Exam 1: GI Flashcards
1
Q
Stomach breakdown/digestion is caused by what?
A
HCl-
HCl- also helps kill bacteria
2
Q
Stomach contractions are regulated by which nervous system
A
PsNS - involuntary muscles
3
Q
Stomach nerves are modulated with what?
A
Acetylcholine
Disrupted by anti-cholinergics
4
Q
Why is vomiting dangerous
A
It disrupts electrolyte balance of K+, H+ and Cl- in stomach
5
Q
SI
A
- Site of chemical digestion (thanks to enzymes secreted by liver and pancreas)
- Main site of water reabsorption
- Large surface area designed for maximizing absorption of nutrients and minerals
- Three distinct segments
- duodenum
- jejeunum
- ileum
6
Q
LI
A
- additional water reabsorption
- forming poop
- colonic bacteria synthezie vitamin K, hiamine, and riboflavin
- Appendix - very thin outlet, easily blocked
7
Q
Disorders of oropharynx
A
- dysphagia
- xerostomia
- thrush
- stomatitis
8
Q
Disorders of stomach
A
- Gastritis
- GERD
- Hiatal Hernia
9
Q
Peptic Ulcer Disease subcategories
A
- Gastric
2. Duodenal
10
Q
Disorders of intestines
A
- Inguinal, umbilical or ventral hernia
- bowel obstruction
- divertiulitis/diverticulosis
- appendicitis
11
Q
Dyspepsia
A
Indigestion
Subjective
Nonspecific abdominal/digestive discomfort that may manifest as bloating, fullness, or a sharp burning/gnawing pain
12
Q
Anorexia
A
Loss of appetite due to some disease condition
Common in COPD, cancer patients, or patients with GI conditions
13
Q
Cachexia
A
weakness and wasting of the body due to severe chronic illness
associated with anorexia
14
Q
Interventions for anorexia
A
nutritional supplements, figure out what foods they like or NG tube
15
Q
Nausea and vomiting causes
A
Lots of potential causes:
- distension or increased pressure in GI tract triggers mechanoreceptors in gut –> nausea (also decreased GI motility)
- Drugs (brain has chemoreceptor trigger zone - registers drugs as position and want to throw them up - opioids)
16
Q
Nausea and vomiting risks
A
- electrolyte abnormalities
- threat to airway
- dehydration/malnutrition (might have to give IV fluids in nausea severe)
- tooth decay
17
Q
Why is constipation so common in hospitals?
A
opioids, dehydration, and anticholinergic medications are all typical post-surgical cocktail
18
Q
What are nursing interventions for constipation?
A
Intervene early:
- hydration
- mobilize
- eating meals (fiber)
- Sitting the bed up will help immediately with breathing if v distended
- if v distended, use an IS to monitor lung capacity
19
Q
What are risks associated with constipation?
A
Any condition that causes abdominal distension can put patients at risk for impaired breathing by reducing diaphragm’s ability to completely lower
Atelectasis since lungs aren’t able to fully expand –> risk for pneumonia
20
Q
What is atelectasis?
A
a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid
21
Q
What is xerostomia and what causes it?
A
Dry mouth often caused by radiation treatments or anticholinergic medications; can be caused by autoimmune disease (like Sjogren’s syndrome)
22
Q
What are interventions for xerostomia?
A
Offer pt frequent sips of water
Artificial saliva is also available
23
Q
What are risks fo xerostomia?
A
Malnutrition b/c tastes buds not working well and probably don’t want to eat
24
Q
What is thrush?
A
Candida albicans superinfection – common consequence of antibiotics
Appears as white, fungal appearing film in mouth
(also vaginal thrush)
25
How is thrush treated?
Oral nystatin
26
What is stomatitis?
General word for irritation/inflammation of the mouth
27
What causes stomatitis?
Can be caused by ulcerations, infections (like herpes zoster) or many other conditions (bleeding gums)
28
What are interventions for stomatitis?
Prescribe softer diets first
monitor calorie intake
29
What is dysphagia?
Any difficulty/painfulness when swallowing
subjective
discomfort, but does not mean food is in trachea
30
What are causes of dysphagia?
- Stroke - most common
- Also, poor dentition (mechanics of mouth change when lose teeth --> loss of more teeth --> no teeth --> bone erodes --> altered swallowing)
- scar tissue 2/2 GERD
- Head and neck cancer
- degenerative neuro disorders
good musculoskeletal synchronization is required to get air into the esophagus rather than trachea.
31
What are some interventions for dysphagia?
Monitoring patient's ability to swallow/chew/take pills
If a patient is coughing/choking - bad sign.
- sit patient upright
- ensure good dentition
- ensure good musculoskeletal function
- bedside swallow study
- formal swallow study with SLP
- assess O2 saturation and breath sounds if you are concerned that your patient has aspirated
32
What is the main risk of dysphagia?
ASPIRATION
33
What are some common diets for dysphagia?
Diets in order of severity:
- regular diet
- mechanical soft diet (small pieces)
- pureed
Liquids:
- thin liquids
- thickened liquids (nectar or honey thick
34
What is Helicobacter pylori a major cause of?
gastritis
peptic ulcer disease
35
What does H pylori do?
H pylori likes to burrow into the stomach lining and cause inflammation in cells --> gastritis and peptic ulcer disease
70% of infections are asymptomatic
36
What is gastritis?
Inflammation of the gastric mucosa
37
What usually causes gastritis?
H. pylori or NSAID use (NSAIDs inhibit PG production which ups mucous and decreases acidity of stomach. This causes stomach to have less mucus and more acidity)
Also associated with alcohol and tobacco use
38
What would you look for in an assessment for gastritis?
- dyspepsia (gnawing epigastric pain)
- anorexia
- nausea/vomiting
- blood in stool --> potential anemia
39
What can gastritis be confused with?
MI (would want eliminate this possibility first
40
What are some interventions for gastritis?
- dietary changes (avoid spicy foods, caffeine, nicotine, alcohol)
- smoking cessation
41
What are tests for gastritis?
- EGD (make sure not stomach cancer or perforated ulcer)
- Fecal Occult Blood Study
- CBC (check for anemia)
- B12 levels - (intrinsic factor in stomach that helps absorb B12 - if you don't have these cells, you will not absorb B12)
42
What are some associated risks of gastritis?
anemia due to blood loss in poop or lack of B12 b/c no intrinsic factor in stomach
erosive gastritis
if gastritis progresses --> ulceration in the stomach lining (gastric ulcers, peptic ulcer disease)
43
What is the fecal occult blood study?
It is a study to reveal the small amounts of blood in the stool that may be too small to see with the naked eye
If blood is present, paper strip is blue
44
Why is the fecal occult blood study useful?
If patients show up with unexplained anemia, this can help assess if blood is being lost somewhere in the GI system
45
What is an EGD?
Often it's necessary to pass a small, fiberoptic camera through the GI system to get a true sense for what's going on.
Helps distinguish between GERD, gastritis, and PUD
46
What is peptic ulcer disease?
Ulceration (carved out spot in membrane/sore) of mucosa or the GI tract - either stomach (gastric ulcer) or duodenum (duodenal ulcer)
47
What can lead to PUD?
- Gastritis
- H. pylori
- alcohol/tobacco intake
- NSAIDs
- physiologic stress (and/or glucocorticoids)
48
What are the assessment findings of PUD?
- Pain:
1. gastric pain: gnawing, sharp pain in the epigastric area within 30 minutes of eating
2. Duodenal pain: pain in epigastric region 1.5-3h after a meal
- anemia on CBC without other cause
- melena (more common with duodenal) or hematemesis (more common with gastric)
49
Which type of PUD is melena more commonly associated with?
Duodenal
50
Which type of PUD is hematemesis more commonly associated with?
Gastric
51
What is melena?
coffee ground-appearing blood in stool (brown - digested)
52
What is hematemesis?
blood in vomit (bright red)
53
What are tests used to diagnose PUD?
- CBC (check for anemia)
- Fecal occult blood study
- EGD
- CT with oral contract for perforation (dye)
54
What does treatment look like for PUD?
- Antibiotics to treat H. pylori if that is an issue
- reduce acidity of stomach (PPI/H2 blockers)
- coat stomach with protective layer (Carafate)
- eliminate NSAIDs
- Dietary changes like gastritis (avoid spicy foods, caffeine, alcohol, nicotine, cigarettes)
55
What are major complications of PUD?
1. hemorrhage - if ulcerate far enough will reach blood vessel-rich tissue --> more bleeding
2. perforation of the ulcer (ulcerate through stomach entirely and spill gastric contents into peritoneal cavity) --> PERITONITIS
56
How does peritonitis present?
Rigid, board-like abdomen with rebound tenderness and pain
Often a high fever
57
What are GI bleeds associated with the rectum?
Melena (dark, tarry stools - digested)
| Hematochezia (bright red blood - lower GI bleed)
58
What are GI bleeds associated with vomit?
Hematemesis (bright red blood - most serious)
| Coffee ground emesis (digested blood)
59
Why does peritonitis develop?
Gastric contents (or other contents) leak into the peritoneal cavity that needs to be sterile.
Robust immune response --> rigid, board-like abdomen
EMERGENCY - often surgery
60
What is GERD?
Gastroesophageal Reflux Disease
It is a dysfunction of LES allowing gastric contents to reflux into esophagus
61
What can GERD cause?
Damage to the esophagus due to stomach acid and digestive enzymes (pepsin)
62
What are contributing factors of GERD?
- Obesity
- ETOH use
- smoking
- caffeine
- fried food
63
What would you look for in an assessment of GERD?
- dyspepsia - burning epigastric pain in chest
- subj. hx of reflux/heartburn
- belching after eating
- acid taste in the mouth
- advanced cases --> dysphagia
64
What are tests for GERD?
No definitive diagnostic test
- EGD and/or pH measurement can help diagnose
65
What are associated risks of GERD?
1. Barret's esophagus (recurrent cycles of damage and repaire --> precancerous cells) - diagnose with EGD
2. strictures due to scar tissue (narrowing of esophagus)
3. electrolyte abnormalities from overdoing it with antacids
66
What are interventions for GERD?
1. dietary changes
- smaller meals
- weight loss
- eliminate chocolate, fried food, alcohol, caffeine, carbonated bevs
- avoid eating right before bed
2. sitting upright after meals
3. place blocks under head of bed
4. Pharm:
- PPI
- H2 receptor blockers
67
What is education that should happen with GERD?
importance of changing diet - which is hard to do
the risk of overuse of NSAIDs which disrupt the natural stomach acid/mucus ratio and antacids which disrupt electrolyte balance
68
Why is overuse of antacids bad?
Antacids contain calcium carbonate or magnesium --> electrolyte imbalance
69
What is a LINX procedure?
Magnets that close LES
70
What are hiatal hernias?
Herniation = protrusion of tissue through a body opening (brain herniation, herniated discs)
Hiatal hernia = stomach bulges through diaphragm
71
What are the symptoms of hiatal hernias?
GERD-like symptoms due to structural defects and decreased LES pressure
72
What is the test for hiatal hernias?
EGD
73
What are the types of intestinal hernias?
1. ventral (typically through a surgical incision)
2. umbilical
3. inguinal
74
What would you look for in an assessment for intestinal herniation?
1. soft, spongy, painless mass proturuding through muscle
2. should be "reducible"
3. usually more noticeable when bearing down
75
What is the main intervention for hernias?
surgery
76
What are the complications with hernias?
If a hernia is not reducible --> incarcerated or irreducible hernia --> potential for small bowel obstruction
If a hernia is irreducible and the muscle tightens or intestinal tissue gets inflamed/swollen --> strangulation
Strangulation --> potential ischemia and is a surgical emergency - typically painful b/c of ischemia
77
What is bowel obstruction?
Partial or complete obstruction of the intestine - preventing forward movement
78
What would you find in an assessment for bowel obstruction?
Abdominal distension and discomfort
79
What are causes of bowel obstruction?
1. hernias
2. constipation/impacted stool
3. intussusception (rare, serious disorder in which one part of the intestine slides into another)
4. volvulus (intestines twisting on themselves - can also cause ischemia)
5. adhesions - scar tissue/fibrous tissue (often the result of surgery, but ironically lead to more surgery...)
6. ileus
80
What is a Paralytic Ileus
Function obstruction caused by impaired peristalsis - nothing is wrong with bowel walls
Peristalsis is either absent or possibly asynchronous
81
What causes paralytic ileus?
- Surgery/anesthesia
- opioids
- electrolyte abnormalities
- prolonged immobility
82
What would you find in an assessment for bowel obstruction?
- abdominal distension
- pain
- nausea/vomiting
- anorexia
- bowel sounds may be hypoactive or absent
83
What is a sign of progress for bowel obstruction?
ability to pass flatus
84
What are tests for bowel obstruction?
KUB (kidney ureter bladder) - x-ray will show if there is gas or stool trapped in bowel
85
What are interventions for mechanical bowel obstruction?
surgical - (intussusception and volvulus are typically considered surgical emergencies - like strangulated hernias - due to risk of ischemia)
86
What are interventions for paralytic ileus?
just need to make sure pt doesn't become nauseated and vomit
- wean narcotics as tolerated/encourage non-opioid pain treatment
- encourage PO intake, high fiber diet (unless dietary intolerance/nausea/vomiting)
- hydration
- mobility
- stool softeners and laxatives
87
What are interventions for GI intolerance?
- NG tube to low wall suction
| - IV fluids if patient at risk for dehydration
88
What is diverticulosis
pouch-like herniations (diverticula) of intestinal mucosa result from high intraluminal pressure
89
What is diverticulitis?
inflammation of diverticula due to food/fecal matter trapping and abscessing
90
What are assessment findings of diverticular disorders?
- typically seen in older adults
- diverticulosis - usually asymptomatic
- diverticulitis:
1. cramping pain, worsened when bending over, straining or lifting
2. nausea/vomiting
3. bloody stools
4. elevated WBC count
91
What is the treatment for diverticular disorders?
1. low residue food - no nuts, seeds, indigestible roughage
2. increase water
3. increase dietary fiber - roughage
4. bulk-forming laxatives
92
What is appendicitis?
Blockage (usually a fecalith) creates an inflamed, infected appendix. Tends to occur in younger people
93
What would you find in an assessment for appendicitis?
1. acutely painful RLQ tenderness
2. neausea/vomiting
3. fever, elevated WBC count
94
What is an associated risk of appendicitis?
rupture of appendix --> fecal matter/bacteria spray all over inside of peritoneal cavity --> PERITONITIS
95
A patient comes in with gnawing substernal pain that's worse after eating. How would you assess the situation?
Get a history of:
1. changes in appetite, weight, stool
2. GI disorders or abdominal surgeries
3. Medications, herbs, supplements
4. smoking history
5. travel
6. nutrition
Ask how GI health problem affects life, lifestyle, activites, employment
