Upper GI 2 Flashcards

Question

Esophageal Varices (varices is varacose) what is the cause?

Answer 1

Dilated, tortuous veins at the lower end of the esophagus caused by portal HTN

Answer 2

the most life- threatening complication of cirrhosis and considered a medical emergency.

Answer 3

Erosion of GI mucosa resulting from digestive action of HCl acid and pepsin

Answer 4

▪ Lower esophagus ▪ Stomach ▪ Duodenum ▪ Margin of gastrojejunal anastomosis after surgical procedures

Answer 5

▪ Superficial erosion ▪ Minimal inflammation ▪ Short duration: resolves quickly when cause is identified and removed

Answer 6

▪ Long duration ▪ Muscular wall erosion with formation of fibrous tissue ▪ Present continuously for many months or intermittently throughout person’s lifetime ▪ More common than acute erosions

Answer 7

■ Develop only in presence of an acid environment ■ Excess HCl may not be necessary for ulcer development ■ Pepsinogen converts to pepsin in presence of HCl acid and at pH of 2 to 3 ■ pH increases to 3.5 or more when – Food or antacids neutralize the stomach acid – Drugs block acid secretion ■ Back diffusion of HCl acid into gastric mucosa results in cellular destruction and inflammation ■ Histamine is released from damaged mucosa ■ Causes vasodilation, increased capillary permeability and further secretion of acid and pepsin

Answer 8

Helicobacter pylori (2/3 of world's pop is infected) ▪ Major risk factor for PUD ▪ Produces enzyme urease ▪ Urease activates immune response ▪ Antibody production ▪ Release of inflammatory cytokines ▪ Leads to increased gastric secretions and causes damage

Answer 9

▪ Inhibit prostaglandin synthesis ▪ Increase gastric acid secretion ▪ Reduce integrity of the mucosal barrier ▪ Responsible for majority of non-H. pylori peptic ulcers ▪ NSAIDs in presence of H. pylori increase risk of PUD

Answer 10

▪ ↓ Rate of mucosal cell renewal ▪ ↓ Protective effects

Answer 11

■ Occur in any portion of stomach ■ Less common than duodenal ulcers ■ More prevalent in women ■ Peak incidence >50 years of age ■ More likely than duodenal ulcers to result in obstruction

Answer 12

▪ H. pylori ▪ Medications ▪ Bile reflux

Answer 13

▪ Account for ~80% of all peptic ulcers ▪ Occur at any age and in anyone ▪ ↑ Between ages of 35 and 45 years ▪ H. pylori is found in 90% to 95% of patients ▪ Associated with increased HCl acid secretion

Answer 14

▪ COPD ▪ Cirrhosis of liver ▪ Chronic pancreatitis ▪ Hyperparathyroidism ▪ Chronic kidney disease ▪ Zollinger-Ellison syndrome

Answer 15

■ Also called physiologic stress ulcer ■ Acute ulcers that develop after major physiologic insult ▪ Trauma or surgery

Answer 16

▪ Pain generally high in epigastrium ▪ 1–2 hours after meals ▪ “Burning” or “gaseous” ▪ Food aggravates pain if ulcer has eroded through gastric mucosa

Answer 17

▪ Pain in midepigastric region beneath xiphoid process ▪ Back pain—if ulcer is located in posterior aspect ▪ 2–5 hours after meals ▪ “Burning” or “cramplike” ▪ Tendency to occur, then disappear, then occur again

Answer 18

great pain

Answer 19

decrease pain

Answer 20

▪ Hemorrhage ▪ Perforation ▪ Gastric outlet obstruction ▪ All considered emergency situations

Answer 21

▪ Most common complication of PUD ▪ Dudoenal ulcers cause more UGIB (upper GI bleeds) episodes than gastric ulcers ▪ Clinical Manifestations: ▪ Changes in vital signs, ↑ in amount and redness of aspirate ▪ Signals massive upper GI bleeding ▪ ↑ Amount of blood in gastric contents ▪ ↓ Pain because blood neutralizes acidic gastric contents

Answer 22

■ Occurs when ulcer penetrates serosal surface with spillage of contents into peritoneal cavity

Answer 23

▪ Sudden, dramatic onset ▪ Initial phase (0–2 hours after perforation) ▪ Sudden, severe upper abdominal pain- quickly spreads throughout abdomen ▪ Pain radiates to back ▪ Rigid, boardlike abdominal muscles ▪ Shallow, rapid respirations ▪ Tachycardia, weak pulse ▪ Bowel sounds absent ▪ Nausea/vomiting

Answer 24

▪ Immediate focus: ▪ Stop spillage of gastric or duodenal contents into peritoneal cavity ▪ Restore blood volume ▪ NG tube ▪ IVF ▪ pRBCs may be necessary ▪ ECG if patient has history of cardiac disease ▪ Broad-spectrum antibiotics ▪ Open or laparoscopic repair

Answer 25

■ Acute and chronic PUD can result in gastric outlet obstruction ■ Distal stomach and duodenum obstruction is the result of: ▪ Edema ▪ Inflammation ▪ Pylorospasm and fibrous scar tissue formation

Answer 26

▪ Pain worsens toward end of day as stomach fills and dilates ▪ Relief obtained by belching or vomiting ▪ Vomiting is common, often projectile

Answer 27

▪ Decompress stomach via NGT ▪ Correct any existing fluid and electrolyte imbalances ▪ PPI or H2 receptor blocker if obstruction due to active ulcer ▪ Balloon dilation for pyloric obstruction ▪ Surgery may be needed to remove scar tissue

Answer 28

Endoscopy with biopsy ▪ Most often used as it allows for direct viewing of mucosa ▪ Tissue specimens can be obtained to identify H. pylori and rule out stomach cancer ▪ Determine degree of ulcer healing after treatment

Answer 29

Noninvasive tests for H. pylori ▪ Urea breath test ▪ Can determine active infection ▪ Stool antigen test ▪ Serum or whole blood antibody tests ▪ Immunoglobin G (IgG) ▪ Will not distinguish between past and current infection

Answer 30

Invasive tests for H. pylori infection ▪ Endoscopic procedure ▪ Biopsy of stomach ▪ Rapid urease testing

Answer 31

Barium contrast study ▪ Reserved for patient who cannot undergo endoscopy ▪ Not accurate for shallow, superficial ulcers ▪ Used in diagnosis of gastric outlet obstruction ▪ Gastric analysis ▪ Analysis of gastric contents for acidity and volume ▪ NG tube is inserted, and gastric contents are aspirated ▪ Contents analyzed for HCl acid

Answer 32

Laboratory analysis ▪ CBC ▪ Liver enzyme studies ▪ Serum amylase determination ▪ Stool examination for blood

Answer 33

▪ Adequate rest ▪ Drug therapy ▪ Smoking cessation ▪ Dietary modification ▪ Long-term follow-up care

Answer 34

▪ Reduce degree of gastric acidity ▪ Enhance mucosal defense mechanisms

Answer 35

▪ Generally treated in ambulatory care setting ▪ Pain disappears after 3–6 days ▪ Ulcer healing requires many weeks of therapy ▪ Endoscopic examination most accurate method to monitor healing

Answer 36

▪ PPIs ▪ H2R blockers ▪ Antibiotics ▪ Antacids ▪ Anticholinergics ▪ Cytoprotective therapy

Answer 37

▪ No single agent has been effective in eliminating H. pylori ▪ Prescribed concurrently with a PPI for 14 days

Answer 38

▪ Adjunct therapy for PUD ▪ Increase gastric pH by neutralizing HCl acid

Answer 39

Used for short-term treatment ▪ Protection for esophagus, stomach, and duodenum

Answer 40

▪ Sucralfate ▪ Misoprostol

Answer 41

■ No specific dietary modifications ■ Eat and drink foods and fluids that do not cause symptoms ■ Avoid alcohol use

Answer 42

■ PMHx ■ Medication ■ Heartburn ■ Weight loss ■ Black, tarry stools ■ Epigastric tenderness ■ Nausea and vomiting ■ Abnormal laboratory values ■ Acute pain ■ Ineffective health management ■ Nausea

Answer 43

Vagotomy and Pyloroplasty

Answer 44

▪ Dumping syndrome ▪ Postprandial hypoglycemia ▪ Bile reflux gastritis

Answer 45

Experienced by 20% of patients after PUD surgery. symptoms usually lasts less than 1 hour

Answer 46

see other slide

Answer 47

▪ Small, dry feedings daily ▪ Low carbohydrates ▪ Restricted sugar with meals ▪ Moderate amounts of protein and fat

Answer 48

▪ After total or partial gastrectomy ▪ Due to loss of intrinsic factor (substance that helps vitamin B12 be absorbed) ▪ Patient will require cobalamin replacement therapy

Answer 49

▪ ↑ Morbidity/mortality in older adults ▪ Concurrent health problems ▪ ↑ Use of NSAIDs ▪ First manifestation may be frank gastric bleeding or ↓ hematocrit ▪ Treatment similar to that for younger adults ▪ Emphasis placed on prevention

Answer 50

■ Inflammation of gastric mucosa ■ One of most common problems affecting the stomach ■ May be acute or chronic ■ Result of a breakdown in gastric mucosal barrier ■ Stomach tissue unprotected from autodigestion by HCl acid and pepsin

Answer 51

▪ Direct irritating effect on gastric mucosa ▪ NSAIDs, including aspirin and corticosteroids, inhibit prostaglandin synthesis

Answer 52

diffuse back into the mucosa resulting in: ▪ Tissue edema ▪ Disruption of capillary walls ▪ With loss of plasma into gastric lumen ▪ Possible hemorrhage

Answer 53

▪ Being female ▪ Being over age 60 ▪ Hx of ulcer disease ▪ Anticoagulants, other NSAIDs, or ulcerogenic drugs ▪ Having a chronic debilitating disorder ▪ Diet ▪ ETOH ▪ Microorganisms ▪ H. pylori ▪ Important cause of chronic gastritis ▪ Promotes breakdown of gastric mucosal barrier ▪ Bacterial, viral, and fungal infections

Answer 54

▪ Affects fundus and body of stomach

Answer 55

▪ Anatomic changes following surgical procedures ▪ Prolonged vomiting ▪ Intense emotional responses ▪ CNS lesions

Answer 56

■ Anorexia ■ Nausea ■ Vomiting ■ Epigastric tenderness ■ Feeling of fullness ■ Hemorrhage ▪ Common with alcohol abuse ▪ May be only symptom

Answer 57

▪ Symptoms are similar to those of acute gastritis ▪ Loss of intrinsic factor can occur when acid-secreting cells are lost or nonfunctioning ▪ Essential for absorption of cobalamin (vitamin B12)

Answer 58

patient’s symptoms and history of drug or alcohol use

Answer 59

nonspecific symptoms

Answer 60

▪ Necessary for definitive diagnosis

Answer 61

Samples of breath, urine, serum, stool, and gastric tissue to determine H. pylori infection

Answer 62

Radiologic (x-rays) studies not helpful

Answer 63

▪ CBC ▪ Confirm presence of anemia from blood loss or lack of intrinsic factor ▪ Occult blood test ▪ Serum tests for antibody to parietal cells and intrinsic factor ▪ Tissue biopsy with cytologic examination ▪ Rule out gastric cancer

Answer 64

Focuses on evaluating and eliminating specific cause

Answer 65

▪ Bloody vomitus ▪ Appears fresh, bright red blood or “coffee grounds”

Answer 66

▪ Black, tarry stools ▪ Caused by digestion of blood in GI tract ▪ Black appearance—due to iron

Answer 67

▪ Small amounts of blood in gastric secretions, vomitus, or stools ▪ Undetectable by appearance ▪ Detectable by guaiac test

Answer 68

– Chronic esophagitis – GERD – Mucosa-irritating drugs – Smoking – Alcohol use

Answer 69

– Peptic ulcer disease ■ Bleeding ulcers account for 40% of cases of UGI bleeding – Drugs ■ Aspirin, NSAIDs, corticosteroids

Answer 70

■ Also called physiologic stress ulcers ■ Most common in critically ill patients – Severe burns, trauma, or major surgery – Patients with coagulopathy on mechanical ventilation

Answer 71

Endoscopy ▪ Primary tool for diagnosing source of upper GI bleeding ▪ Before performing ▪ Lavage may be needed for clearer view ▪ NG or orogastric tube placed, and room-temperature water or saline used ▪ Do not advance tube against resistance ▪ Stomach contents aspirated through a large-bore (Ewald) tube to remove clots

Answer 72

Angiography ▪ Used to diagnose only when endoscopy cannot be done ▪ Invasive procedure ▪ May not be appropriate for high-risk or unstable patient ▪ Catheter placed into left gastric or superior mesenteric artery until site of bleeding is discovered

Answer 73

BP ▪ Rate and character of pulse ▪ Peripheral perfusion with capillary refill ▪ Neurologic status

Answer 74

Indwelling urinary catheter for assessment of hourly output

Answer 75

▪ Tele/CPO ▪ Central venous pressure line for assessment of fluid volume status ▪ Supplemental oxygen

Answer 76

▪ Presence or absence of bowel sounds ▪ Tense, rigid, boardlike abdomen: may indicate perforation and peritonitis

Answer 77

▪ 2 large bore IVs ▪ Isotonic crystalloid- Lactated Ringers ▪ Volume replacement ▪ Whole blood, packed red blood cells, fresh frozen plasma

Answer 78

▪ First-line therapy of upper GI bleed ▪ Goal: to coagulate or thrombose the bleeding vessel ▪ Useful for gastritis, Mallory-Weiss tear, esophageal and gastric varices, bleeding peptic ulcers, and polyps

Answer 79

▪ Indicated when bleeding continues ▪ Regardless of therapy provided ▪ Site of bleeding identified

Answer 80

May be necessary when ▪ Patient continues to bleed after rapid transfusion of up to 2000 mL whole blood ▪ Remains in shock after 24 hours

Answer 81

During acute phase, used to ▪ ↓Bleeding ▪ ↓ HCl acid secretion ▪ Neutralize HCl acid that is present

Answer 82

with epinephrine during endoscopy for acute hemostasis ▪ For bleeding due to ulceration ▪ Produces tissue edema → pressure on bleeding source

Answer 83

▪ Used for upper GI bleeding ▪ Reduces blood flow to GI organs and acid secretion ▪ Given in IV boluses for 3–7 days after onset of bleeding

Answer 84

▪ Low BP ▪ Rapid, weak pulse ▪ Increased thirst ▪ Cold, clammy skin ▪ Restlessness

Answer 85

■ Most lethal complication ■ Common in large penetrating duodenal ulcers ■ Perforated gastric ulcers often located on lesser curvature of stomach ■ Mortality rate associated with perforation of gastric ulcers is higher

Answer 86

■ Large perforations need immediate surgical closure ■ Small perforations may spontaneously seal themselves

Answer 87

▪ Bacterial peritonitis may occur within 6–12 hours ▪ Difficult to determine from symptoms alone if gastric or duodenal ulcer has perforated ▪ Manifestations of peritonitis are the same

Answer 88

▪ Aspirin and nonselective NSAIDs are discontinued for 4–6 weeks ▪ Patients receiving low dose aspirin may need long-term PPI treatment

Answer 89

▪ Effects on empty stomach in 20–30 minutes ▪ If drugs taken after meals, effects may last 3–4 hours

Answer 90

▪ ↑ Sodium preparations: used cautiously in older patients and patients with ↑BP, heart failure, liver cirrhosis, or renal disease ▪ Magnesium preparations: not to be used in patients with renal failure ▪ Can enhance or decrease the absorption of some drugs

Answer 91

increased risk of gastric cancer ▪ May be linked to presence of H. pylori and development of autoimmune chronic gastritis`

Answer 92

▪ Halitosis ▪ Inability to belch ▪ GERD ▪ Regurgitation ▪ Weight loss

Answer 93

▪ Constipation is a common complaint ▪ Dehydration ▪ Decreased dietary intake ▪ Anorexia ▪ Swelling in stomach and upper abdomen