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PNP #2 > upper gi > Flashcards

upper gi Flashcards

1
Q

Appetite controlled by

A

hypothalamus
Stimulated by hypoglycemia, empty stomach, decreased body temperature, brain input

Deglutition: swallowing
Includes mouth, pharynx, and esophagus

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2
Q

Absorption

A

occurs in the small intestine (villi)

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3
Q

Digestion is completed in the

A

small intestine.

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4
Q

Carbohydrates

Digestion starts in

A

mouth

Followed by digestion in the small intestine

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5
Q

Proteins

Digestion starts in

A

stomach, continues in small intestine

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6
Q

Lipids

Emulsified by

A

bile prior to chemical breakdown
Action of enzymes form monoglycerides and free fatty acids
Formation of chylomicrons

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7
Q

Fat-soluble vitamins

A

Vitamins A, D, E, K

Absorbed with fats

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8
Q

Water-soluble vitamins

A

Vitamins B and C—diffuse into blood

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9
Q

Electrolytes

A

Absorbed by active transport or diffusion

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10
Q

Drugs are primarily absorbed in the

A

intestine.
Various transport mechanisms
Some (e.g., aspirin) absorbed in the stomach

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11
Q

Gastric Secretion Phases

A

Cephalic (nervous)
–Secretion of hydrogen chloride (HCL), pepsinogen, mucus

Gastric (hormonal and nervous)
–Secretion of gastric hormone from antrum to stimulate gastric secretions

Intestinal (hormonal)
–Acidic chyme (pH <2): release of secretin, gastric inhibitory polypeptide, cholecystokinin
Chyme (pH >3): release of duodenal gastrin

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12
Q

Parasympathetic nervous system (PNS)

A

Primarily through vagus nerve (cranial nerve
[CN] X)
Increased motility
Increased secretions

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13
Q

Sympathetic nervous system (SNS)

A

Stimulated by factors such as fear, anger
Inhibits gastrointestinal activity
Causes vasoconstriction
Reduced secretions and regeneration of epithelial cells

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14
Q

which cranial nerves

A

Facial (CN VII) and glossopharyngeal (CN IX) nerves

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15
Q

Stomach empties within

A

2 to 6 hours after meal.

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16
Q

Gastrin

A

Secreted by mucosal cells (stomach) in response to distention of stomach or partially digested substances

Increases gastric motility, relaxes pyloric and ileocecal sphincters—promotes stomach emptying

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17
Q

Histamine

A

Increased secretion of hydrochloric acid

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18
Q

Secretin

A

Decreases gastric secretions

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19
Q

Cholecystokinin

A

Inhibits gastric emptying; stimulates contraction of gallbladder

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20
Q

Elimination

A

mainly happens in the large intestine

Haustral churning

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21
Q

what does pepsin breakdown

A

proteins

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22
Q

stomach forms

A

chyme

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23
Q

where does vit k synthesis happen?

A

in large intestine

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24
Q

if you throw up too much

A

alkalosis .
this aint important
and i might be wrong

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25
Q

Vomiting center located in the medulla

A

Coordinates activities involved in vomiting

Protects airway during vomiting

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26
Q

Presence of blood—hematemesis

A
  • Coffee ground vomitus—brown granular material indicates action of HCl on hemoglobin
  • Hemorrhage—red blood may be in vomitus
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27
Q

Yellow- or green-stained vomitus

A

Bile from the duodenum

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28
Q

Deeper brown color

A

May indicate content from lower intestine

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29
Q

Recurrent vomiting of undigested food

A

Problem with gastric emptying or infection

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30
Q

Diarrhea

A

May be accompanied by cramping pain

Prolonged may lead to: dehydration, electrolyte imbalance, acidosis, malnutrition

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31
Q

Large-volume diarrhea (secretory or osmotic)

A

Watery stool resulting from increased secretions into intestine from the plasma
Often related to infection
Limited reabsorption because of reversal of normal carriers for sodium and/or glucose

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32
Q

Small-volume diarrhea

A

Often caused by inflammatory bowel disease
Stool may contain blood, mucus, pus
May be accompanied by abdominal cramps and tenesmus

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33
Q

Steatorrhea—“fatty diarrhea”

A

Frequent bulky, greasy, loose stools
Foul odor
Characteristic of malabsorption syndromes
Celiac disease, cystic fibrosis
Fat usually the first dietary component affected
Presence interferes with digestion of other nutrients.
Abdomen often distended

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34
Q

Frank blood

A

Red blood—usually from lesions in rectum or anal canal

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35
Q

Occult blood

A

Small hidden amounts, detectable with stool test
May be caused by small bleeding ulcers
(happens in the small intestine or higher)

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36
Q

Melena

A

Dark-colored, tarry stool
May result from significant bleeding in upper digestive tract
(GI bleed)

37
Q

types of gas

A
  • Eructation - belching
  • Borborygmus – rumbling or gurgling noise made by movement of fld/gass
  • Abdominal distention and pain
  • Flatus (post surgery people gots to do this)
38
Q

Chronic constipation may cause

A

hemorrhoids, anal fissures, or diverticulitis.

39
Q

normal BM can range from

A

3/day to q 3 days

40
Q

Causes of Constipation

A 
Weakness of smooth muscle - age or illness
Inadequate dietary fiber
Inadequate fluid intake
Failure to respond to defecation reflex
Immobility
Neurological disorders
Drugs (i.e., opiates)
Some antacids, iron medications
Obstructions caused by tumors or strictures
41
Q

normal fiber intake

A

(25- 30 mq day)

42
Q

Dehydration and hypovolemia are common complications

A

of digestive tract disorders.

43
Q

Metabolic alkalosis

A

Results from loss of hydrochloric acid with vomiting

44
Q

Metabolic acidosis

A

Severe vomiting causes a change to metabolic acidosis because of the loss of bicarbonate of duodenal secretions.
Diarrhea causes loss of bicarbonate.

45
Q

PQRST

A 
P = Provocation / Palliation
Q = Quality / Quantity
R = Region / Radiation
S = Severity Scale
T = Timing
46
Q

Referred Pain

A

Results when visceral and somatic nerves converge at one spinal cord level

Source of visceral pain is perceived as the same as that of the somatic nerve.

47
Q

REVIEW SLIDE 55

A

.

48
Q

Causes of limited malnutrition—specific problem

A

Vitamin B12 deficiency

Iron deficiency

49
Q

Radiological studies

A 
Upper gastrointestinal series (barium swallow)
Lower gastrointestinal series (barium enema)
Abdominal ultrasonography (May show unusual masses)
Computed tomography (CT) - (we get radiation from this_ so watch out) (its slices shit so you can find stuff like an acute bleed, stroke, i might be wrong about that )
Magnetic resonance imaging (MRI)
50
Q

Endoscopy (Biopsy may be done during procedures)

A

Endoscopic ultrasonography
Capsule endoscopy
Sigmoidoscopy and colonoscopy

51
Q

Liver function serum studies

A

Liver function, pancreatic function, cancer markers

52
Q

Laboratory analysis of stool specimens

A

Check for infection, parasites and ova, bleeding, tumors, malabsorption

53
Q

upper GI drugs

A

Antacids
To relieve pyrosis

Antiemetics
To relieve vomiting

Laxatives or enemas
Treatment of acute constipation

Antidiarrheals
Reduction of peristalsis
Relieve cramps

54
Q

Sulfasalazine

A

Anti-inflammatory and antibacterial

Used for acute episodes of inflammatory bowel disease

55
Q

Clarithromycin or azithromycin

A

Effective against Helicobacter pylori infection

Usually combined with a proton pump inhibitor

56
Q

Sucralfate

A

Coating agent

Enhance gastric mucosal barrier against irritants such as nonsteroidal anti-inflammatory drugs (NSAIDs)

57
Q

Anticholinergic drugs

A

Reduce PNS activity

Reduce secretions and motility

58
Q

Histamine 2 antagonists

A

Useful for gastric reflux

59
Q

Proton pump inhibitors

A

Reduce gastric secretion

60
Q

Neurological deficit of dysphagia

A

Infection
Stroke
Brain damage
Achalasia (Failure of the lower esophageal sphincter to relax because of lack of innervation)

61
Q

pancreatitis can sometimes show as

A

shoulder pain

62
Q

appendix

A

usually starts with the whole stomach and then narrows down to one place

63
Q

when you take x rays you gotta watch out for

A

preggos, watch out for thyroids. we got to cover the thyroid and protect reproductive.

64
Q

always turn them to their lefts

A

when doing anything like enemas

65
Q

Dysphagia

A

Causes:

-Neurological deficit (stroke, infection, Achalasia
Failure of the lower esophageal sphincter to relax because of lack of innervation)
-Muscular disorder
-Mechanical obstruction
(Congenital atresia (abnormal narrowing)- Developmental anomaly. Upper and lower esophageal segments are separated. AND Stenosis- Narrowing of the esophagus. AND Esophageal diverticula
Outpouchings of the esophageal wall )

66
Q

Hiatal Hernia

A

Protrusion of the stomach through the esophageal hiaus of the diaprhragm into the throx.

67
Q

Sliding hernia

A

More common type

Portions of the stomach and gastroesophageal junction slide up above the diaphragm

68
Q

Rolling or paraesophageal hernia

A

Part of the fundus of the stomach moves up through an enlarged or weak hiatus in the diaphragm and may become trapped.

69
Q

Hiatal Hernia: Assessment

A

Signs:
Pyrosis (Heartburn)
Frequent belching
Increased discomfort when laying down
Substernal pain that may radiate to shoulder and jaw
Feeling fullness after eating or a feeling of breathlessness or suffocation
Symptoms worse when lying down

70
Q

Gastroesophageal Reflux Disease (GERD)

A
  • Periodic reflux of gastric contents into distal esophagus causes erosion and inflammation.
  • Often seen in conjunction with hiatal hernia
  • Severity depends on competence of the lower esophageal sphincter.
  • Delayed gastric emptying may be a factor.
71
Q

GERD: Assessment

A

 Consumption of: fatty foods, caffeinated beverages, chocolate, nicotine, alcohol, peppermint
 Drug history: beta-blockers, calcium channel blockers, nitrates, anticolinergic drugs, estrogen & progesterone
 Inflammation, discomfort up to 2 h after each meal
 Regurgitation with a sensation of warm fluid traveling upward to the throat, leaving a bitter, sour taste in the mouth
 Dysphagia
 Flatulence and/or bloating after eating

72
Q

Collaborative care

GERD

A

 Lifestyle modifications
• Weight loss and smoking cessation
 Nutritional therapy
• Reducing fatty foods, caffeinated beverages, chocolate, nicotine, alcohol, peppermint, intake of spicy and acidic foods.
• Eat 5 – 6 small meals during the day (decreases pressure
 Drug therapy
• Antacids - neutralizes gastric acid
• Proton pump inhibitor (PPI) – most powerful!! Blocks final step in the H+ion secretion by the parietal cell
• Cispride and Metroclopramide – GI stimulants – improves gastric emptying
 Surgical therapy

73
Q

Teach patients to avoid factors that cause reflux:

A

Smoking cessation
Elevating HOB to 30 degrees (6” blocs under HOB)
Avoid lying down 2-3 hours after eating
Avoid late-night eating (3 h before sleep)
Avoid restrictive clothing, lifting heavy objects, straining, working bend over.

74
Q

Gastritis

A

Inflammatory process of the mucosal lining of the stomach.

75
Q

Acute:

gastritis

A

Alcohol or ingestion of aspirin or NSAIDs **
Infection by microorganisms
Ingestion of excessive amounts of tea, coffee, mustard, cloves, paprika or pepper
Ingestion of corrosive or toxic substances
Radiation or chemotherapy
Severe stress
Food poisoning (staph) and infections (candida, herpesvirus)

 Usually self-limiting.
 Complete regeneration of gastric mucosa
 Supportive treatment with prolonged vomiting
 May require treatment with antimicrobial drugs
 May resolve in 48h (rapid cell proliferation and restoration of gastric mucosa)

76
Q

Chronic:

gastritis

A

Type A – autoimmune
Type B – Helicobacter pylori

 Long-term F/U gastric CA
 Pernicious anemia (destruction of parietal cells in fundus and body leads to inadequate vitamin B12 absorption)
 H2 Receptor antagonist – bocks gastric secretion and maintains pH of gastric contents above 4.0 thus decreasing inflammation
 Antibiotics – treat H. pylori

77
Q

Gastritis: Manifestations

A

Discomfort with facial grimaces and restlessness
Anorexia, nausea, vomiting may develop
Hematemesis caused by bleeding
Epigastric pain, cramps or general discomfort
With infection, diarrhea may develop.

78
Q

Gastritis: Gastroenteritis

A

Inflammation of stomach and intestine

Microbes can be transmitted by fecally contaminated food, soil, and/or water

79
Q

Escherichia coli Infection

A

Although E. coli is usually harmless as a resident in the human intestine, infective strains can cause significant problems.

80
Q

Peptic Ulcer: Gastric & Duodenal Ulcers

A

Most caused by H. Pylori infection

Usually occur proximal duodenum

81
Q

Both the acute and the chronic ulcers may penetrate the entire wall of the stomach.

A

.

82
Q

Damage to mucosal barrier predisposes to development of ulcers and is associated with

A
  • Inadequate blood supply
  • Excessive glucocorticoid secretion or medication
  • Ulcerogenic substances break down mucous layer.(like asprin, nsaids, etoh)
  • Atrophy of gastric mucosa
  • Increased acid pepsin secretions
83
Q

Signs and symptoms and diagnostic tests:

peptic ulcer

A

Epigastric sharp, gnawing or burning localized pain,
Duodenal ulcer occurs 90m to 3h after eating, relieved with food or antacids
Gastric ulcer pain is precipitated by foo and not relieved by antacid

Diagnostic tests
Esophagogastroduodenoscopy
Barium x-ray

84
Q

Peptic Ulcer: Treatment

A

 Combination of
• antimicrobial – to eradicate H. Pylori
• proton pump inhibitor – optimizes ulcer healtin by binding to the proton pump of parietal cell and inhibiting secretion of H+ ions into gastric lumen
• H2 antagonist – reduces acid secretion to optimize ulcer healing

 Reduction of exacerbating factors

85
Q

Complications of peptic ulcer

A

 Hemorrhage
• Caused by erosion of blood vessels
• Common complication
• May be the first sign of a peptic ulcer

 Perforation
• Ulcer erodes completely through the wall.
• Chyme can enter the peritoneal cavity.
• Results in chemical peritonitis

 Obstruction
• May result later because of the formation of scar tissue.

86
Q

Age-Related Considerations: Peptic Ulcer Disease

A

Incidence in patients over 60 years of age is increasing.
(Related to increased use of NSAIDs)

In the older adult, pain may not be the first symptom associated with an ulcer.

87
Q

Stress Ulcers

A

 Associated with severe trauma or systemic problems

  • -Burns, head injury
  • -Hemorrhage or sepsis

 Rapid onset

  • -Multiple ulcers (usually gastric) may form within hours of precipitating event
  • -First indicator—hemorrhage and severe pain
88
Q

causes of dysphagia

A
  1. fibrosis
  2. compression( like a tumor)
  3. diverticulum (like a pouch that was formed and now blocks tube)
neurological defects
ACHALASIA 
OR STENOSIS (which is the narrowing of the tube)

PNP #2 (10 decks)

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