UPPER G.I Flashcards by Kate Carmie

is a painful disorder characterized by inflammation and ulcerations in the mouth, including the lips, tongue, and mucous membranes

Stomatitis

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Causative agent of herpetic stomatitis

Herpes simplex virus (HSV) type 1

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Diffuse, shiny erythematous involvement of the gingiva with edema and gingival bleeding

Herpetic Stomatitis

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Also known as Canker Sore

Aphtous Stomatitis

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Clinical Manifestation of Aphtous Stomatitis

-Small, white painful ulcers
- Well-circumscribed lesion

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Medical Management of Stomatitis

Acyclovir (Zovirax), if cause is HSV

-Analgesics, as ordered

-Lidocaine hydrochloride (Xylocaine)- topical anesthetic

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Nursing Management of Stomatitis

-Provide soft, bland foods during acute episodes

-Diet as tolerated (DAT) as the sores heal

-Encourage small, frequent feedings

-Encourage to drink room temperature liquids

-Let patient rinse mouth with NSS after eating

-Avoid alcohol- based mouthwash

-Use soft- bristled toothbrush

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The opening of the diaphragm through (hiatus) which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax

Hiatal Hernia

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Occurs when the upper stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax

Sliding Hiatal Hernia

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It’s primary cause is muscle weakness in the esophageal hiatus

Hiatal Hernia

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Occurs when all or part of the stomach pushes through the diaphragm beside the esophagus

Rolling Hiatal Hernia

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What is the primary cause of Rolling Hiatal Hernia?

Anatomical defect

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How many percent are asymptomatic in Hiatal hernia?

91% are asymptomatic (Smith & shahjehan, 2021)

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Clinical Manifestations of Hiatal Hernia

-Pyrosis: heartburns
-Dysphagia (difficulty swallowing),
-odynophagia (painful swallowing) - due to compression of esophagus
-Dyspnea
-Abdominal pain
-Nausea and vomiting
-Gastric distention
-belching
-flatulence

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The confirmatory test Hiatal hernia

Barium Swallow

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Visualizes esophagus, stomach, duodenum, and jejunum

Barium Swallow

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What is the inital position of Barium Swallow?

Taken on staning, and lying position

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Nursing Care of Hiatal Hernia

-Pre Procedure
NPO 6-8 hours

-Post Procedure
Laxatives, as ordered
Increase OFI
Inform client that stool may become white for 24-72 hours

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Medical Management of Hiatal Hernia

-H2- receptor antagonist
- Cimetidine (Tagamet)
-Ranitidine (Zantac)
-Famotidine (Pepcid)

-Proton pump inhibitors
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Losec)

-Antiemetics
- Metoclopramide (Plasil)
-Ondansetron (Zofran)
- Promethazine (Phenergan)

-Antacids
- Aluminum hydroxide
- Magnesium hydroxide

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Surgical Management of Hiatal Hernia that known as “Gastric Wrap-Around”

Nissen Fundoplication

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Reserved for extreme cases which involves gastric outlet obstruction or suspected strangulation

Nissen Fundoplication

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The upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.

Nissen Fundoplication

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Nursing Management of Hiatal Hernia

-High- protein diet - to enhance LES pressure

-Small frequent feedings- prevent gastric distention and prevents further protrusion of stomach into thoracic cavity

-Instruct client to eat slowly and chew food properly

-Avoid foods and beverages that decrease LES pressure such as fatty foods, cola beverages, coffee, tea, chocolate, alcohol
L
-Let the client assume upright position before and after eating for 1 to 2 hours

-Instruct client to avoid eating at least 3 hours before bedtime

-Advise client to reduce body weight, if obese.

-Elevate HOB 6 to 12 inches for sleep
-Avoid factors that increase abdominal pressure like use of constrictive clothing, straining at stool, heavy lifting, bending, stooping, vigorous coughing

-Avoid cigarette smoking as smoking causes rapid and significant drop in LES pressure

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Is a disorder characterized by backflow of gastric or duodenal contents into the esophagus

GERD or Gastroesophageal Reflux Disease (GERD)

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Foods and Medications that Weakens the LES

-Chocolate -Alcohol -Peppermint -Caffeine -Smoking -Morphine/Meperidine -Calcium- channel blockers

Typical Symptoms of GERD

H- Heartburn R- Regurgitation D- Dysphagia

retrosternal sensation of burning or discomfort that usually occurs after eating or when lying supine or bending over

Heartburn

effortless return of gastric and/or esophageal contents into the pharynx

Regurgitation

a sensation that food is stuck, particularly in the retrosternal area.

Dysphagia

Atypical Symptoms of GERD

C- Cough H- Hoarseness in AM O- Otitis Media N- Non-cardic chest pain A- Asthma

Complications of GERD

-Esophagitis - Esophageal stricture - Barret's Esophagus

Lifestyle Modifications of GERD

-Weight loss and control A-voiding alcohol, chocolate, citrus juice, and tomato-based products -Avoiding large meals -Waiting 3 hours after a meal before lying down -Elevating the head of the bed by 8 inches

Drugs for GERD are:

-Antacids - For mild symptoms only - Taken after each meal and at HS -H2 Receptor Antagonist - First-line agent for GERD w/without esophagitis -also used as maintenance therapy to prevent relapse -taken on an empty stomach - Proton Pump Inhibitor -Must be used ONLY when GERD has been objectively documented - May aggravate cardiac conduction abnormalities

Indication of Nissen Fundoplication

-Patients with symptoms uncontrolled by PPI -Barrett esophagus -Presence of atypical symptoms -Young patients -Patients with cardiac conduction problems -Habitual non-adherence to treatment

is the inflammation of the gastric mucosa

Gastritis

Gastritis that caused by LOCAL irritants such as aspirin and NSAIDs, Alcohol, and Gastric radiation therapy

Acute Erosive Gastritis

Gastritis that caused by Helicobacter pylori

Acute Non-Erosive Gastritis

Releases toxins which are associated with stomach mucosal inflammation and host tissue damage (Malik et al., 2021)

Helicobacter Pylori

Acute Gastritis Clinical manifestations

H- Hematemesis E- Epigastric Pain (acute) M- elena A-Anorexia N- Nausea and vomiting

Medical management of Acute Gastritis

- H2 blockers or PPI - Anti-emetics, if with n/v - If cause is H.pylori, antibiotic therapy with (Amoxicillin + Clarithromycin_

Nursing Management of Acute Gastritis

-Maintain on NPO until acute symptoms subsides -Maintain IV fluids, as ordered -In severe cases, NG tube may be used to monitor for bleeding, to lavage precipitating agent from stomach, or to keep stomach empty and free of noxious stimuli -Monitor VS and check vomitus for blood

Results from repeated exposure to irritating agents or recurring episodes of acute gastritis

Chronic Gastritis

More common in older adults

Chronic gastritis

Causes of Chronic Gastritis

A- autoimmune B- Bacterial C- Chemical

Caused by chronic gastric mucosal irritation

Chronic Gastritis

Clinical Manifestations of Chronic Gastritis

B- Belching E- Epigastric Pain S- Sour Taste in mouth P- Pernicious Anemia L- Lack of Energy I- Intolerance to spicy/fatty foods S- Satiety Early

Medical Management of Chronic Gastritis

-Treat underlying cause -Discontinue irritating substance -Antibiotic therapy for H. pylori -Vitamin B12 therapy, if with pernicious anemia (Give via IM)

Nursing Management of Chronic Gastritis

-Non- irritating diet (no spices, non fatty) -Provide small frequent feedings -Advice client about smoking cessation and reduction of alcohol consumption -Stress management

A condition characterized by erosion of the GI mucosa resulting from digestive action of hydrochloric acid (HCl) and pepsin

Peptic Ulcer Disease

Commonly occurs in the stomach (gastric ulcer) and proximal duodenum (duodenal ulcer)

Peptic Ulcer Disease

What are the risk factors of Peptic Ulcer Disease?

-H.Pylori Infection - Medications (NSAIDs and Aspirin) -Stress -Foods (Fatty/Spicy/highly acidic) - Zollinger-Ellison Syndrome -Type A personality -Blood Type O

Diagnostic Test for Peptic Ulcer Disease

-Upper GI Endoscopy -Urea Breath Test

Gold standard investigation for confirmation of H. pylori

Upper G.I Endoscopy

Detects the presence of H.Pylori and most accurate test among the non-invasive techniques

Urea Breath Test

Urea Breath Test Patient Preparation

- Avoid the following 14 days prior: -Antibiotics -Proton Pump Inhibitors -H2 receptor Blockers -Bismuth preparations -Barium -NPO for 4-6 hours prior to procedure -Educate on need to swallow a capsule containing the urea preparation and that he/she will be required to breathe out into a bag or container

Normal HCI secretion and increased back diffusion of HCI into gastric mucosa

Gastric Ulcer

Increased HCI secretion

Duodenal Ulcer

Pain radiates to the RIGHT side since the duodenum is located in the right side

Duodenal Ulcer

What is the onset of pain of duodenal ulcer?

Onset of pain is 3 to 4 hours after eating

Manifestation of Duodenal Ulcer

Melena

Pain radiates to LEFT side since the stomach is located in the left side

Gastric Ulcer

Onset of pain is ½ to 2 hours after meals

Gastric Ulcer

Manifestation of Gastric Ulcer

-Nausea and Vomiting -Hematemesis

What is the main presentation of Peptic Ulcer Disease?

Dull, aching, gnawing epigastric pain

Drugs/Medication for Peptic Ulcer Disease

Antacids - Aluminum-Magnesium Hydroxide (Maalox) - Milk of Magnesia- Magnesium Trisilicate (Gaviscon) -Calcium carbonate (Tums) H2 Blockers (Cimetidine) Cytoprotective Agents (Sucralfate (Carafate)

Medical Management If H.Pylori is Infected

Triple Therapy -PPI BID -Clarithromycin 500 mg BID -Amoxicillin 500 mg BID or -Metronidazole (Flagyl) 500 mg BID Taken for 10-14 days Quadruple Therapy -Bismuth subsalicylate 525mg QID -Tetracycline 500 mg BID -Metronidazole 250 mg QID PPI OD

Severing of the vagus nerve. Decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin

Vagotomy

Surgical dilatation of the pyloric sphincter to treat bleeding duodenal ulcers. Longitudinal incision is made into the pylorus and transversely sutured closed to enlarge the outlet and relax the muscle

Pyloroplasty

surgical removal of the antrum portion of the stomach (50%)

Antrectomy

removal of 65% to 75% of the stomach

Partial gastrectomy

removal of at least 80% of the distal stomach

Subtotal gastrectomy

removal of the entire stomach

Total gastrectomy

removal of the lower portion of the stomach (which contains cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.

Billroth I (Gastroduodenostomy)

removal of the lower portion of the stomach with anastomosis to the jejunum. A duodenal stump remains and is oversewn

Billroth II (Gastrojejunostomy)

Nursing Management for Peptic Ulcer Disease

-DAT when asymptomatic -Bland diet during exacerbation -Advise client to eat slowly and chew food properly -Small, frequent feeding during exacerbation -Instruct to avoid the following: Fatty foods, coffee, tea, chocolate, cola drinks, spices, alcohol -Bedtime snacks -Binge eating -Large quantities of milk

A group of unpleasant vasomotor and GI symptoms caused by rapid emptying of gastric contents into the jejunum.

Dumping Syndrome

What is the common cause of Dumping Syndrome?

Billroth II Procedure

Early Manifestation of Dumping Syndrome

occurs 5 to 30 mins pc D-diarrhea A- Abdominal Cramps W- Weakness N- Nausea S- SNS stimulation

Late Manifestations of Dumping Syndrome

(2 to 3 hours pc) -Hyperglycemia (initially) - Hypoglycemia

Nursing Management of Dumping Syndrome

-Position patient to LEFT SIDE- LYING after meals -Provide small, frequent feedings -HIGH- PROTEIN DIET - Protein empties in the stomach slowly. -Limit carbohydrates -Instruct patient to drink water AFTER MEALS not within meals -Octreotide- decrease GI symptoms -Acarbose- for clients with late dumping -Billroth II to Billroth I conversion

UPPER G.I Flashcards

(80 cards)