Week 10: GI Flashcards
What is nausea and vomiting?
common symptoms with various underlying causes.
How is management for nausea and vomiting?
determining the cause and providing symptomatic relief.
What should be checked for in the emesis (vomiting)
fecal odor (bowel obstruction)
greenish color (bile)
cherry red color (GI bleed).
What does the Pharmacological Approaches to Nausea and Vomiting do?
alleviating discomfort
Dimenhydrinate (Gravel)
Over-the-counter antiemetic.
Available in oral, IV, and suppository forms.
Haloperidol
Antipsychotic, used less frequently for nausea.
Diphenhydramine
Antihistamine with anti-nauseate properties.
Metoclopramide (Reglan)
Facilitates gastric emptying.
Chlorpromazine (Largactil)
Serotonin antagonist, also used for hiccups.
Scopolamine
Anticholinergic drug to dry up secretions
Ondansetron (Zofran)
Effective antiemetic, commonly used for chemotherapy-induced nausea and other types of nausea
What is GERD?
Gastroesophageal Reflux Disease
the reflux of acidic stomach contents into the esophagus, causing irritation and inflammation
What are common causes of GERD?
Lower esophageal sphincter (LES) incompetence.
Hiatal hernia
Decreased esophageal clearance.
Delayed gastric emptying.
What is Esophagitis inregards to GERD?
Inflammation and irritation of the esophagus due to gastric secretions.
What is Pepsin in regards to GERD?
Gastric enzyme that is very irritating to the stomach lining.
What are the diagnostic procedures of GERD?
History and physical exam.
Upper GI endoscopy/scope.
Barium swallow (to detect tumors or ulcerations).
Motility studies (less common).
For patients with GERD how should the bed be?
Use blocks (4 inches) to elevate the head.
How is the diet for a pt with GERD?
High protein, low-fat diet, avoiding foods that increase pressure or irritation (coffee, chocolate)
What medications are used for GERD?
Antacids: To coat the irritated area.
Anti-secretory agents: H2 blockers, proton pump inhibitors (PPIs) to decrease acid production.
Prokinetic drug therapy: Metoclopramide.
What should be included in health teaching for GERD?
Avoid spicy foods and caffeine.
Weight loss for overweight/obese patients.
Smoking cessation.
Avoid large meals and remain upright after meals/medications.
What are stress ulcers?
Stress ulcers are multiple small ulcerations that form due to physiological stress, leading to increased acid production and breakdown of the stomach lining
How do you prevent stress ulcers?
Gut protection (PPIs or H2 blockers) and DVT prophylaxis for hospitalized patients.
What medications are used to treat stress ulcers?
Proton pump inhibitors (e.g., pantoprazole) or H2 blockers (e.g., ranitidine).
What are risk factors for upper GI bleeding?
Older adults, women, NSAID use.
What are the clinical manifestations for upper GI bleeding?
Hematemesis: Bloody emesis (fresh red blood).
Coffee Ground Emesis: Dark, grainy, digested blood.
Melena: Black, tarry, foul-smelling stools due to digested blood.
Occult Bleeding: Small amounts of blood in gastric secretions, vomitus, or stool.
What is a key indicator for upper GI bleeding?
The iron smell
How can you test for upper GI bleeding?
Dipsticks can confirm the presence of blood in emesis.
What are the drug induced causes for GI bleeding?
Corticosteroids (e.g., prednisone): Can cause stomach lining breakdown.
NSAIDs (e.g., ibuprofen, indomethacin): Irritating to the stomach.
Antiplatelet/Anticoagulant Drugs (e.g., ASA, clopidogrel): Increase bleeding risk.
What are the esophageal causes of upper GI bleeding?
Esophageal Varices: Varicose veins in the esophagus due to portal hypertension.
Esophagitis: Inflammation of the esophagus.
Mallory-Weiss Tear: Tear in the esophagus due to forceful vomiting.
What are the Gastric/Duodenal Causes of upper GI bleeding?
Gastric Cancer: More prevalent in certain populations.
Hemorrhagic Gastritis: Erosion of the stomach lining.
Stress Ulcers: Ulcers due to physiological stress.
What are the 2 Systemic Diseases that can cause upper GI bleeding?
Blood Dyscrasias (e.g., leukemia): Platelet dysfunction.
Renal Failure and Liver Failure: Systemic conditions contributing to bleeding.
How can H.pylori cause upper GI bleeding?
Bacterium transmitted through contaminated food/water or person-to-person contact.
Treated with triple or quadruple antibiotics and a PPI.
What is included in the initial assessment of GI bleeding?
Assess ABCs (Airway, Breathing, Circulation).
Cardio, respiratory, and abdominal assessments
What’s included in the full physical assessment for upper GI bleeding?
Blood Pressure: Assess for postural drop (10-15 mmHg drop indicates hypovolemia).
Capillary Refill: Should be less than 3 seconds.
Pulse: Check for strength and regularity.
Vital Signs: Monitor every 15-30 minutes.
Respiratory Status: Assess carefully.
What is included in the abdominal assessment for upper GI bleeding?
Bowel Sounds: Hyperactive bowel sounds due to blood irritation.
Abdominal Curvature: Assess at eye level.
Tense, Rigid Abdomen: May indicate perforation and peritonitis.
What should you do for vascular access for GI bleeding?
Establish two large-bore IVs (e.g., 18 gauge or larger) in the antecubital fossa is essential for rapid fluid and blood administration
What should be included for initial monitoring/assessment for any GI bleeding?
Saline Infusion: Initiate saline infusion to maintain intravascular volume.
Cross and Type: Prepare the patient for a minimum of four units of blood.
Blood Tubing Flush: Prime blood tubing to ensure immediate availability for transfusion.
