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MedSurg - Exam 1 > GI > Flashcards

GI Flashcards

(42 cards)

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1
Q

Peritonitis Etiology

A

Bacterial Infection & Perforation of the GI tract

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2
Q

Peritonitis Manifestation/Assessment

A
  1. Pain: Diffuse, turns into a more constant, intense & localized. Worse when moving
  2. Extremely tender, distended, rigid abd
  3. Late Stage: septic shock
  4. Anorexia, n/v, fever, tachy, hypotension
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3
Q

Peritonitis Diagnostics

A
  1. WBC- elevated (H&H is low if bleeding)
  2. Electrolyte imbalances
  3. Xray - Free air & fluid & distended bowel loops
  4. CT scan - abscesses
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4
Q

Causes of Peritonitis

A

Peritoneal dialysis, perfd appendicitis, perfd duodenal ulcer, diverticulitis, intestinal obstruction, pancreatitis, perfd gastric ulcer, H.pylori, external sources (trauma, injury, GSW, perfd tumor)

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5
Q

Salem Sump

A

Type of NGT
Large bore, double lunem, rigid
Blue pigtail: vents to prevent sticking to stomach and prevents reflux of the tube
Utilized for decompression, irrigation, short term aspiration
small/large bowel obstruction to prevent further vomiting

Inserted through the nose, instruct pt to tilt their chin forward & swallow water while you are inserting it.
To measure: from nose to xphoid process
Very uncomfortable for pt.
Should be on intermittent low wall suction 30-40 (high causes pH and electrolyte imbalances)

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6
Q

Gastric Lavage

A

“Wash out belly” from overdose
Analysis for labs

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7
Q

NGT Proper Placement

A

KUB (xray)

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8
Q

Actions to take if concerns with placement of NGT

A

STOP feeding

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9
Q

NG Tube

A

Very fine tubing, high risk of clogging
Place pt in 30-45 degrees (can cause pneumonia)

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10
Q

Uses of Enteral Nutrition

A
  • Decompression/Drainage
  • Anytime the stomach has to be bypassed - risk of aspiration
  • bowel obstruction
  • inability to swallow
  • active GI bleed
  • lavage
  • diagnose (gastric analysis)
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11
Q

High Risk for NGT

A

Decreased mental consciousness
Altered mental status

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12
Q

Peritonitis Medical Management

A

Monitor/replace fluid & electrolytes
Pain control
IV abx
Sx

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13
Q

Levin Tube

A

Type of NGT
Single-lumen
Utilized for decompression
Used only for feeding and admin meds
Not typically used for suctioning due to its harshness against lining

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14
Q

PEG tube

A

Percutaneous Endoscopic Gastrostomy
Long-term
Refusal/Unable to eat, extreme malabsorption, psychiatric reasons

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15
Q

Antacids

A

Acid neutralizing agent
1. Mg OH- (MOM)
2. Al OH- (Amphojel) phosphate binder : increased Al elimination
3. Ca CO3- (Tums) : constipation
4. Na HCO3- (alka seltzer) does not tx ulcers
5. Combo of Al, Mg hydroxide & simethicone (Mylanta)

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16
Q

H2RA

A

Antiulcer - PUD, GERD, heartburn, esophagitis
“Tidine”
Give with meals or
Do not stop abruptly

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17
Q

Sucralfate (Carafate)

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A
  • Antiulcer GI Protectant, mucosal barrier
  • sticky
  • take on empty stomach
18
Q

Bismuth subsalicafate (Pepto-Bismol, Kaopectate)

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A
  • Antiulcer GI Protectant
  • has antibacterial action against H.pylori
  • used for antidiarrheal
  • black,gray stool
  • risk of salicylate toxicity (tinnitus)
19
Q

Misoprostol (Cytotec)

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A
  • Antiulcer GI Protectant
  • suppresses acid & inc mucus
  • NO pregnancy
20
Q

PPIs

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A

Antiulcer
Prevents pumping acid
Give before meals, AM
Must slowly taper off
S/E: VitB12 deficiency, bone fractures, malabsorption, CDAD

21
Q

Anti-flatulent

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A

Simethicone (Gas-X)

22
Q

Barrett Esophagus

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A

Irritation of the lining caused by chronic reflux
Changes the lining similar to stomach & intestines
S/S heartburn
Diagnostic: EGD (esophagogastroduodenoscopy) can do biopsy, position on L side
TX: PPIs, repeat EGD 3-5 yrs, endoscopic resection, RF ablation

23
Q

GERD

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A

Common disorder marked by backflow of gastric/duodenal contents
Leads to: pyloric stenosis, incompetent esophageal sphincter, Barrett’s

24
Q

GERD Diagnostics

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A

EGD
Barium swallow
Wireless capsule pH monitoring (Bravo test)

25
GERD Management
Low fat diet Avoid: caffeine, alcohol, tobacco, milk, mint, carbonated beverages, eating/drinking before bed, tight fitting clothes HOB elevated 30 Meds: antacids, antiulcers, Reglan
26
H.pylori Diagnostics
EGD w/ biopsy Blood test for antibodies Breath test Stool test
27
H.pylori TX
Triple Therapy: Amoxicillin, Clarithromycin, PPI Quad Therapy: bismuth subsalicylate, tetracycline, metronidazole, PPI
28
Gastritis (ACUTE)
Causes: (EROSIVE - NSAIDs, alcohol, gastric radiation) (NON EROSIVE - H.pylori) Manifestations: anorexia, epigastric pain, hematemisis (coffee ground), BRBPR
29
Gastritis (CHRONIC)
Manifestations: bleeding ulcer, early satiety, heartburn, vague, epigastric, discomfort, relieved by eating, sour taste in mouth, belching, intolerant to spicy fatty foods Assessment: fatigue, heartburn, malabsorption of vitamin B12 (pernicious anemia) Management: diet, modification, reduce stress, avoid alcohol & NSAIDs, medication
30
Gastritis
Inflammation/Disruption of mucosal barrier (or lack thereof) that leads to superficial erosion, eventually causing hemorrhage General Management: Monitor for hemorrhagic gastritis, encourage fluids, avoid irritating foods, symptoms/pain relief
31
Peptic Ulcer Disease
Cant withstand HCl & pepsin Involves gastric, duodenal, esophageal, or combination of all Deep erosion that may extend into the muscle layers and through the peritoneum Risk factors: age, stress, chronic NSAIDs, H.pylori, tobacco & alcohol, family hx, type O blood, COPD, cirrhosis, CKD
32
Causes of PUD
H.pylori NSAID overuse Stress Smoking Alcohol Genetics
33
PUD Complications
Hemorrhage Perforation/penetration Gastric outlet obstruction (pylorus)
34
Stress Ulcer
Acute mucosal ulceration of the duodenal or gastric area as a result of physiological stressful event Such as ventilator, burns shock, sepsis, MODS
35
Manifestations of PUD
Asymptomatic initially Pyrosis GI bleeding sour burping burning sensation in the mid epigastric area or back pain after eating (gastric ulcer quicker than duodenal) Bleeding ulcers may not be painful (essentially healing) If perfd sudden severe pain in upper abd
36
PUD Diagnostics
Upper endoscopy CBC - detect bleeding, antibodies Occult blood test Stool test - H.pylori Urea breath - H.pylori
37
PUD Management & Interventions
- 6 sm meals per day - no eating/drinking before bed - H.pylori triple/quad therapy - antiulcers Sx (may be an emergent situation) - vagostomy - pyloroplasty - antrectomy w/ gastroduodenostomy Billroth I or II
38
Dumping Syndrome
Rapid emptying of gastric entente into the small intestine from surgical removal of a significant portion of the stomach or pyloric sphincter Lasts for a few months Occurs 10 to 30 minutes after eating Resolves within one hour or with bowel evacuation (enema, suction/vacuum)
39
Prevention of Dumping Syndrome
5-6 sm meals Avoid fluids with meals Inc fiber intake Lie down to slow digestion Octreotide (sandostatin) slows down gastric emptying
40
Vagotomy
Cut vagus nerve to reduce gastric secretion Diminishes rest & digest effects S/E: feeling full, dumping syndrome, gastritis
41
Pyloroplasty
Widen the pyloric sphincter which fixes the thickened pylorus causing blockage Same S/E as vagotomy
42
EN High Risk
- altered LOC - poor/absent cough/gag reflex - agitation during insertion

MedSurg - Exam 1 (3 decks)

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