14442428
Description
Flashcards by Wednesday Patches, updated more than 1 year ago
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Created by Wednesday Patches
over 6 years ago
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| Question | Answer |
| What can the nurse implement before and after a procedure? Or from the moment they are engaging the client? | Teaching |
| Name three diagnostic testing that is implemented for upper GI issues? | Xray MRI EGD |
| Swallow Barium Study is what type of Diagnostic testing and what does the study test? | Xray-of swallowing liquid or food. It test for difficulty swallowing (Dysphagia) and if the patient is pocketing food |
| MRI is what type of Diagnostic testing and what does the study test? | 3D image of internal structures Masses or other possible ulceration |
| With a Swallow Barium Study inform the patient 7 things, they are? | NPO status Check if they allergic to components possible MRI may need done Stool may look gray or chalky white They could be constipated If constipated they may need a laxative |
| What do you teach the patient about an MRI? | No metal devices in them on them No exposure to metal or work with metal No trauma exposure |
| EGD or esophagagastroduodenoscopy is what type of Diagnostic testing and what does the study test? | Upper GI exam Test to examine the lining of 3 structures; esophagus stomach the first part of the small intestine -duodenum |
| With a EGD Study inform the patient about 6 things, they are? | NPO before and after test OR until the gag reflex returns 2. sedation will be required 3. concern for perforation 4. sudden pain 5. sudden temperature increase 6. EGD goes all the way from esophagus to duodenum |
| The EDG uses an endoscope during the exam. What 3 things can I identify? | Esophageal Ulcer Gastric Ulcer Duodenal ulcer |
| EGD that is performed in the lower GI tract are what? | Colonoscopy Endoscopy-video capsule; defecated |
| Laproscopy is what? | an incisional procedure to view the peritoneal cavity (ABD) and take a looksy. |
| With a colonoscopy Study inform the patient about 3 things, they are? | NPO 2. bowel prep day before and night before 3. bowel prep agent is usually GOLYTE |
| What type of test is defacography? | Toilet Seat on an X-ray table that watches you go poo. |
| When you think about about Upper GI and Lower GI you think about what common Signs and symptoms; list 5? | 1. Nausea and Vomiting-main complaint assoc. is N, and V 2. Gastritis 3. GERD 4. Peptic Ulcers 5. Food poisoning |
| What is Nausea and what is it accompanied by? | Nausea is a epigastrium discomfort that makes you want to vomit 2. symptom accompanied by anorexia. |
| What is Vomiting and what 3 things is it accompanied by? | Vomiting is a forceful ejection of stomach contents. 1. risk for aspiration 2. When prolonged vomiting-dehydration and electrolyte imbalance. 3. Risk for metabolic alkalosis (Ph of tissue is elevated above normal range decrease of HCL and increase of bicarb) from a loss of gastric HCL |
| Nauseas and vomiting have a specific populace that are at risk, they are? | Younger patients and older patients |
| Vomiting issues unrelated to GI is also associated with what 10 additional issues? | 1. CNS problems - 2. head trauma 3. brain tumor 4. pregnancy 5. Right Sided heart failure 6. Renal failure (electrolyte imbalance) 7. SE of drugs 8. Chemo 9. Anesthesia 10. cancer |
| Upper and lower GI and N, V come with several additional terminology and assessments | 1. regurgitation-term 2. projectile vomiting-term 3. emesis-term 4. Fecal odor-assess 5. Color of emesis-assess for green or brown-bright red, coffee ground color is a GI bleed 6. production of melena-follow internal bleeding; swallowing blood is a dark, tarry, sticky feces appearance can be containing partly digested blood or no blood 7. time of day occurring |
| When we talk about upper GI and additional terms and assessment, what is a "clue" and what does it mean? | clue-Bright red blood or coffee ground color means-Acute bleeding; possible long term ongoing bleeding in intestine where change is happening. |
| What stimulates or is the stimuli in vomiting and where is it located? | 1. Vertigo in the ear, nose, and eyes a. motion sickness and other conditions r/t NV b. complex system can initiate vomiting because of: balance in ear problems in stomach-most obvious kidneys heart or other organs. 2. vomiting center is located in the brainstem and have many components involved in vomiting. |
| Name the 9 structures of stimuli in vomiting? | GI tract Skeletal muscle Vestiblular stimulation Brainstem CTZ-chemoreceptor trigger zone Emetic center Nose Eye Sight Center Smell center |
| What is the 3 main physiology stimuli of N and V and what do they release to cause the medullary vomiting center to stimulate N and V? | The talked about 9 stimuli 3 are indeed physiological responsible for N and V= 1. Visceral Stimuli-Dope and Sero release 2. CTZ-Dope and Sero release 3. Vestibular Input-Hist and Acetylcholine relaxer |
| How do you treat N and V and what main clue would cause RN to indicate more assessment is needed to tx symptoms? | 1. determine underlying cause-careful history 2. treat the cause or stimuli assessed 3. Tx symptoms also of NV but caution you could be delaying or masking another dx CLUE-projectile vomiting is possibly CNS and or 9 symptoms asked earlier. |
| What is an antiemetic and name 4 antiemetic medications? | 1. an effective drug/med used against N, and V also used to tx motion sickness, or SE of an opioid analgesic, anesthesia, antipsychotic med., or chemo med 2. 4 meds: Comp/Proch (azine), Phenergam, Zofr/Ond (an)setron, Reglan/metoclopro |
| So the antiemetics Compa/prochlo(azine), and Phenergan/promo work by what 4 actions? | 1. decrease dope and antiH 2. decrease vertigo 3. decrease CTZ/chemorecept trig zone stimulation 4. useful in motion sick, post-op pain, and chemo |
| So the antiemetics Compa/prochlo(azine), and Phenergan/promo have 6 SE, they are? 2. Also HUGE deal Phenergan/promo is a what and how do we treat not when we give oral but when we inject med.? | 1. GI sedation (slow or no go gut) 2. HypoTN 3. HTN-older patients, more sedated with this med. 4. dry mouth 5. constipation 6. rashes Phen/promo is an irritant; dilute it well when giving it in the lg. muscle (Russians abuse this drug ketorlac) |
| So the antiemetic Zofran/Ondansetron, work by what 6 actions? | 1. block zero-which 2. increases CTZ-chemotrigrecep and 3. increases gastric emptying 4. used in chemo s. used in post-op N and V 6. Used in migraine N and V |
| So the antiemetics Zofran/ondansetron have 4 SE, they are? | 1. Constipation 2. HA 3. diarrhea 4. fatigue-duh |
| So the antiemetics Zofran/ondansetron and Phenergan/promo have a specific safety need, what is it? | 1. Phenergan/promo is used more freq. than Zofran/ondansetron and they say to go back and forth with and try not to use aforan as freq. |
| So the antiemetic Reglan (meet-clopromide), work by what 5 actions? | 1. Promotility (pro kinetic) 2. so duh, it is useful in dysfunctional motility of upper GI 3. Enhances acetylcholine (nerve/chem transmitter) to- 4. Increase gastric motility and emptying 5. not sure but it might improve their want of nutrition/consumption of food because it is a cannabis related drug? |
| *ON TEST* Focus on the side effects--So the antiemetic Reglan (meto-clopromide), have 4 SE, they are? Is Reglan OTC? Is this drug related to Cannabis like product? | 1. I’m anxious 2. I have spastic/involuntary movement (the big one for him) 3. shake/tremors 4. twitches YES-OTC Yes, cancer patients only |
| So why Non-drug therapy to help upper GI signs and symptoms of discomfort, and name 5 alternative/non-drug therapies? | NSAIDS and TYLENOL can exacerbate tummy breakdown so non-drug therapy is an alternative. 1. Acupunc/acupress 2. Botanicals-ginger(ale), pepper 3. Breathe/ relax exercise 4. environment (no odor, well vent, rest)-cx pop. super sensitive starts at the beginning ofc. visit, psychosocial will make them gag. 5. Oral hygiene-related to GI tract |
| Okay, the so say the antiemetic Reglan (meto-clopromide), cannabis related drug is not increasing their nutrition; what 5 things can try to deliver nutrition therapy? | 1. IV fluids-duh 2. clear liquids (be mindful of temp; too hot/cold is not well rep’d or palatable so they won’t eat. 3. NG Tube 4. Some Solid Foods (crack or dry toast) 5. BRAT-bananas, rice, applesauce, toast (vomiting not necessarily diarrhea) |
| 7 additional nutritional therapy knowledge to implement or list are? | 1. back off food altogether 2. Thin liquids to start 3. carb Bev should be a flat fizz otherwise it will upset the client tummy 4. a little sugar is okay 5. mentioned again too hot/cold do avoid 6. Brat Diet 7. Don’t consume a lot of salt (soup) or sugar (gatorade); just a little sugar. |
| What is the initial fluid of choice when recovering from Nausea and vomiting? | Water |
| Back to nutritional therapy; where do we go from the 5 and then 7 additional nutrition therapies when the patient is ready? what 4 important points are we going to keep in mind? | Advance to solid food 1. advance slowly to a soft diet from clear/thin liquids. 2. advance to a bland HIGH/LOW since it is easier to digest (carb/fat-baked potato, rice, pasta) 3. avoid/or how about no spicy or acidic food 4. eat/consume slow and sm portions/amnts. |
| Name 4 nursing DX for N and V? | 1. Dx-nausea 2. fluid volume deficiency 3. imbalanced nutrition 4. less than body requirements. |
| What is the most common upper GI problem in adults? | GERD-gastroenteritis reflux disease |
| What is the most common upper GI problem that causes persistent mild reflux and how often does it occur; and what is the cause of this disease? | 1. GERD 2. >2x a week 3. No single cause |
| This upper GI disease has no main cause; BUT identify one main cause that is a suspect in several causes? Also, what fluid is responsible for the irritation? | 1. GERD is the disease 2. main cause-Incompetent lower esophageal sphincter (LES) 3. stomach acid fluid falls back into the esophagus and causes the erosion of the lining of the esophagus and eventually wears at the LES. eventually incompetent LES of stomach and esophagus becomes defected. |
| GERD has ’13’ symptom risk factors, oh my; name them? | 1. Impaired esophageal motility 2. Incompetent Ileus/ileus dysfunction 3. reflux of gastric contents is persistent and mild 4. sm. intestine reflux of the bowel 5. cirrhosis (scarring) beneath sternum that can spread to the throat. 6. dyspepsia (pain in upper abd. and midline) 7. regurgitation-another term for Vomiting 8. coughing 9. dyspnea-SOB 10. wheezing 11. sore throat 12. lump 13. chest pain (feels cardiac) but relief is obtained with oral antacid |
| Gerd has recommendations to relieve symptoms? What test is used to differentiate between barrels (precancerous) and esophageal metaplasia complications? | 1. Sleep with HOB raised 2. Loose clothing 3. eat smaller meals 4. No late meals 5. no caffeine 6. no chocolate 7. no milk Test with a BIOPSY |
| Tx GERD with what OTC meds? What are the SE and why? | PPIs and H2 agonists 1. risk factor/SE is CDIFF and Diarrhea because your lowering the Acid |
| This has been mentioned but again what are 6 Predisposing Factors of GERD? | 1. Impaired esophageal motility 2. Defective mucosal defense 3. Delayed gastric emptying 4. LES dysfunction 5. Sm. intestine reflux of bile 6. reflux of gastric contents. |
| We indicated that their is no one cause but their was a main cause (LES) for the upper GI disease known as GERD? can you tell me the two factors and what they cause? | HCL acid + Pepsin reflux into lower esophagus and cause inflammation (esophagitis) which can then lead to ulcers. |
| List the 3 major GERD symptoms? | 1. Heartburn (pyrosis)-burning sensation beneath the lower sternum; can spread to throat 2. Dyspepsia-Pain in the upper abdomen and midline 3. regurgitation/vomiting of a hot, bitter, or sour liquid coming into throat or mouth. |
| How can we really dx S/S history of GERD? | by trying OTC or prescribed medications first; here is a proton and if the pain does not go away then yes it is GERD and further evaluation is needed. |
| I feel like we have gone over this but name 4 main GERD symptoms? | Client will report: 1. coughing, wheezing, dyspnea-SOB 2. Hoarseness, sore throat 3. lump in throat 4. chest pain: feels cardiac but is relieved by antacids. |
| Name 4 GERD diagnostic studies? | 1. Protonic/medication relief-so, DX usually is based on symptoms and patients response to therapy. 2. ESOPHAGOSCOPY-visualize LES, inflammation, ulcers, and strictures. 3. Manometric Studies: Measure pressure in LES and esophagus, and esophageal motility. 4. BIOPSY-to differentiate Barrett’s from CANCER |
| Chronic GERD versus Barrett’s Cancer how can I tell? | With chronic GERD the cells being exposed to the stomach fluid will on a slide be scene as changing shape over time which can then cause cancer and so they would test for that change. |
| Name 7 GERD complications? | 1. Esophagitis and ulcers (esophageal, stomach, duodenal) 2. Esophageal Strictures (narrowing from scar tissue) 3. dysphagia-cannot swallow 4. Barrett’s esophagus 5. regurgitation-vomiting which can cause aspiration/ or dental erosion 6. respiratory cough from irritation of upper airway. 7. Respiratory asthma, chronic bronchitis, pneumonia (secondary to aspiration) |
| Teach me 8 things about GERD in order to improve signs and symptoms? | 1. lose wt. if your over wt. this is to decrease intrabdominal pressure. 2. avoid smoking and ETOH; doing both of these will decrease the LES pressure; duh, smoke irritates the mucosa. 3. Sleep with HOB at a 30 degree bubble or 4-6 blocks 4. do not lie down flat 2-3 hours after you eat. 5. avoid tight clothing around the waist 6. eat small frequent meals (to prevent gastric distention) 7. avoid late evening meals or snacks 8. avoid foods that irritate or decrease LES pressure; no spicy; no chocolate, no peppermint, no caffeine, no fatty foods, no ETOH, these decrease LES pressure, no milk particularly at bedtime this will actually increase your HCL in your tummy. No red wine, no tomatoes, no OJ (irritates your esophagus) |
| What are the RN goals of GERD drug therapy; list 4 goals? | 1. Improve LES function 2. decrease the volume and acidity of reflux 3. increase esophageal clearance 4. Protect esophageal mucosa |
| List 5 GERD drugs that we use therapeutically? | 1. Antacids-neutralize HCL acid 2. Antisecretary-decreases secretion of HCL 3. Cholinergic-Increases LES pressure, Increases esophageal and gastric emptying 4. Prokinetic-Increase gastric motility 5. Cytoprotective-protects stomach and esophageal lining.] |
| List 5 GERD drugs that we use therapeutically and assign a drug name? | Antacids: neutralize HCL acid Most effective taken after meals On empty stomach lasts 20-30 minutes; if full lasts 3-4 hours Antisecretary: ↓ secretion of HCl H2 (histamine) receptor blockers: famotadine (Pepcid) Proton pump inhibitors (PPI’s): pantoprazole (Protonix) PPI’s more effective than H2 Blockers for ↓ HCL & esophageal healing Cholinergic: ↑LES pressure, ↑ esophageal /gastric emptying bethanechol (Urecholine) Prokinetic: ↑ Gastric motility metoclopramide (Reglan) Cytoprotective: protect stomach & esophageal lining Sucralfate (Carafate), Pepto Bismol |
| True or false? Patients on PPIs in the hospital have a 65% increased risk of getting CDiff diarrhea then when taking at home? | True When you reduce the stomach acid in the stomach you then increase the risk for infection, especially CDIFF and PNEUMONIA |
| Is there Surgical Therapy for GERD; what is our goal? | Yes their are some surgical procedures that we are getting away from and are only needed if conservative therapy fails or if they have complications (So usually not needed). Our GOAL—is to reduce the reflux by enhancing integrity of the LES |
| If and only if their becomes a complication with the conservative treatment of GERD name a surgical procedure utilized to treat GERD; and describe? | 1. Neissen Fundoplication-hot dog wrap around LES then sutured into place. 2. LINX Reflux Management System: magnetic bead bracelet implanted around the LES…SUPER IMPORTANT…A patient with the LINX system should never have an MRI |
| What is a herniation of a portion of the stomach into the esophagus through an opening, or hiatus, in the diaphragm? | Hiatal Hernia |
| What is also referred to as a diaphragmatic hernia and esophageal hernia? Also give me two super important facts that go with this type of hernia? | Hiatal Hernia Fact: Common in Older adults Fact: Occur more often in women |
| Name 2 types of Hiatal/diaphragmatic, and esophageal hernias? which is positional and which is an emergency? Which is more common in older women? | 1. Sliding Hernia—looks like a rubber band of stomach around the whole esophagus at the level of the LES GERD symptoms More Common in women Positional Symptoms 2. Rolling Hernia—Looks like a small balloon popped out one part of the LES stomach junction. EMERGENCY We are rolling to the ED now |
| Hiatal/diaphragmatic, and esophageal hernias have 3 causes, what are they? | 1. Structural changes- a Weakening of muscles around LES– occurs with aging 2. Increased intraabdominal pressure Obesity, ascites, tumors, heavy lifting. 3. Congenital weakness |
| With Hiatal/diaphragmatic, and esophageal hernias what big complication is associated with this structural cause? Name the additional 4 symptoms that are also symptoms of GERD? | -Strangulation- 1. Ulcer 2. Stenosis/narrowing 3. Esophagitis-inflammation of esophagus 4. regurgitation-vomiting |
| With treatmen, Diagnosis, and drug therapy for Hiatal/diaphragmatic, and esophageal hernias is it the same as GERD? | YES |
| Hiatal/diaphragmatic, and esophageal hernias have 8 symptoms, what are they? | 1. asymptomatic 2. Similar to GERD- 3. Coughing 4. Heartburn (pyrosis) 5. regurgitation-vomiting 6. Not GERD Symptomy is a pain when bending over. 7. Not GERD Symptomy is a relief from pain when sitting and or standing. |
| two tests for Hiatal/diaphragmatic, and esophageal hernias used to Dx, what are they? | Barium swallow endoscopy |
| What options of surgical therapy do I have for a Hiatal/diaphragmatic, and or esophageal hernias, name 4 and what are they? | Goal of Sx is to reduce and secure herniation of stomach into the abdomen around the esophagus: 1. Herniotomy-excision of hernia sack itself 2. Herniorrhaphy-closure of hiatal deficit 3. Gastroplexy-attachment of stomach subdiaphragmatically 4. Nissen Fundoplication-only to enhance the integrity of the LES |
| What is Gastritis? What causes Gastritis? Is it acute, chronic, or both? | 1. an inflammation of gastric mucosa 2. cause is a result of a breakdown in gastric mucosal barrier (stomach tissue is then unprotected from corrosive action of HCL acid and pepsin. 3. Can be BOTH acute or chronic |
| What 6 agents cause gastritis not what aggravates to cause gastritis? | 1. Genetics—autoimmune gastritis; immune response against parietal cells that are blocked by intrinsic factor; cannot absorb vitamin B12 (cobalamin) which is essential for RBCs and therefore malabsorption results in pernicious anemia. 2. Drugs-NSAIDS, Steroids, and aspirin 3. Diet-BINGE ETOH abuse, spicy food 4. Microorganisms-H Pylori 5. Physiologic and Psychologic Stress (BOOM increases you HCL acid in your tummy) |
| List 6 ACUTE Gastritis symptoms, they are? | 1. N and V 2. Epigastric tenderness 3. FULL FEELING 4. Bleeding 5. Self-limiting 6. last a few hours to a few days 7. complete healing of the mucosa of tummy expected. |
| List 10 Chronic Gastritis symptoms, they are? | 1. N and V 2. Epigastric tenderness 3. FULL FEELING 4. Bleeding 5. Self-limiting 6. last a few hours to a few days 7. complete healing of the mucosa of tummy expected. 8. Signs and Symptoms are same as Acute 9. Sometimes Asymptomatic 10. may cause B!2 pernicious anemia when parietal cells are lost. (don’t be confused but yes this symptom is also assoc. w/ good ol gastritis. so not seeing it on acute gastritis just gastritis and chronic. |
| So Gastritis and Chronic gastritis may cause pernicious anemia when parietal cells are lost, So what will this patient need for the rest of their life? | B12 vitamin/cobalamin supplement |
| Gastritis diagnostic studies for acute we have one study and chronic we have 4 studies with one of them being a Gold Std., name them? | 1. Acute Gastritis-DX is based on symptoms of drug abuse and or ETOH abuse. 2. Chronic Gastritis-DX may be delayed do to non-specific symptoms. B. Definitive DX via Endoscopy to include gastric biopsy C. CBC for pernicious anemia D. Test for H Pylori-breath test for urea E. GOLD STANDARD-gastric BIOPSY to test for urease (a by-product of H pylori organism) |
| Acute Gastritis Collaborative Care involves 10 steps, name them? | 1. Duh, eliminate the cause-drugs and alcohol (ETOH) 2. If Acute Gastritis involves vomiting- 3. NPO 4. IV fluids 5. rest 6. antiemetics 7. NGT to monitor bleeding, lavage, and to keep the stomach empty. 8. Clear liquids when s/s have subsided 9. gradual reintroduction of solids 10. drug therapy-to include PPIs/H2 receptor blockers |
| Chronic Gastritis Collaborative Care involves 10 steps, name them? | 1. Eliminate the cause 2. Non irritating diet 3. 6 sm. freq. meals per day 4. avoid smoking 5. drug therapy—to include PPIs/H2 receptor blockers to decrease the HCL 6. ABX if H Pylori is the identified organism 7. Cobalamin (vitamin B12) shots for lifelong treatment if patient has pernicious anemia identified by a CBC. |
| PUD or Peptic Ulcer Disease can involve what structures of the body and provide a general description? Also, is it acute, chronic or both? List a fun fact to share? | 1. structural involvement-esophageal, gastric, and duodenal. 2. general description—is an erosion of GI mucosa resulting from digestive action of HCL acid and pepsin. 3. Can be BOTH acute and or chronic FUN FACT: 80 of PUD is duodenal |
| PUD has 6 main causes, they are? | 1. A destroyer of mucosal barrier 2. Chronic gastritis 3. H. Pylori-organism (2/3 of the world pop. are infected: increase HCL production 4. Aspirin, NSAIDS-again all of these in crease the production of HCL in the tummy. 5. Corticosteroids: DECREASE mucosa renewal and protective effects 6. ETOH-increases HCL 7. Coffee and Caffeine, decaffeinated-all increase HCL in the tummy. |
| What do you call a physiologic stress ulcer that is acute ulcer flair up that develops after a physiologic insult, such as; major surgery, severe burns, and or trauma? | Stress-Related Mucosal Disease |
| PUD or Peptic Ulcer Disease has 10 Signs and Symptoms that help DX disease, they are? | 1. asymptomatic 2. Broken into anatomical locations—Gastric or Duodenal 3. determinie Gastric PUD by the PAIN location of UPPER GASTRIC; 1-2 hours after a delicious meal; AGGRAVATED BY FOOD CONSUMPTION H8s it has food on the Tummy-No food for the gastric PUD 4. Determine duodenal PUD by again PAIN location; MID GASTRIC 2-5 hours after a delicious meal; TUMMY FULL THEN MID GASTRIC/DUODENAL IS HAPPY AND IN NO PAIN. 5. Not the food but the HCL responding to the food that is the GOLD STD. Full/D not feeling full Gastric upper. 6. Rigid stomach 7. Sudden dramatic pain that is cardiac type pain. 8. Absent bowel sounds 9. N and V 10. a perforation that might require surgery. |
| When is PUD, peptic ulcer disease considered an emergency or complicated? Identify the 3 major complications, they are? Are any of these considered more emergent than the others? | 1. Hemorrhage—most common 2. Perforation—most lethal/deadly 3. Gastric Outlet Obstruction-paralytic ileum?? This is going to be an obstruction in distal stomach and duodenum. hear absent sounds below obstruction for 5 minutes. Check all four quadrants. and hyperactive above level of obstruction. 4. ALL ARE EMERGENCIES |
| PUD Hemorrhage has 3 identifiers, name them? | 1. most common complication of PUD 2. Develops from erosion of granulation tissue. 3. Can ulcerate through a major blood vessel. |
| PUD Perforation has 4 identifiers name them? | 1. Most lethal complication of peptic ulcer 2. Ulcer penetrates serosal surface & spills gastric or duodenal contents into peritoneum → hypovolemia and peritonitis 3. If small, can seal themselves when fibrin produced; but may cause strictures 4. If large, need immediate surgery |
| Peptic Ulcer PUD perforation has 8 symptoms, name them? | 1. Sudden, dramatic onset 2. Severe abdominal pain, can radiate to back 3. Rigid, board like abdominal muscles (self protection) 4. Shallow, rapid respirations & weak, rapid pulse What do these v/s indicate? 5. Absent bowel sounds 6. Nausea/vomiting 7. Hx indigestion or previous ulcer 8. Bacterial peritonitis within 6-12 hrs if untreated |
| Okay question a duodenal ulcer of the posterior wall penetrates the head of the pancreas, results in a walled-off perforation, who are you? Are these more common in males or females? | -Duodenal Ulcer Perforation- More common in males Remember females get gastric ulcers commonly. |
| A peptic ulcer disease gastric outlet obstruction in the distal stomach and duodenum is a result of 4 things, name them? | 1. Edema 2. Inflammation 3. Pylorospasm 4. Scar tissue |
| PUD/Peptic Ulcer Disease has 8 Gastric Outlet Obstruction Symptoms, name them? | 1. Usually long history of ulcer pain 2. Generalized upper abdominal discomfort 3. Pain worsens toward end of day 4. Relief obtained by belching or self induced vomiting 5. Projectile vomiting is common 6. Emesis may contain food ingested hours or days before 7. Constipation due to dehydration 8. Bulging of stomach in upper abdomen |
| PUD/Peptic Ulcer Disease has 4 diagnostic studies that can identify PUD, name them? | 1. Endoscopy with biopsy (view ulcer & r/o CA) 2. Biopsy of stomach to test for urease --Gold standard to test for H pylori— 3. Barium contrast studies (gastric outlet obstruction) 4. Lab analysis: CBC (anemia?), liver enzymes (cirrhosis/scarring ?), stools (blood?) |
| Their are 5 collaborative care suggestions for PUD/peptic ulcer disease and one major Goal, name them? | Conservative Therapy: 1. Adequate rest 2. Elimination of smoking & alcohol 3. Eliminate aspirin & NSAIDS for 4-6 weeks 4. Stress management 5. Drug therapy GOAL— would be the Pain disappears in 3-6 days, but ulcer healing takes 3-9 weeks |
| So their are 5 PUD/Peptic Ulcer Disease Drug therapies, name them? | 1. Antibiotics (for H Pylori) 2. Antisecretory agents: ↓ HCl secretion H2 receptor blockers: --famotadine (Pepcid) --PPI’s: pantoprazole (Protonix) more effective than H2 blockers for ↓ HCl & healing ulcers 3. Cytoprotective: protects lining of esophagus/stomach/duodenum 4. Antacids: neutralize acid; adjunct therapy Take after meals to prolong effect ; 5. Antidepressants if needed-again have an anticholinergic effect (nerve cell transmitter) SE of the PPIs and H2 receptors is going to be constiboohoopation. |
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