TOPIC 7 - GI system

Question 1

GI diseases

Answer 1

GERD, hiatal hernia, peptic ulcer disease, gastritis, gastroenteritis, inflammatory bowel disease (crohns and colitis), diverticulitis, IBS, intestinal or bowel obstruction, bowel surgery, ostomies, bariatric surgery

Question 2

symptoms of GERD

Answer 2

heart burn, burning, tight sensation under lower sternum, spreading towards throat or jaw, felt intermittently

chest pain can mimic angina, relieved with antacids

resp : wheezing, coughing, dyspnea, nocturnal discomfort

Question 3

predisposing factors of GERD

Answer 3

incompetent lower esophageal sphincter
decreased LES pressure
increased intraabdominal pressure
hiatal hernia

Question 4

GERD complications

Answer 4

Barretts esophagus
esophageal varices
esophageal ulcers
respiratory (from irritation of upper airway) : cough, bronchospasm, laryngospasm

Question 5

diagnostic tests

Answer 5

upper GI endoscopy
ambulatory esophageal pH monitoring
radionuclide tests

Question 6

meds

Answer 6

PPIs, H2R blockers, acid protective, pro kinetic drugs, antacids

Question 7

PPIs

Answer 7

promote esophageal healing
ex : omeprazole
s/e : headache

Question 8

H2R blockers

Answer 8

decrease secretion of HCl
reduce symptoms and promote esophageal healing
ex : famotidine
uncommon s/e

Question 9

acid protective

Answer 9

cytoprotective properties
ex : sucralfate

Question 10

prokinetic drugs

Answer 10

promote gastric emptying
reduce risk of reflux
ex: metoclopramide

Question 11

antacids

Answer 11

quick but short lived relief
neutralize HCl
taken 1-3 hours after meals
ex : maalox, mylanta

Question 12

interventions for GERD

Answer 12

elevate HOB 30 degrees
do not lie down for 2-3 hours after eating
avoid smoking, alcohol, acidic foods
stress reduction
weight reduction
small, frequent meals

Question 13

surgical therapy for …

Answer 13

patients with med intolerance, barretts meaplasia, esophageal stricture and stenosis, chronic esophagitis, failure of conservative therapy

Question 14

nissen fundoplication

Answer 14

treat more than 1 clinical condition

fundus of stomach is wrapped around distal esophagus and sutured to itself

Question 15

hiatal hernia - sliding

Answer 15

stomach slides through hiatal opening in diaphragm when patient is supine, goes into abdominal cavity when patient is standing upright

Question 16

hiatal hernia - rolling

Answer 16

fundus and greater curvature of stomach stomach roll up through diaphragm, forming a pocket alongside the esophagus
Paraoesophageal junction remains in normal position
Acute paraoesophageal hernia is a medical emergency

Question 17

complications of hiatal hernia

Answer 17

GERD, esophagitis, hemorrhage, stenosis, ulcerations of herniated portion

Question 18

diagnostics

Answer 18

esophagogram (show protrusion of mucosa)
endoscopy (visualize lower esophagus)

Question 19

surgical therapy

Answer 19

gastropexy : anti-reflux procedure, attachment of stomach sub-diaphragmatically
herniotomy : reduction of herniated stomach, excision of hernia sac
herniorrhaphy : closure of hiatal defect

Question 20

first indication in geriatric population

Answer 20

esophageal bleeding or respiratory complications

Question 21

invasive imaging for diagnostics patient prep

Answer 21

NPO, bowel prep, take normal meds, IV access for sedation, cardiac monitor, labs: electrolytes and CBC,
monitor LOC, RR, O2, vitals

risk for perforation

Question 22

causes of peptic ulcer disease

Answer 22

Hydrochloric acid & pepsin
Helicobacter Pylori
Medications (aspirin, NSAIDS, corticosteroids, anticoagulants, SSRIs)
Lifestyle (excessive ETOH, coffee, smoking, stress)

Question 23

peptic ulcer disease :

Answer 23

erosion of GI mucosa from action of HCl, affecting lower esophagus, stomach, and duodenum

Question 24

acute peptic ulcer disease

Answer 24

superficial erosion, minimal inflammation, short duration, resolves when cause treated

Question 25

chronic peptic ulcer disease

Answer 25

erodes through the muscular wall, present continuously for years or intermittent through life, most common type of ulcers

Question 26

diagnostic studies for peptic ulcer disease

Answer 26

endoscopy with biopsy, invasive tests (endoscopic procedure or biopsy), noninvasive (urea breath test), stool antigen test, serum or whole blood antibody test (IgG - wont distinguish between past and current infection) barium contrast study (patients who cant undergo endoscopy, not for superficial ulcers, diagnose gastric outlet obstruction) gastric analysis (content for acidity and volume, NG tube, analyze for HCl) labs (CBC, liver enzymes, serum amalyse, stool exam)

Question 27

meds for peptic ulcer

Answer 27

PPIs H2R blockers Antibiotics Antacids Anticholinergics Cytoprotective therapy

Question 28

antibiotics for peptic ulcer

Answer 28

Eradicates H. pylori infection No single agent has been effective in eliminating H. pylori Prescribed concurrently with a PPI for 7 to 14 days

Question 29

complications of ulcers

Answer 29

hemorrhage (hematemesis, melena, EGD, type and screen, PRBC give and hold, IV access, O2) perforation (sudden, sharp, epigastric pain, peritonitis, rebound tender, rigid) gastric outlet obstruction (edema, inflammation, pain worse at end of day, burping, constipation)

Question 30

surgical interventions and complications

Answer 30

partial gastrectomy, vagotomy, pylorplasty dumping syndrome, posprandial hypoglycemia, bile reflux gastritis

Question 31

gastritis

Answer 31

Breakdown of the normal mucosal barrier Causes: Drugs, Diet, Microorganisms, Environment, diseases, and other factors Nausea, vomiting, anorexia, epigastric tenderness, feeling of fullness, gi bleed Chronic Management: remove causes, manage symptoms, treat pernicious anemia for stomach tissue atrophies

Question 32

gastroenteritis

Answer 32

Inflammation of the mucosal lining Causes: bacterial, viral, food contamination Table 42-1, Harding et al… Sudden diarrhea, nausea, vomiting, fever, abdominal cramping Self-limiting Management: fluids replacement, antipyretics

Question 33

foods that trigger exacerbations

Answer 33

Lactose intolerance High-fat foods Cold foods High-fiber foods

Question 34

goals of treatment of IBD

Answer 34

Rest the bowel Control inflammation Combat infection Correct malnutrition Alleviate stress Relieve symptoms Improve quality of life

Question 35

nutritional therapy during acute exacerbations

Answer 35

regular diet not tolerated liquid enteral feedings (high calorie, lactose free, easily absorbed, low fiber)

Question 36

goal of drug treatment

Answer 36

induce and maintain remission

Question 37

meds

Answer 37

Aminosalicylates Antimicrobials Corticosteroids Immunosuppressants Biologic and targeted therapy

Question 38

bowel obstruction causes

Answer 38

mechanical : tumor, adhesion, stricture vascular : interference of blood supply

Question 39

bowel obstruction assessment

Answer 39

vomiting, abdominal distention, hyperactive proximal to blockage, colicky type pain, fluid/electrolyte imbalance

Question 40

barium enema only used after what is ruled out

Answer 40

perforation

Question 41

bowel obstruction complications

Answer 41

infection, ischemia-infaraction, perforation, severe dehydration, electrolyte imbalance

Question 42

bowel obstruction treatment

Answer 42

NG tube - decompression surgery - ileostomy or colostomy

Question 43

bowel obstruction interventions

Answer 43

NPO, IV fluids, abdominal assessment, I+O, monitor CBC,BMP, pain meds, anti-emetics, oral care

Question 44

purpose of bariatric surgeries

Answer 44

decrease client weight as safely as possible, decrease risks of obesity related diseases

Question 45

who should adjust NG tube placement

Answer 45

only provider