symtpoms of gastritis include
asymptomatic, loss of appetite, n/v, epigastric tenderness, feeling of fullness
what problem may lead to a diagnosis of gastritis?
B12 deficiency, anemia
Alcohol induced gastritis would have what symptom
bleeding (may be confused with upper GI bleed)
what oral intake would a patient with gastritis have?
NPO, Iv fluids
what medication would a patient with gastritis take?
antiemetics, antacis, PPIs,H2 receptor antagonists
How is peptic ulcer disease diagnosed?
endoscopy, barium contrast
Symptoms of peptic ulcer disease
dyspepsia, back pain, silent, pain when stomach is empty (children), anemia, tenderness
In duodenal peptic ulcers, what makes the ulcer feel better?
food
the most common complication of PUD is
hemorrhage
the most lethal complicationof PUD is
perforation
In this complication of PUD, pain is worse at the end of the day
gastric outlet obstruction
Why would pain pain in gastric outlet obstruction be worse at the end of the day?
edema, swelling
How does bleeding affect pain in PUD?
decreases (if pain goes away, watch!)
If pain goes away in PUD, what do you need to do?
watch for bleeding
If a perforation occurs in PUD, what do you anticipate?
place and monitor NG tube, hydrate, surgical repair
If obstruction occurs in PUD, what do you anticipate?
NG tube with clamping trial
complete healing of PUD takes
3 to 9 weeks
Surgical interventions for PUD include
partial gastrectomy, vagotomy, pylorplasty
Post op complications in PUD
acute bleeding, dumping syndrome, post prandial hypoglycemia, bile reflux gastritis
when would you expect dumping syndrome to occur?
15 to 30 minutes after a meal
what symptoms would a patient with dumping syndrome experience?
dizzy, sweating, palpitations
In this postop complication of PUD, bile refluxes into the stomach and causes a reoccurrance of PUD
bile reflux gastritis
A chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver tissue
cirrhosis
Causes of cirrhosis
fatty liver disease, chronic hep c and b, cholangitis
early signs and symptoms of cirrhosis
gi upset, weight loss
Late signs and symptoms of cirrhosis
jaundice, skin lesions, hematologicl problems, endocrine problems, neuropathy
An intervention for cirrhosis in patients with respiratory complications or pain is
paracentesis
what interventions help manage bleeding in cirrhosis?
fluids, meds, endoscopic ligation
How do you reduce the amount of ammonia buid up in cirrhosis?
lactulose
what kind of diet would you anticipate for a patient with cirrhosis?
high calorie, low sodium
Why is oral hygiene before meals important in cirrhosis?
increase appetite by oral stimulation
Why is it important to assess skin in cirrhosis?
edema, pruritis (can lead to skin breakdown)
How should a cirrhosis patient itch if they have to?
with their knuckles
What kinds of bleeding should you be alert for in cirrhosis?
hepatisis, melena
Why is it important to maintain a safe environment in cirrhosis?
confusion (r/t build up of ammonia, ect)
what causes hypertrophic pyloric stenosis?
thickening of the muscle of the pyloric sphincter
When does hypertrophic pyloric stenosis develop?
first few weeks of life
Which children are most likely to get hypertrophic pyloric stenosis?
first born
Which gender of children is most likely to get hyperpyloric stenosis?
boys
The symptoms of hypertrophic pyloric stenosis
vomiting, dehydration, weight loss, metabolic alkalosis
What metabolic syndrome is a baby with hypertrophic pyloric stenosis vulnerable to?
alkalosis (vomiting = losing acid)
What needs to happen before a baby can have surgery for hypertrophic pyloric stenosis?
rehydration, electrolyte imbalances corrected
How is hypertrophic pyloric stenosis corrected surgically?
pyloromyotomy via laproscope (low mortality rate)
Most common cause of intestinal obstruction in children age 3 months to three years
intussusception
Oftentimes, what is the cause of intussusception?
hypertrophy of intestinal tissue secondary to viral infections
what will the stools of a child with intussusception look like?
currant jelly
what kind of pain will children with intussusception experience?
crampy
what position will children with intussusception take?
knee to chest
What kinds of behavioral symptoms will children with intussusception have?
inconsolable crying
What kind of physical symptoms will children with intussusception have?
vomiting, lethargy
How is intussusception managed?
conservatively; IV fluids, NG tube, abx, hydrostatic reduction surgery (rarely)
Abnormal rotation of the intestine that occurs as a result of the abnormal rotation of the intestine around the superior mesenteric artery during embryonic development
malrotation and volvulus
Why is malrotation and volvulus one of the most serious obstructions?
may result in perforation or bowel obstruction (in complete volvus), may be asymptomatic
How is malrotation and volvulus treated?
surgery immediately
congenital anomaly that results in obstruction from dysmotility
hirscprung disease
Who is more likely to get hirschsprung disease?
males
When is hirschsprung disease diagnosed?
first few months of life
Symptoms of hirschsprung disease?
distended abdomen, feeding intolerance, bilious vomiting, delay in passage of meconium
How is hirschsprung disease treated?
remove segment of bowel with absent ganglion cells, frequent enemas, bowel retraining
How would the bowel movements of an infant with hirschsprung disease appear?
ribbon like, foul odor
If malnurishment in hirschsprung disease, what might you need to administer?
TPN
what do you need to monitor in hirschsprung disease?
fluids, electrolytes, signs of bowel perforation
what do you need to prepare and educate patients and parents about regarding hirschsprung disease?
colostomy, care of ostomy
What do you need to measure in a patient with hirschsprung disease?
abdominal circumference
which patients would not need bowel prep for hirschsprung disease?
babies (stool is still considered sterile)
What causes malabsorption syndromes?
impaired absorption of fats, carbohydrates, proteins, minerals, vitamins
What regulates digestion?
stomach, small intestine, liver, pancrease
What breaks down nutrients?
digestive enzymes
What causes malabsorption syndrome?
biochemical, enzyme deficiencies, disturbed lymphatic and vascular circulation, bacterial proliferation, small intestinal mucosal disruption, surface area loss
What is an example of a biochemical or enzyme deficiency?
lactose intolerance
what is an example of disturbed lymphatic and vascular circulation?
lymphoma, HF
what is an example of bacterial proliferation?
tropical sprue
what is an example of a small intestinal mucosal disruption?
celiac disease
What is an example of a surface area loss disruption?
gastrectomy, ileal resection
Celiac is what kind of disease
autoimmune
Chronic inflammation that occurs in response to ingesting gluten
celiac disease
Signs of celiac
foul smelling diarrhea, fatty stools, gas, distention, weight loss
The most common malabsorptive disease
lactase deficiency
In lactase deficiency, what is the problem?
not enough lactase to break down lactose
Symptoms of lactase deficiency
bloating, gas, crampy pain, diarrhea
How to deal with lactase deficiency
eliminating lactose, lactaid before ingesting dairy
If a patient is curled on side, think
appendicitis, volvulus
If a patient is in a supine posture as their most comfortable position, you should think
visceral pain
If a patient is restless in their position, think
obstruction (stones)
If a patient is guarding/splinting, think
trauma
Absent bowel sounds may indicate
peritonitis
What is the purpose of the NG tube in acute abdominal pain?
decompression
What are you on the lookout for in patients with acute abdominal pain?
hypovolemia (shock)
Why would you not give opioids to patients with chronic abdominal pain?
slows bowel
what causes the inflammation in appendicitis?
obstruction (feces, foreign body, tumor, excessive growth of lymphoid tissue)
Who has more complications from appendicitis?
children, elderly
What kind of pain would you expect in appendicitis?
periumbilical pain shifts to right lower quadrant
What might patients report as factors that worsen the pain?
coughing, sneezing, deep inhalation
What symptoms of appendicitis are specific to children?
irritability, upper respiratory congestion, right hip pain
What GI symptoms would happen with appendicitis?
anorexia, nausea, vomiting
What do you suspect in an appendicitis patient who has the pain go away?
rupture
What SHOULDN'T you give to a patient with appendicitis?
heating pack, laxatives, enemas
When would you expect an appendicitis patient to have an NG tube?
when there is a rupture
Saccular structures that form in the colon due to insufficient fiber leading to higher pressures in the colon
diverticulosis, diverticulitis
Where would you expect pain to be in diverticulitis?
left lower quadrant
What symptoms would appear if there are any symptoms at all in diverticulitis?
bloating, pain in LLQ
What dietary practices will reduce/prevent diverticular disease?
increase fiber, increase fruits and beggies, decrease fat and red meat, weight reduction, avoid activities that increase intraabdominal pressure
How would you treat diverticular disease?
colon rest, hospitalization, surgical resection
Chronic functional disorder characterized by intermittent and recurrent abdominal pain, constipation, diarrhea
irritable bowel syndrome
What are some things that might cause irritable bowel syndrome?
altered bowel motility, psychological stress
Involuntary passage of stool occuring when the structures that promote continence are disrupted
fecal incontinence
Diarrhea is more than _____ loose stools per day
3
Treatment of diarrhea is focused on monitoring what?
fluid, electrolyte balance
When is a person considered constipated?
when they have fewer stools than normal
Causes of constipation
insufficient fiber, fluids, decreased physical activity, medications, ignoring the urge
Chronic inflammation of the GI tract
inflammatory bowel disease
What is the cure for inflammatory bowel disease?
no cure
What is the cause of inflammatory bowel disease
unknown cause
What are the types of inflammatory bowel disease?
Crohn's disease or ulcerative colitis
In crohn's disease what happens?
inflammation of all layers of the bowel wall
Which would you expect fistuals and peritonitis, crohn's disease or ulcerative colitis?
Crohn's disease (fistulas and abcesses rare in ulcerative colitis)
In ulcerative colitis, fistulas and abcesses are
rare
What are the symptoms of crohn's disease and ulcerative colitis?
diarrhea, bloody stools, weight loss, abdominal pain, fever, fatigue
How is crohn's disease and ulcerative colitis diagnosed?
CBC, stool culture, sigmoidoscopy, colonoscopy
What would you expect to see in the CBC of a patient with CD or UC?
iron deficiency, anemia, possible increased WBC
What is more common in Crohn's than ulcerative colitis?
strictures
First line of treatment of inflammatory bowel diseases are
aminosalicylates
Besides aminosalicylates, what other drug therapy would you expect to administer?
antimicrobials, corticosteroids, immunosuppresants, biologic and targeted therapy
The focus of interventions in inflammatory bowel disease are
hemodynamics, fluid, electrolytes, nutrition, pain control
The only cure for colon cancer
surgery
Ostomy in the ilieum
ileostomy
ostomy in the colon
colonostomy
The more ______ the ostomy the closer the stool looks to normal formed stool
distal
How often should you assess a new stoma?
every 4 hours
How long is swelling normal in a new stoma?
2 to 3 weeks
How long might stool not be present in a new stoma?
72 hours
Ostomies that need a bag are
incontinent
will continence be achieved in ileostomies?
no
How often is the bag changed in ileostomies?
4 to 7 days unless leakage occurs
What does a nurse need to monitor with ileostomies?
skin, fluid, electrolytes, I&O
What should a nurse encourage with an ileostomy?
fluids
How often does an ileostomy pouch need to be emptied?
frequently
What are some causes of short bowel syndrome?
surgical resection, congenital defect, disease process
What are some symptoms of short bowel syndrome?
diarrhea, steatorrhea, signs of malnutrition
What kind of nutritional interventions are necessary in patients with short bowel syndrome?
parenteral, high carb low fat, 6 small meals
What kinds of medications would you anticipate administering for short bowel syndrome?
antidiarrheal drugs
What should be done if gastric residual volume is greater than 250 mL after second residual check?
promotility agent should be considered
What should be done if gastric residual volume is greater than 500 mL?
hold enteral nutrition, reassess patient tolerance
What temperature should tube feedings be given at to reduce likelihood of diarrhea and other GI complaints
room or body temp
What complications of enteral nutrition are elderly patients at higher risk for?
fluid overload (HF), dehydration (diarrhea, impaired cognition), electrolyte imbalances, glucose intolerance, aspiration (GERD)
How often is tubing changed in PN?
24 hours (PN with lipids), 72 hours (PN with amino acids and dextrose)
What are the symptoms of refeeding syndrome?
fluid retention, electrolyte imbalances, hyperglycemia
foods that decrease LES pressure and should be avoided in GERD
chocolate, peppermint, tomatoes, coffee, tea, milk (esp at bedtime)
When should GERD patients consume fluids?
between meals
Antiulcer drug used for its cytoprotective properties
sucralfate
Cancers related to excess body fat
breast, endometrium, kidney, colon/rectal, pancreas, esophagus, gallbladder