Upper GI Flashcards by Katy Peterson

What is included in the post procedure care for a UGI/LGI series?

Laxative and fluids
Report constipation
Scheduling!!
SBFT (small bowel follow through)

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What is included in post procedure care after an esophagogastroduodenoscopy (EGD)?

Check gag reflex
Pt will probably have sore throat
Monitor for complications:
- Perforation
- Hemorrhage
- Infection

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What is an Endoscopic Retrograde CholangioPancreatography (ERCP)?

Visualizes the liver, gallbladder, bile ducts, and pancreas

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What does the post procedure care include after an ERCP?

Monitor vital signs
Check for gag reflex
Monitor for complications:
- Pancreatitis
- Perforation
- Hemorrhage
- Infection

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What is included in post procedure care after an endoscopy (colonoscopy or Procto/Sigmoidoscopy)?

Monitor vital signs
Monitor for pain, bleeding
Monitor for complications:
- Perforation
- Hemorrhage
- Infection

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Diet for after bariatric surgery

Post op:
Begin with small amts of liquids (30 mL ever 2 hours)
Diet is progressive, 6 small meals per day

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Possible complications after bariatric surgery

Pulmonary complications
Vomiting is common
Anemia: vitamin deficiencies
Anastomosis leaks (drainage)
Wound infections

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What is dumping syndrome?

Cluster of symptoms that can occur following eating food.
Food enters small intestine too rapidly, causing fluid shifts in the gut.
This causes abdominal distention
(Is often related to the amount of sugar in the food)

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Cause of early dumping (w.in 30 min of eating)

Stomach can’t control amount of chyme passing into small intestine
Large fluid bolus of hypertonic fluid enters intestine
Fluid is drawn into bowel lumen, causing decrease in plasma volume, bowel distention, and rapid intestinal transit
(Decreased plasma volume)

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S/S of early dumping

Generalized weakness, perspiration
Palpitations, tachycardia, hypotension, syncope, dizziness, flushing
Abdominal cramping/pain, borborygmi, urge to defecate
(Usually lasts less than 1 hour)

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What causes later dumping (2 hrs after eating)?

Too much insulin being released in response to an increase in blood sugar from carbs entering into the jejunum (secondary hypoglycemia)

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S/S of later dumping

Hypoglycemia
Perspiration
Hunger
Weakness
Confusion
Tremor
Tachycardia
Anxiety

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Pt teaching for management of dumping syndrome

Do not drink liquids with meals
Eat 5-6 small meals per day
High protein, low fat
Low to moderate carb intake
Lie down after meals to decrease peristalsis
Wait 1 hour after meals to drink fluids

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Risk factors for GERD

Fatty foods, caffeine, chocolate, nicotine
Drugs: beta blockers, CCB, morphine, Anticholinergics, nitrates, Valium (Benzos)
Obesity
Smoking
Hiatal hernia

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Pt teaching for nutritional therapy for GERD

Avoid foods that decrease LES pressure or irritate esophagus
Small, frequent meals
Avoid late evening meals
Drink fluids between meals
Chewing gum and oral lozenges is ok

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Diagnostic tests done for GERD

Ambulatory esophageal pH monitoring
Endoscopy

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Interventions for pts with GERD

Diet: restrict spicy/acid/fatty foods
4-6 low fat small meals
Avoid carbonated beverages
Avoid evening snacks / 2-3 hrs before sleep
Chew thoroughly, eat slowly

Elevate HOB on 4-6 inch blocks
Quit smoking, limit alcohol
Remain upright for 2-3 hrs after eating
Weight loss

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After someone has diagnostic studies for a hiatal hernia or GERD, what is the post treatment care?

Force fluids to flush the contract out
Let pt know stool will be dark and chalky

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What is Nissan fundoplication?

A surgery to correct GERD that tightens the junction between the esophagus and stomach
(Pt would have conservative tx first, and then would have the surgery if no relief)

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Med treatment for helicobacter pylori

PPI (proton pump inhibitors) and antibiotics (Flagyl, *tetracycline)

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Characteristics of gastric ulcers

High mortality
*High epigastric pain
*Occurs 30-60 min after eating
*Not relieved by food
*Hematemesis = bright red blood or coffee grounds
*Weight loss

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Complications from gastric ulcers

*Hemorrhage (more likely to happen than with duodenal ulcers)
Perforation
Peritonitis

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Characteristics of duodenal ulcers

High morbidity
*Mid-epigastric pain (lower than gastric ulcers)
*Occurs 2-4 hours after eating and at bedtime (when stomach is empty)
*Relieved by food
*Melena (dark, tarry stools)
*Weight stays stable
*low risk of malignancy

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Complications of duodenal ulcers

*Perforation (more likely than gastric ulcers)
Hemorrhage
Peritonitis

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Ages of people who typically get duodenal ulcers vs gastric ulcers

Duodenal = younger than gastric (any age, but 35-45 more common)

Diagnostic studies for H. Pylori

Endoscopy (*EGD) = direct visualization *Noninvasive H. Pylori: serology, stool, breath test Labs: CBC, liver enzymes, serum amylase

Symptoms of peritonitis

Sudden, severe upper abdominal pain - quickly spreads throughout abdomen Pain radiates to back *Rigid, board-like abdominal muscles N/V *No bowel sounds (as infection worsens) **This is an emergency - can be fatal if no intervention

What are the surgical interventions for PUD?

Bilroth I: cut off portion of diseased stomach and connect to duodenum Bilroth II: cut off portion of stomach and connect to jejunum

Post op management for PUD surgery

NPO NGT: to decompress stomach (suck fluid out) Return of GI function? (If pt can pass gas/stool) B-12 (parenteral) for life b/c cant absorb orally anymore

Nursing consideration for antacids

No antacids should be given within 1 hour of taking other meds b.c it will decrease their efficacy

Common side effects of Mg antacids

Diarrhea Renal failure Ng+ toxicity (No constipation)

Side effects of Al antacids

Constipation Low phosphorous

Side effects of CaCo3 antacids

Constipation

Side effects of NaHCO3 antacids

Fluid retention Alkalosis Constipation

Function of H2 antagonists

Decrease gastric acid secretionby blocking histamine receptor in parietal cells

Most common type of H2 antagonist

Famotidine (Pepcid)

Use of H2 antagonists

PUD GERD H. Pylori ulcers

Side effects of H2 antagonists

Confusion Dizziness (elderly) Diarrhea Monitor for bleeding

Patient teaching for H2 antagonists

Avoid smoking, aspirin, NSAIDs, and alcohol

What are PPI (proton pump inhibitors) used for?

PUD GERD

Function of PPIs

Antisecretory agents Cause irreversible inhibition of enzyme producing gastric acid Suppresses gastric acid production

Most common type of PPI

Pantoprazole (Protonix)

Side effects of PPI

HA Dizziness Diarrhea Decreased Ca+ absorption = bone fracture with long term tx Thrombophlebitis at IV site

Pt teaching for PPIs

Avoid smoking, alcohol, aspirin, and NSAIDs

What are prokinetis used for?

GERD Diabetic gastroparesis Post-op motility

Function of prokinetics

Promote gastric emptying Reduce risk of gastric acid reflux By increasing action of acetylcholine, causing increased GI motility and increases esophageal sphincter tone

Side effects of prokinetics

Extrapyramidal effects: - tardive dyskensia Sedation Diarrhea Hypoglycemia

Contraindications for prokinetics

GI obstruction/perforation

Most common type of prokinetic

Metoclopramide (Reglan)

Most common type of antiflatulant

Simethicone (Mylicon)

Function of Simethicone

Relieves excessive gas by changing surface tension of gas bubbles, allowing them to stick together and pass through belching or flatulence

Nursing considerations for Simethicone

Shake suspension Monitor bowel sounds Have pt walk and avoid gas producing foods

Most common prostaglandin/Cytoprotective

Misoprostol (cytotec)

Use of misoprostol (Cytotec)

Prevent PUD in Long term NSAID administration (Ex: rheumatoid arthritis) Accelerates ulcer healing Acts as a prostaglandin in GI tract to increase protective mucosal barrier of gastric lining

Side effects of misoprostol (cytotec)

Diarrhea

Nursing considerations for misoprostol (Cytotec)

Avoid mg containing antacids (b.c misoprostol already causes diarrhea) Take with meals and at sleep

What are anti ulcer/mucosal barrier fortifiers/cytoprotectives used for?

Duodenal ulcers

anti ulcer/mucosal barrier fortifiers/cytoprotective drug name

Sucralfate (Carafate)

Function of sucralfate (carafate)

Duodenal ulcers Forms viscous sticky gel that adheres to ulcer crater, creating a protein barrier lasting up to 6 hours Accelerates ulcer healing

Side effects of sucralfate

Constipation Decreases absorption of digoxin, warfarin, and phenytoin

Nursing considerations for sucralfate

Increase fluids and fiber Give 1 hr before or 2 hrs after meals Do not give within 30 min of other meds or antacids