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Patho > Upper GI problems > Flashcards

Upper GI problems Flashcards

1
Q

causes of nausea

A

GI issues
CNS issues
CV issues
pregnancy
endocrine/metabolic stuff
med side effects
anesthesia
chemo
psych
motion

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2
Q

pathophysiology of pukine

A

chemoreceptor trigger zone in brainstem responds to stimuli from dugs, toxins, and motion and activates ANS

SNS = tachycardia, tachypnea, diaphoresis
PNS = relaxes LES, increases gastric motility, increases saliva

Stimuli from GI tract, kidney, heart, or brain send impulses to vomiting center in medulla

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3
Q

Goal when treating vomiting

A

-Identify and treat cause

Watch for
-anorexia/weight loss
-fluid and electrolyte imbalance
-acidosis/alkalosis
-hypovolemia
-circulatory issues

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4
Q

What do these types of vomit mean:
1. partially digested
2. fecal odor and bile
3. bile
4. bright red blood
5. coffee ground

A
  1. gastric outlet obstruction or delayed gastric emptying
  2. obstruction below pylorus –> EMERGENCY
  3. obstruction below ampulla of vater
  4. active bleeding (varices, ulcer, cancer)
  5. gastric bleeding (gastritis or gastric ulcer)
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5
Q

Nursing interventions for vomiting

A

NPO
IV fluids
NGT (aspiration)
Monitor I/O, VS –> dehydration
Psychosocial/environmental comfort

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6
Q

Oral cancer causes

A

unknown, but risks are:
-tobacco
-alc
-sun
-pipe stem or other irritation
-HPV (get the shot)
-STDs

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7
Q

Oral cancer symptoms

A

vague –> usually delayed treatment

sore throat, dysphagia, slurred speach, salivaion issues, toothache

leukoplakia and erythroplakea = precancerous lesions

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8
Q

oral cancer diagnosis

A

biopsy is main one
oral exfoliative cytology = scraping
toludine blue test is screening

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9
Q

oral cancer treatment

A

Surgery: BE CAREFUL —> HEAD BLEEDS A LOT!!
radiation
chemo
palliative –> 80% die w/in 5 yrs
nutritional
PEG tubes

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10
Q

GERD primary factor

A

incompetent LES allows acid to come up and inflame mucosa

food, drugs, obesity, smoking, and hiatal hernia or mucosal damage all affect LES pressure

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11
Q

Manifestations of GERD

A

Heartburn (pyrosis) (can spread to jaw)
Dyspepsia (abdominal pain)
Regurgitation
Resp issues (wheezing, coughing, throat irritation)

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12
Q

Complications of GERD

A

esophagitis
-ulceration leads to scar tissue, stricture, and dysphagia

Barrett’s esophagus
-metaplasia of cells; increase risk for cancer

Aspiration leading to asthma, bronchitis, or pneumonia

Dental erosion

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13
Q

Gerd nursing interventions

A

low fat, small meals w/o caffeine, alc, or tobacco
-upright 2-3 hrs after meals
-no tight clothes
-no food hrs b4 bed
-weight loss

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14
Q

Drugs for GERD

A

PPIs and H2
-PPIs are more effective, but H2 are cheaper
-risk of infection with PPIs bc of alkaline environment that they create

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15
Q

PPIs

A

-stop HCl secretion
-good for treating esophagitis
-take b4 1st meal
-if you take it too long, bad for bone density kidney, vet B12, magnesium, dementia

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16
Q

H2 receptor blocks

A

takes 1 hr to work –> lasts 12 hrs
-take with antacid

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17
Q

Antacids

A

neutralize acid
-take 1-3 hrs after meal and bedtime
-increases Na+, so careful if old, cirrhosis, htn, or kidney issues

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18
Q

Nissen Fundoplication

A

tie LES tighter

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19
Q

Hiatial hernia

A

hernia @ LES
-can be sliding (not too bad) or paraesophageal (serious)

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20
Q

Esophageal cancer tumors

A

appear as ulcers
often advanced
metastasis to liver and lungs

21
Q

manifestation of esophageal cancer

A

progressive dysphagia
swallowing pain
weight loss
regurgitation
hemorrhage, perforation, obstruction

22
Q

Eosiophilic Esophagitis

A

-Allergic reaction
-manifests as heartburn, dysphagia, food impaction, nausea, vomiting, weight loss
-treat with PPIs and corticosteroids

23
Q

Esophageal strictures

A

Usually from GERD
-dysphagia, regurgitation, weight loss
-treat by dilating with balloon –> careful of rupture

24
Q

Achalasia

A

lower 2/3 of esophagus wont peristalsis

manifests as dysphagia, globus sensation or chest pain; nighttime regurgitation, halitosis, can’t eructate, weight loss

treat with endoscopic dilation or Heller myotomy
-also botulinum, nitrates, and CCBs

25
Q

Gastric ulcer risk factors

A

H pylori
NSAIDs –> don’t take on empty stomach
bile reflux
corticosteroids and anticoagulants
stress
alc, caffeien, tobacco

26
Q

Duodenal ulcer risk factors

A

COPD, cirrhosis, pancreatitis, hyperparathyroidism

pretty much always H pylori –> take antibiotics

27
Q

H pylori

A

causes 80% gastric ulcers and 90% duodenal ulcers

from oral-oral or oral-fecal transmission

lives a long time

produces urease

28
Q

Diagnostic study for peptic ulcers

A

Endoscopy!

Also can do serology, stool, or breath test for H pylori

29
Q

how to treat peptic ulcers

A

PPI to reduce acid secretions
antibiotics to eliminate H pylori –> penecilin or metronidazole

Cytoprotective drugs given 1-2 hrs before or after antacids protect mucosa

30
Q

Complications of PUD

A

hemorrhage, perforation, gasatric outlet obstruction

Hemorrhage is most common, but perforation is most lethal - if untreated, bacterial peritonitis w/in 6-12 hrs

31
Q

Stomach cancer

A

-often metastasized when diagnosed
-a/w H pylori, autoimmune inflation, repeated irritant exposure
-spreads by direct extension –> liver and adjacent tissue

32
Q

manifestations of stomach cancer

A

Anemia!
GI stuff: weight loss, pain, indigestion, early satiety

Late: ascites

33
Q

Gastric surgery complications

A

Hemorrhage

Dumping syndrome - lasts 1 hr –> weakness, sweating, dizziness, cramping –> chyme bolus causes pushes fluid into bowel causing hypovolemia

Postprandial hypoglycemia = variant of dumping syndrome –> caused by carb bolus resulting in excess insulin

Bile reflux gastritis (after fixing or removing pylorus) –> bile damages gastric mucosa –> administer cholestyramine

34
Q

most serious complication post op gastric surgery

A

anastomosis leak
-tachycardia, dyspnea, fever, ab pain, anxiety, restlessness
-requires immediate treatment to prevent sepsis and death

35
Q

Why use NGT post op for gastric surgery?

A

For decompression –> reduces pressure to suture and decreases edema and inflammation

**aspirate for blood –> reporet if more than 75 cc/hr
**irrigate
**should change to dark yellow-green in 36 to 48 hrs

36
Q

nutrition post gastric bypass

A

wound healing vits: C,D,K,B
give meds for pernicious anemia
soft, bland, low fiber, high complex carbs, high prot
no fluid with meals –> chew a lot
no simple sugars, lactose, or fried food
-avoid extreme temps
-avoid hypoglycemia

37
Q

Gastritis

A

basically peptic ulcer but without to ulcer
-tissue edema, loss of plasma thru capilaries, possible hemorrhage

caused by same stuff as PUD - emphasis on corticosteroids

38
Q

More causes of gastritis

A

alc and spicy food
H pylori
radiation and smoking
autoimmune issues, hiatal hernia, physical stress, renal failure, sepsis , shock

39
Q

Manifestations of acute and chronic gastritis

A

acute:
anorexia, nausea/vomiting, epigastric tenderness, hemorrhage

chronic:
similar to acute or asymptomatic –> possibly pernicious anemia

40
Q

care for acute gastritis

A

fix the cause

rest, NPO, IV fluids, antiemetics, watch for dehydration

possibly NGT to watch bleeding and lavage

monitor for bleeding

Drugs: PPIs or H2 receptor

41
Q

chronic gastritis

A

fix cause
antibiotics for H pylori
cobalamin for pernicious anemia
small frequent meals
no smoking
take meds

42
Q

melena

A

black tarry stools from upper GI bleed

43
Q

Reasons for upper GI bleeds

A

PUD usually
Stress related mucosal disease
Chronic esophagitis, Mallory Weiss tear, or esophageal varices

44
Q

Upper bleed diagnostic studies

A

endoscopy
angiography

labs
-cbc –> hgb and hct
-bun –> GI tract bacteria breakdown prot
-PTT, liver enzymes, electolytes, ABGs

vomit and stool for gross or occult blood

45
Q

What constitutes a massive GI bleed

A

more than 1500 ml blood loss
25% intravascular volume

Assess for shock - monitor I/O

46
Q

What to watch for with massive GI bleed

A

shock
O2 status –> give no matter what
perforation and peritonitis –> tense, rid
hypovolemia

47
Q

Drug therapy for massive GI bleed

A

PPI - IV bolus then infusion
Antacids - after acute phase

48
Q

Acute care

A

NGT management
lavage
watch for withdrawal if alcoholic

Patho (44 decks)

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