Upper GI Flashcards
What is nausea?
feeling of discomfort in epigastrium with a conscious desire to vomit
what is vomiting?
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 does vomiting affect SNS and PNS?
SNS - tachycardia, tachypnea, diaphoresis
PNS - relaxation of lower esophageal sphincter, increase in gastric motility, increase in saliva
what are clinical manifestations of nausea and vomiting?
nausea is a SUBJECTIVE symptom
anorexia, dehydration, watch YouTube to know key exam symptoms
what do you do if the patient has nausea and vomiting?
medications and NPO until ethology confirmed
What is GERD? gastroesophageal reflux disease
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
what are clinical manifestations of Gerd?
- heartburn (pyrosis) : burning tight sensation felt in lower sternum and spreads upward to the throat or jaw (RULE OUT CARDIAC CHEST PAIN)
- respiratory symptoms
what are 2 main complications of GERD?
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
what are some inter professional care for GERD?
main is lifestyle modifications
diet, quit smoking, lose weight
what is hiatal hernia?
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
what are symptoms of hiatal hernia?
asymptomatic or similar presentation to GERD
treated like GERD; 2 options
1) lifestyle modifications and meds
2) surgical therapy ; fundoplication
what is the barium swallow study?
swallow barium (contrast medium) to visualize esophageal, stomach and small intestine disorders with fluroscopy and radiographic images
what is gastritis?
inflammation of gastric mucosa
breakdown in normal gastric mucosal barrier that protects the stomach tissue from auto digestion by HCL and pepsin
what causes gastritis?
NSAIDS, some meds
Alcohol, spicy/irritating foods
H.pylori infection
Autoimmune
what are some clinical manifestations of gastritis?
- anorexia
- nausea vomiting
- feeling of fullness
what does chronic gastritis cause?
cobalamin (VITAMIN B12) deficiency from lack of absorption contributes to development of anemia and neurological complications
what are diagnostic studies for gastritis?
- history of drug and alcohol use
- endoscopic exam with biopsy
- CBC
- stool
- test for H.pylori
what are nursing managements for gastritis?
1) eliminating cause
2) supportive care ; bed rest, NPO, IV fluids if vomiting
3) Meds - to reduce irritation of gastric mucosa
discuss gastric cancer
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
discuss surgical therapy for gastric cancer
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)
what are the 4 types of blood loss in upper GI bleeding?
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
what are the 5 types of blood consistency?
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
what are emergency assessments and management?
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
why does Hgb and Hct not help in estimating degree of blood loss? for upper GI bleeding?
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
how do you check hydration for upper GI bleed?
urine specific gravity test
indwelling catheter to monitor UOP Q1H
what is diagnostic tool for upper GI bleed?
endoscopic procedures to identify source of bleeding through direct visualization
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
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
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
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
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
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
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
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
what are the diagnostic studies for peptic ulcers?
endoscopy
H.pylori tests - stool test gold standard
what are some inter professional care to keep in mind for peptic ulcer disease?
conservative therapy: diet, STOP smoking
surgical therapy
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
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
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
