upper GI Flashcards
N/V
Most common manifestations of GI disease
GI sends impulses to via
afferent pathways to the medulla, and this starts the vomiting process.
obstruction or constipation will cause
vomiting bc things can’t move down
things that cause vomiting (don vomiting)
menningitis, MI - esp. in women, diabetes, anesthesia
Metabolic alkalosis - from loss of what?
from loss of gastric HCl
Metabolic acidosis (not common)
from loss of bicarbonate if contents from small intestine are vomited - if very severe
drugs for vomiting
zofran (seratonin blocker), marinol (cannabis)
vomiting - nursing care
keep pt NPO
vomiting - Gerontologic Considerations
■ More likely to have cardiac or renal insufficiency
■ Increased risk for life-threatening fluid/electrolyte imbalances
■ Increased susceptibility to CNS side effects of antiemetic drugs (use lowest dose possible for least amount of time)
GERD - what gets damaged?
■ Chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus.
■ Most common UGI problem
GERD - Predisposing factors- Incompetent lower esophageal sphincter (LES) (most common) - foods (CAA) and what position?
▪ most common,
▪ gastric contents to move from stomach to the esophagus when Pt is
supine or increased abdominal pressure
▪ Decreased LES pressure can be due to certain foods or drugs (caffeine, alcohol, anticholingerics, etc)
other causes of GERD (gerd is heavy)
▪ Increased intraabdominal pressure (obesity) ▪ Hiatal hernia
clinical manifestations of GERD - heartburn - constant or not?
most common = heartburn (pyrosis). Burning, tight sensation felt beneath lower sternum and spreading upward to throat or jaw
■ Felt intermittently
GERD-related chest pain - more common among who?
▪ Described as burning, squeezing
▪ Radiating to back, neck, jaw, or arms
▪ Can mimic angina
▪ More common in older adults with GERD ▪ Relieved with antacids
Otolaryngologic symptoms of GERD - think throat
▪ Hoarseness
▪ Sore throat
▪ Lump in throat sm
Hypersalivation
▪ Choking
GERD-related chest pain - More common in
older adults with GERD
GERD - repeated exposure
Repeated exposure: scar formation, esophageal stricture, dysphagia
GERD complication (gerd gets complicated at the met)
Barrett’s esophagus (esophageal metaplasia = change from one cell type to another type)
esophageal metaplasia
▪ Replacement of flat epithelial cells with columnar epithelium
▪ Precancerous lesion
▪ Thought to be primarily due to GERD
▪ Diagnosed in 5% to 20% of patients with chronic reflux
▪ Must be monitored every 2–3 years by endoscopy
GERD diagnostics - Upper GI endoscopy (the end of gerd inflammation)
▪ Useful in assessing LES competence, degree of inflammation, scarring, strictures
▪ Obtain biopsy and cytologic specimens
Barium swallow - GERD diagnostics (barium is a protusion)
Can detect protrusion of gastric fundus
GERD - Esophageal manometric (motility) studies (man that’s pressure)
Measure pressure in esophagus and LES
GERD - Radionuclide tests (the radio can see the reflux)
▪ Detect reflux of gastric contents
▪ Evaluate rate of esophageal clearance
GERD diet
▪ Small, frequent meals
▪ Avoid late evening meals
▪ Drink fluids between meals
▪ Chewing gum and oral lozenges
foods that decrease LES pressure (everything you love)
chocolate, peppermint, tomatoes, coffee, tea,
meds for GERD
proton pump and histamine blockers (most popular), Acid protective, Cholinergic, Prokinetic drugs, Antacids
PPI - how to take?
start with one dose before meals
long term PPI associated with (pp on my bones)
bone density
GERD - goal of surgery
Goal of surgical therapy is to enhance the integrity of the LES
GERD surgery only for ppl with
▪ Failure of conservative therapy
▪ Medication intolerance
▪ Barrett’s metaplasia
▪ Esophageal stricture and stenosis ▪ Chronic esophagitis
LINX Reflux Management System - for GERD (link the magnets)
magnets to keep esoph closed. can’t have an MRI with this one
nursing management for GERD (HOB and when to lie down?)
■ Elevate head of bed 30 degrees
■ Do not lie down for 2–3 hours after eating
■ Avoid factors that cause reflux
– Stop smoking
– Avoid alcohol and caffeine
– Avoid acidic foods
■ Stress reduction techniques
■ Weight reduction, if appropriate
■ Small, frequent meals
■ Evaluate effectiveness of medications
■ Observe for side effects of medications