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Medical Surgical Nusing > Upper Gastrointestinal Problems > Flashcards

Upper Gastrointestinal Problems Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the 5 common upper GI problems

A

Hiatal Hernia, Gastroesophagel Reflux Disease (GERD), Peptic ulcer disease (PUD), Upper GI bleed (UGIB), Gastric Cancer

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2
Q

What are the common S/S of GI Disorders? (8 things)

A

N/V, Pain, Bleeding, Jaundice (usually a sign of accessory organ problem), Weight loss/malabsorption, Diarrhea, Constipation, Change in bowel habits

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3
Q

What are three common diagnostic exams?

A

Barium swallow, Upper GI series (radiologic exam)

Esophagogastroduodenoscopy (EGD, Upper endoscopy)- diagnostic and therapeutic

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4
Q

Barium Swallow: what is it used to test for?

A

Reveal presence or absence of foreign bodies, varices, tumors, hiatal hernia (Not sensitive to esophagitis of Barrett’s); contraindicated for intestinal obstruction

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5
Q

Barium Swallow: How is it performed?

A

NPO (3 hours prior), swallow barium in supine position (take xray as patient swallows)

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6
Q

Barium Swallow: what are the risks

A

Aspiration, constipation (stool may appear white), anaphylaxis

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7
Q

UGI Series: What is it used to test for?

A

Hiatal hernia, diverticula, ulcers, varices, tumors, Crohn’s,, ileus/obstruction; X-ray with contrast

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8
Q

UGI Series: how is it performed?

A

Patient changes position on table, 1-2 hours duration, double contrasted insertion of air, NPO after MN

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9
Q

EGD: How is it performed?

A

Direct visual exam of GI mucosa, lumen using scope with camera and light source

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10
Q

EGD: what are the contraindications?

A

Non-compliance NPO, uncooperative, bleeding d/o, severe cardiac decomposition, respiratory compromise

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11
Q

EGD: what are the risks?

A

respiratory depression, perforation, aspiration, hemorrhage, hypotension, cardiac arrhythmia

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12
Q

What are some of the functions of the stomach? (6 things)

A
  • 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.
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13
Q

What is a Hiatal Hernia?

A

Part of the stomach protrudes through the diaphragm into the thoracic cavity; 2 types (Sliding and Rolling hernia)

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14
Q

What is a sliding hernia?

A

Most common type associated with weakened LES and reflux (usually asymptommatic)

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15
Q

What is a rolling hernia?

A

caused by intra-abdominal pressure; feeling discomfort/fullness after meals, blood flow can become interrupted causing infection/gangrene (PC: strangulation and infarction)

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16
Q

Hiatal Hernia: What are the risk factors?

A

Age (common in older people), women > men, increased abdominal pressure

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17
Q

Hiatal Hernia: What are the 6 complications?

A

Heartburn, GERD, Esophagitis, Dysphagia, Stenosis, Strangulation/ischemia (usually seen in rolling hernias)

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18
Q

Hiatal Hernia: What diagnostic tests are used to dx?

A

Barium swallow, Upper GI series, EGD

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19
Q

Hiatal Hernia: What are some medical treatments/managments?

A 
drug therapy: antacids, H2 blockers, proton pump inhibitors (PPIs)
Laproscopic fundoplication (Nissen, Toupet)
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20
Q

What is GERD?

A

A syndrome, not a disease; reflux of stomach acids into lower esophagus

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21
Q

GERD: What are some of the predisposing factors? (4 things)

A

Hiatal Hernia, Incompetent LES, Pyloric stenosis, Motility d/o

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22
Q

GERD: What are the 6 S/S (manifestations)?

A

Dyspepsia, Heartburn, Dysphagia, Regurgitation, Respiratory (coughing, wheezing, dyspnea), Otolaryngologic (hoarseness, sore throat, choking)

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23
Q

GERD: What are 5 complications?

A

Esophagitis, Barrett’s esophagus, Esophageal stricture (scarring), aspiration pneumonia, dental erosion

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24
Q

GERD: what diagnostic tests are used to detect GERD?

A

Barium swallow or upper GI series, 24 hour pH, EGD (mainly used to see damage), Esophageal monometry- motility study (measure of pressure in stomach)

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25
Q

GERD: What are the three goals for collaborative care?

A

relief of symptoms, heal damaged mucosa, prevent complications

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26
Q

GERD: what are the medical treatments/managments?

A

drug therapy: antacids, H2 blockers, PPIs

Laproscopic fundoplication, transesophageal endoscopic therapies

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27
Q

GERD: What would you teach the patient to prevent future reoccurances?

A 
Dietary: avoid alcohol, peppermint (relaxes LES), caffeine, fatty-foods.
Weight loss and avoid tight garments
elevate HOB
smoking cessation
Medication
28
Q

What is Barrett’s Esophagus?

A

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

29
Q

Barrett’s: What diagnostic test is used to detect Barrett’s?

A

Regular surveillance EGD with biopsy: early detection of neoplastic changes (dysplasia)

30
Q

Barrett’s: What are 3 treatments for Barrett’s?

A

Thermal ablation, Endoscopic mucosal resection, esophagectomy

31
Q

Barrett’s: What are 2 treatments for Barrett’s?

A

Drug therapy (PPI), lifestyle changes

32
Q

What is Gastritis?

A

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)

33
Q

Gastritis: what is the diagnostic test used to detect gastritis?

A

EGD

34
Q

Gastritis: What is the treatment for Gastritis?

A

Pharm.: Vitamin B12 (cobalamin), antacids, H2 blockers, PPIs

35
Q

What is peptic ulcer disease?

A

location: lower esophagus, stomach (pylorus), duodenum.

Stress related mucosal disease (SRMD): associated with serious injury, bleeding may occur within 3-7 days

36
Q

PUD: what are the 7 risk factors for PUD?

A

H pylori infection, chronic NSAID use, family hx, cigarette smoking, delayed gastric emptying, zollinger-ellison syndrome, bile reflux/pyloric sphincter incompetence.

37
Q

PUD: how does PUD develop/occur?

A

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.

38
Q

PUD: what are 4 S/S (manifestations)?

A

Abdominal tenderness, pain (temporary relief may occur with food), N/V, weight loss

39
Q

PUD: what are the 5 complications of PUD?

A

hemorrhage, perforation peritonitis, penetration, obstruction.

40
Q

PUD: what 2 diagnostic exams are used?

A

UGI series, EGD (exam of choice)

41
Q

PUD: how are some treatments for PUD?

A

Antacids, antisecretory (PPIs, H2 blockers), Antibiotics for H pylori, pepsin inhibitor for mucosal barrier, laproscopic surgery

42
Q

PUD: What would you teach the patient?

A

S/S of complications: bleeding (stool or emesis), vomiting, increased pain. Restrict: caffeine, alcohol, nicotine (all stimulate gastrin release and delay healing).

43
Q

What is Zollinger-Ellison Syndrome?

A

Pancreatic and/or duodenal tumors. Tumor cells secrete gastrin which leads to excessive HCL acid production and can develop duodenal ulcers/diarrhea.

44
Q

Zollinger-Ellison: what are 4 diagnostic tests used?

A

gastrin levels, EGD, CT, MRI

45
Q

Zollinger-Ellison: what are some treatment options?

A

surgery may/may not be an option, debulking/embolization of tumor, chemo, PPI (medication of choice).

46
Q

Upper gastric bleed (UGIB): what are the 4 types of bleeding that can occur?

A

Hematemesis: specks streaks, “coffee ground”, copious BRB in emesis.
Melena: black tarry stool.
Fecal Occult blood.
Hypovolemia.

47
Q

UGIB: what are 7 causes for UGIB?

A

Esophagitis, variicies, Mallory-Weiss tear, ulcers, gastritis, gastric cancer, FBI (foreign body ingestion)

48
Q

UGIB: What are 4 diagnostic test used to detect UGIB?

A

labs GI series, EGD (test of choice, angiography (used to detect a very small bleed)

49
Q

UGIB: what are some treatments for UGIB?

A 
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)
50
Q

UGIB: What are some nursing/collaborative care options?

A

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.

51
Q

What is esophageal varices?

A

dilation of submucosal veins in distal esophagus

52
Q

Esophageal varices: what are some causes for EV?

A

increased portal hypertension (caused by alcoholic cirrhosis, chronic hepatitis).

53
Q

Esophageal Varices: what are 3 S/S?

A

possible melena, hematemesis, asymptomatic

54
Q

Esophageal varices: what is the complication associated with EV?

A

life-threatening bleeding

55
Q

Esophageal Varices: what is the diagnositc test used?

A

EGD

56
Q

Esophageal Varices: what are 6 treatment options?

A

banding/ligation, betablockers (used to control portal HTN), TIPS (transjugular intrahepatic portosystemic shunt), transfusion, Vasopressin/octreotide (if patient is going into shock), balloon tamponade.

57
Q

What is a Mallory-Weiss tear?

A

Mucosal tear at the gastroesophageal junction

58
Q

Mallory-Weiss tear: what are some causes?

A

prolonged forceful vomiting, childbirth, trauma, alcohol abuse, aspirin therapy heriatal hernia.

59
Q

Mallory-Weiss tear: what is the symptom and treatment for tear?

A

blood loss small (stops spontaneously), profuse bleeding treated endoscopically.

60
Q

Gastric CA: what are some risk factors?

A

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

61
Q

Gastric CA: what are some S/S or manifestations?

A

asymptomatic; mild abdominal discomfort, unexplained weight loss/anorexia/early satiety, dysphagia to solid foods, anemia, ascities (worst prognosis; sign of late stage).

62
Q

Gastric CA: what are some diagnostic test?

A

X-ray, GI series, CT scan, EGD with biopsy. Labs (decreased Hct, positive OB, CEA, CA 19-9, amylase, liver enzymes, hypoalbuminemia)

63
Q

Gastric CA: what are the three surgical treatments?

A

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

64
Q

Gastric CA: what is Dumping syndrome?

A

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.

65
Q

Gastric CA: what are some S/S of dumping syndrome?

A

tachycardia, pallor, sweating, palpitations, syncope, fullness distention, cramping, diarrhea.

66
Q

Gastric CA: what are some treatments for Dumping Syndrome?

A

Meals: small, dry, decreased carbs, moderate protein and fat; rest after meal.

67
Q

Gastric CA: what are some nursing diagnosis/ pt goals?

A

Emotional needs (maintain spiritual psychological well-being appropriate for disease stage), adequate nutrition (achieve optimal nutritional status), pain management (experience little/no pain)

Medical Surgical Nusing (3 decks)

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