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NURS 2514 > Week 5 - Disorders of the Stomach and Upper Small Intestine > Flashcards

Week 5 - Disorders of the Stomach and Upper Small Intestine Flashcards

1
Q

list 3 different disorders of the stomach and upper small intestine (3)

A
  • gastritis (acute and chronic)
  • upper GI bleeding
  • peptic ulcer disease
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2
Q

what is peptic ulcer disease

A
  • ulcerative lesions in the stomach or duodenom caused by exposure of the mucosa to acid-pepsin secretions and hydrochloric acid
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3
Q

what are the 3 parts of the small intestine

A
  • duodenum (first part)
  • jejunum
  • ileum
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4
Q

what is pepsin? what is it’s inactive form

A
  • protein digesting enzyme

- active form of pepsinogen

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5
Q

what is the GI mucosa

A
  • the innermost layer of the GI tract
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6
Q

how is the GI mucosa normally protected from acid-pepsin secretion

A

protected by:

- mucus made by the mucosa which contains HCO3- and mucin

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7
Q

how does HCO3- protect from acid-pepsin secretion

A
  • neutralizes the acid
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8
Q

what is mucin? how does it protect the mucosa from acid-pepsin

A
  • a protective glycoprotein

- has a coating action

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9
Q

acid-peptic disease develops when…. (3)

A
  1. there is excessive acid secretion
  2. diminished mucosal defence
  3. or combo of both
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10
Q

what are the 2 most common locations of peptic ulcer

A
  • stomach = gastric ulcer

- duodenom

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11
Q

what are the 2 most common causes of peptic ulcer?

A
  1. helicobacter pylori infection

2. NSAID use

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12
Q

how does helicobacter pylori lead to peptic ulcer?

A
  • produces proteases & toxins that damage mucosal cells, and inhibit mucus production
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13
Q

how does NSAID use lead to peptic ulcer?

A
  • inhibit prostaglandin, which is a prime signal that tells the cells to make mucus
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14
Q

what is the 4 layers of the stomach wall

A
  • mucosa (inner)
  • submucosa
  • muscularis
  • serosa
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15
Q

for erosion, acute ulcer, and chronic ulcer, which layer of the stomach does each go into?

A
  • erosion = mucosa
  • acute = mucosa & submucosa
  • chonic = mucosa, submucosa, and muscularis (may go into serosa) = scarring
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16
Q

what % of people w peptic ulcers are infected w H. pylori and have chronic gastritis?

A
  • 90-100%
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17
Q

do all people infected w H.pylori develop ulcers?

A
  • no
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18
Q

up to what % of people w peptic ulcers are chronic NSAID users?

A
  • up to 20%
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19
Q

what % of NSAID ulcers are asymptomatic?

A
  • 30-50%
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20
Q

what are contributing factors to the developing of ulcers? are these causative? (4)

A
  • diet
  • smoking
  • alcohol
  • stress

not causative

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21
Q

what kind of diet contributes to ulcers? (3)

A
  • spicy
  • salty
  • animal products
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22
Q

what is a rare cause of ulcers

A
  • zollinger-ellison syndrom
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23
Q

what is zollinger-ellison syndrome?

A
  • where a gastrin-secreting tumor (gastrinoma) triggers excess acid production
  • can be benign or malignant
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24
Q

what are the 4 manifestations/complications of peptic ulcer disease

A
  • pain
  • hemorrhage (bleeding)
  • obstruction
  • perforation
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25
Q

what kind of pain is present during peptic ulcers?

A
  • burning, gnawing, or cramp-like epigastric pain = dyspepsia
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26
Q

how does dyspepsia vary between a duodenal and a stomach ulcer

A
  • duodenal = relieved by food or antiacids

- stomach = worsened after eating

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27
Q

how can hemorrhage manifest as?? (3)

A
  • hematemesis
  • melena
  • occult blood
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28
Q

what is hematemesis? when does this occur?

A
  • bloody vomit appearing as fresh, bright red blood, or “coffee grounds” appearance
  • when bleeding very quickly = does not have chance to digest
29
Q

what is melena? when does occur?

A
  • black, tarry, foul smelling stools

- occur when bleeding occurs slowly, allowing the blood to be partially digested

30
Q

what causes the black appearance in melena

A
  • the presence of iron
31
Q

what is occult bleeding? when does this occur?

A
  • small amounts of blood in gastric secretions, vomit, or stools not apparent by appearance
  • “hidden blood”
  • occurs when bleeding is very very slow, allowing the blood to be digested
32
Q

how is occult bleeding detected?

A
  • by stool guaiac test (fecal occult blood test)
33
Q

what occurs if hemorrhage is severe during peptic ulcer? (2)

A
  • anemia

- hypovolemia

34
Q

what causes obstruction during ulcer disease (3)

A
  • edema
  • scar tissue
  • spasm
35
Q

what does obstruction during peptic ulcer disease cause? what can this lead to?

A
  • prevent passage of chyme from the through the pylorus into the small intestine
  • severe = may be vomiting of undigested food
  • mild = reflux
36
Q

what causes perforation w peptic ulcer disease? what does this result in?

A
  • when an ulcer erodes thru the GI wall

= gastric juice & air enters the peritoneum

37
Q

what does perforation in peptic ulcer disease cause?

A

= peritonitis & potential pancreatitis

38
Q

what are the 2 types of therapy/treatment for peptic ulcer disease

A
  • drug therapy

- surgical theraoy

39
Q

what are some postop complications after surgical therapy for peptic ulcer disease (3)

A
  • dumping syndrome
  • postprandial hypoglycemia
  • bile reflux gastritis
40
Q

what is dumping syndrome

A
  • when you “dump what you eat”

- episodes of vomitting or diarrhea after eating

41
Q

what nutritional therapy may occur after surgery (2)? why do we need this?

A
  • B12 supplements –> need the protein intrinsic factor produced by the stomach to absorb B12
  • iron supplements –> iron is not dissolved well without an acidic enviro
42
Q

what nutritional therapy may occur after surgery? why do we need this?

A
  • B12 supplements –> need the protein intrinsic factor produced by the stomach to absorb B12
  • iron supplements –> iron is not dissolved well without an acidic enviro
43
Q

what is gastritis

A
  • inflammation of the stomach lining (mucosa)
44
Q

what is gastritis a significant cause of?

A
  • GI bleeding (espiecally in hospitalized patients)
45
Q

what is gastritis a significant cause of?

A
  • GI bleeding (espiecally in hospitalized patients)
46
Q

what does gastritis increase the risk of

A
  • peptic ulcers
  • stomach cancer

(if it occur chronically)

47
Q

list the causes of gastritis (7)

A
  • alcoholism
  • NSAIDs
  • portal hypertension-induced gastropathy
  • H. pylori
  • crohn’s disease
  • pernicuous anemia
  • stress
48
Q

who does stress related gastritis commonly occur in? what does this cause?

A
  • critically ill hospitalized patients

- cause significant GI bleeding in 5-10% of these patients

49
Q

list major risk factors for stress related gastritis (7)

A
  • trauma
  • burns
  • hypotension
  • sepsis
  • coagulopathy
  • hepatic or renal failure
  • need for mechanical ventilation
50
Q

what are the manifestations of gastritis (6)

A
  • often asymptomatic
  • dyspepsia
  • nausea
  • vomiting
  • hematemesis
  • GI bleeding
51
Q

what does hematemesis and GI bleeding during gastririts cause (2)

A
  • iron-deficiency anemia

- hypovolemia

52
Q

upper GI bleeding represents a significant clinical & societal burden because…

A

associated:

  • morbidity
  • mortality
  • financial implications
53
Q

list the causes of upper GI bleeding (3)

A
  • esophageal origin
  • stomach origin
  • duodenal origin
54
Q

how prevalent is stomach cancer?

A
  • 10th leading cause of cancer death in Canada

- one of the most common cancers world-wide

55
Q

who does stomach cancer often effect?

A
  • people between the ages 50-70

- twice as common in men than women

56
Q

list 5 risk factors for the development of stomach cancer

A
  • chronic gastritis
  • H. pylori infection
  • gastric polyps
  • pernicious anemia
  • carcinogenic factors in the diet
57
Q

list examples of carcinogenic factors in the diet (5)

A
  • nitrates
  • smoked food
  • high salt
  • spicy foods
  • alcohol
58
Q

what is a carcinoma

A
  • cancer that begins in the epithelial cells
59
Q

describe the manifestations of stomach cancer (7)

A
  • usually asymptomatic until later in its course & it becomes metastatic
  • anemia
  • occult blood
  • NV
  • hematemesis
  • pyloric obstruction
  • dysphagia
60
Q

where does stomach cancer often metastasize to (3)

A
  • lymph nodes
  • ovaries
  • liver
61
Q

what symptoms occur when stomach cancer metastasizes

A
  • symptoms similar to peptic ulcer (dyspepsia)

- weight loss

62
Q

why does anemia occur as a manifestation of stomach cancer

A

due to:

  • hemorrhage
  • diminished intrinsic factor secretion
63
Q

what is pernicuous anemia

A
  • anemia due to deficiency in vitamin B12
64
Q

what is the treatment for stomach cancer?

A
  • partial gastrectomy

- resection

65
Q

list 3 types of treatment for peptic ulcer

A
  1. eradication of H pylori by antibiotic therapy
  2. mucosal protection
  3. decrease gastric acid production
66
Q

describe the rationale for antibiotic therapy for treatment of peptic ulcer disease

A
  • causes resolution of gastritis & allows the ulcer to heal

- associated w lowest risk of recurrence (5% with, 80% without)

67
Q

list 3 ways to provide mucosal protection in peptic ulcer therapy

A

agents such as sucralfate:

  • coat the mucosa
  • stimulate bicarb
  • have antimicrobial effect
68
Q

decsribe how gastric acid production can be decreased for peptic ulcer theraoy

A
  • thru blocking the histmine receptor on mucosal cells

- inhibit the mucosal proton pump to decrease the amount of acid produced by mucosal cells

NURS 2514 (75 decks)

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