gastritis may be clasified as ?

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Nutrition/ adult

test 4 level 3

Question	Answer
2 major disorders of stomach and UPPER small intestine?	Gastritis and Peptic ulcer disease
an inflamtion of the gastric mucosa is one of the most common problems affecting the stomach	Gastritis
gastritis may be clasified as ?	acute or chornic and diffuse or locaziled
occurs as a result of a breakdown in the normal gastric mucosal barrier.	Gastritis
protects the stomach tissue from the corrosive action of HCL acid and pepsin	Function of gastric mucosal barrier
In gastritis when the mucosal barrier is broken, HCL acidm and pepsin can diffuse back into the mucusa resulting in?	tissue edema, disruption of cappilary walls with loos of plasma into gastric lumen and possibly hemmorhage
Drugs that contribute to the development of acute/chronic gastritis?	NSAIDS, inlduign aspirin and corticosertiods, as they inhibit prostaglandin(which is protective to GI mucosal wall) and anticoagulants and digoxin
Injesting alchol, eating large quanitites of spicy, irriating foods and renal failure can cause?	Gastritis
an important cause of chronic gastritis?	Helicobacter pylori
Bacterial, viral and funfal infections have been associated with?	chronic gastrites
Intense emotional responses and CNS lesion may produce inflmation of mucosal lining as a result of hypersecretion of HCL acid	cause of gastritis
Anorexia, nausea, vommiting, epigastric tenderness and a feeling of fullness. Hemmorhage is associated with alchol abuse and at time is the ONLY symptom	S/S of acute gastrits
Prognosis of acute gastritis?	Self limiting, lasts a a couple hours or days, complete healing
When the parietal cells are lost as a result of atrohy the source of intrinsic factor is lost.	Chronic gastritis and results in cobalmin deficiency/ pernicious anemia
A CBC in gastritis may show?	anemia from blood lossor lack of intrinsic factor
If vommiting accompanies acute gastritis do what?	rest, NPO status and IV fluids, antimetics
treatmet of acute gastiris focuses on reducing irritation of the gastric mucosa and providing symptomatic relief through giving?	PPI's( azoles) or H2 receptor blockers (tidine)
Treatment of chronic gastrits?	Antibitotics for H. pylori, colabalmin therapy, non irritating diet w/ six small meals a day
drug and alchol abuse think?	gastritis
in gastritis check stool for?	occult blood
a severe case of acute gastritis may require?	NG tube for lavage
Neutralize acid in stomach and esophagus, rapid onset and short effect	Antacids
When give antacids?	before a meal
Reduce gastric HCL secretion, slower onset longer duration	H2 receptor blockers
Inhibits gastric acid secretion has a prolonged effect	Proton pump inhibitor
smoking is contraindicated in?	all forms of Gastritis
A condition charecterized by errosision of the GI mucosa resulting from digestive action of HCL acid a pepsin	Peptic ulcer disease
What part of GI tract is suspetible to ulcer development?	Any portion of the GI tract that comes into contact with gastric secretions
How are petic ulcers classified?	acute or chronic
accoiated with superficial erosion and minimal inlamation, resolves quickly when the cause is removed	The acute ulcer
eroding throguh the musclular wall with the formation of fibrous tissue	A chronic ulcer
peptic ulcers develop only in an?	acidic enviorment
histamine in released from the damaged mucosa, resulting in vasodilation and increased cappilary permeability in peptic ulcers results in?	further secretion of acid and pepsin
In adition to chronic gastritic H pylori is associated with?	peptic ulcers
alters gastric secretion and produces tissue damage leading to?	peptic ulcer disease
Aspirin and NSAIDS inhibit prostaglandis, increase gastric acid secretion and reduce the integrity of the mucosal barrietr	Ulcerogenic drufs
Coffe and alchol	Stimulate gatric acid production this Peptic ulcers
stress affects what in ulcers?	The healing of them
gastric ulcers are most commonly found in the?	Antrum
Gastric ulcers are more likely than duodenal ulcers to result in?	Obstruction
H.Pylori, meds, smoking and bile reflux are R/F for?	Gastic ulcers
Most common ulcer?	Duodenal
Most common cause of duodenal ulcer?	H. pylori
high epigastrum pain, occurs 1-2 hours after meals, pain is burning, if ulcer has eroded through mucosa food agravates this	Gastric ulcer
Occurs when gastric acid comes in contact with the ulcers/ With meal ingestion food is present to help buffer the acid, symptoms occur 2-5 hours after a meal, pain is burning and is midepigastrum and possible back pain antacids /h2 receptor block fix S/S	Duodenal ulcers
Tendencey to occur continously for a few weeks or months and then disaper for a time then recurs	Duodenal ulcers
Older adults and ulcers	usually siletn
Three major complications of PUD?	Hemorrhafe, perforation and gastric outlet obstruction, EMERGENCIES
Hemmorahfe is the more common in	Duodenal ulcers
Most lethal complication of PUD?	Perferation
the ulcer penetraties the serosal surface with spillage of either gastric or fuadenal contents into the periotenal cavity	Perferation
Sudden severe upper abdominal pain that quickly spreads throughout the abdomen. The pain radates to the back and is not relievedd byt food or antacids	Perforation
Bowel sounds usally absent, absomen appears rigid and boardlike tachy/ HISTORY of ulcer disease or recurrent symptoms of indigestion	[erforation
if perforaiton is untreaed bacterial periotnitis may occur within?	6-12 hours
obstruction in the distal stomavh and duodenum is the result of what in regards to PUD?	edema, inflamation or pylorspasm and fibrous scar tissue formation
how can relief be obtained with gastric out obstruction due to PUD?	belching or self-induced vommiting
Vomit that contains food particles that were injested hours or days before the vommiting episode signals?	Gastic outlet obstrcution due to PUD
most accurate diagnostic procedure for PUD?	Endoscopy
Eoscopy with biopsy is used in PUD to rule out?	H. Pylori
no invasive tests for H. Pylori?	Stool or breath test.
A CBC in PUD?	may show anemia
A serum amlyasyse determination s done to determine _______________ when posterior duodenal ulcer penetration of the pancreas is suspected	Pacreatic
aim of treatment with PUD?	Decrease gastric acidity and enhnace mucosal defense mechanisms
Pain from ulcers disaper in?	3-6 days but not heal till 3-9 weeks
important follow up for PUD?	follow up endoscoppy
Patietns with H. Pylori are treated with? (and PUD)	Antibiotics and PPI
with PUD it is important to stop?	smoking
Because ulcers frequently recur, interupption or discontinuation of therapy can have?	harmfull results so encourage continuing and follow up
H2 receptor blockers and PPIs may be stopped after?	the ulcer has healed or used as low dose maintance
This promotes ulcer healing, onset is one hour and lasts 12 hours	H2 receptor blockers
More effective than others in reducing gastric secretion and promoting ulcer healing	Proton pump inhibiros
These increase gastric Ph by neutralzaing the HCL acid. magnesium hydroxide or aluminum hydroxide	Antacids
Whent take antacids	after meals so they last a long time
If Ph is less than 5 with PUD consider?	NG suction
used for short term treatment of ulcers. It proovides cytoprotection for the esophagus, stomach and duodenum, should be given 30 minutes before an antacid.	Sucrafate
what antidepressants for PUD?	Tricylic
DIet for PUD?	No caffeine, no aclhol, do bland diet, (no broth tho)
PUD vleeding, increased pain and discomfort and N/V	Acute exacerbation
What to do in perferoation?	NG tube for decompression/stop aspiration, volume replacement, antibitoics, pain meds and surgery
What to do in gastric outlet obstruction?	Decompress stomach, fix fluid imbalance, clamp tube overnight and see if its still backing up.
symtpms related to gastric irritation during PUD?	Epigastric pain
Treatment of acute phase of PUD?	NP, NG tube/suction, IV fluid replacement
sudden severe abdominal pain, rigid boardlike abdomen, severe generalized abdominal and shoulder pain, fetal position and grunting respirations, bowel sounds ABSENT	perforation
direct result of surgical removal of a large portion of the stomach and the pyloric sphincter	Dumping syndrome
what is more common acute or chronic PUD?	chronic
Pathology of PUD?	Not neccesarly the amount of HCL secreted but the ability of it to penetrate the mucosal barrier
pain in high epigastrum	Gastric ulcer
pain is burning or gaseous pain is spnontaineous usually 1-2 hours after meals, food can agravate it?	Gastric ulcers
occurs 2-4 hours after eating, relieved by antacids or H2 receptor blockers, burning cramplike pain in mid epigastric and may radiate to back	Duodenal ulcers
Duodenum ulcers involves the duodenum and the?	pylorus
This ulcer pain is often relived by food?	duodenum ulcer
serum or whole blood antibody testing including IGg	Does not distinguish between current or past PUD but good still
Upper Barium GI contrast studies with gastric analysis may be helpful in diagnosing?	PUD
What diet in PUD? according to powerpoint?	6 bland small meals a day, no spicy, alchol, carbonated beverage/caffeine stop smoking dont take NSAIDS/aspirin
Most common complication of PUD?	Hemmorhage
sudden sharp severe abdominal/shoulder pain, black or bloody stools bloody vomit that looks like coffee grounds rebound tenderness think?	Perforation
In pud, hemmorage, perforation and gastric outlet obstruction are all?	medical emergencies
acute ulcers that follow a major physiologic insult	Physiologic stress ulcer
dx: for physiologic stress ulcer?	endoscopy
prevention of physiologic stress ulcer?	prophylaxis with antisecretory agents
treatment of physiologic stress ulcer	reduction of gastric acid secretion with PPI or h2 receptor blockers
physiologic stress ulcers occurs most often in?	infants and children
Acute inflamtion of the pancreas. varies from mild edema to severe hemorrhagic necrosis	Acute pancreatitis
Acute pancreatis is more common in?	Middle aged men and women.
race for pancreatis?	more african americans
Most common cause of acute pancretitis?	Gallbladder, second is chronic alchol intake
Independent risk facto for	acute pancretitis
a mixture of cholesterol crystals and calcium salts found in patients with acute pancreatis?	Biliary sludge
Formation of bilary sludge is seen in patients with bile?	staiss
hypertriglyceridema is associated with	Acute pancretitis
most common pathogenic mechanism of acute oancreatis is?	autodigestion of the pancreas
Activated trypsin in the __________ can digest the ________ and produce bleeding	Pancreas
Edematous or interstial pacreatitis	Mild pancreaitis
Necrotizing pancreatitis	Severe pacreatitis
Predominant manifestation of acute pancreatitis	Abdominal pain
The pain is due to distention , peritoneal irritation and obstruction of the billary tract	Pain in pancreaitis
Where is the pain in pancreaittis?	Left upper quadrant, may be midepigastrium radiates to back commonly
The pain has a steady onset and is described as severe, deep, piercing and continous or steady, pain is agravated by eating and occurs when recumbnent	Pancreaitis
Patient may assume various positions involving flexion of the spine in an attempt to relieve severe pain, may see N/V fever, leukocytosis, hypotension, jaundice, muscle guarding	Pacereatis
Bowel sounds in pacreatis?	decreased or absent
Paralytic illeuls and crackles of lungs may be present in?	pancreatitis
cyanosis or greenish to yellow-brown discolaration of the abdominal wall.	Pancreatisis
in pancreatis echmyoses of the flanks	Grey turners, and the periumbical area is cullens
Result from seepage of blood stained exufate from the pacreas	Grey turner/cullens, discolorations of abdominal walls
Two significant local complications of acute pancreaitis?	Pseudocyst and abscess
An acummulation of fluid, pancreatic enzymes, tissue debrs, and inflamatory exudate surronded bt a wall	A pancreatic pseudocyt
Palpable epigastric pain is evident of?	pacreatic pseudocyts
Serum amlysase levls in pancreatits is?	high
Pacreatic pseudocysts can perferoate cuasing	perotonitis
A pancreatic absess is a?	collection of pus
upper abdominal pain, abdominal mass, high fever and leuko cytosis	pacreatic absess need to treat to prevent sepsis
Main systemic complications of acute pancreatis?	pulmonary (pneumonia, ARDS, pleural effusion) and cardiovasculare (hyptension) and tetant thanks to hypocalcemia
enzyme induced inflamtion of the diapragm occurs with the end result being?	atelectasis
Trypsin in pancreatis puts the patient at risk for?	DIC, thrombi
primary diangostic tests for acute pancreatits?	serum amylase and serum lipase
Why is serum lipase more important than serum amylase in DX pancreatitis	amylase is raised in other disoreders
increase i liver enzymes, increase in trigluycerides and decrease in calcium points to?	pancreatits
Goals of tx for acute pancreatits?	Prevent shock, reduce pancreatic secretions, corect FE imbalances, prevent/treat infections, remove cause
in aute pancreatis pain meds are given in addition to?	antispasmodics
To pevent shock in pacreatis	blood volume replacements are used, like lR
It is important to reduce or supress pancreatic enzymes to decrease stimulation of the pancreas and allow it to rest in acute pancreatits how is this accomplished?	NPO, NG suction to reduce vommiting/gastric distention and to prevenet gastric acidic contents from entering the duodenum, PPI'S/antacids
In patients with acute necrotizing pancreatitis, what is the leading cause of death?	Infection
drugs that cure pancreaitis?	none
When food is allowed, in aucte pancreatits what is the diet?	Frequent feedings, high in carbs that is least stimulatinf no alchol
is frequent vommiting seen in acute pancreatis?	yes
major focus of care in acute pancreatits is?	pain
Diet teaching for acute pancreatits includes?	reduction of fat as the stimulare onacreas, carbs are less stimulating
If a person with acute pancreatitis recognizes symptoms of infection diabetes or steatorrhea do what?	Call dr.
A continous, prolonged inflamatroy and fibrosing of the pancreas, the pancreas is progressivly destroyed as it is replaced by fibroitic tissue	Chronic pancreaitis
Strictures and calcifications may occur in the pancreas in what disease?	Chronic pnacreatis
Can be due to alchol, obstruction by gall stones, timor, pseudocyts or traumas, disease, autoimmune pancreatis and cystic fiboris, may have NO history of acute condiition	Chronic pancreatis
Most common cause of obstructive pancreaitis is?	inflamation of the sphincter of oddi ascociated with gall stones
in non obstructive pancreaitis there is inflamtion and sclerosis mainly in the head of the oancres and around the pancreatic duct this type of chronic pancreatiis is the?	most commobn
Chronic pancreatits can be caused by those who abuse?	alchol
abdominal pain that is heavy gnawing feeling or burning and cramplike, not relived with food, come and goes	Chronic pancreatis
Malabsotption with weight loss, consitpation, mild jaundice with dark urine, steatorrhea and diabetes melitys are signs of	Chronic pancreaitis
Frothey urine and stool, steatorhea can become severe with vommitius	Chronic pancreatis
The level of serum amylase and lipase may be elvated slightly, bilirubin is increased, incresred ESR and mild leukocytosis, alkaline phosphate	Chronic pancreatis
Used to visualize the pancreatic and common bile duct	ERCP
Deficiency of fat-soluble vitamins, cobalmin, glucose intelerance and dibetes may be found in	chronic pancreaitis
Ways to control pancreatic insufficency in chronic pancreatits?	Diet, pancreatic enzyme replacement and control of diabetes, small bland frequent meals, no alchol or caffeine prescribe bile salts to help with fat absorption
Pacreatic enzymes are taken with ?	a meal or snack
shock/vasodilation is seen in?	acute pancreatis
Cavity continous with or surronding outside of pancreas filled with necrotic produts and liquid secretions	pancreatic pseudocytst
Large fluid containing cavity within the pnacreas resulting from extensive necrosis in the pancreas	Pancreatic absess
urinart amylase may be seen in?	acute pancreatits
TPN in acute pancreatis may be needed if there is a ?	severe nutritional defict
if enteral feedings are needed in acute pancreatits it is via a ?	jejunal feeeding tube
Two major types of chronic pancreatis?	Chronic obstructive pancreaitis, and chronic calcifying pancreatisi
chronic pancreatis may be associated with acute?	billary diseae
Mild jaundice with dark urine is seen in?	Chronic pancreatits
Most common disorder of the bilairy sytem is?	Cholelithias (stones of gallbladdder
Where may the gallstones lodge ?	neck of the gallbladder or in the cystic duct.
Inflamation of the gall bladder, this is usually associated with choleithiasis (gall stones)	Cholecystis (usually occur with gall stones)
Many people with stones are	asymptomatic
Cholecystectomy is?	removal of the gall bladder
Who is at higher risk for cholilithiasis?	Women, multipara and over 40, oral contraceptives, sedetary lifestyle and obesity. asins
Cause of gallstones?	Unknown
Develops when the balance that keeps cholesterol, bile salts calcium in solution is altered so that these substances precipitate	Cholelithiasis
Conditions that upset the balance of cholesterol, bile salts and calcium in solution	Infection and disturbances in metabolism of cholesterol
when bile is supersaturated with cholesterol what occurs?	Gall stones
besides cholesterol what 4 things can cause gall stones?	Protein, calcium, bilirumbin and bile salts.
Most common gallstone?	mixed predominatly cholsterol
stasis of bile as well as changes in composition of bile (bilary sludge) can lead to?	gall stones
The gallstones may remain in the gallbladder or migrate to the?	cystic duct or the common bile duct
Gallstones cause pain as they?	pass through the ducts and produce an obstruction
What size gallstones are more liekly to produce an obstruction	Smalls
if blockage of gallstone is in cytic duct?	bile can still get though
Choleosytisi is most commonly associated with?	obstruction caused by gallstones or billary sludge
asccoiated with prolonged immobility, elderly, diabetes and prolonged PN?	Just choleocytis
The gallblader is edmeatous and hypermic and may be distended with bile or pus	During an acute attack of cholecystits
When a stone is lodged in the ducts or when stones are moving through the ducts,	spasms may result
bilarly colic, pain is often steady, pain can be excurtating and accomponied by tachy , diaphoresis, may last up to an hour	Cholelithiasis
When the pain of cholethiasis subsides resuldual tenderness is felt in the?	right upper quadrant
The attacks of pain from gallstones occurs 3-6 hours after?	a high fatty meal or patient lays down
dark amber urine, obsructive jaundice, clar colored stools, bleeding tendencies, steatorheaa	Total obstrutction by gall stones related to bilary obstruction
indgestionand pain / tendeness in right upper quadrant	Choliethesiais
History of fat intoleracne, dyspesia, heartburn and flatulence	Chronic Chlecytutus
Most common complications of choleysitis in older or diabetic	Gangrenous cholecytisi and bile peritonits
Commonly used to dx gallstones? grear id allergic to contrast!	ultrasound
Allows visualaztion of the gall bladder , the cystic duct, the common hepatic duct and the common bile duct, bile taken during this is sent for culture.	ERCP
Insertion of a needle directly into the gallbladder duct followed by injection of contrast	Percutaneous transhepatic cholangiography
WBC in choleothasis?	increased
Blood levels elevated in cholestais?	ALT, AST, and alkaline phosphate
Once gallstones become syptmotic do what?	Surgical intervention with cholecystectomy
during an acute episode of cholecystits, treatment focus on?	pain control, control of possible infection with antibiotics and maintece of FE NG insertion of N/V is severe
may be used to drain purluent material from the obstructed gallbladder	a cholecysstostomy
Treatment of choice for symptomatic cholethiasis	Laproscoprtic cholecystectomy
able to return to work how long after choleystecomy?	a week
Common complication in laproscopic cholestectomy?	Injury to common bile duct
most common drrugs used in the treatment of gallbladder disease?	Analgesics, anticholinergics(antispasmodics) , fat soluble vitamins and bile salts
fat soluble vitamis needed if?	bilary tract is obstructed
Nutrition during acute gallbladder disease?	Small frequent meals with some fat at end of meal to increase gallblader emptying
After laproscopic cholestrectomy nuttrition adive?	Eat nutrion foods avoid fat for 4-6 weeks
jaundice, clay colored sools, dark foamy urine, steatorhea, fever and increased WBC count	Bilary tract obstruction
bleeding may result in cholesthiasis from	decreased prothrombin time thus take care during injections
abdominal pain and fever may indicate?	Pancreaitis
A common complication postop from laparscopic chlecystectomy is?	shoulder pain
how help with shoulder pain after a lap choleystectomy?	SIMS position, nsaids/codeine
after surgery for gallstones as well as acute period?	avoid exess fat
inflamation to mucosa lining or entire wall of gallblader, edmea	CholthiatITIS
absess, pancreatis, cholingitis, billary cirhosis and fistula are common complications of?	Gallbladder disease
in gallbladder disease what is a major complication if not treated?	rupture of gallblader resulting in peritonitis
antimetics are often given in?	choliethithais
ESWL	can use a lithiotripter to break apart a gallstone

Created by: rebo14

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