|GERD||The backward flow (reflux) of GI contents into the esophagus. Cause relates to: increase gastric volume or infra-abdominal pressure, or decreased esophageal sphincter tone. Esophagus becomes inflamed due to refluxed gastric or duodenal contents; degree of inflammation varies.|
|GERD (Manifestations)|| Heartburn, substernal or retrosternal burning sensation, dyspepsia, regurgitation, hypersalivation, dysphagia, and odynophagia. |
Other: chronic cough, asthma, atypical chest pain, belching, flatulence, bloating, N/V
|GERD (Diagnostics)||24-hr ambulatory pH monitoring, esophageal manometry, scintigraphy, EGD|
|GERD (Collaborative Care)||Patient education, nutrition therapy, lifestyle changes ie: HOB ^ 6", sleep in right lateral decubitus position, stop smoking, and alcohol consumption, avoid factors that increase intra-abdominal pressure, identify possible medication contributors.|
|GERD (medication therapy)|| Antacids, alluminum or magnesium. Histamine receptor antagonists; e.g., Zantec, Pepcid. Proton pump inhibitors e.g., Prilosec, Prevacid|
|Hiatal Hernia|| Stomach protrudes through the esophageal hiatus of the diaphragm, sliding or rolling. |
Symptoms: Heartburn, regurgitation, pain, dysphagia, and belching. Symptoms are worse after eating or in recumbent position.
|Hiatal Hernia (Complications)||Regurgitation, aspiration, hemorrhage, esophageal stenosis, hernia strangulation|
|Hiatal Hernia (Collaborative Care)|| Non-surgical: Patient teaching, nutrition, wgt reduction, + measures as for GERD. Drug therapy: antacids, histamine receptor antagonist|
|Gastritis||Mucosal inflammation worsened by histamine release and vagal nerve stimulation. HCl acid diffuses into the mucosa causing injury.|
|Acute Gastritis||Abdominal tenderness, bloating, hematemesis, melena, dyspepsia, intravascular depletion and shock. May r/t infection (H.pylori, E.coli or exposure to irritants e.g, NSAIDs|
|Chronic Gastritis||Vague C/O epigastric distress, anorexia, +/- pain w/ food, weight loss. |
A diffuse inflammatory process, heals without scarring; +/- ulcer formation or hemorrhage; multiple iritants.
Type A: antibodies to parietal cells.
Type B: associated w/ H. Pylori.
Atrophic: older adults, exposure to toxins, h. pylori, or autoimmune factors.
|Gastritis (Collaborative Care)||Identify and eliminate causative factors. H2 receptor antagonists, Mucosal barrier fortifier, antacids, vitamin b12, limit intake of trigger foods, stress reduction.|
|Gastritis (Surgical Management)||Partial gastrectomy, Pylorplasty, Vagotomy, Total gastrectomy (also used for peptic ulcer disease)|
|PUD (peotic ulcer disease)|| A stomach or duodenal mucosal lesion caused when mucosal defenses impaired; relates to the effects of acid,pepsin, & h. Pylori.|
3 types: Gastric, Duodenal, Stress
|PUD (Complications)||Hemorrhage, perforation, pyloric obstruction, incurable disease.|
|PUD (Assessment)|| Contributors, life-style, meds, diseases, diet, alcohol & tobacco. |
Document: type of pain, effect of eating on the GI symptoms, N/V, change in bowel pattern, fatigue/dizziness
|PUD (Diagnostics)||Hgb/Hct, testing for H. Pylori, +/- chest and abdominal x-ray, or CT, EGD|
|PUD GI Bleed||Hematemesis: bright red blood or coffee ground. Stools: melana or occult bleed May C/O: epigastric tenderness, dyspepsia, abdominal pressure, fullness or hunger.|
|IBS (Irritable Bowel Syndrome)||A functional GI disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating.|
|IBS (Criteria)||Abdominal pain relieved by defecation or falling asleep. Pain rt changes in stool frequency or consistency, abdominal distention, the sense of incomplete evacuation of stool, the presence of mucus w/ stool passage|
|IBS (Collaborative Care)|| 'symptom diary', identify triggers, management strategies, eliminate offending foods, nutrition consule, i.e., fiber, gluids, etc. |
Drug therapy: bulk forming laxatives, antidiarrheal agents, 5-HT4 antagonists, M3-receptor antagonists, tricyclic antidepressants
|CRC (Colorectal Cancer)||The large intestine, most are adenocarcinomas. Rectal bleeding, anemia, and change in the stool; depends on tumor location.|
|CRC (diagnostics)||Hemoglobin and hematocrit are decreased, fecal occult blood test, possible increase of carcinoembryonic antigen (CEA), imaging|
|Stage 1||tumor invades up to muscle layer|
|Stage 2||Tumor invades to other organs; perforates peritoneum|
|Stage 3||any level of tumor invasion, <4 regional lymph nodes|
|Stage 4||Any level of tumor invasion; many lymph nodes affected with distant metastasis|
|CRC (Collaborative Care)||Radiation and drug therapy. Surgical management: minimally invasive surgery, colon resection, colectomy, abdominoperineal (AP) resection, Colostomy.|
|Ulcerative Colitis||Inflammation of the rectum, recto-sigmoid colon & +/- the entire colon with epithelial destruction= decreased absorptive surface; fluid/electrolyte loss, bleeding & diarrhea, and colon wall thickening. Remissions/exacerbations; increase colon cancer risk.|
|Ulcerative Colitis (Assessment)||Tenesmus, loose stools w/ blood/mucus. Major: bloody diarrhea & abdominal pain, poor absorption of vital nutrients|
|Ulcerative Colitis (Diagnostics)||Barium enema, sigmoidoscopy, CBC, electrolytes, total protein, albumin, stool specimens (blood, C/S)|
|Ulcerative Colitis (Complications)||Malabsorption, systemic immune response|
|Ulcerative Colitis (Collaborative Care)|| Nutrition: increase cal/protein, decrease residue, vitamins, iron; elemental diet and parenteral nutrition |
Meds: Sulfasalazine, steriods and anti-inflammatory, immunomodulators, antidiarrheal drugs.
Surgery: TOtal colectomy w/ continent ileostomy or total colectomy w/ ileoanal anastomosis
|Crohn's Disease||A chronic inflammatory disorder affecting any part of lower GI (jejunum, terminal ileum, & colon); exacerbation and remissions. Transmural inflammation w/ skip lesions, deep longitudinal ulcerations & strictures (cobblestone appearance) +/- abscess or fistula. Malabsorption of vitamins and nutrients, Tumor Necrosis Factor (TNF) correlates w/ disease|
|Crohn's Disease (Manifestations)||Diarrhea, fatigue, abdominal pain, decrease weight, fever|
|Crohn's Disease (Complications)||Obstructions, fistulas, perforations, abscesses. Malabsorption & nutritional deficiencies; fat soluble vitamins; gluten intolerance (barley, wheat, rye), systemic: arthritis, liver/GB & renal disorders|
|Crohn's Disease (Diagnostics)||Lab studies: electrolytes, CBC, serum protein, stool specimens. Studies: barium, endoscopy/capsul endoscopy, colonscopy|
|Crohn's Disease (Collaborative Care)||Diet: low residue & roughage, high calories and protein. Considerations: gluten and lactose intolerances. |
Medications: Sulfasalazine: principal drug, decreases GI inflammation, antimicrobials, prevent or treat secondary infection, corticosteriods:acute flare-ups, decrease inflammation, immunonosuppressants: non responders to other meds. Other: biologic therapies (inhibit TNF), antidiarrheals, hematinics & vitamins
Surgery: laparoscopy, small bowel resection and ileocecal resections, stircturoplasty. Surgery DOES NOT cure
|Diverticular Disease||The presence of many abnormal pouchlike herniations in the wall of the intestine.|
|Diverticular Disease (Assessment)|| H&P, clinical manifestations, diagnostic assessment. |
Non-surgical management- rest, NPO, IV Fluids, IV antibiotics, nutrition therapy, drug therapy, avoid laxatives and enemas.