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132 exam 4

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Gastritis - inflammation of the gastric mucosa
Drug related gastritis - NSAIDs (aspirin) - Corticosteroids
NSAID related gastritis - piroxicam (Feldene) - naproxen ( Naprosyn) - ibuprofen
Risk factors for NSAID related gastritis - women over 60 - taking anticoagulants - Corticosteroids -NSAIDs -
Heart drugs that cause gastritis. - digitalis ( digoxin) - alendronate (Fosamax)
Diet - alcoholic drinking binge - eating large quantities of spicy, irritating foods
H- Pylori - causes acute gastritis in most effected persons - may lead to stomach cancer
Prolonged vomiting.. Bulimia may contribute to Gastritis
Autoimmune Gastritis - inherited condition in which there is an immune response directed against parietal cells. - mostly effects women of northern European decent - loss of parietal cells cause malabsorption of cobalamin (b12)
Symptoms of acute Gastritis.. - anorexia, N& V, epigastric tenderness, feeling of fullness
Intrinsic factor.. - essential for absorption of cobalamin (b12)
Lack of Cobalmin.. - B12 is essential for growth and maturation of RBCs, leading to Pernicious Anemia
Diagnostic studies - usually diagnosed on pt symptoms - Endoscopic exam w/ biopsy is needed for definite diagnosis
Tests for H-Pylori - Breath, urine, stool, and gastric tissue
If Vomiting accompanies gastritis.. - rest, NPO status, and IV fluids are prescribed - Antiemetics (41-1) - Monitor for dehydration
In severe cases of acute gastritis.. - NG tube may be used - PPIs & H2 receptors used
Treatment of Chromic Gastritis - evaluating & eliminating specific cause (smoking, drinking, H-Pylori eradication)
Patients with Pernicious Anemia.. - need lifelong Cobalamin therapy
Is smoking contradicted in all forms of gastritis? SHO IS
PUD -Condition characterized by erosion of the GI mucosa from the digestive action of HCL acid & Pepsin
H-Pylori - is associated with PUD - usually spread from childood from family members
Medication-Induced Injury - NSAIDs are responsible for majority of non H-pylori ulcers
Lifestyle factors - high alcohol intake is associated with acute mucosal lesions - coffee - smoking
Gastric ulcers - mostly found in antrum - less common than duodenal - greater in women ages 50-60 - greater risk of cancer - Burning / gaseous pressure in epigastrium - Pain 1-2 hours after meals - Food DOES NOT help - Higher mortality rate - obstruction likely
Duodenal Ulcers - First 1-2 cm of duodenum - greater in men ages 35-45 - no increase risk of cancer - Associated w/ other diseases - Burning, cramping, pressure-like pain across midepigastrium & upper abdomen - Pain 2-5 hours after meal - food & antacids HELP pain
Hemorrhage - Most common complication - more common in duodenal ulcers
Perforation - most lethal complication - more common in gastric ulcers
In perforation.. - stomach looks board like and rigid - respirations shallow and fast - tachycardia - weak pulse - absent bowel sounds
Gastric Outlet Obstruction - patient reports pain that is worse near end of day - belching or self- induced vomiting may relieve pain - Projectile vomiting common - vomit may contain food particles from several days prior - constipatiion
Diagnostic studies for PUD - Endoscopy is most ACCURATE ( tissue samples taken to assess for H-Pylori) -
Gold standard for diagnosis H-Pylori.. - biopsy of the antral mucosa with testing for urease (rapid urease testing) - Urea breath test can diagnose active H-Pylori
Elevated fasting serum gastrin levels may indicate? - presence of possible gastrinoma (Zollinger-Ellison Disease)
Serum Amylase test evaluates? - pancreatic function when posterior duodenal ulcer penetration of the pancreas is suspected
Therapy of PUD - Pain disappears 3-6 days but ulcer healing takes 3-9 weeks - Most accurate method to monitor ulcer healing is endoscopic exam
Aspirin & nonselective NSAIDs are discontinued for how long? - 4- 6 weeks
Drug therapy focuses on.. - reducing gastric acid secretion and eliminating H-Pylori if present
Eradicating H-Pylori - use PPI and Antibiotic for 7-14 days
PPIs - more effective than H2 in reducing gastric acid secretion and promoting gastric ulcer healing
H2 receptors - promote ulcer healing - onset is 1 hour - Famotidine, ranitidine, cimetidine given orally or Iv - Nizatidine only given orally
Antacids - increase gastric pH by neutralizing HCL acid - Mg Hydroxide & Aluminum Hydroxide - taken after each meal effects last 3-4 hours
Cytoprotective drugs - Sucralfate used for short term treatment of ulcers - provides cytoprotection for the esophagus, stomach, and duodenum - give 60 minutes before or after antacid - Misoprostol used for NSAID induced ulcers & doesnt interfere with beneficial effects of
Tx for perforation - stop spillage of gastric contents into peritoneal cavity - NG tube provides continuous aspiration - circulating blood volume replaced by lactated ringer - Procedure involing least risk to patient is simple oversewing and reinforce area with a graft
Tx for Gastric Obstruction - must decompress stomach - Ng tube used - pain relief subsides with decompression - PPI or H2 used if onstruction is due to active ulcer
Pylorric obstruction may be treated by.. - balloon dilations
With hemmorhage bleeding.. - patients pain may decreases due to blood neutralizing gastric acid
OTC PPI and H2 -warn patient not to take these!!
Gastroduodenostomy/ Billroth 1 - partial gastrectomy with removal of the distal two thirds of the stomach and anastomosis of the gastric stump to the duodenum
Gastrojejunostomy / Billroth 2 - if the gastric stump is anastomosed to the jejunum
Vagostomy - severing of the vagus nerve that decreases gastric acid secretion
Pyloroplasty - surgical enlargement of the pyloric sphincter to facilitate the easy passage of contents from the stomach
Dumping syndrome - direct result of surgical removal of a large portion of the stomach and pyloric sphincter - S/S: 15 to 30 mins after eating include sweating, palpitations, dizziness due to sudden decrease in plasma volume - last less than 1 hour after eating
Postprandial hypoglycemia - result of uncontrolled gastric emptying of a bolus of fluid high in carbohydrate into the small intestines - reflex hypoglycemia - 2 hours after eating
Bile reflux gastritis - Cholestyramine (questran) given before or after meals that binds with bile salts that are the source of irritation
After surgery care - NG tube used to decompress stomach - Bright red aspirate normal & gradual darkening in 24 hours - color changes to yellow 36-48 hours Monitor I & O q4h - Splint area with pillow to prevent rupturing
IBS - disorder characterized by chronic abdominal pain/ discomfort/ alteration of bowel patterns
Men - IBS with diarrhea
Women - IBS with constipation
Key to accurate diagnosis? - thorough hx & physical exam
Avoid foods - common-gas forming - avoid dairy products if need be
Eat? - lots of fiber
Drug therapy - Antispasmodic meds - Bentyl to decrease GI motility to reduce diarrhea - Amitiza & Linzess for constipation SSRIs may help reduce symptoms
Appendicitis - inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum - most common emergency surgery
Common cause of Appendicitis? - obstruction of the lumen by feces which can lead to music producing gangrene
How does Appendicitis begin? - typically starts as dull periumbilical pain - pain is persistent and shifts to RLQ localizing at McBurney's point (halfway between umbilicus & right iliac crest) - low grade fever and rebound tenderness - pt prefers to lie still with rt leg flexed
Diagnostic studies - Mildy to moderate Elevated WBC count
Preferred diagnostic procedure for Appendicitis? - CT scan
Tx of Appendicitis - Appendectomy - antibiotics and fluid resuscitation are started before surgery
If appendix have ruptured.. - if abscess is evident, giving parenteral fluids and antibiotics therapy for 6-8 hours prior to surgery to prevent sepsis
Nursing Managment of Appendicitis - ensure stomach is empty in case surgery is need NPO - Patients usually discharged after 24 hours and return to normal life after 2-3 weeks
Rovsing Sign - apply pressure to lower left quadrant which will make the RLQ hurt if appendicitis is present
Psoas Sign - Place hand on Pt's right knee and have them raise their leg
Obturator Sign - Pt flips on left side bring leg into flexion at the hip and then internal rotation at the thigh
Inflammatory Bowel Disease (IBD) - chronic inflammation of the GI tract characterized by periods of remission interspersed with periods of exacerbation - exact cause and cure is unknown
Ulcerative Colitis - usually limited to the colon
Crohn's disease - can involve any segment of the GI tract from the mouth to the anus
Both diseases.. - commonly occur during teenage years and early adulthood - Occur in whites & Ashkenazic Jewish origin - most sufferers have other members of family with disease
IBD - autoimmune disease - more common in industrialized countries - high intake of total fats, etc lead to IBD
High fiber& fruit intake decreases risk for? - Crohn's Disease
High vegetable intake decreases risk for? - ulcerative colitis
Crohn's Disease - Occur anywhere in the GI tract - commonly involves distal ileum & proximal colon - "skip lesions" - inflammation involves all layers of bowel wall - cobblestone appearance - Strictures at areas of inflamm can cause bowel obstruction - fistulas
Ulcerative colitis - starts in rectum & moves in a continual fashion toward cecum - disease of colon & rectum - Inflammation & ulcerations occur in mucosal layer - fistulas & abscesses are rare - diarrhea w/ electrolyte loss is common - Pseudopolyps
Manifestations of Crohn's - diarrhea & cramping pain are common - weight loss if small intestine is involved - rectal disease
Ulcerative Colitis - bloody diarrhea & abdominal pain
Complications of IBD - Hemorrhage, strictures, perforation, toxic megacolon - Megacolon is at risk for perforation & may need an emergency colectomy ** ulcerative colitis** - Perineal abscess & fistulas in Crohn's disease
Crohn's gives increased risk for.. - small intestinal cancer
People with IBD suffer from.. - joint, eye, mouth, kidney, bone, vascular & skin problems
Liver function tests are important.. - because sclerosing cholangitis, a complication of IBD, can lead to liver failure
CBC - Shows Iron-deficiency anemia from blood loss
Elevated WBC - Indication of toxic megacolon or perforation
Elevated erythrocyte sedimentation rate, C-reactive protein, WBC's - reflect inflammation
Imaging studies double contrast barium enema, small bowel series, transabdominal ultrasound, CT, & MRI are helpful in diagnosis IBD
Colonoscopy - allows for exam of entire large intestine lumen and sometimes the most distal ileum - can only enter the distal ileum
Capsule Endoscopy - used to diagnose Crohn's in small instestine
Goals of tx of IBD - Rest the bowel NPO - Control Inflam etc
Preferred tx for Crohn's? - drugs preferred over surgery
5-aminosalicylic Acid (5-ASA) - mainstay in achieving & maintaining remission & preventing flare-up of IBD - sulfasalazine (Azulfidine) - MORE EFFECTIVE FOR ULCERTAIVE COLITIS - HOWEVER, 1st line defense for mild-mod Crohn's when colon is involved
Topical Application of 5-ASA - application to intestinal mucosa suppresses pro-inflammatory cytokines & other inflammatory mediators - advantage of delivering directly to affected tissue minimizing systemic effects
Larger the dose of 5-ASA - More likely patients will improve during acute phase & remain in remission
Side effects of sulfasalazine - headaches, nausea, & fatigue - infertility in long term use in men
Corticosteroids - used to achieve remission in IBD - given for shortest possible time b/c of side effects
Oral Prednisone - given to patients w/ mild to moderate disease who did not respond to either 5-ASA or topical corticosteroids
Immunosuppresants - given to maintain remission after corticosteroid induction therapy
ImmunoSuppressants require.. - regular CBC monitoring because they suppress bone marrow & lead to inflammation of the pancreas and liver
Immunosuppresants have a.. delayed onset of action and are not good for flare ups
Methotrexate - most useful in Crohn's disease
Don't feel like doing other meds read in book page 947-948
Surgical cure for ulcerative colitis? - total proctocolectomy
Total proctocolectomy w/ ileal pouch/ anal anastomies (IPPA) - Most commonly used surgical procedure for ulcerative colitis - diverting ileostomy performed and ileal pouch is created & anastomosed directly to anus - 2 surgeries 8-12 weeks apart Major complication: acute or chronic pouchitis
Total proctocolectomy w/ pernament ileostomy - one-stage surgery - removal of the colon, rectum, and anus w/ closure of anal opening - end of terminal ileum is brought out through abdominal wall to form a stoma - stoma placed in RLQ below belt line
Crohn's disease and surgery - Most patients eventually require surgery - Most common surgery involves resection of the diseased segments w/ reanastomosis of the remaining intestine
Short bowel sydrome - seen in crohns patients who had surgery leaving too little small intestine surface area to maintain nutrition & hydration
Other sx for Crohn's? - strictureplasty: opens up narrowed areas obstructing the bowel
Diverticula - saccular dilations or outpouchings of the mucosa that develop in the colon
Diverticulosis - presence of multiple noninflamed diverticula
Diverticulitis - inflammation of one or more diverticula, resulting in perforation into the peritoneum
Diverticula are most seen in the? - LEFT (descending,sigmoid) colon
Main factor thought to contribute to diverticulosis? - lack of dietary fiber intake
Vegetarians - rarely have diverticula
Symptoms of diverticulosis include - abdominal pain, bloating, flatulence, and changes in bowel habits
Most common s/s of diverticulitis -acute pain in LLQ, palpable abdominal mass, N&V, systemic infection - can cause erosion of the bowel wall and perforation into the periotoneum - localized abscess develops when the body is able to wall of area of perforation
When is diverticular disease discovered? - during routine sigmoidoscopy or colonoscopy - diagnosis based on history and physical exam
Preferred diagnostic test for diverticular disease? - CT scan w/ oral contrast
Management of Diver? - high-fiber diet, from fruit and vegetables w. decreased red meat and fat
Goal of tx in acute diverticulitis - let the colon rest & inflammation subside
If hospitalized.. - patient is kept NPO w/ IV fluids and antibiotics - when acute attack subsides, give oral fluids first and progress the diet to semisolids
Surgical solution - involves resection of the involved colon w/ primary anastomosis
Teach importance of.. - high-fiber diet & encourage fluid intake of 2L/day
Celiac disease - autoimmune disease characterized by damage to the small intestine mucosa from ingesting wheat, barley, and rye - AKA Celiac Sprue & gluten-sensitive enteropathy
Gluten contains specific peptides called? - prolamines
Damage is most seen in? - duodenum
Classic symptoms of Celiac - foul-smelling diarrhea, stetorrhea, flatulence, abdominal distension & malnutrition
Dermatitis herpetiformis - an intensely pruritic, vesicular skin lesion, sometimes present and occurs as a rash on the butt, scalp, face, and knees
In celiac disease is protein, fat, and carb absorption affected? YES!
Iron deficiency anemia common? Yes!
Confirmed by? - combo of hx & physical exam -
Gold standard for confirming diagnoses? - Histologic evidence
Only effective treatment for celiac? - gluten-free diet
Individuals with celiac disease have increased risk for? - non-Hodgkin's lymphoma & GI cancers
Lactase Deficiency - condition in which the lactase enzyme is deficient or absent
Lactase - enzyme that breaks down lactose into glucose and galactose
Symptoms include: - bloating - flatulence - cramping abdominal pain - diarrhea - symptoms occur 30 minutes to several hours after drinking milk
Lactose intolerance is diagnosed with what test? - lactose tolerance test, lactose hydrogen breath test, genetic testing
Prompt resolution of symptoms? - lactose-free diet
Lactase enzyme ( LACTAID) - available as an over the counter product which breaks down lactose present in ingested milk
Cheese - less lactose than milk and ice cream
Created by: KristinL