Upper GI problems Flashcards by Caleigh Justen

causes of nausea

GI issues
CNS issues
CV issues
pregnancy
endocrine/metabolic stuff
med side effects
anesthesia
chemo
psych
motion

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pathophysiology of pukine

chemoreceptor trigger zone in brainstem responds to stimuli from dugs, toxins, and motion and activates ANS

SNS = tachycardia, tachypnea, diaphoresis
PNS = relaxes LES, increases gastric motility, increases saliva

Stimuli from GI tract, kidney, heart, or brain send impulses to vomiting center in medulla

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Goal when treating vomiting

-Identify and treat cause

Watch for
-anorexia/weight loss
-fluid and electrolyte imbalance
-acidosis/alkalosis
-hypovolemia
-circulatory issues

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What do these types of vomit mean:
1. partially digested
2. fecal odor and bile
3. bile
4. bright red blood
5. coffee ground

gastric outlet obstruction or delayed gastric emptying
obstruction below pylorus –> EMERGENCY
obstruction below ampulla of vater
active bleeding (varices, ulcer, cancer)
gastric bleeding (gastritis or gastric ulcer)

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Nursing interventions for vomiting

NPO
IV fluids
NGT (aspiration)
Monitor I/O, VS –> dehydration
Psychosocial/environmental comfort

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Oral cancer causes

unknown, but risks are:
-tobacco
-alc
-sun
-pipe stem or other irritation
-HPV (get the shot)
-STDs

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Oral cancer symptoms

vague –> usually delayed treatment

sore throat, dysphagia, slurred speach, salivaion issues, toothache

leukoplakia and erythroplakea = precancerous lesions

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oral cancer diagnosis

biopsy is main one
oral exfoliative cytology = scraping
toludine blue test is screening

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oral cancer treatment

Surgery: BE CAREFUL —> HEAD BLEEDS A LOT!!
radiation
chemo
palliative –> 80% die w/in 5 yrs
nutritional
PEG tubes

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GERD primary factor

incompetent LES allows acid to come up and inflame mucosa

food, drugs, obesity, smoking, and hiatal hernia or mucosal damage all affect LES pressure

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Manifestations of GERD

Heartburn (pyrosis) (can spread to jaw)
Dyspepsia (abdominal pain)
Regurgitation
Resp issues (wheezing, coughing, throat irritation)

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Complications of GERD

esophagitis
-ulceration leads to scar tissue, stricture, and dysphagia

Barrett’s esophagus
-metaplasia of cells; increase risk for cancer

Aspiration leading to asthma, bronchitis, or pneumonia

Dental erosion

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Gerd nursing interventions

low fat, small meals w/o caffeine, alc, or tobacco
-upright 2-3 hrs after meals
-no tight clothes
-no food hrs b4 bed
-weight loss

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Drugs for GERD

PPIs and H2
-PPIs are more effective, but H2 are cheaper
-risk of infection with PPIs bc of alkaline environment that they create

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PPIs

-stop HCl secretion
-good for treating esophagitis
-take b4 1st meal
-if you take it too long, bad for bone density kidney, vet B12, magnesium, dementia

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H2 receptor blocks

takes 1 hr to work –> lasts 12 hrs
-take with antacid

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Antacids

neutralize acid
-take 1-3 hrs after meal and bedtime
-increases Na+, so careful if old, cirrhosis, htn, or kidney issues

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Nissen Fundoplication

tie LES tighter

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Hiatial hernia

hernia @ LES
-can be sliding (not too bad) or paraesophageal (serious)

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Esophageal cancer tumors

appear as ulcers
often advanced
metastasis to liver and lungs

manifestation of esophageal cancer

progressive dysphagia
swallowing pain
weight loss
regurgitation
hemorrhage, perforation, obstruction

Eosiophilic Esophagitis

-Allergic reaction
-manifests as heartburn, dysphagia, food impaction, nausea, vomiting, weight loss
-treat with PPIs and corticosteroids

Esophageal strictures

Usually from GERD
-dysphagia, regurgitation, weight loss
-treat by dilating with balloon –> careful of rupture

Achalasia

lower 2/3 of esophagus wont peristalsis

manifests as dysphagia, globus sensation or chest pain; nighttime regurgitation, halitosis, can’t eructate, weight loss

treat with endoscopic dilation or Heller myotomy
-also botulinum, nitrates, and CCBs

Gastric ulcer risk factors

H pylori NSAIDs --> don't take on empty stomach bile reflux corticosteroids and anticoagulants stress alc, caffeien, tobacco

Duodenal ulcer risk factors

COPD, cirrhosis, pancreatitis, hyperparathyroidism pretty much always H pylori --> take antibiotics

H pylori

causes 80% gastric ulcers and 90% duodenal ulcers from oral-oral or oral-fecal transmission lives a long time produces urease

Diagnostic study for peptic ulcers

Endoscopy! Also can do serology, stool, or breath test for H pylori

how to treat peptic ulcers

PPI to reduce acid secretions antibiotics to eliminate H pylori --> penecilin or metronidazole Cytoprotective drugs given 1-2 hrs before or after antacids protect mucosa

Complications of PUD

hemorrhage, perforation, gasatric outlet obstruction Hemorrhage is most common, but perforation is most lethal - if untreated, bacterial peritonitis w/in 6-12 hrs

Stomach cancer

-often metastasized when diagnosed -a/w H pylori, autoimmune inflation, repeated irritant exposure -spreads by direct extension --> liver and adjacent tissue

manifestations of stomach cancer

Anemia! GI stuff: weight loss, pain, indigestion, early satiety Late: ascites

Gastric surgery complications

Hemorrhage Dumping syndrome - lasts 1 hr --> weakness, sweating, dizziness, cramping --> chyme bolus causes pushes fluid into bowel causing hypovolemia Postprandial hypoglycemia = variant of dumping syndrome --> caused by carb bolus resulting in excess insulin Bile reflux gastritis (after fixing or removing pylorus) --> bile damages gastric mucosa --> administer cholestyramine

most serious complication post op gastric surgery

anastomosis leak -tachycardia, dyspnea, fever, ab pain, anxiety, restlessness -requires immediate treatment to prevent sepsis and death

Why use NGT post op for gastric surgery?

For decompression --> reduces pressure to suture and decreases edema and inflammation **aspirate for blood --> reporet if more than 75 cc/hr **irrigate **should change to dark yellow-green in 36 to 48 hrs

nutrition post gastric bypass

wound healing vits: C,D,K,B give meds for pernicious anemia soft, bland, low fiber, high complex carbs, high prot no fluid with meals --> chew a lot no simple sugars, lactose, or fried food -avoid extreme temps -avoid hypoglycemia

Gastritis

basically peptic ulcer but without to ulcer -tissue edema, loss of plasma thru capilaries, possible hemorrhage caused by same stuff as PUD - emphasis on corticosteroids

More causes of gastritis

alc and spicy food H pylori radiation and smoking autoimmune issues, hiatal hernia, physical stress, renal failure, sepsis , shock

Manifestations of acute and chronic gastritis

acute: anorexia, nausea/vomiting, epigastric tenderness, hemorrhage chronic: similar to acute or asymptomatic --> possibly pernicious anemia

care for acute gastritis

fix the cause rest, NPO, IV fluids, antiemetics, watch for dehydration possibly NGT to watch bleeding and lavage monitor for bleeding Drugs: PPIs or H2 receptor

chronic gastritis

fix cause antibiotics for H pylori cobalamin for pernicious anemia small frequent meals no smoking take meds

melena

black tarry stools from upper GI bleed

Reasons for upper GI bleeds

PUD usually Stress related mucosal disease Chronic esophagitis, Mallory Weiss tear, or esophageal varices

Upper bleed diagnostic studies

endoscopy angiography labs -cbc --> hgb and hct -bun --> GI tract bacteria breakdown prot -PTT, liver enzymes, electolytes, ABGs vomit and stool for gross or occult blood

What constitutes a massive GI bleed

more than 1500 ml blood loss 25% intravascular volume Assess for shock - monitor I/O

What to watch for with massive GI bleed

shock O2 status --> give no matter what perforation and peritonitis --> tense, rid hypovolemia

Drug therapy for massive GI bleed

PPI - IV bolus then infusion Antacids - after acute phase

Acute care

NGT management lavage watch for withdrawal if alcoholic