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From Flashcardlet > GI Part 1 > Flashcards

GI Part 1 Flashcards

1
Q

What is the Endoscopic Retrograde Cholangiopancreatography (ERCP)?

A

cannula into common bile duct, dye, can remove gall stones or a stent can be placed if a stricture

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2
Q

What are some of the complications with a Endoscopic Retrograde Cholangiopancreatography (ERCP)?

A

sepsis, perforation, pancreatitis, cholangiitis (GB inflammation)—will have severe pain if occurs—

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3
Q

When can the complications with a Endoscopic Retrograde Cholangiopancreatography (ERCP)?

A

may be hours or up to 2 days when occurs so educate

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4
Q

What is the preparation for a colonoscopy?

A

clear liquid 24 hours and NPO 8 hours, no asa or NSAIDS, bowel prep

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5
Q

What needs to be observed for every 15 minutes along with VS after a Colonoscopy?

A

15 observe for bowel perforation pain and hemorrhage, decrease BP

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6
Q

What age does screening for colon cancer begin?

A

age 50 for routine screening, earlier if their is a family history

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7
Q

What does an Upper GI or barium swallow UGI do?

A

gives an outline of the upper GI structures and can do small bowel follow through see it go thru the gi tract.

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8
Q

What does an Upper GI or barium swallow UGI check for?

A

motility time, strictures, hiatal hernia

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9
Q

How is a patient prepared for an Upper GI or barium swallow UGI?

A

npo for 8 hours—ideally no analgesics or anticolinergic drugs that will slow motility—drink barium—

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10
Q

What is a Barium Enema?

A

x-ray of the large intestine—outline of the bowel

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11
Q

How is a patient getting a Barium Enema prepared?

A

same as colonoscopy

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12
Q

What is patient given post procedure of a Barium Enema?

A

post procedure given a laxative or stool softener, and encourage fluids to eliminate barium

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13
Q

How long is stool chalky white after a barium enema?

A

24-72 hours

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14
Q

How is a patient prepared fro an Esophagogastroduodenoscopy (EGD)?

A

npo 8 hours—may take htn drugs—hold NSAIDS, anticoagulants, aspirin—conscious sedation with versed and fentynl

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15
Q

What does an Esophagogastroduodenoscopy (EGD) do?

A

suppresses gag reflex and swallowing may be impaired

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16
Q

How often are VS taken after an Esophagogastroduodenoscopy (EGD)?

A

every 30 min

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17
Q

When does the gag reflex usually return after an Esophagogastroduodenoscopy (EGD)?

A

1-2 hours - priority is to prevent aspiration

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18
Q

What is Gastroesophageal Reflux Disease (GERD)?

A

Syndrome in which gastric acid goes back up into the esophagus

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19
Q

What is GERD often associated with?

A

hiatal hernia
delayed gastric emptying
incompetent lower esophageal sphincter (LES)

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20
Q

What happens in the inflammatory response with GERD?

A

breaks down mucosal barrier –> corrosive esophagitis

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21
Q

What may result from GERD?

A

Barrett’s esophagus

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22
Q

What happens with Barrett’s Esophagus?

A

tissue in the lower esophagus changes –> precancerous

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23
Q

What are GERD manifestations?

A 
pyrosis (heartburn) substernal, like angina
regurgitation--hot, bitter
belching
flatulence
dysphagia
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24
Q

What are some complications of GERD?

A

aspiration pneumonia or scar tissue

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25
Q

How is GERD diagnosed?

A

with history of symptoms plus barium swallow or UGI or EGD

Esophageal pH

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26
Q

What is given after meals for therapeutic management with GERD?

A

antacids 1-3 hours after meals and HS

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27
Q

What is the goal of the therapeutic management of GERD?

A

Prevent and relieve stomach pain

Neutralize acid

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28
Q

When a patient is given Sodium Bicarbonate for GERD, what can it cause?

A

can cause alkalosis

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29
Q

When a patient is given Amphojel (Aluminum Hydroxide gel), what can it cause?

A

constipation

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30
Q

What can Magnesium Salts (Milk of Magnesia) cause when a patient is given this?

A

diarrhea

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31
Q

What are Reglan and Urecholine given for with patient’s who have GERD?

A

increase LES (lower esophegeal s pressure /Prokinetics

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32
Q

What combination type is given with patient’s with GERD?

A

Mylanta II

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33
Q

What combination type has the largest capacity for buffering and has anti-flatulent, simethicone?

A

Mylanta II

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34
Q

When is Riopan good with patients who have GERD?

A

if they are on low sodium diet

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35
Q

What is Gaviscon given for with patients who have GERD?

A

an antacid and alginic acid foam that floats and forms a barrier

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36
Q

What is given to decrease acid secretion with GERD?

A

H2 receptor antagonist

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37
Q

What are the drugs such as Tagamet, Zantac, Pepcid, and Axid given for with patients who have GERD?

A

they are H2 receptor antagonist - decreases acid secretion

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38
Q

What are Proton Pump inhibitors given for with Patient’s who have GERD?

A

virtually eliminate acid secretion

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39
Q

What are some examples of Proton Pump Inhibitors?

A

Prilosec (omeprazole)
Nexium (esomeprazole)
Prevacid (lansoprazole)
Protonix (pantoprazole)

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40
Q

What are medications are given for Mucosal protective agents with patient’s who have GERD?

A

Carafate

Cytotec

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41
Q

What medication forms a past over irritated area in the stomach?

A

Carafate

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42
Q

What medication enhances mucosal defenses/aids in mucus production?

A

Cytotec

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43
Q

How does the diet of a patient with GERD need to be changed?

A

small, frequent meals to decrease over-digestion
increase protein
decrease fat

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44
Q

what does fatty foods in the diet do to patients who have GERD?

A

decreases LES pressure and delays gastric emptying

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45
Q

What foods exacerbate symtoms of GERD?

A

chocolate
peppermint
coffee
tea

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46
Q

What food increases gastric acid secretion in patients with GERD?

A

milk

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47
Q

When do fluids need to be drunk when a patient has GERD?

A

between meals

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48
Q

What kind of juices irritate mucosa with GERD?

A

citrus juices

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49
Q

What does alcohol do to patients who have GERD?

A

damages esophageal epithelium and weakens LES

50
Q

What lifestyle change should be changed to decrease GERD?

A

lose weight if obese

51
Q

What needs to be taught about smoking when a patient has GERD?

A

it decreases LES tone

52
Q

What additional information need to be taught to patient’s who have GERD?

A 
Increase HOB at least 4 inches when sleeping
Don’t lie down 2-3 hours after meals
No late night eating
No tight clothing around waist
No bending at waist, esp. after eating
53
Q

What is a hiatus?

A

opening at the diaphragm

54
Q

What is a Hiatal Hernia?

A

portion of the stomach to pass through the opening in the chest

55
Q

What causes a Hiatal Hernia?

A

Muscular collar around the esophagus and diaphragm junction loosen

56
Q

Who has a increase incident for Hiatal Hernias?

A

women and older population

57
Q

Why is there an increase risk for Hiatal Hernia in older adults?

A 
Muscle weakness
Kyphosis
Increased abdominal pressure with obesity
Increased valsalva with constipation
Straining, increases abdominal pressure
58
Q

What are the S&S and treatment of Hiatal Hernia similar to?

A

GERD

59
Q

What are the S & S of a Hiatal Hernia?

A 
Substernal discomfort
pyrosis (hr burn) sev. hrs after meals
Belching and flatulence 
May develop aspiration--respiratory symptoms
Dysphagia
60
Q

What substernal discomfort aggravated by with a Hiatal Hernia?

A

reclining

61
Q

What is belching and flatulence due to with a Hatial hernia?

A

air swallowed to reverse reflux

62
Q

What is dysphagia due to with a Hiatal hernia?

A

stricture/decreased motility

63
Q

When is surgery indicated with a Hiatal Hernia?

A

if have severe esophagitis, suffer frequent aspiration, cannot control symptoms

64
Q

What is a Nissen Fundoplication?

A

repair defect in diaphragm; wrap fundus around hiatal hernia

65
Q

What is Peptic Ulcer Disease (PUD)?

A

Erosion of the GI mucosa

66
Q

What is PUD resulting from?

A

the digesting action of pepsin and HCl acid

67
Q

does stress, smoking and spicy foods cause PUD?

A

no it just aggravates the problem because it increases acid secretion

68
Q

Where are the Ulcers with PUD?

A

in stomach or small intestine

69
Q

What are the primary causative factors for PUD?

A

H. pylori infection which produces chronic gastritis

Side effects of NSAIDS

70
Q

What do both NSAIDS and H. Pylori infection target?

A

mucosal defenses and eventually lead to ulceration in vulnerable people

71
Q

What is the stomach normally protected from?

A

from autodigestion by the gastric muscosal barrier

72
Q

If the gastric mucosal barrier is impaired, what happens?

A

“back diffusion” of acid into the mucosa can occur

73
Q

What impairs the mucosal barrier?

A

H. Pylori and NSAIDS

74
Q

What is a Duodenal Ulcer?

A

Hypersecretion of acid–increased rate of gastric emptying, so increased acid is dumped into duodenum

75
Q

What are the signs of a Duodenal Ulcer?

A

Epigastric pain, gnawing, burning

76
Q

When does the pain come with a Duodenal Ulcer?

A

2-3 hours after eating and 1-2 AM

food relieves pain – pain–>food–>relief

77
Q

When is there no pain with a Duodenal Ulcer and why?

A

upon rising there is no pain because acid secretion is at its lowest

78
Q

What is a Gastric Ulcer?

A

Normal to decreased acid secretion–mucosa has decreased resistance

79
Q

Where is the pain with gastric ulcers?

A

epigastric pain

80
Q

Does food relieve pain with a Gastric Ulcer?

A

no, may aggravate the pain

81
Q

Is the recurrent rate high or low for PUD?

A

high for both types

82
Q

Since the mucosa heals rapidly, what does this cause?

A

an increase and decrease in symptoms

83
Q

How is PUD diagnosed?

A

EGD or blood test for H. Pylori

84
Q

What is the recurrent rate of PUD if treated with antibiotics?

A

10%

85
Q

What is the recurrent rate for PUD if not treated with antibiotics?

A

95%

86
Q

What are some complications of PUD?

A

Hemorrhage
Perforation
Gastric outlet obstruction

87
Q

What are the two types of hemorrhage with PUD?

A

Melena

Hematemesis

88
Q

What is the most lethal complication with PUD?

A

perforation

89
Q

What the three main types of medications given for PUD?

A

Antacids
H2 receptor antagonists
anticholinergics (occasionally) to decrease acid secretion and delay gastric emptying

90
Q

What is the main PUD management?

A

Rest
Diet
No Smoking
Medications

91
Q

What are the Cytoprotective drugs or PUD management?

A

Carafate

Bismuth

92
Q

What does Bismuth used for with PUD?

A

helps heal and partially effective against H. Pylori

93
Q

What is the antibiotic regimen to treat H. Pylori when a patient has PUD?

A

Biaxin, Amoxicillin, Prevacid

94
Q

Before Gastric Surgery, what is done in the preop?

A

work on respiratory hygiene

95
Q

What take place postop of Gastric Surgery?

A

NGT to low wall suction, bloody drainage first 24 hr., then change to dark brown with bile-colored drainage–be alert for hemorrhage

96
Q

What should there be an order for after a Gastric Surgery?

A

order to irrigate NGT with approx. 20cc saline every 2 hours

97
Q

Why should there be an order to irrigate NGT with approx. 20ml saline every to hours?

A

to keep patent–keep NGT draining to decrease pressure on the suture line

98
Q

What do you do if NGT is not draining after Gastric Surgery?

A

call Dr.–do not manipulate the NGT–the rigid tube may go through suture line

99
Q

What needs to be assessed after Gastric Surgery?

A

bowel sounds
distention
place in semi-fowlers to facilitate drainage

100
Q

When should patient get out of bed after a Gastric Surgery and why?

A

1st day postop - movement will help increase peristalsis

101
Q

What needs to be assessed for before removal of NGT after Gastric Surgery?

A 
Bowel sounds present
Decreased drainage from NGT
Passing flatus
Has had a bowel movement
Abdomen soft, not distended
102
Q

What can occur as a Post Op complication with Gastric Surgery because of rapid emptying into bowel?

A

decreased absorption of calcium and Vit. D

103
Q

What can occur as a Post Op complication with Gastric Surgery due to lack of “intrinsic factor” being secreted in stomach?

A

Vitamin B12 deficit

104
Q

What will patients need if they have a Vitamin B12 deficit Post Op Complication of Gastric Surgery?

A

will need monthly B12 injections or they can develop pernicious anemia

105
Q

What is Dumping Syndrome?

A

a Post Op complication of Gastric Surgery where there is gastric incontinence - contents leave rapidly

106
Q

Where do contents go when they leave rapidly in Dumping Syndrome?

A

they are “dumped” into jejunum shortly after meal

107
Q

What takes place in Dumping Syndrome 5-30 minutes after a meal?

A 
pt. develops vertigo
sweats
pallor
palpitations
diarrhea
nausea
108
Q

What is the nausea due to with Dumping Syndrome?

A

due to rapid movement of extracellular fluids into bowel (body trying to make substance isotonic)

109
Q

What happens to fluid in Dumping Syndrome?

A

patient has a rapid fluid shift –>leads to decreased circulating blood volume–>symptoms

110
Q

After the initial symptoms of Dumping Syndrome take place, what is there a marked increase in?

A

increase in blood sugar

111
Q

What is a marked increase in Blood sugar due to in Dumping Syndrome?

A

sugar due to the bolus of food–> insulin is secreted–>2-3 hr later have a decrease in blood sugar–> irritable, nausea, diaphoretic

112
Q

What are the nutrition suggestions to decrease Dumping Syndrome symptoms?

A 
High protein
moderate fat
low carbohydrate
low fiber
Small, frequent meals
113
Q

What should patient not eat or drink with Dumping Syndrome?

A

No milk, sweets, sugar
No liquids, except between meals
Sedatives or antispasmodics can delay gastric emptying

114
Q

What foods are good to eat with Dumping Syndrome?

A

Meat, fish, poultry, eggs, cheese are good

Eat dry foods

115
Q

How should patient eat with dumping syndrome?

A

eat semi-recumbant

Lie down after eating

116
Q

How are complex carbohydrates added into the diet of a patient who has Dumping Syndrome?

A

gradually

117
Q

When do manifestations of Dumping Syndrome usually go away?

A

6 months to a year

118
Q

What are some of the requirements for Bariatric Surgery?

A

Have been overweight >5 years
Have tried many different ways to lose weight
Must be >100 lbs. Overweight

119
Q

What is the most common surgery for weight loss?

A

Roux-en-Y Gastric Bypass

120
Q

What is Roux-en-Y Gastric Bypass surgery?

A

leaves a 15ml pouch

121
Q

What are some of the complication with surgery for obesity?

A

wound infection, anastomotic leak (most serious and most common cause of death after bariatric surgery), dumping syndrome (75% of patients), incisional hernia, nutritional deficiencies (iron, calcium, B12)

From Flashcardlet (107 decks)

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