week 8: upper GI and accessory organ disorders

Question 1

what is GERD

Answer 1

stomach acid leaks back into esophagus

Question 2

what are complications of GERD

Answer 2

barretts epithelium, respiratory issues (aspiration), esophagitis, dental decay, hemmorhage

Question 3

where do GERD symptoms stem from

Answer 3

tissue injury and too much stomach acid

Question 4

whats the difference between a sliding hartal hernia and a parasophageal hernia

Answer 4

sliding: herniated portion of stomach just kind of slides out

paraesophageal: pouch of stomach kind of rolls out

Question 5

what are the symptoms of a hiatal hernia similar to

Answer 5

GERD
if LES is normal there are no symptoms

Question 6

how does a CPAP help with Gerd

Answer 6

makes sleep apnea better and for some reason helps with GERD

Question 7

when are GERD symptoms usually worse

Answer 7

when a person is eating or lying down

Question 8

which drugs help with GERD

Answer 8

antacids, PPIs, H2 receptor blockers

Question 9

which drugs make GERD worse

Answer 9

oral contraceptives, anticholinergic drugs, sedatives, NSAIDS, nitrates, CCB
all lower LES pressure

Question 10

what are long term complications of PPI;s

Answer 10

PPIs long term lead to more risk of infection because stomach acid kills bacteria

also leads to inflammation of the kidney and inability to absorb calcium = bone fracture

Question 11

what is a fundoplication

Answer 11

wrap fundus/herniated part of hernia around a band and secure it and it’ll eventually fall off

Question 12

what is post op priorities when a person has a fondoplicaiton

Answer 12

preventing respiratory complications (raise HOB, early ambulation, Deep breathe and cough, support incision, pain control)

Question 13

what does normal NG tube drainage look like

Answer 13

it’ll go from dark brown to yellowish green, if it goes back to dark brown that could mean GIB

Question 14

what is a sign that fondification is too tight

Answer 14

inability to bleach, dysphagia, aerophagia (air swallowing)

Question 15

what are the first signs/symptoms of oesophageal tumours

Answer 15

dysphagia

then it’ll move on to odynophagia, hoarseness and weight loss

Question 16

what are the non surgical interventions for oesophageal tumours

Answer 16

nutritional and swallowing therapy
chemo and radiation
esophageal dilation

Question 17

what is the main surgical intervention for an esophageal tumour

Answer 17

esophagectomy
- basically removing a part of esophagus

Question 18

what is the highest priority post-procedure thing for esophagectomy

Answer 18

respiratory care (DB + C, turning, pain support)

Question 19

what is an important thing to note about an NG tube

Answer 19

don’t reposition, measure the length

Question 20

what is an anastomotic leak and why is it so serious

Answer 20

it is when GI fluid leaks out of esophagus sutures into mediastinum (after an esophagectomy)

it could lead to sepsis/peritonitis

Question 21

what are symptoms of anastomotic leak

Answer 21

• fever, increased chest tube drainage, early signs of shock (high pulse, low BP)

Question 22

what is a blumberg sign

Answer 22

rebound tenderness

Question 23

what is steatorrhea

Answer 23

increased fat excretion of stools usually due to inflammation of the gall bladder

Question 24

what is extra-corporeal shock wave lithotripsy and why does it help with gall stone management

Answer 24

it uses ultrasound shock waves to break up stones so that they can pass

Question 25

what is a percutaneous transhepatic biliary catheter

Answer 25

a stent inserted to divert bile from liver into the duodenum

Question 26

what is the gold-standard method for treating cholecyctotis

Answer 26

laparoscopic cholecystectomy

Question 27

why would a patient have gaseous pain after a cholecystectomy

Answer 27

because they need to fill the abd wall with 3-4L of CO2 to lift the wall and visualise the internal organs

Question 28

what is a Jackson-pratt drain

Answer 28

small drain that sits near where the gall was used for an open approach cholecyctectomy

Question 29

why would one use an open approach cholecystectomy

Answer 29

used in severe biliary obstruction where surgeon needs to look around and figure out the cause

Question 30

what does pancreatitis pain look like

Answer 30

starts in LUQ, radiates to back, L flank and L shoulder

Question 31

what are the pain causes of pancreatitis

Answer 31

gall bladder stones and ahcolol use

Question 32

what is the primary nutritional intervention for pancreatitis

Answer 32

NPO to give pancreas a rest

Question 33

what are signs of hypocalcemia

Answer 33

muscle spasms and cramps

Question 34

why do you need to monitor respiratory status with pancreatitis

Answer 34

pancreatic juice can migrate to peritoneum and cause atelectasis monitor for cough and fever, look for crackles in the lungs

Question 35

what are the signs of peritonitis

Answer 35

fever, loss of appetite, abd pain, change in mental status

Question 36

what are the two main vasoactive meds to treat an active bleed d/t liver cirrhosis

Answer 36

octreotide, vasopressin

Question 37

what is a TIPS procedure

Answer 37

blood flow from portal vein shunted to hepatic vein

Question 38

which medication helps with confusion with liver cirrhosis

Answer 38

lactulosewhy

Question 39

why do you need to use drugs sparingly with liver cirrhosis

Answer 39

because they get metabolised in the liver

Question 40

why do you need moderate protein intake when managing and preventing confusion in a liver cirrhosis patient

Answer 40

because ammonia competes with protein in the gut

Question 41

what is the goal of pooping with lactulose

Answer 41

2-3 soft stools per day

Question 42

what should you monitor with lactulose

Answer 42

monitor for hypokalaemia, dehydration, asterisks and fetor hepaticus

Question 43

which medication helps with itchy skin due to liver cirrhosis

Answer 43

sertraline

Question 44

where would you experience pain with hepatitis

Answer 44

right upper quadrant pain

Question 45

what is the main drug management with hepatitis B and C

Answer 45

antiviral drugs

Question 46

what is the primary patient education with antiviral drugs

Answer 46

avoid large crowds and sick people because it can suppress the immune system