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GI > Upper GI (PUD & GI Bleed) > Flashcards

Upper GI (PUD & GI Bleed) Flashcards

1
Q

What is PUD?

A

Erosion of the GI mucosa resulting from the digestive action of HCL and Pepsin

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2
Q

Common causes of PUD

A

Helicobacter pylori - Triggers inflammation
Drugs - NSAIDs
H. pylori + NSAIDs = DOUBLE TROUBLE

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3
Q

Other causes of PUD

A

Alcohol
Smoking
Family History
Stress (can aggravate an existing ulcer)

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4
Q

Ulcers associated with H. pylori (think location)

A

Gastric Ulcer - Most of the time in the antrum of the stomach

Duodenal Ulcer - 80% of Ulcers; 90-95% have H. pylori

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5
Q

What is the most accurate diagnostic procedure for PUD

A

EGD

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6
Q

Tests to confirm H. pylori

A 
Non-Invasive = Urea breath testing and stool testing
(Urea = by product of metabolism of H. pyori)

Invasive = Biopsy of antral mucosa and testing for urease (gold standard for diagnosis)

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7
Q

Other PUD diagnostic studies

A

CBC - anemia

Stool - for occult blood

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8
Q

Acute Ulcers

A

Short duration; resolves quickly

Does not penetrate as deeply

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9
Q

Chronic Ulcers

A

4 Times more common
Penetrate deeply
More severe
More long term

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10
Q

Complications of PUD

A

H.O.P.

Hemorrhage - Most common complication
Obstruction
Perforation - Most lethal complication

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11
Q

Assessment for Hemorrhage

A

Assess for change in vital signs
Change in amount &/or redness of gastric aspirate
With hemorrhage, pain may decrease at first

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12
Q

Hemorrhage Interventions

A

Similar to UGI bleed

NG to LWS

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13
Q

When does Obstruction happen

A

Can happen at any time

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14
Q

Obstruction is most likely to occur…..

A

If ulcer is located close to pylorus

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15
Q

T/F: Obstruction has a rapid onset of symptoms

A

False: Obstruction has a gradual onset of symptoms

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16
Q

Obstruction interventions

A

NG to LWS until resolved

Irrigate gut as needed per protocol

17
Q

Onset of Perforation

A

Sudden and dramatic

Initial phase (0-2 hours) = sudden, severe upper abdominal pain; spreads throughout abdomen; radiates to back; not relieved by food or antacids.

18
Q

Signs of Perforation

A

Pain:
Sudden, severe upper abdominal pain; spreads throughout abdomen; radiates to back; not relieved by food or antacids.

Abdomen = Rigid/ Board like

Respirations = Shallow and Rapid

Pulse = Weak and Tachycardic

Bowel sounds = May be absent

19
Q

How soon after Perforation can Bacterial Peritonitis occur

A

Within 6-12 hours

20
Q

Rebound Tenderness

A

An unexpected finding
Cue of Peritonitis

No pain when compressing on palpation. Pain occurs when you take the pressure off of the abdomen.

21
Q

PUD: Collaborative care

A

Adequate Rest = Decrease in stress response

Smoking cessation

Individual dietary modifications as needed (no specific diet)

22
Q

PUD: Drug therapy

A

Stop Aspirin and NSAIDs for 4-6 weeks.
If Aspirin must be continued, give with a PPI

Antibiotics if H. pylori
PPI
Cytoprotective (sucralfate)

23
Q

Refractory PUD: Surgical options

A

Billroth reconstruction following gastrectomy

Billroth 1 and Billroth 2
Both methods of reconstruction of gut path

24
Q

PUD: Post op Complications

A

Dumping syndrome

25
Q

What is Dumping Syndrome?

A

Food (undigested and hyperosmolar) dumps into the small intestine
Develops most often when part of the stomach has been removed
- Gastrectomy
- Fundoplication
- Roux-en-Y (Gastric bypass surgery)

26
Q

Dumping Syndrome: Why does it happen?

A

Bolus of hypertonic food dumps into small intestines. Manifestations are a result of fluid rapidly shifting out of the plasma and into the GI tract.

27
Q

Clinical Manifestations of Dumping Syndrome

A

Weakness, sweating, palpitations, dizziness

Abdominal cramping, borborygmi, urge to defecate - diarrhea

28
Q

When do symptoms of dumping syndrome occur

A

15 minutes after eating a hyperosmolar meal

29
Q

T/F: Treatment for Dumping syndrome is to avoid concentrated sweets.

A

True: avoid drinking them during meals. Drink them between meals.

30
Q

What is a consequence of Dumping Syndrome?

A

Postprandial Hypoglycemia (after meal hypoglycemia)

31
Q

Postprandial Hypoglycemia: How does it work?

A

Bolus of fluid high in CHO into small intestines - > Results in hyperglycemia - > Release in excessive amounts of insulin - > results in Hypoglycemia about 2 hours after eating

32
Q

How to manage Dumping Syndrome

A

No large meals
6 small meals per day
Fluids should not be taken with meal (30 mins before or 30 mins after)
Avoid concentrated sweets
Proteins and fats encouraged to promote rebuilding tissue Post - op
Rest period after eating
Symptoms are self limiting (months to year)

33
Q

Characteristics of Upper GI bleed

A

Slow (insidious) vs Sudden onset

Hematemesis

  • Bright red (frank) blood indicates recent/ongoing GI bleed
  • Coffee ground indicates significant bleed has stopped

Melena (black, tarry stool) - Transit time > 8 hours

Occult blood - Not apparent by appearance
- + for Guaiac

34
Q

Upper GI bleed causes

A

Esophageal Varices

Stomach and Duodenal Ulcers (~50% of UGI bleeds)

35
Q

Esophageal Varices occurs with…

A

Severe Portal Hypertension and cirrhosis

36
Q

What device is used for Esophageal Varices bleed?

A

Sengstakin-Blakemore tube

  • NG with a balloon that applies direct pressure to the Varices
  • Pt will ultimately end up in ICU
37
Q

Nursing Interventions for UGI bleed

A

Monitor Vital Signs closely (Baseline/trend/orthostatic)

Assess S/S of Hypovolemia (Rapid loss in blood volume = Hypovolemic Shock) (Change in VS, Increased thirst, Cold clammy skin, Restlessness)

Assess S/S of peritonitis (rigid board-like abdomen/Distention/guarding)

Monitor Labs H&H/BUN (BUN can increase with GI bleed)

38
Q

Related Nursing Interventions: UGI bleed

A

Establish large bore IV access - anticipate giving PRBCs
NG Lavage to rid stomach of blood
Administer appropriate meds
Prepare for endoscopy/endotherapy

39
Q

Patient Teaching: UGI bleed

A

Know/understand meds that are given

  • Antacids, PPI, H2 blockers, protective barriers, PCN’s
  • Avoid ASA/NSAIDs

Teach patient about S/S of GI bleed

GI (9 decks)

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