1
Q
: lack of hydrochloric acid in digestive secretions of the stomach
A
achlorhydria
2
Q
: removal of the pyloric (antrum) portion of the stomach with anastomosis (surgical connection) either to the duodenum (gastroduodenostomy or Billroth I) or to the jejunum (gastrojejunostomy or Billroth II)
A
antrectomy
3
Q
: physiologic response to rapid emptying of gastric contents into the small intestines, manifested by nausea, weakness, sweating, palpitations, syncope, and diarrhea (synonym: vagotomy syndrome)
A
dumping syndrome
4
Q
: first portion of the small intestine, between the
stomach and the jejunum
A
duodenum
5
Q
: indigestion; upper abdominal discomfort
assoclated with eating
A
dyspepsia
6
Q
: refers to the stornach
A
gastric
7
Q
any condition that mechanically impedes normal gastric emptying; there is obstruction of the channel of the pylorus and duodenum through which the stomach empties; also called pyloric obstruction
A
gastric outlet obstruction:
8
Q
: inflammation of the stomach
A
gastritis
9
Q
: a spiral-shaped gram-negative bacterium that colonizes the gastric mucosa; is involved in most cases of peptic ulcer disease
A
Helicobacter pylori (H. pylori)
10
Q
: vomiting of blood
A
hematemesis
11
Q
: bright red, bloody stools
A
hematochezia
12
Q
: tarry or black stools; indicative of occult blood in stools
A
melena
13
Q
: fold of the peritoneum that surrounds the stomach and other organs of the abdomen
A
omentum
14
Q
: thin membrane that lines the inside of the wall of the abdomen and covers all of the abdomina! organs
A
peritoneum
15
Q
: surgical procedure to increase the opening of the pyloric orifice
A
pyloroplasty
16
Q
: opening between the stomach and the
duodenum
A
pylorus
17
Q
: a burning sensation in the stomach and esophagus that moves up to the mouth (synonym; heartburn)
A
pyrosis
18
Q
: thin membrane that covers the outer surface of the stomach; visceral peritoneum covering the outer surface of the stomach
A
serosa
19
Q
: fatty stool; typically malodorous with an oly appearance and floats in water
A
steatorrhea
20
Q
: narrowing or tightening of an opening or passag in the body
A
stenosis
21
Q
The erosive form of acute gastritis is most often caused by local irritants such as
A
aspirin
(NSAIDs)
alcohol consumption;
and gastric radiation therapy
22
Q
The nonerosive form of acute gastritis is most often caused by
A
an infection with a spiral-shaped gram-negative bacterium, Helicobacter pylori (H. pylori)
23
Q
more severe form of acute gastritis is caused by the ingestion of ______, which may cause the mucosa to . becomé gangrenous or to perforate (see Chapter 67). Scarring can occur, resulting in ______(narrowing or tightening) or obstruction.
A
strong acid or alkali
pyloric stenosis
24
Q
Acute gastritis also may develop in acute ilnesses, especially when the patient has had major traumatic injuries, burns, severe infection, lack of perfusion to the stomach lining, or major surgery. This type of acute gastritis is often referred to as
A
stress-related gastritis or ulcer
25
chemical gastric injury ______ as the result of long-term drug therapy
(gastropathy)
26
may occur as a result of erosive disease and may lead to hemorrhage.
Superficial ulceration
27
The patient with acute gastritis may have a rapid onset of symptoms, such as
epigastric pain or discomfort,
dyspepsia
anorexia
28
The patient with chronic gastritis may complain of
fatigue,
pyrosis after eating,
halitosis
29
Patients with chronic gastritis may not be able to absorb _____ because of diminished production of intrinsic factor by the stomach's parietal cells due to atrophy, which may lead to _____
vitamin B12
pernicious anemia
30
•The definitive diagnosis of gastritis is determined by an
endoscopy
and
histologic examination of a tissue specimen obtained by biopsy
31
Acute Gastritis
Gastrointestinal
Manifestations
and
systemic manifestation
anorexia
Hiccups
hematemesis
systemic manifestation: possible signs of shock
32
chronic gastritis
Gastrointestiha
Manifestations
and
systemic manifestation
Belching
Early satiety
pyrosis
systemic manifestation: anemia & fatigue
33
The gastric mucosa is capable of repairing itselt after an episode of acute gastritis. As a rule, the patient recovers in about _____ although the patient's appetite may be diminished for an additional _____
1 day,
2 or 3 days.
34
Therapy for gastritis is supportive and may include
, antacids,
IV fluids
proton pump inhibitors
35
may be necessary to treat gastric outlet obstruction, also called pyloric obstruction, a narrowing of the pyloric orifice, which cannot be relieved by medical management.
gastric resection
or a
gastrojejunostomy (anastomosis of jejunum to stomach to detour around the pylorus)
36
Nursing Management for gastritis
Reducing anxiety
Relieving pain
promoting fluid balance
37
Daily fluid intake and output for gastritis are monitored to detect early signs of dehydration (minimal fluid intake of ___, urine output of less than _____).
1.5 L/day
1 mL/kg/h
38
If food and oral fluids are with-held in gastritis , IV fluids (____) usually are prescribed and a record of fluid intake plus caloric value (1 L of 5% dextrose in water = ___ calories of carbohydrate) needs to be maintained.
3 L/day
170
39
The nurse must always be alert to any indicators of hemorrhagic gastritis, which include
hematemesis (vomiting of blood),
tachycardia,
and hypotension.
40
A peptic ulcer may be referred to as a ______, depending on its location.
gastric, duodenal, or esophageal ulcer
41
s an excavation (hollowed-out area that forms in the mucosa of the stom-ach, in the pylorus (the opening between the stomach and duodenum), in the dúodenum (the first portion of the small intestine, between the stomach and the jejunum), or in the esophagus.
peptic ulcer i
42
(thin membrane that lines the inside of the wall of the abdomen
peritoneum
43
s an excavation (hollowed-out area that forms in the mucosa of the stom-ach, in the pylorus (the opening between the stomach and duodenum), in the dúodenum (the first portion of the small intestine, between the stomach and the jejunum), or in the esophagus.
peptic ulcer i
44
Peptic ulcers are more likely to occur in the ___ than in the stomach.
duodenum
45
Chronic gastric ulcers tend to occur in the
lesser curvature of the stomach, near the pylorus.
46
Esophageal ulcers occur as a result of the
backward flow of HCl from the stomach into the esophagus (gastroesophageal reflux disease (GERD)).
47
Those who are 65 years and older present to both outpatient and inpatient settings for treatment of peptic ulcers more than any other age group. This trend may be explained, at least in part, by higher rates of ____ and ____ in older adult populations
NSAID use and H. pylori infections
48
In the past, stress and anxiety were thought to be causes of peptic ulcers, but research has documented that most peptic ulcers result from
infection with H. pylori,
Person-to-, person transmission of the bacteria
49
The use of NSAIDs, such as ______, represents a major risk factor for peptic ulcers.
ibuprofen and aspirin
50
people with blood type ___ are more susceptible to the development of peptic ulcers
O
51
is a rare condition in which benign or malignant tumors form in the pancreas and duodenum that secrete excessive amounts of the hormone gastrin
Zollinger-Ellison syndrome (ZES)
52
Peptic ulcers occur mainly in the ___ because this tissue cannot withstand the digestive action of gastric acid (HCI) and pepsin.
gastroduodenal mucosa
53
54
Patients with ____ secrete more acid than normal, whereas patients with _____ secrete normal or decreased levels of acid.
duodenal ulcers
gastric ulcers
55
peptic ulcer
The use ofNSAIDs inhibits ___, which is associated with a disruption of the normally protective mucosal barrier.
prostaglandin synthesis
56
ZES is suspected when a patient has
several peptic ulcers
or
an ulcer that is resistant to standard medical therapy.
57
ZES is identified by the following:
hypersecretion of gastrin,
duodenal ulcers,
and gastrinomas (islet cell tumors) in the pancreas or duodenum.
58
The patient with ZES may experience
epigastric pain,
pyrosis,
diarrhea,
and steatorrhea (fatty stools).
59
is the term given to the acuté mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events, such as burns, shock, sepsis, and multiple organ dysfunction syndrome
Stress ulcer
60
results in the reflux of duodenal contents into the stomach, which increases exposure of the unprotected gastric mucosa to the digestive effects of gastric acid (HCI) and pepsin
Mucosal ischemia
61
Specific types of ulcers that result from stressful conditions include ___
Curling ulcers
and
Cushing ulcers.
62
is frequently observed after extensive burn injuries and often involves the antrum of the stomach or the duodenum
Curling ulcer
63
is common in patients with a traumatic head injury, stroke, brain tumor, or following intracranial surgery.
Cushing ulcer
64
These _ ____ most commonly occur in older adults and those taking aspirin and other NSAIDs
silent peptic ulcers
65
These _ ____ most commonly occur in older adults and those taking aspirin and other NSAIDs
silent peptic ulcers
65
As a rule, the patient. with an ulcer complains of
dull, gnawing pain
or
a burning sensation in the mid epigastrium or the back.
66
the pain associated with _____ most commonly occurs immediately after eating, whereas the pain associated with ______ most commonly occurs 2 to 3 hours after meals.
gastric ulcers
duodenal ulcers
67
Other nonspecific symptoms of either gastric ulcers or duodenal ulcers may include 1. ____ These symptoms are often accompanied by 2. ______ which is common when the patient's stomach is empty.
1. pyrosis,
vomiting,
constipation
2. sour eructation (burping),
68
is the preferred diagnostic procedure for peptic ulcer because it allows direct visualization of inflammatory changes, ulcers, and lesions.
Upper endoscopy
69
(lack of HCI),
(low levels of HCI),
(high levels of HCI.
achlorhydria
hypochlorhydria
hyperchlorhydria
70
Currently, the most commonly used therapy for peptic ulcers is a combination of
antibiotics,
proton pump inhibitors
, and sometimes bismuth salts that suppress or eradicate H. pylori.
71
Currently, the most commonly used therapy for peptic ulcers is a combination of
antibiotics,
proton pump inhibitors
, and sometimes bismuth salts that suppress or eradicate H. pylori.
72
are used to treat ulcers not associated with
H. pylori infection.
H2 blockers and
proton pump inhibitors that reduce gastric acid secretion
73
Recommended combination drug therapy is typically prescribed for 10 to 14 days and may include triple therapy with
2 antibiotics (metronidazole, amoxicillin)
plus a PPI (omeprazole)
74
quadruple therapy for peptic ulcer with
two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts
75
For patients with ZES, hypersecretion of gastrin stimulates the release of gastric acid (HCI), which may be controlled with proton pump inhibitors. _____, a medication that suppresses gastrin levels, also may be prescribed
Octreotide
76
Drug Regimens for Peptic Ulcer Disease
Ulcer healing
H2 receptor antagonist
Cimetidine 400 mg bid or 800 mg at bedtime
Famotidine 20 mg bid or 40 mg at bedtime
Nizatidine 150 mg bid or 300 mg at bedtime
PPIs:
Omeprazole 20 mg daily
Pantoprazole 40 mg daily
Rabeprazole 20 mg daily
77
Drug Regimens for Peptic Ulcer Disease
H. pylori infection
Quadruple therapy with bismuth subsalicylare 525 mg qid, plus tetracycline 500 mg qid, plus metronidazole 500 mg. bid, plus a PPI daily for 10-14 days
Alterate therapy with clarithromycin 500 mg bid, amoxicillin 1g hid, metronidazole 500 mg hid, plus PPI for 10-14 days
78
Drug Regimens for Peptic Ulcer Disease
Prophylactic therapy for
NSAID ulcers
Pepric ulcer healing doses of PPIs (above)
Misoprostol 100-200 mcg qid
79
should not be taken by a pregnant woman as it can soften the cervix and result in miscarriage or premature labor.
Misoprostol
80
transecting nerves that stimulate acid secretion and opening the pylorus),
pyloroplasty
81
, which is removal of the pyloric (antrum) portion of the stomach with anastomosis
antrectomy
82
Surgery is usually recommended for patients with intractable ulcers (12-16weeks), life-threatening hemorrhage, perforation, obstruction, or ZES unresponsive to medications. Surgical procedures include ____
vagotomy
83
NURSING PROCESS
The Patient with Peptic Ulcer Disease
how to Assess
The nurse asks the patient to describe pain, its pattern, whether it occurs predictably (e.g., after meals, during night), and strategies used to relieve it.
84
NURSING PROCESS
The Patient with Peptic Ulcer Disease
COLLABORATIVE PROBLEMS/POTENTIAL COMPLICATIONS
Potential complications may include the following:
• Hemorrhage
• Perforation
• Penetration
• Gastric outlet obstruction
85
nursing intervention for Patient with Peptic Ulcer Disease
Relieving pain
Reduce anxiety
MAINTAINING OPTIMAL NUTRITIONAL STATUS
86
are the two most common causes of upper GI tract bleeding
Gastritis and hemorrhage from peptic ulcer
87
When the hemorrhage is large (2000 to 3000 mL), most of the blood is.
peptic ulcer
vomited
88
When the hemorrhage is small, much or all of the blood is
peptic ulcer
passed in the stools,
89
that bleeding can be detected quickly. Patients suspected of having an ulcer who present with symptoms of acute Gl bleeding should undergo evaluation with endoscopy within ____ to confirm the diagnosis
12 h
90
These endoscopic interventions to stop peptic ulcer GI bleeding
injecting the bleeding site with epinephrine
or alcohol,
or cauterizing the site,
or clipping the ulcer, all in efforts to stop the bleeding
91
For patients who are not candidates for surgery or for those with persistent, severe bleeding despite medical and endo-. scopic treatment, _____ may be indicated
arteriography with embolization
92
Arteriography with embolization is more commonly referred to as
Transcatheter Arterial Embolization (TAE).
93
is an interventional radiologic procedure in which a catheter is placed percutaneously (through the skin) into an artery (e.g., femoral or brachial artery and is advanced under use of fluoroscopy to the site of the bleeding peptic ulcer.
Transcatheter Arterial Embolization (TAE).
94
is the erosion of the ulcer through the gastric serosa (thin membrane covering the outer surface of the stomach) into the peritoneal cavity without warning.
Perforation
95
Signs and symptoms of perforation include the following:
• Sudden, severe upper abdominal pain
• Vomiting
• Collapse (fainting)
• Extremely tender and rigid (boardlike) abdomen
96
is the leading benign (noncancerous) cause of gastric outlet obstruction
Peptic ulcer disease
97
occurs when the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down.
Gastric outlet obstruction
98
In treating the patient with gastric outlet obstruction, the first consideration is to
insert an NG tube to decompress the stomach.
99
Confirmation that obstruction is the cause of the discomfort is accomplished by assessing the amount of fuid aspirated from the NG tube. A residual of more than _____ suggests obstruction.
400 mL
100
peptic ulcer
Expected patient outcomes may include:
1. Reports freedom from pain between meals and at night
2: Reports feeling less anxious
3. Maintains weight.
3RD YEAR 2ND SEM
flashcards
Decks in class (13)
# Cards
-
PSYCHIA ADV. CLASS LINGAD129
-
DEFENSOR LIVER PRELIM65
-
DEFENSOR 2ND QUIZ (HEPA, CHOLE, CIRR106
-
DEFENSOR 3RD QUIZ THYROID115
-
ERWIN SECOND QUIZ56
-
Defensor 4th QUIZ adrenal and DM102
-
DEFENSOR CHAPTER 38 DIGESTIVE AND GASTRO171
-
ERWIN SCHIZOPHRENIA96
-
DEFENSOR CHAP 39114
-
LINGAD CHAP 14 & 17183
-
Lingad chap4567121
-
DEFENSOR CHAP 40101
-
Midterm Reading Assignment0
