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Nutrition; GI
NP2, Test 6 Prof. Jordan
| Question | Answer |
|---|---|
| What substances does the stomach absorb | water, alcohol, sugars, salt, electrolytes and some drugs |
| GERD is caused by | gastric acid flowing upward into the esophagus from an incompetent lower esophageal sphincter |
| GERD's most common symptom is | heartburn, which is burning chest pain behind breast bone that moves upward toward throat, may mistake for heart attack |
| Lifestyle factors that contribute to GERD include | relaxed lower esophageal sphincter (LES), overweight, overeating, caffeine/alcohol, smoking, gastritis, ulcer disease, stress, nonsteroidal anti-inflammatory drugs (NSAIDs), certain foods (citrus, peppermint, chocolate, fatty and spicy food) |
| GERD diagnostic tesing includes | Upper GI series (barium swallowing), Esophagogastroduodenoscopy (EGD; can perform biopsy), Esophageal manometry, PH monitoring, Berstein test |
| An Esophagogastroduodenoscopy (EGD) uses an | endoscope for direct visualization, oral anesthetic is used so observe for return of "gag reflex" |
| An Esophageal manometry is used to determine the strength of | the muscles in the esphagus by inserting a small nasal tube |
| The determining factors for how to treat GERD include | age, overall health and medical hx, extent of condition, tolerance to specific meds, procedures and therapies, expectation for the course of condition, patient opinion or perference |
| Treatment options for GERD include | diet and lifestyle changes, medications, quit smoking, observe food intake and food types, eat smaller portions, avoid overeating, watch alcohol consumption, decrease fluid intake, lie on left side, elevate HOB 30, lose excess weight |
| Non-surgical treatment for GERD is | stretta procedure |
| Surgical treatment for GERD includes | Nissen fundoplication |
| What is stretta procedure | use radiofrequency to make tiny cuts on the LES leading to scar tissue |
| Types of antacids are | sodium bicarbonate, calcium carbonate, aluminum hydroxide, magnesium hydroxide |
| Antacids work by | neutralizing stomach acid |
| H2-receptor blockers include | Zantac (ranitidine), Pepcid (famotidine), Tagment (cimetidine), Axid (nizatidine) |
| H2-receptor blocker work by | blocking histamine, can be prescription or OTC, reduces acid and pain |
| Proton pump inhibitors include | Prevacid (lansoprazole, Aciphex (rabeprazole), Prilosec (omeprazole), protonix (pantoprazole), Nexium (esomeprazole) |
| Proton pump inhibitors work by | blocking the enzymen in the stomach that produces acid; promotes healing of the stomach and esophagus |
| Prevacid (lansoprazole) is what type of medication | proton pump inhibitor |
| Aciphex (rabeprazole) is what type of medication | proton pump inhibitor |
| Prilosec (omeprazole) is what type of medication | proton pump inhibitor |
| Protonix (pantoprazole) is what type of medication | proton pump inhibitor |
| Nexium (esomeprazole) is what type of medication | proton pump inhibitor |
| Zantac (ranitidine) is what type of medication | H2-receptor blocker |
| Pepcid (famotidine) is what type of medication | H2-receptor blocker |
| Tagment (cimetidine) is what type of medication | H2-recptor blocker |
| Axid (nizatidine) is what type of medication | H2-recptor blocker |
| Prokinetic agents include | Reglan (metoclopramide) |
| Prokinetic agents work by | assisting the stomach in emptying more rapidly by increasing the churning of the stomach, may tighten the LES, Perscription only |
| Reglan (metoclpramide) is what type of medication | prokinetic agent |
| Antispasmotic medications include | Bentyl, Dibent (dicyclomine), Levsin, Cystospaz (hyoscyamine) |
| Antispasmotic medications work by | relaxing smooth muscles of the intestine and decrease digestion; prescription only |
| Bentyl, Dibent (dicyclomine) are what type of medications | antispasmotics |
| Levsin, Cystospaz (hyoscyamine) are what type of medications | antispasmotic |
| Cytoprotective agents include | Prescription: Carafate (sucralfate), cytotec (misoprostol) OTC: peto-bismol (bismuth subsalicylate) |
| cytoprotective agents work by | protecting the lining of the stomach and intestine but does not increase teh amount of acid, used to prevent ulcer formation |
| Carafate (sucralfate) must be mixed with | water to make a "slurry" |
| Complications of GERD include | Esophagitis, esophageal stricture, Barretts esophagus, hiatal hernia |
| A sliding hiatial hernia is | stomach moves back and forth through hiatus of the diaphrahm (falls back in place when standing) |
| A paraeshophageal or rolling hernia is | a greater curvature of the stomach moves above the diaphragm forming a pocket, food can get stuck in the "pocket" |
| Primary prevention's of a hiatal hernia includes | weakening of diaphragm muscles, increased intra-abdominal pressure, increased age, trauma, poor nutrition, forced recumbant positioning, congenital, obesity |
| S/S of hiatal hernia include | heartburn, nocturnal heartburn, dysphagia, mimics gallbladder disease, may be asymptomatic |
| Complications of hiatal hernia include | GERD, hemorrhage, esophageal stenosis, ulceration, strangulation, regurgitation with aspiration |
| Diagnostic test for hiatal hernia include | EGD and Barium swallow |
| Secondary prevention for hiatal hernia includes | lifestyle modifications, medications, nissen fundoplication (sx) |
| What is Nissen fundoplication | Laproscopic procedure where the stomach is pulled through the diaphragm then wrapped around itself (stomach) to create a plug; makes a smaller stomach |
| Peptic ulcer disease is | erosion of the GI mucosa from the action of HCL and pepsin, PUD includes gastric and duodenal |
| Phases of PUD (3) | Erosion, Acute ulcer, Perforated ulcer (acid goes into abd. cavity) |
| most common cause of PUD is | Helicobacter pylori (H.Pylori) |
| H.Pylori is a _______ infection and weakens the stomachs ________ _______ | bacteria, protective mucus |
| PUD etiology includes | lifestyle, overactive acid and pepsin secretion, smoking, caffeine, alcohol, vagal nerve stimulation, stress, NSAIDS, corticosteroids |
| PUD s/s | may be asymptomatic until serious complications occur, heartburn, gnawing/burning pain, acid, bitter, slimy taste in mouth, belching/indigestion, nausea/vomiting, weight loss and poor appetite, feeling tired and weak |
| PUD complication: Hemorrhage | Most common SE, black and tarry stools (melena), occult blood, emesis (coffee ground or fresh) |
| PUD complication: Perforation | Most lethal complication, require sx, causes peritonitis, s&s onset sudden and dramatic |
| S&S of perforation | sudden, severe upper abd pain, abdomen muscles contract-rigid and "board-like", respirations shallow and rapid, absent bowel sounds |
| PUD complication: Gastric outlet obstruction | Narrowing of pylorus from scar tissue, pylorospasm, edema/inflammation. Vomiting projectile, contains food particles offensive odor |
| Lifestyle modifications for PUD (tx) | bland diet & 6 small meals/day, protein neuralizes but stimulates gastric secretions, adequate physical/emotional rest, Stop ASA & NSAID's, strict adherance to prescribed meds, antibiotic therapy for H.pylori |
| Drug therapy for PUD includes | Carafate (sucralfate): give on empty stomach 1 hr before meals and at bedtime Pepto-Bismol: Promotes healing, may blacken stools Cytotec (misoprostol): for pt's taking ASA or NSAID's, prevents gastric ulcers induced by the above |
| PUD tx: Indications for Sx therapy includes | obstruction, perforation, hemorrhage, ulcers unresponsive to tx, multiple ulcer sites, possilbe malignancy |
| Sx tx for PUD include | Billroth I & II, gastrojejunostomy, vagotomy, pyloroplasty |
| Gastrojejunostomy is performed when | there is a gastric outlet obstruction, food bypasses the obstruction |
| A vagotomy is | truncal (total), selective, reduces acid, decreases gastric motility, often combined with billiroth I & II, food can sit for up to 10 hours |
| A pyloroplasty is | surgical enlargement, aids gatric emptying, can do balloon angioplasty,only works on some pts |
| Post-op complications for PUD tx | Dumping Syndrome: results from lg portion of stomach & pyloric sphincter removal Postprandail Hypoglycemia: form of dumping syndrome, lg bolus of carbs dumps into sm. intestine resulting in low bs Bile Reflux Gastritis: related to sx on pyloric sphinc |
| Second leading cause of cancer-related deaths are from | gastric cancer |
| Chances of gastric cancer are increased if | over age 55 and male, higher in african americans |
| Etiology of gastric cancer | unknown |
| Factors that contribute to gastric cancer include | diet high in nitrates, salt,and spiced foods. food perserved by salt-curing, smoking, pickling or dying. poor drinking water or lack of refrigeration, hx of GI CA, Type A blood, perniciouse anemia, chronic gastritis, intestinal polyps, GERD, Obesity |
| S&S of gastric CA include (indicates advanced disease) | abd. pain, stool guiac +, GI bleeding, bloating after meals, indigestion, heartburn, diarrhea or constipation, fatigue, weak, anorexia, nausea, vomiting, weight loss |
| Surgical intervention for gastric CA includes | total gastroectomy (esophojejunostomy); stomach is completely removed, anastamosis of lower esophagus to the jejunum, lymph node involvement followed by chemo and radiation |
| The gallbladder's function is | store bile from liver and concentrates bile, essential for emulsification of fats, powerful antioxidant, is a pear-shaped muscular sac |
| Bile's characteristics and consists of | bitter, yello fluid. cholesterol, calcium, bile salts, acids, produces gallstones, liver manufactures 1-1.5 quarts/day |
| Cholelithiasis is | gallstones of the bladder |
| Cholecystitis is | inflammation of the gallbladder or cystic duct |
| Obstructo of gallbadder is caused by | gallstones |
| Alterations of the gallbladder are more frequent in | women in childbearing years, over 40 years, caucasian, native american/mexican-american, familial tendency, sedentary lifestyle, obesity, 4 F's-female, fertile, fat & forty |
| Gallstones are | solid crystalline precipitates, are a major component in cholesterol, some are from calcium salts |
| Gallstones can cause life threatening infection of | liver, bile duct and pancreas |
| Causes of gallstones include | Stasis/stagnation of bile, incomplete emptying of gb, pure cholesterol stones (white diet, soda and lots of meat), |
| Cholecystitis is | inflamation of the gallbladder and/or cystic duct, may be acute or chronic |
| Cause of cholecystitis include | gallstones (usually), bacterial infection, tumor of pancreas or liver, decreased blood supply to gallbladder, gallbladder "sludge" |
| S/S of cholecystitis include | may be asymptomatic, attacks last 2-3 days, intense, sudden pain RUQ, recurrent attacks several hrs after meals, pain (may radiate up to right shoulder), nausea, vomiting, indigestion, rigid abd muscles or bloating, slight fever, chills, leukocytosis |
| Complications of cholecystitis include | abscess, pancreatitis, biliary cirrhosis, fistulas, rupture of the gallbladder, inflammation of biliary ducts, bile peritonitis |
| Cholelithiasis is | gallstone formation, bile supersaturated with cholesterol, solid crystalline percipitates form gallstones caused by bile stagnation |
| Bile stagnation can be caused by | immobility, pregnancy, inflammation, obstructive lesions |
| S/S of cholelithiasis includes | asymptomatic, if obstruction is present... amber (tea) colored urine, clay colored stools, jaundice, pruritis, steatorrhea, bleeding tendencies |
| S/S of biliary colic includes | severe steady pain due to spasm, tachycardia, diaphoresis, and prostration, pain may last up to an hour with RUQ tenderness, occurs 3-6 hrs afer heavy meal |
| complications of cholelithiasis include | imflammation of biliary ducts, biliary cirrhosis, carcinoma, obstruction, peritonitis |
| Chlecystogram is | used to detect gallbladder problems, oral contrast, pills, abd. x-rays |
| Cholangiogram is | used to detect gallbladder problems, iv contrast with series of x-rays |
| ERCP (endoscopic retrograde cholangiopancreatography) is | use of endoscope, injection of dyes with series of x-rays |
| CT-scan with or without contrast is a | 2-dimensional image |
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