week 5: concept of elimination Flashcards
what is peptic ulcer disease?
A condition characterized by erosion of the gastric or duodenal mucosa.
The mucosal barrier is broken and HCL enters the tissues causing injury to the tissues
why does PUD happen?
can be precipitated by drugs, stress and H pylori
whats the difference between gastric and duodenal ulcer?
gastric: Peak at age 50-70 years
* Pain can be aggravated by food
* May be malnourished
* N or decreased gastric secretion
* Pain 30-60 min after a meal
* Heals with tx -if it recurs it is in the same location
Duodenal
* Peak at age 20-50 years.
* Pain relief with antacid and food. * Usually well nourished.
* Increased Gastric secretions
* Pain 1 1⁄2-3 hrs after meal
* Often has remissions and
exacerbations
what kind of ulcer does this look like?
* Peak at age 20-50 years.
* Pain relief with antacid and food. * Usually well nourished.
* Increased Gastric secretions
* Pain 1 1⁄2-3 hrs after meal
* Often has remissions and
exacerbations
duodenal
what kind of ulcer does this resemble?
* Peak at age 50-70 years
* Pain can be aggravated by food
* May be malnourished
* N or decreased gastric secretion
* Pain 30-60 min after a meal
* Heals with tx -if it recurs it is in the same location
gastric
what is apart of recognize cues - assessment/diagnostic test
Pt Hx
* Review Rx nd OTC drugs, alcohol and tobacco use, diet, stress, other factors that cause GI upset, dyspepsia (gnawing pain)
Lab Assessments
* H pylori testing (blood, breath or stool)
* HGB and HCT low if bleeding ulcer
Esophagogastroduodenoscopy
* Gold Standard for dx
* Can visualize ulcers, take bx
* Test for H. pylori
Nuclear Medicine Scan
* Can test for bleeding
what are the four complications for PUD?
hemorrhage/ upper gi bleed, perforation, gastric outlet obstruction (* Narrowing of pylorus from scarring, edema inflammation of pyloric sphincter)
what are the recognize cues(ASSESSMENT) and take action for upper GI bleed?
upper gi bleed: * When an ulcer erodes causing a bleed that can lead to hemorrhage
Recognize Cues: Assessment
* Hematemesis/ coffee ground emesis
* Tarry black stool (bleed from higher up/longer duration) * Abdominal pain
* Can proceed to shock
Take Action: Stabilize Patient
* Treat like for hypovolemic shock
* Calm approach, frequent VS, O2,
* IV fluids +++ (monitor for fld overload)
* I&O, monitor urine output
* Monitor stools/emesis
* Monitor lab work
take action: stop the bleed! what are you doing?
Endoscopic therapy (primary treatment procedure)
* Epinephrine sclerosing needles (epinephrine or glue)
* Endoclips (clamp off bleed)
* Electrocoagulation probes ( heat coagulates bleed)
Surgery
* If bleeding continues despite endoscopic therapy
may have to repair by open surgery
Drug Therapy
* Octreotide (Sandostatin)
* Vasopressin
* Antacids- aluminum hydroxide (Amphogel) * PPIs-omeprazole (Losec)
* H2 Receptor Blockers- famotidine (Pepsid)
true or false: gastric outlet obstruction-narrowing of the pyloris from inflammation and scar tissue buildup overtime
Recognize Cues
* Pain that progresses and becomes
* Swelling of upper abdomen
* Projectile vomiting
* undigested particles from hours or days ago
Take Action
* Decompress with NG tube
* IV fluid and electrolyte replacement
* Surgery to open obstruction and remove scar tissue
true
put take action Pharma- what are you giving?
H2 receptor blockers:
* famotidine (Pepsid)
PPI:
* omeprazole (Losec),
* pantoprazole (Pantoloc)
Antibiotics for H Pylori
* Tetracycline,Amoxicillin
* metronidazole (Flagyl) Cytoprotective
* sulcrafate bismol subsalicylate (Pepto-Bismal)
Antacids
* Magnesium Hydroxide (Milk of Magnesia)
* calcium carbonate (Tums)
true or false: teaching for PUD-conservative therapy
* Dietary Modifications
* Avoid spicy foods, acidic foods, caffeine, alcohol
* Stop Smoking
* Avoid OTC Meds
* Take all meds as prescribed
* dont Report bloody emesis, tarry stools, increased epigastric pain
* Encourage patient to share concerns about following lifestyle changes
all true but REPORT always report
surgery is uncommon only if pharmacological management isn’t working- which are?
billroth I: gastroduodenostomy
* Billroth II: Gastrojejunostomy
* Vagotomy
* Pyloroplasty
what is billroth I and II?
Partial gastrectomy with removal of distal
2/3 stomach and anastomosis of gastric stump to duodenum. Antrum and pylorus removed.
billroth II: Partial gastrectomy with removal of distal 2/3
stomach and anastomosis of gastric stump to Jejunum. Antrum and pylorus removed.
severe of vagus nerve - eliminates the stimulus to secrete HCL is vagotomy
true
what is pyloroplasty ?
Surgical enlargement of the pyloric sphincter
what is apart of take action post op care for surgery PUD - just read
- Will have NG to decompress stomach
- Monitor bowel sounds
- Monitor N/G content (color and amounts)
- Ensure patency of NG tube
- Remove NG tube when peristalsis returns
- IV fluids with K+ and vitamin replacement
- Introduce foods when ordered
- Care of abdominal incision
- Encourage DB&C with splinting
- Encourage ambulation to increase peristalsis
why is pernicious anemia long term comp?
remove so much of tissue removed - intrinsic factor is produced, need intrinsic factor ro syn vit b12 and we need this for the syn of hgb
what is dumping syndrome?
- Happens after removal of large portion of stomach and pyloric sphincter
- Result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine.
Take Action: Prevent dumping syndrome - Small dry feedings daily
- Avoid fluids with meals
- Low carbs mod protein &fat * Restrict sugar
what is the post op complications for bilroth 1 and 2?
Postprandial hypoglycemia
* Variant of dumping syndrome
* Hyperglycemia releases insulin resulting in secondary hypoglycemia
and bile reflux gastritis:
When the surgery involves the pylorus
* Results in back up of bile into stomach
how to treat postprandial hypoglycemia?
Take Action: Treat and prevent
* Immediate ingestion of sugar when hypoglycemic
* Prevent rebound hypoglycemia by limiting the amount of sugar consumed with each meal and by eating small frequent meals
how to treat bile reflux gastritis?
Take Action: Treat and Prevent
* Cholestyramine either before or with meals.
* Can administer antacid
what is gastric cancer?
Adenocarcinoma of the stomach wall (tumor can start small and grow big)
- No specific causative agent
- May be genetic component
- May be caused by long term exposure to irritants (spicy/ salty food, NSAID use, alcohol,H. pylori)
what is this describing?
gastric cancer
what are the recognize cues for gastric cancer?
- Anemia
- Vague epigastric fullness
- feelings of early satiety after meal
- weight loss, dysphagia, dyspepsia
the tumour can take up space
what are the diagnostics for gastric cancer?
Esophagastroduduodenoscopy with bx
* During an endoscopic ultrasound can be performed to evaluate
depth of tumor and presence of lymph nodes
* Other tests are CT, PET and MRI to look for metastasis
true or false for gastric ca:
* Staging is determined based on diagnostic tests.
* Type of surgery and chemo/ radiation in combination with surgery depends on extent of CA
* If in early stages laparoscopic surgery may be all that is needed however in late stages a total gastrectomy may be required.
true
what are the two take action for gastric cancer?
Total Gastrectomy with Esophagojejunostomy (removal of stomach with resection of esophagus to jejunum) and Partial Gastrectomy: Billroth I or II procedure
Total Gastrectomy with Esophagojejunostomy (removal of stomach with resection of esophagus to jejunum)
* will have N/G (drainage minimal)
* will have chest tubes because enter through chest wall. * Clear fluids initiated after several days to solid foods
* At risk for poor nutritional status, wt loss, vitamin
deficiency, pernicious anemia, dumping syndrome, postprandial hypoglycemia
* Radiation/ chemotherapy to adjunct or if surgery is not an option
truuu
