Upper GI Flashcards

(39 cards)

1
Q

What is nausea?

A

feeling of discomfort in epigastrium with a conscious desire to vomit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is vomiting?

A

forceful ejection of partially digest food and secretions from the upper go tract

  • can occur when GI tract becomes overly irritated, excited or distended
  • Autonomic nervous system activated before vomiting occurs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how does vomiting affect SNS and PNS?

A

SNS - tachycardia, tachypnea, diaphoresis
PNS - relaxation of lower esophageal sphincter, increase in gastric motility, increase in saliva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are clinical manifestations of nausea and vomiting?

A

nausea is a SUBJECTIVE symptom

anorexia, dehydration, watch YouTube to know key exam symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what do you do if the patient has nausea and vomiting?

A

medications and NPO until ethology confirmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is GERD? gastroesophageal reflux disease

A

Reflux of gastric contents into the lower esophagus

  • causes esophageal irritation and inflammation

results when defines of lower esophagus are overwhelmed by the reflux of stomach acidic contents into esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are clinical manifestations of Gerd?

A
  • heartburn (pyrosis) : burning tight sensation felt in lower sternum and spreads upward to the throat or jaw (RULE OUT CARDIAC CHEST PAIN)
  • respiratory symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are 2 main complications of GERD?

A

1) Esophagitis - inflammation of esophagus, shows up as esophageal strictures from scar tissue formation

2) Barrett’s esophagus - esophageal metaplasia ( Precancerous lesion) ; cell changes from chronic reflux, POTENTIAL to develop into esophageal cancer

other complications include; dental erosion from acid reflux into mouth, respiratory complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are some inter professional care for GERD?

A

main is lifestyle modifications

diet, quit smoking, lose weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is hiatal hernia?

A

herniation of a portion of the stomach into the esophagus through an opening (hiatus) in the diaphragm (aka diaphragmatic hernia and esophageal hernia)

  • weakening of the muscles in the diaphragm around the esophagastric opening: intra abdominal pressure like obesity, preggo, tumours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are symptoms of hiatal hernia?

A

asymptomatic or similar presentation to GERD

treated like GERD; 2 options
1) lifestyle modifications and meds
2) surgical therapy ; fundoplication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the barium swallow study?

A

swallow barium (contrast medium) to visualize esophageal, stomach and small intestine disorders with fluroscopy and radiographic images

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is gastritis?

A

inflammation of gastric mucosa

breakdown in normal gastric mucosal barrier that protects the stomach tissue from auto digestion by HCL and pepsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what causes gastritis?

A

NSAIDS, some meds
Alcohol, spicy/irritating foods
H.pylori infection
Autoimmune

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some clinical manifestations of gastritis?

A
  • anorexia
  • nausea vomiting
  • feeling of fullness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what does chronic gastritis cause?

A

cobalamin (VITAMIN B12) deficiency from lack of absorption contributes to development of anemia and neurological complications

17
Q

what are diagnostic studies for gastritis?

A
  • history of drug and alcohol use
  • endoscopic exam with biopsy
  • CBC
  • stool
  • test for H.pylori
18
Q

what are nursing managements for gastritis?

A

1) eliminating cause
2) supportive care ; bed rest, NPO, IV fluids if vomiting
3) Meds - to reduce irritation of gastric mucosa

19
Q

discuss gastric cancer

A

adenocarcinoma of the stomach wall

caused by: H.pylori infection, Epstein Barr virus, type A blood

S&S:
Anemia - chronic blood loss
Peptic ulcer disease symptoms - pain, indigestion, weight loss

treatment:
surgical removal or radiation/chemo shows little results

20
Q

discuss surgical therapy for gastric cancer

A

removing the tumour by resecting as much of the stomach as necessary and a margin of normal tissue

Total gastrectomy with esophagojejunostomy (basically NO stomach.
- anastomosis of the lower end of the esophagus to the jejunum
- chest cavity exposed; chest tube placed
- NGT removed after a few days
- Vitamin deficiency (C, D, K, B-Complex absorbed in upper part of small intestines)

21
Q

what are the 4 types of blood loss in upper GI bleeding?

A

1) Esophagus - secondary to cirrhosis of liver
2) Esophagitis
3) Mallory-Weiss tear (from sever retching and vomiting)
4) Stomach or duodenum - peptic ulcer disease, acute gastritis, stress ulcers

22
Q

what are the 5 types of blood consistency?

A

1) bright red blood - blood has not been in contact with stomach acid secretions

2) “coffee grounds” vomitus - blood and contents have been in stomach and changed by contact with gastric secretions

3) Melena - black, tarry stools, slow bleeding from an upper GI source

4) Hematemesis - bloody vomitus appearing as fresh, bright red blood or having “coffee grounds” appearance (dark, grainy digested blood)

5) Occult bleeding - small amounts of blood in gastric secretions, vomitus or stools not apparent by appearance; detectable by guaiac test

23
Q

what are emergency assessments and management?

A

most upper GI bleeds stop spontaneously

  • vital signs Q15-30 minutes
  • monitor for S&S of shock
  • Labs
  • Fluid replacement 16 or 18 gauge PIV for fluid/blood replacement
24
Q

why does Hgb and Hct not help in estimating degree of blood loss? for upper GI bleeding?

A

Hgb and Hct may not help in estimating degree of blood loss but provide a
baseline for treatment – Hct may reflect blood loss 4-6 hours post fluid
replacement – do blood work q4-6h

25
how do you check hydration for upper GI bleed?
urine specific gravity test indwelling catheter to monitor UOP Q1H
26
what is diagnostic tool for upper GI bleed?
endoscopic procedures to identify source of bleeding through direct visualization
27
what are the 3 aims of meds for upper GI bleed?
1) Decrease bleeding - Epinephrine during endoscopy (causes tissue edema and pressure) - Sclerosant during endoscopy (causes inflammation and fibrosis) 2) Decrease HCl secretion - H2-receptor blockers (ranitidine) or PPI (pantoprazole) IV - Somatostatin analogue IV (octreotide) decreases splanchnic blood flow and acid secretion 3) Neutralize the HCl that is present - Antacids
28
discuss peptic ulcer disease
basically erosion of the GI mucosa that results from the digestive action of HCL and pepsin 2 types: 1) acute ulcers; superficial erosion and minimal inflammation 2) chronic ulcers; trod through muscular wall with formation of fibrous tissue
29
what are the key differences in gastric vs duodenal ulcers?
gastric is superficial, mostly in women and mostly located in antrum duodenal is penetrating, 1-2cm of the duodenum, mostly in men. watch YouTube video for key NCLEX highlights
30
what is stress-related mucosal disease?
acute ulcer that develops after a major physiological insult such as trauma or surgery - a form of erosive gastritis
31
what are clinical manifestations of peptic ulcer disease?
no pain is common or other symptoms NOTE: gastric and duodenal mucosal NOT risk in sensory fibres thats why you aint feeling it lol duodenal ulcer pain: burning, cramp like, mid-epigastric region gastric ulcer pain: burning, gaseous, high in epigastrium
32
what is the most common peptic ulcer complication?
hemorrhage because of the erosion of the granulation tissue at base of ulcer through a major blood vessel
33
what is the most lethal complication?
perforation where spillage of gastric contents into peritoneal cavity - looks like sudden, dramatic onset of upper abdominal pain that spreads throughout the belly
34
another misc complication?
gastric outlet obstruction - ulcers in antrum (basically a block at the base of the stomach). this causes the stomach to increase contractile force needed to empty the stomach and over time your stomach looses its tone
35
what are the diagnostic studies for peptic ulcers?
endoscopy H.pylori tests - stool test gold standard
36
what are some inter professional care to keep in mind for peptic ulcer disease?
conservative therapy: diet, STOP smoking surgical therapy
37
what are 4 surgeries you an get for peptic ulcer disease?
1) partial gastrectomy 2) gastrojejunostomy - partial gastrectomy with removal of 2/3 of stomach 3) vagotomy - severing of the vagus nerve, decreases gastric motility and gastric emptying 4) pyloroplasty - surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from stomach - mostly done after vagotomy - vagotomy + pyloroplasty = increase gastric emptying
38
discuss dumping syndrome
pt experiences vagal symptoms after meal (15-30min) which leads to weakness or dizziness - direct result of surgical removal of a large portion of stomach + pyloric sphincter watch YouTube video
39
what are 2 post op complications for peptic ulcer disease?
1) bile reflux gastritis : result in reflux alkaline gastritis - vomitting relives the distress temporarily 2) postprandial hypoglycemia : variant of dumping syndrome, symptoms same as hypoglycaemic reaction