Upper GI 1 Flashcards
(85 cards)
1
Q
What does intrinsisc factor due
A
aids b12 absorption
2
Q
Do you auscultate the ab before or after palpation and why
A
before bec palp can cause bowel sounds
3
Q
What are the fat soluble vitamins
A
DEAK
4
Q
How many minutes before you can say no bowel sounds
A
5 minutes per quadrants
5
Q
What is the normal percussion sounds for the ab
A
little dull like full bladders
more tympanic for lots of gas
6
Q
What is rebound tenderness
A
pain after relieving pressure
7
Q
What does rebound tenderness indicate
A
inflammation so itis’s
8
Q
When should you not assess for rebound tenderness
A
if you know there is already a condition in the ab happening
9
Q
Where do people usu complain of apendicitis
A
at mcburneys point
10
Q
Where is mcburneys point
A
Halfway between the umbilicus and the right iliac crest
11
Q
is nausea sub or objective
A
subjective
12
Q
What is something people with NG tubes getting there stomach sucked at risk for
A
metabolic alkalosis
13
Q
What are people getting doudenal suctioning at risk for and why
A
metabolic acidosis bec were taking out alkalotic secretions
14
Q
What does a fecal odor and bile in the emesis indicate
A
lower obstruction
15
Q
If the vomit looks dark red like coffee grounds it is likely from
A
the stomach or lower
16
Q
If the vomit is bright red is likely came from
A
above the stomach
17
Q
What does NG tube suctioning also help with
A
decompressio n
18
Q
What are some nutritional considerations for N/V
A
IV to replace F and E NG Food with no temp etremes fluids between meal not during High carb meals
19
Q
Why is fluids given between meal s for N/V
A
less likely to get distention
20
Q
Why is high carb diets better for N/V
A
its easier to digest
21
Q
When replacing fluids for n/v what is a consideration
A
take it slow bec of decreased renal and heart failure
22
Q
What could unintended weight loss indicate
A
cancer and depression
23
Q
To diagnose GERD what do we need
A
symptomatic changes or condition from stomach content
24
Q
What is hiatal hernia
A
part of the stomach bulges above the diaphragm
25
What is decreased gastric emptying
stuff in the stomach isnt leaving into teh duodenum fast enough
26
What is decreased esophageal clearance
when the LES isnt opening up enough
27
When is heartburn more common
at night
28
What are the clinical mani's of GERD
```
Heartburn- like burning or tightness below lower sternum
Wheezing
Coughing
Dyspnea
Hoarseness
Sore throat
Lump in throat
Choking
regurgitation
Early satiety
post meal bloating
n/v
```
29
What should you be considering when they have the symptoms early saiety ost meal bloating and n/v
delayed gastric emptying
30
What does barium do
absorbs Ecs-ray
31
What are some ways to diagnose GERD
```
Barium swallow
Endoscopy
Biopsy and cytologic specimens
esophageal manometric studies
radionuclide
```
32
What are eso manometric studeis looking at
how good our parastalsis is and the pressure within the eso
33
What does radionuclide tests assess
Measures transit time and percentage of emptying of esophagus (rate of esophageal clearance)
34
What does radionuclide tests assess
Measures transit time and percentage of emptying of esophagus (rate of esophageal clearance)
35
What are some life style modifications for GERD
Stop smoking
Elevate HOB ~30°
Do not lie down 2 – 3 hours after eating
Avoid eating within 3hrs of bed
36
What are some nutritional therapy care for GERD
Avoid acid or acid producing foods
Smaller, more frequent meals . . . . . None near bedtime
Do not lie down after eating
If it bothers you, do not eat it. (maybe caffeine, tomato, fatty, fried, chocolate)
37
What does GERD put you at higher risk for
aspirations pneumonia
38
What are the risk factors for eso cancer
```
Smoking
Excessive alcohol use
Diet low in fruits and vegetables
vitamins and minerals
Achalasia
delayed emptying of lower esophagus)
Exposure to asbestos and metal
History of GERD (big predictor)
History of swallowing lye
```
39
Are the symptoms of esophageal cancer early or late
late
40
What are some mani's of eso cancer
```
Progressive dysphagia
Odynophagia
Pain
epigastric area, substernally, or in the back
may radiate to the neck and jaw
Sore throat, choking, and hoarseness
Weight loss is common
```
41
What are the comlications of eso cancer
```
Hemorrhage
with erosion thru esophagus to aorta
Esophageal perforation
fistula formation into lung or trachea
Obstruction of esophagus
Metastasis- liver and lung are common sites of metastasis
```
42
What are some post-op considerations for eso cancer surgery
```
NG tube
increased risk for aspiirations
cardiac dysrythmias
fowlers or semifowlers
possible mediastinum pain, temp, dyspnea
```
43
What are some nutrition considerations with eso cancer
parenteral fluids first
after bowel sounds, 30-60 ml of water given hourly
eventually move to small bland meals
44
What is achalasia
decreased lower esophagus emptying
45
What are some things we do to care for eso cancer
health promo like smoking, alc, oral hygeine and diet
high protein and calories diet
ecplainations of procedures like chest tubes, NG tubes, turn cough and deep breath
46
What are the causes gastritis
Drugs
Aspirin, NSAIDs, and digitalis
Dietary indiscretions
Alcoholic drinking binge
H. pylori infection
Other bacterial, viral, and fungal infections
Mycobacterium, cytomegalovirus, and syphilis
47
Are the acute and chronic symptoms of gastritis similar
yes
48
What are the manifestations of gastrtis
```
Anorexia
N/V
Epigastric tenderness
Feeling of fullness
Hemorrhage commonly associated with alcohol abuse
```
49
How to diagnose gastritis
Endoscopic examination with biopsy
| H. pylori presence tested in breath, urine, serum, or gastric tissue
50
What is the care for
```
Supportive care similar to N/V
NPO, Fluids, Bed rest, NG tube
Drug therapy
Eliminate cause
Antibiotics and anti-secretory agent combinations
Correct anemia
Lifestyle changes
```
51
If someone has gastritis or PUD and they start bleeding what condition might they get
anemia
52
What is PUD
the erosion of the GI mucosa now showing the underlying tissue
53
What a key difference between acute and chronic PUD
chronic might show erosion of the muscularis and formation of scar tissue
54
What life style problem is usu found in chronic PUD pats
drinking
55
Which people are at high risk for PUD
people needing ASA, NSAIDS, corticosteroids, anticoagulants and SSRI's
56
What people might need ASA NSAIDS or Anticoags
Heart pats
57
What pats might need corticosteroids
COPD
Inflammatory bowel diseases
Arthritis possibly
58
What are mani's of gsatric ulcers
```
mid epigastric pain 1-2 hrs after eating
Burning and gassy pain
Normal to decreased secretions
increase in cancer risk
H. pylori infection in 80%
↑ With incompetent pyloric sphincter and bile
reflux
```
59
What are the mani's of Duodenal ulcers
```
4-5 hrs after eatng
burning, cramping, and back pain
increased gastric secretions
no increased risk of cancer
H. pylori inf in 90%
associated with COPD, chronic renal dis, pancreatic dis
```
60
Is it common to have no pain with PUD
yes
61
What are the three major complications of PUD
Hemorrhage
Perforation
Obstruction
62
What is the most common comp of PUD
hemorrahge
63
What is the most lethal comp of PUD
perforation
64
What might you see in a pat with a gastric obstruction related to PUD
hypertrophy of stomach wall bec of an increased need for contractile force
Scarring
65
What might be some mani's for PUD obstruction
const
vomit
upper ab swelling
66
What might a short duration or absence of pain with PUD obstrucitons indicate
malignancy
67
What is the care provided for PUD without comps
```
Adequate rest
Dietary modification
Drug therapy- probably PPI’s
Elimination of smoking
Long-term follow-up care
```
68
How long might the healing process take for PUD
3-9 wks
69
What is an essential recommendation for activity for PUD pats
moderate activity
70
Is the drugs therapy for gastritis different or the same for PUD
same
71
If the problem is coming from H pylori what might be the drug therapy
Triple drug therapy
-- PPI, amoxicillin, clarithromycin
Quadruple drug therapy
--PPI, bismuth, tetracycline, and metronidazole
72
What are some dietary modifications for PUD
```
avoid hot spicy foods like peppers tea, coffee broth
avoid alc
avoid carbonated drinks
avoid high roughage foods
protein is best
milk can help
```
73
What is the general care provided for all three comps of PUD
NG tube in stomach with intermittent suction for about 24 to 48 hours
Fluids and electrolytes IV infusion until able to tolerate oral feedings without distress
74
What is the care that is more specific for perforations with PUD
focus on stopping spillage first
place NG tube near perforation
replace blood volume with lactated ringer and albumin
insert central venous pressure line and indwelling urinaary catheter and mon hourly
75
What is the care that is more specific to gastric outloet obst for PUD
NG with continuous suction
IV fluids and electrolytes for loss
PO clear liquids can be given after aspirate falls below 200mls
76
What are some signs and symps of hemorrhage for PUD
Changes in vital signs like increased HR RR and hypotension
↑ in amount and redness of aspirate
↑ amount of blood in gastric contents ↓ pain because blood helps neutralize acidic gastric contents
77
What are some signs and symps of Perforation or PUD
sudden and severe pain
board-like abdomne
shoulder pain
shallow resps
78
What is something to double check as soon as perforation is suspected
all known allergies are recorded
79
What are some surgeries for treating PUD
Gastroduodenostomy (Bilroth I)
Partial gastrectomy ( upper 2/3) with re-connection to duodenum
Gastrojejunostomy (Bilroth II)
Partial gastrectomy ( upper 2/3) with re-connection to jejunum
Vagotomy
“de-nerve” all or part of the stomach
Combo of the vagotomy with either the Bilroth I or II will remove the ulcer and the stimulus for additional secretions
Pyloroplasty
Repair (expand) the pyloric opening
80
What is a patient at risk for after a sugery for PUD
dumping syndrome
| postprandial hypoglycemia
81
What are people withdumping syndrome at risk for
absorption probs like
b12 deficiency
weight loss
liquid stools
82
How do we treat dumping syndrome
small freq meals
liquid between meal s
avoid bulky foods
83
What is postprandial hypoglycemia
pancreas is still producing same amount of insulin but the amount of cal per meal decreases bec smaller more freq meals
84
How is postprandial hypo treated
bolus of fluid high in carbohydrate into small intestine
| Release of excessive amounts of insulin into circulation
85
What are some lifespan sonsiderations for PUD
increased risk over 60
