1
Q
endoscopy
A
•direct visualization of body cavities, tissues, and organs thru use of flexible, lighted tube
•used for diagnostic and therapeutic procedures..
-obtain specimens
-remove abnormalities
-cauterize bleeding ulcer
2
Q
colonoscopy
A
•enter colonoscope thru anus to visualize rectum and all parts of the colon
3
Q
EGD (esophagogastroduodenoscopy)
A
•enter thru mouth into esophagus, stomach, and duodenum
4
Q
ERCP (endoscopic retrograde cholangiopancreatography)
A
- thru mouth into biliary tree via duodenum
* used to visualize biliary ducts, gall bladder, liver, and pancreas
5
Q
sigmoidoscopy
A
•scope shorter than colonoscope, allowing visualization of anus, rectum, and sigmoid colon
6
Q
endoscopic procedure basics
A
- NPO 6-8 hrs
- avoid anticoags and NSAIDS prior
- ensure return of gag reflex before giving food/fluid
7
Q
endoscopic complications
A
- oversedation
- hemorrhage- tachy/cool/clammy/dizzy
- aspiration
- perforation of GI tract- tachy/pain/nv/fever
8
Q
gastric analysis
A
- measures HCl and pepsin content to evaluate gastric and duodenal ulcers
- NPO 12 hrs prior
- NG tube inserted to obtain samples
9
Q
decreased gastric acid indicates
A
•cancer
10
Q
increased gastric acid indicates…
A
- Zollinger-Ellison syndrome
* duodenal ulcers
11
Q
Zollinger-Ellison syndrome
A
•increased production of gastrin caused by tumors (gastrinomas) in pancreas and duodenum
12
Q
gastrointestinal series
A
- radiocraphic imaging of esophagus, stomach, and entire intestinal tract
- may or may not use contrast
- barium drink for UGI
- barium enema for LGI
13
Q
gastroesophageal reflux disease (GERD)
A
- gastric content and enzyme back flow into esophagus
* causes irritation to esophageal tissue, which delays clearance and lead to further irritation
14
Q
GERD causes
A
- excessive relaxation of LES*
- frequent abdominal distention from overeating or delayed emptying
- increased abdominal pressure
- medications that relax LES or cause gastric acid secretion
- hyperemia, erosion
- hiatal hernia
- lying flat
- stress
15
Q
food that relax LES
A
- fatty, fried
- chocolate
- caffeine
- peppermint
- spicy
- tomatoes
- citrus
- etoh/tobacco
16
Q
reasons for increased abdominal pressure
A
- obesity
- preggo
- bending at waist
- ascites
- tight clothing
17
Q
hiatal hernia
A
- part of stomach sticks up into diaphragm
* causes LES displacement into thorax w/ delayed esophageal clearance
18
Q
medications that cause GERD
A
- PO contraceptives
- calcium channel blockers (HTN)
- nitrates (vasodilators)
- NSAIDS
- sedatives
- anti-cholinergics
19
Q
s/s of GERD
A
- dyspepsia after eating
- pain (relieved w/ anti-acids)
- throat irritation/globus
- atypical chest pain
- pyrosis (heartburn)
- increased flatus
- eructation
- tooth erosion
- hoarseness
- chronic cough (aspiration)
- consistent symptoms
20
Q
diagnostics of GERD
A
- EGD
- ambulatory esophageal pH monitoring
- pt keeps food diary
21
Q
24-hr ambulatory esophageal pH monitoring
A
- small catheter placed thru nose and into distal esophagus
- pH reading taken in relation to food, position, and activity
- most accurate method for testing GERD
22
Q
GERD tx
A
- diet/lifestyle changes
- medication
- surgery
23
Q
antiacids
A
•increase pH of gastric contents •deactivate pepsin •buffer acids •best given on empty stomach •aluminum -> constipation •magnesium -> diarrhea *Sodium Bicarbonate, Maalox, Mylanta
24
Q
histamine receptor antagonists
A
- antagonize (block) production of histamine
* do not impact reflux as much as reduce acid production and promote healing of inflamed tissue
25
proton pump inhibitors
•primary tx for GERD
•long-acting inhibition of gastric acid by impacting proton pump of parietal cells in mucosa
•given IV to treat/prevent stress ulcers
*Prilosec, Zantac, Prevacid
26
long term use of proton pump inhibitors
* may mask symptoms
* may cause pneumonias and C-diff
* increase risk of hip fractures in elderly b/c of Ca2+ loss
27
complications of GERD
* aspiration of gastric secretions
* Barrett's epithelium (premalignant)
* esophageal adenocarcinoma
28
Barrett's epithelium
* tissue lining the esophagus changes to resemble tissue lining inside of intestine
* caused by untreated GERD and esophageal exposure to acid/pepsin
29
esophageal varices
* swollen, fragile blood vessels in esophagus
* often due to tobaccos and heavy alcohol intake
* hemorrhage of varices has high mortality rate
30
gastritis
* inflammation of lining of stomach
* scattered or localized
* can be erosive and cause ulcers, increasing risk for stomach cancer
* common causes are histamine release, HCl, and CN 10 stimulation
31
prostaglandins
* form protective layer over lining of stomach
| * reduce gastric acid secretions
32
acute gastritis
* sudden onset/short duration
* may result in gastric bleeding
* caused by H. pylori, E. coli, salmonella
* caused by NSAIDs and stress
33
acute gastritis s/s
* hematemesis
* melena
* dyspepsia
* epigastric pain
* anorexia
* N/V
34
acute gastritis interventions
* diet/lifestyle changes
* medication
* transfusion if bleeding severe
* fluid replacement
* surgery
35
chronic gastritis
* slow onset
| * may damage parietal cells -> pernicious anemia b/c B12 can't be absorbed
36
type A chronic gastritis
* r/t autoimmune response to parietal (acid-secreting) and intrinsic factor cells
* genetic
37
type B chronic gastritis
•caused by H. pylori infection, which stimulates release of inflammatory cytokines
38
chronic gastritis s/s
```
*few unless ulceration present
•vague epigastric pain (relieved by food intake)
•anorexia
•N/V
•intolerance of fatty/spicy
•pernicious anemia
```
39
chronic gastritis interventions
* test for H. pylori
* find underlying cause (inflame. bowel, toxic sub., etc)
* shilling test for pernicious anemia
40
drugs to avoid w/ gastritis
* corticosteroids
* erythromycin
* NSAIDS
41
Dumping syndrome
* vasomotor response to food ingestion due to stomach being no longer able hold contents and "dumping" mass amounts into small intestine
* reduced circulatory volume b/c trying to supply intestines
* s/s of tachycardia, hypotension, dizziness
* compilation of GERD and PUD
* high protein diet, avoiding wheat and dairy
42
peptic ulcer
•erosion of mucosal lining of stomach or duodenum
•if eroded enough, epithelium exposed to gastric acid/pepsin, which leads to bleeding and perforation
•3 types
-gastric
-duodenal
-stress
*most caused by H. pylori
43
location fo duodenal ulcers ulcers
* upper portion of duodenum
| * evening pain 1.5-3 hrs after meal
44
stress ulcers
* gastric lesions as a result of medical crisis, stress, or trauma
* Curling's ulcer- burn pt
* Cushing's ulcer- increased ICP
45
gastric ulcers
* located in stomach
| * have normal gastric acid secretion, but have delayed stomach emptying
46
most serious complications of PUD
* hemorrhage
* perforation
* pyloric obstruction
47
hemorrhage
* massive bleeding in form of hematemesis or melena
| * can lead to shock (hypotension, tacky, dizzy, confusion) or decreased Hgb
48
hematemesis
•upper GI bleed, above duodenojejunal jxn
•bright red blood in vomit
*gastric acid digestion of blood appear like coffee grounds
49
melena
•dark red blood in tarry appearing stool
50
perforation
* deep ulcer goes thru lining of stomach or duodenum
| * can cause peritonitis
51
perforation presentation
```
•severe epigastric pain spreading across abdomen
•round, board-like abdomen
•hyperactive or diminished bowel sounds
•rebound tenderness
*surgical emergency
```
52
pyloric obstruction
* pyloris at end of stomach is blocked due to stasis and gastric dilation
* etiology is edema, scarring, and inflammation resulting from PUD
53
nursing interventions for GI bleeding
* ABCs
* vital signs (prevent hypovolemic shock)
* fld replacement
* NG tube lavage
* manage pain
* admin meds
54
NG tube gastric lavage
* NS instilled and then removed with blood
| * pt on L side to limit flow out of stomach
55
Why would a client with gastric ulcers need to be cautious about using OTC cold remedies?
* OTC medications may have aspirin in them
* OTC medications may contain NSAIDs
* Drug interactions may occur causing deepening of the stomach ulcers
56
why do NSAIDs cause bleeding
•inhibit prostaglandin production
•prostaglandins are responsible for providing mucosal layer of stomach
*nothing to protect stomach
57
Chronic gastritis can cause
* Pernicious anemia
* Sickle cell anemia
* Gastric ulcers
* Electrolyte imbalance
* Cancer of the stomach
58
role of parietal cells
* intrinsic factor that helps absorb B12
* destroyed in chronic gastritis
* require B12 injection for life
* also secrete HCl (diminished in older adult)
59
pt side postion to promote gastric emptying
* right
| * gravity guides contents into bowel
60
GI changes in older adult
* atrophy of gastric mucosa (parietal cells) leads to decreased HCl, which leads to decreased absorption of iron and B12
* atrophic gastritis may occur as consequence of overgrowth of bacteria
* increased risk of candidiasis d/t diminished immune function (diabetes, malnourished, and stress)
61
GERD in elderly
•may not have s/s of reflux b/c diminished parietal cell HCl production
*more severe complications b/c immunocompromised
•atypical chest pain
•ENT infections; Barrett's esophagus
•pulmonary symptoms
•sleep apnea
•asthma
62
pt side position to prevent GERD complications
•left side
| *varies based on individual
63
The danger of aspiration is increased if regurgitation occurs when the client
•lying down
64
dysphagia indicates ____; and assessment by RN should include ____
* stricture of esophagus
| * when it occurs in pt
65
interventions for antacid admin
* give on empty stomach
* monitor for constipation
* don't give w/ other drugs
* assess pt for hx of HF or renal dz first
