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Med Surg > Upper GI 1 > Flashcards

Upper GI 1 Flashcards

1
Q

What does intrinsisc factor due

A

aids b12 absorption

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2
Q

Do you auscultate the ab before or after palpation and why

A

before bec palp can cause bowel sounds

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3
Q

What are the fat soluble vitamins

A

DEAK

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4
Q

How many minutes before you can say no bowel sounds

A

5 minutes per quadrants

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5
Q

What is the normal percussion sounds for the ab

A

little dull like full bladders

more tympanic for lots of gas

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6
Q

What is rebound tenderness

A

pain after relieving pressure

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7
Q

What does rebound tenderness indicate

A

inflammation so itis’s

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8
Q

When should you not assess for rebound tenderness

A

if you know there is already a condition in the ab happening

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9
Q

Where do people usu complain of apendicitis

A

at mcburneys point

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10
Q

Where is mcburneys point

A

Halfway between the umbilicus and the right iliac crest

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11
Q

is nausea sub or objective

A

subjective

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12
Q

What is something people with NG tubes getting there stomach sucked at risk for

A

metabolic alkalosis

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13
Q

What are people getting doudenal suctioning at risk for and why

A

metabolic acidosis bec were taking out alkalotic secretions

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14
Q

What does a fecal odor and bile in the emesis indicate

A

lower obstruction

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15
Q

If the vomit looks dark red like coffee grounds it is likely from

A

the stomach or lower

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16
Q

If the vomit is bright red is likely came from

A

above the stomach

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17
Q

What does NG tube suctioning also help with

A

decompressio n

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18
Q

What are some nutritional considerations for N/V

A 
IV to replace F and E
NG 
Food with no temp etremes
fluids between meal not during 
High carb meals
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19
Q

Why is fluids given between meal s for N/V

A

less likely to get distention

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20
Q

Why is high carb diets better for N/V

A

its easier to digest

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21
Q

When replacing fluids for n/v what is a consideration

A

take it slow bec of decreased renal and heart failure

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22
Q

What could unintended weight loss indicate

A

cancer and depression

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23
Q

To diagnose GERD what do we need

A

symptomatic changes or condition from stomach content

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24
Q

What is hiatal hernia

A

part of the stomach bulges above the diaphragm

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25
Q

What is decreased gastric emptying

A

stuff in the stomach isnt leaving into teh duodenum fast enough

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26
Q

What is decreased esophageal clearance

A

when the LES isnt opening up enough

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27
Q

When is heartburn more common

A

at night

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28
Q

What are the clinical mani’s of GERD

A 
Heartburn- like burning or tightness below lower sternum
Wheezing
Coughing
Dyspnea
Hoarseness
Sore throat
Lump in throat
Choking
regurgitation
Early satiety 
post meal bloating 
n/v
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29
Q

What should you be considering when they have the symptoms early saiety ost meal bloating and n/v

A

delayed gastric emptying

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30
Q

What does barium do

A

absorbs Ecs-ray

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31
Q

What are some ways to diagnose GERD

A 
Barium swallow 
Endoscopy 
Biopsy and cytologic specimens
esophageal manometric studies 
radionuclide
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32
Q

What are eso manometric studeis looking at

A

how good our parastalsis is and the pressure within the eso

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33
Q

What does radionuclide tests assess

A

Measures transit time and percentage of emptying of esophagus (rate of esophageal clearance)

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34
Q

What does radionuclide tests assess

A

Measures transit time and percentage of emptying of esophagus (rate of esophageal clearance)

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35
Q

What are some life style modifications for GERD

A

Stop smoking
Elevate HOB ~30°
Do not lie down 2 – 3 hours after eating
Avoid eating within 3hrs of bed

36
Q

What are some nutritional therapy care for GERD

A

Avoid acid or acid producing foods
Smaller, more frequent meals . . . . . None near bedtime
Do not lie down after eating
If it bothers you, do not eat it. (maybe caffeine, tomato, fatty, fried, chocolate)

37
Q

What does GERD put you at higher risk for

A

aspirations pneumonia

38
Q

What are the risk factors for eso cancer

A 
Smoking
Excessive alcohol use
Diet low in fruits and vegetables 
vitamins and minerals	
Achalasia
delayed emptying of lower esophagus)
Exposure to asbestos and metal
History of GERD (big predictor)
History of swallowing lye
39
Q

Are the symptoms of esophageal cancer early or late

A

late

40
Q

What are some mani’s of eso cancer

A 
Progressive dysphagia
Odynophagia 
Pain
epigastric area, substernally, or in the back
may radiate to the neck and jaw
Sore throat, choking, and hoarseness
Weight loss is common
41
Q

What are the comlications of eso cancer

A 
Hemorrhage
with erosion thru esophagus to aorta
Esophageal perforation
fistula formation into lung or trachea 
Obstruction of esophagus
Metastasis- liver and lung are common sites of metastasis
42
Q

What are some post-op considerations for eso cancer surgery

A 
NG tube 
increased risk for aspiirations
cardiac dysrythmias 
fowlers or semifowlers
possible mediastinum pain, temp, dyspnea
43
Q

What are some nutrition considerations with eso cancer

A

parenteral fluids first
after bowel sounds, 30-60 ml of water given hourly
eventually move to small bland meals

44
Q

What is achalasia

A

decreased lower esophagus emptying

45
Q

What are some things we do to care for eso cancer

A

health promo like smoking, alc, oral hygeine and diet
high protein and calories diet
ecplainations of procedures like chest tubes, NG tubes, turn cough and deep breath

46
Q

What are the causes gastritis

A

Drugs
Aspirin, NSAIDs, and digitalis
Dietary indiscretions
Alcoholic drinking binge
H. pylori infection
Other bacterial, viral, and fungal infections
Mycobacterium, cytomegalovirus, and syphilis

47
Q

Are the acute and chronic symptoms of gastritis similar

A

yes

48
Q

What are the manifestations of gastrtis

A 
Anorexia
N/V
Epigastric tenderness
Feeling of fullness
Hemorrhage commonly associated with alcohol abuse
49
Q

How to diagnose gastritis

A

Endoscopic examination with biopsy

H. pylori presence tested in breath, urine, serum, or gastric tissue

50
Q

What is the care for

A 
Supportive care similar to N/V
NPO, Fluids, Bed rest, NG tube 
Drug therapy
Eliminate cause
Antibiotics and anti-secretory agent combinations
Correct anemia
Lifestyle changes
51
Q

If someone has gastritis or PUD and they start bleeding what condition might they get

A

anemia

52
Q

What is PUD

A

the erosion of the GI mucosa now showing the underlying tissue

53
Q

What a key difference between acute and chronic PUD

A

chronic might show erosion of the muscularis and formation of scar tissue

54
Q

What life style problem is usu found in chronic PUD pats

A

drinking

55
Q

Which people are at high risk for PUD

A

people needing ASA, NSAIDS, corticosteroids, anticoagulants and SSRI’s

56
Q

What people might need ASA NSAIDS or Anticoags

A

Heart pats

57
Q

What pats might need corticosteroids

A

COPD
Inflammatory bowel diseases
Arthritis possibly

58
Q

What are mani’s of gsatric ulcers

A 
mid epigastric pain 1-2 hrs after eating
Burning and gassy pain
Normal to decreased secretions
increase in cancer risk
H. pylori infection in 80%
↑ With incompetent pyloric sphincter and bile
reflux
59
Q

What are the mani’s of Duodenal ulcers

A 
4-5 hrs after eatng
burning, cramping, and back pain
increased gastric secretions 
no increased risk of cancer
H. pylori inf in 90%
associated with COPD, chronic renal dis, pancreatic dis
60
Q

Is it common to have no pain with PUD

A

yes

61
Q

What are the three major complications of PUD

A

Hemorrhage
Perforation
Obstruction

62
Q

What is the most common comp of PUD

A

hemorrahge

63
Q

What is the most lethal comp of PUD

A

perforation

64
Q

What might you see in a pat with a gastric obstruction related to PUD

A

hypertrophy of stomach wall bec of an increased need for contractile force
Scarring

65
Q

What might be some mani’s for PUD obstruction

A

const
vomit
upper ab swelling

66
Q

What might a short duration or absence of pain with PUD obstrucitons indicate

A

malignancy

67
Q

What is the care provided for PUD without comps

A 
Adequate rest
Dietary modification
Drug therapy- probably PPI’s 
Elimination of smoking
Long-term follow-up care
68
Q

How long might the healing process take for PUD

A

3-9 wks

69
Q

What is an essential recommendation for activity for PUD pats

A

moderate activity

70
Q

Is the drugs therapy for gastritis different or the same for PUD

A

same

71
Q

If the problem is coming from H pylori what might be the drug therapy

A

Triple drug therapy
– PPI, amoxicillin, clarithromycin
Quadruple drug therapy
–PPI, bismuth, tetracycline, and metronidazole

72
Q

What are some dietary modifications for PUD

A 
avoid hot spicy foods like peppers tea, coffee broth
avoid alc
avoid carbonated drinks 
avoid high roughage foods
protein is best
milk can help
73
Q

What is the general care provided for all three comps of PUD

A

NG tube in stomach with intermittent suction for about 24 to 48 hours
Fluids and electrolytes IV infusion until able to tolerate oral feedings without distress

74
Q

What is the care that is more specific for perforations with PUD

A

focus on stopping spillage first
place NG tube near perforation
replace blood volume with lactated ringer and albumin
insert central venous pressure line and indwelling urinaary catheter and mon hourly

75
Q

What is the care that is more specific to gastric outloet obst for PUD

A

NG with continuous suction
IV fluids and electrolytes for loss
PO clear liquids can be given after aspirate falls below 200mls

76
Q

What are some signs and symps of hemorrhage for PUD

A

Changes in vital signs like increased HR RR and hypotension
↑ in amount and redness of aspirate
↑ amount of blood in gastric contents ↓ pain because blood helps neutralize acidic gastric contents

77
Q

What are some signs and symps of Perforation or PUD

A

sudden and severe pain
board-like abdomne
shoulder pain
shallow resps

78
Q

What is something to double check as soon as perforation is suspected

A

all known allergies are recorded

79
Q

What are some surgeries for treating PUD

A

Gastroduodenostomy (Bilroth I)
Partial gastrectomy ( upper 2/3) with re-connection to duodenum
Gastrojejunostomy (Bilroth II)
Partial gastrectomy ( upper 2/3) with re-connection to jejunum
Vagotomy
“de-nerve” all or part of the stomach
Combo of the vagotomy with either the Bilroth I or II will remove the ulcer and the stimulus for additional secretions
Pyloroplasty
Repair (expand) the pyloric opening

80
Q

What is a patient at risk for after a sugery for PUD

A

dumping syndrome

postprandial hypoglycemia

81
Q

What are people withdumping syndrome at risk for

A

absorption probs like
b12 deficiency
weight loss
liquid stools

82
Q

How do we treat dumping syndrome

A

small freq meals
liquid between meal s
avoid bulky foods

83
Q

What is postprandial hypoglycemia

A

pancreas is still producing same amount of insulin but the amount of cal per meal decreases bec smaller more freq meals

84
Q

How is postprandial hypo treated

A

bolus of fluid high in carbohydrate into small intestine

Release of excessive amounts of insulin into circulation

85
Q

What are some lifespan sonsiderations for PUD

A

increased risk over 60

Med Surg (35 decks)

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