Upper GI 1 Flashcards
What does intrinsisc factor due
aids b12 absorption
Do you auscultate the ab before or after palpation and why
before bec palp can cause bowel sounds
What are the fat soluble vitamins
DEAK
How many minutes before you can say no bowel sounds
5 minutes per quadrants
What is the normal percussion sounds for the ab
little dull like full bladders
more tympanic for lots of gas
What is rebound tenderness
pain after relieving pressure
What does rebound tenderness indicate
inflammation so itis’s
When should you not assess for rebound tenderness
if you know there is already a condition in the ab happening
Where do people usu complain of apendicitis
at mcburneys point
Where is mcburneys point
Halfway between the umbilicus and the right iliac crest
is nausea sub or objective
subjective
What is something people with NG tubes getting there stomach sucked at risk for
metabolic alkalosis
What are people getting doudenal suctioning at risk for and why
metabolic acidosis bec were taking out alkalotic secretions
What does a fecal odor and bile in the emesis indicate
lower obstruction
If the vomit looks dark red like coffee grounds it is likely from
the stomach or lower
If the vomit is bright red is likely came from
above the stomach
What does NG tube suctioning also help with
decompressio n
What are some nutritional considerations for N/V
IV to replace F and E NG Food with no temp etremes fluids between meal not during High carb meals
Why is fluids given between meal s for N/V
less likely to get distention
Why is high carb diets better for N/V
its easier to digest
When replacing fluids for n/v what is a consideration
take it slow bec of decreased renal and heart failure
What could unintended weight loss indicate
cancer and depression
To diagnose GERD what do we need
symptomatic changes or condition from stomach content
What is hiatal hernia
part of the stomach bulges above the diaphragm
What is decreased gastric emptying
stuff in the stomach isnt leaving into teh duodenum fast enough
What is decreased esophageal clearance
when the LES isnt opening up enough
When is heartburn more common
at night
What are the clinical mani’s of GERD
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
What should you be considering when they have the symptoms early saiety ost meal bloating and n/v
delayed gastric emptying
What does barium do
absorbs Ecs-ray
What are some ways to diagnose GERD
Barium swallow Endoscopy Biopsy and cytologic specimens esophageal manometric studies radionuclide
What are eso manometric studeis looking at
how good our parastalsis is and the pressure within the eso
What does radionuclide tests assess
Measures transit time and percentage of emptying of esophagus (rate of esophageal clearance)
What does radionuclide tests assess
Measures transit time and percentage of emptying of esophagus (rate of esophageal clearance)
What are some life style modifications for GERD
Stop smoking
Elevate HOB ~30°
Do not lie down 2 – 3 hours after eating
Avoid eating within 3hrs of bed
What are some nutritional therapy care for GERD
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)
What does GERD put you at higher risk for
aspirations pneumonia
What are the risk factors for eso cancer
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
Are the symptoms of esophageal cancer early or late
late
What are some mani’s of eso cancer
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
What are the comlications of eso cancer
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
What are some post-op considerations for eso cancer surgery
NG tube increased risk for aspiirations cardiac dysrythmias fowlers or semifowlers possible mediastinum pain, temp, dyspnea
What are some nutrition considerations with eso cancer
parenteral fluids first
after bowel sounds, 30-60 ml of water given hourly
eventually move to small bland meals
What is achalasia
decreased lower esophagus emptying
What are some things we do to care for eso cancer
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
What are the causes gastritis
Drugs
Aspirin, NSAIDs, and digitalis
Dietary indiscretions
Alcoholic drinking binge
H. pylori infection
Other bacterial, viral, and fungal infections
Mycobacterium, cytomegalovirus, and syphilis
Are the acute and chronic symptoms of gastritis similar
yes
What are the manifestations of gastrtis
Anorexia N/V Epigastric tenderness Feeling of fullness Hemorrhage commonly associated with alcohol abuse
How to diagnose gastritis
Endoscopic examination with biopsy
H. pylori presence tested in breath, urine, serum, or gastric tissue
What is the care for
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
If someone has gastritis or PUD and they start bleeding what condition might they get
anemia
What is PUD
the erosion of the GI mucosa now showing the underlying tissue
What a key difference between acute and chronic PUD
chronic might show erosion of the muscularis and formation of scar tissue
What life style problem is usu found in chronic PUD pats
drinking
Which people are at high risk for PUD
people needing ASA, NSAIDS, corticosteroids, anticoagulants and SSRI’s
What people might need ASA NSAIDS or Anticoags
Heart pats
What pats might need corticosteroids
COPD
Inflammatory bowel diseases
Arthritis possibly
What are mani’s of gsatric ulcers
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
What are the mani’s of Duodenal ulcers
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
Is it common to have no pain with PUD
yes
What are the three major complications of PUD
Hemorrhage
Perforation
Obstruction
What is the most common comp of PUD
hemorrahge
What is the most lethal comp of PUD
perforation
What might you see in a pat with a gastric obstruction related to PUD
hypertrophy of stomach wall bec of an increased need for contractile force
Scarring
What might be some mani’s for PUD obstruction
const
vomit
upper ab swelling
What might a short duration or absence of pain with PUD obstrucitons indicate
malignancy
What is the care provided for PUD without comps
Adequate rest Dietary modification Drug therapy- probably PPI’s Elimination of smoking Long-term follow-up care
How long might the healing process take for PUD
3-9 wks
What is an essential recommendation for activity for PUD pats
moderate activity
Is the drugs therapy for gastritis different or the same for PUD
same
If the problem is coming from H pylori what might be the drug therapy
Triple drug therapy
– PPI, amoxicillin, clarithromycin
Quadruple drug therapy
–PPI, bismuth, tetracycline, and metronidazole
What are some dietary modifications for PUD
avoid hot spicy foods like peppers tea, coffee broth avoid alc avoid carbonated drinks avoid high roughage foods protein is best milk can help
What is the general care provided for all three comps of PUD
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
What is the care that is more specific for perforations with PUD
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
What is the care that is more specific to gastric outloet obst for PUD
NG with continuous suction
IV fluids and electrolytes for loss
PO clear liquids can be given after aspirate falls below 200mls
What are some signs and symps of hemorrhage for PUD
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
What are some signs and symps of Perforation or PUD
sudden and severe pain
board-like abdomne
shoulder pain
shallow resps
What is something to double check as soon as perforation is suspected
all known allergies are recorded
What are some surgeries for treating PUD
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
What is a patient at risk for after a sugery for PUD
dumping syndrome
postprandial hypoglycemia
What are people withdumping syndrome at risk for
absorption probs like
b12 deficiency
weight loss
liquid stools
How do we treat dumping syndrome
small freq meals
liquid between meal s
avoid bulky foods
What is postprandial hypoglycemia
pancreas is still producing same amount of insulin but the amount of cal per meal decreases bec smaller more freq meals
How is postprandial hypo treated
bolus of fluid high in carbohydrate into small intestine
Release of excessive amounts of insulin into circulation
What are some lifespan sonsiderations for PUD
increased risk over 60
