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110 Cards in this Set
- Front
- Back
Mouth -> Esophogus -> Stomach ->Duoednum ->Spinchters (cardiac and pyloric) is the anatomy of the
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Upper GI Tract
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a mucus secreting barrier of epiphelial cells that line and coat the stomach.
must be in tact. |
Gastric Mucosal Barrier
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What does it take to keep replacing the Gastric Mucosal Barrier?
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Blood Supply
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Name some things that decrease blood supply?
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Stress, Smoking (causes vasoconstriction) and Alcohol
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What is the area of the GI Tract where food enters
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Mouth
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area of the GI Tract after the Food enters the Mouth, it goes into
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Esophogus
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What is located in the Upper Left Quadrant ; It is here that food arrives and gets more acidic
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Stomach
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What is the area of the GI Tract that is the first portion of the small intestine?
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Duoedenum
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After the Dueodeunum - both Cardiac (L.E.S.) and Pyloric
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Sphincters
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Cardiac Sphincter ??????
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j
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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.
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pyloric sphincters
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the three phases of digestion are:
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Cephalic
Gastric Intestinal |
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the backward flow of GI contents into the esophogus is known as
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GastroEsophagel Reflux Disease
or GERD |
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GERD is caused by the backward flow of GI contents into the esophogus - name 3 causes of why this could happen
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Incompetent Sphincter (LES)
Abnormal Esophageal Cleareance Delayed Gastric Emptyingq |
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what makes the stomach not empty due to a slowed down peristalsis
(ex: aging, meds) |
Pyloric Sphincter
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what helps to break down vitamin B12 - without this nutritional essential one would aquire Anemia
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Intrinsic Factor
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Your patient is experiencing symptoms of GERD - name a few causes of GERD
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Diet (fatty foods, citris foods, tomatoes)
Caffeine, chocolate medication, Smoking, Alcohol |
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Your patient is on medication that causes GERD, name some of the meds that cause GERD
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BCP - birth control pill
HTN meds (hypertension) Sedatives also - NG Tubes |
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your pt is experiencing food that is not moving down the esophogus, this is called
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abnormal esophageal cleareance
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In the mucosal barrier - 1/2 million cells are lost every minute and replaced within 2 days ...
T/F |
TRUE
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You must have a competent Lower Esophogael System
T/F |
TRUE
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Your patient is experiencing Dyspepsia and Dysphagia - What is happening?
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He is having abdominal pain (dyspepsia) as well as difficulty breathing (dysphagia)
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Your patient is having odynophagia, a common symptom of GERD, what is happening?
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painful swallowing (odynophagia)
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Your patient is having eructation with regurgitation - common symptoms of Gerd, what is happening
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The pt is burping (eructation) as
well as an acidic taste in throat (regurgitation) |
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Your pt is complaining of heartburn and chest pain,common symptoms of GERD - what is the medical name for this
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Pyrosis
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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
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24 hour PH Monitoring
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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
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Barium Swallow (upper GI)
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The most common GI disorder affecting more than 25-30% of all patients
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Gastroesophogael Reflex Disease
GERD |
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Your PT is having an xray of the UPPER GI . this diagnostic test is knwon as
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Upper GI test
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The most common reason for Emergency response, especially in the aging, is usually just
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Pyrosis (Chest pain/heartburn)
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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 |
Endoscopy EGD
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Name some Nursing Diagnoses for GERD
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Acute and chronic pain
impaired swallowing ineffective management of therapuetic regimen risk for aspiration |
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what is a precancerous condition in 15-20% of patients- continual irritation to esophagus. Cells and structures begin to change and cancer can result
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Barrett's esophagus
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When treating your PT with GERD - Explain how you would take care of him after meals.
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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! |
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Your PT wants to lie down after he has dinner, Because of his GERD condition, what do you tell him,
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The PT must remain upright for 3 hours PC (after meals)
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This will always cause constipation as well as a white -greyish stool
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Barium
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You must tell your PT some of the things that he/she has to eliminate because of GERD - What are they
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no smoking, alcohol
restrict spicy foods, acidic foods, chocolate, fat, mints, carbonated drinks. Eat SLOWLY and CHEW FOOD WELL. |
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Your patient diagnosed with GERD wants to lift weights in a gym when they go home, what do you tell them
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No straining , lifting or even wearing constricting clothing .
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If lifestyle changes for your PT do not work, then you must begin
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Drug Therapy
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What drug can be used to neutralize gastric secretion
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Antacids
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What reduces histamine stimulated acid secretions
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Histamine Receptor Antagonsits or
H2 blocker |
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Explain to your PT how an H2 blocker works
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H2 blocker will block histamine receptors and stops body from producing ACID
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Tums, Malox, Mylanta , Amphogel are all examples used to help neutralize gastric secretions.
What classification drug are these? |
Antacids
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Ranitidine, Famotidine and Nizatidine are all classified as
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H2 BLOCKERS
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The suffix TIDINE will always be classified as a
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H2 BLOCKER
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Explain to your PT how Anatacids help neutralize gastric secretions
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Antacids are BASES combined with HCL to turn into a SALT in order to stop pain.
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If you decrease gastric secretions too much, what would occur
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Rebound Effect
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Name side effects of anatacids
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Diareeah, Constipation
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Your PT has Impaired Swallowing and Risk for aspiration - diagnose him
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GERD
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What works to produce ACID regardless of food
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Histamine
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What supress proton pump acid secretion?'
most common with food |
PPI - Proton Pump Inhibitors
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Omeprazole, Pantoprazole, Rabeprazole and Esomeprazole are all classified as
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PPI
Proton Pump Inhibitors |
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What drugs increase gastric emptying (peristalsis)
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Prokinenetic drugs
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Your PT needs surgery to deal with his symptoms of GERD, what are his two options
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Endoscopic Therapy
Laparoscopic Surgery |
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What is a break or alteration in mucosal barrier related to a decreased blood flow and EROSION to gastric mucosa, common in women
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PUD - Peptic Ulcer Disease
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Your PT has delayed gastric emptying - this could be due to a dysfunction of his
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pyloric sphincter , leading to
Peptic Ulcer Disease |
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Decreasing ACID will INCREASE how fast stomach empties and this will protect the gastric mucosa
T/F |
TRUE
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The suffix PRAZOLE will always be classified as
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PPI
Proton Pump Inhibitors |
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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
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Pyloric Sphincter
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Your PT has erosion of the gastric mucosa due to contents of food staying too long inside body, this leads to
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Peptic Ulcer Disease
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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
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self-treated
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What is the major cause of Peptic Ulcer Disease due to the fact that it increases Vasoconstriction
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Alcohol ETOH Consumption
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drugs with analgesic, antipyretic and, in higher doses, anti-inflammatory effects - they reduce pain, fever and inflammation
(Aspirin) |
NSAIDS
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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 |
Duodenal Ulcers
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Duodenals ulcers are on the outside and usually do not show any signs until bleeding
T/F |
TRUE
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A gram NEGATIVE bacteria that produces enzymes that cause tissue damage , common in underdeveloped countries.
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H. PYLORI
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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
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Peptic Ulcer Disease PUD
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Your PT is asymptomatic, meaning he is healthy and carries no sign of disease - can he still be carrying H. PYLORI
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YES
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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 |
Duodenal Ulcers
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What are an ulcerogenic medication that increases the risk of ulcers forming due to the irritation of GI tract
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NSAIDS
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The # 1 Major cause of ULCERS
90% DUODENAL 70-80% GASTRIC |
H. Pylori
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Explain to your PT how he can become a carrier of H. Pylori
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By not washing your hands
you can acquire H. Pylori via oral-fecal, oral-oral route of transmissions |
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What is the age group for the best candidate to aquire H. Pylori?
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Over the age of 50
(75% ) |
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What happens when one aquires H. Pylori?
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Urease and Ammonia elevates
PH causing immune response |
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a less frequent type of ulcer, acute gastric or duodenal erosion causing ischemia (tissue damage due to bloodsupply) and increased acid
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Stress Ulcers
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blood in stool that could be cause of duodenal ulcer
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melena
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the vomiting of blood. The source is generally the upper gastrointestinal tract - occurs along with nausea, vomiting with stress ulcers
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Hematemesis
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Gastric Stress Ulcers cause a weight GAIN OR LOSS?
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Gastric Stress - LOSS WEIGHT
(opposites) |
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What occur in response to severe stress - Increases with hospital stay - Mortality Rate is 50% !
occurs from severe trauma, burns , illness causing shock, sepsis |
Stress Ulcers
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Duodenal ulcer cause a weight GAIN OR LOSS?
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Duodenal - GAIN
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To figure out where an ulcer is, what tests can you take?
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Barium swallow
EGD |
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To find out how much bleeding you can check for the proportion of blood volume that is occupied by red blood cell or
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Hematocrit
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Hidden Blood in the stool is called
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Fecal Occult Blood Test
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what transfers oxygen from the lungs to the rest of body?
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Hemoglobin
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what is a blood test that can easily test for ulcers/h.pylori?
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IgG Serology
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a normal treatment that does not work and requires your PT to go to surgery is called
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Intractable Disease
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Your PT is in acute and chronic pain and can not be treated normally , must go to surgery - This is primary diagnosis for
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ULCERS
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15-25% of patients - have an altered GI tissue perfusion causing a
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hemmorage
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what is the FIRST thing you see when a hemmorage is happening
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INCREASE IN PULSE RATE
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Explain the physiology of a hemmorage
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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. |
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what is a sudden painful hole in the stomach
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perforation
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what causes altered GI tissue perfusions?
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ineffective health maintanece
imbalanced nutrition PYLORIC OBSTRUCTION |
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what is obstruction at the level of the pylorus, which is the outlet of the stomach.
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gastric outlet syndrome
or PYLORIC OBSTRUCTION |
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Medications to deal with GI disturbances are
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Antacids
H2 Blockers PPIs |
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To deal with H. Pylori, an effective medication is to mix
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2 antibiotics with a PPI
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What increases the mucous production?
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Prostaglandin Analogues
ex) Misoprostol |
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what stimulate mucous production
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Mucosal Barrier Fortifiers
ex) Sucralfate |
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WHat decreases motility and gastric secretions
ex) dicyclomine, hyoscyamine |
anticholinergeics
decrease motility and gastric secretions |
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Surigcal procedure that cuts the vagus nerve to stop losing acid
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Vagotomy
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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 |
Pyloroplasty
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If you MUST take an NSAID you will also get what drug
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Prostoglandin Analogues
( MISOPROSTOL) |
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the surgical creation of a connection between the stomach and the jejunum to allow food to bypass a broken duodenum.
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Gastroenterostomy
(a drain to bottom of stomach) |
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what is it called when yo uremove anthrectomy of stomach and hook it to duodenal?
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billroth 1
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what is it called when you connect stomach to jejunum
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Billroth 2
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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
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dumping syndrome
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the patient has an NG tube to manage gastric dilitation during surgery for Antrectomy
T/F |
TRUE
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What is an intervention for a patient having surgery for eating
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Small meals, NO fluids with meals, LOW CARBS, lay down after meal
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nutritional management for patients having surgery is
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vitamin deficiencies such as B12 (Intrinsic factor) folic acid, iron, calcium, vitamin D
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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.
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Pernicious Anemia
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Nausea, Vomiting, Hematemesis (vomiting blood), Melena (blood in stool) and weight loss or gain are all symptoms of
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stress ulcers
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