam
  • stool guaiac, Gastroccult
  • large bore IVs
  • PRBCs, FFP, whole blood
  • O2 per NC
  • I&O
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23
Q

labs for UGI bleeding

A
  • CBC (H&H)
  • BUN and Cr (hypovolemia -> renal failure)
  • PT/PTT/INR
  • Type and cross match
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24
Q

diagnostic tests for UGI bleeding

A

EGD

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25
collaborative care for UGI bleeding
- endoscopic hemostasis therapy - surgical therapy - antacids (H2 blockers; PPIs) - avoid smoking and EtOH - take meds w/ food - NPO -> CL diet -> advanced as tolerated
26
where are ulcers located in PUD
- lower esophagus - stomach - duodenum (most common)
27
cause of PUD
gastric mucosa is damaged and unable to repair itself due to very acidic gastric acid
28
levels of gastric ulcers
- erosion of the mucosa - acute ulcer into the submucosa - chronic ulcer that gets down into the muscular and causes scarring
29
causes of PUD
- H. Pylori (90-95% of duodenal ulcers) - Medications (ASA, NSAIDs, corticosteroids, and SSRIs) - Physiological and psychological stress - EtOH, coffee, and smoking
30
describe gastric ulcers
- occurs in the stomach - caused by H. Pylori, smoking, EtOH, and meds - pain 1-2 hours after meals - pain is described as burning or gaseous
31
describe duodenal ulcers
- occurs in duodenum - caused by H. Pylori, smoking, EtOH, meds, stress and other illnesses - pain relieved by food (lessens amount of acid touching ulcers) - pain occurs between meals and at night - pain described as burning or cramping located in the midepigastric region (around naval); also back pain
32
complications of PUD
- hemorrhage - perforation (medical emergency) - gastric outlet obstruction
33
describe signs of gastric perforation
- sudden severe upper ABD pain that spreads throughout the ABD - N/V - absent bowel sounds - ABD rigidity - shallow rapid respirations
34
diagnostic studies for PUD
- EGD w/ biopsy | - tests for H. Pylori
35
labs for PUD
- CBC (H&H) | - stool guaiac
36
collaborative care for PUD
- H2 blocker and PPIs - antibiotics for H. Pylori (amoxicillin, biaxin, and Flagyl) - stop or decrease dose of irritating meds - avoid spicy foods, alcohol, carbonated beverages, tea, and coffee - smoking cessation - adequate rest and stress reduction
37
collaborative care for PUD if complications present
- NG tube to LIS - IV fluids - antibiotics - blood transfusion - surgical repair of perforation
38
intermittent and recurrent alterations in bowel patterns (umbrella term)
irritable bowel syndrome (IBS)
39
sxs of IBS
- ABD pain - bloating - flatulence - urgency to defecate - stool irregularities - no specific physical findings or structural changes
40
autoimmune disease that causes chronic recurrent inflammation of the intestinal tract; periods of remission and exacerbation
inflammatory bowel disease (IBD)
41
describe IBD
- genetic susceptibility - includes UC and Crohn's disease - onset usually teens to mid 30s - higher prevalence in industrialized countries - higher incidence in caucasians
42
sxs of UC and Crohn's
- diarrhea - ABD pain - fever - fatigue
43
describe UC
- weight loss rare - blood stools common - malabsorption and nutritional deficit minimal - rectum and colon -> continuous inflammation - mucosa and submucosa - fistulas and anal abscesses rare - cure w/ colectomy
44
describe Crohn's disease
- weight loss common - blood stools infrequent - malabsorption and nutrition deficit common - whole GI tract -> skip lesions; cobblestone appearance - entire thickness of bowel wall - fistulas and anal abscesses common - reoccurs after resections
45
complications w/ IBD
- hemorrhage - perforation and peritonitis - toxic megacolon (UC) - UC -> risk for colorectal cancer - Crohn's -> risk for small bowel cancer - systemic complications (for both) include primary sclerosis cholangitis (Liver disease), thromboembolism, arthritis, and osteoporosis
46
diagnostic tests for IBD
- CBC - electrolytes and albumin - ESR - stool culture - capsule endoscopy (pill w/ camera) - sigmoidoscopy - colonoscopy w/ biopsy
47
collaborative care for IBD
- dietary management - vitamin and iron supplements - TPN (may be during exacerbation for bowel rest) - medications - surgery
48
dietary management for IBD
- high calorie and high protein (want as many nutrients as possible) - low residue (no fibrous or stringy fruits/vegetables - lactose free - avoid seeds and whole grains - avoid caffeine and alcohol
49
fruits to avoid for low residue diet
- no fibrous or stringy fruits/vegetables - peel skin off fruits/vegetables - celery - pineapple - lettuce
50
types of meds for IBD
- aminosalicylates: mesalamine (Asacol, Pentasa) - antimicrobials: metronidazole (Flagyl) and ciprofloxacin (Cipro) - corticosteroids: budesonide (Entecort), and prednisone - immunosuppressants: azathioprine (Immuran) - biologic and targeted therapies: adalimumab (Humira)
51
surgery for IBD
- bowel resections (Crohn's) - total proctocolectomy w/ ileal pouch/anal anastomosis (IPAA) - total proctocolectomy w/ permanent ileostomy (UC)
52
describe total proctocolectomy w/ ileal pouch/anal anastomosis (IPAA)
- most common procedure for UC - total colectomy - rectal mucosal stripping - ileal-anal reservoir - temporary ileostomy while reservoir is healing - allows them to have regular bowel movements
53
post-op care for ileostomy
- stoma viability - peristomal skin integrity (CDI) - initially, output up to 1500-2000 mL per 24 hours -> monitor dehydration and bowel obstruction - liquid drainage (moreso closure to stomach) - pt teaching needed (increase fluid intake due to liquid stools)
54
types of ostomies
- ileostomy | - colostomy (ascending, transverse, sigmoid)
55
caring for ostomies
- stoma should be reddish pink and moist - stoma protrudes about 1 cm from skin - peristomal skin CDI - change bag every 4-7 days - stoma edema resolved 2-3 weeks post-op - cut bag about 1/8 to 1/16 inches larger than stoma - small amount of bleeding around the stoma when changing the bag is normal
56
ostomy signs and sxs to report
- dark reddish/purple or black stoma or pale stoma (ischemia or necrosis) - unusual bleeding - mucocutaneous separation (stoma sinks back in)
57
collaborative care for ostomies
- begin functioning 2-4 days post - empty pouch 1/3 to 1/2 full - assess for gas in bag - control and odor w/ food choices
58
gas producing foods to avoid w/ ostomies
- beans - cabbage - onions - beer - carbonated drinks - strong cheeses - brussel sprouts
59
odor producing foods to avoid w/ ostomies
- broccoli - eggs - garlic - onions - fish - cabbage - alcohol
60
potential ileostomy obstruction foods to avoid w/ ostomies
- nuts - raisins - seeds - popcorn - corn - celery
61
describe mechanical intestinal obstructions
- occlusion of intestine - most in small intestine (surgical adhesions, hernia, intussusception following bariatric ABD surgery, stricture from Crohn's) - large intestine (cancer, diverticular disease)
62
describe nonmechanical intestinal obstructions
- neuromuscular or vascular disorders - paralytic ileus (no bowel sounds or peristalsis) -> may be due to surgery, peritonitis, inflammatory responses like acute pancreatitis or acute appendicitis, low K levels, thoracic/lumbar spinal fractures - emboli and atherosclerosis of mesenteric As. -> ischemic bowel
63
clinical manifestations of intestinal obstructions
- N/V - constipation - lack of flatus - absent (below) or hypersensitive (above) relative to obstruction - ABD pain and distention
64
diagnostic tests for intestinal obstructions
- CT - Xray - colonoscopy
65
collaborative care for intestinal obstructions
- NPO - NG tube to LIS - IV fluids - surgery if above methods don't work
66
surgeries for intestinal obstructions
- bowel resection and reanastamosis | - bowel resection w/ ileostomy or colostomy
67
complications of diverticulitis
- infection - abscess - perforation - fistula - bleeding
68
risk factors for diverticulosis
low fiber intake
69
clinical manifestations of diverticulosis and diverticulitis
- most asymptomatic - diverticulitis: LLQ ABD pain, fever, and increased WBC - older adults may be afebrile or have normal WBC
70
diagnostic tests for diverticulosis and diverticulitis
- CT - Xray - colonoscopy
71
collaborative care for diverticulosis and diverticulitis
- high fiber, low fat diet - low intake of red meat - fiber supplement and stool softeners - physical activity - weight reduction - avoid straining, lifting, and tight clothes - NPO or clear liquids - IV fluids - antibiotics - surgery (bowel resection) if abscess or obstruction

Adult Health 2 (8 decks)

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