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107 Cards in this Set
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- 3rd side (hint)
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what is the most common kind of ulcer, 80% of ulcers
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duodenol ulcer
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close to pylorus, funnel shaped lesions extends into muscularis layer
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what is the most common kind of ulcer, 80% of ulcers
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duodenol ulcer
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close to pylorus, funnel shaped lesions extends into muscularis layer
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What is PUD
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break in mucosal wall of the stomach, pylorus or duodenum
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gastric ulcer- 15%
duodenal ulcer- 80% |
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what is the pylorus
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opening between the stomach and the duodenum
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duodenol ulcers occur here
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duodenol ulcer
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funnel shaped lesion extending into muscularis layer
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-pyloric region
-30 to 45 yrs old -blood type O -increased acid secretion |
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Duodenal Ulcer: Associated Diseases
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Alcoholic, cirrhosis, COPD, renal failure, chronic pancreatitis
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heliobactor: present in 100%
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Gastric Ulcer: Associated Diseases
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Increase with stress ulcers, after major trauma or emotional stress
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heliobactor: present in 60-80%
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Duodenal Ulcer: Family History?
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YES, family Hx
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30-45 yrs:peak age
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Gastric Ulcer:Family History?
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NO, no family Hx
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50-60yrs:peak age
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Duodenal Ulcer:peak age
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30-45 yrs:peak age
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YES, family Hx
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Gastric Ulcer:location, acid
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antral region & lesser curvature
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acid secretion: normal to less
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Duodenal Ulcer:location, acid
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pyloric region
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acid secretion: increased
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Duodenal ulcer: pain occurs when?
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pain occurs when? 2-3 hours after meal, ingestion of food relieves pain, Awakens @ night
hemorrhage - / melena |
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Gastric Ulcer: pain occurs when?
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pain occurs when?- 30min-1 hour after meal; no pain @ night; relief by vomiting; hemorrhage +/ hematemisis
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PUD tests
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s&s, endoscopy, upper gi series, EGD, test for heliobactor pylori
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treatment for PUD (nonsurgical)
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medical: same as GERD
Pharm: *treat for H. Pylori *PPInhibitor- Prevacid, Prilosec, Aciphex *Antiobotic 10-14 days- Flagly, Amoxil, Biaxin |
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Diet for PUD
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same as GERD
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Duodenal Ulcer Incidence- male to female
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2-3:1
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Gastric Ulcer Incidence- male to female
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1:1
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PUD surgical treatment
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Vagotomy (w or w/o pyloroplasty)
Antrectomy Subtotal Gastrectomy Biliroth removal |
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Vagotomy
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PUD t/x surgery: severing vagus nerve (-) gastric acid/ parietal cells less responsive to gastrin;
problems: fullness, dumping syndrome, diarrhea, gastritis |
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Antrectomy
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removal of part of stomach that contains gastrin secreting cells and small part of duodenum and pylorus; problems: fullness, dumping syn. diarrhea
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pyloroplasty
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assists with gastric emptying. adjunct to Vagotomy.
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Biliroth I
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removal of distal half of the stomach w/anastomosis to the duodenum
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Biliroth II
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removal of distal portion of the stomach w/anastomosis to the proximal jejunum
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PUD surgery post op N.I
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post-op: observe site- excess drainage, hemorrhage, gastric distension, NV, pulm prob, F/E, monitor bowel sounds
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PUD surgery pre op N.I
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pre-op teaching ex. reason for NG tube, IV line, DB, splinting, coughing
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PUD surgery DIscharge teaching
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diet, meds, activity, stress mgmnt, F/U appts
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Gastric Cancer Causes
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*dietary exposure (nitrate preserved foods (smoked/pickled), salt, fat)
*environmental- metal/ chemical industry *other exposure- peptic ulcer, polyps, pern anemia, H pylori infection *genetic- Fam Hx, Type A blood |
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2 types of Gastric cancer
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* Diffuse
*Intestinal |
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Diffuse Gastric Cancer
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more common in women; poorly differentiated tumor cells; "leather bottle" appearance
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typical p/t w/ Gastric Cancer
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non-white (N.A, HA, AA are twice as likely), male, btwn 40-70 yrs
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Gastric Cancer Assessment
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-Loss of weight
-Dyspepsia (indigestion) -Can't eat full meal -Change in Eating habits -decrease app/ nausea -chronic bleeding-->guiac stool -Hx of H. pylori -Hx of smoking/ ETOH abuse |
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Labs for Gastric Cancer
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-presence of lactic acid
-increased LDH in Gastric juice |
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Dx for Gastric Cancer
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-biopsy: esophagogastroduodenoscopy
-CT exam for staging -Uper GI Series and endoscopy |
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Dumping Syndrome: what is it?
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rapid emptying of the stomach contents into the small intestines causing sweating, weakness, diarrhea
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Describe how Osmolality >300 can cause Dumping Syndrome
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large amounts of fluid/water-->to stomach & sm. Intestines from organs & vasc. compartmnts: fullness, nausea, diarrhea/ dehydration, Hypotension, tachycardia
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deficiency in Vitamin B12, caused by DUmping Syndrome or dietary presents with these symptoms
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numbness, tingling in hands or feet
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Gastric Cancer: Medical Intervention
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-TPN->> Central line
-small frequent meals -pain control |
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Gastric Cancer: Surgical Intervention
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-Gastric resection
-Partial Gastrectomy Billroth I -Billroth II (gastrojejunostomy) -Total gastrectomy |
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Total Gastrectomy causes what?
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removal of the stomach = pernicious anema
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Gastric Cancer: Complications of surgery
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*Iron loss, increase/decrease vit B12
*Vita, Mineral deficiencies *s&s *postop hemmorrhage (monitor S&s for blood loss) *dumping S (after eating foods high in CHO/electrolyes |
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S&S of Gastric Surgery (dumping syndrome)
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dizziness, weakness, diaphoresis, cramps, vasomotor symptoms (pallor, palpitations, HA, feeling warm, nauseated
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Gastric Cancer P/O complications:
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hemorrhage, intestinal obstruction, anastomatic leaks, infection, peritonitis
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Benign tumors of mouth
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Lipomas, Neurofibromas
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premalignant tumors of mouth
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leukoplakia, erythroplakia
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leukoplakia
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precancerous, yellow-white or grey lesion <25 malignant
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erythroplakia
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red velvety appearing patch; indicates early squamous cell carcinoma; 50-60 yrs of age
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Malignant tumors:Medical management
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*Radiation T/x
*Interstitial Radiation T/x *Chemotherapy (if advanced) |
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Radiation T/x
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external beam therapy or interstitial thereapy passes through the skin or mucous membrane to tumor
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Interstitial radiation T/x
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involves implanting radioactive seeds used for small lesions that haven't infiltrated surrounding tissue
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chemotherapy
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if cancer is advanced
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Cancer of Esophagus: S&S
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-Dysphagia
-Odynophagia -increases salivation -mucous in throat -regurgitation -can't swallow liquids/food |
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Odynophagia
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pain on swallowing
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Cancer of Esophagus:Test Ordered
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Upper Gi endoscopy, Barium Swallow, CT scans, cytology exams & biopsy
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Cancer of Esophagus:T/x
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*Radiation T/x
*Chemotherapy *Total Resection of esophagus *esophagectomy |
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Malignant Tumor in Mouth: Nursing Intervention
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*meticulous oral care with 1/2 h202 ( hydrogen peroxide)
*semifowlers- lymph drainage *patent airway- pulse ox/suction *monitor beeding- 1<jp |
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Cancer of Esophagus: Diet
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no caffeine, no carbonation, avoid eating 2-3 hours before bedtime
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electrolytes depleted r/t Dumping Syndrome
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K+ (potassium) Na (sodium)
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what IV is given for dumping syndrome ( k + or Na depletion)
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3% NS
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electrolytes depleted r/t Dumping Syndrome
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K+ (potassium) Na (sodium)
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what IV is given for dumping syndrome ( k + or Na depletion)
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3% NS hypertonic
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What labs findings show Gastric Cancer
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LACTIC ACID & increased LDH in gastric juice
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What is Pernicious Anemia
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Decrease in red blood cells because body can't absorb B12 (absorbed in Ileum), or lack of B12.
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Why is Pernicious Anemia a complication of a partial or total Gastrectomy?
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Pernicious Anemia is caused by lack of Vitamin B12. Intrinsic factor, produced by parietal cells of gastric mucosa, is necessary for B12 absorption.
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What is hemopoietic factor?
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combination of b12 and intrinsic factor
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Medical Interventions for Gastric Cancer
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small freq meals w/supplements
TPN- CENTRAL LINE pain control; Surgery; radiation or chemo |
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Empyema
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gall bladder with pus
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acute cholecystitis
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90% associated with gall stones
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cholelithiasis
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presence of gallstones
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pain in what quadrant is commonly r/t cholecystitis
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RUQ
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what factors are associated with cholecystitis and cholelithiasis?
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5 F's Fat, Fertile, Female, Forty, Fair
Diabetes, Obesity, Chrohn's, cirrhosis Pima women- 75% over 25 whites 2x than blacks (U.S) |
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Alkaline phosphate (ALP)
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42-136 u/L
enzyme produced in liver and bone -if elevated: OBD; or other bone/liver disease |
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Cholesterol (lipoprotein)
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normal level: below 200 mg/dl
synthesized in liver to form bile salts if greater: artherosclerosis; DM; biliary cirrhosis |
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Ammonia
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15-45 mcg/dl
-byproduct of protein (by liver)->> urea excreted by kidneys -if high, hepatic failure, coma |
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Treatment for high Ammonia (NH4)
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low protein diet, neomycin, Lactulose, Magnesium Sulphate
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ALT Alanine Aminotransferase
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10-35 u/L
if high: acute viral hep, hepatocellular destruction, ETOH |
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AST Apartate Aminotransferase
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8-38 u/L
-exercise -liver damage |
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common complications of partial or total gastric resection
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1. dumping syndrome
2.hemorrhage 3. pneumonia 4. pernicious anemia |
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gastric bypass nursing plan
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foods rich in calcium
high protein diet (exits stomach slowly) vitamin B12 shots increase fluids (bc of DS) |
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High Protein Diets are prescribed with these diseases/procedures
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Pancreatitis
Gastrectomies Chron's |
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Low Protein Diet prescribed if:
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Liver Failure
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Contraindicated in Cholecystitis but prescribed for Pancreatitis
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Morphine
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+HIDA
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screening for Cholelithiasis (along with Ultrasound)
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5f's
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Cholecystitis
Cholelithiasis |
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Pima N.A women 75% over age 25
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Cholelithiasis
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cardinal symptom-pain after eating fat
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cholecystitis
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+ Murphy's sign
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Cholecystitis
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Labs to check Cholecystitis
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Alkaline Phosphate; Serum direct bilirubin
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where does pain begin in pancreatitis
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mid-epigastrium, radiates to back
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Labs for Pancreatitis
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Serum Lipase (15-280 iu/L)
mild azotemia (BUN) |
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diseases of spleen
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mono, malraia, ITP idiopathis thrombocytopenia purpura, splenomegaly
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Hemolytic Uremic Syndrome
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10% of e. coli infected develop it
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TPN glucose and Amino Acid percentage
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glucose-50 % in 500ccs
amino acids - 8.5 % in 500 ccs |
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Each liter of TPN provides how many calories?
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1000 cal= 6 g of nitrogen
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Intralipids
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white solution and fat emulsion, isotonic
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how often do you accucheck if TPN
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AT LEAST Every 12 hours, every 6 hours more common
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How often do you change tubing for TPN
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every 24 hours
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How often do you change dressing site for TPN
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every 3 to 5 days
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Labs for Gastric Cancer
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high lactic acid and LDH in gastric juice
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what med for Cancer of Esophagus
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Calcium Channel Blockers- reduce spasms
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symptoms of hiatal hernia
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heartburn 30-60 min after meals
gerd acid regurg(water brash) salty spit, eructation (belching) |
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Pain in Left Lower Quadrant
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Ulcerative Colitis
Diverticulitis |
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Toxic Megacolon
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Ulcerative colitis- extreme dilation of colon
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spans entire length of colon
involves only mucosa and sub mucosa sigmoid and descending colon |
Ulcerative colitis areas
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may skip segments of alimentary tract, common location:terminal ileum. involves entire thickness
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Chron's disease
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liver labs
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1. ALT > 10-35 u/L
2. AST > 8-38 u/L (exercise increases levels) 3. Ammonia > 15-45 mcg/dL |
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