*321 Exam 4 (Gastritis & Pud P. 1-4)

Front 1

Gastritis
Can be acute or chronic
-what is it?
-what is it caused by?
-how is it treated?

Back 1

-Inflammation of the stomach mucosa

-Caused by drugs (ASA and NSAIDS), chemicals (ETOH, radiation, smoking), & stress

-Treated the same as an ulcer, but it’s not the same thing

Front 2

Gastritis

CM: asymptomatic to having GI symptoms

Back 2

-Indigestion
-Upper abdominal pain
-Nausea & Vomiting
-Decreased appetite
-Bloating
-Hematemesis
-Stools or emesis that is positive for occult blood
-Weight loss

Front 3

Gastritis

Diagnosis (3)

Back 3

EGD, gastric analysis: mostly it’s based on history and physical exam.

Front 4

Gastritis

Diagnosis
-what does the lab test show?
-what is an EGD

Back 4

-lab tests shows anemia
-Esophagogastroduodenoscopy (EGD) or upper endoscopy is a small flexible scope that is inserted through the mouth into the esophagus, stomach, and duodenum to visualize the upper digestive tract. This procedure allows for a biopsy, cauterization, removal of polyps, dilation, or diagnosis.

Front 5

Gastritis

Treatment:
Diet?

Back 5

Bland diet
-Small frequent meals and eat slowly
-Avoid foods and drugs that cause gastric irritation (ex: alcohol and caffeine)

Front 6

Gastritis

-what do you teach them to report? (3)

Back 6

n/v, constipation, bloody stools

Front 7

Gastritis

-monitor for signs of gastric bleeding, such as:

-what does their vomit look like
-what does their stool look like
-what happens to their BP
-what happens to their HR

Back 7

(coffee ground emesis, black tarry stools, hypotension, tachycardia)

Front 8

Gastritis drugs

-what is the problem with people if they take too many antacids?

Back 8

If people take too many antacids, they can develop electrolyte imbalances. Most meds need gastric acid to break down, so if you neutralize the acid, you may not absorb the drugs. Antacids don’t really heal, but they do symptom management.

Front 9

Gastritis drugs

-H2 receptor blockers such as Tagamet, Zantac, Pepsid

What is their action?

Back 9

Block histamine, which stimulates acid production

Front 10

Cytotec and Carafate/sultrafate are anti-ulcer agents

What is their mechanism of action?

Back 10

they form a coating over the ulcer which protects it. Forms a paste over it.

Front 11

Gastritis

Drugs to avoid: (3)

Back 11

NSAIDs (ASA & Ibuprofen) If ulcer has healed, they can take them again, but they should only take it if they really need to. Minimum dosage. With food.


-Avoid Coumadin or take with extreme caution. Doesn’t mean you can NEVER take them (coumadin prevents clotting and the pt with gastritis is already having inflammation and bleeding so this would potential a GI bleed)

-Steroids (stops prostaglandin synthesis)

Front 12

Risk factor
-Gastritis:

what is the most common cause of bacterial infections?

Back 12

Helicobacter pylori is the most common cause of a bacterial infection

Front 13

Gastritis

-what are some other risk factors?

Back 13

-ETOH
-Radiation
-Advanced age
-Smoking
-Caffeine
-Stress
-Exposure to contaminated food/H2O
-Autoimmune disease (lupus and rheumatoid arthritis)

Front 14

Complication of gastritis is what?

why?

Back 14

pernicious anemia


As the disease progresses, the walls and lining of the stomach thin and atrophy. With progressive gastric atrophy from chronic mucosal injury, the function of the parietal (acid secreting) cells decreases and the source of intrinsic factor is lost. The intrinsic factor is critical for absorption of vitamin B12.

Front 15

Peptic Ulcer Disease (PUD)

A peptic ulcer is what?

Back 15

an erosion of the mucosal lining of the stomach or duodenum

Front 16

Peptic Ulcer Disease (PUD)

-The mucous membranes of a peptic ulcer can become eroded to the point that the epithelium is exposed to gastric acid and pepsin, and can precipitate bleeding and perforation.
-Complete perforation that extends through all layers of the stomach can cause

Back 16

peritonitis

Front 17

Peptic Ulcer Disease (PUD)

An individual with a peptic ulcer has peptic ulcer disease (PUD)

True or false

Back 17

true

Front 18

what 3 things stimulate acid secretion?

Back 18

Protein rich meals, calcium, and vagus nerve excitation stimulate acid secretion

Front 19

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

-Pain on empty stomach: if you eat, the pain gets better

Back 19

duodenal ulcer

Front 20

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

Pain 30 minutes to 1 hour after eating

Back 20

Gastric ulcer

Front 21

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

-Pain exacerbated by food

Back 21

• Gastric ulcer

Front 22

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

-Pain occurs at night

Back 22

duodenal ulcer

Front 23

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

-Pain occurs in the upper epigastrium with localization to the left of the midline

Back 23

• Gastric ulcer

Front 24

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)


Weight gain

Back 24

duodenal ulcer

Front 25

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

-Pain 1.5 – 3 hrs after meal

Back 25

(Duodenal ulcer

Front 26

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

-Pain often occurs at night

Back 26

(Duodenal ulcer

Front 27

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

pain on empty stomach

Back 27

if you eat, the pain gets better


(Duodenal ulcer) - antacids help

Front 28

Peptic Ulcer Disease (PUD) (Duodenal ulcer or Gastric ulcer)

Pain is located to the right of the epigastrium

Back 28

(Duodenal ulcer

Front 29

What is the most definitive diagnosis of peptic ulcers?

Back 29

EGD

Front 30

-Esophagogastroduodenoscopy (EGD)

-pre procedure diet?
-tell me about the sedation?

Back 30

-NPO 6-8 hrs prior to procedure.
-conscious sedation;
- medication with lidocaine that is sprayed or gargled to numb the back of the throat to take away gag reflex.

Front 31

-Esophagogastroduodenoscopy (EGD)

-pre procedure, what do you inspect in their mouth and what do you tell them they will have placed in their mouth?

Back 31

-If they have dentures in, take them out.
-Make sure they don’t have any loose teeth.
-They will have a bite block put in – round piece of plastic with hole in the middle to keep from biting down on the scope.

Front 32

-Esophagogastroduodenoscopy (EGD)

-Is the patient positioned on the left or right side?

Back 32

-Person will usually be on their left side.

Front 33

-Esophagogastroduodenoscopy (EGD)

-what 2 things do you have to have ready at the bedside because you are taking away their gag reflex?

Back 33

-Oxygen & suction ready because you have taken away their gag reflex.

Front 34

-Esophagogastroduodenoscopy (EGD)

-Post procedure: what is the most important to thing

Back 34

watch for gag reflex to return to prevent aspiration

Front 35

- Avoid taking bismuth (pepto-bismol), histamine 2 agonsists, misoprotol, sucralfate prior to EGD, why?

Back 35

because they can interfere with testing for H. pylori and cause false negatives.

Front 36

EGD & PUD

-H/H?

Back 36

H/H (low from bleeding)

RBC: men 4.5-5.3; women 4.1-5.1
Hematocrit: men 37-49%; women 36-46%
Hemoglobin: men 13-18; women12-16

Front 37

PUD

-Tell me about their pain
-where is it located?
-what may indicate perforation of an ulcer?

Back 37

Epigastric pain upon palpation. Pain that radiates to the back may indicate perforation is imminent

Front 38

PUD
-tell me about their vomit and stool?

Back 38

Bloody emesis or bloody stools (melena) is not good

Front 39

what is the most commonly reported CM with PUD?

Back 39

Dyspepsia (indigestion) which is discomfort in the epigastric or upper abdomen
- It is usually described as sharp, burning or gnawing.

Front 40

When you have a bleed, often times the n/v is from what?

Back 40

the blood breaking down and iron sitting in your stomach

Front 41

Complications of PUD:

-this is a medical emergency
-what is a CM of this complication?

Back 41

Hemorrhage – medical emergency (CM is hematemesis or coffee ground blood)

Front 42

Complications of PUD:

Perforation can result if the ulcer becomes so deep that the entire thickness of the stomach is worn away. The stomach contents then leak into the peritoneal cavity.
-CM, tell me about pain?
-what position will the pt be in?
-what will their abdomen feel like?

Back 42

-Sudden, sharp pain begins in the midepigastric region and spreads over the abdomen
-The pt assumes a fetal position (knee to chest) to decease the tension on the abdominal muscles.
-
-The pts abdomen will be rigid and boardlike accompanied by rebound tenderness

Front 43

Complications of PUD:

-what 2 complications can result from peritonitis

Back 43

Bacterial septicemia and hypovolemic shock can develop

Front 44

Complications of PUD:


Pyloric Obstruction- can result which is manifested by

Back 44

vomiting caused by stasis and gastric dilation.

Front 45

Vomiting causes what acid base imbalance?
NG tube can cause what acid base imbalance?



Diarrhea causes what acid base imbalance?

Back 45

metabolic alkalosis
metabolic alkalosis



metabolic acidosis

Front 46

Treatment - Reduce acid –

what is the drug of choice for PUD?

Back 46

(PPI are the drug of choice)

Front 47

PUD

Antibiotics: Flagyl, amoxicillin, bismuth (pepto-bismol), tetracycline = may be given for what reason?

Back 47

eliminate H. pylori infection, may need 2-3 different antibiotics.

Front 48

H2 antagonists such as Ranitidine hydrochloride (Zantac) and famotidine (Pepcide) are used in conjunction with antibiotics to treat what?

Back 48

ulcers caused by H. pylori to suppress the secretion of gastric acid by blocking H2 receptor cells in the lining of the stomach.

Front 49

Diet for PUD – eliminate irritating foods/beverages such as:

Back 49

(ETOH, caffeine, carbonated drinks), citrus, mints, onions, fatty meals, chocolate, tomatoes, spicy, pepper

Front 50

PUD
-Surgery is done if there is no response to medication

-what is a Vagotomy
-what is a Pyloroplasty

Back 50

Vagotomy: the branches of the vagus nerve that supply the stomach are cut to disrupt acid production

Pyloroplasty: the opening between the stomach and small intestine is enlarged to increase the rate of gastric emptying

Front 51

Prevention for PUD- avoid NSAIDS such as ASA and Ibuprofen. Why?

Back 51

They break down the mucosal barrier and disrupt the
mucosal protection mediated by cox inhibition.

Front 52

Prevention for PUD
-diet

avoid what type of food which stimulates acid production?

Back 52

-avoid caffeine, tea, cola, alcohol, and tobacco because they stimulates acid production

Front 53

Prevention for PUD
-diet

what do you teach them about snacks?

Back 53

-avoid bed time snacks because they stimulate acid secretion

Front 54

What is Morrhaute?

Back 54

Sclerosing agent that causes scaring (for people with bleeding ulcers); can also inject epinephrine (vasoconstrictor)

Front 55

-Dumping syndrome:
is a complication of gastric surgery that consists of vasomotor symptoms occurring in response to what?

Back 55

food ingestion

Front 56

-Dumping syndrome:

Symptoms result from what?

Back 56

the rapid emptying of gastric contents into the small intestine. In response to this, the small intestine pulls fluid from the extracellular space to convert the hypertonic fluid to an isotonic fluid.

Front 57

-Dumping syndrome:

CM: This fluid shift causes a decrease in circulating volume, resulting in vasomotor symptoms such as:

Back 57

syncope, pallor, palpitations, dizziness, headache

Front 58

-Dumping syndrome:

What position do you assist the patient do when they have these CM occur?

Back 58

- Assist client to lie down when those s/s occur because it slows the movement of food within the intestines

Front 59

- Treatment for dumping syndrome:

-what do you tell them about meals (2)

-what should their diet consist of?

Back 59

-lie down after meals, no liquids with meals,

eat high protein, high fat, low fiber, low carbs

Front 60

- Treatment for dumping syndrome:

how often should you tell them to eat?

Back 60

-small frequent meals rather than large ones

Front 61

- Treatment for dumping syndrome:

what foods do you teach them to avoid? 3

Back 61

-avoid milk, sweets, or sugars (fruit juice, milk shakes, honey, syrup, jelly)

Front 62

what poses the greatest risk for dumping syndrome?

Back 62

-gastric surgery, especially gastrojejunostomy