Upper Gastrointestinal Problems Flashcards
What are the 5 common upper GI problems
Hiatal Hernia, Gastroesophagel Reflux Disease (GERD), Peptic ulcer disease (PUD), Upper GI bleed (UGIB), Gastric Cancer
What are the common S/S of GI Disorders? (8 things)
N/V, Pain, Bleeding, Jaundice (usually a sign of accessory organ problem), Weight loss/malabsorption, Diarrhea, Constipation, Change in bowel habits
What are three common diagnostic exams?
Barium swallow, Upper GI series (radiologic exam)
Esophagogastroduodenoscopy (EGD, Upper endoscopy)- diagnostic and therapeutic
Barium Swallow: what is it used to test for?
Reveal presence or absence of foreign bodies, varices, tumors, hiatal hernia (Not sensitive to esophagitis of Barrett’s); contraindicated for intestinal obstruction
Barium Swallow: How is it performed?
NPO (3 hours prior), swallow barium in supine position (take xray as patient swallows)
Barium Swallow: what are the risks
Aspiration, constipation (stool may appear white), anaphylaxis
UGI Series: What is it used to test for?
Hiatal hernia, diverticula, ulcers, varices, tumors, Crohn’s,, ileus/obstruction; X-ray with contrast
UGI Series: how is it performed?
Patient changes position on table, 1-2 hours duration, double contrasted insertion of air, NPO after MN
EGD: How is it performed?
Direct visual exam of GI mucosa, lumen using scope with camera and light source
EGD: what are the contraindications?
Non-compliance NPO, uncooperative, bleeding d/o, severe cardiac decomposition, respiratory compromise
EGD: what are the risks?
respiratory depression, perforation, aspiration, hemorrhage, hypotension, cardiac arrhythmia
What are some of the functions of the stomach? (6 things)
- Initiate digestion thru chemical secretions and mechanical movements.
- Glands secrete mucus, pepsinogen, bicarbonate, HCL acid, intrinsic factor, gastrin, serotonin, hormonal products.
- Absorption of Vitamin B12 thru intrinsic factor
- 1.5-3 L gastric fluid produced daily
- Reservoir/regulates emptying into duodenum.
What is a Hiatal Hernia?
Part of the stomach protrudes through the diaphragm into the thoracic cavity; 2 types (Sliding and Rolling hernia)
What is a sliding hernia?
Most common type associated with weakened LES and reflux (usually asymptommatic)
What is a rolling hernia?
caused by intra-abdominal pressure; feeling discomfort/fullness after meals, blood flow can become interrupted causing infection/gangrene (PC: strangulation and infarction)
Hiatal Hernia: What are the risk factors?
Age (common in older people), women > men, increased abdominal pressure
Hiatal Hernia: What are the 6 complications?
Heartburn, GERD, Esophagitis, Dysphagia, Stenosis, Strangulation/ischemia (usually seen in rolling hernias)
Hiatal Hernia: What diagnostic tests are used to dx?
Barium swallow, Upper GI series, EGD
Hiatal Hernia: What are some medical treatments/managments?
drug therapy: antacids, H2 blockers, proton pump inhibitors (PPIs) Laproscopic fundoplication (Nissen, Toupet)
What is GERD?
A syndrome, not a disease; reflux of stomach acids into lower esophagus
GERD: What are some of the predisposing factors? (4 things)
Hiatal Hernia, Incompetent LES, Pyloric stenosis, Motility d/o
GERD: What are the 6 S/S (manifestations)?
Dyspepsia, Heartburn, Dysphagia, Regurgitation, Respiratory (coughing, wheezing, dyspnea), Otolaryngologic (hoarseness, sore throat, choking)
GERD: What are 5 complications?
Esophagitis, Barrett’s esophagus, Esophageal stricture (scarring), aspiration pneumonia, dental erosion
GERD: what diagnostic tests are used to detect GERD?
Barium swallow or upper GI series, 24 hour pH, EGD (mainly used to see damage), Esophageal monometry- motility study (measure of pressure in stomach)
GERD: What are the three goals for collaborative care?
relief of symptoms, heal damaged mucosa, prevent complications
GERD: what are the medical treatments/managments?
drug therapy: antacids, H2 blockers, PPIs
Laproscopic fundoplication, transesophageal endoscopic therapies
GERD: What would you teach the patient to prevent future reoccurances?
Dietary: avoid alcohol, peppermint (relaxes LES), caffeine, fatty-foods. Weight loss and avoid tight garments elevate HOB smoking cessation Medication
What is Barrett’s Esophagus?
Normal squamous epithelium is replaced by columnar epithelium, found in 10% of patients with GERD, greatest incidence among older white males, endoscopic visualization with tissue biopsy, risk for development of adenocarcinoma
Barrett’s: What diagnostic test is used to detect Barrett’s?
Regular surveillance EGD with biopsy: early detection of neoplastic changes (dysplasia)
Barrett’s: What are 3 treatments for Barrett’s?
Thermal ablation, Endoscopic mucosal resection, esophagectomy
Barrett’s: What are 2 treatments for Barrett’s?
Drug therapy (PPI), lifestyle changes
What is Gastritis?
Inflammation of gastric mucosa; gradual blood loss undetected for years (acute: illness, alcoholism, localized trauma, gastrectomy. Chronic: commonly associated with normal aging, pernicious anemia, gastric ulcers, gastric cancer, H. pylori)
Gastritis: what is the diagnostic test used to detect gastritis?
EGD
Gastritis: What is the treatment for Gastritis?
Pharm.: Vitamin B12 (cobalamin), antacids, H2 blockers, PPIs
What is peptic ulcer disease?
location: lower esophagus, stomach (pylorus), duodenum.
Stress related mucosal disease (SRMD): associated with serious injury, bleeding may occur within 3-7 days
PUD: what are the 7 risk factors for PUD?
H pylori infection, chronic NSAID use, family hx, cigarette smoking, delayed gastric emptying, zollinger-ellison syndrome, bile reflux/pyloric sphincter incompetence.
PUD: how does PUD develop/occur?
Erosion mucosa/ barrier disruption, histamine release, further stimulation of acid secretion, mucosal edema, damage to mucosal capillaries and submucosal blood vessels, hemorrhage and shock, possible perforation and peritonitis.
PUD: what are 4 S/S (manifestations)?
Abdominal tenderness, pain (temporary relief may occur with food), N/V, weight loss
PUD: what are the 5 complications of PUD?
hemorrhage, perforation peritonitis, penetration, obstruction.
PUD: what 2 diagnostic exams are used?
UGI series, EGD (exam of choice)
PUD: how are some treatments for PUD?
Antacids, antisecretory (PPIs, H2 blockers), Antibiotics for H pylori, pepsin inhibitor for mucosal barrier, laproscopic surgery
PUD: What would you teach the patient?
S/S of complications: bleeding (stool or emesis), vomiting, increased pain. Restrict: caffeine, alcohol, nicotine (all stimulate gastrin release and delay healing).
What is Zollinger-Ellison Syndrome?
Pancreatic and/or duodenal tumors. Tumor cells secrete gastrin which leads to excessive HCL acid production and can develop duodenal ulcers/diarrhea.
Zollinger-Ellison: what are 4 diagnostic tests used?
gastrin levels, EGD, CT, MRI
Zollinger-Ellison: what are some treatment options?
surgery may/may not be an option, debulking/embolization of tumor, chemo, PPI (medication of choice).
Upper gastric bleed (UGIB): what are the 4 types of bleeding that can occur?
Hematemesis: specks streaks, “coffee ground”, copious BRB in emesis.
Melena: black tarry stool.
Fecal Occult blood.
Hypovolemia.
UGIB: what are 7 causes for UGIB?
Esophagitis, variicies, Mallory-Weiss tear, ulcers, gastritis, gastric cancer, FBI (foreign body ingestion)
UGIB: What are 4 diagnostic test used to detect UGIB?
labs GI series, EGD (test of choice, angiography (used to detect a very small bleed)
UGIB: what are some treatments for UGIB?
Endoscopically: injection of some sclerosing agents (constrict to decrease blood flow; epinephrine, ethamolin, denatured alcohol), electrocoagulation (cautery; use of metal clamps to stop bleeding), AVM. Surgical therapy (is unsuccessful endoscopically)
UGIB: What are some nursing/collaborative care options?
calm patient, VS, S/S shock, large bore IVV cath., maintain airway/oxygen, monitor urinary output, monittor labs (Hgb, Hct BUN), NGT (lavage), ewald tube (suction), S/S alcohol withdrawl.
What is esophageal varices?
dilation of submucosal veins in distal esophagus
Esophageal varices: what are some causes for EV?
increased portal hypertension (caused by alcoholic cirrhosis, chronic hepatitis).
Esophageal Varices: what are 3 S/S?
possible melena, hematemesis, asymptomatic
Esophageal varices: what is the complication associated with EV?
life-threatening bleeding
Esophageal Varices: what is the diagnositc test used?
EGD
Esophageal Varices: what are 6 treatment options?
banding/ligation, betablockers (used to control portal HTN), TIPS (transjugular intrahepatic portosystemic shunt), transfusion, Vasopressin/octreotide (if patient is going into shock), balloon tamponade.
What is a Mallory-Weiss tear?
Mucosal tear at the gastroesophageal junction
Mallory-Weiss tear: what are some causes?
prolonged forceful vomiting, childbirth, trauma, alcohol abuse, aspirin therapy heriatal hernia.
Mallory-Weiss tear: what is the symptom and treatment for tear?
blood loss small (stops spontaneously), profuse bleeding treated endoscopically.
Gastric CA: what are some risk factors?
family history, male, age, asian/pacific islander/african american/hispanic, lower socioeconomic status, smoking, diet high in nitrates/pickled vegs./ smoked fish or meats, gastric ulcer, H pylori, pernicious anemia, gastric atrophy, adenomatous polyps
Gastric CA: what are some S/S or manifestations?
asymptomatic; mild abdominal discomfort, unexplained weight loss/anorexia/early satiety, dysphagia to solid foods, anemia, ascities (worst prognosis; sign of late stage).
Gastric CA: what are some diagnostic test?
X-ray, GI series, CT scan, EGD with biopsy. Labs (decreased Hct, positive OB, CEA, CA 19-9, amylase, liver enzymes, hypoalbuminemia)
Gastric CA: what are the three surgical treatments?
Total gastrectomy, sub-total gastrectomy (Billroth I: removal of lower stomach and attach to duodenum, Billroth II: removal of lower stomach and attach to jejunum with the duodenum still remaining), lymph node dissection
Gastric CA: what is Dumping syndrome?
rapid dumping of chyme into small intestine; 15-30 minutes post meal d/t rapid shift of extracellular fluids to bowel, causing hypovolemia and bowel distention.
Gastric CA: what are some S/S of dumping syndrome?
tachycardia, pallor, sweating, palpitations, syncope, fullness distention, cramping, diarrhea.
Gastric CA: what are some treatments for Dumping Syndrome?
Meals: small, dry, decreased carbs, moderate protein and fat; rest after meal.
Gastric CA: what are some nursing diagnosis/ pt goals?
Emotional needs (maintain spiritual psychological well-being appropriate for disease stage), adequate nutrition (achieve optimal nutritional status), pain management (experience little/no pain)
