Upper GI Flashcards

Question

consequences of prolonged vomiting

Answer 1

* Rupture * Hematemesis (bleeding) * Dehydration * Acid-base imbalances * Malnutrition * Aspiration pneumonia

Answer 2

B. Metabolic alkalosis

Answer 3

* Small frequent meals * Avoid being too hungry or too full * Eat slowly * Eat plain foods * Eat cold foods * Drink liquids 30-60 minutes after or before meals * Wear loose fitting clothing * Try ginger (like ginger popsicle: hydration + nausea help; ginger ale)

Answer 4

1: Liquids to avoid: water, apple juice, sports drink, warm or cold tea, lemonade Suck on ice chip first, if tolerated-> 1 teaspoon every 10min. Increase to 1 tbsp. Double the amount of lfid every hour. If diarrhea-> only use rehydration beverage 2. Solid food intro: add one solid food at a time if no vomiting for at least 8h Avoid high fiber and fat foods Recommended foods: - Crackers, grains, milk and dairy products, meat and poultry, dry toast, yogurt, clear broth

Answer 5

duodenum and antrum

Answer 6

• H.Pylori- main cause - lives under mucus layer of stomach; attached to mucus-secreting cells - Produces proteins that damage mucosa and cause inflammation • Decreased mucosal integrity: - Use of NSAIDs (e.g., ibuprofen) or steroids - Alcohol abuse • May be a genetic link • Reduced blood supply caused by shock, stress, smoking • Exacerbation of symptoms with certain foods and stress

Answer 7

both ulcer and GER show a sign of pain | the difference between GERD and peptic ulcer is that with ulcers pain will go away after eating

Answer 8

``` • Epigastric pain that occurs 90min- 3 hours after eating and is usually relieved by eating or use of antacids - Rebound gastrin • Presence of blood in vomit or stool > bleeding ulcer ```

Answer 9

• Dx: Endoscopy and tissue biopsy; Urea breath test • Triple/quadruple therapy for H. Pylori (disgusting, thus important to motivate the pt to finish the course) • Meds to reduce acid secretion (e.g., proton pump inhibitor) • Surgical resection if disease is refractory or complications develop

Answer 10

no evidence that diets can cause ulcers

Answer 11

iron, B12 and calcium

Answer 12

* Complications of peptic ulcer disease (PUD)->hemorrhage, perforation, obstruction of pyloric sphincter * Malignancy * Weight loss

Answer 13

• Gastrectomy- stomach resection • Selective Vagotomy: eliminate innervations from the vagus nerve to parietal cells in order to decrease gastric acid production poor gastric emptying • Total Vagotomy with pyloroplasty: innervations to parietal cells severed + portion of vagus nerve controlling gastric emptying no acid production • Reconstruction with Billroth I (gastroduodenostomy- stomach connected to duodenum) & II (gastrojejunostomy- stomach connected to jejunum), Roux-en-Y: - reconstruction always has to be performed with gastrectomy

Answer 14

• Nutritional risk related to: 1) Reduced capacity of stomach-> early satiety 2) Changes in gastric emptying & transit time (could either lead to dumping or gastroparesis_ • Food normally remains in stomach 1-3 hrs in order to liquefy and partially digest. Chyme should enter duodenum slowly via pyloric sphincter and is neutralized by pancreatic bicarb 3) Components of digestion altered or lost • E.g., Reduction in intrinsic factor secretion (required for B12 absorption) • Standard practice to prescribe prophylactic B12 injections • Most common deficiencies documented: B12, thiamin, vitamin D, iron, copper • Common nutritional problems: dumping

Answer 15

early dumping (75%) - 10-30 min after eating - fluid gets moved from blood to intestine in an attempt to dilute food - bloating, nause, vomiting, diarrhea - due to decreased blood volume: reapid heart rate, dizziness late dumping: 1-3 hours - rapid increase of insulin production in an attempt to prevent hyperglycemia - result in overproduction of insulin and hypoglycemia (-> weakness, sweating, confusion, tremors) may experience both late and early

Answer 16

``` • Prophylactic B12 injection • Liquid multivitamin/mineral • 5-6 small meals per day • May need to lie down after eating for early dumping • Nutrient dense • Limit simple sugars to prevent hyperosmolality and hypoglycemia- late dumping • Avoid sweetened beverages esp. • Lactose is often not tolerated • Do not restrict unless have to! • Liquids in between meals - Liquids facilitate quick movement through GI • Soluble Fibre, Pectin ```

Answer 17

syndrome of objectively delayed gastric emptying in the ABSENCE of mechanical obstruction. Cardinal symptoms including early satiety, postprandial fullness, nausea, vomiting, bloating, and upper abdominal pain

Answer 18

* Dx: when gastric retention of food continues after 4 hours | * Sx: nausea, vomiting, early satiety

Answer 19

Gastric emptying is complex and involves: • Hormones • Muscles • Nervous system Abnormalities in any of the above can lead to delayed gastric emptying • E.g., autonomic nerve damage d/t diabetes or surgery

Answer 20

* High risk of malnutrition d/t intolerance of oral intake and subsequent reduced intake * Dehydration * If DM, glycemic control is difficult d/t unpredictable absorption of food

Answer 21

• 5-6 small meals per day • Avoid lying down after eating, try to be active instead. • Low in fat (<3-5g/serving) and low in fiber (<3g/serving) • Modular supplements may be needed to enhance nutrient density • ONS may be needed • Chew well • Avoid carbonated beverages and gas- producing foods legumes, cruciferous foods • If enterally fed, may need post-pyloric feeding