upper GI Flashcards

Question

foods that decrease LES pressure (everything you love)

Answer 1

chocolate, peppermint, tomatoes, coffee, tea,

Answer 2

proton pump and histamine blockers (most popular), Acid protective, Cholinergic, Prokinetic drugs, Antacids

Answer 3

start with one dose before meals

Answer 4

bone density

Answer 5

Goal of surgical therapy is to enhance the integrity of the LES

Answer 6

▪ Failure of conservative therapy ▪ Medication intolerance ▪ Barrett’s metaplasia ▪ Esophageal stricture and stenosis ▪ Chronic esophagitis

Answer 7

magnets to keep esoph closed. can't have an MRI with this one

Answer 8

■ Elevate head of bed 30 degrees ■ Do not lie down for 2–3 hours after eating ■ Avoid factors that cause reflux – Stop smoking – Avoid alcohol and caffeine – Avoid acidic foods ■ Stress reduction techniques ■ Weight reduction, if appropriate ■ Small, frequent meals ■ Evaluate effectiveness of medications ■ Observe for side effects of medications

Answer 9

cause constipation

Answer 10

Most are adenocarcinomas ▪ Others are squamous cell tumors

Answer 11

glands lining esophagus Resemble cancers of stomach and small intestine cause unknown INCREASES with age

Answer 12

▪ Barrett’s esophagus ▪ Smoking ▪ Excessive alcohol intake ▪ Obesity ▪ Hx of achalasia (delayed emptying of lower esophagus)

Answer 13

middle and lower portions of esophagus

Answer 14

▪ Usually appears as ulcerated lesion ▪ May penetrate muscular layer and outside wall of esophagus ▪ Obstruction in later stages

Answer 15

Symptom onset is late

Answer 16

Spreads via lymph system, so Liver and lungs are common sites for mets

Answer 17

Progressive dysphagia is most common symptom ▪ Initially with only meat, then with soft foods, and eventually with liquids Weight loss ▪ Regurgitation of blood-flecked esophageal contents

Answer 18

pain develops late

Answer 19

Substernal, epigastric, or back areas ▪ Increases with swallowing ▪ May radiate to neck, jaw, ears, shoulders

Answer 20

▪ Sore throat ▪ Choking ▪ Hoarseness

Answer 21

▪ Hemorrhage ▪ If erodes through esophagus and into aorta ▪ Esophageal perforation with fistula formation ▪ Esophageal obstruction

Answer 22

Endoscopy with biopsy ▪ Necessary for definitive diagnosis

Answer 23

Endoscopic ultrasonography (EUS) ▪ Important tool to stage

Answer 24

Poor prognosis ▪ Usually not diagnosed until advanced

Answer 25

Esophagectomy - removal of part or all of esophagus

Answer 26

Resection of portion of esophagus and anastomosis of remaining portion to stomach

Answer 27

Inject IV porfimer (Photofrin), which is absorbed by cancer tissue

Answer 28

Allow food and liquid to pass through stenotic area, helps with nutrition

Answer 29

▪ Swallowing study may be done before patient can have oral fluids ▪ When permitted, water (30–60 mL) is given hourly ▪ Gradual progression to small, frequent, bland meals

Answer 30

pain, fever, dsypnea - could indicate leakage

Answer 31

▪ NG tube with bloody drainage for 8–12 hours ▪ Changes gradually to greenish yellow ▪ NG tube should not be repositioned or reinserted without surgeon’s approval

Answer 32

■ Adenocarcinoma of stomach wall ■ Often metastasized when diagnosed ■ 5-year survival if confined to stomach = 71% ■ 5-year survival with metastasis = 31%

Answer 33

Etiology—no known specific cause ■ Nonspecific factors: H. pylori, autoimmune-related inflammation, repeated exposure to irritants

Answer 34

Dietary: smoked foods, salted fish and meat, pickled vegetables – H. pylori infection at early age; Lymphoma of stomach; atrophic gastritis, pernicious anemia, polyps, achlorhydria; smoking, obesity

Answer 35

by direct extension—liver and adjacent tissue

Answer 36

■GI:unexplained weight loss, indigestion, abdominal discomfort/pain, early satiety ■ Anemia: pale, weak, fatigue, dizzy, short of breath, heme + stool

Answer 37

Metastasis/late signs: – Supraclavicular lymph node enlargement – Ascites

Answer 38

■ H&P ■ Upper GI Endoscopy with biopsy- best tool*** ■ EUS, CT, MRI, PET—staging ■ Laparoscopy—determine peritoneal spread ■ Labs: CBC, liver enzymes, amylase, tumor markers ■ Stool—occult blood

Answer 39

surgery is the best

Answer 40

gastroctomy - partial or full

Answer 41

billroth 1 is 50 -75% of stomach, billroth 2 is just 50%

Answer 42

hemmorhage, Dumping syndrome, Postprandial hypoglycemia—variant of dumping syndrome, Bile reflux gastritis—after reconstruction or removal or pylorus

Answer 43

– – – – Gastric chyme enters small intestine as large hypertonic bolus; pulls fluid into bowel lumen causing decreased plasma volume, distention of bowel lumen, and rapid transit within 15 to 30 minutes of eating See weakness, sweating, palpitations, dizziness, cramping, borborygmi, and defecation urge Lasts about 1 hour Reduced with rest after eating

Answer 44

– –Uncontrolled high carbohydrate bolus enters small intestine causing excess insulin and resulting in hypoglycemia ~ 2hours after eating See: sweating, weakness, confusion, palpitations, tachycardia, anxiety (hypoglycemia reaction)

Answer 45

– – – Bile reflux causes damage to gastric mucosa, chronic gastritis, and PUD See: epigastric distress temporarily relieved with vomiting Administer cholestyramine—binds bile salts

Answer 46

Teach patient about procedure and postoperative expectations ■ Comfort measures/pain management ■ Cough and deep breath ■ NGT ■ IV fluids

Answer 47

– Fluid and electrolyte balance ■ IV fluids to oral to solids ■ Monitor I & O, daily weight – Prevent respiratory complications ■ Respiratory assessment; VS, dyspnea, chest pain, cyanosis ■ Splint incision with cough and deep breathing ■ Analgesia, early ambulation, reposition frequently – Maintain comfort: pain, nausea/vomiting

Answer 48

Prevent infection ■ Monitor VS ■ Assess wound Monitor for complications (especially if obese): ■ Atelectasis, pneumonia, DVT, PE, pneumothorax ■ Anastomosis leak—tachycardia, dyspnea, fever, abdominal pain, anxiety, restlessness – Requires immediate treatment to prevent sepsis and death ■ Hemorrhage—VS, NG aspirate

Answer 49

NGT for decompression; reduces pressure to suture line; decreases edema and inflammation

Answer 50

■ Dietician consult; reinforce instructions ■ Enteral feedings or parenteral nutrition ■ Wound healing: potassium, vitamins C, D, K, and B-complex

Answer 51

Pernicious anemia—loss of intrinsic factor; needed for absorption of cobalamin in terminal ileum; essential for RBCs – Administer cobalamin, multivitamins with folate, calcium, vitamin D, and iron (life-long therapy)

Answer 52

– First few weeks: soft, bland, low fiber, high complex carbohydrates, and high protein – Small, frequent meals – No fluids with meals, chew thoroughly – Avoid simple sugars, lactose, and fried foods – Avoid extreme food temperatures – Avoid hypoglycemia—limit sugar with meals; moderate protein and fat

Answer 53

▪ Turning, coughing, and deep breathing every 2 hours ▪ Incentive spirometer use ▪ Positioned in semi-Fowler’s or Fowler’s ▪ Should be maintained at least 2 hours after eating ▪ Monitor for complications

Answer 54

Observe gastric aspirate: color, amount, odor Bloody drainage expected for 2 to 3 hours; report excess (greater than 75mL/hr); monitor for clots/obstruction;

Answer 55

irrigate with NSS to avoid: rupture of sutures, leakage into peritoneal cavity, hemorrhage, and abscess formation Should darken and change to yellow-green in 36 to 48 hours