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Upper and Lower GI Flashcards

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1
Q

Why is nausea sometimes difficult to medicate?

A

Very complex process in brain
Lots of different causes
Some meds work on the CTZ (chemical receptors in brain)
Some meds work on the ANS to affect the vomiting center.
Must find the CAUSE before can medicate correctly

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2
Q

What can fluid losses in vomiting lead to?

A

Metabolic acidosis
Hyponatremia
Hypokalemia
Hypochloremia

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3
Q

What is promethazine? How is it administered? Side effects? Drug class? How does it work?

A

Phenergan
Oral or rectal NOT IV
Dry mouth, hypotension, sedation, rash, constipation
Phenothiazine
Acts on CTZ to block dopamine receptors that trigger N/V

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4
Q

What is metoclopramide? Side effects? Drug class? How does it work?

A

Reglan
CNS side effects like anxiety, hallucination, tardive dyskinesia, tremors
Inhibits action of dopamine
Increases gastric motility»diarrhea
Prokinetic class

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5
Q

What is ondansetron? How does it work? Side effects?

A

Zofran
Blocks action of serotonin
Serotonin antagonist
Constipation, diarrhea, headache, fatigue, Increases liver enzymes

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6
Q

What is the initial fluid of choice in oral rehydration?

A

Water (at room temp)
Sip small amounts q 15 min
If tolerates, can move to other clear liquids.

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7
Q

What are some important things to remember when rehydrating/re-feeding after nausea/vomiting subsides?

A

Bland and dry
High carb/low fat
No smelly food
Room temp liquids
Eat slowly/small amounts/wait
Liquids BETWEEN meals not during
Gatorade and broth-watch sodium

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8
Q

What are some things to remember when geriatric patients have N/V?

A

Needs careful frequent assessments
Great risk for fluid/electrolyte imbalance
Increased risk of confusion/falls
Careful with CNS side effects from anti-emetic drugs
Rehydrate slowly if kidney disease

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9
Q

What is cause of gingivitis? S/Sx? Treatment?

A

Cause: Bad oral hygiene/teeth
S/Sx: Inflamed gums, pus, loose teeth
Tx: Prevention by good oral hygiene

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10
Q

What is cause of oral candidiasis? S/Sx?
Tx?

A

Cause: candida overgrowth
Abx, corticosteroids, immune deficiency
S/Sx: Pearly, white curd like lesions, sore mouth
Tx: Miconazole, nystatin, amphotericin B buccal tablets or oral suspension

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11
Q

What is parotitis? Cause? S/Sx? Tx?

A

Inflammation of the parotid gland in back of throat (mumps)
Cause: Usually staph, possibly poor oral hygiene, extended NPO, dehydration
S/Sx: Pain in throat/ear, purulent exudate from gland, redness, ulcers
Tx: ABx, (if from staph)
Rehydrate, warm compresses, chewing gum, candy, mouthwashes

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12
Q

What is stomatitis? Cause? S/Sx? Tx?

A

Mouth inflammation
Cause: Chemo, radiation, trauma, irritants, systemic disease
S/Sx: Halitosis, Increased salivation, sore mouth
Tx: Find cause, soft bland diet, soothing oral solutions, topical meds

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13
Q

What is Vincent’s infection? Cause? S/Sx? Tx?

A

Necrotizing ulcerative gingivitis
(Trench mouth)
Cause: Bacteria, poor oral hygiene, Vitamin B and C deficiency, stress, fatigue
S/Sx: Painful bleeding gums, necrotic lesions, bleeding ulcers, Increased salivation, mouth odor, anorexia, fever, malaise
Tx: Topical ABx, mouth irrigation with chlorhexidine and saline solutions

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14
Q

What is herpes simplex? Cause? S/Sx? Tx?

A

Cold sores/Fever blisters
Cause: herpes simplex 1 or 2 virus
S/Sx: Painful lesion on mouth/lip
Tx: Antiviral (acyclovir)
Corticosteroid cream, camphor

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15
Q

What are some risk factors for oral cancer?

A

Smoking
Alcohol use
Sun exposure (lip cancer)
Fair, ruddy complexion (lip cancer)
Poor oral hygiene (mouth)
HPV (mouth)
Syphilis (tongue and lip)

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16
Q

What are some manifestations of oral cancer? Early to late?

A

Chronic sore throat
Sore mouth
Voice changes
Ulcer on tongue that thickens
Leukoplakia (white patch on tongue)
Erythroplakia (red velvety patch on tongue)
Limited tongue movement
Increased salivation
Dysphagia
Toothache
Earache

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17
Q

What are some risk factors for GERD? Make it worse?

A

Obesity
Sedentary
Smoking
Hiatal hernia
NSAIDs
Fatty diet
Acidic foods
Alcohol
Minty foods
Caffeine
Chocolate

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18
Q

S/Sx of GERD

A

Heartburn
Chest pain (can mimic angina)
Dyspepsia (Pain in midline upper abdomen)
Regurgitation
Cough, dyspnea, wheezing
Lump in throat
Hoarseness
Sore throat

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19
Q

What is Barrett esophagus?

A

Complication of GERD
Epithelial cells of esophagus change
Pre-cancerous

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20
Q

Conservative treatment for GERD.

A

Lifestyle changes:
Diet changes/Smoking cessation/Healthy weight/Exercise
Small frequent meals with water in between meals
Avoid food 2 hours before bed
Elevate HOB 30 Degrees

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21
Q

Drug therapy for GERD.

A

PPI’s (Nexium, Prilosec, Protonix)
H2 Receptor blockers (Pepcid)

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22
Q

How do PPI’s work? Pros/Cons?

A

Reduce stomach acid
Pros: Work well to heal esophagitis
Cons: Long term use decreases bone density, cause kidney disease, B12 and mag deficiency

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23
Q

What is the suffix for PPIs?
What are some commonly used PPIs?

A

—prazole
Nexium
Prevacid
Prilosec
Protonix

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24
Q

What is the suffix for histamine blockers? Commonly used H2 blocker?
Most frequent side effect in Geri population?

A

—tidine
Pepcid
Confusion

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25
How is cytotec used in GERD and PUD? What is generic name? Side effects?
Protects lining of stomach Increases gastric mucus Decreases acid production --Misoprostol-- Abdominal pain, diarrhea, GI bleeding, uterine rupture (in pregnancy)
26
What are some precautions with antacids?
Renal failure patients: watch magnesium containing antacids like Maalox and mylanta Antacids interact with MANY drugs Enhance benzos Some contain high Na+content
27
What is a hiatal hernia? Causes? S/Sx?
Herniation of stomach into the esophagus through the diaphragm Obesity with big belly, heavy lifting, pregnancy, older age S/Sx similar to GERD
28
What is achalasia?
Delay in emptying of lower esophagus Rare, chronic disorder Dysphagia is most common symptom
29
S/Sx of esophageal cancer.
Progressive dysphagia Substernal fullness/food stuck Pain (late sign) with swallowing, neck, ears shoulders Weight loss Esophageal stenosis
30
What is an anastomosis?
Connection --Sometimes used in surgical descriptions--
31
What is photodynamic therapy?
Treatment for esophageal cancer. Done by endoscope Given IV photofrin (cancer absorbs) Lighted endoscopic fiber inserted down esophagus and light reacts with photofrin and destroys cancer cells
32
Important care for esophageal cancer surgeries. (pre-op)
Nutrition: They will be malnourished. Need high protein/high calorie diet before surgery is scheduled. Strict I/O's IV fluid replacement Parenteral nutrition Meticulous oral care
33
Important care for esophageal cancer surgeries (post-op)
NG tube for 5-7 days Drainage fro NG tube may be bloody for first 8-12 hours Oral and nasal care DON'T irrigate, reposition, reinsert NG tube (VERY careful with it) Keep Semi-Fowlers or Fowlers Watch for fluid accumulation on chest/lungs
34
What is eosinophilic esophagitis?
Swelling of esophagus from infiltration of eosinophils. ALLERGIC disease
35
What are esophageal varices?
Dilated veins in lower esophagus Associated with liver disease and alcoholism --NO NG TUBE--
36
What is Peptic Ulcer disease? What is cause? Risk factors?
Erosion of GI mucosa Usually caused by H pylori or NSAIDs Alcohol, caffeine, stress, smoking
37
What is conservative treatment of PUD?
Smoking cessation Rest, reduce stress Cut out alcohol/caffeine
38
What is preferred treatment for H pylori?
Amoxicillin, clarithromycin Metronidazole (Flagyl)
39
What meds may be used in PUD?
PPIs H2 blockers Sucralfate Antacids
40
What are some complications of PUD?
GI bleeding Perforation Obstruction
41
S/Sx of PUD
Pain in epigastric Burning Cramplike pain
42
What are the signs of perforation of stomach?
Sudden dramatic severe abdominal pain Rigid abdomen Absent bowel sounds N/V Weak pulse
43
What are some health promotion teaching for prevention of PUD?
Take NSAIDs with food Smoking cessation Report frequent heartburn
44
What are some S/Sx of stomach cancer?
Unexplained weight loss Indigestion Abdominal discomfort Anemia Fatigue, weakness Pallor
45
What are Billroth 1 and 2 surgeries?
Stomach is partially removed and reconnected (anastomosis) to duodenum or jejunum
46
What is a gastrectomy?
Removal of entire stomach
47
What is a pyloroplasty?
Surgical enlargement of pyloric sphincter to promote easier passage of contents from stomach
48
What is a vagotomy?
Severing of vagus nerve at stomach. Decreases gastric acid secretion
49
In post-op care of patient after gastric surgery, what should we expect from NG tube drainage? When should we notify surgeon?
Small volumes of bloody drainage is normal for first 2-3 hours. Call surgeon if bleeding after this period becomes excessive or bright red blood that does not decrease.
50
What should you do if NG becomes clogged?
Gently irrigate with NS
51
If an NG tube must be replaced or repositioned after gastric surgery, who must do it?
Doctor or surgeon
52
How do you identify a possible leak at anastomosis site post-op?
Tachycardia Dyspnea Fever Abdominal pain Anxiety Restlessness --This is an emergency and can lead to sepsis--
53
Why does a patient develop pernicious anemia after gastric surgery?
Loss of stomach surface area means loss of intrinsic factor (made by parietal cells in stomach) Intrinsic factor needed to absorb cobalamin ( B-12). No cobalamin=anemia
54
What are some causes of gastritis?
Same as PUD Can be caused by H.Pylori or all the other things that can cause an ulcer. Gastritis=breakdown of mucosal lining of GI tract
55
What can hematemesis look like?
Bright red=has never contacted stomach acid Coffee ground=has contacted stomach acid
56
What is melena?
Black tarry stools Means slow bleed in UPPER GI Tract
57
What is stress related mucosal disease? (SRMD)
Critically ill patients will develop ulcers (small to large) along GI tract.
58
What is the primary tool to diagnose source of GI bleeding?
Endoscopy
59
Why are hemoglobin and hematocrit values not helpful in acute bleeds?
Will have lost plasma as well so values of HCT and HGB won't change until fluid replacement happens
60
What is the best measure of vital organ perfusion?
Urine output
61
What drugs will be given in GI bleeds?
PPIs by IV bolus and infusion This decreases stomach acid and allows platelets to better clot at source of bleed.
62
What is E.Coli O157:H7?
Powerful bacteria Causes hemorrhagic colitis and kidney failure Elderly and kids are most at risk Can get from person to person contact, nursing homes, daycares Found in undercooked meats, fruit, leafy veg, nuts Bloody diarrhea Lasts 5-7 days
63
Info about campylobacter jejuni infection.
Blood diarrhea Fever Abdominal pain/cramping N/V From undercooked poultry Lasts about 1 week Usually in summer
64
Info on CDif
Watery diarrhea Fever Nausea Abdominal pain Spread by contact Wash with soap and water
65
Info on salmonella
Diarrhea Fever Abdominal cramps Lasts 4-7 days Undercooked poultry, raw eggs, animals
66
Info on Giardia lamblia
Parasite Abdominal cramps Nausea Diarrhea Highly contagious Found in water source or fecal-oral
67
Info on rotavirus
Virus N/V Diarrhea Abdominal cramping Rapid onset Lasts 1-2 days Very contagious Vaccine given to babies
68
What are some factors that alter susceptibility to pathogens?
Extremes of age Gastric acidity Gut health Immune health PPI's Corticosteroids Antibiotics Immunocompromised (HIV)
69
What are the three biggest concerns when caring for patients with diarrhea?
Preventing transmission Replacing fluid/electrolytes Skin protection
70
Why are antidiarrheal drugs not typically used to treat diarrhea in hospital?
Potentially prolong exposure to the organism
71
What is normal stool types in Bristol Stool Scale?
Types 3, 4, 5 The higher the number the more lose the stool. Goes up to 7
72
What does a hard, distended abdomen indicate in the presence of trauma?
Intraabdominal bleeding
73
What is Cullens sign?
Bruising around umbilicus
74
What is Turner sign?
Bruising around flanks
75
What is IBS? S/Sx? Tx?
Irritable bowel syndrome Can be diarrhea (IBS-D) Or constipation (IBS-C) Abdominal distention Nausea Flatulence Mucus in stool Fatigue Headache Sleep disturbances Tx: Low FODMAP, high fiber Antidepressants Antispasmodics Rifaximin (slows diarrhea)
76
What are some signs of appendicitis?
Positive psoas sign (pain when stick out right leg) Positive obturator sign (passive internal rotation of flexed thigh) Rovsing (RLQ pain when LLQ palpated) Coughing, sneezing worsens pain McBurney point pain Low grade fever
77
Common causes of peritonitis.
Cirrhosis of liver with ascites Abdominal organ perforation and spill contents in peritoneum
78
S/Sx of peritonitis.
SEVERE CONTINUOUS AB PAIN Tenderness over area Rigidity Spasms Distention Fever Tachycardia Tachypnea N/V Decreased bowel sounds
79
What is gastroenteritis usually caused by?
Virus
80
What are two types of inflammatory bowel disease? (IBD)
Crohns Ulcerative colitis
81
What is IBD caused from?
Autoimmune Caused widespread tissue destruction of gut Chronic inflammation of gut Bad bacteria grows unchecked
82
What are some differences between Crohn's and UC?
Crohn's can cause lesions throughout entire GI tract UC will be only in colon and rectum. Crohns involves all layers of gut UC only involves mucosal layer
83
Which type of IBD (Crohn's or UC) will cause malabsorption and weight loss?
Crohns
84
Which type of IBD causes microscopic leaks and fistulas to form in gut?
Crohns
85
What is the primary complaint in UC?
Bloody diarrhea and abdominal pain
86
What are some systemic complications of IBD?
Inflammation of eye Canker sores in mouth Gallstones Liver disease Arthritis Ankylosing spondylitis (arthritis in spine) Kidney stones Osteoporosis Erythema nodosum (red knots on shins) Pyoderma gangrenosum (open sores that get gangrene)
87
What is tx for IBD?
Focus is on drug therapy Group are: 5-Aminosalicylates (5-ASA) Abx Corticosteroids Immunomodulators Anti-TNF drug JAK inhibitors Limit fiber
88
What is Short bowel syndrome?
Problem when bowel is resected in Crohn's and other surgeries. Not enough to maintain nutritional and hydration needs.
89
What is difference in onset of small bowel vs large bowel obstruction?
Small=fast onset Large=slower build up
90
What is most common cause of SBO?
surgical adhesions
91
What is paralytic ileus?
Bowel won't wake and start peristalsis. Common after abdominal surgery
92
What are the 4 hallmark signs of bowel obstruction?
Abdominal pain (usually the 1st symptom) N/V Distention Constipation
93
What is difference in vomitus in proximal SBO and distal SBO?
Proximal=Rapid onset, projectile, contains bile Distal=fecal matter and stinky, gradual onset
94
In large bowel obstruction what is rare?
Vomiting
95
What are signs of LBO?
Constant cramping pain No flatus Distention
96
What is biggest danger in SBO?
Dehydration occurs rapidly
97
What's tenesmus?
Feeling like you got to poop all the time
98
Risk factors for colorectal cancer.
Alcohol Smoker Family history Obesity Red meat Black
99
How do you decrease your risk of developing CRC?
Healthy weight Good diet with lots of fruits/veg and whole grains Activity No smoking Limit alcohol
100
At what age should you start screening for CRC?
45----75 Every ten years
101
S/Sx of CRC
Fatigue Weight loss Abdominal pain Bleeding on BMs (sometimes) Diarrhea (if cancer on right side)
102
How is CRC staged?
TNM Tumor, Node, Metastasis
103
How are ostomies named?
Location (Ileum=ileostomy or colon=colostomy) Anatomic site (ascending, transverse, descending, sigmoid)
104
What will be the difference in output depending on location of ostomy?
Higher in GI tract=more liquid Lower in GI tract=more formed
105
What is difference between an ostomy and a stoma?
Ostomy is the opening Stoma is the outermost part of the gut that is stitched outside the abdomen.
106
What does a pale stoma indicate? Blanched, dark red or blue purple
Pale=Anemia Inadequate blood flow, ischemia
107
What does an edematous stoma mean?
Obstruction Allergic reaction to food Gastroenteritis
108
When should ostomy bags be emptied?
1/3 full
109
How long can a drainable ostomy pouch last?
4-7 days
110
Can you swim, bathe, shower normally with ostomy?
Yes. It can get wet
111
What is a hernia repair called?
Herniorrhaphy
112
What does celiac disease do to the intestine?
Autoimmune disease Inflammation damages microvilli Brush border destroyed Decreased surface area Malabsorption happens Most severe at duodenum
113
What is hemorrhoid surgery called?
Hemorrhoidectomy
114
115
What is sign of duodenal ulcer?
Pain that is alleviated by eating

Gastrointestinal (5 decks)

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