Upper GI Disorders Flashcards by Nick Eaton

Name the risk factors for GERD.

Increased intra-abdominal pressure (over-eating, obesity, pregnancy, ascites, heavy lifting), medications (Calcium channel blockers), smoking, hiatal hernia, delayed gastric empying

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Define GERD.

Reflux of gastric contents into the esophagus due to LES incompetence ≥2x/week.

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What are the diagnostic tests for GERD?

Endoscopy
Biopsy
pH monitoring
Manometry (LES pressure test)
Upper GI barium study
GI cocktail

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Name two common complications of GERD.

Esophagitis
Barrett’s esophagus

Respriratory compromise
Laryngopharyngeal Reflux

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What is Barrett’s esophagus and what is it caused by?

Permanent change to columnar epithelium, considered precancerous. Caused by GERD.

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What is the first-line medication class for GERD?

Proton pump inhibitors (PPIs).

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What medications are used to treat GERD?

PPIs
Prokinetic agents
Acid neutralizers
H2 receptor blockers

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What is the most common type of hiatal hernia? Explain the condition.

Sliding hernia, where the stomach (typically the fundus) slides above the diaphragm and back down.

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Which type of hiatal hernia has a higher risk of strangulation? Explain the condition.

Rolling (paraesophageal) hernia. Fundus of the stomach rolls through diaphragm and stays, forming a pocket next to the esophagus and is at risk for strangulation.

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Name risk factor for hiatal hernias.

Increased abdominal pressure (ascites, obesity, pregnancy, heavy lifting, constipation)
Advanced age
Gender (more common in women
Trauma
Congenital (rare)

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Name some clinical manifestations of hiatal hernias.

Belching/ regurgitation
GERD/ heartburn
Indigestion
Chest pain
Swallowing difficulty
Acidic taste
N/V
Dyspnea
Nocturnal cough/ wheeze

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Name complications of hiatal hernias

Bowel obstruction
Pulmonary complications
Ulcers
Hemorrhage
Strangulation
Esophagitis

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What are the diagnostic tests for hiatal hernias?

Barium series aka esophagram or Barium swallow - (x-ray the throat and esophagus)
Upper Endoscopy
pH monitoring

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First-line med for hiatal hernia?

Proton pump inhibitor (PPI).

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Surgical option for refractory hiatal hernia?

Nissen fundoplication (360%)
Toupet fundoplication (270%)

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What is gastritis?

Inflammation of the stomach mucosa due to breakdown of protective barriers.

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Name risk factors for Gastritis.

NSAIDS, ETOH, H. pylori, radiation exposure, stress conditions

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Name common symptoms of gastritis.

Epigastric pain, dyspepsia, anorexia, nausea, vomiting.

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What are the diagnostic tests for gastritis?

Esophagogastroduodenoscopy (EGD) with biopsy, H. pylori test, CBC (intrinsic factor), Guaiac test for occult blood

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What are the treatment options for gastritis?

Eliminate cause if known
NG tube
PPIs
H2 blockers
Antacids
Abx (if caused by H. pylori)

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What are the complications of gastritis?

Ulcer, hemorrhage, increased risk of stomach cancer

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Name the risk factors of Peptic Ulcer Disease.

H. pylori (the major risk factor - causing 80% of gastric and 90% of duodenal ulcers)
NSAIDs (inhibit prostaglandin synthesis, increase gastric acid secretion and reduce the integrity of the mucosal barrier)
Stress
ETOH
Smoking
Genetic predisposition
Older age
Irregular/ poor diet

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Gastric ulcer pain timing?

Shortly after eating (1-2 hours)

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Duodenal ulcer pain timing?

2–5 hours after meals and at night.

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Clinical manifestations of Peptic ulcers

Pain epigastric ("burning" or "gaseous") N/V, bloating/ early satiety Dyspepsia Hematemesis Melena

Most dangerous ulcer complication?

Perforation → peritonitis/septic shock.

Nursing implications for ulcers:

Watch for S/sx of perforation NPO Intermittent NG tube, minimal manipulation (stomach ulcer) IV fluids Medications Pt education Possible blood transfusion Possible surgery

When should antacids be taken in ulcer treatment?

1-3 hours after meals and at bedtime

When should sucralfate be taken in ulcer treatment?

Give on an empty stomach (1 hour before meals, or 2 hours after, most effective at a low pH so give it at least 60 minutes before or after an antacid, typically given 1 hour before meals and at bedtime)

How do H2 receptor blockers work and what is an important administration caution?

They block histamines from binding to H2 receptors, reducing acid production. And they shouldn't be given with antacids or sucralfate because they interfere with absorption of H2 blockers.

What is the role of bismuth subsalicylates in ulcer treatment?

Used with ulcers associated with H. pylori; covers ulcer and directly harms H. pylori bacteria.

What is the role of proton pump inhibitors in H. pylori therapy?

Reduce stomach acid; given with antibiotics in H. pylori multi drug therapy

What prokinetic agent is used in ulcer treatment and what does it do?

Metoclopramide; increases gastric emptying (Met-oh-KLOE-pra-mide)

Name four antibiotics used to eradicate H. pylori

Amoxicillin, clarithromycin, metronidazole (Flagyl), tetracycline

What is triple-drug therapy for H. pylori?

PPI + 2 Abx (clarithromycin + metronidazole or amoxicillin)

What is Quadruple drug therapy for H. pylori?

PPI + Bismuth Subsalicylate + 2 Abx (metronidazole + tetracycline) Me-troe-NI-da-zole

What is the urgent priority in an upper GI bleed?

Finding the source of bleeding and stopping it

Name esophageal causes of an upper GI bleed

Varices, Mallory-Weiss tear, esophagitis, ulcers, malignancy

Name causes of stomach/ duodenum upper GI bleed

Gastritis, peptic ulcer, malignancy, steroids, NSAIDs, shallow mucosal artery

What medications are risk factors for upper GI bleed?

Steroids and NSAIDs

What is the difference between chronic and acute upper GI bleed?

Chronic = insidious and hard to detect Acute = sudden or massive onset

What are key findings that indicate upper GI bleeds?

Abdominal pain Abdominal rigidity Hematemesis Melena Nausea

What are key signs of hypovolemic shock from a massive bleed?

↓ BP * Cool, clammy skin * ↑ HR * ↓ Level of consciousness * Slow capillary refill * ↓ Urine output (<0.5 mL/kg/hr)

How often should H/H be. checked in an active upper GI bleed?

Every 4-6 hours

What vital signs monitoring is crucial in UGI bleed?

Frequent trending of BP, HR, and O2 saturation

What IV medications are commonly used for UGI bleed?

PPI or H2 blocker infusion Octreotide (Sandostatin) ok-TREE-oh-tide

What medications are needed in chronic GI bleeding management?

PPI, sucralfate, and iron supplement

What are key nursing interventions (at least to be prepared for) for UGI bleed?

monitor for S/sx of hypovolemic shock or perf Frequent VS (BP, HR, O2) H/H with type and cross LOC/ neuro checks Multiple large bore IVs (18G or central line) NG tube (LIWS) Fluid replacement Blood transfusion

What should be done with NG tubes after gastric surgery?

Expect minimal output, and do not manipulate without order (esp. for gastric ulcers)

what is a common gastric surgery post-op complication affecting blood sugar?

Postprandial hypoglycemia

What is Billroth I surgery?

Gastroduodenostomy (stomach connected to duodenum)

What is Billroth II surgery?

Gastrojejunostomy (stomach connected to jejunum)

What is a major complication affecting 20-60% of gastric surgery patients?

Dumping syndrome

Name nutritional complications of gastric surgery

pernicious or iron deficient anemia, bile reflux, infection

What causes dumping syndrome after gastric surgery?

Loss of pyloric control --> hypertonic chyme rapidly enters small intestine, pulling in fluid. This creates a decrease in plasma volume, distention of the bowel lumen, and rapid intestinal transit.

When do early dumping symptoms begin?

15-30 minutes after eating

Name symptoms of dumping syndrome

Weakness, dizziness, tachycardia, sweating, abdominal cramping, urge to defecate

Key patient education for dumping syndrome

small frequent meals, avoid simple sugars, lie down after eating, meds to delay emptying

How to reduce risk of postprandial hypoglycemia after gastric surgery?

Limit sugar with meals, eat protein + complex carbs, moderate fat, small frequent meals

Name two common bariatric procedures

Gastric bypass and gastric sleeve

What key education must patients follow after bariatric surgery?

Strict diet and mediation restrictions; extreme lifestyle changes required

Upper GI Disorders Flashcards

(61 cards)