Term
|
Definition
| mechanical muscle movement of food through GI tract |
|
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Term
| leaving the intestines, nutrients return to___, then enter into the blood stream |
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Definition
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Term
| From mouth to anus, the GI system is approximately __ft long from start to finish |
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Definition
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Term
| Starch digestion begin in the ____. |
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Definition
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Term
| The upper GI system is perfused by the ____ artery. |
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Definition
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Term
| The small intestine is perfused by the ___ & ____ arteries. |
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Definition
| hepatic & superior mesenteric (arteries) |
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Term
| The __ & ___ arteries perfuse the large intestine. |
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Definition
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Term
| the ___ ____ vein carries blood from the GI tract to the liver. |
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Definition
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Term
| The ____ is the space that gets infected in a burst appendicitis, and the infection is called ___. |
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Definition
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Term
| Upper GI (Barium Swallow) |
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Definition
x-ray with fluoroscopy & contrast medium (barium)
abnormalities of esophagus, stomach, duodenum
Pre Exam - **NPO p MN**, drink chalk tasting medium, various positions on x-ray table
Post - adm. laxatives & fluids; white stool |
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Term
|
Definition
x-ray of colon with barium thru rectum
Pre - Clear liquids, laxatives (Golytely) & enemas until clear, if not done, can hold up/cancel procedure; **NPO p MN**; cramping & urge to defecate; Assume various positions
Post - laxatives & fluids; white stool |
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Term
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Definition
direct visualization by flexible, fibroptic endoscope
Pre - **NPO p MN**; Permit/consent signed; Pre-op med - sedation; local anesthetic
Post - NPO until return of gag reflex; Vital signs - temp; warm saline gargles - sore throat & hoarseness
**BP important to assess in case of perforation/tear and internal bleeding** |
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Term
|
Definition
Direct visualization of colon
Knee-chest position
Pre-Test: clear liquids, laxatives, enemas until clear; NPO, consent signed
Post-test: VS; complications: bleeding, perforation; abdominal cramping |
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Term
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Definition
| noninvasive; ultrasound waves - masses, acities |
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Term
|
Definition
| - direct visualization rectum & sigmoid colon; laxatives or enema; knee-chest position; Consent |
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Term
| ANTIEMETICS/ ANTIHISTAMINES |
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Definition
Phenothiazines - depresses Chemorecptor triggerzone (CTZ);decrease nausea & vomiting
SE – major SE is decrease in BP; dry mouth, dizziness; sedation; |
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Term
Differnt Phenothiazines:
-prochlorperazine/____
-diphenhydramine/____ |
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Definition
prochlorperazine/Compazine (known for extra pyramidal side effects)
diphenhydramine/Benadryl |
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Term
|
Definition
Block dopamine receptors peripheral & CNS; Stimulate gastric emptying-decrease nausea & vomiting
SE - restlessness, sedation, extrapyramidal symptoms; arrthymias, constipation |
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Term
Prokinetic drugs:
-metoclopramide/____
-ondansetron/_____ |
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Definition
metoclopramide/Reglan
ondansetron/Zofran |
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Term
|
Definition
Neutralize gastric HCl - lower gastric pH
Magnesium - MOM
Aluminum-alum. hydroxide
Combination - Mylanta, Maalox
SE:
Magnesium - diarrhea; Do not give to pts with renal dx. Magnesium Citrate- diarrhea.
Aluminum - constipation
absorp. of meds - give 1-3 hrs pc & HS |
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Term
| H2 BLOCKERS (ANTAGONISTS) |
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Definition
Blocks histamine on H2 receptors on gastric parietal cells-lowers HCL secretion
SE: - Zantac - HA, malaise; Tagamet - mental confusion in elderly, agranulocytosis, aplastic anemia, neutropenia, thrombocytopenia;
Pepcid & Axid - HA, constipation, dizziness |
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Term
H2 Blocker drugs:
ranitidine/____
cimetidine/___
famotidine/____
nizatidine/____ |
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Definition
-ranitidine (Zantac)
-cimetidine (Tagamet)
-famotidine (Pepcid)
-nizatidine (Axid) |
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Term
| PROTON PUMP INHIBITORS (PPIs) |
|
Definition
Blocks APTase enzyme ;lowers HCL secretion
SE - abd. pain, diarrhea; hematuria, proteinuria, *may increase effects of warfarin, dilantin (imp), valium; |
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Term
PPI drugs:
-omeprazole/____
-lansoprazole/___
-Pantoprazole/____ |
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Definition
omeprazole (Prilosec)
lansoprazole (Prevacid)
Pantoprazole (Protonix) *common in IV format* |
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Term
CRYOPROTECTORS
-sucralfate/____ |
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Definition
-Coats & protects GI tract
take 1 hour before meals and antacids 1-3 hours after meals.
SE - Constipation; absorp. Fat soluble vitamins, Dilantin, tetracycline; Antacids - effectiveness of sucralfate
Take on empty stomach
-sucralfate (Carafate) |
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Term
PROSTOGLANDIN ANALOGS;
-misoprostol/____ |
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Definition
-decrease gastric acid secretion & increase mucus production
SE - diarrhea; abd. pain; avoid during pregnancy
Take with or PC & HS
-misoprostol (Cytotec) |
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Term
|
Definition
To kill Helicobacter pylori bacteria (H pylori)
Tetracycline - take on empty stomach; Avoid dairy products, sun; superinfection
Amoxicillin - allergy; Nausea; nephritis,
Flagyl - antifungal; GI distress, antabuse reaction, dark or red urine
clarithromyci (Biaxin) - macrolide; HA, diarrhea, leukopenia, increase PT |
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Term
|
Definition
| discomfort in epigastria region with desire to vomit |
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Term
|
Definition
forceful ejection of partially digested food, gastric secretions, etc
-Emesis; Color - RT time in contact with gastric/intestinal secretions - Bright red - active bleeding;
Coffee ground - stomach contents;
*Bile, fecal, partially digested food - S&S of obstruction*
-NG tube can be used to decrease vomiting, but continuous suction may cause hypokalemia |
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Term
| Gastroesophogeal Reflux (GERD) |
|
Definition
Backflow of gastric secretions into esophagus
Predisposing conditions:
-Incompetent Lower Esophageal
-Hiatal hernia
-Decreased esophageal clearance
-Decrease gastric emptying
-Irritating substances;caffeine, smoking, alcohol, chocolate, spicy foods
*Incompetent Lower Esophageal sphincter (LES) - B/W Esophagus & Stomach
scar tissue common |
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Term
|
Definition
Heartburn (pyrosis) - burning, tight sensation below sternum; may radiate to throat & jaw
Pulmonary - cough, wheeze, dyspnea
Otolaryngologic - hoarseness, sore throat, sensation, chocking
Gastric - early satiety, bloating, N&V, dysphasia; Regurgitation - hot, bitter, sour liquid
Esophagitis-inflammation
Smoking, cold or hot foods, alcohol irritate
*chest pain warrants a cardiac/MI workup* |
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Term
|
Definition
-Pre cancerous lesion
-Increase risk for cancer |
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Term
| Complications & Management of GERD |
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Definition
-Complications -Esophageal Stricture
Diagnostic Studies: UGI - Barium Swallow,Endoscope
-Management:
Eliminate irritating foods & beverages
Diet - 6 small meals/day- protein, fat,
Avoid milk products
raise HOB 30 degrees - 4-6 in. blocks
Avoid supine position - 2-3 hrs p eating |
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Term
|
Definition
Drug Tx:
Antacids - neutralize gastric acid
H2 Blockers - lowers gastric acid secretion |
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Term
|
Definition
protrusion of portion of stomach into esophagus
-decreased esophageal clearance
-decreased gastric emptying
S&S are same as GERD
Bend over with CO of burning pain
Surgery-Reduces the hernia |
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Term
| PEPTIC ULCER DISEASE (PUD) |
|
Definition
-Erosion of GI mucosa RT digestive action of HCl acid and pepsin
-Association B/W PUD & H pylori
-Develop in acid environment, but in acid secretion not necessary
Chronic - long duration with eroding of muscular wall & fibrous tissue formation |
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Term
| 2 types of gastic ulcers: |
|
Definition
-gastric: primarily located in antrumIrritating foods & beverages; Incompetent pyloric sphincter (B/W Stomach & duodenum); Stress ulcers, drugs (ASA, NSAIDS, steroids,) alcohol, gastritis, smoking.
Pain increase in epigastric area 1 to 2 hrs p meals
-duodenal: most in 1-2cm of duodenum..80% of all ulcers are duodenal. painful! 1/2 million new cases DX'd each year.
Psych. factors - prolonged stress; Smoking, Medications, Alcohol; Chronic Dx - COPD, Pancreatitis, Hyperparathyroidism, Increased HCL secretion, alcohol & smoking, H. pyloric, (90%)
Pain midepigastric region 2 to 4 hrs p meals |
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Term
|
Definition
-Hemorrhage- most common
-Perforation- most lethal; spillage of gastric contents into abdominal cavity
-Sudden and dramatic abdominal pain
*Abdomen feels like an ironing board
-Gastric Outlet/Pyloric Obstruction: upper abd. Pain worse during day; relieved by vomiting. Loud peristalsis
NPO; NG Tube |
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Term
| Medical management of PUD |
|
Definition
Symptomatic phase - bland diet
Healing phase - avoid foods & beverages that cause pain or harmful effects
Drug Tx - Antibiotics & Proton Pump (IMP)
Cryoprotective tx
Prostoglandin Analog - Cytotec - prev. gastric ulcers RT NSAIDS & ASA USE |
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Term
| Surgical management of PUD |
|
Definition
Billroth I - gastroduodenostomy - removal of distal 2/3 of stomach (partial gastrectomy) & anastomosis to duodenum
Billroth II - gastrojejunostomy - removal of distal 2/3 of stomach (partial gastrectomy) & anastomosis to jejunum
Lie down 30 min. after each meal (dizziness, weakness, and palpations-test ?
Preferred - prevents reoccurrence of duodenal ulcers
Vagotomy - ligation of vagus nervegastric acid secretion
Gastrectomy - removal of entire stomach |
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Term
| Prevention/management of PUD |
|
Definition
Limit CHO & sugars;
No fluids with meals;
6 small meals - Mod. Protein, & fat;
Rest - recumbent position |
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Term
| Post op care after PUD repair surgery |
|
Definition
NG tube - Do Not Irrigate or Reposition without order; Notify if no drainage
Assess NG drainage - 1500-2000cc/day nl
Initially - Bright red
6-12 hrs - dark red or brown
24-36- greenish-yellow (bile)
Assess bowel sounds- absent 24-72 hrs post op |
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Term
| Complications of GI Surgery |
|
Definition
Dumping Syndrome - reservoir capacity RT removal of stomach & pyloric sphincter
loss of control of amt of gastric chyme & speed of food entering the small intestine
S/S - 15-30 min. pc; weakness, sweating, palpitation, dizziness
-- Perforation:
VS q 15 min
NPO, NG tube;
IV fluids - LR, PRBC, albumin
I & O - hourly
Broad spectrum antibiotics
Analgesics
Surgical tx - if fails to heal spontaneously |
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Term
| Nutritional counseling for PUD Pts |
|
Definition
Avoid - hot, spicy, high roughage foods, * milk products
increase protein - neutralizing, increases gastric secretions
increase CHO, fat - lowers neutralizing, lowers gastric secretions
6 small meals/day
Educational - 3-9 wks. to heal; Healing confirmed by Endoscope |
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Term
| Types of Inflammatory Bowel Disease |
|
Definition
-Crohn’s disease
-Ulcerative Colitis
General characteristics of both:
-Chronic
-Recurrent inflammation of intestinal tract
-Long periods of remission interspersed with periods of acute inflammation
-Both can be debilitating |
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Term
| Compare and contrast Chron's vs Ulcerative Colitis |
|
Definition
-Ulcerative colitis
Young to middle age
Diarrhea common
Cramping pain possible
Intermittent fever
Weight loss
Severe Tenemus
Rectal bleeding common
Minimal Malabsorption
uses bathroom 20x day
Location: starts distally spreads in a continuous pattern
Mucosa and submucosa
Pseudo polyps common
Appearance – no cobble stoning
-Crohn’s disease
Young
Diarrhea common
Cramping pain common
Fever common
Weight loss severe
Rare Tenemus
Rectal bleeding infrequent
Malabsorption
Location: anywhere in GI tract most frequent: terminal ileum
Segmental, entire thickness of bowel wall
Pseudo polyps rare
Cobble stoning present |
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|
Term
| Chron's compared to Ulcerative colitis (II) |
|
Definition
Ulcerative colitis
Small bowel involvement minimal
Fistulas rare
Strictures rare
Anal abscesses rare
Perforation common
Cancer increased incidence p 10 years
Recurrence after surgery – cure with colectomy
Chron's disease:
Small bowel involvement common
Fistulas common
Strictures common
Anal abscesses common
Perforation common
Cancer slightly > than general population
Recurrence after surgery –70% |
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Term
| Colon cancer diagnostic tests |
|
Definition
CT scan
Stool cultures
CBC (anemia)
Increased WBC
Sigmoidscope
Colonscopy
Barium enema |
|
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Term
| Colorectal cancer treatments |
|
Definition
Medications
Antimicrobials - Azulfidine
Corticosteroids – Cortisone, Prednisone
Anticholinergics -Banthine
Sedatives – Valium
Antidiarrheals – Lomotil
Immunosuppressives –Imuran, Cyclosporine
Hematinics & vitamins – Iron dextran, Cobalamin, Zinc
Surgery: Colectomy ; Total Proctorcolectomy |
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|
Term
| In 2007, colorectal cancer was the #____ most common form of cancer, affecting___ % of men and ___% of women. |
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Definition
| 3rd, 9% of men, 10% of women. |
|
|
Term
| Risk factors for colorectal cancer |
|
Definition
Prevalent over age 50 years
Cecum, ascending colon and sigmoid colon
20% within reach of the examining finger
50% within reach of sigmoidoscope
Cause: unknown
Risk factors : age, polps, chronic IBD, Family hx
genital and breast cancer, high fat/or low-fiber diet |
|
|
Term
|
Definition
Mostly nonspecific
Rectal bleeding most common sign
Alternating constipation and diarrhea
Decreased size of stool, pencil thin, ribbon like
Obstruction symptoms due to smaller lumen.
Right side :asymptomatic
Vague abdominal discomfort
anemia |
|
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Term
| Colorectal Cancer treatment options |
|
Definition
The only curative treatment (colectomy)
Chemotherapy & radiation therapy |
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Term
|
Definition
Ostomy-opening to allow passage of intestinal contents from bowel to stoma
-Ileostomy- ileum to abdominal wall
-Cecostomy- cecum to abdominal wall
-Colostomy- colon to abdominal wall
----Ascending
----Transverse
----Sigmoid (may not need to wear ostomy full time, only when passing a BM) |
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Term
| characteristics of ostomy in the sigmoid colon: |
|
Definition
Stool formed
No change in fluids
Yes-bowel regulation
Maybe or maybe not skin barrier
Irrigation: q 24-48 hours |
|
|
Term
| characteristics of ostomy in the transverse colon: |
|
Definition
Semi-liquid to formed
Increase fluids
Bowel regulation-uncommon
Skin barriers
No irrigations |
|
|
Term
| characteristics of ostomy in the ascending colon: |
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Definition
Semi-liquid
Increase fluid
No bowel regulation
Skin barriers
No irrigation |
|
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Term
| Health & unhealthy stoma characteristics |
|
Definition
Bright red or cherry red are normal
Dusky blue stoma-ischemia
Brown black- necrosis
Dark red to purple-blood supply inadequate
Paleness-anemia |
|
|
Term
| It is normal to not see stool in a new ostomy until ___ days post-op |
|
Definition
|
|
Term
| Edema around a new stomy site will not likely subside until___ weeks post op |
|
Definition
|
|
Term
| Common stoma complications |
|
Definition
Electrolyte imbalances-Drink Gatorade
Pouch problems
Stoma shrinks-Wear pouch 5-7 days
Stoma problems
Colostomy irrigation
Rarely seen |
|
|
Term
|
Definition
1 piece or 2 piece snaps
Drainable or closed in
Reusable :wash in lukewarm water-no vinegar
Odor free
Pouch emptied when one-third full
Monitor F & E imbalance (Na, K, Cl); I & O
Initially 3000 cc day
Roughage diet increased as tolerated
Cleaned with H20 and soak
Shower with or without pouch
Candida - Flagyl |
|
|
Term
| Diet/lifestyle reqs for patients w/ ostomies |
|
Definition
Decrease fiber
Try new foods at 3 day intervals
Odor- Flatus-onions beer, seafood, spicy pizza, cabbage, eggs
Travel don’t irrigate unless you can drink it
Drugs
Vitamins, antibiotics steroids and hormones destroy flora and drink buttermilk or yogurt or Lactaide to restore flora
-ok to swim and wear jeans |
|
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Term
| Troubleshooting an ostomy w/ no drainage |
|
Definition
concern when no drainage for > 24-48 hrs
Constant liquid drainage
Wear pouch at all times
Output- 1000-1800 initially then 800cc/da
Drink 2-3L daily
Susceptible to Metabolic Acidosis
Drink Gatorade
Tsp. Of salt and tsp. Baking soda 1 quart H20 |
|
|
Term
| psychological issues for Pts w/ new ostomies |
|
Definition
Misconceptions
Allay fears
Sex
Body image-grieve
ENT-enterostomal nurse
Productive and independent (Kate Jackson Richard Gere) |
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