Upper Gi

Front 1

Barium swallow Use, Prep and post

Back 1

Use: detects structural changes in esophagus, stomach, and duodenum
prep: NPO
post: fluids/laxatives, assess for white chalk barium passage (otherwise can cause constipation)

Front 2

Barium enema Use, Prep, and post

Back 2

Use: detect anatomic change in lower GI tract
Prep: Clear liquids, NPO, bowel prepe- golyteley etc. (same as colonoscopy)
Post: fluids/laxatives, assess for passage of contrast barium

Front 3

Abdominal ultrasound use, prep, and post

Back 3

Use: detect solid masses or cysts, abdominal ascites
Prep: NPO 8-12hrs before
Post: none

Front 4

Gallbladder ultrasound use, prep, post

Back 4

Use: detect masses, cysts, tumors and cirrhosis of liver and biliary tract
Prep: NPO 8-12 hrs before
Post: no special care

Front 5

Esophagogastroduodenoscopy (EGD) use, prep, post

Back 5

Use: DIRECT visualization of mucosal lining of esophagus, stomach and duodenum, ABILITY TO PERFORM BIOPSY, gastric sampling
- Sclerotherapy done if esophogeal varices

Prep: NPO 8-12hrs before SIGNED CONSENT (MAY ALSO HAVE CONSENT FOR BIOPSY, ETC.) prep med, SEDATION DURING PROCEDURE

Post: NPO UNTIL GAG RETURNS, post procedure recovery (monitor vitals 15 min to start), assess for bleeding if biopsy (vomiting blood or dark stool since its from upper GI)

Front 6

Colonoscopy and Proctosigmoidoscopy use, prep, post

Back 6

Use: direct visualization of mucousal lining of colon to ileocecal valve (irritable bowel, diverticulitis, polyps) vs sigmoid colon and rectum only

Prep: Clear liquids 1-2 days before prep, NPO 8-12h before, signed release and preop meds, SEDATION during procedure

Front 7

Capsule Endoscopy use, prep, post

Back 7

Use: images of stomach, small intestine
Prep: NPO 8-12h until 4 h after swallow
Post: patient passes capsule in bowel movement, images downloaded

Front 8

Percutaneous cholangiography

Back 8

- gallbladder
Use: local anesthesia entered with needle under fluoroscopy--radiopaque contrast injected to assess filling of hepatic ad biliary duct filling

Prep: NPO

Post: Assess for hemorrhage or BILE LEAKAGE (liver is one of the most vascular organs in body- watch vitals, bruising hur spreading in that are of abdomen)

Front 9

Computer tomography (CT scan)

Back 9

may have contrast dye (check for iodine allergy)
- assess renal function (kidneys must be working for dye), monitor labs and check allergy to shellfish

Front 10

Magnetic Resonance Imaging

Back 10

- IV contrast may be used
- Use caution with metal implants (pacemaker, joint replacements, automatic defibrillator device, shrapnel)

Front 11

Nuclear imaging scans (scintography)

Back 11

Use: radioactive isotope introduced into pt
- gastric emptying- egg/liquid used to assess ability of stomach to empty
- hepatobiliary (HIDA)- IV injection to assess distribution into liver, biliary tree, gallbladder, small bowek
- GI bleeding- pt's RBCs injected to assess GI bleeding

Prep: substance contain little or no radioactivity

Post: none

Front 12

serum amylase

Back 12

pancreatic disease (made in mouth and pancreas)

Front 13

serum lipase

Back 13

pancreatic disease
**most specific**

Front 14

serum protein levels

Back 14

may be low in liver disease and in malnutrition

Front 15

Diet modifications for occult blood test

Back 15

NO:
- red meat
- poulty
- fish
- raw vegetables
- Vitamin C
- Aspirin (or any anti platelet factor)
- Ibuprofen
- Anticoagulants

Front 16

Sympathetic activation before vomiting signs

Back 16

tachycardia, tachypnea, diaphoresis

Front 17

Acid/Base from vomiting and diarrhea

Back 17

metabolic alkalosis from losing too much hydrochloric acid from vomiting

metabolica acidosis from losing bicarb in diarrhea

Front 18

characteristics of emesis

Back 18

- fecal odor and bile- fecal obstruction below thepylorus
- partially digested food several hrs after a meal- gastric outlet obstruction or delayed gastric emptying
- bile- obstruction below the ampulla vater
- bright red blood- esophogeal or Mallory Weiss tear (can be from vomiting), esophogeal varices, duodenal or gastric ulcer, or neoplasm
- early morning- pregnancy
- emotional stressors with no evident pathologic disorder may elicit vomiting during or immediately after eating
coffee grounds- stomach and lower GI

Front 19

Vomiting, regurg, projectile

Back 19

Regurg- effortless process in which partially digested food slowly comes up from the stomach. Retching or vomiting rarely occurs before it.

Projectile vomiting: forceful expansion of stomach contents without nausea and is characteristic of CNS (brain and spinal cord) tumors and may accompany obstructive disorders, possible stricture or scaring from weight loss surgery, etc.

Front 20

Phenothiazines (Phenergan, Compazine)

Back 20

makes us sleepy, a good thing unless impaired mental status and could aspirate

Front 21

Anticholinergics (Scopalamine)

Back 21

- nausea pathces
- blocks SLUD
- proble if pt has a problem with defecation or urination

Front 22

Antihistamines

Back 22

Dramamine, Phenergan

Front 23

Prokinetic drugs

Back 23

Reglan
- can cause extrapyramidal reactions

Front 24

Seratonine antagonists

Back 24

Zofran

Front 25

Butyrophenone

Back 25

Inapsine

Front 26

Dexamethasone/Decardon

Back 26

chemo induced nausea
- combined with zofran commonly

Front 27

Dronabinol

Back 27

Marinol/ Marijuana

Front 28

N/V care

Back 28

- IV fluids to replace F&E and glucose
- NG tube suction to decompress if vomiting severe or related to obstruction

- Clear liquids start first
- 5-15mL every 15-20 mion
- no extremely hot or cold liquids (no ice water or hot tea, tepid is better)
- Room temp carbonated beverages without carbonation is ok
**Use gatorade, broth with caution in CHF/renal pts due to high sodium content
- warm tea ok
- may advance slowly to dry toast and crackers
- advance to high carbs, low fat next (easier to digest)-- baked potato, plain gelatin, sereal
- eat slowly and in small amounts
- fluids between meals (instead of with meals) to avoid overdistention
- dietition may be helpful with appropriate food with adequate nutritional value

Front 29

Acute Interventions for N/V

Back 29

- usually managed at home
- persistent vomiting will need hospitalization with IV fluids and NPO status
- record I&O and daily weights
- Monitor VS--BP DROP WHEN STANDING = ORTHOSTASIS/TANK EMPTY
- Assess for dehydration (babies and older adults can't use turgur, monitor BUN, creatinine, over 20 BUN = dehydration)
- maintain quiet, oder-free environment

Front 30

Hiatal Hernia

Back 30

Herniation or perfusion of stomach into esophagus through an opening in the diaphragm

Types:
- Sliding- most common, slides through diaphragm
- Paraesophageal or rolling- esophagogastric junction in normal position, Fundus rolls up through diaphragm

Front 31

Risk for hiatal Hernia

Back 31

- cause unknown, possible increase in abdominal pressure (obesity, Pregnancy, Ascites, Tumor, Heavy lifting, trauma, congenital

Front 32

Clinical manifestations of hiatal hernia

Back 32

- after meals
- lying supine
- relieved with sitting or standing- bed needs to be elevated
- pain with bending
- pain with large meals, alcohol and smoking
-NOCTURNAL heartburn
Dysphagia or burning in thoat

Front 33

Tx of hiatal hernia

Back 33

Conservative
- eliminate constrictive garments
- Avoid lifting and straining
- Eliminate smoking and ETOH
- Antacids and antisecretory medications (H2 blockers)
- Weight loss

Surgery (avoided if possible)

Front 34

GERD

Back 34

not a disease, a syndrome

Front 35

Degree of inflammation from GERD depends on:

Back 35

- Amount and composition of gastric reflux
- Ability of esophagus to clear the acidic contents
- Most pts experience NO mucosal damage

Front 36

Clinical Manifestations of GERD

Back 36

- Heartburn (most common manifestation, burning or tightness felt beneath the lowere sternum and spreads upward to throat or jaw, intermittent, and relieved with milk, alkaline substances, or water)
- accoring more than once a week
- rated as severe
- occurring at night and wakes patient

- Dyspepsia (pain or discomfort centered in upper abdomen)
- Hypersalvation
- Noncardiac chest pain (more common in older adults)

My also report:
- Wheezing )may induce asthma symptoms from aspiratin acid)
- coughing
- dyspnea
- hoarseness
- sore throat
- lump in throat
- choking
- regurgitation

Additional evaluation needed if:
mild symptoms for period of 5 years or more
- symptoms associated with difficulty swallowing
- Older adults with recent onset of heartburn

Front 37

Esophagitis

Back 37

- complication of GURD, hiatal hernia, and chemical irritation
- inflammation of esophagus
- frequent complication of GURD
- repeated exposure --> esophageal stricture (scarring) --> dysphagia

Front 38

Barrett's esophagus

Back 38

- GURD complication
- normal squamous epithelium --> columnar epithelium (metaplasia, reversible but can progress to dysplasia) --> neoplasm
- high risk for esophageal cancer **precancerous lesion**
- s/s: none to perforation

** Must be monitored q 3yr by endoscopy due to esophageal cancer risk**

Front 39

Esophageal manometric (motility) studies

Back 39

measures pressure in esophagus and LES (lower esophogeal sphincter)

Front 40

Radion uclide tests

Back 40

- detect reflux of gastric contents
- rate of esophageal clearance

Front 41

Nutritional therapy for GURD

Back 41

- avoid triggers
- decrease high fat foods
- fluids BETWEEN meals
- avoid milk products at night
- AVOID LATE NIGHT SNACKING (avoid chocolate, peppermint, caffeine, tomato products, orange juice)
- weight reduction therapy

Front 42

Histamine H2 Blockers for GURD

Back 42

Tagamet, Zantac, Pepcid, Axid

Front 43

Proton Pump Inhibitors For GURD

Back 43

Protonix, Nexium
- only use for 4-8 weeks becasue of risk of hip/osteoporitic hip fractures