week 8: upper GI and accessory organ disorders Flashcards
what is GERD
stomach acid leaks back into esophagus
what are complications of GERD
barretts epithelium, respiratory issues (aspiration), esophagitis, dental decay, hemmorhage
where do GERD symptoms stem from
tissue injury and too much stomach acid
whats the difference between a sliding hartal hernia and a parasophageal hernia
sliding: herniated portion of stomach just kind of slides out
paraesophageal: pouch of stomach kind of rolls out
what are the symptoms of a hiatal hernia similar to
GERD
if LES is normal there are no symptoms
how does a CPAP help with Gerd
makes sleep apnea better and for some reason helps with GERD
when are GERD symptoms usually worse
when a person is eating or lying down
which drugs help with GERD
antacids, PPIs, H2 receptor blockers
which drugs make GERD worse
oral contraceptives, anticholinergic drugs, sedatives, NSAIDS, nitrates, CCB
all lower LES pressure
what are long term complications of PPI;s
PPIs long term lead to more risk of infection because stomach acid kills bacteria
also leads to inflammation of the kidney and inability to absorb calcium = bone fracture
what is a fundoplication
wrap fundus/herniated part of hernia around a band and secure it and it’ll eventually fall off
what is post op priorities when a person has a fondoplicaiton
preventing respiratory complications (raise HOB, early ambulation, Deep breathe and cough, support incision, pain control)
what does normal NG tube drainage look like
it’ll go from dark brown to yellowish green, if it goes back to dark brown that could mean GIB
what is a sign that fondification is too tight
inability to bleach, dysphagia, aerophagia (air swallowing)
what are the first signs/symptoms of oesophageal tumours
dysphagia
then it’ll move on to odynophagia, hoarseness and weight loss
what are the non surgical interventions for oesophageal tumours
nutritional and swallowing therapy
chemo and radiation
esophageal dilation
what is the main surgical intervention for an esophageal tumour
esophagectomy
- basically removing a part of esophagus
what is the highest priority post-procedure thing for esophagectomy
respiratory care (DB + C, turning, pain support)
what is an important thing to note about an NG tube
don’t reposition, measure the length
what is an anastomotic leak and why is it so serious
it is when GI fluid leaks out of esophagus sutures into mediastinum (after an esophagectomy)
it could lead to sepsis/peritonitis
what are symptoms of anastomotic leak
- fever, increased chest tube drainage, early signs of shock (high pulse, low BP)
what is a blumberg sign
rebound tenderness
what is steatorrhea
increased fat excretion of stools usually due to inflammation of the gall bladder
what is extra-corporeal shock wave lithotripsy and why does it help with gall stone management
it uses ultrasound shock waves to break up stones so that they can pass
what is a percutaneous transhepatic biliary catheter
a stent inserted to divert bile from liver into the duodenum
what is the gold-standard method for treating cholecyctotis
laparoscopic cholecystectomy
why would a patient have gaseous pain after a cholecystectomy
because they need to fill the abd wall with 3-4L of CO2 to lift the wall and visualise the internal organs
what is a Jackson-pratt drain
small drain that sits near where the gall was
used for an open approach cholecyctectomy
why would one use an open approach cholecystectomy
used in severe biliary obstruction where surgeon needs to look around and figure out the cause
what does pancreatitis pain look like
starts in LUQ, radiates to back, L flank and L shoulder
what are the pain causes of pancreatitis
gall bladder stones and ahcolol use
what is the primary nutritional intervention for pancreatitis
NPO to give pancreas a rest
what are signs of hypocalcemia
muscle spasms and cramps
why do you need to monitor respiratory status with pancreatitis
pancreatic juice can migrate to peritoneum and cause atelectasis
monitor for cough and fever, look for crackles in the lungs
what are the signs of peritonitis
fever, loss of appetite, abd pain, change in mental status
what are the two main vasoactive meds to treat an active bleed d/t liver cirrhosis
octreotide, vasopressin
what is a TIPS procedure
blood flow from portal vein shunted to hepatic vein
which medication helps with confusion with liver cirrhosis
lactulosewhy
why do you need to use drugs sparingly with liver cirrhosis
because they get metabolised in the liver
why do you need moderate protein intake when managing and preventing confusion in a liver cirrhosis patient
because ammonia competes with protein in the gut
what is the goal of pooping with lactulose
2-3 soft stools per day
what should you monitor with lactulose
monitor for hypokalaemia, dehydration, asterisks and fetor hepaticus
which medication helps with itchy skin due to liver cirrhosis
sertraline
where would you experience pain with hepatitis
right upper quadrant pain
what is the main drug management with hepatitis B and C
antiviral drugs
what is the primary patient education with antiviral drugs
avoid large crowds and sick people because it can suppress the immune system
