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Med Surg > 41 - Upper GI Problems > Flashcards

41 - Upper GI Problems Flashcards

1
Q

patients w GI problems are likely to have…

A
  • malnutrition fr impaired nutritional intake
  • altered fluid
  • electrolyte imbalance
  • pH imbalance
  • difficulty w eating drinking talking
  • sleep problems
  • fatigue
  • aspiration
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2
Q

most common manifestations of GI disease

A

n/v

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3
Q

NG tubes

A

used for decompression

may before persistent vomiting, bowel obstruction, paralytic ileus,

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4
Q

severe vomiting needs….

A

IV fluid therapy w electrolytes + glucose replacement

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5
Q

oral candidiasis aka

A

moniliasis or thrush

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6
Q

oral candidiasis/thrush

etiology

A

candida albicans
-prolonged high dose of abx or corticosteroid therapy

-sore mouth, yeasty halitosis, milk curds on tongue

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7
Q

oral candidiasis/thrush

tx

A
  • miconazole buccal tablets (Oravig)
  • nystatin or amphotericin B as oral suspension or buccal tabs
  • good oral hygiene
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8
Q

is GERD a disease?

A

NO, it is a symptom

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9
Q

GERD

A

chronic symptom of mucosal damage caused by reflux of stomach acid into lower esophagus

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10
Q

most common upper GI problem

A

gerd

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11
Q

GERD s/s

A

heartburn (pyrosis) + regurgitation

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12
Q

complications of GERD are due to direct local effects of _______ on the esophageal mucosa

A
  • gastric HCl + pepsin secretins fr stomach

- proteolytic enzymes like trypsin ) buile fr intestines if present

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13
Q

one of the main factors that cause GERD

A

incompetent LES

-may be due to certain foods, drugs, obesity

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14
Q

pyrosis

A

heartburn

-tight burning feeling in chest

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15
Q

severe pyrosis/heartburn occurs more than ___/wk, and is assoc w ______

A

occurs more than 2x/week

  • assoc w dysphagia
  • if occurs at night, wakes the person fr sleep
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16
Q

unlike angina, GERD related chest pain is relieved w ____

A

antacids

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17
Q

dyspepsia

A

pain/discomfort centered in the upper abdomen

–usually midline

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18
Q

resp complications of GERD

A

wheezing, coughing, dyspnea

  • bronchospasm
  • laryngospasm
  • cricholaryngeal spasms
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19
Q

common complications of GERD

A
  • esophagitis>esophageal ulcers

- Barrett’s esophagus

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20
Q

Barrett’s esophagus

A

esophageal metaplasia

  • flat epithelial cells turn columnar
  • incr risk in 60+, male, white, obese
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21
Q

metaplasia

A

reversible change fr one type of cell to another type due to abnormal stimulus
-precancerous

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22
Q

complications fr aspirations

A

irritated the airway, may cause

  • asthma
  • chronic bronchitis
  • pneumonia
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23
Q

endoscopy for GERD

A

to assess

  • LES competence
  • degree of inflammation
  • potential scarring
  • potential strictures
24
Q

lifestyle mods for GERD

A
  • head of bed is raised

- should not be supine 2-3 hrs after a meal

25
GERD | drugs
PPI: more effective than H2 w healing -decr bone density + kidney issues + low B12 + low Mg H2: also reduce sympt + promote healing
26
GERD | diet
- avoid fatty food, choc, peppermint, acid, alcohol, soda, wine, OJ - avoid milk or late night snacking before bedtime
27
fundoplication
common laparoscopic antireflux surgery | -reserved for pt w complications, med intolerance, BE, or persistent sympt
28
Peptic Ulcer Disease
erosion of GI mucosa fr digestive action of HCl + pepsin | -any part of GI tract
29
Acute PUD vs Chronic PUD
A- superficial erosion, minml inflammation C-erodes thru muscular wall, w formatio of fibrous tissue ----more common than acute
30
PUD only develops in an ___ environment
acidic
31
is excess HCl necessary for peptic ulcer dvlpt?
no, but HCl is needed to activate pepsinogen into pepsin
32
major risk factor of PUD
CagA pos strain of H Pylori - survives in gastric epithelial cells in mucosal layer - makes UREASE which metabs urea-producing ammonium chloride + other damaging chems
33
risk factors for PUD
- cagA H Pylori (most common) - ETOH - ASA + NSAIDS (2nd most common) - irritating food - caffeine - smoking
34
NSAID on PUD
- inhibit prostaglandin synth - incr gastric acid secretion - reduce integrity of mucosal barrier - pt taking corticosteroids or anticoag are at higher risk
35
Gastric vs Duodenal | lesion
G-superficial, smooth D-penetrating assoc w deformity of duodenal bulb
36
Gastric vs Duodenal | location of lesion
G-mostly ANTRUM, but maybe body or funduc D- first 1-2 in of D
37
Gastric vs Duodenal | INCIDENCE
G-more in women, peak age 50-60 -incr risk of cancer D-more in men, peak age 35-45 --more common than G
38
Gastric vs Duodenal | pain mealtime
G-pain 1-2hr AFTER meal -----food aggravates D-2-5hr AFTER meal -----food/antacid relieves pain
39
duodenal ulcer is often assoc w high HCl. those at high risk incl
- H Pylori (most common cause) - COPD - cirrhosis - pancreatitis - hyperparathyroidism - CKD - Zollinger syndrome
40
zollinger syndrome
rare condition w severe peptic ulcer + HCl hypersecretion
41
____ ulcers are more likely to cause obstruction
GASTRIC ulcers
42
main risk factors for gastric ulcers
- h pylori - nsaids - bile reflux
43
gold standard for h pylori Dx
biopsy of antral mucosa w resting for urease -rapid urease testing -antibody test are NOT accurate
44
most accurate procedure to determine presence + location of ulcer
endoscopy
45
how long does pain relief + healing usually take in ambulatory care?
with rest, pain is gone 3-6 days healing may take 3-9 wks
46
PUD | treatment
- supportive (rest) - NPO - NG tube for perforation or gastric outlet obstruction - Abx PPI H2 Sucralfate - surgery - lifestyle changes
47
3 major complications of PUD
``` 1 hemorrhage (upper GI bleeding) 2 perforation (most lethal) 3 gastric outlet obstruction ```
48
nursing action for perforation
- notify dr - take VS q15-30min - stop all feeding + drugs - start abx - surgery if does not self seal
49
Gastritis
inflammation of gastric mucosa - breakdown of normal gastric mucosal barrier that normally protects fr HCl + pepsin - acute or chronic
50
Gastritis | risk factors
- drugs: ASA, corticostrds, iron supplmt, nsaids, digitalis - diet: etoh, spicy/irritating food, caffeine - microbes - smoking, radiation - stress
51
Acute gastritis
typically caused by irritant or infection - tx is to remove cause - often self limiting - etoh can lead to hemorrhage
52
Chronic gastritis
- bacterial infection like H Pylori which damages the stomach - may lose parietal cells>low intrinsic factor>low cobalamin absorption
53
Gastritis | s/s
- anorexia - n/v - epigastric tenderness - feeling of fullness
54
Gastritis | diagnosis
- endoscopy - pt hx - CBC for chronic gastritis
55
Gastritis | tx
- supportive tx - NPO + NG - Drugs - lifestyle changes
56
Gastritis
- monitor for dehydration (can occur rapidly in acute) - NPO + IV if vomiting - NG tube to monitor bleed, lavage precipitating agent, keep stomach empty + free of noxious stimuli

Med Surg (18 decks)

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