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NUR 201 Week 9 > Upper GI Disorders/Ingestion > Flashcards

Upper GI Disorders/Ingestion Flashcards

1
Q
  • GERD
    > Esophagitis, Barrett’s esophagus
    > Risk for cancer w/chronic irritation
  • Hiatal hernia
    > Sliding & para esophageal
  • Gastritis
    > Acute & chronic
A
  • Peptic ulcer disease (PUD)
  • Gastric cancer
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2
Q

?

  • Is the most common GI disorder in the US
  • Occurs as a result of backward flow of stomach contents into esophagus from LES
  • Hiatal hernias inc risk
  • During healing, Barrett’s epithelium & esophageal stricture are concerns
A

GERD (Gastroesophageal Reflux Disease)

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3
Q

Symptoms: Recognize Cues

  • History
  • May be initially asymptomatic
    > Morning hoarseness
    > Coughing or wheezing at night
A

Physical Assessment/ s/s
> Dyspepsia, regurgitation, “lump” in throat
> Auscultate lungs for crackles

Psychosocial Assessment
> How are coping with stress? ETOH use?; tobacco smoking?; diet history

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4
Q

Diagnostics

> Ambulatory esophageal pH monitoring

A

! EGD: esophagogastroduodenoscopy [definitive]

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5
Q

EGD

  • Fiberoptic endoscope threaded through the mouth to duodenum for visual inspection (it will allow for bx or cauterization if needed)
  • Hold anticoag’s, asa, NSAIDs before procedure
A
  • NPO 6-8 hrs prior
  • Dentures removed
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6
Q

GERD - Health Promotion/Maintenance

  • Healthy eating habits; smaller meals
  • Limitation of fried, fatty, spicy foods
  • Avoid factors that affect Lower Esophageal Sphincter (LES)
A
  • Sit upright for 1 hr >eating
  • Eat @ least 3 hrs before going to bed
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7
Q

Factors that decrease LES pressure (! these should be avoided or lessened)

  • Caffeinated beverages
  • Coffee, tea, & cola
  • Chocolate
  • Nitrates
  • Citrus fruits
  • Tomatoes & tomato products
  • Alcohol
A
  • Peppermint, spearmint
  • Smoking & use of other tobacco products
  • Calcium channel blockers
  • Anticholinergic rx’s
  • High lvls of estrogen & progesterone
  • NG tube placement
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8
Q

Gerd - Rx’s

  • H2 receptor agonists
  • Proton pump inhibitors
  • Mucosal protective agents
  • Antacids
A
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9
Q

?

The opening in the diaphragm where the esophagus passes to the stomach becomes relaxed

A portion of the upper stomach tissue then passes through the diaphragm into the chest cavity

A

Hiatal hernia

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10
Q
  • Sliding HH’s = 90%
A
  • Paraesophageal hernias = 10%
    > When the stomach enters the thoracic cavity through the diaphragm beside the esophagus (! these are at greater risk for torsion)
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11
Q

Etiology - HH

  • R/t inc intraabdominal pressure
    > Obesity, pregnancy, heavy lifting
    > Intense physical exertion
    > Congenital weakness in the diaphragm at the hiatal opening or ascites
A

Complications - HH

  • GERD w/possible aspiration r/t an incompetent LES
  • Esophagitis (Barrett’s) w/chronic irritation from gastric contents - may cause a precancerous lesion or a stricture forming @ the site
  • Hemorrhage from erosion
  • Stenosis, ulcerations
  • Strangulation of the stomach
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12
Q

? Symptoms of ?

  • Postprandial fullness
  • Postprandial breathlessness/suffocation
  • CP similar to angina
  • Worsening of sx’s while recumbent
A

Paraesophageal (HH)

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13
Q

? Symptoms of ?

  • 50% asymptomatic
  • Pyrosis [heartburn]
  • Regurgitation
  • Dysphagia
  • CP
  • Belching
A

Sliding (HH)

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14
Q

A common diagnostic is a barium swallow w/xray or fluoroscopy

A

Management

  • Freq small feedings/low fat foods
  • Reduce wt, avoid tight clothing, straining & exercise postprandial
  • No reclining 2-3 hr postprandial
  • HOB elevated on 4-8 inch blocks w/sleep
  • Rx’s & possible surgery
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15
Q

Surgery Recommended when @ risk for or experiencing -

  • Volvulus (twisting of GI tract & mesenteric vascularity)
  • Bleeding, obstruction
  • Strangulation
  • Perforation
  • Airway obstruction, aspiration
A

> Surgery done open or laparoscopically

> Hiatus is tightened & stomach is placed back in the abdominal cavity (surgeon may enter abd cavity or thoracic; if latter, anticipate chest tubes)

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16
Q

Additionally, to prevent the stomach from entering the chest cavity or to prevent regurgitation of GERD, a __ __ is implemented

After, the hiatus is tightened and the tip of the stomach is wrapped around the esophagus

A

Nissen fundoplication

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17
Q

Postop Period

  • NGT; advance diet >peristalsis re-established
  • Expect temporary dysphagia
A
  • Encourage early ambulation & avoid carbonation; gas-producing foods; chew gum; use straws; & eat high fat foods
    > Gas bloat syndrome - simethicone
  • Pulmonary toilet w/splinting (C&DB, IS)
    > Risk for atelectasis & pneumonia
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18
Q

NGT

  • N/V sx’s of impaired GI peristalsis can be alleviated
  • LWS (low wall suction) empties or decompresses the stomach, minimizing N/V, retching
  • Auscultate BS w/suction disconnected
  • LWS is 0-80 mmHg (40-60 mmHg preferred)
A
  • Traumatic injury can happen during NGT placement & result in GI bleed
  • Prolonged use can cause ulcer formation
  • Once pt is passing gas & has positive BS, NGT is clamped (it’s disconnected from suctioning)
19
Q

Managing the Patient w/a NG Tube >Esophageal Surgery

> Check tube placement every 4-8 hrs
Ensure tube is patent & draining; drainage should turn from bloody to yellowish green by end of first postop day

> Secure tube well to prevent dislodgement
Don’t irrigate or reposition tube w/o hcp order

A

> Provide meticulous oral care & nasal hygiene q2-4 hrs

> Keep HOB elevated @ least 30°

> When pt can have a small amt of water, place them in a upright position & observe for dysphagia

> Observe for leakage from the anastomosis site (indicated by fever, fluid accumulation, & sx’s of early shock [tachycardia, tachypnea, AMS])

20
Q

?

Or inflammation of the lining of the mucosa of the stomach; may be acute or chronic

A

Gastritis

21
Q

Acute Gastritis - Etiology

  • Short-term inflammatory/erosive process of usually the mucosa, caused by bacterial or chemical irritants
A

Acute Gastritis - Sx’s

> Anorexia, N/V
Abd cramping or diarrhea
Dyspepsia, feeling of fullness
Acute epigastric pain; fever; GI bleed

22
Q

Acute Gastritis - Management

> Self-limiting when irritant removed
Symptomatic treatment

A

Irritants

  • asa, NSAIDs
  • Corticosteroids, stress
  • ETOH, tobacco, caffeine
  • Radiation exposure
  • Bacterial contamination of food or water
  • Ingestion of caustic substances
23
Q

Chronic Gastritis

  • 2 types: A & B
A

Chronic Gastritis - Sx’s

> Vague epigastric pain relieved by food
Anorexia, N/V, intolerance to spicy food, pernicious anemia
May be at higher risk for gastric cancer

24
Q

Type ?

Is most caused by H. pylori

A

Type B

25
Q

Type ?

Autoimmune, genetic, antibodies attack parietal cells

A

Type A

26
Q

Chronic Gastritis: Diagnostics

? Which exam is done ?

A

EGD

27
Q

Chronic Gastritis: Management

> Avoid rx’s that cause gastritis; avoid irritants
Admin B12 injections, antacids, H2 receptor agonists, proton pump inhibitors, mucosal barriers, prostaglandin analogs, antimicrobials as ordered

A
28
Q

Peptic Ulcers

  • Gastric - usually near pylorus
  • Proximal duodenum
  • Stress
A

Differential Features of Gastric & Duodenal Ulcers

29
Q

What are 2 of the most common causes of peptic ulcer disease (PUD)?

A

NSAIDs, H. pylori

30
Q

Etiology

! H. pylori, NSAIDs

  • Excessive secretion of HCl/pepsin
    > Stress/steroids
    > Milk/calcium
    > Caffeine, smoking
    > ETOH
    > Protein
A
  • Genetics
  • Stress ulcers
  • Zollinger-Ellison syndrome
31
Q

H. pylori in stomach mucosa > urease prevents organism from being killed by HCl

A
32
Q

Peptic Ulcer Sx’s

  • Asymptomatic
  • Dyspepsia syndrome: fullness, epigastric discomfort, vague nausea, distention, bloating
A
  • Anorexia, wt loss, & pain worsened by food (gastric); wt gain & pain lessened by food (duod)
  • Hematemesis/hemorrhage (gastric); melena/perf (duod)
33
Q

Diagnostics

  • Endoscopy w/bx
  • Radiology studies - cxr or barium studies
  • Breath test
  • H. pylori IgG antibodies in serum
A
  • Stool for OB
  • CBC to check anemia
  • ELISA
34
Q

Treatment

  • H2 receptor agonists
  • Proton pump inhibitors
  • Mucosal protective agents
  • Antacids
  • Antimicrobials
A

! Complications we’re trying to avoid include bleeding and/or perforation that empties stomach contents systemically

> EGD may be used to stop bleeding or other surgical procedures may be used to address perforation or intractable ulcers

35
Q

Surgery for Intractable Ulcers

  • Vagotomy w/ or w/o pyloroplasty
A
  • Billroth I (gastroduodenostomy)
  • Billroth II (gastrojejunostomy)
36
Q

Complications

  • Obstruction - pyloric outlet
  • Hemorrhage - hematemesis (coffee-ground emesis/bright red)
    > Melena, hematochezia
A
  • Perforation & peritonitis
37
Q

Nursing Interventions

  • Discourage caffeine, spicy foods, tobacco, & ETOH; avoid milk & cream products; ? referral
  • NPO for gastric rest; maintain hydration/electrolytes/caloric intake
A
  • Monitor coffee-ground/hematemesis/melena/CBC
  • Monitor pain level w/interventions/avoidance of irritants
  • Limit anxiety; teach dz process & importance of rx’s
38
Q

Gastric Cancer - Risk Factors

  • Familial clusters - 1st deg relative = 2-3x risk
  • Environmental - high nitrates in soil & H2O
  • Cultural - diets high in salt, smoked, pickled or dry = atrophic gastritis
A
  • GI surgery, pernicious anemia, achlorhydria, gastric polyps
  • Smoking
  • H. pylori - chronic gastritis
39
Q

Gastric Cancer Sx’s

  • Asymptomatic in 80% - early
  • Vague dyspeptic sx’s - nausea, dyspepsia, bloating, early satiety, anorexia
A
  • Pain & wt loss - late
  • Bowel obstruction - late
40
Q

Gastric Cancer Diagnostics

  • EGD w/bx
  • EUS
  • CT, MRI, PET
  • CBC (anemia ?)
  • (+) OB stool
  • CEA (carcinoembryonic antigen)
A

Management

  • Palliative vs curable
  • Radiation
  • Chemotherapy
  • Surgery
41
Q

Gastric Resections - Billroth I & II

I

  • Anastomosis of gastric segment to duodenum
A

II

  • Anastomosis of gastric segment to proximal jejunum
42
Q

Postop Care

  • Pain rx’s; anxiety
  • Pulmonary toilet w/splinting & DVT prevention
  • Fowler’s position - optimize drainage
  • NGT - well secured/decompressed
  • Drsg changes
  • IV fluids/electrolytes
  • Enteral or parenteral feeding
A

Complications

! Marginal ulcers / hemorrhage
! Duodenal bile reflux - Questran [lowers cholesterol]
! Vit B12 & folic acid deficiency

! Malabsorption of calcium & Vit D
! Dumping syndrome
! Fistula
! Pyloric obstruction
! Afferent loop syndrome

43
Q

?

A term that refers to a group of vasomotor sx’s that occur >eating in pts who have had a gastrectomy

Believed to happen as a result of rapid emptying of food contents into SI, which shifts fluid into the gut, causing abd distention

Sx’s can occur within 30 min of eating

A

Dumping sydrome

44
Q

Dumping syndrome - Management

  • Eat small, frequent meals
  • Low Fowler’s position
  • Eat a moderate fat, high protein diet
  • Limit carbs; no simple sugars
A
  • Minimal liquids w/meals
  • Avoid extremes in food temperature
  • Rest on left side postprandially for 20-30 min
  • Rx’s as ordered

NUR 201 Week 9 (4 decks)

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