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MS 2 > UPPER G.I > Flashcards

UPPER G.I Flashcards

1
Q

is a painful disorder characterized by inflammation and ulcerations in the mouth, including the lips, tongue, and mucous membranes

A

Stomatitis

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2
Q

Causative agent of herpetic stomatitis

A

Herpes simplex virus (HSV) type 1

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3
Q

Diffuse, shiny erythematous involvement of the gingiva with edema and gingival bleeding

A

Herpetic Stomatitis

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4
Q

Also known as Canker Sore

A

Aphtous Stomatitis

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5
Q

Clinical Manifestation of Aphtous Stomatitis

A

-Small, white painful ulcers
- Well-circumscribed lesion

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6
Q

Medical Management of Stomatitis

A
  • Acyclovir (Zovirax), if cause is HSV

-Analgesics, as ordered

-Lidocaine hydrochloride (Xylocaine)- topical anesthetic

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7
Q

Nursing Management of Stomatitis

A

-Provide soft, bland foods during acute episodes

-Diet as tolerated (DAT) as the sores heal

-Encourage small, frequent feedings

-Encourage to drink room temperature liquids

-Let patient rinse mouth with NSS after eating

-Avoid alcohol- based mouthwash

-Use soft- bristled toothbrush

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8
Q

The opening of the diaphragm through (hiatus) which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax

A

Hiatal Hernia

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9
Q

Occurs when the upper stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax

A

Sliding Hiatal Hernia

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10
Q

It’s primary cause is muscle weakness in the esophageal hiatus

A

Hiatal Hernia

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11
Q

Occurs when all or part of the stomach pushes through the diaphragm beside the esophagus

A

Rolling Hiatal Hernia

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12
Q

What is the primary cause of Rolling Hiatal Hernia?

A

Anatomical defect

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13
Q

How many percent are asymptomatic in Hiatal hernia?

A

91% are asymptomatic (Smith & shahjehan, 2021)

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14
Q

Clinical Manifestations of Hiatal Hernia

A

-Pyrosis: heartburns
-Dysphagia (difficulty swallowing),
-odynophagia (painful swallowing) - due to compression of esophagus
-Dyspnea
-Abdominal pain
-Nausea and vomiting
-Gastric distention
-belching
-flatulence

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15
Q

The confirmatory test Hiatal hernia

A

Barium Swallow

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16
Q

Visualizes esophagus, stomach, duodenum, and jejunum

A

Barium Swallow

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17
Q

What is the inital position of Barium Swallow?

A

Taken on staning, and lying position

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18
Q

Nursing Care of Hiatal Hernia

A

-Pre Procedure
NPO 6-8 hours

-Post Procedure
Laxatives, as ordered
Increase OFI
Inform client that stool may become white for 24-72 hours

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19
Q

Medical Management of Hiatal Hernia

A

-H2- receptor antagonist
- Cimetidine (Tagamet)
-Ranitidine (Zantac)
-Famotidine (Pepcid)

-Proton pump inhibitors
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Losec)

-Antiemetics
- Metoclopramide (Plasil)
-Ondansetron (Zofran)
- Promethazine (Phenergan)

-Antacids
- Aluminum hydroxide
- Magnesium hydroxide

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20
Q

Surgical Management of Hiatal Hernia that known as “Gastric Wrap-Around”

A

Nissen Fundoplication

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21
Q

Reserved for extreme cases which involves gastric outlet obstruction or suspected strangulation

A

Nissen Fundoplication

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22
Q

The upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.

A

Nissen Fundoplication

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23
Q

Nursing Management of Hiatal Hernia

A

-High- protein diet - to enhance LES pressure

-Small frequent feedings- prevent gastric distention and prevents further protrusion of stomach into thoracic cavity

-Instruct client to eat slowly and chew food properly

-Avoid foods and beverages that decrease LES pressure such as fatty foods, cola beverages, coffee, tea, chocolate, alcohol
L
-Let the client assume upright position before and after eating for 1 to 2 hours

-Instruct client to avoid eating at least 3 hours before bedtime

-Advise client to reduce body weight, if obese.

-Elevate HOB 6 to 12 inches for sleep
-Avoid factors that increase abdominal pressure like use of constrictive clothing, straining at stool, heavy lifting, bending, stooping, vigorous coughing

-Avoid cigarette smoking as smoking causes rapid and significant drop in LES pressure

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24
Q

Is a disorder characterized by backflow of gastric or duodenal contents into the esophagus

A

GERD or Gastroesophageal Reflux Disease (GERD)

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25
Q

Foods and Medications that Weakens the LES

A

-Chocolate
-Alcohol
-Peppermint
-Caffeine
-Smoking
-Morphine/Meperidine
-Calcium- channel blockers

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26
Q

Typical Symptoms of GERD

A

H- Heartburn
R- Regurgitation
D- Dysphagia

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27
Q

retrosternal sensation of burning or discomfort that usually occurs after eating or when lying supine or bending over

A

Heartburn

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28
Q

effortless return of gastric and/or esophageal contents into the pharynx

A

Regurgitation

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29
Q

a sensation that food is stuck, particularly in the retrosternal area.

A

Dysphagia

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30
Q

Atypical Symptoms of GERD

A

C- Cough
H- Hoarseness in AM
O- Otitis Media
N- Non-cardic chest pain
A- Asthma

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31
Q

Complications of GERD

A

-Esophagitis
- Esophageal stricture
- Barret’s Esophagus

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32
Q

Lifestyle Modifications of GERD

A

-Weight loss and control
A-voiding alcohol, chocolate, citrus juice, and tomato-based products
-Avoiding large meals
-Waiting 3 hours after a meal before lying down
-Elevating the head of the bed by 8 inches

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33
Q

Drugs for GERD are:

A

-Antacids
- For mild symptoms only
- Taken after each meal and at HS

-H2 Receptor Antagonist
- First-line agent for GERD w/without esophagitis
-also used as maintenance therapy to prevent relapse
-taken on an empty stomach

  • Proton Pump Inhibitor
    -Must be used ONLY when GERD has been objectively documented
    - May aggravate cardiac conduction abnormalities
34
Q

Indication of Nissen Fundoplication

A

-Patients with symptoms uncontrolled by PPI
-Barrett esophagus
-Presence of atypical symptoms
-Young patients
-Patients with cardiac conduction problems
-Habitual non-adherence to treatment

35
Q

is the inflammation of the gastric mucosa

A

Gastritis

36
Q

Gastritis that caused by LOCAL irritants such as aspirin and NSAIDs, Alcohol, and Gastric radiation therapy

A

Acute Erosive Gastritis

37
Q

Gastritis that caused by Helicobacter pylori

A

Acute Non-Erosive Gastritis

38
Q

Releases toxins which are associated with stomach mucosal inflammation and host tissue damage (Malik et al., 2021)

A

Helicobacter Pylori

39
Q

Acute Gastritis Clinical manifestations

A

H- Hematemesis
E- Epigastric Pain (acute)
M- elena
A-Anorexia
N- Nausea and vomiting

40
Q

Medical management of Acute Gastritis

A
  • H2 blockers or PPI
  • Anti-emetics, if with n/v
  • If cause is H.pylori, antibiotic therapy with (Amoxicillin + Clarithromycin_
41
Q

Nursing Management of Acute Gastritis

A

-Maintain on NPO until acute symptoms subsides
-Maintain IV fluids, as ordered
-In severe cases, NG tube may be used to monitor for bleeding, to lavage precipitating agent from stomach, or to keep stomach empty and free of noxious stimuli
-Monitor VS and check vomitus for blood

42
Q

Results from repeated exposure to irritating agents or recurring episodes of acute gastritis

A

Chronic Gastritis

43
Q

More common in older adults

A

Chronic gastritis

44
Q

Causes of Chronic Gastritis

A

A- autoimmune
B- Bacterial
C- Chemical

45
Q

Caused by chronic gastric mucosal irritation

A

Chronic Gastritis

46
Q

Clinical Manifestations of Chronic Gastritis

A

B- Belching
E- Epigastric Pain
S- Sour Taste in mouth
P- Pernicious Anemia
L- Lack of Energy
I- Intolerance to spicy/fatty foods
S- Satiety Early

47
Q

Medical Management of Chronic Gastritis

A

-Treat underlying cause
-Discontinue irritating substance
-Antibiotic therapy for H. pylori
-Vitamin B12 therapy, if with pernicious anemia (Give via IM)

48
Q

Nursing Management of Chronic Gastritis

A

-Non- irritating diet (no spices, non fatty)
-Provide small frequent feedings
-Advice client about smoking cessation and reduction of alcohol consumption
-Stress management

49
Q

A condition characterized by erosion of the GI mucosa resulting from digestive action of hydrochloric acid (HCl) and pepsin

A

Peptic Ulcer Disease

50
Q

Commonly occurs in the stomach (gastric ulcer) and proximal duodenum (duodenal ulcer)

A

Peptic Ulcer Disease

51
Q

What are the risk factors of Peptic Ulcer Disease?

A

-H.Pylori Infection
- Medications (NSAIDs and Aspirin)
-Stress
-Foods (Fatty/Spicy/highly acidic)
- Zollinger-Ellison Syndrome
-Type A personality
-Blood Type O

52
Q

Diagnostic Test for Peptic Ulcer Disease

A

-Upper GI Endoscopy
-Urea Breath Test

53
Q

Gold standard investigation for confirmation of H. pylori

A

Upper G.I Endoscopy

54
Q

Detects the presence of H.Pylori and most accurate test among the non-invasive techniques

A

Urea Breath Test

55
Q

Urea Breath Test Patient Preparation

A
  • Avoid the following 14 days prior:

-Antibiotics
-Proton Pump Inhibitors
-H2 receptor Blockers
-Bismuth preparations
-Barium

-NPO for 4-6 hours prior to procedure

-Educate on need to swallow a capsule containing the urea preparation and that he/she will be required to breathe out into a bag or container

56
Q

Normal HCI secretion and increased back diffusion of HCI into gastric mucosa

A

Gastric Ulcer

57
Q

Increased HCI secretion

A

Duodenal Ulcer

58
Q

Pain radiates to the RIGHT side since the duodenum is located in the right side

A

Duodenal Ulcer

59
Q

What is the onset of pain of duodenal ulcer?

A

Onset of pain is 3 to 4 hours after eating

60
Q

Manifestation of Duodenal Ulcer

A

Melena

61
Q

Pain radiates to LEFT side since the stomach is located in the left side

A

Gastric Ulcer

62
Q

Onset of pain is ½ to 2 hours after meals

A

Gastric Ulcer

63
Q

Manifestation of Gastric Ulcer

A

-Nausea and Vomiting
-Hematemesis

64
Q

What is the main presentation of Peptic Ulcer Disease?

A

Dull, aching, gnawing epigastric pain

65
Q

Drugs/Medication for Peptic Ulcer Disease

A

Antacids
- Aluminum-Magnesium Hydroxide (Maalox)
- Milk of Magnesia- Magnesium Trisilicate (Gaviscon)
-Calcium carbonate (Tums)

H2 Blockers (Cimetidine)

Cytoprotective
Agents (Sucralfate (Carafate)

66
Q

Medical Management If H.Pylori is Infected

A

Triple Therapy
-PPI BID
-Clarithromycin 500 mg BID
-Amoxicillin 500 mg BID or

-Metronidazole (Flagyl) 500 mg BID
Taken for 10-14 days

Quadruple Therapy
-Bismuth subsalicylate 525mg QID
-Tetracycline 500 mg BID
-Metronidazole 250 mg QID
PPI OD

67
Q

Severing of the vagus nerve.
Decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin

A

Vagotomy

68
Q

Surgical dilatation of the pyloric sphincter to treat bleeding duodenal ulcers. Longitudinal incision is made into the pylorus and transversely sutured closed to enlarge the outlet and relax the muscle

A

Pyloroplasty

69
Q

surgical removal of the antrum portion of the stomach (50%)

A

Antrectomy

70
Q

removal of 65% to 75% of the stomach

A

Partial gastrectomy

71
Q

removal of at least 80% of the distal stomach

A

Subtotal gastrectomy

72
Q

removal of the entire stomach

A

Total gastrectomy

73
Q

removal of the lower portion of the stomach (which contains cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.

A

Billroth I (Gastroduodenostomy)

74
Q

removal of the lower portion of the stomach with anastomosis to the jejunum. A duodenal stump remains and is oversewn

A

Billroth II (Gastrojejunostomy)

75
Q

Nursing Management for Peptic Ulcer Disease

A

-DAT when asymptomatic
-Bland diet during exacerbation
-Advise client to eat slowly and chew food properly
-Small, frequent feeding during exacerbation
-Instruct to avoid the following:
Fatty foods, coffee, tea, chocolate, cola drinks, spices, alcohol
-Bedtime snacks
-Binge eating
-Large quantities of milk

76
Q

A group of unpleasant vasomotor and GI symptoms caused by rapid emptying of gastric contents into the jejunum.

A

Dumping Syndrome

77
Q

What is the common cause of Dumping Syndrome?

A

Billroth II Procedure

78
Q

Early Manifestation of Dumping Syndrome

A

occurs 5 to 30 mins pc

D-diarrhea
A- Abdominal Cramps
W- Weakness
N- Nausea
S- SNS stimulation

79
Q

Late Manifestations of Dumping Syndrome

A

(2 to 3 hours pc)

-Hyperglycemia (initially)
- Hypoglycemia

80
Q

Nursing Management of Dumping Syndrome

A

-Position patient to LEFT SIDE- LYING after meals
-Provide small, frequent feedings
-HIGH- PROTEIN DIET - Protein empties in the stomach slowly.
-Limit carbohydrates
-Instruct patient to drink water AFTER MEALS not within meals
-Octreotide- decrease GI symptoms
-Acarbose- for clients with late dumping
-Billroth II to Billroth I conversion

MS 2 (27 decks)

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