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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
Q

collaborative care for UGI bleeding

A
  • endoscopic hemostasis therapy
  • surgical therapy
  • antacids (H2 blockers; PPIs)
  • avoid smoking and EtOH
  • take meds w/ food
  • NPO -> CL diet -> advanced as tolerated
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26
Q

where are ulcers located in PUD

A
  • lower esophagus
  • stomach
  • duodenum (most common)
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27
Q

cause of PUD

A

gastric mucosa is damaged and unable to repair itself due to very acidic gastric acid

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28
Q

levels of gastric ulcers

A
  • erosion of the mucosa
  • acute ulcer into the submucosa
  • chronic ulcer that gets down into the muscular and causes scarring
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29
Q

causes of PUD

A
  • H. Pylori (90-95% of duodenal ulcers)
  • Medications (ASA, NSAIDs, corticosteroids, and SSRIs)
  • Physiological and psychological stress
  • EtOH, coffee, and smoking
30
Q

describe gastric ulcers

A
  • 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
Q

describe duodenal ulcers

A
  • 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
Q

complications of PUD

A
  • hemorrhage
  • perforation (medical emergency)
  • gastric outlet obstruction
33
Q

describe signs of gastric perforation

A
  • sudden severe upper ABD pain that spreads throughout the ABD
  • N/V
  • absent bowel sounds
  • ABD rigidity
  • shallow rapid respirations
34
Q

diagnostic studies for PUD

A
  • EGD w/ biopsy

- tests for H. Pylori

35
Q

labs for PUD

A
  • CBC (H&H)

- stool guaiac

36
Q

collaborative care for PUD

A
  • 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
Q

collaborative care for PUD if complications present

A
  • NG tube to LIS
  • IV fluids
  • antibiotics
  • blood transfusion
  • surgical repair of perforation
38
Q

intermittent and recurrent alterations in bowel patterns (umbrella term)

A

irritable bowel syndrome (IBS)

39
Q

sxs of IBS

A
  • ABD pain
  • bloating
  • flatulence
  • urgency to defecate
  • stool irregularities
  • no specific physical findings or structural changes
40
Q

autoimmune disease that causes chronic recurrent inflammation of the intestinal tract; periods of remission and exacerbation

A

inflammatory bowel disease (IBD)

41
Q

describe IBD

A
  • genetic susceptibility
  • includes UC and Crohn’s disease
  • onset usually teens to mid 30s
  • higher prevalence in industrialized countries
  • higher incidence in caucasians
42
Q

sxs of UC and Crohn’s

A
  • diarrhea
  • ABD pain
  • fever
  • fatigue
43
Q

describe UC

A
  • 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
Q

describe Crohn’s disease

A
  • 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
Q

complications w/ IBD

A
  • 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
Q

diagnostic tests for IBD

A
  • CBC
  • electrolytes and albumin
  • ESR
  • stool culture
  • capsule endoscopy (pill w/ camera)
  • sigmoidoscopy
  • colonoscopy w/ biopsy
47
Q

collaborative care for IBD

A
  • dietary management
  • vitamin and iron supplements
  • TPN (may be during exacerbation for bowel rest)
  • medications
  • surgery
48
Q

dietary management for IBD

A
  • 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
Q

fruits to avoid for low residue diet

A
  • no fibrous or stringy fruits/vegetables
  • peel skin off fruits/vegetables
  • celery
  • pineapple
  • lettuce
50
Q

types of meds for IBD

A
  • 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
Q

surgery for IBD

A
  • bowel resections (Crohn’s)
  • total proctocolectomy w/ ileal pouch/anal anastomosis (IPAA)
  • total proctocolectomy w/ permanent ileostomy (UC)
52
Q

describe total proctocolectomy w/ ileal pouch/anal anastomosis (IPAA)

A
  • 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
Q

post-op care for ileostomy

A
  • 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
Q

types of ostomies

A
  • ileostomy

- colostomy (ascending, transverse, sigmoid)

55
Q

caring for ostomies

A
  • 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
Q

ostomy signs and sxs to report

A
  • dark reddish/purple or black stoma or pale stoma (ischemia or necrosis)
  • unusual bleeding
  • mucocutaneous separation (stoma sinks back in)
57
Q

collaborative care for ostomies

A
  • 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
Q

gas producing foods to avoid w/ ostomies

A
  • beans
  • cabbage
  • onions
  • beer
  • carbonated drinks
  • strong cheeses
  • brussel sprouts
59
Q

odor producing foods to avoid w/ ostomies

A
  • broccoli
  • eggs
  • garlic
  • onions
  • fish
  • cabbage
  • alcohol
60
Q

potential ileostomy obstruction foods to avoid w/ ostomies

A
  • nuts
  • raisins
  • seeds
  • popcorn
  • corn
  • celery
61
Q

describe mechanical intestinal obstructions

A
  • 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
Q

describe nonmechanical intestinal obstructions

A
  • 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
Q

clinical manifestations of intestinal obstructions

A
  • N/V
  • constipation
  • lack of flatus
  • absent (below) or hypersensitive (above) relative to obstruction
  • ABD pain and distention
64
Q

diagnostic tests for intestinal obstructions

A
  • CT
  • Xray
  • colonoscopy
65
Q

collaborative care for intestinal obstructions

A
  • NPO
  • NG tube to LIS
  • IV fluids
  • surgery if above methods don’t work
66
Q

surgeries for intestinal obstructions

A
  • bowel resection and reanastamosis

- bowel resection w/ ileostomy or colostomy

67
Q

complications of diverticulitis

A
  • infection
  • abscess
  • perforation
  • fistula
  • bleeding
68
Q

risk factors for diverticulosis

A

low fiber intake

69
Q

clinical manifestations of diverticulosis and diverticulitis

A
  • most asymptomatic
  • diverticulitis: LLQ ABD pain, fever, and increased WBC
  • older adults may be afebrile or have normal WBC
70
Q

diagnostic tests for diverticulosis and diverticulitis

A
  • CT
  • Xray
  • colonoscopy
71
Q

collaborative care for diverticulosis and diverticulitis

A
  • 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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