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EXAM 2 - MED SURG
GERD, ULCERS, BARIATRICS
| Question | Answer |
|---|---|
| GERD Clinical Manifestations | Heart burn is most common clinical manifestation. Burning, tight sensation felt beneath the lower sternum and spreading upward to throat or jaw. Hypersalivation may also be reported Felt intermittently |
| and spreading upward to throat or jaw. Hypersalivation may also be reported Felt intermittently | |
| Dyspepsia | Pain or discomfort centered in upper abdomen |
| Regurgitation | Described as hot, bitter, or sour liquid coming into throat or mouth |
| Barrett's Esophagus (Esophageal Metaplasia) | Replacement of normal squamous epithelium with columnar epithelium. Signs and symptoms are: none to perforation. Perforation can be evidenced by increased temp. Must be monitored every 2-3 years by endoscopy |
| Esophagitis | Inflammation of gastric acid |
| GERD Etiology and Pathophysiology | Incompetent lower esophageal sphincter (LES). Results in decreased pressure in distal portion of esophagus. Gastric contents move from stomach to esophagus, |
| History & Physical Examination EDUCATION | Lifestyle modifications- avoid triggers, maintain appropriate weight, smoking cessation, stress management |
| Upper GI endoscopy | Useful in assessing LES competence, degree of inflammation, scarring, strictures. Obtain biopsy and cytologic specimens |
| Barium Swallow | Can detect protrusion of gastric fundus |
| Complications of GERD | include inflammation of the esophagus, narrowing of the esophagus (strictures), asthma, pneumonia, voice changes, wheezing and fluid in the lungs |
| Treatment of GERD | Calcium antacids have high neutralizing capacity and rapid onset. The drugs may cause rebound acidity and hypercalcemia and so are not used for the treatment of peptic ulcer disease or GERD. |
| GERD Interventions | Elevate head of bed at least 30 degrees, Encourage small meals, Evaluate effectiveness of meds |
| What should a patient with GERD avoid? | Lying down after eating (should wait 2-3 hours), late night eating, lying flat, caffeinated beverages, spicy foods |
| Ethnicity at a greater risk | African American's --> Native American Females --> Hispanic Males --> White Females --> Native American Females |
| Underweight | <18.5 |
| Normal Weight | 18.5-24.9 |
| Overweight | 25.0-29.9 |
| Obesity Class I | 30.0-34.9 |
| Obesity Class II | 35.0-39.9 |
| Obesity Class III | 40 or greater |
| Obesity | Abnormal or excessive fat accumulation that may impair health. Impairs normal bodily functions, possesses characteristic signs and symptoms and can cause morbidity. |
| Goals for Care | Setting weight loss goals, improve lifestyle behaviors, diet habits and physical activity, address barriers to change, consider use of adjunctive pharmacotherapy agents, and self-monitor and strategizing ongoing lifestyle changes aimed at a healthy weight |
| Weight Loss Options | Nutritional therapy, drug therapy, exercise, behavior modification, support groups, Bariatric Surgeries |
| Bariatric Surgeries | usually reserved for those with a BMI of greater than 40. This threshold is lowered to a BMI of 35 if one is afflicted with an at-risk condition such as sleep apnea, diabetes or heart disease. |
| Vagal Blocking Therapy | Also known as gastric stimulation. Involves placement of a pacemaker like device Pre-programmed, pulsating signal is delivered for 12 hours daily. Causing intermittent blocking of the vagus nerve. Results in diminished gastric contraction and emptying, limited ghrelin secretion, and diminished pancreatic enzyme secretion |
| Intragastric Balloon Therapy | Intragastric balloon therapy involves endoscopic placement of a gas-filled balloon results in an increased feelings of fullness and decreased gastric emptying. |
| Sleeve Gastrectomy | Narrow, tubular stomach. 75-85% of stomach is removed. There is no intestinal diversion |
| Roux-en-Y gastric bypass (RYGB) | Small stomach pouch made from the top of stomach. Pouch empties directly to intestines. Food and enzymes meet lower down in the intestine. It is a combination of restrictive and malabsorptive surgery. |
| gastric banding | Silastic Band, Inflatable Balloon Tubing, Port. Silicone band around top of stomach, slowly moves food through the band. Portion Control |
| Which is the least invasive? | Vagal blocking, intragastric balloons, or bariatric embolization |
| Post-Op teaching for patient having bariatric surgery | Pain meds, wound assessment |
| Meal size? Frequency? Main Consumption? | Eat slow, stop when full, NO LIQUIDS with solid food |
| How to preventing Dumping Syndrome? | Increasing amount of protein and fiber in your diet. Eat 5-6 small meals each day. Avoid drinking fluids until after eals, avoid simple sugars like table sugar, in foods and beverages, increasing the thickness of food or beverages |
| When to drink fluids? | After meals |
| Peptic Ulcer | May be referred to as a gastric, duodenal, or esophageal ulcer, depending on the location. |
| When is pain experienced with duodenal Ulcers | Most commonly occurs 2-3 hours after meals. Also 50-80% of patients report pain that wakes them at night |
| Curling Ulcer | frequently observes after extensive burn injuries and often involves the antrum of the stomach or the duodenum |
| Crushing Ulcer | common in patients with traumatic head injuries, stroke, brain tumors, or following intracranial surgery. Thought to be caused by ICP |
| Stress Ulcers | term given to acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events such as burns, shock, sepsis, multiple organ dysfunction syndrome |
| Esophageal Ulcers | occur as a result of the backward flow of HCl from the stomach to the esophagus (like in GERD) |
| Which ulcers secrete more acid than normal | Duodenal |
| Which ulcers secrete normal or decreased levels of acid | Gastric |
| What disease can Helicobacter pylori (H. pylori) cause | Peptic Ulcer |
| Dietary Recommendations for patients with peptic ulcer disease & what should be avoided | DO eat regular 3 meals a day to neutralize acid. AVOID Extreme of temp in food and beverages and overstimulation from the consumption of alcohol, coffee (caffeinated and decaffeinated), other caffeinated beverages. |
| Testing | Serologic Testing for antibodies against H. pylori antigen, stool antigen test, and urea breath test. CDC to assess for bleeding, and stools of occult blood |
| Signs of Peptic Ulcer Perforation | sudden onset of symptoms including sharp upper abdominal pain, may refer to shoulder, extreme abdominal tenderness, nausea or vomiting, hypotension, tachycardia may occur indicating the onset of shock |
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