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NURS 3512 acute & chronic > Week 5 Upper GI bleed/ PUD/ Gastric CA > Flashcards

Week 5 Upper GI bleed/ PUD/ Gastric CA Flashcards

1
Q

What is Peptic ulcer disease (PUD) and what does it do?

A

gastric mucosa and/or duodenal mucosa are eroded

This allows HCL (hydrochloric acid) into the sensitive tissues d/t breakdown of mucosal layer.

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2
Q

What layer of tissue does erosion affect in PUD?

A

top layer - mucosa

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3
Q

What layer of tissue does acute ulcer affect in PUD?

A

first two layers - mucosa and sub mucosa

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4
Q

What layer of tissue does chronic ulcer affect in PUD?

A

All the layers
mucosa
submucosa
muscularis
almost to serosa

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5
Q

What 3 things precipitate PUD?

A
  1. Drugs - NSAIDS & ASA
  2. Stress
  3. Bacteria - h. pylori
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6
Q

How do we specifically identify a gastric ulcer? (compared to a duodenal)?

A
  1. Age - peak is 50-70
  2. Pain - food makes it worse - 30-60 min post meal
  3. Malnourished cuz eating hurts
  4. Gastric secretions - decreased b/c less food
  5. Heals with treatment
  6. recurs - usually same location
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7
Q

How do we specifically identify a duodenal ulcer? (compared to gastric)

A
  1. Age - peak is 20-50 yrs
  2. Pain - food & antacids makes it better- pain shows up 1.5-3 hrs later
  3. Well nourished cuz eating helps
  4. Gastric secretions - Increased cuz food is there
  5. Heals with treatment
  6. recurs - remissions & exacerbations
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8
Q

What do we want to ask about regarding pt history with suspected PUD?

A
  1. meds & OTC (esp. NSAID use)
  2. alcohol & tobacco use
  3. Diet
  4. Stress
  5. dyspepsia (heart burn)
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9
Q

What does PUD pain typically feel like?

A

sharp
burning
gnawing

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10
Q

What lab assessments do we do for PUD and why?

A
  1. H. pylori - *most common is blood test - can do breath or stool - can be treated easily
  2. HGB & HCT (will be low if bleeding ulcer)
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11
Q

What is the gold standard test to diagnose PUD?

A

Esophagogastroduodenoscopy

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12
Q

What can an esophagogastroduodenoscopy do?

A

visualize ulcers
take a biopsy
test for h. pylori

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13
Q

What does a Nuclear medicine scan test for?

A

Bleeding of PUD

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14
Q

What are the 3 most common complications of PUD (and any GI bleeding)

A
  1. Hemorrhage/upper GI bleed
  2. Perforation
  3. Gastric outlet obstruction
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15
Q

What has happened with someone’s ulcer when they have a hemorrhage or upper GI bleed

A

Erosion of the ulcer through a major blood vessel

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16
Q

Why is perforation dangerous?

A

non-sterile gastric contents go into the sterile environment of the peritoneal cavity and wreck havoc

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17
Q

What causes gastric outlet obstruction?

A

pylorus narrows due to scarring & inflammation,

Pyloric sphincter issues from edema or inflammation

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18
Q

If a person has frank blood in their emesis, where is the bleed likely and how do we know?

A

esophagus - b/c it hasn’t hit the stomach yet to be partially digested

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19
Q

If a person has coffee ground vomit in their emesis where is the bleed likely and how do we know?

A

stomach - b/c partly digested blood

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20
Q

If someone has black/tarry stool where is their bleed likely from and how do we know?

A

Duodenum (upper GI bleed) b/c the blood is digested

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21
Q

What are the FIRST things we do if someone is experiencing a massive GI bleed?

A

Stay calm
get in a large bore IV needle
IV fluids - monitor for fluid over load
O2 sats
frequent VS

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22
Q

What are some things we can do after someone with hematemesis is initially stabilized?

A

Monitor I&O
Fluid overload (esp cardiac peeps)
Monitor stool/emesis
Monitor lab work

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23
Q

What is the PRIMARY treatment procedure for an Upper GI bleed?

A

endoscopic therapy
1. epi or glue used
2. endo clips
3. cauterize

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24
Q

What are the 3 main general ways that upper GI bleed can be treated?

A
  1. endoscopic therapy
  2. Surgery
  3. Drug therapy
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25
Q

What drugs are used with Upper GI bleeds and why

A
  1. Octreotide (sandostatin)
    - decreases blood flow to abdominal organs
    - vasoconstriction
    - Given IV 5-6 days after bleed
  2. Vasopressin
    -vasoconstrictor
  3. Drugs to help decrease irritants:
    Antacids - aluminum hydroxide
    PPIs - omeprazole
    H2 Recept. blockers- famotidine
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26
Q

What are the 3 main signs of hernia perforation ?

A
  1. rigid board like abdomen
  2. Pain
  3. Increasing distention
27
Q

What are the two MAIN things we are monitoring for in someone with perforation?

A
  1. hypovolemic shock
  2. septic shock
28
Q

How do we quickly treat hypovolemic shock/septic shock?

A
  1. NG for gastric decompression - get the stomach contents out!
  2. Antibiotics
  3. Prep for surgery
29
Q

What should we NEVER do if someone’s mucosa is perforated ?

A

NOTHING DOWN THE NG
patients should not swallow anything!

30
Q

How do we recognize Gastric outlet obstruction?

A
  1. Pain that progresses and becomes worse over the day b/c stomach fills and can’t empty well d/t pyloric narrowing/sphincter
  2. Swelling of upper abdomen- see above
  3. Projectile vomiting - see above
    (undigested particles from hours or days ago)
31
Q

what are the 3 interventions for Gastric outlet obstruction?

A
  1. NG tube decompression – insert NG tube & drain the stomach . when inflammation subsides, clamp the tube just to see
  2. IV fluid and electrolyte replacement
  3. Surgery to open obstruction and remove scar tissue – pyloroplasty (widens the sphincter)
32
Q

What Drugs are given for PUD?

A

H2 receptor blockers:
famotidine (Pepsid)

PPI:
omeprazole (Losec),
pantoprazole (Pantoloc)

Antibiotics for H Pylori
Tetracycline, Amocicillin
Metronidazole (Flagyl)

Cytoprotective
sulcrafate bismol subsalicylate (Pepto-Bismal)

Antacids
Magnesium Hydroxide (Milk of Magnesia)
calcium carbonate (Tums)

33
Q

What can we teach people about managing PUD?

A

1.Dietary Modifications
Avoid spicy foods, acidic foods, caffeine, alcohol

  1. Stop Smoking - if applicable
  2. Avoid OTC Meds (NSAIDS, ASA)
  3. Take all meds as prescribed - prevent further acid
  4. Report bloody emesis, tarry stools, increased epigastric pain
  5. Encourage patient to share concerns about following lifestyle changes - ie) spicy changes as part of cultural food
34
Q

What are the surgical interventions for PUD?

A
  1. Billroth I: Gastroduodenostomy
  2. Billroth II: Gastrojejunostomy
  3. Vagotomy
  4. Pyloroplasty
35
Q

What is a Billroth I: Gastroduodenostomy ?

A

-Partial gastrectomy
-removal of distal
2/3 stomach
- anastomosis of gastric stump
to duodenum

36
Q

What is a Billroth II Gastroduodenostomy?

A

-Partial gastrectomy
-removal of distal
2/3 stomach
- anastomosis of gastric stump
to Jejunum

37
Q

What is a vagotomy?

A

Severing of vagas nerve so that HCL does not get secreted

38
Q

What is Pyloroplasty?

A

enlargement of the pyloric sphincter

39
Q

After surgery, when is the NG tube removed?

A

When peristalsis returns (walking helps with this) and doc orders it (need both)

40
Q

What is normal to see in NG content post surgery?

A

Some blood and then should change colour to stomach contents colour (yellow/green) 26-48 hours after

41
Q

How often might we have to do a saline irrigation of the NG tube?

A

Q 4 hrs.

42
Q

What is a possible complication associated with a plugged NG tube that is used to suction?

A
  1. Rupture of the suture lines
  2. Gastric contents leaking into peritoneum
43
Q

Right after PUD surgery, what can a person eat?

A

Nothing, they are NPO.
gradually work up to foods starting with fluid when appropriate

44
Q

What pain do patients post PUD surgery often experience and what non-medical intervention do we use?

A

Gas pain
Walking - to increase peristalsis

45
Q

Why is pernicious anemia a long term complication of PUD surgery?

A

-intrinsic factor is produced in parietal cells and many get removed in PUD surgery
-intrinsic factor helps synthesize B12
- B12 is needed to help synthesize hemoglobin

46
Q

What is dumping syndrome and why is it a problem?

A
  • a huge sudden urge to deficate

The result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into small intestine.
The stomach wants to dilute the high carb so it takes fluid from vascular space to try to dilute it.

post Billroth I and II

47
Q

What are the symptoms of dumping syndrome and why?

A
  1. sudden urge to deficate - b/c large amount of carbs and fluid suddenly in the stomach/intestine
  2. weakness/dizziness/vertigo/low BP/tachycardia -b/c of hypovolemia d/t water being drawn into stomach
48
Q

What is the main consequence of unmanaged dumping syndrome that we are concerned with?

A

Hypovolemia that leads to shock

49
Q

How do we help patients prevent/manage Dumping syndrome?

A
  1. small dry feedings daily
  2. Don’t drink fluid w/meals
  3. low carb, moderate protein/fat
    4.* restrict simple sugars
  4. Lie down 15-30 min post eating
50
Q

Of all the interventions for helping someone prevent/manage dumping syndrome, what one tends to be MOST impactful/important ?

A

restricting simple sugars like fruit juice, candy, etc.

51
Q

How long should someone with dumping syndrome lie down after eating?

A

15-30 min

52
Q

Is dumping syndrome acute or chronic?

A

Acute
eventually the body adjusts and the sudden feeling to deficate goes away

53
Q

What are the 3 complications post PUD surgery?

A
  1. dumping syndrome
  2. postprandial hypogylcemia
  3. Bile reflux Gastritis
54
Q

Which complication is a variant of dumping syndrome?

A

Postprandial hypoglycemia

55
Q

What is postprandial hypoglycemia and why?

A

When there is hypoglycemia after eating

Hyperglycemia d/t high carb chyme occurs so the body releases insulin causing hypoglycemia

56
Q

How do we helpe someone prevent/manage postprandial hypoglycemia ?

A
  1. give sugar if hypoglycemic
  2. prevent rebound hypoglycemia
    - limit sugar each meal
    - small frequent meals
57
Q

What is bile reflux Gastritis?

A

bile backs up into the stomach d/t messing around with the pylorus during surgery

58
Q

What are the two drug interventions we can administer for someone with bile reflux gastritis?

A
  1. cholestyramine
  2. antacid
59
Q

What are some symptoms of Gastric cancer - Adenocarcinoma of the stomach wall?

A

Anemia
vague epigastric fullness
feeling full too early when eating (b/c of tumour)
weight loss
dysphagia
dyspepsia

60
Q

What surgeries are used for gastric cancer typically?

A
  1. billroth I or II
  2. Total gastectomy with Esophagojejunostomy
61
Q

Will someone with Gastric cancer who has Total Gastrectomy with Esophagojejunostomy surgery have a lot of fluid or minimal fluid from the N/G and why?

A

Minimal fluid because the stomach is removed

62
Q

Which GI illness will we see chest tubes post surgery and why?

A

Total Gastrectomy with Esophagojejunostomy because they operate through the chest

63
Q

What 6 complications are people who have Total gastrectomy with esophaojejunostomy surgery at risk for?

A
  • poor nutritional status
  • wt loss
  • vitamin deficiency
  • pernicious anemia
  • dumping syndrome
  • postprandial hypoglycemia

NURS 3512 acute & chronic (29 decks)

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