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z_NUR411_Medsurge: UNIT 2 > Stomach Disorders: Surgical Interventions > Flashcards

Stomach Disorders: Surgical Interventions Flashcards

1
Q

What are the 6 surgical interventions for peptic ulcer disease and gastric cancer?

A
  • Total gastrectomy
  • Vagotomy
  • Gastric Resection (antrectomy)
  • Billroth I (Gastroduodenostomy)
  • Billroth II (Gastrojejunostomy)
  • Pyloroplasty
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2
Q

What is pyloroplasty?

A
  • Pyloroplasty is surgery to widen the pylorus.
  • Involves cutting through and removing some of the pyloric sphincter to widen and relax the pylorus.
  • This makes it easier for food to pass into the duodenum.
  • In some cases, the pyloric sphincter is entirely removed
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3
Q

What are some conditions that precipitate pyloroplasty?

A
  • Pyloric stenosis
  • Peptic ulcers and peptic ulcer disease
  • Gastroparesis, or delayed stomach emptying
  • Vagus nerve damage or disease
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4
Q

What are the two ways pyloroplasty can be performed?

A
  • Open surgery
  • Laparoscopic surgery
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5
Q

Describe an open pyloroplasty.

A
  • A longitudinal incision is made along the pylorus
  • Make several small cuts through the muscle of the pylorus sphincter muscles, widening the pyloric opening.
  • Stitch the pyloric muscles back transversely
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6
Q

What gastric function does the vagus nerve serve?

A

• Vagus nerve fibers from the medulla stimulate the parasympathetic nervous system of the stomach which, in turn, stimulates gastric secretion

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7
Q

What is a vagotomy?

A

• A surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion

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8
Q

What is a truncal vagotomy?

A
  • This procedure cuts out part of the vagus nerve at the gastroesophageal junction
  • After this surgery, the stomach won’t have nerve supply, which can reduce gastric acid to about 50%
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9
Q

How does the vagus nerve affect gastric motility and how is it affected by a vagotomy?

A
  • Gastric motility is regulated through the vagus nerve
  • After vagotomy the stomach becomes atonic and hypomotile
  • The small intestine also receives its parasympathetic nerve supply through the vagus and vagal stimulation can cause increased motility of the small intestine.
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10
Q

What is a selective vagotomy?

A

• More precise than truncal vagotomy
• Only the part of the nerve that goes to the stomach is removed, and the vagus nerve connection to the gallbladder and intestine is left in place
o Gastric branches severed, hepatic branches preserved

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11
Q

What is a highly selective vagotomy?

A
  • This procedure is also called parietal cell vagotomy and is the most precise option.
  • It involves removing part of the vagus nerve only where it connects with the parietal cells in the stomach wall that release gastric acid.
  • The rest of the nerve is left there where it can still stimulate the pyloric valve
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12
Q

What is an anastomosis?

A

• A connection made surgically between adjacent blood vessels, parts of the intestine, or other channels of the body, or the operation in which this is constructed.

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13
Q

What is a Billroth I procedure?

A

• The partial gastrectomy is performed with anastomosis to the duodenum

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14
Q

What is a Billroth II procedure?

A
  • The partial gastrectomy is performed with anastomosis to the jejunum
  • Former site of pyloric sphincter at duodenum is sewn shut
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15
Q

A billroth I is also called a…

A

• Gastroduodenostomy

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16
Q

A billroth II is also called a…

A

• Gastrojejunostomy

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17
Q

Explain a total gastrectomy procedure.

A
  • The stomach and pylorus removed with anastomosis to the jejunum
  • Duodenal stump is sewn shut
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18
Q

What is the Roux-en-Y procedure?

A
  • Total gastrectomy procedure with an adjustment to jejunum/duodenal junction
  • Former site of pyloric sphincter at duodenum is sewn shut
  • Duodenum is severed from the jejunum
  • Jejunum is attached to esophagus
  • Duodenum is re-attached further down the jejunum
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19
Q

In a total gastrectomy, why is the duodenum attached further down the jejunum.

A

• It allows time for the digestive juices from the pancreas to travel down to the jejunum and mix with chyme before proceeding into the small intestine

20
Q

Why will a pt with a total gastrectomy require Vit B12 supplementation?

A

• Production of intrinsic factor is removed with the stomach and unless supplements are taken, there will be a reduction in RBC production and pernicious anemia will result

21
Q

What is a possible surgical complication of Billroth II and total gastrectomy, but not Billroth I?

A
  • Duodenal stump leak
  • Leakage of the blind end of the duodenum
  • Typically, on the fourth or fifth day after surgery
  • It is due to improper closure of duodenal stump, especially when the duodenum is inflamed and edematous.
22
Q

What is gastric decompression used for?

A

• To control of gastric distention and vomiting

23
Q

Gastric decompression protects the patient against…

A

• the bronchial aspiration of gastric contents

24
Q

Gastric decompression encourages the adequate and rapid…

A

• healing of intestinal suture lines

25
Q

Gastric decompression minimizes the incidence of

A

• Abdominal wound dehiscence and evisceration

26
Q

Gastric decompression decreases the incidence of…

A

• postoperative adhesive obstruction

27
Q

The NG tube used for gastric decompression should be no greater than ___ for ease of passage and pt safety.

A

• 5/8”

28
Q

What kind of NG tube is used for gastric decompression and why?

A
  • A double-lumen nasogastric tube.
  • There is one large lumen for suction and one smaller lumen to act as a sump.
  • A sump allows air to enter so that the suction lumen does not become adherent to the gastric wall or become obstructed when the stomach is fully collapsed
29
Q

After placement of NG tube for gastric decompression or feeding, what is the priority action?

A
  • Check placement w/ xray
  • Tape down well when confirmed
30
Q

What are the top 3 post-op complications of gastric surgery?

A
  1. Bleeding
  2. Dumping Syndrome
  3. Diarrhea
31
Q

With gastric removal or resection, comes a decrease in intrinsic factor that reduces or eliminates vitamin b12 absorption. What conditions can result due to this?

A
  • Iron deficiency anemia
  • Pernicious anemia
  • Megaloblastic anemia
  • Folic acid deficiency
  • Fluid and Electrolyte imbalance
32
Q

How does rapid gastric emptying result in anemia?

A

• Decreases absorption of iron

33
Q

A pt had a Billroth II and is complaining of severe abdominal pain. You observe a bile stained dressing, what do you expect is the issue?

A

• Duodenal stump leak

34
Q

A gastric post-op pt starts to vomit while having their vitals taken. What immediate actions should the nurse take?

A
  • Raise HOB
  • Check airway
  • Check breathing
  • Double check NG tube placement (and that it is on)
35
Q

Why do we want to prevent N/V in a gastric post-op pt?

A

• The pressures of vomiting can rupture incisions

36
Q

How often do we run a CBC for a gastric post-op pt and why?

A
  • Every 8hrs
  • To check for electrolyte imbalance
37
Q

Bleeding is the number 1 gastric post-op complication. Where and when does it typically occur?

A
  • At the anastomosed site
  • w/in the first 24hrs and
  • post-op days 4-7
38
Q

Besides checking the incision site/bandage, how else can we assess for bleeding in a gastric post-op pt?

A

• Check NG tube for stomach contents

39
Q

Why is a gastric post-op pt on NG suction for the first few days after surgery?

A
  • Should bleeding occur:
    • It can be discovered immediately
    • It will avoid pressure build up, thus N/V complications and prevent wound dehiscence
40
Q

Bleeding is typical after gastric surgery, how are we monitoring healing via the NG tube?

A
  • Monitor suction container for volume and color over time.
  • Be sure to measure OP at the end of every shift and document amount and color
41
Q

It is day 6 post gastric surgery and the pt is found to have gastric retention. What action should the nurse take?

A

• Insert NG tube and initiate suction

42
Q

Why does gastric surgery lead to a malabsorption of fat?

A
  • Surgery results in
    • Decreased stomach acids
    • Pancreatic secretions and
    • Increases upper GI mobility cutting down available absorption time
43
Q

When assessing gastric aspirate, when do we expect to see w/in the first 24hrs?

A

• Bright red blood at first, then it should darken

44
Q

When assessing gastric aspirate, when do we expect to see w/in 36-48hrs?

A

• Color should change to yellow-green

45
Q

How often are we checking VS after gastric surgery?

A

• Every 4hrs

46
Q

What are s/s that indicate gastric post-op intestinal obstruction?

A
  • Decreased peristalsis
  • Lower abdominal discomfort

z_NUR411_Medsurge: UNIT 2 (25 decks)

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