Upper Gastrointestinal Problemz Flashcards by Brina Quintanilla Reyes

What are the two indicators that something is going wrong In the GI tract?

Nausea and vomiting ( Emesis )

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Medications for nausea/vomitting (2)

Antihistamines
- dimendydrainate
- promethazine
- meclizine
- hydroxyzine

Phenothiazines
- prochlorperazine
- chlorpromazine

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Whenever giving nausea medications, the answer to all test questions is that there is a what type or risk?

Fall risk

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Common side effects of Nausea medications are (5)

Dry mouth
Hypotension
Sedative effects
Rashes
Gi disturbances

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Promethazine isn’t good for Iv, it’s better for which type of injection and causes what?

IM injection
Severe tissue damage

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Antihistamines and anticloinergies should never been given to patients who are? (5)

Glaucoma
Prostatic hyperplasia
Pyloric
Bladder neck obstruction
Biliary obstruction

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Zofran can cause what?

Constipations

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Nursing assessment
What will we want to see and indicates what?
Partially disgested
Fecal odor and bile
Bile
Bright red blood
Coffee ground

Gastric outlet obstruction & delayed gastric emptying

Obstruction below pylorus

Obstruction below ampulla or vater

Active bleeding ( Mallory Wei’s, varies, ulcer, cancer )

Gastric bleeding

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What causes aMallory weiss tear?

Violent coughing or vomiting

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Esophageal varies is what?
And when they burst what happens
Is it life threatening?

Who do we see this in more often? What type of patients?

Varicose veins in the esophagus
Bleeding

Yes because loss of blood loss

Alcohol patients

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Nursing implentstuon
Acute care (5)

NPO, IV fluids
NGT
monitor input and output
( dehydration )

Psychosocial and environmental
Aspiration precautions

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Nursing implemention
Ambulatory care (4)

Manage nausea / vomiting
Avoid sudden position change
Notify provider if symptoms persist
New med awareness

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When a patient was NPO, we want them to start on what? Every how many minutes?

Clear liquids
15-20mins

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We want to what type clear liquids

Carbonated
Room temp
Warm tea

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After clear liquid, you want to progress to what?

High carb low fat ; bland foods

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Gerontologic considerations
You want to be careful with them why?(3)

Monitor with fluid loss and rehydration
( cardiac & renal issues )

Aspiration precautions

Antiemetic drugs ; CNS effects ( confusion and falls )

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Esophageal problems

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What is gastriesophageal reflux disease ( GERD )

Gastric contents reflux into esophagus causing irrational and inflammation

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What is the primary factor of GERD?

Incompetent LES

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How does LES normally act in the body?

Acts an anti reflux barrier

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An incompetent LES allows gastric contents to move from the stomach to the esophagus when the patient is ?

Supine or has an increase in intrabadominal pressure

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What are some factors that affect LES pressure? (4)

Food and drugs
Obesity
Smoking
Hiatal hernia

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What are the clinical manifestations of GERD? (4)

Heart burn ( pyrosis)
Dyspepsia ( pain discomfort in upper abdomen )
Regurgitation ( hot bitter sour liquid in throat ) ( Verp)
Respiratory- wheezing

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What is pyrosis ?
It mimics what and relived with?

Heart burn
Burning tight sensation under lower sternum spread into throat or jaw

Mimics angina but relived with antacids

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Patients who have GERD may have globus sensation, which is?

Sense of a lump in the throat

What are complications of GERD? (4) Explain first two

Esophagitis ( ulceration, scar tissues, stricture; dysphagia ) Barrerts esophagus - metaplasia of cells ; increase risk of cancer Respiratory Dental Erosion

People who smoke are at higher risk of getting what?

Barretts esophagus

Diagnostic study of GERD is? (2)

Endoscopy Barium swallow ; radiography X ray (1,2,5mins )

The most important answer choice to choose when it comes to GI and things making it worse What 3 things we need to avoid?

Alcohol Caffeine Smoking

Nursing managements for GERD (6)

Low fat diet Upright position 2-3 hours after meals Avoid eating 3 hours before bend HOB increased 4-6 Weight reduction Drug therapy

Drug therapy for GERD (4)

PPI H2 receptor blockers Prokinetics Antacids

PPIs helps GERD patients how? Is it the most effective for healing esophagitis? What are the complications of this? (4)

Decrease HCI secretions and irritation ( also most effective for healing esophagitis ) Decreased bone density Kidney disease Deficient of vitamin b12 Dementia

H2 receptors help GERD patients how? They have an onset of how long? Available in what forms?

Decrease HCI secretion and Irritation 1 hours to 12 hours Oral, IV, combined with antacid

How does Prokinetics help GERD? Side effects? (2)

Increase gastric emptying and motility Hallucinations, extrapyradmidal effects ( tremor and dyskinesia )

How does antacids help GERD? You want to take every ? Becareful with elderly because Can cause ?

Neutralize acid Provides quick relief for mild Intermittent symptoms ( short duration ) 1-3 hours after meals and bedtime Increase sodium Renal failure - no magnesium preparations

Antacids they are putting calcium and magnesium, so patients with renal failure, you don’t want that? True or false

True

Antacids are quick relief for mild symptoms? True or false

True

Nutritional therapy for GERD (4)

No specific diet Avoid milk and eating before bedtime Encourage small meals and fluids between meals Weight reduction

Surgical therapy we can do for GERD is? (3)

Anti reflux surgery Nissan and Toupet fundoplications Linx Reflux management

Antireflux surgery helps?

Reduce reflux and enhances LES function

Linx Reflux mangament system help GERD how?

Ring of titanium beads with magenta implanted into LES to prevent reflux by keeping it closed when not eating or drinking

Nissan Fundoplication how does it work?

Tighten the fundus and wrap it around to reduce reflux

What is Hiatal Hernia?

Herniation is part of the stomach into the esophagus through and opening in the diaphragm

Hiatal hernia is also called?

Diaphragmic or Esophageal hernia

There are two types of hiatal hernia?

Sliding and paraesophgeal

Sliding is the most common hiatal hernia and it’s?

The junction of the stomach and esophagus is above the diaphragm Part of the stomach slides through the hiatal opening in the diaphragm And occurs when the patient is supine

What is paraesophageal or rolling Hiatal hernia? This is also a medical emergency!?

Fundus and greater curvature of the stomach roll up through the diaphragm forming a pocket alongside the esophagus

What is eosinophilic esophagitis?

Swelling of esophagus due to infiltration of eosinophils

Eosinophilic Esophagitis can be ? (2)

Personal or family history of allergies

Eosinophilic esophagitis can be from food triggers and environmental factors like?

Milk, eggs, wheat, rye and beef Pollen, molds, animals

Clinical manifestations of eosinophilic esophagitis are? (6)

Heart burn Dysphagia Food impaction esophagus Nausea Vomiting Weight loss

Diagnostic studies of EOE? (2)

Endoscopy with biopsy Allergy testing

Treatment of EOE? (3)

Avoid allergies Ppi and corticosteroids ( monitor for candidiasis )

Who is esophageal diverticula?

Saclike outpouching of 1 or more layers

Symptoms of esophageal diverticula? (5)

Dysphagic Regurgitation Chronic cough Aspiration Weight loss

When food gets trapped in the pouches you could have?

Sour taste or smell

What are complications of esophageal diverticula ? (3)

Malnutrition Aspiration Perforation

Esophageal diverticula treatment? (3)

Dietary modifications Surgery Endoscopic procedures

What is esophageal strictures? Most often from?

Narrowing of esophagus GERD

Other factors that effect esophageal strictures are?

Chemical ingestions Radiation Surgery Trauma

Manifestations of esophageal structures are? (3)

Dysphagia Regurgitation Weight loss

Treatment of esophageal strictures ? (2)

Dilation with bougies or balloons using endoscopy or fluoroscopy Surgical excision

What is achalasia?

Absent peristalsis in lower 2/3 esophagus ( food is getting stuck, not loving along where, be careful with eating )

What is the pathophysiology of achalasia?

Increase LES pressure with incomplete relaxing may cause obstruction near diaphragm ( tapered ) ; fluid and foods accumulation Upper esophagus dilates

What is manifestations of achalsia? (7)

Dysphagia Globus sensation ( chest pain ) Night time regurgitation Halitosis ( foul breath ) Inability to erucatate Symptoms of GERD Weight loss

What is globus sensation?

Lump in throat but painless

What is diagnostic study of achalsia? (3)

Barium swallow Manometry Endoscopy

Treatment goals for achalsia are? (3)

Relieve Dysphagia & regurgitation Improve esophageal emptying by disrupting LES Precent development of mega esophagus

You could do surgiesis for achalsia which are (2)?

Endoscopic dilation Heller myotomy ( cuts LES muscle )