| Question | Answer |
| Gastritis | - inflammation of the gastric mucosa |
| Drug related gastritis | - NSAIDs (aspirin)
- Corticosteroids |
| NSAID related gastritis | - piroxicam (Feldene)
- naproxen ( Naprosyn)
- ibuprofen |
| Risk factors for NSAID related gastritis | - women over 60
- taking anticoagulants
- Corticosteroids
-NSAIDs
- |
| Heart drugs that cause gastritis. | - digitalis ( digoxin)
- alendronate (Fosamax) |
| Diet | - alcoholic drinking binge
- eating large quantities of spicy, irritating foods |
| H- Pylori | - causes acute gastritis in most effected persons
- may lead to stomach cancer |
| Prolonged vomiting.. | Bulimia may contribute to Gastritis |
| Autoimmune Gastritis | - inherited condition in which there is an immune response directed against parietal cells.
- mostly effects women of northern European decent
- loss of parietal cells cause malabsorption of cobalamin (b12) |
| Symptoms of acute Gastritis.. | - anorexia, N& V, epigastric tenderness, feeling of fullness |
| Intrinsic factor.. | - essential for absorption of cobalamin (b12) |
| Lack of Cobalmin.. | - B12 is essential for growth and maturation of RBCs, leading to Pernicious Anemia |
| Diagnostic studies | - usually diagnosed on pt symptoms
- Endoscopic exam w/ biopsy is needed for definite diagnosis |
| Tests for H-Pylori | - Breath, urine, stool, and gastric tissue |
| If Vomiting accompanies gastritis.. | - rest, NPO status, and IV fluids are prescribed
- Antiemetics (41-1)
- Monitor for dehydration |
| In severe cases of acute gastritis.. | - NG tube may be used
- PPIs & H2 receptors used |
| Treatment of Chromic Gastritis | - evaluating & eliminating specific cause (smoking, drinking, H-Pylori eradication) |
| Patients with Pernicious Anemia.. | - need lifelong Cobalamin therapy |
| Is smoking contradicted in all forms of gastritis? | SHO IS |
| PUD | -Condition characterized by erosion of the GI mucosa from the digestive action of HCL acid & Pepsin |
| H-Pylori | - is associated with PUD
- usually spread from childood from family members |
| Medication-Induced Injury | - NSAIDs are responsible for majority of non H-pylori ulcers |
| Lifestyle factors | - high alcohol intake is associated with acute mucosal lesions
- coffee
- smoking |
| Gastric ulcers | - mostly found in antrum
- less common than duodenal
- greater in women ages 50-60
- greater risk of cancer
- Burning / gaseous pressure in epigastrium
- Pain 1-2 hours after meals
- Food DOES NOT help
- Higher mortality rate
- obstruction likely |
| Duodenal Ulcers | - First 1-2 cm of duodenum
- greater in men ages 35-45
- no increase risk of cancer
- Associated w/ other diseases
- Burning, cramping, pressure-like pain across midepigastrium & upper abdomen
- Pain 2-5 hours after meal
- food & antacids HELP pain |
| Hemorrhage | - Most common complication
- more common in duodenal ulcers |
| Perforation | - most lethal complication
- more common in gastric ulcers |
| In perforation.. | - stomach looks board like and rigid
- respirations shallow and fast
- tachycardia
- weak pulse
- absent bowel sounds |
| Gastric Outlet Obstruction | - patient reports pain that is worse near end of day
- belching or self- induced vomiting may relieve pain
- Projectile vomiting common
- vomit may contain food particles from several days prior
- constipatiion |
| Diagnostic studies for PUD | - Endoscopy is most ACCURATE ( tissue samples taken to assess for H-Pylori)
- |
| Gold standard for diagnosis H-Pylori.. | - biopsy of the antral mucosa with testing for urease (rapid urease testing)
- Urea breath test can diagnose active H-Pylori |
| Elevated fasting serum gastrin levels may indicate? | - presence of possible gastrinoma (Zollinger-Ellison Disease) |
| Serum Amylase test evaluates? | - pancreatic function when posterior duodenal ulcer penetration of the pancreas is suspected |
| Therapy of PUD | - Pain disappears 3-6 days but ulcer healing takes 3-9 weeks
- Most accurate method to monitor ulcer healing is endoscopic exam |
| Aspirin & nonselective NSAIDs are discontinued for how long? | - 4- 6 weeks |
| Drug therapy focuses on.. | - reducing gastric acid secretion and eliminating H-Pylori if present |
| Eradicating H-Pylori | - use PPI and Antibiotic for 7-14 days |
| PPIs | - more effective than H2 in reducing gastric acid secretion and promoting gastric ulcer healing |
| H2 receptors | - promote ulcer healing
- onset is 1 hour
- Famotidine, ranitidine, cimetidine given orally or Iv
- Nizatidine only given orally |
| Antacids | - increase gastric pH by neutralizing HCL acid
- Mg Hydroxide & Aluminum Hydroxide
- taken after each meal effects last 3-4 hours |
| Cytoprotective drugs | - Sucralfate used for short term treatment of ulcers
- provides cytoprotection for the esophagus, stomach, and duodenum
- give 60 minutes before or after antacid
- Misoprostol used for NSAID induced ulcers & doesnt interfere with beneficial effects of |
| Tx for perforation | - stop spillage of gastric contents into peritoneal cavity
- NG tube provides continuous aspiration
- circulating blood volume replaced by lactated ringer
- Procedure involing least risk to patient is simple oversewing and reinforce area with a graft |
| Tx for Gastric Obstruction | - must decompress stomach
- Ng tube used
- pain relief subsides with decompression
- PPI or H2 used if onstruction is due to active ulcer |
| Pylorric obstruction may be treated by.. | - balloon dilations |
| With hemmorhage bleeding.. | - patients pain may decreases due to blood neutralizing gastric acid |
| OTC PPI and H2 | -warn patient not to take these!! |
| Gastroduodenostomy/ Billroth 1 | - partial gastrectomy with removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the duodenum |
| Gastrojejunostomy / Billroth 2 | - if the gastric stump is anastomosed to the jejunum |
| Vagostomy | - severing of the vagus nerve that decreases gastric acid secretion |
| Pyloroplasty | - surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach |
| Dumping syndrome | - direct result of surgical removal of a large portion of the stomach and pyloric sphincter
- S/S: 15 to 30 mins after eating include sweating, palpitations, dizziness due to sudden decrease in plasma volume
- last less than 1 hour after eating |
| Postprandial hypoglycemia | - result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestines
- reflex hypoglycemia
- 2 hours after eating |
| Bile reflux gastritis | - Cholestyramine (questran) given before or after meals that binds with bile salts that are the source of irritation |
| After surgery care | - NG tube used to decompress stomach
- Bright red aspirate normal & gradual darkening in 24 hours
- color changes to yellow 36-48 hours Monitor I & O q4h
- Splint area with pillow to prevent rupturing |
| IBS | - disorder characterized by chronic abdominal pain/ discomfort/ alteration of bowel patterns |
| Men | - IBS with diarrhea |
| Women | - IBS with constipation |
| Key to accurate diagnosis? | - thorough hx & physical exam |
| Avoid foods | - common-gas forming
- avoid dairy products if need be |
| Eat? | - lots of fiber |
| Drug therapy | - Antispasmodic meds
- Bentyl to decrease GI motility to reduce diarrhea
- Amitiza & Linzess for constipation
SSRIs may help reduce symptoms |
| Appendicitis | - inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum
- most common emergency surgery |
| Common cause of Appendicitis? | - obstruction of the lumen by feces which can lead to music producing gangrene |
| How does Appendicitis begin? | - typically starts as dull periumbilical pain
- pain is persistent and shifts to RLQ localizing at McBurney's point (halfway between umbilicus & right iliac crest)
- low grade fever and rebound tenderness
- pt prefers to lie still with rt leg flexed |
| Diagnostic studies | - Mildy to moderate Elevated WBC count |
| Preferred diagnostic procedure for Appendicitis? | - CT scan |
| Tx of Appendicitis | - Appendectomy
- antibiotics and fluid resuscitation are started before surgery |
| If appendix have ruptured.. | - if abscess is evident, giving parenteral fluids and antibiotics therapy for 6-8 hours prior to surgery to prevent sepsis |
| Nursing Managment of Appendicitis | - ensure stomach is empty in case surgery is need NPO
- Patients usually discharged after 24 hours and return to normal life after 2-3 weeks |
| Rovsing Sign | - apply pressure to lower left quadrant which will make the RLQ hurt if appendicitis is present |
| Psoas Sign | - Place hand on Pt's right knee and have them raise their leg |
| Obturator Sign | - Pt flips on left side bring leg into flexion at the hip and then internal rotation at the thigh |
| Inflammatory Bowel Disease (IBD) | - chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation
- exact cause and cure is unknown |
| Ulcerative Colitis | - usually limited to the colon |
| Crohn's disease | - can involve any segment of the GI tract from the mouth to the anus |
| Both diseases.. | - commonly occur during teenage years and early adulthood
- Occur in whites & Ashkenazic Jewish origin
- most sufferers have other members of family with disease |
| IBD | - autoimmune disease
- more common in industrialized countries
- high intake of total fats, etc lead to IBD |
| High fiber& fruit intake decreases risk for? | - Crohn's Disease |
| High vegetable intake decreases risk for? | - ulcerative colitis |
| Crohn's Disease | - Occur anywhere in the GI tract
- commonly involves distal ileum & proximal colon
- "skip lesions"
- inflammation involves all layers of bowel wall
- cobblestone appearance
- Strictures at areas of inflamm can cause bowel obstruction
- fistulas |
| Ulcerative colitis | - starts in rectum & moves in a continual fashion toward cecum
- disease of colon & rectum
- Inflammation & ulcerations occur in mucosal layer
- fistulas & abscesses are rare
- diarrhea w/ electrolyte loss is common
- Pseudopolyps |
| Manifestations of Crohn's | - diarrhea & cramping pain are common
- weight loss if small intestine is involved
- rectal disease |
| Ulcerative Colitis | - bloody diarrhea & abdominal pain |
| Complications of IBD | - Hemorrhage, strictures, perforation, toxic megacolon
- Megacolon is at risk for perforation & may need an emergency colectomy ** ulcerative colitis**
- Perineal abscess & fistulas in Crohn's disease |
| Crohn's gives increased risk for.. | - small intestinal cancer |
| People with IBD suffer from.. | - joint, eye, mouth, kidney, bone, vascular & skin problems |
| Liver function tests are important.. | - because sclerosing cholangitis, a complication of IBD, can lead to liver failure |
| CBC | - Shows Iron-deficiency anemia from blood loss |
| Elevated WBC | - Indication of toxic megacolon or perforation |
| Elevated erythrocyte sedimentation rate, C-reactive protein, WBC's | - reflect inflammation |
| Imaging studies | double contrast barium enema, small bowel series, transabdominal ultrasound, CT, & MRI are helpful in diagnosis IBD |
| Colonoscopy | - allows for exam of entire large intestine lumen and sometimes the most distal ileum
- can only enter the distal ileum |
| Capsule Endoscopy | - used to diagnose Crohn's in small instestine |
| Goals of tx of IBD | - Rest the bowel NPO
- Control Inflam
etc |
| Preferred tx for Crohn's? | - drugs preferred over surgery |
| 5-aminosalicylic Acid (5-ASA) | - mainstay in achieving & maintaining remission & preventing flare-up of IBD
- sulfasalazine (Azulfidine)
- MORE EFFECTIVE FOR ULCERTAIVE COLITIS
- HOWEVER, 1st line defense for mild-mod Crohn's when colon is involved |
| Topical Application of 5-ASA | - application to intestinal mucosa suppresses pro-inflammatory cytokines & other inflammatory mediators
- advantage of delivering directly to affected tissue minimizing systemic effects |
| Larger the dose of 5-ASA | - More likely patients will improve during acute phase & remain in remission |
| Side effects of sulfasalazine | - headaches, nausea, & fatigue
- infertility in long term use in men |
| Corticosteroids | - used to achieve remission in IBD
- given for shortest possible time b/c of side effects |
| Oral Prednisone | - given to patients w/ mild to moderate disease who did not respond to either 5-ASA or topical corticosteroids |
| Immunosuppresants | - given to maintain remission after corticosteroid induction therapy |
| ImmunoSuppressants require.. | - regular CBC monitoring because they suppress bone marrow & lead to inflammation of the pancreas and liver |
| Immunosuppresants have a.. | delayed onset of action and are not good for flare ups |
| Methotrexate | - most useful in Crohn's disease |
| Don't feel like doing other meds | read in book page 947-948 |
| Surgical cure for ulcerative colitis? | - total proctocolectomy |
| Total proctocolectomy w/ ileal pouch/ anal anastomies
(IPPA) | - Most commonly used surgical procedure for ulcerative colitis
- diverting ileostomy performed and ileal pouch is created & anastomosed directly to anus
- 2 surgeries 8-12 weeks apart
Major complication: acute or chronic pouchitis |
| Total proctocolectomy w/ pernament ileostomy | - one-stage surgery
- removal of the colon, rectum, and anus w/ closure of anal opening
- end of terminal ileum is brought out through abdominal wall to form a stoma
- stoma placed in RLQ below belt line |
| Crohn's disease and surgery | - Most patients eventually require surgery
- Most common surgery involves resection of the diseased segments w/ reanastomosis of the remaining intestine |
| Short bowel sydrome | - seen in crohns patients who had surgery leaving too little small intestine surface area to maintain nutrition & hydration |
| Other sx for Crohn's? | - strictureplasty: opens up narrowed areas obstructing the bowel |
| Diverticula | - saccular dilations or outpouchings of the mucosa that develop in the colon |
| Diverticulosis | - presence of multiple noninflamed diverticula |
| Diverticulitis | - inflammation of one or more diverticula, resulting in perforation into the peritoneum |
| Diverticula are most seen in the? | - LEFT (descending,sigmoid) colon |
| Main factor thought to contribute to diverticulosis? | - lack of dietary fiber intake |
| Vegetarians | - rarely have diverticula |
| Symptoms of diverticulosis include | - abdominal pain, bloating, flatulence, and changes in bowel habits |
| Most common s/s of diverticulitis | -acute pain in LLQ, palpable abdominal mass, N&V, systemic infection
- can cause erosion of the bowel wall and perforation into the periotoneum
- localized abscess develops when the body is able to wall of area of perforation |
| When is diverticular disease discovered? | - during routine sigmoidoscopy or colonoscopy
- diagnosis based on history and physical exam |
| Preferred diagnostic test for diverticular disease? | - CT scan w/ oral contrast |
| Management of Diver? | - high-fiber diet, from fruit and vegetables w. decreased red meat and fat |
| Goal of tx in acute diverticulitis | - let the colon rest & inflammation subside |
| If hospitalized.. | - patient is kept NPO w/ IV fluids and antibiotics
- when acute attack subsides, give oral fluids first and progress the diet to semisolids |
| Surgical solution | - involves resection of the involved colon w/ primary anastomosis |
| Teach importance of.. | - high-fiber diet & encourage fluid intake of 2L/day |
| Celiac disease | - autoimmune disease characterized by damage to the small intestine mucosa from ingesting wheat, barley, and rye
- AKA Celiac Sprue & gluten-sensitive enteropathy |
| Gluten contains specific peptides called? | - prolamines |
| Damage is most seen in? | - duodenum |
| Classic symptoms of Celiac | - foul-smelling diarrhea, stetorrhea, flatulence, abdominal distension & malnutrition |
| Dermatitis herpetiformis | - an intensely pruritic, vesicular skin lesion, sometimes present and occurs as a rash on the butt, scalp, face, and knees |
| In celiac disease is protein, fat, and carb absorption affected? | YES! |
| Iron deficiency anemia common? | Yes! |
| Confirmed by? | - combo of hx & physical exam
- |
| Gold standard for confirming diagnoses? | - Histologic evidence |
| Only effective treatment for celiac? | - gluten-free diet |
| Individuals with celiac disease have increased risk for? | - non-Hodgkin's lymphoma & GI cancers |
| Lactase Deficiency | - condition in which the lactase enzyme is deficient or absent |
| Lactase | - enzyme that breaks down lactose into glucose and galactose |
| Symptoms include: | - bloating
- flatulence
- cramping abdominal pain
- diarrhea
- symptoms occur 30 minutes to several hours after drinking milk |
| Lactose intolerance is diagnosed with what test? | - lactose tolerance test, lactose hydrogen breath test, genetic testing |
| Prompt resolution of symptoms? | - lactose-free diet |
| Lactase enzyme ( LACTAID) | - available as an over the counter product which breaks down lactose present in ingested milk |
| Cheese | - less lactose than milk and ice cream |
