2 Med/surgical - Upper Gi

Front 1

Mouth -> Esophogus -> Stomach ->Duoednum ->Spinchters (cardiac and pyloric) is the anatomy of the

Back 1

Upper GI Tract

Front 2

a mucus secreting barrier of epiphelial cells that line and coat the stomach.

must be in tact.

Back 2

Gastric Mucosal Barrier

Front 3

What does it take to keep replacing the Gastric Mucosal Barrier?

Back 3

Blood Supply

Front 4

Name some things that decrease blood supply?

Back 4

Stress, Smoking (causes vasoconstriction) and Alcohol

Front 5

What is the area of the GI Tract where food enters

Back 5

Mouth

Front 6

area of the GI Tract after the Food enters the Mouth, it goes into

Back 6

Esophogus

Front 7

What is located in the Upper Left Quadrant ; It is here that food arrives and gets more acidic

Back 7

Stomach

Front 8

What is the area of the GI Tract that is the first portion of the small intestine?

Back 8

Duoedenum

Front 9

After the Dueodeunum - both Cardiac (L.E.S.) and Pyloric

Back 9

Sphincters

Front 10

Cardiac Sphincter ??????

Back 10

j

Front 11

is a strong ring of smooth muscle at the end of the pyloric canal and lets food pass from the stomach to the duodenum. It receives sympathetic innervation from celiac ganglion.

Back 11

pyloric sphincters

Front 12

the three phases of digestion are:

Back 12

Cephalic
Gastric
Intestinal

Front 13

the backward flow of GI contents into the esophogus is known as

Back 13

GastroEsophagel Reflux Disease

or GERD

Front 14

GERD is caused by the backward flow of GI contents into the esophogus - name 3 causes of why this could happen

Back 14

Incompetent Sphincter (LES)

Abnormal Esophageal Cleareance

Delayed Gastric Emptyingq

Front 15

what makes the stomach not empty due to a slowed down peristalsis

(ex: aging, meds)

Back 15

Pyloric Sphincter

Front 16

what helps to break down vitamin B12 - without this nutritional essential one would aquire Anemia

Back 16

Intrinsic Factor

Front 17

Your patient is experiencing symptoms of GERD - name a few causes of GERD

Back 17

Diet (fatty foods, citris foods, tomatoes)
Caffeine, chocolate
medication, Smoking, Alcohol

Front 18

Your patient is on medication that causes GERD, name some of the meds that cause GERD

Back 18

BCP - birth control pill

HTN meds (hypertension)

Sedatives

also - NG Tubes

Front 19

your pt is experiencing food that is not moving down the esophogus, this is called

Back 19

abnormal esophageal cleareance

Front 20

In the mucosal barrier - 1/2 million cells are lost every minute and replaced within 2 days ...

T/F

Back 20

TRUE

Front 21

You must have a competent Lower Esophogael System

T/F

Back 21

TRUE

Front 22

Your patient is experiencing Dyspepsia and Dysphagia - What is happening?

Back 22

He is having abdominal pain (dyspepsia) as well as difficulty breathing (dysphagia)

Front 23

Your patient is having odynophagia, a common symptom of GERD, what is happening?

Back 23

painful swallowing (odynophagia)

Front 24

Your patient is having eructation with regurgitation - common symptoms of Gerd, what is happening

Back 24

The pt is burping (eructation) as
well as an acidic taste in throat (regurgitation)

Front 25

Your pt is complaining of heartburn and chest pain,common symptoms of GERD - what is the medical name for this

Back 25

Pyrosis

Front 26

Your PT s having a tube put through the LES Lower Esophageael System to monitor how acidic the esophogus area is over a 24 hour period. THis test is known as

Back 26

24 hour PH Monitoring

Front 27

Your PT is NPO for 8 hours prior to procedure. He must swallow 16 ounces of barium in order to help get a visualization on esophagus

Back 27

Barium Swallow (upper GI)

Front 28

The most common GI disorder affecting more than 25-30% of all patients

Back 28

Gastroesophogael Reflex Disease

GERD

Front 29

Your PT is having an xray of the UPPER GI . this diagnostic test is knwon as

Back 29

Upper GI test

Front 30

The most common reason for Emergency response, especially in the aging, is usually just

Back 30

Pyrosis (Chest pain/heartburn)

Front 31

This is the best way to make a diagnosis. Your PT is having a procedure where a flexible tube runs through the upper small intestinal area (esophogus into stomach and the dudeodenum)

This is a 3 minute test that allows the doctor to look at Tissue - tissue samples can be taken and tested for H. Pylori. Also you can quarterize bleeding and dialiate strictures

Back 31

Endoscopy EGD

Front 32

Name some Nursing Diagnoses for GERD

Back 32

Acute and chronic pain
impaired swallowing
ineffective management of therapuetic regimen
risk for aspiration

Front 33

what is a precancerous condition in 15-20% of patients- continual irritation to esophagus. Cells and structures begin to change and cancer can result

Back 33

Barrett's esophagus

Front 34

When treating your PT with GERD - Explain how you would take care of him after meals.

Back 34

Symptoms of GERD are worse lying down , therefore a priority would be to elevate the Head of Bed and have him sleep in a LEFT recumbant position (lying on his left side)

Do not lie on stomach!

Front 35

Your PT wants to lie down after he has dinner, Because of his GERD condition, what do you tell him,

Back 35

The PT must remain upright for 3 hours PC (after meals)

Front 36

This will always cause constipation as well as a white -greyish stool

Back 36

Barium

Front 37

You must tell your PT some of the things that he/she has to eliminate because of GERD - What are they

Back 37

no smoking, alcohol

restrict spicy foods, acidic foods, chocolate, fat, mints, carbonated drinks.

Eat SLOWLY and CHEW FOOD WELL.

Front 38

Your patient diagnosed with GERD wants to lift weights in a gym when they go home, what do you tell them

Back 38

No straining , lifting or even wearing constricting clothing .

Front 39

If lifestyle changes for your PT do not work, then you must begin

Back 39

Drug Therapy

Front 40

What drug can be used to neutralize gastric secretion

Back 40

Antacids

Front 41

What reduces histamine stimulated acid secretions

Back 41

Histamine Receptor Antagonsits or

H2 blocker

Front 42

Explain to your PT how an H2 blocker works

Back 42

H2 blocker will block histamine receptors and stops body from producing ACID

Front 43

Tums, Malox, Mylanta , Amphogel are all examples used to help neutralize gastric secretions.

What classification drug are these?

Back 43

Antacids

Front 44

Ranitidine, Famotidine and Nizatidine are all classified as

Back 44

H2 BLOCKERS

Front 45

The suffix TIDINE will always be classified as a

Back 45

H2 BLOCKER

Front 46

Explain to your PT how Anatacids help neutralize gastric secretions

Back 46

Antacids are BASES combined with HCL to turn into a SALT in order to stop pain.

Front 47

If you decrease gastric secretions too much, what would occur

Back 47

Rebound Effect

Front 48

Name side effects of anatacids

Back 48

Diareeah, Constipation

Front 49

Your PT has Impaired Swallowing and Risk for aspiration - diagnose him

Back 49

GERD

Front 50

What works to produce ACID regardless of food

Back 50

Histamine

Front 51

What supress proton pump acid secretion?'

most common with food

Back 51

PPI - Proton Pump Inhibitors

Front 52

Omeprazole, Pantoprazole, Rabeprazole and Esomeprazole are all classified as

Back 52

PPI
Proton Pump Inhibitors

Front 53

What drugs increase gastric emptying (peristalsis)

Back 53

Prokinenetic drugs

Front 54

Your PT needs surgery to deal with his symptoms of GERD, what are his two options

Back 54

Endoscopic Therapy
Laparoscopic Surgery

Front 55

What is a break or alteration in mucosal barrier related to a decreased blood flow and EROSION to gastric mucosa, common in women

Back 55

PUD - Peptic Ulcer Disease

Front 56

Your PT has delayed gastric emptying - this could be due to a dysfunction of his

Back 56

pyloric sphincter , leading to
Peptic Ulcer Disease

Front 57

Decreasing ACID will INCREASE how fast stomach empties and this will protect the gastric mucosa

T/F

Back 57

TRUE

Front 58

The suffix PRAZOLE will always be classified as

Back 58

PPI
Proton Pump Inhibitors

Front 59

What is a strong ring of smooth muscle at the end of the pyloric canal and lets food pass from the stomach to the duodenum - This helps protect gastric mucosa as well

Back 59

Pyloric Sphincter

Front 60

Your PT has erosion of the gastric mucosa due to contents of food staying too long inside body, this leads to

Back 60

Peptic Ulcer Disease

Front 61

the incidence of Peptic Ulcer Disease is not known, although it occurs over the age of 50 - The reason for it being unknown is due to the fact that the disease is usually

Back 61

self-treated

Front 62

What is the major cause of Peptic Ulcer Disease due to the fact that it increases Vasoconstriction

Back 62

Alcohol ETOH Consumption

Front 63

drugs with analgesic, antipyretic and, in higher doses, anti-inflammatory effects - they reduce pain, fever and inflammation

(Aspirin)

Back 63

NSAIDS

Front 64

Your patient has an erosion of duodenal mucosa and increased acid secretion and gastric emptying - The gastric mucosa barrier is NORMAL (NO Gastereitis)

- He is showing symptoms of a

Back 64

Duodenal Ulcers

Front 65

Duodenals ulcers are on the outside and usually do not show any signs until bleeding

T/F

Back 65

TRUE

Front 66

A gram NEGATIVE bacteria that produces enzymes that cause tissue damage , common in underdeveloped countries.

Back 66

H. PYLORI

Front 67

Your patient is a smoker, caffeine drinker that is very stressed out and over the age of 50 years old - He most likely is a candidate to develop

Back 67

Peptic Ulcer Disease PUD

Front 68

Your PT is asymptomatic, meaning he is healthy and carries no sign of disease - can he still be carrying H. PYLORI

Back 68

YES

Front 69

80% of peptic ulcers, PT between age of 35-45 and smoker, ulcerogenic drugs(nsaids) and H. Pylori found in 95-100% of cases.

Your PT has

Back 69

Duodenal Ulcers

Front 70

What are an ulcerogenic medication that increases the risk of ulcers forming due to the irritation of GI tract

Back 70

NSAIDS

Front 71

The # 1 Major cause of ULCERS

90% DUODENAL
70-80% GASTRIC

Back 71

H. Pylori

Front 72

Explain to your PT how he can become a carrier of H. Pylori

Back 72

By not washing your hands

you can acquire H. Pylori via
oral-fecal, oral-oral
route of transmissions

Front 73

What is the age group for the best candidate to aquire H. Pylori?

Back 73

Over the age of 50
(75% )

Front 74

What happens when one aquires H. Pylori?

Back 74

Urease and Ammonia elevates
PH causing immune response

Front 75

a less frequent type of ulcer, acute gastric or duodenal erosion causing ischemia (tissue damage due to bloodsupply) and increased acid

Back 75

Stress Ulcers

Front 76

blood in stool that could be cause of duodenal ulcer

Back 76

melena

Front 77

the vomiting of blood. The source is generally the upper gastrointestinal tract - occurs along with nausea, vomiting with stress ulcers

Back 77

Hematemesis

Front 78

Gastric Stress Ulcers cause a weight GAIN OR LOSS?

Back 78

Gastric Stress - LOSS WEIGHT
(opposites)

Front 79

What occur in response to severe stress - Increases with hospital stay - Mortality Rate is 50% !

occurs from severe trauma, burns , illness causing shock, sepsis

Back 79

Stress Ulcers

Front 80

Duodenal ulcer cause a weight GAIN OR LOSS?

Back 80

Duodenal - GAIN

Front 81

To figure out where an ulcer is, what tests can you take?

Back 81

Barium swallow
EGD

Front 82

To find out how much bleeding you can check for the proportion of blood volume that is occupied by red blood cell or

Back 82

Hematocrit

Front 83

Hidden Blood in the stool is called

Back 83

Fecal Occult Blood Test

Front 84

what transfers oxygen from the lungs to the rest of body?

Back 84

Hemoglobin

Front 85

what is a blood test that can easily test for ulcers/h.pylori?

Back 85

IgG Serology

Front 86

a normal treatment that does not work and requires your PT to go to surgery is called

Back 86

Intractable Disease

Front 87

Your PT is in acute and chronic pain and can not be treated normally , must go to surgery - This is primary diagnosis for

Back 87

ULCERS

Front 88

15-25% of patients - have an altered GI tissue perfusion causing a

Back 88

hemmorage

Front 89

what is the FIRST thing you see when a hemmorage is happening

Back 89

INCREASE IN PULSE RATE

Front 90

Explain the physiology of a hemmorage

Back 90

PULSE INCREASES because body tries to compensate for blood volume
PULSE THEN GETS WEAKER
Then BLOOD PRESSURE DROPS
due to lack of circualtion
followed by SHOCK - loss of consciousness - death.

Front 91

what is a sudden painful hole in the stomach

Back 91

perforation

Front 92

what causes altered GI tissue perfusions?

Back 92

ineffective health maintanece
imbalanced nutrition
PYLORIC OBSTRUCTION

Front 93

what is obstruction at the level of the pylorus, which is the outlet of the stomach.

Back 93

gastric outlet syndrome
or
PYLORIC OBSTRUCTION

Front 94

Medications to deal with GI disturbances are

Back 94

Antacids
H2 Blockers
PPIs

Front 95

To deal with H. Pylori, an effective medication is to mix

Back 95

2 antibiotics with a PPI

Front 96

What increases the mucous production?

Back 96

Prostaglandin Analogues

ex) Misoprostol

Front 97

what stimulate mucous production

Back 97

Mucosal Barrier Fortifiers

ex) Sucralfate

Front 98

WHat decreases motility and gastric secretions

ex) dicyclomine, hyoscyamine

Back 98

anticholinergeics
decrease motility and gastric
secretions

Front 99

Surigcal procedure that cuts the vagus nerve to stop losing acid

Back 99

Vagotomy

Front 100

Surgical procedure in which the lower portion of the stomach, the pylorus, is cut and resutured, to relax the muscle and widen the opening into the intestine

used in gastric and peptic ulcer disease patients

Back 100

Pyloroplasty

Front 101

If you MUST take an NSAID you will also get what drug

Back 101

Prostoglandin Analogues

( MISOPROSTOL)

Front 102

the surgical creation of a connection between the stomach and the jejunum to allow food to bypass a broken duodenum.

Back 102

Gastroenterostomy
(a drain to bottom of stomach)

Front 103

what is it called when yo uremove anthrectomy of stomach and hook it to duodenal?

Back 103

billroth 1

Front 104

what is it called when you connect stomach to jejunum

Back 104

Billroth 2

Front 105

what is the most common effect of Billroth 1 and 2 surgery which happens when the lower end of the small intestine, the jejunum, fills too quickly with undigested food from the stomach

Back 105

dumping syndrome

Front 106

the patient has an NG tube to manage gastric dilitation during surgery for Antrectomy

T/F

Back 106

TRUE

Front 107

What is an intervention for a patient having surgery for eating

Back 107

Small meals, NO fluids with meals, LOW CARBS, lay down after meal

Front 108

nutritional management for patients having surgery is

Back 108

vitamin deficiencies such as B12 (Intrinsic factor) folic acid, iron, calcium, vitamin D

Front 109

is a form of megaloblastic anemia due to vitamin B12 deficiency, caused by impaired absorption of vitamin B-12[1] due to the absence of intrinsic factor[2] in the setting of atrophic gastritis, and more specifically of loss of gastric parietal cells.

Back 109

Pernicious Anemia

Front 110

Nausea, Vomiting, Hematemesis (vomiting blood), Melena (blood in stool) and weight loss or gain are all symptoms of

Back 110

stress ulcers