Week 1 GI Flashcards
1
Q
GERD
PUD
IBD are all what?
A
GI Disorders and Intestinal Obstructions
2
Q
IBD is umbrella term for what 3 diseases?
A
Crohn
UC
Diverticulitis
3
Q
Incompetent LES
Pyloric Stenosis
Hiatal Hernia
Motility Disorder
Barrett’s Esophagus
A
GERD
4
Q
In GERD what generally happens to the LES?
A
It is relaxed and then causes HCI to reflux back into the esophagus
5
Q
Hiatal Hernia
A
Occurs when the upper part of the stomach pushes up into the chest through small opening in the diaphragm the muscle separates the abdomen from the chest.
6
Q
What happens in Barrett’s Esophagus?
A
Condition that occurs when the lining of the esophagus is damaged by stomach acid and heals abnormally.
7
Q
Name the clinical manifestations of GERD
A
Pyrosis
Dyspepsia
Regurgitation
Dysphagia
Odynophagia
Hypersalivation
Esophagitis
8
Q
Body Protective Mechanisms
A
Gravity- Upright body. Assist with the flow back to stomach.
Swallowing-Carries refluxed liquid back to stomach.
Salivary Glands produce saliva that contains bicarbonate.
At night ….
- Gravity has no effect and swallowing stops and secretion of saliva is reduced.
9
Q
Name some increased risks of GERD
A
Pregnancy- elevated hormone levels
Growing Fetus
Weaken Esophageal Muscles
Mixed Connective Tissue Diseases - Sclerodermas
10
Q
Diagnostic for GERD include
A
Endoscopy
Barium Swallow
Ambulatory 12-36 hr esophageal pH monitoring
11
Q
Management of GERD self care include
A
Avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation
Elevate HOB
Dietary modification
Weight Loss
12
Q
Medication management of GERD
A
Antacids
HS blockers
PPIs
TLERs, Baclofen
Reflux Inhibitors, Bethanecol Chloride
Surface Agents, Sucralfate
13
Q
Management Self Care for GERD include
A
Low fat diet
Avoid caffeine
Avoid tobacco
Avoid beer
Avoid milk
Avoid peppermint/ spearmint
Elevate upper body
14
Q
Complications of GERD include
A
Throat and laryngeal inflammation
Cough and asthma
Inflammation and infection of lungs
Collection of fluid sinuses and middle ear
Esophagitis
Strictures
Barrett’s Esophagus
14
Q
Management of Self GERD
A
Avoid carbonated beverages
Avoid eating 2 hrs before bedtime
Avoid tight fitting clothing
Normal body wt
HOB elevated 6-8 in
15
Q
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
A
Peptic Ulcer
Associated with H. Pylori
16
Q
Risk factors of GERD include
A
Excessive secretion of stomach acid
Dietary factors
Chronic use of NSAIDs
Alcohol
Smoking
Familial Tendency
17
Q
Manifestation of this disease include
Dull gnawing pain or burning in the mid epigastrium, heart burn and vomiting may occur
A
Peptic Ulcer
18
Q
Treatment of this disease includes
Treatment MEDS
Lifestyle changes
Occasionally surgery
A
Peptic Ulcer
19
Q
Peptic Ulcers are likely to occur where >
A
Duodenum
20
Q
Peptic ulcers are solidarity or nonsolidarity
A
Solidarity
21
Q
Chronic gastric ulcers occur where?
A
Lesser curvature
Near the pylorus
22
Q
These ulcers occur d/t retrograde flow of HCI
A
Esophageal Ulcers
23
Q
70-90% of peptic ulcers are associated with
A
H. Pylori
24
What ages are affected with peptic ulcer?
Between 40-60 yr
Can occur in infants/ children
25
Is peptic ulcer common in childbearing age?
No
Uncommon
26
Post menopausal women increase the incidence of what?
Peptic Ulcer
27
Etiologies of Peptic Ulcer include
-H. Pylori- Ingested through food and water
- Blood Type o plus
- Familial Tendency
- COPD, Cirrhosis, CKD and autoimmune disorders
- NSAID- Impair protective gastric mucosa
- ZES- Zollinger Ellison Syndrome
28
H. Pylori Characteristics
-Gram - rod
- Selective to the stomach
- Inhabits the antrum
- Causes low level inflammation in the lining
- Strongly linked to PUD's and stomach cancer
- 80% asymptomatic
- Affects > 50% world population
- Prevalence in developing countries
- Transmission: Oral ( Food, water, close contact to emesis)
29
Pathophysiology of PUD
- Duodenal Ulcers - Increased amounts of the acid
- Increases production of gastric acid HCI or pepsin
-Decrease resistance of mucosa
- Damaged mucosa decreases mucous production and protection lining
- Erosion of gastric lining - exposure nerve endings
- In gastric ulcers- normal or decreased acid amount
- Decreases acidity results in decrease resistance to bacteria causes increased bacterial Infections - H. Pylori
30
Manifestations of Peptic Ulcer
-Symptoms intermittent over days, weeks, and months
- Appearing-Disappearing- reappearing
31
Chief Complain of PUD is
Dull gnawing burning pain in the mid epigastric region or back
32
Pain immediately after eating is with
Gastric Ulcer
33
Pain after 2-3 hours of eating is what type of ulcer is
Duodenal Ulcer
34
Heartburn is also known as
Pyrosis can be shown in PUD with sour eructation or burping
35
Manifestation of PUD is
vomiting " relief" after bout of severe pain and bloating
- Diarrhea/ Constipation
- GIB- Bleeding in 15% - Melena - Tarry stools
36
Assessment and Diagnostic Findings for PUD
- Physical Examination
- Endoscopy- PREFEERED DIAGNOSTIC
- Histologic Examination- H. Pylori
- Serologic Examination- H. Pylori
37
Treatments both pharmacological and Surgical is aimed at what for PUD?
Controlling the activity of " certain portions of the stomach"
38
The pylorus secretes what?
- Pepsinogen II
- Gastrin- 34
39
40
The antrum secretes what?
- Gastrin 17
- Gastrin 34
Pepsinogen II
41
Pharmacological Treatments for PUD
Medications
- ABX+PPIs+ Bismuth Salts= 10-14 days - suppress or eradicate H. Pylori
H2 Receptors Antagonists- Tx NSAID induced Ulcers
- PO or IV
- Ex: Cimetidine, famotidine, ranitidine, nizatidine
PPIs
- PO or IV
ex- Esomeprazole, omeprazole, pantoprazole, rabeprazole
42
Ulcer Healing use what meds?
H2 Receptor Antagonist
PPIs
43
H. Pylori Infection
Quadruple therapy with Bismuth Salts
44
Prophylactic Therapy for NSAID ulcers
Peptic Ulcer Healing doses
Misoprostol
45
Dietary Modifications for PUD include
-Avoid extremes in temp. or food and beverages
- Avoid alcohol, coffee, and other caffeinated beverages
- Eat 3 regular meals/ day- Neutralize acid
- Individualized- pts should avoid any foods that cause pain
46
Name the surgical procedures for Peptic Ulcer Surgery
1. Pyloroplasty- Pylorus- note longitudinal incision then have a vertical suture
2. Vagotomy- Vagal nerve
3. Bili Roth II-gastrojejunostomy
4. Antrectomy Bill Roth I- Gastroduodenostomy
47
Surgical procedure #1 for PUD is
Vagotomy
- Severing the vagus nerve, decreases cholinergic to parietal cells
- Can be done w/ drainage-pyeloplasty to aid w/ emptying
Side effects include: c/o absence of satiety, diarrhea, and gastritis
----- Dumping Syndrome
48
Surgical Procedure #2 for PUD is
Pyloroplasty
- Note longitudinal incision w/ vertical suture
49
What is a pyloroplasty?
Longitudinal incision made into the pylorus
- Transversely sutured closed to enlarge the outlet and relax the muscle
50
Side effects c/o absence of satiety. recurrence of ulcer 10-15%
No dumping
Surgical Procedure - Pyloroplasty
51
Surgical Procedure #3 for PUD is
Antrectomy- Biliroth I
- Removal lower part of the antrum
- Controls the release of gastrin
- Dumping Syndrome
52
Surgical Procedure #4 for PUD is
Billroth II
- Removal of the lower portion with anastomosis to jejunum
- Dumping Syndrome
- Anemia
- Malabsorption
- Weight loss
- recurrence rate of ulcer is 10-15%
52
_________ is a vasomotor response to the food ingested
Dumping Syndrome
53
Patho of Dumping Syndrome
Rapid emptying of gastric contents into small intestines resulting from the sudden mix of hypertonic fluid- small intestine pulls fluid from EC space to convert to hypertonic state to isotonic fluid consistency
- Fluid shift results in decrease circulating volume
53
Symptoms in Early Dumping Syndrome
Early
- 30 min after meals - vertigo, syncope, pallor, diaphoresis, increased HR, palpitations)
54
Late Symptoms of Dumping Syndrome
- 90 min after meals
- Excessive insulin nrelease
- abd distention
- Cramping
- borboryrmi, nausea, dizziness, diaphoresis, confusion
55
Lying down after meals - delays gastric emptying
- Eliminate liquids with meals one hour before or after
- Consume high PRO, high fat, low to mod CHO diet
- Avoid milk, sweets, or sugars - fruit juices
- Small frequent meals
Dumping Syndrome
56
Assessment care of PUD patient
- Assess pain/ anxiety
- Dietary intake and 72 hr diet diary
- Lifestyle and habits such as cigarette and alcohol use
- Medications include use of NSAIDs
- S/S of anemia or bleeding
- Abdominal Assessment
57
Nursing Process Diagnosis of Peptic Ulcer
Imbalanced Nutrition
Acute Pain
Anxiety
Deficient Knowledge
58
Nursing Process of Peptic Ulcer planning
Major goals include relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications
59
Relieve pain in PUDs include
Treat with prescriptions medications
Avoid aspirin, NSAIDs, alcohol
60
Anxiety of PUD
- Assess anxiety
- Calm manner
- Explain all procedures and treatments
Help- Help identify stressors
- Explain- Explain the various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification
61
Patient Education for PUD includes
-Medication Education
- Dietary Restrictions
- Lifestyle Changes
62
Collaborative Problems and Potential Complications
- Hemorrhage- Most common 15%
- Perforation
- Penetration
- Pyloric Obstruction- Gastric Outlet Obstruction
63
Hemorrhage is common complication in what?
PUD
64
Hemorrhage complication in PUD monitor for ?
S/S of anemia or bleeding
- CBC
- > 60 y/o- hematemesis may be fatal
- Occurs in 10-20%
-Manifested
--- Hematemesis- Large volumes 2-3 L loss or coffee ground emesis
- Melana- Small volumes loss, blood in stools or tarry stools
65
Management of Potential Complications
Hemorrhage
- Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/ impending shock and anemia
Tx: Includes IV fluids, NG, and Saline or water lavage, oxygen, tx of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention
66
Management of Potential Complications Pyloric Obstruction
Symptoms include
- Nausea/ Vomiting, constipation, epigastric fullness, anorexia, and later weight loss
Insert Ng tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required
67
Management of Potential Complications
Management of perforation or penetration
Signs include
- Severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board like abdomen, and symptoms of shock or impending shock
patient requires immediate surgery
68
Diverticulum
Sac like herniation of the lining of the bowel that extends through a defect in the muscle layer
69
Diverticular Disease may occur anywhere i the intestine but most common where
Sigmoid Colon
70
Multiple diverticula without inflammation
Diverticulosis
71
Infection and inflammation of the diverticula
Diverticulitis
72
Increases with age and is associated with low fiber diet
Diverticular Disease
Diagnosis usually done with colonoscopy
73
Pathophysiology of this disease is where diverticula form when mucosa/ submucosal layers of colon herniate through muscular wall
Diverticulosis
- High intraluminal pressure
- Low volume in the colon
- Decreased muscle strength
Bowel contents accumulate
- Inflammation
- Infection
- Abcess/ Perforation
74
75
Manifestations of Diverticulosis
- Chronic constipation over years
- Bowel irregularity intervals N/D, anorexia
- Bloating or abd distention
Narrowing from fibrotic strictures leading to;
------ Cramps
------------ Narrow stools
----------- Increased constipation
---------- Intestinal obstruction
76
Stool goes how?
Type 1-7
1 being marble like
7 liquid type
77
Complications of
abd pain, rigid board like abdomen, loss of bs, s/s of shock
- Abcess formation
- Fistulas
- Bleeding
78
Medical management for Diverticulitis includes
Diet
- Clear liquid until inflammation subsides
- High Fiber
Bulk Forming Laxative
Medication
- Antibiotics
- Antispasmotics
- Pain Meds
79
Nursing Process of Diverticulitis Assessment Includes
- Chronic constipation preceding development of diverticulosis, frequently asymptomatic but may include bowel irregularities, nausea, anorexia, bloating, and abd. distention
- With diverticulitis symptoms include mild or severe pain in LLQ : nausea, vomiting, fever, chills, and leukocytosis
- Ask regarding the onset and duration of pain and past present elimination patterns
- Nutrition and dietary patterns including fiber intake
- Inspect stool and monitor complications for symptoms potential comlications
80
Collaborative Problems and Potential Complications
- Perforation
- Peritonitis
- Bleeding
- Abscess Formation
81
Nursing Process The care of the patient with Diverticulitis Diagnosis
Constipation
Acute Pain
82
Nursing Process Planning for pt with Diverticulitis
Major goals may include attainment and maintenance of normal elimination patterns, pain relief, and absence of complications
83
Maintaining Normal Elimination Pattern
- Encourage fluid intake of at least 2 L/ D
- Soft foods with increased fiber, such as cooked vegetables
- Individualized exercise program
- Bulk laxatives- pysillium and stool softeners
84
Crohn's is a disease that is
Regional Enteritis
85
Right upper quadrant pain
- Gastrodudenal Crohn's Disease
86
Left Upper Quadrant Pain and Left Lower Quadrant Pain includes
Ulcerative Colitis
87
Crohn's Disease first diagnosed when?
Adolescence or young adulthood
- Incidences increase over past 30 years
88
Crohn's Disease affects who more?
Smokers than non smokers
Affects men and women equally
- Familial
- Jewish Heritage Risks
- African Americans are at the least risk
89
This is an acute/ subacute inflammation of the GI tract and affects any area from the mouth to the anus
Crohn's Disease
90
Does Crohn's extend through all layers?
True
91
Where is Crohn's commonly found in?
Ileum
92
Crohns does have periods of what?
Remission and exacerbation
93
How does Crohn's begins?
Begins with edema and thickening of the mucosa- unfamed mucosa develops ulcers
94
How are the lesions described in Crohn's?
Not in continuous contact- (separated by normal mucosa)
Ulcer cluster- Cobblestone like
95
The inflammation in Crohn's extends into the peritoneum forming what?
Fistulas and fissures and abscess
- Granulomas in 50% of patients
96
In advanced Crohn's what happens?
Thicken Bowel wall and fibrotic intestinal lumen
97
In Crohn's what happens to the diseased bowel loops and they adhere to?
Other portions of the bowel
98
Crohn's is ________________ but worsening diagnosis increases what?
Insidious
Increases extraintestinal symptoms
99
This disease is unrelieved diarrhea by defecation
Crohn's
100
Crohn's disease the abdominal will be?
Tenderness and spasm
101
Where is the cramp usually in Crohn's disease?
RLQ- Crampy abd. pain p.c. d/t food/ peristalsis
- Weight loss- Limit food intake d/t pain leads to anorexia
- Malnutrition and chronic diarrhea and more deficits
-2nd is anemia
102
How are the ulcers in Crohn's?
Weepy discharge, weepy into colon
103
Is the person thin in Crohn's?
Yes, emaciated r/t malabsorption
104
What are the stools like in crohn's?
Steatorrhea- Fatty Stools
105
Crohn's disease will show what?
Fever and Leukocytosis
- Intra abd and anal abscesses
106
Name the diagnostic findings for Crohn's Disease
- CT Scan
---Wall thickening, mesenteric edema, obstructions, abscesses and fistulas
-MRI
-- Identify pelvic and perianal abscesses and fistulas
Labs
--CBC, H&H may be decreased
Elevated WBC and ESR elevated
-Albumin and Protein decreased
107
Intestinal obstruction
Perianal Disease
Fluid and electrolyte imbalances
Malnutrition from malabsorption
- Fistula-- abscess formation (enterocutaneous fistula)
Crohn's Disease Complication
108
This is a recurrent ulcerative and inflammatory disease of the mucosal and submucosal layers of the colon and rectum
UC
109
Highest prevalence in Caucasians and people of Jewish Descent
UC
110
UC is more common in men than women
False
111
UC has many complication r/t disease and has a high mortality rate
True
112
What age group does Crohn's affect?
15-40
5% develop colon cancer
113
Where does UC affect more?
The superficial mucosa of colon
114
Where does UC begin?
Rectum and spreads proximally to entire colon
- Multiple contagious ulcerations and diffuse inflammations
115
This disease involves desquamation or shedding of colonic epithelium
- Bleeding from ulcerations
UC
116
The mucosa her becomes edematous and inflamed and the lesions are contagious
UC
117
This disease has the bowel narrowing, thickening, and shortening
UC
---Muscular hypertrophy
118
What lining does UC affect?
Only the inner lining
NOT transmural
119
This disease has passage of mucous, pus, or blood.
UC
120
LLQ pain
Tenesmus
Rectal bleeding (mild or severe)
UC
121
This disease has
-pallor, Anemia, and fatigue, hypocalcemia
-Anorexia, wt loss, vomiting, dehydration
- Fever
- Cramping( feeling of urgency to defecate)
6 or more liquid stools/ day
Extraintestinal manifestations
UC
122
This disease during the assessment is showing
VS: ^HR, Decrease BP, ^RR, ^T
Skin: Pallor Abdominal: BS plus, stool plus occult, distention and tenderness
Hematology: H/H decreased, Increased WBC, Decreased Albumin levels and electrolyte abnormalities
UC Assessment and diagnostic findings
123
This is a definitive test, reveals friable, inflamed mucosa with exudate and ulcerations; Biopsies taken
Colonoscopy
124
CT, MRI, and US do what in UC
Identify abscesses and perirectal involvement
125
In UC we do a stool exam for parasites ?
R/O dysentery from organisms
126
What are 3 major complications of UC?
Megacolon
Perforation
Bleeding
127
What is Toxic Megacolon?
Inflammatory process- absence of contractility- colonic distention
-s/s- fever, abd. pain, distention, vomiting, fatigue
128
Tx if no response for UC is?
Surgery for total colectomy and ileostomy
Interventions: 24-72 with NGT, IV fluids, steroids, abx, then surgery
129
Management of IBD is aimed at what?
-Remission
-Prevention of flareups
- improving QOL
130
Nutritional and fluid therapy of IBD includes
Low fiber, high protein, high caloric diet with vitamins and iron
- Severe dehydration- IV therapy and TPN
131
Pharmacological Therapy for IBD
Aminoacylates- Azulfidine
Corticosteroids- For pt refractory to remission with other meds
-Immunomodulators- alter immune response
- Anti Tumor Necrosis Factor meds- monoclonial Abs inhibit inflammatory effects of cytokine TNF in gut
- ABX (2ndary infections)
132
For managements of IBD sx are intractable and QOL is affected. t/f
True
133
33% for UC
60-70% for Crohn's
True
134
Strictureplasty is used for
Management for IBD
-Laparoscopic
135
Management of IBD includes small bowel resection up to 80% tolerated
True
136
Proctocolectomy with ileostomy
True for management for IBD
- Intestinal Transplant
137
IBD Assessment includes?
Health Hx
- ID onset, duration, and characteristics of pain
- Diarrhea- urgency, tenesmus
- Nausea, anorexia, wt loss
- Bleeding
- Family Hx
138
Nursing Process The care of the patient with IBD - Diagnoses
- Diarrhea
- Acute Pain
- Deficient fluid
- Imbalanced Nutrition
- Activity intolerance
- Anxiety
- Ineffective coping
- Risk for impaired skin integrity
- Risk for ineffective therapeutic regimen management
139
Nursing Process Planning of Care with IBD
Major goals include
- attainment of normal bowel elimination patterns
- relief of abdominal pain and cramping, prevention of fluid deficit
- maintenance of optimal nutrition and weight
- Avoidance of fatigue
- Reduction of anxiety
- Promotion of effective coping
- Absence of skin breakdown
-Increased knowledge of disease process and therapeutic regimen
-Avoidance of complications
140
How can we maintain normal elimination pattern interventions?
- Identify relationship between diarrhea and food, activities, or emotional stressors
- Provide ready access to bathroom or commode
- Encourage bed rest to reduce peristalsis
- Administer medications as prescribed
- record frequency, consistency, character, and amount of stools
141
Other Interventions of IBD include
Reduce anxiety- Therapeutic manner, listen and let patients express feelings
- Assessment and tx of pain or discomfort, anticholinergic meds before meals, analgesics, positioning diversional activities, and prevent fatgue
-Optimal Nutrition-Elemental feedings that are in protein and low residue or PN may be needed
- Fluid deficit, I&O, daily weight, assessment of symptoms of dehydration or fluid loss, encourage oral intake, measures to decrease diarrhea
142
Patient education for IBD include
-Understanding of disease process
- Nutrition and diet
- Medications
- Ileostomy care if applicable
143
Evaluation of IBD Nursing Process
Patient reports
- Decrease in stool
-Complies with dietary restrictions
- Drink 1-2 L of fluids per day
- Normal T, skin turgor, moist mucosa
- Tolerates small, frequent feedings w/o diarrhea
- Avoids fatigue
- Adequate coping noted( verbalizes feelings, decreased stress)
- Maintains skin integrity- at stomal and anal areas
- Understands disease process and avoid complications
144
This disease happens in adolescence and young adulthood
-Affects all layers of intestine
- Affects mouth to anus- common in ilium
- Develops ulcer cluster/ cobblestone
- Insidious but worsens
-Diarrhea, cramps. steatorrhea, malnutrition
- No cure
Crohn's
145
Ages 15-40
- Only affects mucosal/ submucosal layers
- Begins in rectum/ spreads proximally
- Multiple ulcerations/ diffuse inflammations
- Exacerbations/ remissions
- 10-20 liquid stools/ day (with blood and mucus), cramping and urgency to defecate
- Can surgically treat with the 4 procedures
UC
146
_____ is body mass indices above 30 ng/ m squared
Obesity
147
Obesity related mortality rates are _____ greater for every gain of 5kg/ m sqaured of body mass beyond BMI of 25 kg/ m squared
30%
148
Obesity puts one at the risk for
Disease disorders
Low self esteem 'impaired body image
Depression
Diminished quality of life
149
Obesity prevalence is higher in who?
Women
African American
Hispanic
150
Less educated and who earn less reflects ?
Disparities in the disease burden of obesity
151
Obesity management includes
Lifestyle modifications
- Diet exercise
Pharmacotherapy
Bariatric Surgery
152
Pharmacotherapy includes
Olistat (Xenical)
Lorcaserin ( Belviq)
Sibutramine HCL (Meridia)
Rimonabant ( Acomplia)
153
Morbid obesity persons more than two times IBW, BMW exceeds 30 kg/ m squared, or more than 100 pounds greater than IBW, high risk complications for health
Bariatric Surgery
154
_____________ surgery is only performed only after nonsurgical methods have failed
Surgery
155
What are the selection factors for bariatric surgery?
Body weight
pt hx
Failure to lose weight using other means
Absence of endocrine disorders
Psychological Stability
156
Name the different Bariatric Procedures
Roux en gastric bypass
Gastric Banding
Sleeve Gastrectomy
Biliopancreatic division with duodenal switch
Performed by laparoscopy or by an open surgical technique
157
Roux en Y Gastric Bypass
Weight loss surgery that restricts food intake and prevents absorption of nutrients
- Creates small pouch in the stomach and connecting the newly created pouch directly to the small intestine
158
Gastric Banding
Type of weight loss surgery
- Involves placing an adjustable silicone band around the upper part of the stomach to help people with obesity to eat less.
159
Surgical procedure to help people lose weight
- 50%-85% of the stomach is removed leaving smaller tube shaped stomach that resembles a banana
Sleeve Gastrectomy
160
Biliopancreatic Diversion with Duodenal Switch
Complex weight loss surgery that combines a sleeve gastrectomy with an intestinal bypass to reduce how much food the body absorbs and how much it can eat
161
Pre operative care and evaluation and counseling
- Postoperative care is similar to gastric resection, ut patient is at greater risk for complications related to obesity
- Post op diet- small feedings totaling 600-800 calories/ day
- Patient require psychosocial interventions to modify their eating behaviors
- Follow up care
- Education regarding long term effects
Nursing care for patient undergoing bariatric surgery
162
-Hemorrhage
- Dumping Syndrome
- Bowel or gastric outlet obstruction
- Bile reflux
- Dysphagia
- Venous thromboembolism
Collaborative Problems and Potential Complications
163
Gallbladder stores what
Bile
164
Pancreas is responsible
Insulin
Glucagon
Somatostatin
165
Cholelithiasis Pigment stones is how many %
10-25% cases in US
166
Cholesterol Stones is how many %?
75%
167
What are risk factors for cholelithiasis?
-Obesity
- Women- esp mult pregnancies, Native -American or US SW Hispanic ethnicity
- Frequent changes in weight/ rapid weight loss
- Treatment with high- dose estrogen
- Low - dose estrogen therapy
- Ileal resection or disease
- Cystic Fibrosis
- Diabetes
168
Name the clinical manifestations of cholelithiasis
- None or minimal symptoms - acute or chronic
- Pain (Frequently after rich meal)
- Biliary Colic
- Jaundice (With Obstruction of Bile Duct)
- Grayish or putty colored
169
Medical Management of Cholelithiasis
- Dietary Management
- Medications-- Ursodeoxycholic acid and Chenodeoxycholic acid (takes 6-12 mo)
- ERCP
- Dissolving- Infusion of MTBE into GB
- Laparoscopic Cholecystectomy
Non Surgical removal
- By instrumentation
- Intracorpeal or extracorpeal lithotripsy
170
ERCP
Procedure that uses an endoscope and X rays to examine the liver, gallbladder, bile ducts and pancreas
Used for diagnosis and to treat problems as well.
171
Name nonsurgical ways to remove gallstones
A. T- tube tract to remove stone
B. Removal of stone with basket to catheter threaded through T tube tract
C. ERCP endoscope inserted to Duodenum
D. Papillotome inserted into common bile duct
E. Enlarging opening of sphincter of Odi
F. Retrieval and removal of stone with basket inserted through endoscope
172
Laparoscopic Cholecystectomy
Minimal invasive procedure to remove the diseased gallbladder
173
Nursing Process Care of the Patients with Cholelithiasis Assessment includes?
-Patient Hx
- Knowledge and education needs
- Resp. status and risk factors for resp. complications post operative
- Nutritonal status
- Monitor for potential bleeding
GI Symptoms
174
What are the GI symptoms after laparoscopic ?
Loss of appetite
Vomiting
Pain
Distention
Fever
Potential infection or disruption of GI tract
175
Nursing Process The care of the patient with Cholelithiasis Diagnosis includes
Acute Pain
Impaired Gas exchange
Impaired skin integrity
Imbalanced nutrition
Deficient Knowledge
176
Collaborative Problems and Potential Complications
- Bleeding
- GI Symptoms
- Complications r/t to surgery in general
----atelectasis, thrombophlebitis
177
Planning of care for a patient with cholelithiasis
Goals may include relief of pain, adequate ventilation, intact skin, improved biliary drainage
Then Optimal nutrition
Then Absence of complications
- Understands self- care routines
178
Nursing Process for patient with cholelithiasis interventions include
--Relieving pain- eds, splinting, and positioning
-- Improving resp. status- deep breathing, IS
--- Care of biliary drainage system
---Maintain skin integrity
---Improve nutritional status
---Self care education- Refer to chart 44-2`
179
Pancreas Exocrine function includes
-Secretes digestive enzymes
- Released into pancreatic duct
180
Pancreas Endocrine Function includes
-Islets of Langerhans
- Alpha
-Beta
181
Pancreatic duct enzymes becomes obstructed and enzymes back up
- Causing autodigestion and inflammation in the pancreas
Acute Pancreatitis
182
Progressive inflammatory disorder with destruction of the pancreas
- Cells are replaced by fibrous tissue
- Pressure within the pancreas increases, obstructing the pancreatic and common bile ducts
Chronic Pancreatitis
183
Severe abd. pain/ back tenderness
- May be accompanied by distention, abd mass, decreased peristalsis, vomiting
Acute Pancreatitis
184
- Recurring attacks of severe upper abd./ Back pain
- Become more frequent and severe
Chronic Pancreatitis
185
What is a major symptom of chronic pancreatitis?
- Recurrent attacks of severe abdominal and back pain accompanied by vomiting
- Fever, jaundice, confusion, and agitation
- Ecchymosis in the flank or umbilical area
- ABD. guarding
****Recuurent attacks
186
Medical Management
Acute
Chronic
187
