Term
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Definition
•Backflow of gastric contents into the esophagus
•Causes:
•Incompetent lower esophageal sphincter
•Hiatal hernia
•H-pylori overgrowth
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Term
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Definition
•Pyrosis (burning sensation)
•Dyspepsia (indigestion)
•Dysphagia
•Sour tongue
•Chronic cough
•Chest pain
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Term
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Definition
•Assessment and Diagnosis:
•Made on endoscope
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Term
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Definition
•Diet modification – avoidance foods that contribute to symptomatology. (caffeine, alcohol, milk (fats)
•Lifestyle modification – nicotine cessation, bedtime routine, weight loss, sleep positioning
•Mediations – H2 receptor antagonists, PPI’s, metocloprimide (Reglan)
•Manage H-pylori overgrowth
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Term
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Definition
•Barrett’s Esophagus
Dysplasia of the esophageal lining (squamous epithelium) |
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Term
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Definition
Diagnosed via endoscopic biopsy revealing a change from squamous to columnar epithelial cells and is a predominant factor for cancer
Treatment includes managing the underlying dyspepsia, but also includes close monitoring, and if the dysplasia worsens, then surgical intervention is recommended. Ablation is now the preferred treatment
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Term
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Definition
esophogeal emergency
•Most common type of perforation
•Caused by forceful vomiting which leads to a laceration of the lower esophagus, leading to mediastinal sepsis.
•Patient presentation:
•Severe mid-chest pain, perhaps fever, WBC elevated, and hypotension.
•Diagnosis made on imaging
•Prognosis good if treated early
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Term
| peptic ulcer disease (PUD) |
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Definition
•Excavation of the mucosal wall of the upper GI tract.
•Gastric or Duodenal
•Duodenal much more common
•Can lead to blood loss
•Main cause is H-pylori, usually combined with other factors such as diet, NSAIDS.
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Term
| pathophysiology and presentation of PUD |
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Definition
•Pathophysiology:
•Over secretion of acid and pepsin and usually…
•Decreased resistance of the mucosa
•Presentation
•25% or so are asymptomatic
•Dull, gnawing pain near stomach
•Pain can radiate upward like “heartburn” with N/V
•Bowel changes can occur
•Diarrhea and steatorrhea
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Term
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Definition
•Not usually caused by over secretion of acid alone
•Pain occurs immediately after eating
•Little to no relief with food or antacids
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Term
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Definition
•Caused usually by acid over secretion
•Pain occurs 2-3 hours after a meal and can be relieved with food or antacids.
•More frequent nighttime episodes than gastric ulcers.
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Term
| assessment of peptic ulcer disease |
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Definition
•Tenderness and/or guarding over the abdomen
•Endoscopy
•H-pylori biopsy
•Or stool, blood testing for H-pylori
•CBC to assess for blood loss
•Possible need for transfusion
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Term
| management of peptic ulcer disease |
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Definition
•Treatment is not necessarily chronic
•Combination of 2 antibiotics, H2 blockers, PPI’s, bismuth.
•Duration of treatment with H2 combination therapy is 6-8 weeks, 4-6 with PPI use.
•There are risks associated with prolonged PPI use.
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Term
| peptic ulcer disease complications |
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Definition
•There are always risks…
•Perforation - to the omentum (peritoneal barrier)
•Uncontrolled bleeding – factors that contribute to bleeding and clotting
•Gastric outlet obstructions – scarred tissue that forms stenosis blocking the pyloric sphincter (where the stomach/duodenum empties).
•Balloon dilatation required or surgical bypass.
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Term
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Definition
treatment for complication of PUD
bypass allows food to pass obstruction |
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Term
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Definition
•The appendix normally functions by emptying food into the cecum. The appendix though has a very small lumen and is prone to obstruction and subsequently, infection.
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Term
| patient presentation of appendicitis |
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Definition
•At first, vague peri-umbilical pain develops, mid/low abdomen.
•Pain progresses to right lower quadrant pain as appendix begins to fill with solidified stool and pus.
•Will see fever, N/V, anorexia
•Tenderness over McBurney’s point and some rebound tenderness.
•May also see a positive Rovsing’s, psoas, and obturator sign.
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Term
| dx, complications, treatments, and nursing considerations for appendicitis |
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Definition
•Diagnosis
•Usually reliably made on CT
•Complications
•If left untreated, perforation and then peritonitis
•Treatment
•Can opt for non-surgical wait and watch if perforation risk is low or just opt for surgery.
•Nursing considerations
•Preparing the patient for surgery, pain care, and infection management (abdominal drain post-op)
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Term
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Definition
•Incidence – 145,000 new cases each year, resulting in 50,000 deaths. 1:20 lifetime risk
•Incidence increases with age
•Risk factors:
•Genetic predisposition
•History of colon polyps, inflammatory bowel disease
•Alcohol, smoking history
•Obesity, diet high in fat, low in fiber
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Term
| presenting symptoms and screening of colorectal cancers |
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Definition
•Presenting symptoms
•Change in bowel habits
•Passage of blood = unexplained anemia
•Melena
•Anorexia, weight loss
•Dull abdominal pain (R) and/or intestinal obstruction (L)
•Screening
•Occult blood tests, colonoscopy with biopsy of any polyps
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Term
| colorectal cancer treatment and nursing considerations |
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Definition
•Treatment varies based on staging. Usually surgical combined with chemotherapy
•Nursing considerations include:
•Preparing patient for surgery…possible/probable colostomy
•Body image disturbance, hygiene, nutritional issues.
•Assessment for ileus or bowel obstruction post-operatively
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Term
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Definition
•Inflammation caused usually by gallstones (90%), obstructing flow through the common bile duct.
•Pressure from the backflow of bile can result in vascular compression and lead to gangrene.
•Acalculous types are rare but the result is still a backflow of bile, leading to necrosis and gangrene.
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Term
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Definition
•The presence of stones in the gallbladder, whether they cause inflammation and pain or not.
•Usual risk group: Female, Obese, >40yrs of age.
•Stones are form from pigment (bile) and cholesterol (75% more likely).
•Bile becomes saturated in cholesterol and is unable to be broken down, causing GB wall irritation and inflammation.
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Term
| clinical presentation of cholelithiasis |
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Definition
•Pain: RUQ pain, which can radiate to the right shoulder or sometimes mid chest.
•Pain is termed, biliary colic.
•The pathology is simple.
•Nausea, vomiting, anorexia.
•Pain exacerbated with fatty food.
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Term
| assessment and diag of cholelithiasis |
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Definition
•Murphy’s sign
•U/S and/or CT usually enough to make diagnosis.
•May need ERCP (endoscopic retrograde cholangiopancreatography) to inject contrast and visualize structures such as bile duct. Patient is moderately sedated to suppress the gag reflex.
•Nursing consideration is to make sure patient is NPO until gag reflex returns.
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Term
| treatment of cholelithiasis |
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Definition
•Can try to dissolve stones with a solution that can be delivered during an ERCP or perform lithotripsy.
•Really low success rates initially and with high recurrence rate of stones.
•Surgery
•Laparoscopic preferred, but only if GB is not dilated and inflamed.
•Cholecystostomy (removal of stones) first, then lap-chole after resolution of inflammation.
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Term
| chronic and acute types of pancreatitis |
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Definition
•Acute does not automatically mean its going to be a chronic condition.
•Causes – either alcoholic or obstructive such as from cholelithiasis – combined 80% of cases.
•Bacterial and viral causes. Less rare include medications including sulfa drugs, ACE-I, and Lasix.
•Increased activation of trypsin that auto-digests pancreatic tissue, causing severe damage.
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Term
| clinical presentation of pancreatitis |
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Definition
•Severe mid-abdominal pain, which can radiate to the back. Pain pathophysiology again is quite simple.
•Onset of symptoms 24-48 hours after a large meal and/or consumption of alcohol.
•Abdominal distention with palpable organmegalyand/or mass.
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Term
| assessment and labs with pancreatitis |
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Definition
•Palpation to assess inflammation
•Percussion to assess size
•Labs:
•Amylase – greater than 85 U/L
•Lipase – greater than 140 U/L
•Higher the Amy/Lip, the greater the damage initially.
•WBC elevated, ESR elevated,
•Hypocalcemia and degree can predict severity of pancreatic disease
•CT especially with contrast
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Term
| managment of pancreatitis |
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Definition
•Goal is to relieve symptoms and prevent further complications.
•NPO, perhaps with NG tube
•Nutritional support with IV’s
•Then introduce enteral feedings
•H2 blockers or PPI’s, antiemetics
•Pain management with opioids
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