X GI: Gastrointestinal Disorder (Ms Grant, Burke Chp 24-27) Flashcards
1
Q
Digestive System
A
Mouth to anus
2
Q
What is the beginning of digestion?
A
The mouth
-Eating, speaking, papillae (taste buds)
3
Q
Purpose of teeth
A
Bite, crush, grind food
4
Q
What do salivary glands secrete?
A
Saliva, lubricate and dissolve food (chem process begins)
5
Q
Major enzymes in saliva?
A
Ptyalin
Lysozyme
6
Q
Ptyalin does what?
A
Carb metabolism
7
Q
What does Lysozyme do?
A
- Destroys bacteria
- protects mucous membranes
- protects teeth from decay
8
Q
Esophagus does what?
A
Moves food from mouth to stomach. No digestion, only moves food. (Peristalsis)
9
Q
Length of Esophagus
A
- 10” collapsible tube
- Mouth to thoracic cavity
10
Q
Stomach details
A
- ULQ
- below diaphragm
- size of football
- up to 1L of food
11
Q
Sphincters of the Stomach
A
Cardiac sphincter (LES)- esophagus to stomach Pyloric sphincter - stomach to intestines
12
Q
Where does digestion of protein begin?
A
Stomach
13
Q
What does HCL do?
A
- softens connective tissue (meat)
- kills bacteria
- activate pepsin (protein –> peptones)
14
Q
Intrinsic Factor secreted where? What is it?
A
Stomach.
Enzyme to help absorb B12
15
Q
Digested food becomes ?
A
Chyme.
Through pyloric sphincter
16
Q
Where does most digestion happen?
A
Small intestines
17
Q
Small Intestine anatomy
A
- 20’ in length
- from Pyloric sphincter to Ileocecal Valve
- intestinal juices finish digestion of carbs/proteins
- converts starch to sugar
18
Q
4 major functions of Large Intestine?
A
forms and expels feces
1) completion of absorption
2) manufacture certain vitamins
3) formation of feces
4) expulsion of feces
19
Q
Large Intestine anatomy
A
- 5’ long
- digestion completed here
- cecum –> appendix –> rectum –> anus
20
Q
Accessory organs of digestion
A
Liver
Pancrease
21
Q
Liver facts
A
- largest glandular organ in body
- 1500ml blood delivered to liver p/min
- produces bile (emulsifies fat), stored in Gall bladder
22
Q
where is Bile stored?
A
=gall bladder
23
Q
Pancreas facts
A
-produces pancreatic juices and digestive enzymes (protease, lipase, amylase)
24
Q
Enzymes produced by pancreas.
A
- Lipase: breakdown of fats
- Amylase: breaks down carbohydrates (starch) into sugars. also found in saliva.
- Protease: breakdown of proteins, help keep intestine free of parasites, bacteria, yeast, protozoa.
25
Trypsinogen
which is an inactive(zymogenic) protease that, once activated in the duodenum into trypsin, breaks down proteins at the basic amino acids. Trypsinogen is activated via the duodenal enzyme enterokinase into its active form trypsin.
26
What is the Hypothalmus' job in digestion?
one center stimulates eating, one center signals to stop eating
27
Prader Willy Syndrome?
defect in Hypothalmus causing uncontrolled hunger, stunt growth, sexually underdeveloped. Die of overeating
28
What do Contrast Mediums do?
The enhance visualization of structures and fluids
29
ICCM
Iodine Containing Contrast Medium
- always ask if pt is allergic to shellfish (Iodine)
- people have warm, flush feeling when injected
- come if various forms, Tube, IV, Per Os solution
30
ICCM - minor reactions
- N/V
- flushing face
- mild pruritis
31
ICCM - moderate reaction
- Prolonged or sever vomiting
- generalized rash
- LO BP
- Cardiac Arrest
- Diff Breathing
Rx: corticosteroid prophylactically, Benadryl
32
Types of Contrast Mediums
- ICCM (Iodine Containing Contrast Medium)
- Barium
- Gastrografin
33
Barium
Contrast medium
- tube in rectum
- results in chalky feces until completely leaves body
34
Gastrografin (Diatrizoic acid)
Contrast medium. sometimes used in place of Barium
- water soluble
- quickly absorbed by body
- absorbed by surrounding tissue if escapes GI track.
35
Lab/Diagnostic Exams
- Upper GI series
- Gastric Analysis
- Esophagogastroduodenoscopy (EGD)
- Barium Swallow
- Bernstein test
- Stool for occult blood
- Sigmoidoscopy
- Barium enema
- Colonoscopy
- Stool Culture and sensitivity; stool for ova and parasites
- Flat plate of the abdomen
36
Upper GI Series (Burke 617-620)
- series of xrays/radiographs of lower esophagus, stomach, duodenum
- using Barium as a contrast medium
Pre-Op: NPO after midnight, no smoking, laxative night before
37
How does smoking affect blood vessels
constricting
38
*** Gastric Analysis
Aspirating contents of stomach to determine amount of acid (HCL especially) being produced.
39
What 2 main things are they looking for with a Gastric Analysis?
- amount of HCL acid
| - presence of H Pylori bacteria
40
What is procedure for Gastric Analysis prep.
- NPO 8-12 hrs
- via NG tube
- tell pts it w be uncomfortable
41
(EGD) Esophagogastroduodenoscopy
Direct visualization of upper GI w long flexible scope.
42
What is EGD used for?
patients with
- trouble swallowing
- gastric refulx
- peptic ulcer disease
- ---
- NPO 8hrs before test
- local anesthesia
- remove duntures
43
EGD Post-Op?
- look for NO upper GI bleeing
| - NO eat/drink until gag reflex returns ***
44
SS of GI Bleeding
- severe back/abdominal pain
| - diff swallowing not getting better
45
Barrium Swallow
- more thorough look @ esophagus/upper GI
- see antimicrobial anomalies (i.e. hyatal hernia or ulcers)?
- NPO 8hrs
46
Bernstein Test (Acid Perfusion Test)
- attempt to reproduce SS of gastro esophageal reflux to measure esophageal function
- differentiates btwn reflux pain and Angina (cardiac pain)
The test is done in a gastroenterology laboratory. A nasogastric (NG) tube is passed through one side of your nose and into your esophagus. Mild hydrochloric acid will be sent down the tube, followed by salt water (saline) solution. This process may be repeated several times.
47
Stool for Occult Blood
- checking for benign/malignant tumors.
| - Frank (fresh red) blood would indication hemorrhoids.
48
Sigmoidoscopy
- visualize lower GI.
- use flexible scope w ability to remove tissue.
- can take biopsy from Anus, rectum or sigmoid colon.
49
Barrium Enema
Xray/radiographs of colon to detect presence and location of polyps, tumors and diverticula.
50
Colonoscopy
- Entire colon examined (Anus - Secum)
| - use fiberoptic cam on flexible tube to see ulcerations/ployps. Biopsy of lesions
51
Stool, Culture, Sensitivity
- Examine stool for ova and parasites
| - 3 stool samples, 3 days consecutively
52
Flat Plate of Abdomen (Obstruction Series)
- KUB (kidneys, ureter, bladder)
- series of xrays on pts suspecting bowel obstruction, paralytic illeus, perforated viscous, abdominal abcess
An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the spleen, stomach, and intestines.
When the test is done to look at the bladder and kidney structures, it is called a KUB (kidneys, ureters, bladder) x-ray.
53
***Dental Placque and caries: Etiology/Pathos
***erosive process resulting from action of bacteria on carbs in mouth, which produce acids that dissolve tooth enamel
Rx: proper technic brushing/flossing. Cavity fillings
54
Most common type of Candidiasis
Yeast infection (Candida Albicans)
55
Candidiasis Etiology/Pathos
- infection by species of candida, usually Candida Albicans
- fungus normally present mouth, intestines, vagina, on skin
- AKA Thrush (usually in mouth) and monoliasis
56
Candidiasis manifestation
- small white patches on mucous membrane of mouth
- thick white discharge in vag
- diaper rash
- if untreated will go into blood
- also found in pts w Leukemia, DM, ETOH, LT steroids, LT antibx, chemo, radiation
57
Candadiasis Rx
- Nystatin (oral/vag tabs)
- half strength hydrogen peroxide/saline mouthwash
- Ketoconazol oral tab (Nizoral, used topically for ring worm, athletes foot, jock itch)
- meticulous handwashing
58
Cold Sores
herpes simplex virus (mouth/genital)
59
Cold Sore Rx/Prevention
- comfort and prevention
- can transfer to other areas
- keep moist to prevent drying and cracking. cracking can release pus and spread it
- Abreva (only FDA approved to shorten duration)
- Lydocaine, local anesthesia (relieve pain/itching/drying)
- oral analgesics (Motrin, Tylenol, Naproxin)
- sun protection (clothing/sunscreen)
60
What will drying and cracking of a cold sore cause?
secondary infection
61
Canker Sore
- blisters in mouth/gums
| - painful
62
Canker Sore Rx
- Anti Inflamm paste (Apthasol): controls pain and helps healing. Put directly on sore at first sign.
- Topical Analgesic (benzocaine, butacaine), apply right before eat/drink to prevent pain.
- Peroxide/H20 saline wash
63
Mucositis
- inflammation of mucous membranes
- often in CA pts 5-7 days after Chemo/Radiation
- Poor nutrition resulting from people not eating due to pain
64
Mucositis Rx
- Topical Anesthetic: Lidocaine (swish/spit)
- Viscous lidocaine b4 meals
- MOM (milk of mg), coats mucous membranes
- Nystatin liquid (swish/spit)
- Sucralfate Suspension, topical pain reliever
- Kepivance, approved for tretaing leukemia/lymphona pts undergoing chemo.
65
SE if Lidocaine
- diminished sense of taste
- burns from hot food (due to numbing)
- bite cheek
66
Halitosis
- chronic bad breath
| - eliminate causes, smoking, certain foods
67
Xerostomia
- Dry mouth
- use artificial saliva
- ensure proper denture fit
68
Carcinoma of Oral Cavity
- malignant lesions on lips, oral cavity, tongue or pharynx
| - usually squamous cell epithelioma (metastasize quickly)
69
Carcinoma of Oral Cavity manifestations
- Leukoplakia
- roughened are on tongue
- difficulty chewing, swallowing, speaking
- edema, numbness, loss of feeling in mouth
- earache, face ache, toothache
70
Tumors of Salivary Glands prognosis
usually benign
71
Tumors of Submaxilary gland
- high malignancy rate
| - painful, can impair facial functioning
72
Kaposi's Sarcoma
- Lesions of skin (AIDS)
- malignant skin tumors
- leg in men 50-70
- seen in oral cavity of AIDS pts.
- purple, non ulcerated
- Radiation is Rx of choice
73
Epithelioma
an abnormal growth of the epithelium, which is the layer of tissue that covers the surfaces of organs and other structures of the body.
74
CA of tongue and floor of mouth
- often seen together because they spread to adjacent tissue rapidly
- by the time noticed, 60% pts already metastasized to neck
- more prevalent in drinkers and smokers
- men 10-20 d/t chewing tobacco
75
Heavy Drinking = how many drinks per week
21 drinks or more per week
76
Cancer of Lip
-high cure rate because easy to see and treat.
77
Why does smoking and drinking increase rates of cancer?
- ETOH has dehydrating effect of cell walls and allows tobacco carcinogens to absorb more readily into mouth tissue.
- drinking lowers body's ability to use antioxidants to fight disease/CA.
78
Leukoplakia
- pre-cancerous lesion found inside lining of mouth or on tongue (on the Buccal Mucosa)
- can also form on female genitals
- more common in elderly (? not convinced)
79
Hairy Leukoplakia
furry looking Leukoplakia. usually on Immunocompromised pts. (i.e. HIV, most common sign of HIV.)
- slow developing, then becomes rough, sensitive to heat, foods
- biopsy to look for CA
- can be surgically removed
80
Leukoplakia can develop from...
- irritation
- ill fitting dentures
- fillings, crowns
- pipe smoking, chewing tobacco
- more common in elderly? (not sure about that)
81
Leukoplakia Subjective Data
- lesions usually asymptomatic
| - noticed as disease progresses then notice difficulty swallowing, loss of feeling
82
Leukoplakia Objective Data
usually dentist to notice pre-malignant lesions
83
Carcinoma of Oral Cavity Etiology/Pathos
- malignant lesions on lips, oral cavity, tongue or pharynx
- Usually squamous cell epitheliomas
- metastasize quickly
84
Carcinoma of Oral Cavity S/S/Manifestations
- Leukoplakia
- not many symptoms, less obvious
- sore throat
- UP salivation
- Diff swallowing, chewing, speaking
- blood in sputum
- lumps/edema around neck
- hoarseness
- roughened area on tongue
85
Carcinoma of Oral Cavity: Dx Tests
- Indirect Laryngoscopy (examine soft tissue)
| - Excision Biopsy (most accurate test)
86
?? Carcinoma of Oral Cavity more common in
Men OVER 40 w hx of Dysphasia, Smoking, ETOH ??
87
Carcinoma of Oral Cavity: Med mgt and Interventions
Stage 1: Surgery or radiation
Stage 2/3: Both surgery and radiation
Stage 4: Palliative
Beneficial to have a holistic approach w pts.
- awareness of pt knowledge
- emotional response and coping
- spirituality
- don't generalize, all surgeries diff. metastasize or not
- can be very disfiguring
- family/friends/social work support important
88
Carcinoma of Oral Cavity: Prognosis
Survival rate: under 50%
| 5 yr survival rate: 53% white, 34% AfAm
89
Carcinoma of Oral Cavity: Prevention
- Avoid excessive sun/wind exposure (face/lips)
| - QUIT Smoking
90
What is the most effective Dx test?
Biopsy to determine stage, then determine treatment
91
Carcinoma of Esophagus: Etio/Pathos
Malignant epithelial neoplasm that has invaded the esophagus
- 90% squamous r/t ETO, Smoking
- 6% adenocarcinomas r/t reflux espophagitis
92
Carcinoma of Esophagus: SS
-progressive dysphagia over 6 mos
w start w big food - soft food - liquids
-hoarsness
-by the time symptoms start and patient knows is 12-18mos.
-BAD prognosis, pt often older, fast metastasis, near lymph nodes, accessible to heart and lungs.
-5y survival rate - 12% :(
93
Carcinoma of Esophagus: MM/NI (med mgt, Nurs Interv)
- radiation, curative or palliative
- Sx: palliative or curative
- Chemo
94
Carcinoma of Esophagus: Sx procedures
- Esophagogastrectomy
- Esophaggastrotomy
- Esophagoenterostomy
- Gastrostomy
95
NOT ON TEST:
| -Esophagogastrectomy
resectoin of lower esophageal section forming two blood vessels together (anastomosis) to reconnect esophagus and stomach
96
NOT ON TEST:
| -Esophaggastrotomy
resection of portion of esophagus w anastomosis directly onstomach
97
NOT ON TEST:
| -Esophagoenterostomy
resection of esophagus w anastomosis to colon
98
NOT ON TEST:
| -Gastrostomy
insert catheter into stomach then suture to abd wall (Gtube, temp or perm)
99
Achalasia (failure to relax): Etio/Pathos
- cardiac sphincter of stomach can not relax
- d/t nerve degeneration: LO motility in lower portion Esophagus (constriction), absence of peristalsis
- esophageal dilation: dilation of lower portion of esophagus. no food can go in, so food back up (can hold up to 1L of fluid)
- hypertrophy (Inc size of organ).
- common, 20-50yr,
100
Achalasia (failure to relax): SS
* **Dysphasia (PRIMARY SYMPTOM)
- Regurgitation of food
- substernal chest pain
- loss of weight, weakness (d/t not eating)
- poor skin turgor (dehydration)
101
Achalasia: Dx tests
- Radiologic Studies
| - esophagoscopy
102
Achalasia: MM/NI
- medications: Anticholonergics, nitrates, calcium channel blockers
- dilation of cardiac spinchter (inflate baloon repeatedly in spinchter to stretch open)
- surgery (Cardiomyectomy)
103
Achalasia: Meds
- Anticholonergics: dec secretions and motility of GI tract. Anticholiergics (i.e. Atropine Scopalomine)
- Nitrates: relax peripheral vascular smooth muscle. reuslts indilation of artery and veins (i.e. Nitrobid/Nitrosta)
- Calcium channel blockers: reduces Ca flow, smooth muscle , Dec muscle spasms. (normally hypoCa would cause spasms, but since this condition involves overcontracting of Esop
104
Achalasia: Sx
```
Cardiomyectomy
-preferred sx approach
-longitudinal incision, not thru mucous membrane
-2/3 incision in esophagus
-1/3 in stomach
Good prognosis
```
105
GERD: Gastroesophageal reflux disease: Etio/Pathos
Backward flow of stomach acide into the esophagus
106
GERD: SS
- heartburn (Pyrosis) 20min - 2hrs after eating
- Regurgitation
- Dyspaghia or odynophagia (sensation of burning squeezing pain w swallowing)
- eructation (belching/flatulance)
107
What is the #1 complaint of GERD?
Pyrosis (heartburn).
d/t innapropriate relaxation of LES in response to unknown stimulus. reflux allows acid to flow back up into lower esophagus.
-usually after meal
-pts over 60 w reflux have delayed emtying
-40% population has
-all age groups
-Pyrosis can radiate up neck, jaw, back, shoulder similar to MI (heart attack)
108
GERD: Dx test
- Esopogeal motility
- Bernstein test
- Barrium swallow
- Endoscopy
- 24 pH test
109
GERD: Dx test, Esophageal manometry
used to measure fx of LES and muscles of the esophagus. will tell your doctor if your esophagus is able to move food to your stomach normally.
- measures coordination and force exerted b muscles of esophagus
- measures rhythmic muscle contractions (peristalsis) that occurs when swallow
110
GERD: Dx test, Bernstein test
MORE COMMON TEST
- NPO 8 hrs
- thin flex tube down esophagus. Solution of saline and acid thru tube intermittently. w ask person if and when they feel Pyrosis. Yes = positive.
- 80% accurate Dx GERD
111
GERD: Dx test, 24hr pH test
records frequency, duration and severity of reflux episode
112
GERD: Dx test, Barrium Swallow
- w endoscopy tube
- NPO 8hrs
- can see anatomical anomalies
- can rule out Esophgytis, malignancy, tumors
- use GASTROGRAFIN if allergic to Barrium
113
Substitute Contrast if allergic to Barrium?
Gastrografin
- more H2O soluble than Barrium
- easily absorbed by surrounding tissue
114
GERD: MM/NI
- Antacids/acid blocking meds (LO HCL, UP Gastric pH) H2 receptor antagonist
- diet 4-6 sm meals, low fate, adequate protein, remain upright for 1-2 hrs after eating
- QUIT smoking
- avoid tight clothing
- HOB up at least 6-8" for sleeping
- avoid acidic foods, caffeine
- eat/chew slowly/thoroughly
- no eating 2-3 hrs before hs
115
Frequent bouts of GERD can cause
- asthma attacks
- sever chest pain
- esophageal stricture
116
esophageal stricture
narrowing of the esophagus, the passageway from the throat to the stomach. Stomach acid, accidentally swallowed harsh chemicals, and other irritants may injure the esophageal lining, causing inflammation (esophagitis) and the formation of scar tissue
117
GERD: Meds, Acid Blocking
H2 receptor antagonist (DOWN HCL, UP Gastric pH)
- Tagamet (older drug)
- Zantac
- Pepsid
- Axid
118
GERD: Meds, PPI
Proton Pump Inhibitors
- more powerful than acid blocking
- new, more effective
Reglan?: INC peristalsis w/out stimulating secretions
-Prilosec, Nexium, Protonix, Aciphex, Previcid
119
Fundoplication
last resort Sx procedure to strengthen sphincter
-prevent stomach contents from returning to the esophagus (food tube). This is achieved by wrapping the upper portion of the stomach (fundus) around the lower portion of the esophagus.
120
Barretts Esophagus
If GERD left untreated
- replacement of normal epithelium squamous cells with columnar cells
- lead to adenocarcinoma
121
Hiatal Hernia
stomach bulges up through diapragm
122
OBESITY
- Worldwide problem, esp in industrialized nations
- 300,000 deaths/yr
- Contributes to morbidity of HTN Cardiac Disease.
- Bariatrics: specialty, Control Obesity
123
Contributors of Obesity
- Lifestyle: sendentary, lack of excercise, kids not playing outside, too much fast food, overconsumption, soda
- Genetics
- Meds: UP appetite/UP weight
- Emotional eating
- Age
124
Obese
20% over average heigh/weight
125
How many obese in US?
Half of Americans / 40 mil
126
Obesity contributing factor to other disorders
DM2, HTN, Hyper Lipdemia, CAD, SleepApnea, Arthritis, Coliliathis, knee problems
127
Obese men see Decrease in what hormone?
Sex
128
Obese women see increase in what?
Menstrual Irregularities
| -more prone to polycystic ovarian syndrome
129
BMI
weight (lb) x 703 / ht in inches2
130
BMI of obesity
OVER 30
131
What BMI to be a candidate for Barriatric Sx?
OVER 40
132
Obesity: Tx
- low calorie diet
- exercise
- supervision under physicians care
- stress reduction
- MEDS: appetite suppressants (block fat absorption), short term, (Merida, Xenical)
133
MED: Meridia (SSRI)
App Suppressant. Enhance feeling of fullness. UP Metabolic Rate.
S/E: insomnia, dry mouth, constipation
134
MED: Xenical
- inhibits lipase
- causes fats to remain undigested and unabsorbed fats
- DECREASE calorie intake
S/E: can cause explosive diarrhea (if eat wrong high fat food), N/V, Abd cramping
135
Bariatric Sx
- need BMI OVER 40
- Gastric Band
- Gastric Bypass
- Gastric Sleeve
136
Bariatric Sx: Gastric Band
- reduce capacity of stomach by using band to create small pouch by entrance to stomach, below esophagus
- adjustable band, hollow silicon band, inflate and de-inflate w Saline
- port to adjust under skin
- usually 50-100lb (under 100lb)
- can cause some erosion or leakage at banded area
S/E: 1/3 pts develop Gall Stones
137
Bariatric Sx: Gastric Bypass
small stomach pouch formed. Re-route SI to pouch. Bypass lower stomach, duodenum, jejunum
S/E: vitamin deficiencies, less absorption, 1/3 pts develop Gall Stones
Post Op: Multi vits for life. Ca
138
Bariatric Sx: Gastric Sleeve
Remove portion of stomach and create pouch w remaining stomach.
S/E: malabsorbstion, 1/3 pts develop Gall Stones
Post-Op: vit supp for life
139
MED: Actigall
re Bariatric Sx
Ursodeoxycholic acid (Actigall)
Brand names: Urso, Actigall
May treat: Gallstones, Biliary cirrhosis
Drug class: Bile acid
140
Bariatric Sx: NM
- diet/education
- monitor VS, weight
- exercise program
- keep food diary (``weight watchers)
- weekly mts, support group, counseling/guidance
- post-op care
- laprascopic Sx reduces chance of infection, healing time, bleeding, less scarring
- in hospital 1-5 days post op
- sometimes NG tube used. Dont reposition tube. Might disrupt sutures.
- 1oz liq after Sx per meal, then increase. Clear liq --> broth --> pureed food --> 6wks to whole food.
- dont feel hungry
- under care of Bariatric doc for life
141
Acute Gastritis
- Inflammation of the lining of stomach
- associated w ETOH, smoking, stressful physical problems, MEDS: NSAIDS, Corticosteroids
- H Pylori (20-50%cases)
142
Acute Gastritis: S/S
Objective:
- Vomit
- hematoemesis
- Melena (blk tarry stool) d/t gastric bleeding
- Diarrhea (contam food?)
Subjective:
- Fever/Headache (not common)
- Epigastric pain, N/V (after eating)
- Coating on tongue (w chronic gastritis, not acute)
- Loss of appetite
- anorexia
- sharp nagging pain
143
Acute Gastritis: Dx Tests
- stool for occult blood
- WBC (infection?)
- E (elevated hematocrit?)
- Gastric Tissue Biopsy
144
Acute Gastritis: MM
- Anti emetics (Zofran, Compizine, Tygan (supp or PO))
- Antacids (H2blockers:Zantac, Pepsid, Tagamet PPI: Nexium, Prylosac, Protomix (DECREASE Stomach Acids))
- Antibiotics
- IV fluids
- NG tube and administration of blood, if bleeding
- NPO until SS subside
145
Acute Gastritis: Post Op/NI
- recording I/O
- monitor tolerance to all feedings
- Pt. Teaching: drugs/food that can irritate stomach (aspirin, NSAIDs, ETOH, Tobacco, spicy foods)
Prognosis GOOD w lifestyle changes
146
Peptic Ulcers
- crater like lesions resulting from Necrosis accompanied by inflammatory, malignant process of mucous membrane of GI tract or even deeper structure of GI track
- common in stomach (GASTRIC) + DUODENAL (S.I. where most dig takes place. Pancreatic juices here)
- affects more MEN than women
- UP in older adult d/t INC use of NSAIDS/Aspirin (pain/arthritis)
147
Peptic Ulcers: Cause
- Acid and Pepsin imbalances
| - H. Pylori
148
Peptic Ulcers: Umbrella term for
stomach (gastric) + duodenum (S.I. where most dig takes place. Pancreatic juices here) ulcers
149
What is the shared characteristics of Gastric and Duodenal Ulcers?
- both covered w mucous membrane for protection from breakdown from digestive juices/enzymes
- mostly caused by H. Pylori bacteria
150
Duodenal Ulcer: SS
- aching/burning in upper mid portion of abd, hunger like pain, 2-5 hrs after eating (tummy usually empty)?
- pain in middle of the nights, more acid secretion at night
151
Gastric Ulcer (Stomach)
- immediately after eating
- doesn't respond to antacids well
- eating doe NOT cause pain to subside. Maybe worse.
152
Helicobacter Pylori (H. Pylori)
- spiral shaped bacteria
- grows and lives in digestive tract
- cause of MOST stomach ulcers (70% gastric ulcers, 95% duodenal ulcers)
- Most contract this bacteria in childhood but adults can also contract
- can live in body for years before symptoms
- most DO NOT get ulcers
- attacks lining of mucosa. after enough damage, gives Acid access to cause ulcers, to cause more damage.
- from contaminated food
- more common in countries/communities lacking food sewage system.
- contracted from saliva and other bodily fluids
- feces to mouth, no hand washing (that's why children pick up more readily)
- Most people show no symptoms
- SYMPTOM: If any, abdominal pain
153
Scientists are not sure what stimulates..
H. Pylori
154
Gastric Ulcers: Pathos
Gastric mucosa damaged, acid secreted, mucos erosion occurs, ulcer develops
- DISTAL half of stomach
- Aspirin/NSAIDs
- Smoking
155
Duodenal Ulcer: Pathos
Excessive production or release of GASTRIN, UP sensititviy to Gastrin, or LO ability to buffer the acid secretions
-UPPER region of SI.
156
Peptic Ulcers (Gastric/Duodenal): S/S
- pain: dull, burning, boring, gnawing, epigastric
- Dyspepsia (Indigestion)
- Hematemesis (blood in vomit)
- Melena (black tarry stool)
157
Peptic Ulcers: Dx Tests
- EGD, Esophagogastroduodenoscopy (long flex scope w cam. Detect Gastric/Duodenal
- breath test for H. Pylori
158
Breath test for H. Pylori
- stop all Antacids, PPI, H2 for 2 weeks prior
- blow into bag to determine baseline
- take urea pill (lemon flavored)
- after 30min, blow again into bag.
- If H. Pylori present, Urea w break up. If Urea changed into CO2, Positive for H. Pylori.
159
Peptic Ulcer: MM/NI
- Antacids (neutralize and reduce acid)
- Histamine H2 receptor blocker (LO acid secretions by blocking H2 receptors (Zantac, Pepsid, Tagamet,
- PPI (proton pump inhibitor) anti secretory agent of GASTRIN. Less acid --> stomach (Prylosec, Prevacid, Protonix, Nexium)
- Mucosal Healing Agents (Carafate) help protect lining of stomach
- Abx
- Diet: increase good gut bacteria
- LO protein, dairy, small frequent meals, limit coffee, etoh, smoking, aspirin, HI fiber (fruits/veg), INCREASE mucos in digestive tract (unripe bananas), honey, garlic, cabbage (Abx), yogurt, buttermilk, fermented veges. Food w flavanoids (apples, cranberries, celery, onions, garlic)
- limit caffeine (coffee, tea, soda)
160
Peptic Ulcer: more MM/NI
- Antrectomy (removal of lower portion of stomach, portion that produces gastric acids)
- Gastroduodenostomy (Billiroth 1), fundus of stomach anastemosed to duodenum. often done to remove ulcers/CA in lower stomach
- Gastrojejunostomy (Billiroth 2), duodenum completely closes. Fundus of stomach anestemosed to jejunum. used to remove ulcers/CA in fundus
- Total gastrectomy (remove entire stomach)
- Vagotomy, cur certain branches of vagus nerve to LO gastric acid secreted. Less chance of ulcer recurrence. Peristalsis greatly diminished. w Billiroth 2 to prevent gastric emptying
- Pyloroplasty, surgical enlargement of pyloric outlet d/t stenosis and provides better drainage of gastric contents
161
Peptic Ulcers: Complication after Sx
- dumping syndrome (1/3 experience)
- pernicious anemia
- iron deficiency anemia
Rx:
- 6 sm meals/day.
- UP protein/fate
- LO carbs/sugar
- Eat slowly, avoid fluids during meals
162
Dumping Syndrome
rapid emptying of undigested food into SI. Increase mvmt + peristalsis + change in BG d/t rapid dumping. Triggers pancreas to release Insulin
SS: Diaphoresis, N.V, Epigastric Pain, explosive diarrhea, borgorygmi (rumbling tummy), Dyspepsia (heart burn), Tachycardia
163
Peptic Ulcers: Cause
* ***H Pylori (MAIN CAUSE)
- NSAIDs/Aspirin
- Genetics
- Diet HI fat
- Tobacco/Caffeine/ETOH (UP acid in stomach)
Spricy Foods (NOT CAUSES, only contributing factors)
164
EGD tool...
flexible scope, NOT rigid
165
Bleeding Ulcers
- vessels under erosion could cause the bleeding
- Black Tarry Stool
- Abdominal Pain
- Hematoemesis
- Weakness/Light Headed
166
Bleeding Ulcers: MM/NI
- Endoscope to cauterize area
- Sx (main option, Enterctomy, remove lower portion of stomach)
- Pyloroplasty, open pyloric outlet to provide drainage
- Billiroth 1 and 2
167
NI post op for NG Tube
- don't move around, may rupture sutures
| - ensure tube patency, flush
168
Dumping Syndrome: Rx
- Anticholinergics to DECREASE motility
| - diet: complex carbs, food, UP fiber
169
Dumping Syndrome: Complications
- reflux esophogitis
- nutritional deficits
- malabsorbtion
- anemia + vit deficiency
170
Pernicious Anemia
serious complications d/t total gastectomy or extensive resectoin, bleeding ulcers.
- caused by deficiency of Intrinsic Factor (aids in B12 absorption.
- measure B12 every 2 years, all patients, if lo, will initiate replacement therapy to replace B12.
171
Iron Deficiency Anemia
- most common cause, after gastric surgery, d/t Malabsorption d/t removal of portions of intestines
- take Fe supplements
172
Reasons to use NG tube
-for decompression (removal of secretions and gas from GI tract to relieve abd distention.
Post OP
- don't move around, may rupture sutures
- ensure tube patency, flush
173
Gastroenteritis (Stomach Flu)
- Inflam of stomach and intestines
- cause: bacterial (food psn? Salmonella, E. Coli), Viral (usually norovirus, oral fecal route, bad hand washing), parasitic, infection, toxins
174
Gastroenteritis (Stomach Flu): SS
- Diarrhea
- Abd discomfort
- Vomitting
- Anorexia
175
Gastroenteritis (Stomach Flu): Rx
- key tx is fluids d/t dehydration (V/D)
- if bacterial can take Abx
- IV fluids if vomiting alot
- antiemetic (Zofram, Compazine (oral/rectally))
- anti diarrheal
- OTC Immodium
176
CA of stomach: Ethos
- most commonly adenocarcinoma
| - primary location: pyloric area w matastecis to lymph nodes, liver, spleen, pancrease or esophagus
177
Stomach CA: Risk factors
- Hx of polyps
- pernicious anemia
- hypochlorhydria (LO HCL)
- Gastrectomy; chronic gastritis, gastric ulcer
- Diet HI Salt, Preservatives, Carbs, smokes, nitrates
- Diet LO fresh fruit/vege
- Infection of H Pylori, esp in early age, teens
178
Stomach CA: SS
- asymptomatic, early
- vague epigastric discomfort/indigestion
- postprandial fullness
- ulcer like pain that does not respond to therapy
- Anorexia, weight loss
- weakness
- blood in stools, hematemesis
- V after fluids/meals
- Anemia d/t chronic blood loss. as lesion grows, invades lining, may cause bleeding
- Ascites (POOR prognostic sign)
179
Stomach CA: Dx Test
- GI Series (inc Barrium. make sure all expelled b4 discharge)
- Biopsy (definitive test)
- Endoscopic/gastroscopic exam
- Stool for occult blood
- RBC, hemoglobin and hematocrit, serum B12 (to see if anemic/severity)
180
Stomach CA: MM/NI
Sx: Partial or total gastric resection
- Chemo and/or radiation (chemo more effective esp if metastasized)
- Celiotomy (exploratory sx. to see if metastized of abnocimal area
- look for Dehiscence (splint when coughing)
- look for Evisceration
181
Dehiscence: Contributing Factors
- coughing, malnutrition, obesity, infection can contribute
| - splint when coughing
182
Evisceration
- Intestines protrude thru wound
| - sterile dressing w warm saline over protrusion. then get doc. don't push back in.
183
Stomach CA: survival rate
5yr survival rate: 75% if early, 30% if advanced
- pts usuall gets NG tube.
- pt should know what to expect, feeding, dressing, pain meds.
- the more they know, the less anxious
- SURGEON always does the 1st dressing (change?)
- Pre Sx, build up nutrition, Parenteral Feeding, IV TPN
184
Infection of Intestines: Etio/Pathos
- invasion of alimentary canal by pathogenic microorganisms
- mostly enter thru mouth, in food or water
- person to person contact
- fecal/oral transmission
- LT Abx, cause overgrowth of C Diff
185
C Diff
- normally found in intestines
- Bad intestinal flora, kept under control by good bacteria.
- Abx also reduce good bacteria, not good
- If C diff strong enough, could overpopulate and lead to C Diff Colitis
186
C Diff Colitis
- creates 2 toxins
- Attack intestinal wall
- untreated can cause ulcerations
- early SS: Bloating, D, Cramping
- late SS: Flulike symp, N/V, weakness, fever
- adv SS: blood in stool, death
- pt on isolation
187
C Diff: MEDS
- Flagyl (Metronidazole): Mild-Mod (1st choice)
- Vancomycin (Vancocin): Mild-Mod (2nd choice), oral better than IV. use if pregnant, LESS THAN 10, flagyl not working)
- Dificid (fidaxomicin): as effective as Vancomycin
- Questran (Cholestyramine): powdered drink, slows bowel motility, prevent hedydration, NOT Abx
188
If have recurring C Diff infection, doc will do a ...
-Stool Transplant (Fecal Transplant): infusion of bacterial flora from healthy donor feces. Donors mixed stool w milk or saline to achieve desired consisteny
Administer: Colonoscope, Retention Enema, NG tube/Naso Duodeno tube
??Intestinal Infection: Salmonella, Clostridia??
189
E Coli
- found in 1% cattle. Can contaminate large amount of meat.
- transmitted in under cooked meats, beef, burgers, lamb, turkey, produce
- also found in contaminated pools/lakes
SS: bloody diarrhea, cramping on 2-4th day of exposure
190
AAPMC, Abx Associated Pseudo Membraneous Colitis
- complication of Tx w wide variety of Abx. Severe inflammation of L.I.
- w use sigmoidscope or colonoscope to inspect lesion from AAPMC.
- People w AAPMC, hi risk of C Diff. 90% of pts will develop
191
AAPMC and Intestinal Infection: SS
- bloody Diarrhea
- Melena
- Rectal Urgency
- Tenesmus (ineffective but painful straining w defacating)
- N/V
- Abd Cramping
- Fever
192
AAPMC and Intes Infec: NI
- Take BM history
- Have you recently been on Abx?
- contaminated pools, lakes
- recent travel?
- new restaurant?
- any shellfish allergies? Bad seafood?
- Heavy metal poisoning?
193
AAPMC: Dx Test
- Stool culture
| - Blood chemistry
194
AAPMC: Rx
- Abx
- Fluid/Electrolyte replacement (orally)
- Kaopectate (UP stool consistency)
- Pepto Bismol (LO intestinal secretion, LO volume diameter)
- Kaopectate/Pepto give in LG doses (30-60ml/30min)
195
Irritable Bowel Syndrome (IBS): Ethos/Pathos
- hypersensitivity of bowel wall
- episodes of alternation in bowel function
- spastic and uncoordinated muscle contr of colon
196
IBS: SS
- abdominal pain (chronic low abd pain, Hx of childhood sex abuse)
- frequent bms
- sense of incomplete evacuation
- flatulence, constipation and/or diarrhea
- ***can affect quality of life and lead to depression (several digestive issues)
- correlation btwn IBS and Panic Attacks
- can be associated w phsyscological probs
197
IBS: Dx tests
-History and physical exam (hx of sex abuse, family hx of IBS, Dietary Hx)
198
IBS: MM, NI
* **Diet and buking agents
| - Meds
199
IBS: Diet
AVOID
Some foods can trigger/irritate spastic colon
-Fats (venison, red meat, bacon, ham, hot dogs .
- avoid dark meat/skin
- dairy prod
- fried food
- oils, mayo , salad dressing
EAT
- whole grain bread/cereal
- UP fiber (fruits/veges)
200
IBS: Debulking agent
- Metamucil (mix w OJ, H20)
- not w ASA/Dijoxin
Give Meds 2 hrs before or after Metamucil. Metamucil w prevent absorption of Meds
201
IBS: Patient Teacher
- Coping skills
- nutrition planning (dietician)
- understand phych effects on body
- listening skills
- food diary log
- # daily stools, presence/duration of pain?
- good relationship w pt
- utilize community resources (support group, clinic)
202
IBD - Inflammatory Bowel Disease
- Umbrella Term : Crohn's Disease, UC Ulcerative Colitis
- Chronic episodic inflammatory disease
- usually young adults (esp Jewish, Euro descent)
- new increase among Af-Am
- Asian/Hispanic - lowest incidence
203
IBD - Inflammatory Bowel Disease: Cause
- theories, genetic/env factors
- Viral infection
- certain food allergies
- immunological factors
- pshychosomatic disorder
- periods of exacerbation/remission
204
IBD: Ulcerative Collitis
- ulceration of mucosa and submucosa of the colon
- tiny abscesses form which produce purulent drainage, slough the mucosa and ulcerations occur (capillaries bleed, cause diarrhea w pus/blood,)
- 2ce MORE common as Crohn's
- Ecoli is a factor
- can affect segments of entire colon.
205
IBD: Ulcerative Collitis: S/S
- Diarrhea (pus/blood, 5-30 stools/day)
- abdominal cramping b4 BM
- involuntary leakage of stool
206
PseudoPolyps
little projecting mass of tissue. common in UC. can become CA. become covered by regeneration of epithelial cells
207
IBD: Ulcerative Collitis: more facts
- 2ce MORE COMMONG than Crohn's
- causes social isolation. Frustration, Diff Coping and dealing w everyday life
- Abscess/ulcerations, sloughing off, forms scar tissue
- colon may lose elasticity and absorbtion
208
IBD: Ulcerative Collitis: Complications
***TOXIC MEGACOLON
toxic dilation of large bowel
-life threatening
-
209
Toxic Megacolon: S/S
toxic dilation of large bowel
-life threatening
-
210
Chronic UC (10-15yrs) can lead to...
CA of colon in 50% pts w total colon involvement
211
Chrohn's/UC: 3 main causes for flare ups?
1) Stress
2) Sickness
3) Smoking
212
IBD: UC: Dx Tests
- Barium studies (flush out b4 pt goes home)
- colonoscopy
- stool for occult blood
213
IBD: UC: MM/NI
- Meds
- Diet
- Stress control (assist pt to find coping mechanism)
214
UC Meds
MEDS
- *Azulfidine:
- *Dipentum:
- *Rowasa:
* 5 ASA (amino salicylic acid, aspirin like. chemically similar) Tx of choice/maintenance of remission in MILD - MOD UC
- Corticosteroids
- Imodium
215
UC Diet
- no milk, spicy food
- HI protein
- HI calorie
- TPN (severe only)
216
Med of choice for MILD - MOD UC
5 ASA (amino salicylic acid, aspirin like. chemically similar) -
- Azulfidine:
- Dipentum:
- Rowasa:
217
MED: Azulfidine (5ASA)
- Tx of MILD - MOD UC
- affects inflammatory response and some abd activity
- decrease inflammation
Adverse:
- bone marrow suppression
- LO sperm motility (irreversible)
- urine bright orange
- photo sensitivity
- SULFA drug - not for pts w allergies
218
MED: Dipentum/Rowasa (5ASA)
- NON SULFA drugs
- decrease ABD pain
- decrease diarrhea/rectal bleeding
DIPENTUM: PO, Increases time btwn attacks
ROWASA: retention enema, Tx of pain, inflammation
219
MED: Corticosteroids
MOD - SEVERE
| -anti-inflammatory, Codeine
220
MED: Immodium
Anti diarrheal, preferred over anti cholinergic
| -Tx of cramping/diarrhea
221
UC: MM/NI
Surgical interventions
- COLON RESECTION (remove diseased portion, reattach 2 ends)
- ILEOSTOMY (end of ileum brought through belly wall (stoma)(RT side abd)
- ILEOANAL ANASTAMOSIS (J pouch, removal of colon/rectum. Anus left intact w spinchter. Join SI and Anus)
- PROCTOCOLECTOMY (remove colon, rectum, anus. Create Stoma.)
- Koch pouch, Sx removal of rectum and colon w formation of reservoir in intestine that can be controlled w valve/catheter. Empty into toilet. no bag necessary.
222
Sx can cure intestinal disease, but LT UC can contribute to other complications which will need to be treated after Sx
liver disease, joint inflamm
223
What part of the DIG tract is affected w UC/Crohns
UC - Colon
| Crohn's - any part of GI tract
224
Crohn's Disease:Ethos/Pathos
- not as common as UC
- inflammation, fibrosis, scarring and thickening of bowel wall.
- Segments anywhere from MOUTH to ANUS.
225
Crohn's Disease: Cause
- UNKNOWN, but associated w altered immune mechanisms
- young people 15-30yrs
- can alternate w multiple segments
- ulceration DEEP and extend to ALL LAYERS of bowel wall.
- can have ulcerations of parts of Int Wall that change into horizontal rows. COBBLE STONE appearance.?????
226
Crohn's Disease: S/S
- weakness, loss of appetite
- diarrhea, 3-4 daily, w mucus/pus (no blood like UC)
- RT LOW abd pain (SI)
- Steatorrhea
- Anal fissures/fistulas
- Pernicious Anemia: Decrease B12 absorb in SI
- Fluid/E imbalance (esp Na + K) d/t diarrhea or excessive SI drainage through fistulas.
227
UC vs CROHN's
UC vs CROHN's
-Young -- Young
-2ce more com -- not as com
-LI -- anywhere on GI tract
-inflammation continuous -- inflam patches
-LLQ -- LRQ
-Colon wall thin - thick
-continuous inflam - cobble stone
-Toxic Megacolon -- NA
-ulcer in lining LI - ulcer deep thru all layers bowel wall
-5-20 bloody stools -- 3-4 diarrhea, no blood (only sm amt d/t fissures)
Sx Cures (not complications though) - Sx does not cure
-anemia d/t severe bleeding -- Pernicious Anemia (lo B12, no absorption)
228
Peptic Ulcer: DAR
D:
229
Pain: OPQRST (mike linares)
- Onset
- Provoke, what brings it on
- Quality, stabbing, dull
- Radiating?
- Severity (1-10)
- Time, how long for
230
Crohn's: MM, NI
Diet:
- HI protein (d/t malnutrition/absorption
- Elemental (minerals)
- Hyperalimentation (over feeding. nutrient demands in excess of necessary)
- TPN
Avoid:
-lactose, brassica veges (brocolli,cauli,aspar), caffeing, beer, msg, hi seasoning, soda, fatty food
231
Crohn's Elemental Diet
induces remission in 90% pts and helps w diarrhea.
- Required minimal digestion.
- LO stools
- Liquid diet w nutrients
- less stress on Dig Syst
- PO, NG tube (Criticare, Transvasorb)
232
Crohn's: more MM/NI
MEDS
- Corticosteroids (SEVERE Inflam)
- Azulfidine (5asa, Abx, Sulfa)
- Antidiarrheal/Antispasmotics (Imodium/Danitol)
- Enteric coated fish oil caps (prevent relapse)
- B12 replacement
- SX (does not cure as it does in UC)
233
Appendicitis:Ethos/Patho
- inflammation of vermiform appendix.
- UnDx, can lead rapidly to perforation and peritonitis.
- more common in Male (teens, young adults)
- Lumen of appdnix becomes obstructed (dt accum feces, tumor), Ecoli multiply, infect develops.
- If infection severe, can rupture --> sepsis -->death
- sometimes pus filled abcess w form outside inflamed appendix. scar tissue w wall appendix off from rest of abdomen. Protect from spread infection.
234
Appendicitis: S/S
- rebound tenderness at McBurne's Pt (RLQ, light palpation btwn umbilicus and RT illuem crest.
- dull --> sharp pain
- V
- Lo grade fever (99-102)
- UP WBC (90% pts have WBC UP 10,000. Norm is 43-10K)
- Loss of appetite
235
Blumberg's sign (rebound tenderness)
clinical sign that is elicited during physical examination of a patient's abdomen by a doctor or other health care provider. It is indicative of peritonitis. It refers to pain upon removal of pressure rather than application of pressure to the abdomen.
236
Appendicitis: Dx tests
- WBC
- Roentgenogram (abd CT)
- US
- Laparoscopy (sm incision in abd, scope w camera, min invasive sx)
237
Appendicitis: MM/NI
Appendectomy - remove appendix
- mortality rate related to performation
- if rupture occors, Abx stat
- profilactically
238
Appendicitis: Comlications
- infection
- intra abd acess
- small bowel obstruction
239
Appendicitis: NI
- Vital Signs
- Ed on Dx tests
- bedrest
- NPO (ice for comfort)
- comfort for PAIN (no OPIODs cause w mask symptoms)
- cure rate HIGHER before rupture
- **NO HEAT (UP circulation could cause rupture)
240
Diverticular Disease: Ethos/Pathos
- Diverticulosis: pouch like herniations thru musc layer of colon
- Diverticulitis: inflammations of one or more diverticula.
241
Pts of Diverticular Disease usually have what kind of diet?
- Over 50
- HI refined, white sugar, corn syrup
- LO fiber
- sedentary lifestyle
- postpone BMs
242
Diverticulitis
- penetration of feces in diverticula causing inflammation. Lumen can narrow and become obstructed
- a complication of diverticulosis.
- undigested food trapped in diverticulum.
- bacterial invasion
- diverticula can lead to out pouching perforations, abscess, peritonitis, obstruction
243
Diverticulosis S/S
- few if any symptoms
- constipation, diarrhea, flatulence
- pain in LLQ
- Anorexia
- N
244
Diverticulitis S/S
- inflammation
- mild to sev pain, LLQ
- UP WBC, lo grade fever
- abd distension
- V
- Blood in stool d/t perforation
- bloating/gas
- loss of appetite
245
Diverticulosis MM/NI
- muscular atrophy (muscle wasting not so common)
- lo res diet (broil, roast, steam)
- stool softeners
- cheese (cheddar, swiss, american, cottage to reduce amt of BMs ????)
- bedrest
246
Diverticulosis
- w UP intracolonic pressure and muscle thickening
- ***HI fiber diet
- Sulfa drugs (Azulfidine)
- Amx, Analgesics
247
Diverticular Disease: more MM
Sx
- Hartmann's pouch (w rectal CA or sev perf)
- double barrel transverse colostomy
- transverse loop colostomy
-Start w bowel prep (lax, enem)
Golytely, intestinal lavage
-Abx orally/parentally
-if any perf, temporary colostomy
248
External Hernias:Ethos
- congenital or aquired weakness of abd wall or postoperative defect
- Abd
- Femoral/Inguenal
- Umilical
- protrusion of viscera w protrude through weakened area of abd cavity.
- Hernia can contain loop of intes/bowel or other internal organs
- Insicsional Hernia
249
Incisional Herna
weakened in abd wall at site of previous hernia
found in pts
obese
multiple Sx, same site
poor wound healing d/t malnutrition or infection
250
Abdominal Hernias
loop of bowel protruding through abd musclature
251
Femoral/Inguenal Hernia
75 - 80% of all hernias
Femoral:
-more common in women
SS: bulge in upper thigh, just below groin. Femoral artery/vein
Inguenal Canal: --> testes
(carries spermatic cord, in women, that cord holds uterus
252
Femoral/Inguenal Hernia: SS
- protrustion of abd contents thru inguenal canal
- men: bulge in scrotal area
- Pain noticeable when cough, any straining
- get better when lying down
- bulge gets larger when bearing down
RISK for Strangulation: blood supply blocked to portion of bowel
253
Umbilical Hernia
Protrusion of intestines around umbilical area (common in babies)
254
Hernias: Risk Ractors
- smoking
- COPD
- obesity
- pregnancy
- peritoneal dialysis
- older adults d/t aging/weakening
- older adults usually no symptoms
- w men, usually leave it alone if hernia not giving pain or complications
255
External Hernias: S/S
- protruding mass/bulge around umbilicus, in the inguinal area, or near an incision
- Incarcerations/Irreducible (CAN NOT be returned to body cavity b/c contents trapped d/t narrow opening in hernia. Intestinal flow can be obstructed
- Strangulation (most dangerous)
DEF: Reducible: to return hernia contents to reg postn by manual manipulation, sometimes by lying down.
256
External Hernias: Strangulation
when blood supply and intestinal flow obstructed. Can lead to infactcion of tissue --> necrosis of affected portion of bowel. Sever pain perforation --> infection --> temp UP
257
External Hernias: Dx Tests
- Radiographs
| - Palpation (of weakened wall. feel protruding viscera)
258
External Hernias: MM/NI
- if no discomfort, hernia left unrepaired
- Truss (firm pad placed over hernia site helps keep hernia from protruding. Holds hernia in place, only if it can be reduced manually)
- Sx (synthetic mesh applied to weakened area of abd wall.
- Post OP: educate pts on when to seek help. Abd pain, abd distension, UP temp, N/V
259
External Hernias: Sx
Strangulated Sx: more serious. needs open abd Sx. Longer hospital stay
Post OP:
- NG tube, IV Abx, E fluid.
- parental analgesics, until peristalsis returns
- monitor urine retention, wound infection
Inguinal Hernia Repair: can have sever scrotal edema
- help relieve edema by elevating scrotum
- coughing/deep breathing. Splint
260
Hiatal Hernia: Ethos/Pathos
Weakness of Diaphragm
| -occur in 40% population
261
Hiatal Hernia: Contributing Factors
Obesity
Trauma
Aging- general weakening of supporting structures w aging
262
Hiatal Hernia: SS
- few if any
| - GERD, heartburn after over eating
263
Hiatal Hernia: Complications
- strangulation
- infarction
- ulceration of herniated stomach
264
Hiatal Hernia: MM/ NI
- head of bed slightly elevated
Sx:
- posterior gastropexy (stomach returned back to abd and sutured in place.)
- Transabdominal Fundoplication: Fundus wrapped around esophagus
Prognosis good
265
Intestinal Obstruction: Ethos
- Intestinal contents can not pass through GI tract
- partial or complete
MECHANICAL(occlusion of lumen of the intestinal tract. Mostly ileum, narrowest party of SI.
- 90% of all intestinal obstruction d/t Adhesions usually after Abd Sx. Surfaces bind to one another.
- Incarcerated (ireduceable) Hernia - can't return to body cavity, they can become twisted and trapped
- volvulus= strangulation
NON MECHANICAL d/t neurological vascular disorders
- Paralytic Ileus, usually after abd Sx. Absence of intestinal peristalsis
- Inflam response (Pancreatitis, Acute Apendicitis)
- E abnormalities
- Thoracic/Lumbar spinal trauma
- Vascular Obstructions (embolus, atherosclerosis)
266
Intestinal Obstruction: SS
- vomiting w feces
- dehydration
- abd tenderness and distention
- constipation
- diminished , complete absence of bowel sounds
267
Intestinal Obstruction: Dx tests
- radiographics exam (and X-rays) can show gas/fluid in abd
- UP BUN, LO K, LO Na, LO hemoglobin, UP hematocrit
- NPO until peristalsis returns
268
Intestinal Obstruction: MM/NI
Evacuation of Intestine
- NG tube to decompress bowel (attached to LO continuous suction, used for most vowel obstruction, Short Term: used to remove gastric secretions, abd bloating, V, provide w to feed and give Meds.
- Nasointestinal tube w Mercury weight ( don't use anymore)
- ND: NasoDuedenol / NJ (NasoJejunum): for people w problems digesting food or who aspirating
269
Mechanical Obstruction: MM/NI
- monitor vs
- monitor fluid E
- tubes to decompress and relieve obstruction
- ensure placement of tubes
- NonOpioid pain Meds b/c OPIOIDs w decease intestinal motility
- emotional support
- Fowlers position
- encourage nose breathing, no swallowing air
- deep breathing/cough/splint
- tubes in place until bowel action returns
- assess for bowel sounds
- measure bowel girth
270
Intestinal Obstruction: Prognosis
Depends on early detection as well as success of Sx
Poor prognosis for pts w major complications (I.e hypovolemic shock )
- decrease BP
- threads pulse
- rapid breathing
