Lifespan II, Unit V
|Another name for the esophagogastric sphincter||Cardiac|
|Other names for the gastroduodenal junction||Pyloris /Terminal Antrum|
|What are functions of the hormone Gastrin?|| Helps regulate rate of gastric emptying|
Promotes Hydrochloric Acid Secretion
|In what part of the body does the large intestine begin?||lower right side of abdomen|
|GERD is commonly found in patients with what other conditions?||Hiatal Hernia, Asthma, Obesity|
|What is the diagnostic tool which measures pressure in the esophagus?||Esophageal Manometry (increases during episodes of reflux)|
|What is an EGD?|| Endoscopic Examination:|
|How should a patient prepare for an EGD?||Stop taking anticoagulants prior to procedure; NPO 6-12 hours before; also hold meds EXCEPT insulin, B/P meds, seizure meds, cardiac meds.|
|What is the major complication of an EGD?||Perforation (take VS q 15 minutes, watching especially for any increase in temperature or pain).|
|How should a patient prepare for gastric analysis?||Withhold any meds which affect gastric secretion for 24-48 hours.|
|What is Barium Sulfate and how is it used in diagnosis?|| A metallic compound which shows up on X-ray.|
Assists in showing abnormalities in the esophagus and stomach.
|What is a fundoplication?||Surgical suturing of the stomach around the esophagus and anchoring it below the diaphragm. (used for hiatal hernias and severe cases of GERD)|
|Describe Barrett's esophagus|| A condition in which cells similar to your stomach's glandular cells develop in the lower esophagus. |
These new cells are resistant to stomach acid, but they also have a high potential for malignancy.
|Describe Gastroenteritis||Inflammation of stomach and small intestine. Caused by ingesting food / liquid contaminated by virus, bacteria, or parasites. (aka "Food Poisoning")|
|List some fluids containing sugars & electrolytes.||Gatorade, Pedialyte|
|Describe Gastritis||Inflammation of the mucous membranes lining the stomach - leading to "auto-digestion" (?). Can be acute or chronic.|
|How does treatment for acute gastritis differ from treatment for chronic gastritis?|| Acute (short duration): NPO + meds to slow down peristalsis. IV fluids given if severe dehydration or N/V.|
Chronic: diet therapy is of primary importance (no spicy or acidic foods or alcohol). Meds: antispasmodics, antacids, H2-antagonists (ranitidine), PPIs, and/or antibiotics.
|List some types of peptic ulcers||Cushing (ICP), Curling (burns), Stress-induced, Gastric, Duodenal|
|What defines a peptic ulcer? What is the difference between acute and chronic types?|| Loss of tissue from the lining of the digestive tract.|
Acute: affects only the superficial layers of the digestive lining
Chronic: affects the muscle layer
|How is a stress ulcer different from a chronic peptic ulcer?||It is more acute and more likely to produce hemorrhage. Pain is rare, and perforation occurs occasionally.|
|How do gastric and duodenal peptic ulcers differ?||Gastric ulcers are more likely to recur and be malignant.|
Duodenal and prepyloric ulcers are associated with increased amounts or acidity of gastric juices and are 70% associated with H. pylori.
Gastric ulcers are more likely to be associated with H. pylori (90%) and are characterized by normal or low levels of HCl.
Duodenal ulcers are much more common (80%).
Gastric ulcers are more often in men, elderly; duodenal ulcers are more often in young men.
Spontaneous vomiting is more common with duodenal ulcers.
Duodenal: weight gain; Gastric: weight loss.
|S&S of hypovolemic shock|| √ Anxiety - agitation|
√ cool clammy skin
√ decreased or no urine output
√ increase heart rate
√ decrease BP
√ rapid breathing
(can be a complication of hemorrhage from PUD)
|How does PUD cause GI obstruction?||scarring and loss of musculature at the pylorus which narrows the stomach outlet|
|Urea Breath Test||Test used to detect presence of H. pylori in the GI tract -- the bacterium can break down radio-labeled urea into CO2, which is absorbed and excreted through exhalation.|
|How does H. pylori cause peptic ulcers?|| H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath. |
Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
|What meds are used for treatment of H. pylori?|| Bismuth subsalicylate (Pepto Bismal): protects stomach lining.|
Antibiotics: metronidazole, tetracycline, clarithromycin, amoxicillin
H2 blockers /Proton pump inhibitors
|When is surgical treatment of PUD necessary?||When it does not respond to meds; when there is a complication such as hemorrhage, perforation or obstruction; or when cancer is present.|
|Pre-op care for gastric surgery||Liquids only the day before; NPO; NGT inserted; stomach contents removed by suction; enemas to empty colon.|
|Post-op care for gastric surgery|| Handle NG tube carefully (to avoid injury to sutures or introduction of infectious agents).|
Often on TPN or J-tube until healed.
Monitor I&O and for S&S of hemorrhage or infection
After NGT removed: give small amounts of liquid and increase as tolerated. Progress to small, frequent feedings. Three regular meals a day possible within six months.
|Special post-op care for total gastrectomy|| Increase fluids, protein, calories, iron rich foods|
Avoid fatty foods
Take Vitamin supplements
|What is a pseudocyst (pancreatic abscess)?||A sac-like structure that forms on or around the pancreas containing the purulent liquefaction of necrotic pancreatic tissue.|
|What is the typical pattern of onset of acute pancreatitis?|| Alcoholic: 12-14 hours after ingestion of ETOH|
Billiary: immediately after a large meal
|Why is keeping the GI tract empty part of the treatment regimen for acute pancreatitis?||This prevents the pancreas from producing enzymes|
|What is Cholecystitis||Inflammation of the gallbladder|
|What causes Cholecystitis?|| 90-95% of the time from gallstones; Other causes: |
Obstructive tumors, anesthesia
Severely stressful situations
Cardiac surgery, bacteria
Severe burns, or multiple trauma
Toxic chemicals, opiods, starvation
|What is the typical pattern of onset of cholecystitis?||3 hours after a meat high in fat content|
|What is Cholelithiasis?||The presence of gallstones in the gallbladder or biliary tract.|
|What is Choledocholithiasis?||When stones are lodged in the bile duct.|
|How are gall stones formed?|| An imbalance of cholesterol, bile salts, and calcium in the bile causes these substances to precipitate.|
Cholesterol precipitate forms the core, then the stone grows as layers of these substances accumulate over the core.
|What are the milder symptoms of chronic cholelithiasis?|| √ Indigestion after fatty meals|
√ Nausea after eating
√ Right upper quadrant discomfort after meals
|What is the expected recovery period for gallbladder surgery (removal, or cholecyctectomy)?|| Laparoscopic: Discharge home after 24 hours|
Open: 2-4 day stay
6 week recovery period