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GI disorderss
Medsurg
| Question | Answer |
|---|---|
| Esophagus | esophagus is to move the food bolus by peristalsis from pharnyx to stomach. Esophagus does not secrete enzymes, and only mechanical digestion takes place. |
| Stomach | primarily serves as a resevoir. and aids in digestion. |
| Gallbladder | function is to store and concentrate bile. Bile, which is formed in the liver, is excreted into hepatic ducts. |
| Pancrease | produce enzymes for digestion |
| Small intestine | function is the digestion of food and the absorption of nutrients. |
| Large intestine | Absorbs water abd electrolytes from chyme and store the food waste until defecation. |
| Stool Examination | Stool collected for culture, determination of fat content, and exam for presence of ova, parasites, and fresh or occult blood. False negatives can result from Meat poultry, or fish eaten within 3 days before testing, ingestion of aspirin. |
| False negative stool | can result from aspirin or antiinflammatory drugs within 7 days,Meat poultry, or fish eaten within 3 days before testing. Vitamin C greater than 500mg/day may cause a false negative test if consumed 3 days before testing. |
| Upper GI series | involves visualization of esophagus, stomach, duodenum, and upper jejunum through the use of contrast medium. NPO status for at least 6 hrs before test. Monitor I&O |
| Barium enema | Outlines large intestine using contrast medium. NPO 8hrs before test. Teach pt. stools will be white for few days. |
| Esophageal Functions tests | evaluates function of esophagus and determines if esophageal reflux is occuring. 24hr [H monitoring gold standard of diagnosing esphageal reflux. |
| ph monitoring | evaluates competency of lower esophageal sphincter by obtaining a single measurement of esophageal pH normally pH >6.0 |
| Esopagogastroduodenoscopy (EGD) | Prep: NPO 8hrs before the test. Instruct pt. likely to experience a feeling of pressure or fullness.post: v/s taken q 30min for 3-4hrs.Monitor for dyspnea, pain, bleeding, acute dysphagia. Relieve sore throat with lozenge. |
| Colonoscopy | allows exam of entire colon. evaluate growths, remove polyps, take biopsy specimens, and localize bleeding sites. Gold standard for diagnosing colorectal cancers. |
| Colonoscopy | 1-day prep with an oral osmotic solution is now standard because it reduces fluid and electrolyte loss. A gallon of polyethylene glycol is administered. NPO 8hrs before test. postop:monitor LOC,call do if change in v/s, abd pain, rectal bleeding, fever. |
| Colonoscopy | Pt. should not drive, NPO till gag reflux returns (use tongue blade). HOB 30-45 degrees. |
| Cancer of mouth etiology | cancer may develop on the lips, tongue, palate, floor of the mouth,or portions of the oral cavity. Linked to hx of smokiong and alcohol consumption. |
| Cancer of mouth s/s and treatment | often asymptomatic, single lesion is typical.Tx depends on location and stage of tumor. Early stage treated with radiation surgery.Surgery include partial Mandibulectomy, partial and total hemiglossectomy. |
| Cancer of mouth pt. teaching | Pt. teaching: good mouth care is essential to minimize tooth decay and infection and to promote healing. Diet and eating:eat slow,avoid too hot or cold foods,or sharp utensils, rinse freq. use supplemental nutrition if needed. |
| GERD Etiology | A decrease in LES tone is associated with the ingestion of a wide variety of foods and drugs. Occurs when ngastric volume or intraabdominal pressure is elevated or when LES sphincter tone decreased. |
| Barrett's epithelium | is associated with higher risk of adenocarcinoma |
| GERD Manifestations | pyrosis (heartburn), Regurgitation, Water brash,frequent belching, flatulence, dysphagia or odynophagia(painful swallowing), Nocturnal cough, wheezing, hoarseness. |
| GERD Diagnostic tests | 24-hr pH monitoring gold standard for diagnosis, Biopsy, Manometry, Endoscopy. |
| GERD pt. Teachnig | Diet: 4-6 small meals a day, lowfat, adequate protein, reduce intake of chocolate, tea, caffeine, limit alcohol, eat slow, don't 1-2hr before bed, remain upright after meals for1-2hrs, reduce body weight. |
| GERD pt. Teaching | Lifestyle: reduce or quit smoking, avoid tight clothing, avoid straining, heavy-lifiting, elevate HOB, never sleep flat. |
| Hiatal Hernia | develops when the distal esophagus, and possibly a portion of stomach, moves into the thorax through hiatus. ASYMPTOMATIC, Manifestations mimic GERD |
| Hiatal Hernia Surgical Management | A fundoplication antireflux procedure may be performed with surgery, wrapping the stomach fundus around the LES to stabilize it. Nissen fundoplication is mostcommon antireflux procedure, Fundus is wrapped a full 360 around lower esophagus to reinforce LES |
| Hiatal hernia | Facillitating swallowing: large-diameter NG tube is usually inserted during open surgical repairs to prevent the fundoplication from being too tight |
| Esophageal carcinoma squamous cell risk factors | Men, african americans, tabacco use, alcohol, dietary nitrates, poor nutrition, vitamin deficiency, mucosal irritants. |
| Esophageal carcinoma adenocarcinoma risk factors | Men, white, barrett's epithelium, heavy alcohol, smoking, obesity. |
| Diagnostic tests Esophageal carcinoma | barrium swallow with fluoroscopy and endo scopy are two primary diagnostic tools. |
| Esophageal carcinoma Clinical manifestation | asymptomatic, gradual dysphagia, anorexia, weight loss, odynophagia, regurgitation, heartburn. |
| Esophagectomy preop | nutritional support provided as needed via tube feeding or parenteral nutrition. |
| Esophagectomy postop | protect airway, HOB always elevated, promote adequate nutrition, promote coping.prevent aspiration, maintain gastric drainage system. |
| Hiatal hernia teaching | teach splinting call physician if bright red blood Nurb dx: Acute pain |
| Gastritis acute: | initiated by alcohol, drugs, physical stress or trauma, caustic substances, radiation, bacterialcontamination of food or water. NSAIDS |
| Gastritis chronic | H. pylori is cause |
| Gastritis treatment | PPIs, H2 blockers, antacids, teach on alcohol, NSAID use, and aspirin. |
| Peptic Ulcer | caused by diet or stress, acid oversecretion, chronic NSAID use, prevention is key |
| Peptic Ulcer Clinical Manifestations | episodic pain, epigastric region,occurs1-3hrs after meals food relives pain |
| Peptic ulcer test | EGD |
| Peptic ulcer meds | PPIs, H2 blockers, Sulcrafate (Carafate),Misoprostol (Cytotec) |
| stress ulcers | caused by comorbid conditions. |
| Stomach cancer | has an insidious onset,derived from adenocarcinomas of the epithelium. |
| Stomach cancer Complications | rapid weigthloss,cachexia, malabsorption and dumping syndrome, vit b12 deficiency, esophagitis |
| Stomach cancer diagnostic tests | barium contrast upper GI x-ray films, but only biopsy can confirm diagnosis |
| Gastric cancer Manifestations | dyspepsia, epigastric pain, nausea, weight loss, fatigue, weakness, asymptomatic early on. |
| Complications of gstric surgery | Dumping:rapid food entry of food boluses directly into small intestines without being broke down and diluted, causing distention |
| Nasea/vomiting | Avoid fatty foods, milk, ,highly sweet foods |
| Malabsorption Causes | Lactase deficiency, Celiac disease, tropical sprue, Inflammatory bowel disease, gastrectomy, gastric bypass, ileal resection, bypass greater than 3 ft, pacreatic disease,liver biliary disease, bacterial/viral infection of bowel, radiation enteritis,drugs |
| Malabsorption tx | diet modifications and supplements, enteral or parenteral feedings. |
| Enteral Nutrition | critical component of enteral feedings is protein it builds muscles healing. Elevate HOB, types:bolus, continuous, intermitent |
| Parenteral Nutrition | central line #1 concern = infection, must be set on pump. |
| Irritable bowel syndrome | Antidiarrheal agents and cholestyramine for diarrhea, bulk forming laxatives for constipation, and aspasmodics for pain are routine options. |
| Appendicitis | inflammation process of appendicitis,unless treated can lead to gangrene and perforation within 24 to 36 hrs. Pain comes in waves, s/s: nausea,vomiting,fever 100.5-101.5 |
| Diverticular disease | diverticula: are small outpouchings or herniations of the mucosal lining of the colon.Diverticulitis: acute inflamationDiverticulosis- not inflamed. |
| Diverticulosis management | highfiber. bulkforming foods |
| Diverticula, diverticulitis management | NO HIGH FIBER -- can lead to peritonitis, when food gets into pouches. |
| Diverticular diseases tx | resection of small bowel, colostomy while bowels heals. Diagnose with: CT scan, barrium enema. |
| Peritonitis | secondary to inflammation of peritineum, GI complications. |
| Peritonitis Manifestations | rebound tenderness test reveals "board hard" abdomen, peristalis stops no bowel sounds, fever increase WBC, N/V, mortality rate less than 10%, PREVENT SHOCK. |
| Diverticular diseases teaching | Teach maintain librel fluid intake of 2.5-3L/day, eat high fiber, soft foods, including small amounts of bran or bulk forming agents. DON"T STRAIN |
Created by:
dreca2
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