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NURS 401 > Week 6: GI Disorders > Flashcards

Week 6: GI Disorders Flashcards

1
Q

What are normal age-related changes to the GI system (excluding stomach and intestines)?

A
  • Loss of teeth
  • Decreased saliva production
  • Thicker mucous production
  • Diminished sense of taste
  • Presbyesophagus
  • Production and flow of bile decreases (gallstones likely to form)
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2
Q

Presbyesophagus

A

Strength of esophageal contractions and the tension in the upper esophageal sphincter decreases.

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3
Q

Effects of Presbyesophagus

A
  • Many experience difficulty swallowing (dysphagia)

- Heartburn caused by stomach acid entering the esophagus d/t weakened esophageal sphincter.

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4
Q

Decrease in smooth muscle along majority of GI tract can cause

A

Food to move more slowly as contractions necessary for movement and breakdown become weaker.

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5
Q

Normal age-related changes to the stomach

A
  • Stomach lining’s capacity to resist damage decreases -> increases the risk for PUD
  • Cannot accommodate as much food (d/t decreased elasticity)
  • Decreased rate at which the stomach empties food into the small intestine.
  • Aging has little effect on secretion of stomach juices (however conditions that decrease acid secretion is common)
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6
Q

Normal age-related changes to the small intestine

A
  • Movement of contents through the small intestine and absorption of most nutrients do not change much.
  • Lactase levels decrease leading to intolerance of dairy products
  • Excessive growth of certain bacteria is common -> pain, bloating and weight loss
  • Bacterial overgrowth can cause decreased absorption of certain nutrients such as vitamin B12, iron and calcium.
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7
Q

Normal age-related changes of the pancreas

A
  • Decreases in overall weight and some tissue is replaced by scarring (fibrosis)
  • Number of secretory cells decreases resulting in a decrease in the level of fat digestion.
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8
Q

Normal age-related changes to the large intestines

A
  • Does not undergo much change

- Rectum does enlarge somewhat -> constipation becomes more common.

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9
Q

Normal-age related changes to the liver

A
  • Liver’s ability to withstand stress decreases
  • Repair of damaged liver is slower
  • Liver size and blood flow decreases (however liver function tests generally remain normal)
  • Ability of the liver to metabolize many substances decreases (some drugs are not inactivated as quickly)
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10
Q

GERD

A
  • Acidic gastric secretions reflux causing irritation and inflammation
  • Gastric secretions can include pepsin, intestinal enzymes and bile salts which can be corrosive to esophageal mucosa.
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11
Q

GERD: Degree of inflammation depends on what factors?

A
  • Amount and composition of gastric reflux

- Ability of esophagus to clear acidic contents

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12
Q

Pathophysiology of GERD

A

Results when defenses of esophagus are overwhelmed by the reflux of acidic gastric contents into the lower esophagus

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13
Q

What are other causes of GERD?

A
  • Incompetent lower esophageal sphincter (LES)
  • Decreased LES pressure
  • Decreased gastric emptying
  • Obesity and smoking
  • Hiatal hernia
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14
Q

Clinical Manifestations of GERD

A
  • Heartburn (most common)
  • Dyspepsia
  • Hyperslaivation
  • Non-cardiac chest pain
  • Regurgitation
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15
Q

Dyspepsia

A

Pain or discomfort centered in upper abdomen

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16
Q

What are age related changes that may lead to GERD?

A
  • Decreased salivary secretions
  • Diminished esophageal mucosal resistance
  • Decline in esophageal motility and clearance
  • Loss of Lower Esophageal Sphincter (LES) tone
  • Delayed gastric emptying
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17
Q

What is used to diagnose GERD?

A

Endoscopy which remains the GOLD standard for diagnosing GERD

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18
Q

Symptoms of GERD in older adults: Older adults present with

A
  • Decreased complaints of heartburn, regurgitation and chest pain.
  • Increased complaints of dysphagia, respiratory symptoms, vomiting and anorexia.
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19
Q

What are complications of GERD?

A
  • Esophagitis
  • Barrett’s esophagus
  • Respiratory Complications
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20
Q

Esophagitis can lead to

A

Scar tissue formation, stricture and dysphagia

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21
Q

Barrett’ esophagus can lead to

A

Precancerous lesion

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22
Q

GERD: Respiratory complications include

A
  • Chronic cough
  • Bronchospasm
  • Laryngospasm d/t irritation of the upper airway from gastric secretions.
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23
Q

GERD: Drug therapy

A
  • PPI (omeprazole)

- H2 Blockers (Ranitidine)

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24
Q

GERD: Surgery

A

Nissan and toupee fundoplications

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25
Q

GERD: Lifestyle modifications

A
  • Weight reduction

- Smoking cessation

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26
Q

GERD: Nutritional Therapy

A
  • Decrease high-fat foods
  • Fluids between rather than with meals
  • Avoid late-night snacking or meals
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27
Q

GERD: Patient teaching

A
  • Avoid factors that cause reflux (smoking, alcohol, caffeine, acidic/spicy foods)
  • Weight reduction, if appropriate
  • Small frequent meals
  • Elevate the head of the bed
  • Eat the last meal 3 hours before going to bed
  • Avoid tight clothing around the waist
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28
Q

Peptic Ulcer Disease

A

Erosion of GI mucosa resulting from digestive action of hydrochloric acid and pepsin.

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29
Q

Peptic Ulcer Disease: What are causes?

A
  • H. Pylori
  • Medications: NSAIDs, corticosteroids, anticoagulants, SSRIs
  • Lifestyle factors: alcohol, coffee, stress, depression, smoking (delays healing)
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30
Q

PUD develops only in

A
  • The presence of an acid environment

- Excess hydrochloric acid may not be necessary for ulcer development.

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31
Q

Ulcer development can occur in:

A
  • Lower esophagus
  • Stomach
  • Duodenum
  • Margin of gastrojejunal anastomosis after surgical procedures
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32
Q

How can H. Pylori cause PUD?

A
  • In one possible scenario, H. pylori alters gastric secretion and produces tissue damage, leading to PUD.
  • In another possible scenario, H. pylori leads to metaplasia in the stomach resulting in chronic atrophic gastritis and in some cases stomach cancer.
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33
Q

The response to H. Pylori is influenced by a variety of factors including

A

Genetics, environment and diet.

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34
Q

How do medications such as NSAIDs and aspirin cause PUD?

A
  • Inhibit prostaglandin synthesis
  • Increase gastric acid secretion
  • Reduce integrity of the mucosal barrier
  • Responsible for majority of non-H. pylori peptic ulcers
  • NSAIDs in presence of H. pylori increase risk of PUD
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35
Q

How do corticosteroids cause PUD?

A
  • ↓ Rate of mucosal cell renewal

- ↓ Protective effects

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36
Q

How do lifestyle factors such as smoking and alcohol/coffee cause PUD?

A

Alcohol and coffee stimulate acid secretion

Smoking and psychologic distress

37
Q

Types of PUD

A
  • Gastric or Duodenal (differ in their incidence and presentation)
  • Acute or Chronic (depends on degree/duration of mucosal involvement)
38
Q

Acute PUD

A
  • Superficial erosion
  • Minimal inflammation
  • Short duration: resolves quickly when cause is identified and removed
39
Q

Chronic PUD

A
  • Long duration
  • Muscular wall erosion with formation of fibrous tissue
  • Present continuously for many months or intermittently throughout person’s lifetime
  • More common than acute erosions
40
Q

Gastric Ulcers

A
  • Occur in any portion of stomach; most commonly found in the antrum
  • Less common than duodenal ulcers
  • More likely than duodenal ulcers to result in hemorrhage, perforation, and obstruction
  • Live threatening
41
Q

Risk factors for gastric ulcers

A
  • H.pylori
  • Medications
  • Bile reflux
  • Alcohol use and smoking
42
Q

Gastric Ulcer Pain

A
  • Generally high in epigastrium
  • 1–2 hours after meals
  • “Burning” or “gaseous”
  • Food aggravates pain if ulcer has eroded through gastric mucosa
43
Q

Duodenal Ulcers

A
  • Most common
  • Most often caused by h.pylori
  • Associated with increased hydrochloric acid secretion.
  • Alcohol ingestion and smoking associated with formation.
44
Q

What can increase the risk of duodenal ulcers?

A 
COPD
Cirrhosis of liver
Chronic pancreatitis
Hyperparathyroidism
Chronic kidney disease 
Zollinger-Ellison syndrome (rare condition characterized by severe peptic ulceration and hydrochloric acid hypersecretion)
45
Q

Symptoms of duodenal ulcers occur when

A

gastric acid comes in contact with the ulcer

46
Q

Clinical manifestations duodenal ulcers

A
  • Mid-epigastric region beneath xiphoid process
  • Back pain - if ulcer is located in posterior aspect
  • Some experience bloating, N/V and early feelings of fullness.
  • Weight gain
47
Q

Duodenal Ulcer Pain

A
  • 2-5 hours after meals
  • “burning” or “cramplike”
  • Tendency to occur, then disappear, then occur again.
  • Pain relieved by meal.
  • Worst at night
48
Q

Medical regimen for PUD consists of

A
  • Adequate rest
  • Dietary modification
  • Drug therapy
  • Elimination of smoking and alcohol
  • Long-term follow-up care
  • Stress management
49
Q

Aim of treatment program for PUD

A
  • Reduce degree of gastric acidity
  • Enhance mucosal defense mechanisms
  • Minimize harmful effects on mucosa
50
Q

PUD Drug Therapy

A
  • Antibiotics: to eliminate H. Pylori infection.
  • PPI
  • H2 receptor blockers
  • Antacids
51
Q

How long does PUD take to heal?

A

-Complete healing may take 3-9 weeks. (Should be assessed by endoscopic examination)

52
Q

Complications of PUD

A

-Hemorrhage
-Perforation
-Gastric outlet obstruction
All of which are considered emergency situations.

53
Q

Peptic Ulcer Disease: Health Promotion

A
  • Identify patients at risk
  • NSAID users among older adults
  • Early detection and treatment
  • Encourage patients to take ulcerogenic drugs (i.e. NSAIDs, corticosteroids) with food or milk
  • Teach to report symptoms related to gastric irritation to health care provider
54
Q

PUD: Surgical Therapy

A
  • Billroth I or II
  • Vagotomy- to decrease acid secretion
  • Pyloroplasty- Pyloric Sphincter enlargement
55
Q

Dumping Syndrome

A

…

56
Q

Diverticula

A
  • Small, bulging pouches that can form in the lining of the digestive tract.
  • Found most often in the lower part of large intestine (colon).
57
Q

Diverticulitis

A
  • Inflammation or infection in one or more small pouches in the digestive tract.
  • Most commonly found in the left descending sigmoid colon.
58
Q

Causes of Diverticulitis include

A

Diet low in fiber and high in refined carbohydrates

59
Q

Pathophysiology of Diverticulitis

A

Normal bowel flora overgrow in pouch + feces entrapped -> inflammation -> obstruction of diverticular opening -> trapped infection.

60
Q

Symptoms of Diverticulosis include

A
  • Abdominal pain
  • Bloating
  • Flatulence
  • Changes in bowel habits

*Frail older adults may not exhibit any of these symptoms

61
Q

Symptoms of Diverticulitis

A
  • Acute LLQ abdominal pain
  • Palpable abdominal mass
  • Systemic symptoms of infection

*Frail older adults may not exhibit any of these symptoms

62
Q

Diverticulosis/Diverticulitis Diagnostic

A
  • Hx and physical
  • Barium enema
  • Colonoscopy
  • Abdominal X-ray
  • CT scan with oral contrast
63
Q

Nursing Care for Diverticulosis include

A
  • High Fiber diet
  • Dietary Fiber supplements
  • Stool softeners (Colace)
  • Activity as tolerated
  • Weight reduction (if applicable)
64
Q

Diverticulitis Nursing Care include

A
  • NPO status- let the colon rest
  • IV fluids
  • IV antibiotics (Fluoroquinolone and Metronidazole)
  • Surgery- abscess or obstruction; resection of colon and temporary diverting colostomy
65
Q

Diarrhea

A

The passage of at least 3 loose or liquid stools per day.

It is considered chronic if it’s more than 30 days.

66
Q

Causes of Diarrhea include

A
  • Virus (norovirus, rota virus)
  • Bacteria (e.coli, c-diff, salmonella)
  • Food poisoning; contaminated food
  • Medications (ABT)
  • Lactose intolerance
67
Q

Diarrhea caused by E. coli

A

-Watery or bloody diarrhea
-Abdominal cramps
-N & V
-Possible fever
> 60 hours

68
Q

Diarrhea caused by salmonella

A

-Fever
-Abdominal cramps
4-7 days
(undercooked poultry)

69
Q

Diarrhea caused by C-diff

A
  • Watery diarrhea
  • Fever
  • Anorexia
  • Nausea
  • Abdominal pain
70
Q

Diarrhea caused by Giardia lamblia

A
  • Abdominal cramps
  • Nausea
  • May interfere with nutrient absorption
71
Q

Diarrhea caused by food intolerance

A

large amount of undigested food; lactose intolerance and certain laxatives

72
Q

Symptoms of Diarrhea

A
  • Urgency
  • Cramping
  • Bloating
  • Incontinence
  • Pain on defecation
  • Presence of blood in the stool
73
Q

Diarrhea Assessment

A
  • Interview
  • Physical Examination
  • Stool cultures
74
Q

Diarrhea Management

A

-Antidiarrheal agents as appropriate (Lomotil, Imodium AD)
-Soluble fiber

75
Q

Antibiotic Therapy Associated Diarrhea

A
  • Health care associated infection; patient to patient

- Occurs during or shortly after administration of antibiotics

76
Q

Antibiotic Therapy Associated Diarrhea is caused by

A

Clostridium difficile → bowel inflammation + epithelial necrosis -> diarrhea + pseudomembranous colitis

77
Q

Antibiotic Therapy Associated Diarrhea Symptoms

A
  • Watery non-bloody diarrhea (differing degrees)
  • Lower abdominal pain and cramping
  • Low-grade fever
  • Can lead to dehydration, hypotension and colonic perforation
78
Q

C-diff Diagnosis

A

Stool analysis

79
Q

C-diff Treatment

A

-Metronidazole (Flagyl) 250 mg QID for 7 to 10 days (Flagyl)
-If refractory, then Vancomycin 125 mg QID for 7 to 14 days

80
Q

For patients with c-diff, you need to remember

A
  • Hand hygiene (soap and water)
  • Address hypovolemia
  • Contact precautions
81
Q

Symptoms of Constipation

A
  • Two or fewer stools per week
  • Straining during defecation
  • Feeling of incomplete evacuation
82
Q

Causes of Constipation include

A
  • insufficient dietary fiber
  • inadequate fluid intake
  • decreased physical activity
  • ignoring defecation urge
  • medications (particularly opioids)
83
Q

Complications of Constipation include

A
  • Intestinal obstruction
  • Colonic ulceration
  • Overflow incontinence with stool leakage
  • Excessive straining
84
Q

Constipation: Excessive straining can cause

A
  • Syncope
  • Transient ischemic attacks
  • Anal fissures
  • Rectal prolapse
85
Q

Assessment for Constipation

A
  • Carefully evaluate the complaint
  • Interview
  • Review of Medications
  • Physical examination (presence of bleeding, hemorrhoids)
86
Q

Constipation: Interview questions include

A
  • Frequency of bowel movement (fewer than 3 per week)
  • Consistency of stool (hard or difficult to pass)
  • Presence of excessive straining (repeated Valsava maneuvers)
  • Feeling of fullness in the rectum after bowel movement
  • Presence of bright red blood
87
Q

Constipation patient teaching

A
  • Education- fruits and vegetables; grains; whole wheat and bran
  • Hydration
  • Increased mobility
  • Fiber supplementation (20-35 grams/day)
  • Educate the older adult not to depend on laxatives and enemas.
88
Q

Constipation medication includes

A

Bulk laxative
Stool softeners
Magnesium-containing laxatives (harmful if in renal failure)

89
Q

Constipation: Patient and Caregiving Teaching

A

Read Table 42.9 pg. 937 (Lewis et. Al textbook)

NURS 401 (26 decks)

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