UGI Flashcards by Sydney Perry

Impaired neuromuscular coordination of the lower esophagus due to disrupted
innervation is called _________

Impaired swallowing due to:
Decreased ________ in the ______ esophagus
_____________ maintains an excessively high tone and fails to open properly during swallowing
Food is prevented from entering the _______, causing esophageal distention

Achalasia

peristalsis
middle

Lower esophageal sphincter (LES)

stomach

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Symptoms of Achalasia

Esophageal pain after swallowing
Feeling of fullness in the chest
Dysphagia
Frequent regurgitation
Aspiration
Poor intake & weight loss

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Medical Treatment of Achalasia

Anticholinergic drugs (e.g. Bentyl)
Intrasphincteric botulism injection
Mechanical dilation of esophageal sphincter
Myotomy

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MNT for Achalasia

Eat ______ & _____ thoroughly
_________ meals
Take ______ with meals
Altered texture based on tolerance=> _____________
High _________ nutrition supplements

slowly & chew
Small, frequent
fluids
easy to chew diet or blenderized liquid diet
calorie/protein

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Reflux of gastric acid through the lower esophageal sphincter (LES) into the esophagus

GERD

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GERD is caused by ______

Primarily due to spontaneous and transient _______

LES Pressure

relaxation of LES

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LES pressure is decreased by:

Smoking
Certain foods
Distention of the proximal stomach
Hormone changes=> pregnancy, oral contraceptives
Smooth muscle relaxants
Scleroderma

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Intragastric pressure can be increased by:

Large meals
Lifting/bending
Obesity
Tight fitting clothes
Hiatal hernia

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Hiatal Hernia

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Symptoms of GERD

Heartburn
Odynophagia
Chronic cough, hoarseness, asthma

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Complications of GERD

Esophagitis
Esophageal stricture=> dysphagia
Dental erosion
Respiratory problems
* asthma
* aspiration pneumonia
Barrett’s esophagus=> precancerous cells

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goal of GERD medications

decrease gastric acid secretion

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types of GERD medication

H2 receptor antagonists
proton pump inhibitors
FMI of meds that decrease acid secretion
Antacids

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H2 receptor antagonists examples

fomotidine (Pepcid)
cimetidine (Tagamet)

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Proton pump inhibitors are used for _______
examples?

more severe GERD

omeprazole (Prilosec)
pantoprazole (Protonix)

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FMI of meds that decrease acid secretion

lower absorption of Fe, vitamin B12, Ca2+, and Mg2+

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Antacids will _________

Examples?

neutralize gastric acids

Mylanta
Maalox
Tums

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Lifestyle modifications to do for GERD

sleep with HOB elevated 6-8 inches
weight loss if overweight
stress management

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lifestyle modifications to avoid for GERD

eating within 2-3 hours of bed
tobacco products
lying down, bending over, or straining immediately after eating
Tight fitting clothing

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for GERD, a trial of the restriction of these foods that decrease LES pressure

coffee
chocolate
peppermint and spearmint
food with a high fat content

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for GERD, a trial of the restriction of these foods that increase gastric secretion

black and red pepper
alcohol
coffee (reg or decaf)
tea (reg or decaf)
caffeinated beverages

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For GERD avoid eating ____ meals or meals high in ____
also limit _____ beverages

large
high fat
carbonated

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surgical treatment for GERD

Nissen fundoplication where funds of the stomach is wrapped around the lower esophagus to prevent reflux

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problems that may occur after Nissen Fundoplication

esophageal swelling (dysphagia)
gas pain
dumping syndrome

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Post-op MNT: Nissen Diet * Follow a “_________” diet for ~ ________ * Avoid _____________________ * Avoid ______ foods=> peanut butter, untoasted white bread * Consume small frequent meals to avoid distention * No gassy foods; Limit aerophagia * ____________________

Easy-to-Chew 2 months nuts, seeds, tough meats, raw fruits & veg, and sharp edges sticky no drinking through a straw, no gum, no carbonated beverages, dried beans, cabbage family veg

MNT: Nissen Diet * Avoid spicy foods * Eat slowly, take small bites, & chew thoroughly * Anti-dumping diet guidelines: * Drink fluids ____________ * Limit fluid with meals to _____ * Limit ________

between meals ½ cup concentrated sweets

Acute esophagitis is caused by: * Viral or bacterial ______ * _____ * Ingestion of a _______ * ________ therapy * Acute ________ * ___________ esophagitis

infection GERD corrosive agent Radiation vomiting Eosinophilic

Chronic esophagitis is caused by: * Chronic _____ * Recurrent _______

GERD vomiting

Esophagitis Symptoms=> __________ Complications: ___________ __________ ____________

odynophagia Hemorrhage Stricture Dysphagia

Goals of MNT for esophagitis Prevent ____________ Prevent _____ to decrease exposure of esophagus to gastric contents

pain and irritation GERD

MNT for Esophagitis Avoid any foods that exacerbates symptoms: - _________ foods=> citrus fruit & juice, tomatoes & tomato products, carbonated beverages - ______ foods - ______ foods

acidic rough spicy

MNT to prevent GERD for ppl with esophagitis * Avoid ______ meals * Limit dietary ____ * Avoid _____ * Avoid _____

large fat alcohol coffee

Indications for Esophageal Surgery

* Cancer * Barrett’s esophagus * GERD * Achalasia * Trauma * Fistula

Esophagectomy Variations

Gastric pull-up Colonic interposition

Complications of Esophagectomy

- Dysphagia - Dumping syndrome - Early satiety - GERD - Aspiration - Weight loss & malnutrition - Stricture - Fistula (rare) - Chylothorax (rare)

Injury to the thoracic duct is called ________ and its when _____________ into the ________

chylothorax chyle leaks into the thoracic cavity

examples of Chyle

WBC chylomicrons (LCT & Fat soluble vitamins) proteins fluid electrolytes

consequences of chylothorax

pain pleural effusion anorexia hypoalbuminemia decreased electrolytes fat soluble vit depletion EFAD

Goal of MNT for Chylothorax

reduce chyle flow by decreasing LCT intake to <10 g/day

MNT for Chylothorax options

very low fat oral diet with MCT oil supplementation NPO with TF using a very low fat elemental formula NPO with TPN

MNT for Partial Esophagectomy Oral diet: - Begin with _____ and progress to _______ diet - Avoid tough, sticky, or abrasive foods - ________ meals per day - Take small bites, chew thoroughly, eat slowly - MNT to prevent ______ - MNT for dumping syndrome if needed - MNT for _______ if needed

liquids easy-to-chew 6 small reflux dumping syndrome

MNT for Total Esophagectomy

- NPO with JT feedings - When approved by surgeon, begin esophagectomy diet and follow for ~3 months

Nonspecific, persistent upper abdominal discomfort

Dyspepsia

Symptoms of Dyspepsia

vague abdominal pain bloating belching nausea

Dyspepsia Caused by:

* GERD * Peptic ulcer disease * Gastritis * Gallbladder disease * Emotional stress * Eating habits=> eating too much, too fast, high-fat foods

MNT for Dyspepsia

* Eat slowly & chew thoroughly * Smaller size meals * Decrease dietary fat * Limit aerophagia=> eat slowly, chew with mouth closed, avoid straws, no chewing gum * Limit alcohol

inflammation of the gastric mucosa

gastritis

acute gastritis is _______ of inflammation and symptoms

rapid onset

chronic gastritis is a ______ problem with periods of __________ more common in __________

long term exacerbation and remission older adults

symptoms of gastritis

epigastric pain N/V anorexia GI bleeding (GIB)

causes of gastritis come from disruption of the _______ through... Bacteria ? Drugs ? Excessive use of ? acute, severe _______ _______ therapy ___________ (condition) ___________ (condition)

mucosal integrity helicobacter pylori (H. pylori) non-steroidal anti-inflammatory drugs (NSAIDS) aspirin corticosteroids alcohol and tobacco metabolic stress radiation pernicious anemia bile reflux

rare complication of chronic gastritis that results in extensive degeneration of the gastric mucosa

atrophic gastritis

atrophic gastritis results in _______ and loss of ______ resulting in _________ __________

atrophy & loss of parietal cells Achlorhydria (not enough acid secretion) Decreased secretion of intrinsic factor (possible B12 deficiency)

medical treatment for gastritis

antibiotics for H. pylori proton pump inhibitors; H2 receptor antagonists for Acid discontinuing injurious drugs, alcohol, smoking

MNT for Acute Gastritis

follow bland diet and avoid gastric irritants - pepper, chili powder, alcohol avoid foods that increase acid secretion - coffee, tea, caffeine, alcohol, pepper

if acute gastritis is severe, individual might need to follow __________ to decrease inflammation with _____, then later follow the ______

NPO 24-48 hours IVF bland diet

MNT for chronic gastritis

well balanced bland diet for healing monitor for iron deficiency anemia IM or sublingual vit B12 supplementation for atrophic gastritis

an ulceration in the mucosal lining of the ______, _____, ______, or ______ is called _________

duodenum stomach esophagus jejunum peptic ulcer disease (PUD)

peptic ulcer disease. exposes the ______ to ________ and _______ PUD can be acute or chronic with _____ erosions or _____ ulcers

submucosa gastric secretions auto digestion superficial deep

risk factors for PUD include... _______ infection habitual use of _______ or ________ excessive ________ high dose _______ use of ______ _____________

H. pylori infection aspirin or NSAIDS Excessive alcohol high dose corticosteroids tabacco metabolic stress

PUD is a ______, ______, or ______ abnormalities that disrupt the factors that normally maintain mucosal integrity it results in ___ and ____ penetrating the mucosal barrier creating ulceration

microbial chemical neural acid and pepsin

clinical manifestations of PUD

epigastric pain dyspepsia, N/V anorexia and wt loss

epigastric pain can become worse when stomach is _______ may be relieved by ___________ _______ pain is common pain may disappear and then return in a few _______

empty ingestion of food or antacid nocturnal days or weeks

complications of PUD

Hemorrhage gastric outlet obstruction perforation

Medical management for PUD should be to eliminate the cause and decrease risk factors _______ for H. pylori reduce use of ______, quit ________, avoid ________ Decrease gastric secretion with ______ and ______ neutralize gastric acid with ________ _____________ may be required for PUD complications

antibiotics NSAIDS, smoking, alcohol proton pump inhibitors and H2 receptor antagonists antacids surgical resection

proton pump inhibitor examples

Omeprazole (Prilosec) Pantoprazole (Protonix)

H2 receptor antagonists example

famotidine (Pepcid)

examples of antacids

Mylanta Maalox Tums

MNT for PUD

well balanced bland diet avoid alcohol, red and black pepper, coffee, tea, and caffeine smaller frequent meals avoid food not individually tolerated

why would someone need gastric surgery

gastric cancer complications of PUD

surgical widening of the pylorus

pyloroplasty

why does some one need pyloroplasty

gastric outlet obstruction enhance gastric emptying

removal of part of the stomach is _______ removal of whole stomach is _______

partial gastrectomy total gastrectomy

reconstructive procedures that accompany partial gastrectomy

billroth operations

reattachment of remaining stomach to the duodenum

billroth I (gastroduodenostomy)

reattachment of the remaining stomach to the jejunum

Billionth II (gastrojejunostomy)

Nutritional Consequences of Gastric Surgery Early ________; inadequate ______ Malabsorption due to ___________ Fluid & electrolyte imbalances due to ______ ___________; Malnutrition _________ deficiencies Nutritional ________

satiety; intake dumping syndrome diarrhea Micronutrient anemias

gastric surgeries can cause anemias - _____ due to __________ - ______ due to __________

Iron deficiency due to lack of gastric acid vitamin B12 deficiency dure to decreased IF

what is dumping syndrome

rapid emptying of hypertonic chyme from the residual stomach into the small intestine 10-20 minutes after eating

factors that promote dumping syndrome include - loss of ______________ - loss of ________ control when ______ is removed - loss of ________ control by the _______ when it is removed

gastric capacity emptying pylorus feedback duodenum

dumping syndrome resulting in rapid gastric emptying results in __________ in small intestine so _____ shifts from __________ to ___________

high osmotic load fluid vasculature intestinal lumen

early dumping syndrome occurs ______ after eating

10-30 min

dumping syndrome can cause ________, __________, and ____________. Along with distention of the intestine which results in ______, _______, _______, and _______

weakness dizziness rapid heartbeat cramping diarrhea nausea bloating

late stage during syndrome occurs ____ after eating and is _________. Often occurs after eating a _____ meal

1-3 hours less common high carb

late dumping syndrome causes _________ due to rapid rise in ________ level symptoms include _____, _______, _______, and _______.

reactive hypoglycemia insulin weakness diaphoresis shakiness confusion

what is the Post-Gastrectomy/ Anti-Dumping Syndrome Diet

5-6 small meals limit simple sugars high protein & moderate fat (every meal should have pro) Avoid liquids with meals (drink >30-40 min after eating)

for after gastric surgery consider ________ sources and eat slowly and chew well. _______ after meals and avoid ________________(4)

soluble fiber relax and recline caffeine, alcohol, prunes, sorbitol

after gastric surgery, patients should be prescribed ___________ and may need additional ____ and _____ supplements advance to a regular diet within _____ if a total gastrectomy, diet should be____________

MVI with minerals B12 iron 6-8 weeks NPO with jejunal time feeding

nausea and vomiting are caused by the stimulation of ___________ in the __________

chemoreceptor trigger zone medulla

nausea and vomiting zone can be triggered by ...

Infections; Toxins Diseases Medications Gastric or duodenal distention Severe pain Motion sickness; vertigo

Nutritional Consequences of Vomiting (_________) 1. 2. 3. 4. 5.

Emesis - Dehydration - Electrolyte depletion - Poor intake and weight loss - Acid base imbalance (blood too basic) - Learned food aversions

After vomiting stops, begin with ________ then small amounts of ____________ and then ______________ after _____ hours of not vomiting

ice chips clear liquids solid foods 8 hours

for nausea and vomiting, eat _____, ______ meals Avoid high _____ foods and high ____ foods Also avoid ______ foods Avoid ________ flavored, highly ______, or foods with strong ______

small, frequent fat and fiber gassy strong spiced odors

for N/V try to eat ____, _______ and/or _____ foods

dry, starchy, or salty foods

for N/V sip ______ between meals, _______ may be helpful avoid eating ________ when nauseous replace _____ and _______, may consider oral _________ may require _____ status with ______ if severe and prolonged

cold liquids ginger ale favorite foods fluid and electrolytes rehydration solutions NPO parenteral nutrition

UGI Flashcards

(95 cards)