Gastrointestinal Disorders

Question 1

What is the pathophysiology of Gastroesophagel Reflux Disease (GERD)

Answer 1

• LES muscle tone decreased = excess relaxation
• Backward flow of GI content into Esophagus
• Lead to irritation & inflammation of mucosa

Question 2

What are the contributing factors of GERD?

Answer 2

• presence of NG tube
• hx hiatial hernia
• obese/overweight
• pregnancy
• bending over
• tight clothing
• ascietes
• large meal
  -> caffeine, alcohol, fatty, spicy foods
• nighttime prolonged reflux
• espohageal stricture

Question 3

Describe how the following the following factors can contribute to GERD:

• Obese/Overweight
• Hx of hiatal hernias
• Ascites
• Bending Over
• Consuming large meals
• Caffeine, Alcohol, Fatty, Spicy Acidic Food

Answer 3

Obese/Overweight:

• Increased intra-abdominal pressure

Hx of Hiatal Hernias:

• Increased intra-abdominal pressure

Ascities:

• Increased intra-abdominal pressure (bc of build up of fluid)

Bending over:

• Icreased intra-abdominal pressure

Consuming Large Meals:

• gastric distention
• delayed emptying

Caffeine,Alcohol, Fatty, Spicy, Acidic Food:

• Trigger GERD

Question 4

Describe how the following the following factors can contribute to GERD:

• Nightime prolonged reflux
• Esophageal stricture
• Present NG tube
• Pregnancy
• Wearing tight clothing

Answer 4

Nighttime Prolonged Reflux:

• Stomach content flows to esophagus much easier

Esophageal Sticture:

• increased risk of regurgitation
• Exaccerbate GERD S/S

Present NG Tube

• Sphincter opens & acidic contents reflux

Pregnancy:

• Lower esophageal sphincter stress with pressure, reflux back up into esophagus

Wearing tight clothing:

• Increase intra-abdominal pressire

Question 5

What are some clinical manifestations (S/S) of GERD?

Answer 5

• Chest pain/Neck/Jaw pain
  -> Mistake for heart attack (use EKG to verify)
• Abdominal pain/feeling uncomfortable full
• Heartburn
• Indigestion (Dyspepsia)
• Regurgitation
  -> Burping
  -> Nausea
• Difficulty swallowing

Question 6

T/F: In some instances, GERD can cause severe chest pain that can mimic and be mistaken for a heart attack.

Answer 6

True, an EKG must be used to verify if it is a heart attack

Question 7

What are some diagnostic procedures that can be used to diagnose GERD?

Answer 7

• Bravo/pH monitoring
• EGD
• Esophageal Manometry
• Gastric Emptying Study

Question 8

What is the most accurate diagnostic procedure for GERD?

Answer 8

pH monitoring (Bravo)

Question 9

Josh has recently been diagnosed GERD. What drug therapy would you expect Josh to be on to help treat his GERD?

Answer 9

• Antacids (Maolox)
• Histamnie Blockers (Pepcid)
• Proton pump inhibitors (Protonix)

Question 10

Josh has been complaining of severe abdominal pain and chest pain due to his GERD. He has completely transformed his lifestyle and is on every medicaiton possibly, yet it is not helping. What is Josh’s last option?

Answer 10

• Josh may need surgery since his conditions are severe.

Question 11

What is the pathophysiology of a Hiatal Hernia?

Answer 11

• Weakness of abd. or diaphragmatic muscles or increased intra-abd. Pressure
• Protrusion of the stomach into esophageal hiatus of diaphragms
  Stomach enters the thoracic cavity

Question 12

What are the two types of Hiatal Hernia?

Answer 12

• Sliding Hernia
• Paraesophageal (Rolling) Hernias

Question 13

What is the pathophysiology of Sliding Hernias?

Answer 13

• Esophageal junction & portion of stomach slide upward through esophagus

Question 14

What is the pathophysiology of Paraesophageal (Rolling) Hernias?

Answer 14

• Fundus rolls through esophageal into chest beside esophagus

Question 15

What contibuting factors can lead to Hiatal Hernias?

Answer 15

• Sudden straining
  -> Coughing
  -> Consitpation
  -> Overexertion
  -> Frequently bending/heavy lifting
• Pregnancy/Obesity
• Smoking
• Stress
• Heredity

Question 16

What are some clinical manifestations (S/S) of Hiatal Hernias?

Answer 16

• Pain radiates to back, neck, or jaw
  -> Mistaken for heart attack (use EKG to verify)
• Abdominal pain
  -> Pain worse when lying down or bending over
  -> Fullness
• Substernal pressure especially after meal
• Indigestion (Dyspepsia)
• Regurgitation
  -> nausea, burping

Question 17

What are some diagnostic procedure that can help identify Hiatal Hernias?

Answer 17

• Idenityf if S/S worsen:
  -> after eating or wearing tight clothing
• Barium swallow
• EGD

Question 18

What is the most specific way to diagnose and identify Hiatal Hernias?

Answer 18

Barium Swallow

Question 19

What diagnositc proceddures is used to provide images of the esophagus and gasrtic lining?

Answer 19

• Esophagogastroduodenoscopy (EGD)

Question 20

Chipper Snapper has recently been diagnosed a Hiatal Hernia. What drug therapy would you expect Chip to be on to help treat his Hiatal Hernia?

Answer 20

• Antacids
• Histamine blockers
• Proton pump inhibitors

Question 21

Chip is complaining that his hiatal hernia is causing excrutiating symptoms that he can not overcome. Chip has started eathing healthier, is regularly excering, but nothing seems to help his sympotoms. Can Chip get surgery to help his hiatal hernia?

Answer 21

• Yes, Chip is experieining serve complications of his hiatal hernia and can get surgery

Question 22

Nursing Implications

Josh has both GERD and a Hiatal Hernia. His doctor advises that Josh should start losing weight. What can Josh do to lose weight to help with his GERD and Hiatal Hernia?

Answer 22

• Follow restricted diets
• avoid alcohol/caffiene
• avoid eating late
  -> eat small frequent meals
• exercise daily
  -> avoid straining/excessive exercise

Question 23

Josh is diagnosed with GERD and a HIatal Hernia. What are some nursing implications for GERD and Hiatal Hernias?

Answer 23

• Sit in upright position after meals
• Sleep with the HOB 6 inches elavated
• Refrain from wearing tight clothing

Question 24

What is the pathophysiology of Diverticulosis?

Answer 24

• Small pouch-like sacs develop in the walls of the colon.
  -> considered normal and “healthy”

Question 25

What are some **contributing factors** that can lead to the development of **Diverticulosis**?

Answer 25

- Aging process (seen in older adults; considered normal) - Low fiber diets -> Chronic Constipation - Weakened colon muscles

Question 26

T/F: Diverticulosis is considered a normal and a part of the aging process

Answer 26

True

Question 27

What are some **clinical manifestations** of **Diverticulosis**?

Answer 27

**Often no S/S** - Intermittent lower left quadrant pain - complaints of constipation

Question 28

What is the **pathophysiology** of **Diverticulitus**?

Answer 28

1. Undigested food & bacteria trapped in diverticulum 2. Decreased blood supply & bacteria invasion 3. Inflammation 4. Perforation & develop local abscess

Question 29

What are some **clinical manifestations** of **Diverticulitis**?

Answer 29

- N/V - Low grade fever - Localized lower left quadrant pain -> Abdominal tenderness - Possible rectal bleeding - Distention

Question 30

What are some **diagnostic procedures** that can help identify and diagnose **DIverticulitis**?

Answer 30

* Possible Positive Occult Blood * X-Ray * CT scan/Abd US * Colonoscopy * Elevated WBC, Decreased H/H

Question 31

In regards to Diverticulitis, how does an X-Ray help diagnose it?

Answer 31

- Observe free air or fluid in abdominal cavity -> may be an indication of perforation

Question 32

In regards to Diverticulitis, how does an CT scan/Abdomnial Ultrasound help diagnose it?

Answer 32

- identify abscence or thickening of the bowel wall

Question 33

In regards to Diverticulitis, how does a colonoscopy help diagnose it?

Answer 33

- assess the inside of the colon

Question 34

# Lifestyle Changes Karen recently developed **Diverticulitis** and was told by her doctor that she needs to go on a BLAND diet, more specifically a BRAT diet. What are **BLAND** diets? What does the **BRAT** diet entail?

Answer 34

**Bland Diet: type of diet focused on easily digestible, low-fiber foods** - Brat Diet -> Bananas -> Rice -> Applesauce -> Toast

Question 35

Karen recently got diagnosed with Diverticulitis. What drug therapy/medications can she be perscribed to to help treat her **Diverticulitis**?

Answer 35

- IV Fluids - Broad Spectrum ABX - Analgesics

Question 36

In regards to Karen's Diverticulitis, are there any surgical procedures that can be used to help treat her **Diverticulitis**?

Answer 36

- NGT for: N/V, decompression - Colon resection with colostomy or without colostomy

Question 37

What are some nursing implication to help in the Acute Phase of Diverticulitis?

Answer 37

- Low fiber - Clear liquid diet - Avoid laxatives & enemas - Avoid foods with seeds & alcohol

Question 38

What are some nursing implication to help in the Maintenence Phase of Diverticulitis?

Answer 38

- High fiber diet & fluid intake -> Fruit & vegetable intake - Whole grains, wheat bran products with no seeds - Avoid alcohol, fried & high-fat foods

Question 39

What the **pathphysiology** of **Peritonitis**? What are **clinical manifestations** of **Peritonitis**?

Answer 39

**Pathophysiology:** Serious complication of diverticulitis that requires prompt medical attention: - perforated/ruptured diverticulum - contents of bowel leak into peritoneal cavity - bacterial infection of peritoneal cavity **Clinical Manifestations:** - Profound guarding/Abdominal pain/rebound tenderness -> pain when pressed and released - Shock - Hypotension - N/V