Term
| Main function of the GI tract |
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Definition
| to supply nutrients to the body's cells |
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Term
|
Definition
lower esophageal sphincter
-separates the esophagus & stomach
-remains contracted during swallowing, belching, or vomiting |
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Term
| Why does the LES remain closed? |
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Definition
| to prevent aspiration, reflux |
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Term
| Subjective Assessment of GI system |
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Definition
-abdominal pain
-N/V/D/C
-distension
-heartburn
-jaundice
-changes in dietary patterns
-gas, bloating
medication usage |
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Term
| Why do you want to ask about changes in dietary habit? |
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Definition
| -it may reveal or be r/t more symptoms the patient may not have mentioned |
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Term
| Why do you want to ask the patient about medication usage? |
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Definition
-to determine if there are other symptoms the patient may not have mentioned
-ask if they know why they are taking it. |
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Term
| physical assessment: mouth |
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Definition
| check membranes intact, moist, any ulcers or lesions |
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Term
| physical assessment: abdomen |
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Definition
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Term
| physical assessment: abdomen - look |
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Definition
| skin color, symmetry, masses, movement |
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Term
| physical assessment: abdomen - listen |
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Definition
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Term
| physical assessment: abdomen- feel |
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Definition
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Term
Upper GI Barium Swallow
Upper GI with small bowel follow through
Lower GI series or Barium Enema |
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Definition
-diagnostic tests
-Barium is a contrast
-sticks to lining of esophagus, stomach, intestines
-once ingested or given as an enema X rays are taken to visualize the organs |
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Term
|
Definition
Diagnostic test
-allows for visualization of organs (kidneys, gallbladder, liver, stomach, kidneys, and bladder)
-detects abdominal masses, bililary & liver disorders, gallstones |
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Term
|
Definition
esophagogastroduodenoscopy
-directly visualizes the lining of the esophagus, stomach, duodenum using an endoscope |
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Term
|
Definition
-to diagnose inflammation, ulcerations, tumors
-biopsies may also be taken |
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Term
|
Definition
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Term
| sigmoidoscopy & colonoscopy |
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Definition
| directly visualizes the colon |
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Term
| Why is a sigmoidoscopy & colonoscopy performed? |
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Definition
-to diagnose inflammatory bowel disorders, polyps, tumors, diverticulosis,
-biopsies may be taken |
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Term
| As the nurse, what do you need to monitor for in a patient pre-GI procedure? |
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Definition
-electrolytes
-informed consent
-make sure pt has been NPO 6-8 hrs prior to procedure
-clear liquids
-allergies/medications
**make sure bowel is cleaned out |
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Term
| As the nurse, what do you need to monitor for in a pt post GI procedure? |
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Definition
Assess for bowel sound (pt cannot start drinking/eating without return of BS)
-verify gag reflex |
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Term
|
Definition
ileus
perforation
constipation |
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Term
| What is the most common manifestation of GI diseases |
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Definition
|
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Term
| N/V are found in unrelated cases to the GI tract such as... |
|
Definition
-pregnancy
-CV problems
-Metabolic disorders
-side effects of drugs* |
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Term
| What is important in making a diagnosis in N/V? |
|
Definition
| color and content of emesis |
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Term
| What does emesis that contains partially digested foods several hours after eating indicate? |
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Definition
| delayed emptying or obstruction |
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Term
| What does blood in emesis indicate? |
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Definition
|
|
Term
| What does coffee ground emesis indicate? |
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Definition
| blood in stomach for a long time; reacted to gastric secretions |
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|
Term
Assessment of pt c/o N/V:
General Appearance |
|
Definition
-lethargic, pale
-moist mucos mebranes
-skin turgor |
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Term
|
Definition
|
|
Term
|
Definition
Urinary output
-decreased, concentrated |
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Term
| N/V: Assessment -Diagnostic findings |
|
Definition
-altered electrolytes (potassium)
-abnormal endoscopy or x-ray |
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Term
|
Definition
-dehydration
-electrolyte imbalance
-weight loss
-pulmonary aspiration |
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Term
| How do you prevent pulmonary aspiration of N/V? |
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Definition
|
|
Term
|
Definition
1. NGT to LWS
2. Drugs
3. Nutritional Therapy |
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Term
| Why is NGT to LWS used as treatment for N/V? |
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Definition
| to decompress the stomach |
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Term
| What type of drugs are used for N/V? |
|
Definition
antiemetics such as:
promethazine
reglan
zofran
compazine |
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Term
| What type of nutritional therapy is provided as treatment for N/V? |
|
Definition
active vomiting= IV fluids
once vomiting resolved= clear liquids, GRADUALLY add carbs & low fat foods |
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|
Term
|
Definition
gastroesophageal reflux disorder
*most common GI problem in adults |
|
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Term
|
Definition
| -when the esophagus is overwhelmed by acid from the stomach |
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Term
| chronic symptoms of mucosal damage secondary to reflux of gastric contents into the lower esophagus |
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Definition
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|
Term
|
Definition
| not one single cause, but many predisposing factors |
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Term
| Predisposing factors of GERD |
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Definition
1. Incompetent LES
2. Hiatal Hernia
3. Decreased esophageal clearance/impaired esophageal mobility
4. Decreased gastric emptying
5. Obesity, pregnancy, anything that increases ab. P |
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Term
|
Definition
-Heartburn > 3-4x/week
-respiratory symptoms
-hoarse voice
-spre throat/feeling like a lump in throat
-regurgitation
-belching, gas |
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Term
| Why do respiratory symptoms occur with GERD? |
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Definition
| -if acid moves high enough in esophagus, it can irritate airways (chronic coughing, wheezing, asthma exacerbation, hoarse voice) |
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Term
|
Definition
| 1. Esophagitis 2. Barret's Esophagus 3. Respiratory Complications 4. Dental erosion |
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Term
|
Definition
| inflmmation of esophagus from irrtatns or gastric reflux leads to ulcer formation |
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Term
| What is Barrett's Esophagus? |
|
Definition
| -precancerous esophageal metaplasia associated w/ GERD |
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Term
| What types of respiratory complications can occur with GERD? |
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Definition
| cough, bronchospasm, asthma, chronic bronchitis, aspiration pneumonia |
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Term
| How does dental erosion occur as a complication of GERD? |
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Definition
| acid erodes oral cavity, teeth |
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Term
| What diagnostic test is used for GERD? |
|
Definition
EGD
-assess LES competence & visualizes degree of inflmmation
-biopsies may be taken |
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Term
| Collaborative Care of GERD: lifestyle modifications |
|
Definition
AVOID triggers
Nutritional Changes |
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Term
| Types of nutritional changes |
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Definition
1. Decrease fatty foods, chocolate, caffeine, peppermint, acid foods
2. Avoid dairy at bedtime
3. Small frequent meals |
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Term
| Collaborative Care of GERD: Education |
|
Definition
1. Smoking cesssation
2. Elevate HOB 30 degrees(4-6" blocks)
3. Remain upright after eating (2-3 hs)
4. Avoid eating late at night |
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Term
| First line of medication defense for GERD |
|
Definition
Antacid- Mylanta. WHY?
-decreases stomach acid
-give 1-3 hrs AFTER eating |
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Term
| What medication is provided for GERD if no improvement of antacids? |
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Definition
| -PPI or H2 blocker a 6 week course |
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|
Term
|
Definition
proton pump inhibitors
Nexium, Prilosec, Prevacid
-decrease gastric acid secretion by blocking the proton pump mechanism that secrets hydrogen ions |
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|
Term
|
Definition
histamine receptor blockers
Tagament, Zontac, Pepcid
-block action of histamine on the H2 receptors (leads to decrease in acid secretion) |
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Term
| Surgical treament for GERD |
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Definition
-last resort
-GOAL: make LES function better
-nissen fundolication |
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Term
| What is Nissen Fundoplication? |
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Definition
-fundus of the stomach is wrapped around the lower part of the esophagus to reinforce the barrier
-causes a tigher hold around esophagus
-req small frequent meals |
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Term
| Post Surgical Care for GERD |
|
Definition
1. Monitor for respiratory complications
2. If NGT present, maintain patency*
3. Encourage deep breathing
4. Monitor incision or lap sites
5. Pain management
6. Diet (start with clear and gradually advance) |
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Term
|
Definition
| herniation of a portion of the stomach into the esophagus through an opening in the diaphragm |
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Term
|
Definition
| sliding & paraesphageal(rolling) |
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Term
|
Definition
| junction of the stomach & esophagus is above the opening in the diaphragm & part of the stomach slides through the opening when supine |
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Term
| most common type of hernita & does not need to be emergency fixed |
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Definition
sliding hernia
LES is above diaphram w/ fundus of stomach above diagphram; slides up & down |
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Term
| Rolling or paraesophageal hiatal hernia |
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Definition
esophagogastric junction remain in the correct position BUT the fundus & greater curvature of the stomach roll p through the diaphragm forming a pocket along side the esophagus
**medical emergency |
|
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Term
|
Definition
1. Structural Changes
-weakening of diaphragm muscles around the opening
2. Increased intra-abdomminal P
-obesity, pregancy, tumors, heaving lifting |
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|
Term
| Clinical manifestations of Hiatial Hernia |
|
Definition
-asymptomatic
-similar to GERD (heartburn after eating/lying down)
-dysphagia
-bending over may bring a sharp pain (relieved w/ standing) |
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|
Term
| complications of hiatial hernia |
|
Definition
1. GERD
2. Esophagitits
3. Hemorrhage
4. Ulcerations in the herniated portion
5. Narrowing of the Esophagus
6. Regurgitation |
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Term
| Diagnostic studies for Hiatial Hernia |
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Definition
1. Barium Swallow
2. Endoscopy |
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Term
| Treatment for Hiatial Hernia |
|
Definition
Lifestyle Modifcations:
-avoid triggers
-avoid heavy lifting/straining
-eliminate ETOH, smoking
-elevate HOB
-Medications PPI & H2 blockers |
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Term
| Surgical Treatmentof hiatial Hernia |
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Definition
-reduces herniated stomach back into abdomen
-nissen fundocplication |
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|
Term
-Occurs in pts >65 y/o
-mortality 6-10%
-repeat bleeding episode w/in 5 years |
|
Definition
|
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Term
| Causes of Upper GI bleed in eosphagus |
|
Definition
-GERD
-Mallory-Weiss Tear (tear above LES d/t reching/vomiting)
-Esophageal Varices(varicose vains in esophgus; cirrosis, HTN) |
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Term
| Causes of Upper GI bleeding in Stomach & Duodenum |
|
Definition
-bleeding ulcers
-medication use (NSAIDs)
-Stress related Mucosal Disease (physiological stress due to hospitalizations, burns, trauma) |
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Term
| Signs & Symptoms of GI bleeding |
|
Definition
1. Bright red blood in vomit (arterial bleed, no contact w/ GI acid)
2. Coffee ground emesis
3. Melena- black tarry stools |
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Term
| Management of GI bleeding |
|
Definition
-80% occur spontaneously
-Hx of pt important
-Physical Exam (VS, S/S of shcok, abdominal assessment)
-Labs (CBC, CMP, PTT, ABG, Type & Cross)
-IV lines (16-18 gauges; LR, fresh frozen plasma (FFP), blood, albumin)
-foley (monitor I & O, make sure kidneys are functioning) |
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Term
| Diagnostic Treatment for GI bleeding |
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Definition
| Identify bleed and cauterize |
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Term
| When is Medication treatment given for GI bleeding? |
|
Definition
once bleeding stops
PPI & H2 blockers |
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Term
| Goal of treatment for GI bleeding |
|
Definition
-no more bleeding
-cause of bleeding ID & tx
-normal hemodynamic state
-minimal anxiety & pain |
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|
Term
| Inflammation of the gastric mucosa as a result of the breakdown in the normal gastric mucosal barrier |
|
Definition
|
|
Term
|
Definition
| sudden, self limiting, lasts hours to few days |
|
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Term
|
Definition
| gradudal and prolonged course, can last weeks/months |
|
|
Term
|
Definition
1. drugs( ASA, NSAIDS, Digitalis, Fosamax (osteoprosis) --> irritate mucosa
2. diet(ETOH binge drinking, large quantities of spicy foods)
3. H. Pylori Infections |
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|
Term
| Clinical Manifestations of Acute Gastritis |
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Definition
anorexia
N/V
epigastric tenderness
feeling of fullness |
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Term
| Clinical manifestations of chronic gastritis |
|
Definition
-anorexia, n/v, epigastric tenderness, feeling of fullness
-anemia due to lack of absorpbency of cobalamin- vit B 12 (essential for RBC growth & maturation) |
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Term
| Diagnostic Studies of Gastritis |
|
Definition
-endoscopy with biopsy
-breathe test (blow into paper bag, spray mouth, blow into another paper bag, check presence)
-urine
-blood
-stool tests |
|
|
Term
| treatment of acute gastritis |
|
Definition
-eliminate the cause & avoid in future
-tx depends on symptoms
-drug therapy |
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|
Term
| drug therapy treatment for acute gastrtitis |
|
Definition
-antacids work by raising gastric pH greater than 6 (turns)
-H2 blockers/ PPI |
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|
Term
| Treatment of chronic gastritis |
|
Definition
-evaulate & eliminate the specific cause
-cessation of ETOH, smoking
-lifestyle modifications as w/ acute gasttitis
-clear H. Pylori |
|
|
Term
| How is H pylori cleared in patients with chronic gastritis? |
|
Definition
-antibiotics & PPI
-amoxicillin, Bioxin, Flagyl |
|
|
Term
| Teaching to a patient w/ chronic gastritis |
|
Definition
-maintain a bland diety with 6 small meals a day;
-take tyelnol, instead of NSAIDS
-take antacids AFTER meals |
|
|
Term
-Erosion of the GI mucosa from HCL acid & Pepsin
-can occur in any portion of he GI tract |
|
Definition
|
|
Term
|
Definition
|
|
Term
less common than duodenal
more prevalent in women; >50y/o
high incidence of mortality |
|
Definition
|
|
Term
| Risk factors of Gastric Ulcers |
|
Definition
Medications
-smoking
-bile reflux
-H pylori infection |
|
|
Term
| Symptoms of gastric ulcers |
|
Definition
dyspepsia occurs 30-1 hr after eating
-pain occurs high in epigastrium (burning pain)
-food may aggravate symptoms
-RARELY occurs at night |
|
|
Term
80% of all ulcers
occurs at any age (common 35-45 y/o) |
|
Definition
|
|
Term
| Risk Factors of Duodenal Ulcers |
|
Definition
* H. Pylori most common cause
-ETOH
-smoking
-high HCL secretion |
|
|
Term
| High risk populations of duodenal ulcers |
|
Definition
COPD
Cirrhosis
Pancreatitis
Kidney disease |
|
|
Term
| Symptoms of Duodenal Ulcers |
|
Definition
-pain occurs 2-5 hrs AFTER eating (cramp like)
-foods acts as a buffer
-pain in epigastric region
-often OCCURS at night |
|
|
Term
| Diagnostic Test for duodenal ulcers |
|
Definition
-endoscopy (visualizes mucosa, biopsy)
-H. Pylori test (stool, blood, breath)
-Labs ( CBC for anemia; LFT for cirrosis, stool for occult blood) |
|
|
Term
| sharp, stabbing pain in upper abdomen after eating a heavy meal |
|
Definition
|
|
Term
| Goal Treatment for ulcers |
|
Definition
to decrease gastric acid,
enhance mucosal defense &
decrease harmful effects on mucosa |
|
|
Term
|
Definition
dietary modifcations
-smoking & ETOH cessation |
|
|
Term
|
Definition
H2 blockers - promote ulcer healing
PPI - reduce gastric secretion
Antibiotics - if H. pylori infection
-antacids- adjunct therapy, increase gastric pH
-cytoprotective drugs (Carafate - forms a protective covering over the ulcer and prevents further erosion) |
|
|
Term
| T/F Surgical options for Ulcers are common |
|
Definition
|
|
Term
| Types of Surgical options for Ulcers |
|
Definition
1. Gastrectomy (Bill Roth 1 & Bill Roth 2)
2. Vagotomy
3. Pyloroplasty |
|
|
Term
| Types of Surgical options for Ulcers |
|
Definition
1. Gastrectomy (Bill Roth 1 & Bill Roth 2)
2. Vagotomy
3. Pyloroplasty |
|
|
Term
|
Definition
| removal of part of the stomach & reattachment to the duodenum |
|
|
Term
|
Definition
| removal of part of the stomach and reattachment to the jejunum |
|
|
Term
|
Definition
| several parts of the vagus nerve to the stomach (to decreae gastric acid secretion) |
|
|
Term
|
Definition
| enlargement of the pyloric sphincter to allow for easier passage of food from the stomach |
|
|
Term
|
Definition
-hemorrhage
-perforation
-gastric outlet obstruction |
|
|
Term
|
Definition
|
|
Term
| Assessment when hemorrhage occurs |
|
Definition
*VS (BP, pulse, RR)
-abdominal assessment
-s/s of shock
-assess vomit (coffee ground vs bright red bleeding)
-assess stool (melena)
-labs |
|
|
Term
| Labs performed for hemorrhage |
|
Definition
CBC, CMP, PTT, ABG, Type and cross
Stool and vomit for occult blood |
|
|
Term
|
Definition
-Large bore IV x 2
-IVF, Blood, FFP
-Monitor I&O, VS
-PPI
-80-85% will stop bleeding spontaneously.
-Endoscopy to visualize and cauterize bleeding |
|
|
Term
| Most lethal complication of GI |
|
Definition
|
|
Term
| hole in the mucosa allowing for gastric or duodenal contents to spill into peritoneal caviry |
|
Definition
|
|
Term
| T/F small perforations may seal themselves |
|
Definition
|
|
Term
| T/F large perforations are not a medical emergency |
|
Definition
FALSE
*medical emergency that requires surgery |
|
|
Term
| what can spill into the periotneal cavity w/ perforations |
|
Definition
| air, saliva, fod particles, HCL acid, bacteria |
|
|
Term
|
Definition
-sudden, dramatic onset
-severe abdominal pain, unrelieved with meds; may spread to back
-abdomen is RIGID & BOARDLIKE (8pack)
-absent BS
-N/V
-hypovolemia occurs |
|
|
Term
| If perforation is left untreated, what can occur w/in 6-12 hrs? |
|
Definition
|
|
Term
| goal of treatment of perforation |
|
Definition
| -stop spillage of contents into cavity |
|
|
Term
|
Definition
-NGT prevent aspiration/decompress stomach
-increase blood volume via IVF, albumin, blood
-fix perforation (surgery) |
|
|
Term
| -occurs from edema, inflmmation or spasm |
|
Definition
| Gastric Outlet Obstruction |
|
|
Term
| symptoms of gastric outlet obstruction |
|
Definition
-pain worse at end of day d/t stomach filling/dilating
-relief w/ belching/vomiting (projfectilve)
-vomit contains food particles |
|
|
Term
| Manangement of Gastric Outlet Obstruction |
|
Definition
-NGT for decompression
-correct any electrolyte problems
-endoscopy to determine cause |
|
|
Term
| Type of tx for gastric outlet obstruction if ULCER is the cause |
|
Definition
|
|
Term
| Tx for gastric outlet obstruction if STRUCTURAL problem |
|
Definition
|
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