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72 Cards in this Set
- Front
- Back
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Pyrosis?
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heart burn
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Water brush?
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regurgitation/ salavia
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Dyarthia?
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stroke
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Melena?
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black-tary stool
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Define HH?
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portion of stomach herniates through the diaphragm & into thorax
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List the characteristics of HH?
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congenital weakness, aging, trauma, increased intra-ab pressure, GERD
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Name the contributing factors of increased intra-ab pressure?
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lifting heavy objects, coughing, vomiting, obesity, pregnancy
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What is the most common type of HH?
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sliding (direct) 90%: slides into esophagus
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Describe the type of HH that occurs 10% of the time?
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Paraesophageal (indirect or rolling): part of stomach protrudes into diaphragm
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GERD?
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Gastric esophageal reflux dz- functional dz w primary symptom being heartburn. Caused by excess gastric fluids in stomach
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What is the treatment for GERD?
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same as for HH except surgery
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What is the most common co-morbid illness w/GERD?
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asthma (airway big problem)
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GERD presents:
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reflux, heart burn, mimics chest pain, affects sleeping, asymptomatic early morning cough
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When do symptoms occur in HH patients?
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when lower esophageal sphincter becomes incompetent
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S/S of HH?
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gastric reflux, heart burn, full feeling, substernal pain, chest pain, regurg, dysphagia, painful swallowing, beltching
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Best diagnostic test for HH?
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Barium swallow with fluoroscopy
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What is the objective of surgical intervention- Nissen Fundoplication- for HH?
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restore gastroesophageal integrity & prevent Gastric reflux by reinforcement of sphincter muscle
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Name 3 lifestyle changes that need to be encouraged for HH patients?
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smoking cessation, loose weight, don't perform activities that increase ab pressure
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Medications include antacids, H2 receptor blockers, and proton pump inhibitors- How do antacids work?
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neautralize & reduce stomach acid. SHORT ACTING- take only if in pain
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H2 receptor blocker?
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partially block stomach acid by inhibiting action of histamine- last up to 12 hours
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Proton pump inhibitors?
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inhibits stomach acid by deactivating acid pumps in stomach cells that produce acid (LONG LASTING 24 hours)
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Nursing interventions in reference to diet?
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eat small frequent meals. avoid chocolate, caffeine, citrus fruits, tomato products, fatty foods, ETOH, tobacco products, drinking w/ meals to limit volume in the stomach
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Nursing intervention during & after meals?
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maintain upright position
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What is used to avoid regurgitation during sleeping?
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blocks or bricks to elevate hob
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END OF HH
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GASTROENTERITIS/ GASTRITIS
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Define gastroenteritis?
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inflammation of lining of stomach & intestines
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What are 2 main causes of gastroenteritis?
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dz/ influenza, food poisoning
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S/S of gastroenteritis?
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diarrhea, borborygmi: hyperactive bowel sounds
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Tx for gastroenteritis?
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diet: liquids w/ gradual introduction of bland
High pro low cal, low fat, low bulk IV fluids to tx electrolyte loss |
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Gastritis?
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inflammation of stomach, either acute or chronic
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ACUTE gastritis is a short-lived inflammatory process involving?
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erosion of mucosa
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Name the common drugs & circumstances associated with acute gastritis?
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aspiring, anti-inflammatory agents, corticosteroids, alcohol, & stress
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What is the most common cause of acute superficial gastritis?
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alcohol
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What are a form of acute gastritis?
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stress ulcers
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Name the bacterial/ viral infections that cause chronic gastritis?
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Helicobacter pylori & Campylobacter pylori
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S/S of gastritis?
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anorexia, N/V, epigastric fullness, belching, vague epigastric pain, intolerance of spicy or fatty food
dehydration pernicious anemia |
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When is diarrhea & cramps seen in gastritis?
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When gastritis is caused by an infection
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How can pernicious anemia occur in gastritis patients?
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With loss of intrinsic factors - Vit B12 can no be absorbed--> resulting in pernicious anemia. Pt will experience fatigue & neurological problems
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What does tx look for the Helicobacter pylori that is associated with persistent stomach inflammation (chronic superficial gastritis), peptic ulcer disease, neoplasms?
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tx 1-2 week course of a triple therapy antibiotic consisting of 2 anti-infective agents
[clarithromycin (Biaxin) or amoxicillin & metronidazole (flagyl) & proton pump inhibitor |
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What vaccine is being tested to prevent disorders w H. Pylori?
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vaccine Helivax
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What is the aim of medical therapies for gastritis?
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alleviated symptoms (ASA- anti-inflammatory agents)
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Discomfort of gastritis can be lessened with:
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avoidance of foods that cause symptoms (ETOH, caffeine, smoking), bland foods, small frequent meals
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What are the 2 noninvasive tests used to determine H Pylori?
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1.) urea breath test 2. )serology for immunoglobulin G antibodies to H pylori antigens in the serum [amount of Co2)
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End of Gastritis
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Beginning of Peptic Ulcer DZ
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Peptic Ulcer Dz?
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ulcerations that penetrate the mucous membrane or deeper structures of GI tract
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Peptic ulcers are most often caused by?
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1. inflammation 2. gastric secretions which cause low pH (acid)
3. mucosal damage |
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Where are the majority of peptic ulcers found?
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80% found in duodenum
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True or false. Male clients , ages 50-70, lower socio-economic class, & malnoursihed are more likely to have GASTRIC ulcers?
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true
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What patients are more likely to have duodeal ulcers?
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male(3:1), 30-50, executives, competitive leaders, & well-nourished
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Name the complications of peptic ulcers?
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hemorrhage, perforation, pyloric/duodenal obstruction
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Name the bacteria involved in Peptic Ulcer diseases?
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H Pylori & C Pylori
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Duodenal ulcers are caused by?
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hyper secretion of gastric acids
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Gastric ulcers are caused by?
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breakdown in body's protective mechanisms--> inhibition of prostaglandin production caused by NSAIDs, alcohol, cigarette smoking
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Why do alcohol & smoking increase ulcers/
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they stimulate acid production
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Aspirin is often related to?
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mucosal damage & suppressed mucous secretion
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Emotional stress (especially w clients taking steroids) increases gastric motility by way of thalamus stimulation to the vagal nerves.. Describe this pathophysiologically?
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Under stress, SNS causes blood vessels in duodenum to constrict, makes mucosa more vulnerable to trauma from gastric acid & peptic secretion--> stress ulcer
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Stress ulcers are asymptomatic until?
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they produce massive hematemesis & rectal bleeding
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Why are smokers twice as likely to develop ulcers?
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nicotine decreases pressure of pyloric sphincter, allowing a reflux of duodenal juices into stomach
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Classic S/S of peptic ulcers?
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dull pain in mid-epigastrium or back
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S/S of a perforated ulcer?
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sudden, severe, sharp ab pain. (boardlike abdomen w no bowel tones) that increases w intensity
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What is often heard w diarrhea or early bowel obstruction?
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borborygmi (high pitched bowel tones)
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With a gastric ulcer, when does pain occur and how is it relieved?
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Pain on an empty stomach or shortly after a meal, relieved by antacids or vomiting
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Is vomitting common with gastric or duodenal ulcers?
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gastric
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When does pain occur in duodenal ulcers?
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1 to 2 hours after meals & at night. Absent before breakfast, but worsens as day progresses.
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What relieves duodenal ulcer pain?
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ingestion of food, antacids, or vomitting (though its uncommon)
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The ingestion of what increases duodenal ulcer pain?
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coffee, aspirin, alcohol
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Can either gastric or duodenal ulcers be asymptomatic?
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yes, both
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Name the 3 most common diagnostic test for ulcers?
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Barium swallow, GI endoscopy, H & H
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Treatment for Ulcers?
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ABX if caused by H Pylori, provide mucosal barrier, stress management
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What drug provides a mucosal barrier?
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Carafate (sucralfate)--> binds to ulcer, creates a barrier in addition to stimulating prostaglandin release
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What type of diet is encouraged for ulcer patients?
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no specific diet. Avoid meals that overdistend stomach & foods that cause GI distress. Small frequent meals
Limit milk to 1 glass/ day |
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What agents that decrease mucosal resistance & induce damage should be removed?
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alcohol, salicylates, corticosteroids, NSAIDs, caffeine, cigarette smoking
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