GI- Gerd PUD Gastritis Flashcards
(61 cards)
1
Q
Inflammation of the mucosal lining of the stomach=
A
gastritis
*may be part or all of the stomach
2
Q
2 types of gastritis
A
acute and chronic
3
Q
characteristics of acute gastritis
A
- Occurs after exposure to local irritants or other causes
- Sudden
- Thickened, reddened mucous membrane with prominent rugae
- Mild to severe
- Can result in bleeding when muscle layer is involved
- Usually resolves in several days
4
Q
characteristics of chronic gastritis
A
- Patchy diffuse inflammation of mucosal lining of stomach
- Walls and lining of stomach will thin and atrophy
- Parietal cell function decreased
- Intrinsic factor production decreased
- B12 absorption stops
- Acid in stomach decreases
- Results in intestinal metaplasia and Gastric Cancer
5
Q
acute or chronic leads to intestinal metaplasia and gastric cancer?
A
chronic
6
Q
acute or chronic gastritis: Patchy diffuse inflammation of mucosal lining of stomach
A
chronic
7
Q
acute or chronic gastritis: Thickened, reddened mucous membrane with prominent rugae
A
acute
8
Q
acute or chronic gastritis: Occurs after exposure to local irritants or other causes
A
acute
9
Q
acute or chronic gastritis: Parietal cell function and Intrinsic factor production decreased
A
chronic
10
Q
acute or chronic gastritis: Can result in bleeding when muscle layer is involved
A
acute
11
Q
1 cause of chronic and acute gastritis
A
chronic = H pylori acute= NSAIDs
12
Q
True or false: H pylori will always cause gastritis
A
◦ Most people with H. Pylori do not have gastritis
◦ In some people, H. Pylori imbeds into the mucosal layer of stomach
–> Activates toxins and enzymes –>Inflammation of mucosa
13
Q
Causes of gastritis
A
H. Pylori (chronic) NSAIDs (acute) Alcohol Consumption (acute/chronic) Severe Illness (acute) Autoimmune disorders (chronic)
14
Q
Reduce these things to help prevent gastritis and do these other things
A
REDUCE:
- Caffeine
- Spicy food
- Chocolate
- Alcohol
- Tobacco
- Aspirin
- NSAIDS
- Stress
DO:
Exercise
Balanced Diet
15
Q
acute gastritis assessment - feels like, looks like:
A
- Epigastric pain
- Epigastric cramping
- Indigestion
- Anorexia
- Nausea & Vomiting
- Abdominal tenderness
- Hematemesis
- Melena
16
Q
Chronic gastritis assessment- feels like, looks like:
A
- Often Asymptomatic –> when starts to cause sxs seed PUD
- Nausea & vomiting
- Epigastric discomfort
- Often after meal
17
Q
Acute gastritis interventions
A
• Self-limiting • Support ◦ Fluids ◦ Blood products ◦ Bland foods
18
Q
Chronic gastritis interventions
A
- Remove cause
- Medications
- Mucosal barrier
- B12 replacement (IM)
19
Q
what is the most common upper GI disorder in US that can strike at any age (most common in 40’s and older)
A
GERD
20
Q
What is GERD?
A
• Backward flow of stomach contents into esophagus
◦ Highly acidic and irritating contents cause inflammation in esophagus
21
Q
What causes GERD
A
• Lower esophageal sphincter is failing to prevent backflow from stomach to esophagus
Causes: ◦ Excessive relaxation of LES ◦ Increased abdominal pressure ◦ Reduced emptying of stomach ◦ Diabetes: gastric neuropathy
22
Q
stomach pH vs esophagus pH
A
Stomach pH = 1.5-2
Esophagus pH = 6-7
23
Q
What happens to ability to return food to stomach after coming up from GERD over time
A
> > Refluxed contents return to stomach via peristalsis and gravity… as esophagus becomes inflamed, it becomes more difficult to get contents back to stomach (reduced function)
- -> Hyperemia
- ->Erosion
24
Q
Risk factors for GERD
A
- Hiatal hernia
- Alcohol use
- Tube in nose or throat
- Large spicy meals
- Citrus food
- Chocolate
- Carbonated Beverages
- Smoking
- Pregnancy
25
Barrett's epithelium is complication from what disease process? and what is it?
GERD
• Barrett’s epithelium
◦ Normal Squamaous cells of esophagus change to columnar epithelium which is precancerous but withstands acid better
26
complications from GERD
* Esophageal stricture (from scarring)
* Asthma
* Laryngitis
* Dental Decay
* Cardiac Disease
* Aspiration pneumonia
* Bleeding
* Barrett’s epithelium
27
GERD assessment- looks like/feels like:
```
-Dyspepsia/ Indigestion (fullness, nausea, belching)
• Discomfort worsens with bending over, lying down
• Pain may radiate to neck or jaw
• May occur after eating for 20 mins- 2 hours
-Regurgitation
• Bitter taste
• Water brash may occur in response (reflexive saliva)
• Belching and flatulence
-Heartburn
-Asthma
-Morning Hoarseness
-Pneumonia
• Crackles in lungs? Wheezing?
• Coughing?
• Dysphagia
-Painful swallowing
```
28
GERD diagnostics (2 main ones)
* Barium Swallow Study (Esophagus)
* **Upper endoscopy (EGD)- best definitive diagnosis
* **pH exam ** - Ph capsule in esophagus reports pH , Gold standard but most don't get it
* Esophageal Manometry
* Gastric emptying test
Diagnosis is often based sxs and how they respond to treatment --> if respond to treatment then assume its GERD
29
Nutrition education for GERD- what not to eat, how should you eat?
* Avoid irritating foods
* Caffeine
* Chocolate
* Fried food
* Fatty food
* Citrus
* Peppermint
* Spicy foods
* Eat small portions/ small meals more frequently
* Avoid eating before bedtime
30
lifestyle changes to manage GERD
* Stop Smoking
* Reduce Alcohol intake
* Elevate head of bed 6-12 inches
* Sleep on right side
* Weight loss
* Evaluation for obstructive sleep apnea
* Avoid bending over
* Sit upright after eating
* Loose clothes
31
• Medications that CAUSE LED relaxation/ contribute to GERD
```
◦ Nitrates
◦ NSAIDS
◦ Oral contraceptives
◦ CCB’s
◦ sedatives
‣ Avoid these medications is not always possible!
```
32
• Medications for TREATING GERD
◦ Antacids
◦ H2 antagonists
◦ PPI’s
(not meant for long term)
33
Surgery for GERD
• Nissen fundoplication
◦ recreate tighter LED, make incisions in stomach to tighten it
◦ Standard surgical approach for GERD
◦ Continue taking meds/lifestylemod --> high rate of recurrence
34
Peptic Ulcer Disease- what is it?
=Mucosal Lesion of the stomach or duodenum
• “PUD” occurs with impairment of mucosal defenses
◦ --> Acid and pepsin are able to destroy the epithelium tissue of stomach and duodenum
35
Cause of many peptic ulcers is what? how does it cause damage?
H pylori
| • May cause break in mucosal barrier >HCl can then injure epithelium of stomach and causes lesion
36
gastric or duodenal : Ulcer caused by Delayed Stomach emptying
gastric
37
gastric or duodenal: ulcer caused by increased stomach empyting
duodenal
38
Increased, decreased or normal with gastric ulcer:
stomach empyting
acid secretion
diffusion of gastric acid into stomach tissue
Delayed Stomach emptying, normal acid secretion, increased diffusion of gastric acid into stomach tissue
39
increased, decreased, or normal w/ duodenal ulcer?
Stomach emptying
acid secretion
diffusion of gastric acid into stomach tissue
=Increased stomach emptying, increased secretion of gastric acid, and normal diffusion of acid into stomach tissue
40
onset of pain w/ gastric vs duodenal ulcer
gastric= pain occurs 30- 60 min after eating, occurs at night
duodenal= pain occur 1.5-3 hours after eating, occurs in middle of night
41
Gastric vs duodenal ulcer: If bleeding occurs --> ?
```
gastric = hematemesis
duodenal = melena
```
42
Gastric vs duodenal ulcer- where is the pain?
gastric- • Upper epigastrium (and left)
| duodenal- • Below epigastrium (and right)
43
what is stress ulcer? what are some causes?
```
=Occur after medical crisis or trauma
• Sepsis
• Head Injury
• Burns
• NPO for surgery
```
44
why are we concerned about stress ulcers and what we gonna do about it?
>May cause bleeding (Increase death), develop very quickly
>Lead to long hospital stays
> give prophylactic PUD med in hospital to prevent
45
Causes of peptic ulcers
* **H. Pylori infection
* **NSAIDS (COX-1 produces prostaglandins that promote inflammation AND protect the GI mucosal lining
* Gastritis
* Corticosteroids
* Theophylline
* Excessive alcohol intake
* Smoking
* Caffeine
* Alcohol
* Radiation therapy
* Stress
---> same as gastritis!
46
Assessment history for PUD
* Risk Factors?
* Medications?
* What aggravates?
* Past surgeries?
* GI symptoms?
* Relationship of GI symptoms to eating & sleep
* Changes in GI symptoms
47
Assessment for PUD- looks like/feels like:
```
• INDIGESTION (Dyspepsia)
• Sharp, burning pain
• Abdominal fullness
• Epigastric tenderness
• Hyperactive bowel sounds (early)
• Hypoactive bowel sounds (late)
• Nausea & Vomiting
◦ Vital Signs
• Appetite changes
```
48
Diagnostics for PUD
```
Urea Breath test- diagnose H. Pylori
Stool Antigen test
Serum Antibody test
Hemoglobin and hematocrit
Fecal Occult test
CT scan
**Esophagogastroduodenoscopy **
Nuclear Medicine scan
```
49
Goals of drug therapy for PUD
* Provide pain relief
* Eliminate H. pylori
* Heal ulcers
* Prevent recurrence
50
Triple vs Quadruple therapy
-treat PUD:
Triple Therapy:
Proton pump inhibitor
2 antibiotics
Quadruple therapy:
Triple therapy + Pepto-Bismol
51
Nutrition Ed for PUD
* Avoid irritating foods
* Bland foods (acute)
* Avoid bedtime snacks
* Avoid alcohol
* Avoid smoking
52
4 complications to consider for PUD
* Hemorrhage
* Perforation
* Pyloric obstruction
* Chronic & difficult to treat disease
53
Hematemesis (UPPER) coloration?
bright red
| coffee ground --> can be actively bleeding w/ this
54
What is Melena a sign of related to PUD? What does it look like?
hemorrhage, dark tarry stool (digested blood)
55
early detection interventions for GI hemorrhage
* Vital signs
* Hemoccult test for suspicious stool
* H & H
* Patient education
56
nursing interventions for GI hemorrhage
* Airway protection
* Position (side)
* Oxygen
* Volume replacement (IV access)
* Blood transfusion
* Prepare patient for medical intervention
57
Medical interventions for GI bleed
```
-Endoscopic procedure
• Esophagogastroduodenoscopy
◦ Inject chemicals into bleeding site
◦ Treat bleed with heat source
◦ Apply band or clip
◦ IV sedation
```
-Interventional radiological procedure
• Catheter directed embolization of artery that is bleeding
• Emergency situation typically
-Acid Suppression
• To prevent re-bleeding
• IV Protonix
• IV Ocreotide: dhunts blood away from GI system
58
what is a bowel perforation?
Allows contents of GI system to leak into peritoneal cavity
59
s/s of bowel perforation- what we gonna do about it?
• Sudden, sharp mid -epigastric pain that radiates through abdomen
• TENDER, RIGID, BOARDLIKE ABDOMEN = Peritonitis
◦ + Rebound tenderness
◦ This is an emergency
--->SUPPORT AND GET TO SURGERY
60
IV Ocreotide =
shunts blood away from GI system, admin during GI hemorrhage
61
What happens during EGD?
◦ Inject chemicals into bleeding site
◦ Treat bleed with heat source
◦ Apply band or clip
◦ IV sedation
