Gastrointestinal System Flashcards by BEA FAE ONSIANGCO

Reflux, regurgitation and back-flow of gastric acid

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GERD

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Most common symptom of GERD

Heartburn / Pyrosis

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Symptom of Gerd - 2B

Belching / Bloating

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Symptom of Gerd - 2R

Regurgitation / Reflux

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Symptom of Gerd - 2D

Dyspepsia / Dysphagia

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Diagnostic Test for GERD

Esophageal pH monitoring

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Normal PH level of acid in stomach

2-3

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Most important Diagnostic test for GERD

Barium Swallow

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Effect of Relaxation of LES on pressure

Decreased pressure

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Long-standing untreated precancerous GERD

Barrett’s esophagus

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Complication of GERD that results to stricture and ulceration

Esophagitis

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Adenocarcinoma / cancerous GERD

Esophageal cancer

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Surgical procedure for GERD

Anti-reflux surgery (Nissen and Toupet fundoplication)

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Normal value for Esophageal PH monitoring

Below 7.35`

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Antireflux surgery: One suture/complete

Nissen Fundoplication

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Antireflux surgery: Two suture/Partial

Toupet

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GERD Pharmacological Mnemonic

PAPA
Proton Pump Inhibitor
Antacid
Prokinetics
Anti-histamine

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Primary meds for hyperacidity

PPI & anti-histamine

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Indicated for quick/short-lived relief of mild, intermittent heartburn

Antacid

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Increases LES pressure & Improve gastric emptying & regurgitation

Prokinetics

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Examples of anti-histamines for GERD

Cimetidine / Ranitidine

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Examples of PPI for GERD

Omeprazole / Lanzoprazole / Rabeprazole

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Examples of Prokinetics for GERD

Metoclopramide / Baclofen / Cisapride

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Nursing Management for Antacids & anti-ulcer meds

Report signs of GI bleeding

like black stool, tarry stool, and abdominal pain

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Imbalanced Nutrition interventions for GERD

Non-irritating foods | Avoid reflux-inducing foods

Acute Pain interventions for GERD

SFF Eat slowly Avoid eating 2-3 hours before sleep Give fluid in between meals

Protrusion/ enlargement/ pushing upward of stomach and gastric mucosa in the lower thoracic cavity or esophageal hiatus

Hiatal Hernia

Type of Hiatal Hernia: GEJ protrude/move upward with intact diaphragm

Type 1: Sliding / Esophageal Hernia | Most common

Type of Hiatal Hernia: GEJ no movement with Non-intact diaphragm

Type 2: PARAESOPHAGEAL or Diaphragmatic Hernia

Symptom of Hiatal Hernia

``` HERNIA Heartburn Epigastric pain Regurgitation Nocturnal heartburn Indigestion After eating - Dysphagia, Belching, Fullness ```

Diagnostic test for Hiatal Hernia

Barium Swallow Xray Upper GI series

Hiatal Hernia Pharmacological Mnemonic

APA Anti-histamine Proton Pump Inhibitor Antacid

Surgical procedures for Hiatal Hernia

Herniotomy Herniorrhaphy Anti-reflux procedure Gastropexy

Hiatal Hernia surgery: To open & excise

Herniotomy

Hiatal Hernia surgery: To repair the hernia sac

Herniorrhaphy

correct twisting/ torsion of stomach, prevent restriction of blood flow, reduce hernia, increase LES pressure

Gastropexy

Absent or ineffective peristalsis of the distal esophagus

Esophageal Atresia

Esophagus failed to relax, narrows, strictures, dilates, incomplete relax, obstructs, decrease emptying (food content causes dilation proximal to the obstructed area)

Esophageal Atresia

Risk factor of Esophageal Atresia

Idiopathic | Age

Stages of Esophageal Atresia

Early & advanced

Stages of Esophageal Atresia: tapering or NARROWING of lower esophagus

Early

``` Stages of Esophageal Atresia: DILATED tortuous esophagus (food and fluid) or megaesophagus (enlargement of lower esophagus) ```

advanced

Symptom of Esophageal Atresia

``` Dysphagia (most common/primary) Sensation globus Substernal chest pain - after meal Heartburn (pyrosis) **Halitosis (foul smelling breath) ```

Complications of Esophageal Atresia

Aspiration (gastric content) Pulmonary complication Esophagitis

Confirmatory Diagnostic test of Esophageal Atresia

Manometry | - measures esophageal pressure

Nursing intervention for Esophageal Atresia

Elevated HOB while sleeping Semi-soft diet Drink fluids during meals

Esophageal Atresia Meds

Botulinum toxin | Calcium channel blocker (Nifedipine)/ Nitrates ( ISDN or Isordil only)

Indication of Botox for Esophageal Atresia

endoscopically to inhibit contraction of smooth muscles, therefore relaxes the smooth muscles

Surgical procedure for Esophageal Atresia: endoscopic procedure using balloon to stretch the narrowed esophagus

Pneumatic dilatation (surgical reparation)

N.I for Pneumatic dilatation

watch out for perforation - fever, abdominal tenderness

Surgical procedure for Esophageal Atresia: cuts/ separate esophageal muscle fibers to relieve stricture, allow food to pass

Esophagomyotomy (Heller myotomy)

UGIB: profuse, bright red blood

Arterial Bleeding

UGIB: blood in stomach for some time

Coffee-ground vomitus

UGIB: black tarry stool, upper GI bleeding (slow or prolong)

Melena

UGIB: blood loss > 1.5L

Massive UGIH (Upper Gastrointestinal Hemorrhage)

WORST manifestation in GI bleeding

Perforation/ Peritonitis | Absence of bowel sounds

Normal Pulse Pressure

Primary tool to diagnose source/location of UGIB, 1st line management

Endoscopy

N.I for UGIB: best measure for vital perfusion

Measure urine output

N.I for UGIB: fluid volume status, hemodynamic monitoring - SYSTEMIC fluid status of body

Central Venous Pressure line

N.I for UGIB: Which IVF to give and why?

Lactated Ringers - contains sodium, potassium, magnesium, chloride - corrects overall electrolyte imbalance

N.I for UGIB: What kind of needle for IVF and why?

Large bore needle | - used for high fluid volume rescucitation

Normal CVP line value

0-8 mmHg

Gastric Lavage: Vasoconstricting effect

Cold

Gastric Lavage: Vasodilating effect

Hot

Important N.I for Gastric lavage

Withhold feeding if there's presence of blood

Inflammation of gastric and stomach mucosa

Gastritis

Diagnostic test for gastritis

Endoscopy 1 minute ultra rapid urease test (breath test) for detecting H. pylori (>200)

Most common factor for acute gastritis

Alcohol intake

Gastritis: Antidote for corrosive chemicals (STRONG ACIDIC)

Aluminum Hydroxide

Gastritis: Antidote for corrosive chemicals (ALKALINE)

Diluted vinegar/ lemon juice

Medications for H.pylori infection

ANTIBIOTIC amoxicillin, clarithromycin, tetracycline, metronidazole

N.I for Gastritis: When can the patient have solid food?

The patient can have solid food when the patient have done flatus

N.I for Gastritis: Reason why emesis and lavage is avoided?

strong corrosion to prevent further damage and perforation of esophagus

Ulceration, hallowing, excavation and erosion of mucosal wall of the esophagus, stomach and duodenum Food relieves pain

Peptic Ulcer

Most common cause of Peptic Ulcer

Bacterial infection (H. Pylori)

Type of PUD: Deeper; more penetrating ulcer

Cushing Ulcer

Etiology of Cushing Ulcer

BRAIN disorder, increased ICP, vagal stimulation, hypersecretion of Hydrochloric acid

Type of PUD: 3 days after severe burns

Curling's Ulcer

HIGH epigastric burning, gaseous pain Pain tends to WORSEN with food abdominal discomfort occurs 1-2 hours after meals

Gastric Ulcer

burning cramp-like pain | midepigastric and back pain

Duodenal Ulcer

most accurate and most preferred diagnostic procedure for Peptic Ulcer

Endoscopy

PUD Medications: ONLY medication that will cover the ulcer and act as the protective barrier

Sucralfate

Surgical procedure for Gastric ulcer

Billroth 1

Surgical procedure for Duodenal ulcer

Billroth 2

Surgical procedure that reducing the stomach 70- 80%; leads to dumping syndrome

Bariatric surgery

set of manifestations; it is not a disease nor a disorder

Syndrome

Establish condition with identifiable cause

Disease

Irregularity, disturbance, or interruption of normal functions.

Disorder

Unpleasant GI symptoms and physiologic response characterized by rapid emptying of stomach content and rapid passage of foods to jejunum

Dumping | Syndrome

Causes of Dumping syndrome

Gastric surgery Bariatric surgery Rapid NGT/enteral/bolus feeding

Manifestations of Dumping Syndrome

``` Abdominal pain Borborygmi Diarrhea Alternating hyper/hypoglycemia Anorexia ```

How to prevent Dumping syndrome?

Slow Feeding | Checking of gastric residual Vol

What to do if there's a presence of blood during checking of GRV?

Gastric Lavage

What to do If the gastric residual is >100 mL?

Check again after 1 hour or minus from the total prescribed feeding

N.I Dumping Syndrome: AVOID the ff (4)

Eating large meals Lying down after eating Giving NGT too rapidly Positioning NGT too high

Characteristics of Constipation (5)

* Reduced stool volume * Abnormal infrequency/inequality/irregularity of defecation * Incomplete passage of hard stool * Difficulty passing stool * Borborygmus (Hyperactive)

Complications of Constipation (4)

Hemorrhoids HTN Megacolon Bowel perforation

Key factors N.I for Constipation (4)

Diet: High fiber Lots of fluids Exercise Bowel habit

Diarrhea can lead to --- that may result to death

Hypokalemia (<3 mEqs)

Inflammation of the stomach and small intestine

Gastroenteritis

3 common causes of Gastroenteritis

Infection Viral* Lifestyle: Travel

1st sign of Gastroenteritis

Vomiting

Difference of AGE from Diarrhea

Presence of low grade fever

Examples of Antidiarrheal agent for AGE

Loperamide | Imodium

Chronic GI functional disorder (diarrhea/constipation) that alters intestinal motility, bowel pattern NO abdominal alteration (inflamed, or damage) in the GI tract

Irritable Bowel Syndrome

Common cause of IBS

psychological distress, depression, anxiety, stress, panic

N.I for IBS (3)

Cognitive behavioral therapy/Stress management Good dietary habit Avoid food irritants

Impaired/decreased absorption (carbohydrates, fats, protein, vitamin, minerals) that results to interruption in regulating normal digestion process Digestive system (stomach, SI, liver, pancreas) inability to absorb nutrients

Malabsorption Syndrome

Chief result of Malabsorption Syndrome

Malnutrition

Characteristic of stool in malabsorption syndrome

Steatorrhea

Systemic Effect of Malabsorption syndrome

Osteoporosis and anemia (vitamin mineral deficiency)

autoimmune disease damages the small intestine mucosa: (duodenum, jejunum, ileum) gluten-sensitive enteropathy

Celiac Sprue

chronic disorder disruption of jejunal and ileal tissues leading to malnutrition

Tropical Sprue

Risk factors of Celiac Disease (2)

``` Family history (genetic markers: HLA-DQ2,8) Rheumatoid Arthritis ```

To avoid triggering celiac disease

Gluten-free diet only | - only effective treatment

Absent/deficient lactase enzymes (unable to breakdown lactose into glucose and galactose

Lactose Intolerance

Most common complication of Lactose intolerance

Osteoporosis

Inflammation, edema, and infection of the appendix

Appendicitis

First symptom of Appendicitis

Nausea & vomiting

Onset/Secondary symptom of Appendicitis

Perumbilical pain

Best known symptom of Appendicitis

McBurney's point (RLQ pain)

3 signs to confirm appendictis

Rovsing sign Psoas sign Obturator sign

pain elicited in the right lower quadrant with palpation pressure in the left lower quadrant

Rovsing sign

(RLQ pain with extension of the right hip or with flexion of the right hip against resistance)

Psoas sign

Pain on passive internal rotation of the flexed thigh for appendicitis

Obturator sign

Sign of ruptured appendix

Bloomberg's sign | Rigidity/ Board like palpation

Complication of Appendicitis from delayed dx/tx

Peritonitis

Surgical procedure for peritonitis that resulted from appedicitis

Ex Lap | - cause entire region is already affected

Major N.I for appendicitis (3)

``` Don't take analgesic - masks pain symptoms Don't give laxative/enema - to prevent perforation of appendix Prepare for surgery ASAP ```

Standard surgical procedure for appendicitis

Appendectomy

What to do to prevent complications of appendectomy (2)

incisional care | resume to activities 2-3 weeks after surgery

What to do to prevent complications of appendectomy: ATELECTASIS

Semi-fowler and early ambulation

3 Most appropriate test for appendicitis

``` CBC - high wbc and esr CT scan - preferred diag test Xray ```

Post op medication for appendectomy

Opioid Analgesic

Life threatening condition that causes localized or generalized inflammation and infection of the normally sterile peritoneal cavity

Peritonitis

Universal sign of Peritonitis

Abdominal tenderness

2 Most common sign of peritonitis

Severe abdominal pain & board like muscular rigidity

Most common complication of Peritonitis

Paralytic Ileus

4 Diagnostic test for peritonitis

Peritoneal aspiration C&S peritoneoscopy CBC Xray

CBC for peritonitis reveals what

high wbc | low hgb, hct

Abdominal Xray for peritonitis reveals what

air, fluid, distended loops

Medical tx for peritonitis to decrease gastric distention and prevent leakage of bowel contents into peritoneum

NG suction / Intestinal intubation

3 N.I for Peritonitis

Pain control Airway Clearance Fluid Balance

Abnormal saclike herniation, outpouching, saccular dilation of bowel mucosal lining Inflammation and infection of the diverticula due to defective muscle layer, weak intestinal wall, and lodging/retention of food, waste, bacteria

Diverticulitis

Most common location of Diverticulitis

Sigmoid Colon

non-inflammatory diverticula

Diverticulosis

Most common site for diverticulosis

sigmoid colon | and descending colon

2 predisposing factor of Diverticulitis

diet (low fiber/lack dietary fiber | husk food with seeds

Location of pain in diverticulitis

LLQ | - location of sigmoid and descending colon

3 Clinical manifestation of Diverticulitis

tenesmus palpable mass bloating/flatulence

If left untreated, diverticulitis can lead to

septicemia

most preferred diagnostic test/procedure of choice for diverticulitis

CT scan

CBC in diverticulitis revelas

high WBC, ESR

4 Pharmacologic tx for Divertoculitis

Bulk forming laxative Antibiotic Analgesic Antispasmodic

Surgical procedure for Diverticulitis

Hartmann surgery

Tumors adenocarcinoma of the colon and rectum

Colorectal cancer

Risk factors of Colorectal CA (4)

Family hx Lifestyle Diet GI disease

First symptom of Colorectal CA

Weight loss

Most common symptom of Colorectal CA

Change in bowel habit | - Chronic constipation

Second symptom of colorecal CA

Bloody stool

Most common site of metastasis in Colorectal CA

Liver

gold standard, most preferred test for Colorectal CA

Colonoscopy

reliable prognostic predictor for Colorectal CA

High CEA level

Stoma Care for Colorectal Cancer (Normal)

pink, reddish, pink, moist, slight edema

Stoma Care for Colorectal Cancer (Abnormal)

BLEEDING

primary and main treatment for colon cancer

Colectomy, Colostomy

3 Adjuvant terapy for Colorectal CA

Chemotherapy Radiation biologic-5-fluorouracil

Autoimmune disorder wherein antigen triggered inflammation. It includes Crohn’s and Ulcerative colitis Chronic inflammation of GI tract disorder (diarrhea, pain)

Inflammatory Bowel Disease (IBD)

DOC for IBD

Sulfasalazine 5 Aminosalicylate acid

Indication of Sulfasalazine

to suppress inflammatory response mediators (like cytokines)

Other Meds for IBD (2)

Corticosteroids (Prednisone) | Immunosuppressant (Methotrexate)

Gastrointestinal System Flashcards

(172 cards)