Week 5: GI Flashcards
Risk Factors for GI Disorders
- Family Hx
- Lifestyle - stress, poor diet, alcohol, tobacco, smoking can all lead to these disorders - many of the disorders are associated with lifestyle behaviors
- Domino Effect
- Previous abdominal surgeries or trauma
- Neurologic disorders
What can GERD lead to?
Barret’s esophagus –> predisposition for esophageal cancer
What can chronic gastritis lead to?
Predisposition to gastric cancer
What can previous abdominal surgeries lead to?
Can lead to adhesions (development of scar tissue) which can lead to intestinal obstructions
Neurological disorders like MS/Parkinsons can impair what?
Patient’s ability to: 1. Move and have peristalsis which impairs movement of waste products2. Chew and swallow
What is GERD?
Backward movement of gastric or duodenal contents resulting in heartburnEpisodes occur more than 2 times a week
What is the major cause of GERD?
Relaxation or weakness of LES (lower esophageal sphincter)
Obesity can also cause GERD
Things that Trigger LES Relaxation
- Fatty Food
- Caffeinated Beverages
- Carbonation
- Chocolate
- Milk
- Tobacco
- Alcohol
- Peppermint/Spearmint
- Progesterone during pregnancy
- Hormonal replacement in older women
- NG tube
- Medications: NSAIDS, Calcium Channel Blockers, Blood Pressure Meds, Nitroglycerine for chest pain
- Pyloric Stenosis
- Overeating or being overweight
- Eating right before bed or eating/sleeping in recumbent position
- Wearing tight clothing
- Mucosal irritants - tomato’s and citrus
What should you do prior to laying down for the night when you have GERD?
Do not eat 3 hours prior to laying down Avoid laying supine if you do
What is a classic symptom of GERD?
Waking up in the middle of the night feeling a pain in their throat or feeling heartburn
Clinical Manifestations of GERD
- Pyrosis
- Dyspepsia
- Sour Taste
- Hypersalivation - patients will clear throats & swallow more frequently
- Dysphagia
- Ordynophagia
- Eructation
- Fullness (even when eating a v small amount of food)
- Early Satiety
- Nausea
Pyrosis
Burning in the esophagus / heartburnMay radiate to neck and jaw
Dyspepsia
Indigestion that leads to pain in the upper abdomen
Dysphagia
difficulty swallowing
Ordynophagia
Painful swallowing
Eructation
Belching
When do symptoms of GERD occur?
30 min - 2 hours after a meal
When do symptoms worsen for GERD?
Worsen when lying down, bending over, or straining
What should you assess when a patient comes in and complains of symptoms of GERD?
Need to determine if s/sx are caused from GERD or something else (ex: cardiac event)
What are some non-surgical interventions for GERD?
- Dont let the sphincters relax
- Eat small meals
- Explore weight loss options
- Smoking cessation
- Keeping HOB up at night
- Avoid tight clothing
- Avoid lying down after meals - Promote gastric emptying and avoid gastric distention
- Watch those acidic foods
- Medications
Which medications help with GERD?
- Antacids - decrease overproduction of gastric acids2. Pepcid3. Proton pump inhibitors (PPIs) - provide long lasting reduction in amount of acid created by the stomach (ex: Prevacid, Prilosec)4. Prokinetic drugs - for those that have issues with delayed gastric emptying; increase motility/movement (ex: Reglan)
What is a surgical intervention for GERD?
Nissen Fundoplication
What is the procedure forNissen Fundoplication?
Takethe fundus and wrap it around the LES to reinforce the closing function of the sphincter
What are the risks of surgery for Nissen Fundoplication?
- Hemorrhage, bleeding, infection
- Obstruction (If too tight)
- Short bouts of temporary dysphagia
- Bloating and gas buildup
Does Nissen Fundoplication cure GERD?
No, patients still need to follow non-surgical recommendations
What is Barretts Esophagus?
Occurs w/ prolonged GERD
Acid erodes lining of the esophagus and turns cells of esophagus to look like the lining of the intestines
Alterations can lead to esophageal cancer
How is Barrett’s Esophagus diagnosed?
Via an endoscopy and biopsy
What is a Hiatal Hernia?
When the opening through the diaphragm where the esophagus passes becomes enlarged and part of upper stomach moves into lower portion of the thorax
Risk Factors for Hiatal Hernias
- Age
- Obesity
- Women more at risk
Concerns of Hiatal Hernias
Obstructions and Strangulations
What are the two types of Hiatal Hernias?
- Sliding
- Rolling
Sliding Hiatal Hernia
Occur when the upper stomach, lower esophageal sphincter, and the gastroesophageal junction are displaced upward and they slide in and out of the thorax
Gastroesophageal junction is compromised
Rolling Hiatal Hernia
Gastroesophageal junction remains in position
The stomach is pushed through the diaphragm and sits next to esophagus
The fundus rolls through the hiatus and into the thorax
How does a Sliding Hiatal Hernia present?
Can be asymptomatic
GERD symptoms
How does a Rolling Hiatal Hernia present?
Can be asymptomatic
GERD symptoms
Breathlessness after eating
Chest pain that mimics angina
Feeling of suffocation
Worse lying down (SOB)
*Patients will complain of more respiratory symptoms
Which type of hiatal hernia has a higher risk for strangulation?
Rolling Hiatal Hernia
Piece of stomach can be strangulated - leading to higher risk for strangulation
What are the s/s of strangulation with a hiatal hernia?
- Sudden pain in affective area
- Fever
- N/V
- SOB
This is a MEDICAL EMERGENCY!
Interventions for Hiatal Hernias
Similar to Non-Surgical Interventions for GERD
- Limit or eliminate foods that relax LES
- Promote gastric emptying or avoid gastric distention (this also helps prevent movement of the hernia)
- Limit or eliminated foods that add fuel to the acid fire d/t acidic content (tomato and citrus)
- Medications
- Sleep in low fowlers position
What is gastritis?
When the lining of the stomach becomes inflamed or swollen - disrupted stomach lining
Over time the mucosa can erode due to this
Gastritis can be ___ or ___
acute or chronic
How long is acute gastritis compared to chronic gastritis?
Acute = few hours to days
Chronic = repeated exposure/recurrent episodes
What is the cause of non-erosive acute gastritis?
H. pylori
What is the cause of erosive Gastritis?
NSAIDS, Motrin, ASA, Alcohol use
Why can H Pylori lead to pernicious anemia?
Chronic Gastritis can destroy the parietal cells of the stomach leading –> lack of intrinsic factor production which is needed for VitB12 absorption
Vit B12 is needed for RBC production, therefore anemia results
Patients may need lifelong supplementation
What makes gastritis worse?
- Stress
- Caffeinated beverages
- Tobacco
- Spicy/highly seasoned foods
- NSAIDs
- Alcohol
What are some s/s of acute gastritis?
- Anorexia
- Epigastric pain
- Hemtaemesis
- Hiccups
- Melena or hematochezia
- NV
What are some s/s of chronic gastritis?
- Belching
- Early satiety
- Intolerance to fatty or spicy foods
- NV
- Pyrosis
- Sour taste in mouth
- Vague epigastric discomfort relieved by eating
How is gastritis diagnosed?
Via an upper endoscopy
Other orders may include fecal occult blood & CBC to monitor H&H
How is gastritis treated?
Treatment will typically be supportive, which may include:
- NG tube - so the stomach can rest and heal. It will be placed for decompression
- Medications - antacid, Pepcid, PPIs (Prilosec, Prevacid)
- If the patient is NPO, they are given parenteral nutrition (TPN)
- IV fluids
- Foods will be slowly introduced
What are the goals for patients hospitalized for gastritis?
- Relieving pain (abdominal)
- Promote fluid balance
- Reduce anxiety
- Promote optimal nutrition
- Educate about the disorder
Why is nutrition balance and fluid balance impaired with gastritis?
They become essentially NPO and are not consuming enough calories so they aren’t getting the food they need or are drinking and risk dehydration
Interventions to Treat Chronic Gastritis
- If caused by H Pylori –> combo of antibiotics
- NSAIDS/Alcohol –> collaborate with health care team, educate patient, refer
- Smoking cessation
- Stress management
- Avoid trigger foods
* focus on the mind-gut connection*
What is Peptic Ulcer Disease (PUD)?
Sores in the lining of the GI system and these sores can erode the mucosa
How do gastritis and PUD differ?
Gastritis only affects the stomach lining while peptic ulcers are localized sores that can erode past the mucosal layer at least half a centimeter (deeper than gastritis)
A patient with H Pylori induced chronic gastritis is at high risk for developing ____?
PUD
What are the 4 locations peptic ulcers can be found?
- Duodenum
- Stomach
- Pylorus
- Esophagus
___ is the most common location for a peptic ulcer, and ___ is the second most common
Duodenum; Stomach
Risk Factors for PUD
- Age (> 65 y/o)
- Genetics
- Stress
- NSAID use
- Diet
Main Underlying Cause of PUD
H Pylori and Excessive secretion of hydrochloric acid by parietal cells
What is the major symptom of PUD?
Dull, gnawing, burning pain in the mid epigastric area that can radiate into the back
due to radiation to the back rule out other potential causes
What are other symptoms of PUD?
- Pyrosis (heartburn)
- Vomiting
- Constipation
- Diarrhea
- Bloody stools, or emesis
* If the bleeding is considerable, the patient may demonstrate s/s of anemia - monitor CBC, H&H
How is PUD diagnosed?
Upper endoscopy to visualize the inflammation, ulcer, and lesions
Nursing Management and Interventions for PUD
Dietary Modification
Smoking cessation
Pharmacologic therapy
surgical management
What is the drug regimen like for H Pylori infection
triple or quadruple therapy (with quadruple adding bismuth salts)
What is the timing of pain like for PUD depending on if it is duodenal or gastric?
Duodenal (farther down so takes longer): 2-3 hours after a meal, occurs at night, relieved by food
Gastric: Immediately after a meal or 30-60 min after a meal, rarely at night, worse with food
What is the stomach acid secretion like for PUD depending on if it is duodenal or gastric?
Duodenal - Hypersecretion
Gastric - Hypo or normal
What is weight change like with PUD depending on if it is duodenal or gastric and why?
Duodenal - Weight Gain - since food relieves the pain
Gastric - Weight Loss - since it becomes worse with food
4 Types of Surgical Interventions for PUD
- Vagotomy
- Pyloroplasty
- Biliroth I
- Biliroth II