Disturbance in Digestion Flashcards
(47 cards)
1
Q
Gastritis
A
inflammation of the gastric/stomach mucosa
- older adults
2
Q
Gastritis
Acute Gastritis
A
- several hours - few days
- → gangrenous/perforate mucosa → scarring → obstruction/pyloric stenosis
- more severe form form is caused by ingestion of strong acid/alkali
- → severe illness
3
Q
Acute Gastritis (Gastritis)
Erosive
A
caused by:
* local irritants (aspirin, NSAIDs)
* gastric radiation therapy
4
Q
Acute Gastritis (Gastritis)
Nonerosive
A
caused by H. pylori infection
5
Q
Gastritis
Chronic Gastritis
A
- repeated exposure
- most often from H. pylori infection
- in devt. of PU, gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma
- caused by gastropathy
- w/ Hashimoto thyroiditis, Addison d., Grave’s d.
6
Q
Gastritis
Pathophysiology
A
mucosal barrier → disrupted/damaged → irritants (gastric juices) → inflammation
7
Q
Gastritis
Clinical Manifestations
Acute Gastritis
A
- Epigastric pain/discomfort
- Dyspepsia
- Anorexia
- Hiccups
- Nausea
- Vomitting
8
Q
Gastritis
Clinical Manifestations
Erosive Gastritis
A
- hematemesis
- melena
- hematochezia
9
Q
Gastritis
Clincal Manifestation
Chronic Gastritis
A
- fatigue
- pyrosis/heartburn
- anorexia
- nausea
- vomitting
- mild epigastric discomfort
- intolerance to spicy/fatty foods
- slight pain relieved by eating
- not absorb Vit. B12 → pernicious anemia
10
Q
Gastritis
Systemic Manifestations
A
- signs of shock
- fatigue
- anemia
11
Q
Gastritis
Assessment & Diagnostic Findings
A
- endoscopy
- hisotlogic examination
- CBC
12
Q
Gastritis
Medical Management
A
- recovery = 1 day
- appetite diminished to 2/3 days
- non-irritating diet
- NGT
- antacids
- H2 receptor antagonists
- PPIs
- fiberoptic endoscopy
- emergency surgery
- gastrojejunostomy (for gastric outlet obstruction/pyloric obstruction)
- diet modification
- rest
- reduce stress
- X alcohol, gastric irritant meds
- PPIs, antibiotics, bismuth salts
13
Q
Gastritis
Nursing Management
A
- reduce anxiety, stress
- X induce vomitting
- NPO
- ice chips → clear liquids
- X caffeine (CNS stimulant → ↑ gastric activity & pepsin secretion
- X nicotine (< pacreatic bicarbonate → neutralizes gastric acid)
- Fluid intake = 1.5 L/day
- UO = 0.5 mL/kg/h
- IVF = 3 L/day
- Fluid intake + caloric value = 1L = 170 calories of CHO
- NaClK q 24 hours
14
Q
Peptic Ulcers
A
ulcers/breaks on the mucosal lining
15
Q
PUD
Gastric Ulcer
A
- > 50 yo
- both sexes
- 15% - 20%
- stomach antrum
- 30 mins - 1 hr pc
- churning
- vomitting = weight loss
16
Q
PUD
Duodenal Ulcer
A
- 30-60 yo
- male
- 80%
- pylorus
- 2-3 hrs pc
- gnawing
- eating = weight gain
17
Q
PUD
Risk Factors
A
- H. pylori
- Smoking
- Pancreatic tumor (Zollinger-Ellison syndrome)
- Type O
- Family hx
- Drugs (steroids, aspirin, NSAIDs)
18
Q
PUD
Nursing Assessment
A
- characteristic: burning, aching, gnawing pain
- location: epigastrium
- test for H. pylori
19
Q
PUD
Nursing Interventions
A
- Perforation
- Pain
- Pyloric Obstruction (vomitting, fullness)
- Peritonitis (board-like abdomen/rigid abdomen)
- Hemorrhage
20
Q
PUD
Therapeutic Management
A
- aggravants: soda, coffee, tea, chocolate, spicy, ↑ Na and spices
- X smoking
21
Q
PUD
Drugs
A
- Antacid (neutralizes acid; ac/pc)
- H2 receptor antagonist (-tidine; block histamine-stimulated gastric secretion)
- Proton pump inhibitor (-ozole; suppress HCl production; ac)
- Prostaglandin analogue (misoprostol/cytotec; ac)
- Mucosal barrier fortifier (sucralfate; ac)
22
Q
PUD
Diet
A
↑ CHO
↓ CHON
23
Q
PUD
Treatment
A
- Vagotomy (cut CN 10 = X nerve stimulation in stomach)
- Billroth I
- Billroth II
24
Q
PUD (Treatment)
Billroth I
A
creation of anastomosis bet. duodenum and gastric remnants
gastroduodenostomy
feeling of fullness and dumping syndrome
25
# PUD (Treatment)
Billroth II
sewing a loop of jejunum to the gastric remnant
| gastrojejunostomy
## Footnote
dumping syndrome, anemia, wieght loss
26
Gastric Cancer
* 69 yo adults
* men
* hispanic american, african american, asian
* sporadic
* prognosis = poor (5 years)
* adenocarcinoma
* 40% lower, 40% middle, 15% upper, 10% more than 1 part
* common site of mestasis = liver, peritoneum, lungs, brain
27
# Gastric Cancer
Risk Factor
* diet = ↑ smoked, salted, pickled
* diet = ↓ fruits, vegetables
* h. pylori infection (major)
* chronic inflammation
* pernicious anemia
* smoking
* obesity
* achlorhydria
* gastric ulcer
* previous gastrectomy
* genetics (type A, first degree relative)
28
# Gastric Cancer
Clinical Manifestations
| Early Stage
* pain relived by antacids
29
# Gastric Cancer
Clinical Manifestations
| Advanced Disease
* Dyspepsia
* Early satiety
* Weight loss
* Abdominal pain (above umbilicus)
* decrease in appetite
* bloating pc
* nausea and vomitting
* fatigue
30
# Gastric Cancer
Assessment
* palapble as mass
* ascites
* hepatomegaly
* palpabe nodules around umbilicus (Sister Mary Joseph's Nodules)
31
# Gastric Cancer
Diagnostic Findings
* Esophagogastroduodenoscopy
* Barium X-ray of UGIT
* CT scan
* Endoscopic UTZ
32
# Gastric Cancer
Medical Management
* Chemotherapy
* Targeted therapy
* Radiation therapy
33
# Gastric Cancer
Surgical Management
* total gastrectomy (stomach + duodenum ++ LE + mesentery + lymph nodes)
* esophagojejunostomy (jejunum + esophagus)
* radical partial (subtotal) gastrectomy (middle and distal)
* Billroth I or II
* proximal partial (subtotal) gastrectomy (proximal)
34
# Gastric Cancer
Complications of Gastric Surgery
* Hemorrhage
* Dumping Syndrome
* Bile reflux
* Gastric Outlet Obstruction
35
# Gastric Cancer (Complications from Gastric Surgery)
Dumping Syndrome
* rapid passage of food → not enough time for digestion and absorption → intestinal dilation, ↑ inestinal transit, hyperglycemia, rapid onset of GI & vasomotor symptoms
* 25% - 50%
## Footnote
hyperglycemia = ↑ insulin = hypoglycemia 2-3 hours pc
36
# Dumping Syndrome (Complications from Gastric Cancer Surgery)
Early Symptoms
* early satiety
* cramping abdominal pain
* nausea
* vomitting
* diarrhea
| occur within 10-30 minutes pc
## Footnote
resolved within 1 hour or with bowel evacuation
37
# Dumping Syndrome (Complications from Gastric Cancer Surgery)
Vasomotor Symptoms
* headache
* flushing/feelings of warmth
* diaphoresis
* dizziness
* palpations
* drwosiness
* syncope
38
# Gastric Cancer (Complications from Gastric Surgery)
Bile reflux
* manipulation or removal of the pylorus
* = irritation and damage to the gastric mucosa → gastritis, esophagitis, PU
* burning epigastric pain
39
# Bile Reflux (Complications from Gastric Cancer Surgery)
Pharmacologic Management
* Sucralfate/cholestyramine
* Cholestyramine = prevent reabsorption; eliminatin of bile acids in stools
40
# Gastric Cancer (Complications from Gastric Surgery)
Gastric Outlet Obstruction
from stenosis or stricture
## Footnote
fullness, vomitting
41
# Gastric Cancer
Chemotherapy
| chemotherapeutic agents
* fluorouracil
* carboplatin
* capecitabine
* cisplatin
* docetaxel
* epirubicin
* irinotecanoxaliplatin
* paclitaxel
42
# Gastric Cancer (chemotherapy)
Trastuzumab
with fluorouracil or capecitabine and cisplatin = improvement in surival with advanced GC who are HER-2 positive
43
# Gastric Cancer
Radiation Therapy
* before: decrease the size
* after: destroy remaining cancer cells
* 3-dimensional conformal radiation therapy
44
# Gastric Cancer
Nursing Assessment
nutritional intake and status
45
# Gastric Cancer
Nursing Intervention
* Reducing Anxiety
* Promoting Optimal Nutrition
* Relieving Pain
* Providing Psychosocial Support
46
# Gastric Cancer (Nursing Intervention)
Promoting Optimal Nutrition
* small frequent feedings of non-irritating food
* ↑ calories, Vit A and C
* ↓ CHO
* fluid between meals
* Vit B12 injection
47
# Gastric Cancer (Nursing Intervention)
Relieiving Pain
* opioid/PCA
* position changes
* imagery
* distraction
* rest and relaxation
* backrubs
* massage
