Lewis ch 41 - upper GI problems

Question 1

feeling of discomfort in epigastric area; need to vomit

Answer 1

nausea

Question 2

forceful ejection of partially digested food and

secretions

Answer 2

vomiting/emesis

Question 3

where is the “vomiting center” in the brain

Answer 3

medulla

Question 4

2 most common ABG alterations associated with vomiting

Answer 4

1. metabolic alkalosis

2. metabolic acidosis

Question 5

Chronic syndrome of mucosal
damage due to reflux of stomach
acid into lower esophagus

Answer 5

GERD

Question 6

factors affecting LES with GERD (5)

Answer 6

• obesity
• smoking
• hiatal hernia of mucosal damage
• alcohol
• fatty foods

Question 7

4 S+S GERD

Answer 7

• heartburn
• dyspepsia
• regurgitation
• respiratory symptoms

Question 8

4 complications GERD

Answer 8

• esophagitis
• barrett’s esophagus
• respiratory (coughing, asthma, spasm)
• dental erosion

Question 9

treatments for GERD (5)

Answer 9

• low fat diet
• no alcohol, smoking, caffeine
• upright position after meals
• lose weight
• don’t eat 3 hours before bed

Question 10

4 most common and effective drugs for GERD

Answer 10

• proton pump inhibitors
• histamine receptor blockers
• prokinetics
• antacids

Question 11

2 types hiatal hernia

Answer 11

sliding (most common)

rolling

Question 12

S+S hiatal hernia (5)

Answer 12

• heartburn
• dyspepsia
• regurgitation
• chest pain
• respiratory symptoms

Question 13

complications of hiatal hernia (7)

Answer 13

• GERD
• esophagitis
• ulcers
• hemmorhage
• stenosis
• strangulation
• aspiration

Question 14

S+S eosinophilic esophagitis (6)

Answer 14

• heartburn
• dysphagia
• food impaction of esophagus
• nausea
• vomiting
• weight loss

Question 15

possible triggers of eosinophilic esophagitis

Answer 15

• food: milk, eggs, wheat, rye, beef

- environmental: pollens, molds, cat, dog, dust mite allergens

Question 16

treatment eosinophilic esophagitis (3)

Answer 16

• avoid known allergens
• PPIs
• corticosteroids

Question 17

S+S esophageal strictures (3)

Answer 17

• dysphagia
• regurgitation
• weight loss

Question 18

dilated, tortuous veins due to portal hypertension;

complication of cirrhosis

Answer 18

esophageal varices

Question 19

• Erosion of GI mucosa from HCl acid and pepsin

- Susceptible areas of GI tract: lower esophagus, stomach, duodenum

Answer 19

peptic ulcer disease

Question 20

risk factors gastric ulcers

Answer 20

H pylori
NSAIDs
bile reflux

Question 21

risk factors duodenal ulcers

Answer 21

COPD
cirrhosis
pancreatitis
zollinger-ellison syndrome

Question 22

major risk factor with peptic ulcer disease

Answer 22

h pylori

Question 23

risk factors peptic ulcer disease (lifestyle and meds - 5)

Answer 23

• alcohol
• smoking
• caffeine
• NSAIDs
• corticosteroids

Question 24

S+S gastric ulcer (3)

Answer 24

• epigastric discomfort 1-2 hours after meal
• burning or gaseous pain
• sometimes perforation is first symptom

Question 25

S+S duodenal ulcer (2)

Answer 25

- burning/cramplike pain in midepigastric or back | - pain 2-5 hours after meal

Question 26

3 major complications peptic ulcer disease

Answer 26

- hemorrhage - perforation - gastric outlet obstruction

Question 27

most common complication with duodenal ulcer

Answer 27

hemorrhage

Question 28

S+S perforation with PUD (5)

Answer 28

- sudden severe abdominal pain - no relief with food or antacids - abdomen rigid/boardlike - bowel sounds absent - N/V

Question 29

Inflammation of gastric mucosa

Answer 29

gastritis

Question 30

causes gastritis (5)

Answer 30

- NSAIDs or corticosteroids - alcohol - spicy foods - H pylori - smoking

Question 31

S+S acute gastritis (4)

Answer 31

- anorexia - N/V - epigastric tenderness - hemorrhage

Question 32

S+S chronic gastritis

Answer 32

- similar to acute - asymptomatic - pernicious anemia

Question 33

most common cause upper GI bleed

Answer 33

peptic ulcer disease

Question 34

what is considered a massive GI bleed

Answer 34

greater than 1500 mL blood loss | 25% intravascular volume

Question 35

first line management of GI bleed

Answer 35

endoscopic therapy

Question 36

3 methods used to coagulate/thrombose GI bleed during endoscopy

Answer 36

- clips or bands - thermal ablation - injection

Question 37

how much blood loss is required to do surgery for GI bleed

Answer 37

2000 mL or shock

Question 38

S+S foodborne illnesses (4)

Answer 38

- nausea - vomiting - diarrhea - cramping abdominal pain

Question 39

S+S botulism (4)

Answer 39

- onset 12-36 hr - inability to talk or swallow - dizziness - abdominal distention

Question 40

sources of botulism

Answer 40

- home preserved vegetables | - improperly canned or preserved food

Question 41

S+S clostridial food poisoning (3)

Answer 41

- onset 8-24 hr - midepigastric pain - diarrhea

Question 42

sources of clostridial food poisioning

Answer 42

- meat dishes cooked at lower temp | - rewarmed meat dishes

Question 43

S+S E Coli food poisoning (3)

Answer 43

- onset 8 hr-1 week - bloody stools - hemolytic uremic syndrome

Question 44

sources of E Coli

Answer 44

contaminated beef, pork, milk, cheese, fish, cookie dough

Question 45

S+S salmonella (2)

Answer 45

- onset 8 hr-several days | - fever and chills

Question 46

sources of salmonellla

Answer 46

improperly cooked poultry, pork, beef, lamb, and eggs

Question 47

S+S staphylococcal food poisoning (2)

Answer 47

- onset 30 min-7 hr | - V/N/D

Question 48

sources of staph food poisoning

Answer 48

meat, bakery products, cream fillings, salad dressings, milk

Question 49

what can Escherichia Coli o157:H7 lead to

Answer 49

hemorrhagic colitis | kidney failure