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GI I Med-Surg
| Question | Answer |
|---|---|
| N/V can cause metabolic ________ | alkalosis |
| Diarrhea can cause metabolic ________ | acidosis |
| Vagus nerve stimulates production of _____ and ______ | hydrochloric acid, gastrin |
| pH of stomach | 1-2 |
| pH of small intestine | 6-7 |
| neutralizes hydrochloric acid | bicarbonate |
| turns pepsin into pepsinogen | hydrochloric acid |
| where in GI tract chemical digestion primarily takes place | duodenum |
| 9 functions of liver | carb/amino acid/lipid metabolism, synthesis of plasma proteins, phagocytosis by kupffer cells, formation of bilirubin, storage, detox, activation of vit D |
| accessory organs of GI | liver, gallbladder, pancreas |
| length of small intestine | 10 ft |
| length of duodenum | 10 in |
| jejunum length | 3 ft |
| ileum length | 6 ft |
| large intestine length | 5 ft long |
| liver receives oxygenated blood by way of the ? | hepatic artery |
| duodenal mucosa secretes the hormone ______ | cholecystokinin |
| pancreatic digestive enzymes (4) | amylase, lipase, trypsin, bicarb juice |
| Carcinoembryonic Antigen (CEA) marker | used to monitor GI cancer tx effectiveness |
| alanine aminotransferase (ALT) | liver enzyme, increased in chronic liver failure and hepatitis |
| aspartate aminotransferase (AST) | liver enzyme increased in chronic liver failure, viral hepatitis, acute pancreatitis |
| lactic dehydrogenase (LDH) | liver enzyme increased in liver disease |
| DISDA/HIDA/IDA scans | inject pt with a small amt of radioactive isotope, serial images of gallbladder/bile duct/duodenum are recorded. Confirms biliary disease, ejection problem or obstruction |
| esophagogastroduodenoscopy (EGD) | bx peptic ulcers, stomach cancer |
| endoscoptic retrograde cholangiopancreatography (ERCP) | go partially into ampulla of Vater, check for pancreatic CA, gallstones |
| nsg measures for post liver biopsy | lay pt on right side for 8 hrs, pressure dsg on site of biopsy |
| Levin GI tube | not vented, single lumen, used for gastric decompression, irrigation, lavage, feeding |
| Salem-Sump GI tube | Vented, double lumen, used for decompression, irrigations, lavage |
| you should check for stomach residual on continuous tube feeding pts every ____ hour(s) | 8 |
| anticholinergenics/anti-spasmodics contraindicated in what 2 conditions | glaucoma, prostate |
| Roux-en-Y gastric bypass | small stomach pouch created with staples, Y-shaped section of small intestine attached to pouch to allow food to bypass lower stomach and duodenum (into jejunum) |
| vertical banded gastroplasty | small stomach pouch made w/ staple line and mesh band, circular window made with staples, allows band to be placed around pouch - restricts and slows food flow from stomach pouch |
| caput medusae | bluish purple swollen vein pattern extending out from navel |
| icterus | jaundice - yellowing of skin and sclerae of eyes |
| when would GI decompression be needed? | when stomach or small intestine become filled w/ air or fluid |
| how long do you need to do GI compression for? | until active bowel sounds and flatus have returned |
| antiemetics - name 5 | Tigan, Antivert, Phenergan, Compazine, Zofran |
| bulimia can cause acidosis or alkalosis? | metabolic alkalosis |
| what is dumping syndrome? s/s? | food going too quickly into jejunum. nausea/chest and abd cramps/sweating/diarrhea |
| fundoplication | surgical procedure - stomach fundus wrapped around lower part of esophagus for hiatal hernia tx |
| what proton pump inhibitors (PPIs) do | reduce amount of HCl stomach produces |
| 3 proton pump inhibitor (PPI) meds | omeprazole (Prilosec), lansolprazole (Prevacid), rabeprazole (Aciphex) |
| 5 H2 antagonists | cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), nizatidine (Axid), misoprostol (Cytotec) |
| 3 anticholergenics/antispasmodics | Atropine Sulfate, Pro-Banthine, Belladonna |
| anti-reflux/GI motility/prokinetic med | metochlopromide (Reglan) |
| 2 standard tests for checking for GI bleed | hemoglobin and hematocrit |
| 2 types of meds you'd give for a Mallory Weiss tear | PPIs, antiemetics |
| Mallory Weiss tear | longitudinal tear in mucous membrane of esophagus at stomach junction |
| s/s Mallory Weiss tear | bright red bloody emesis, bloody/tarry stools |
| main cause of GERD | lower esophageal sphincter does not close tightly |
| Barrett's esophagus | precancerous lesion caused by longterm acid reflux, puts pt at risk for developing esophageal CA |
| esophageal varices | dilated blood vessels in esophagus, can rupture and be life threeatening, develop from portal HTN |
| type of meds you'd use to treat gastritis (3) | antacids, antiemetics, PPIs |
| type A gastritis | autoimmune, asymptomatic, no intrinsic factor secreted from stomach, difficulty absorbing B12 -> pernicious anemia |
| type B gastritis | caused by H. pylori bacterial infection, generally affects lower stomach |
| gastritis | inflammation of stomach mucosa |
| primary cause of Peptic ulcer disease | bacterium H. pylori |
| what is peptic ulcer disease | erosion of GI lining |
| tests used to dx peptic ulcer disease | EGD, upper GI series, H. pylori test |
| "triple therapy" regimen for H. pylori infection | amoxicillin (Amoxil) + clarithromycin (Biaxin) + omeprazole (Prilosec) |
| what is "triple therapy" for H. pylori infection | 2 antibiotics, 1 proton pump inhibitor |
| "dual therapy" for H. pylori infection | clarithromycin (Biaxin) + omeprazole (Prilosec) |
| what is "dual therapy" for H. pylori infection | antibiotic + proton pump inhibitor OR antibiotic + H2 antagonist |
| stress/Curling's ulcers | ulcer of duodenum in pt with extensive superficial burns or severe bodily injury |
| how to prevent stress/Curling's ulcers (pharmacologically)? | antacids, H2 antagonists, sucralfate, PPIs |
| actions to prevent stress/Curling's ulcers | put in NG tube to neutralize gastric pH, G-tube feedings |
| how H2 antagonists work | inhibit gastric acid secretion by blocking H2 receptors on gastric parietal cells |
| how PPIs work | bind to enzyme on gastric parietal cells to prevent final transport of hydrogen to block gastric acid secretion |
| Early s/s of gastric CA | none |
| Subtotal gastrectomy - Bilroth I (gastroduodenostomy) | distal 75% of stomach removed, remaining part of stomach sutured to duodenum |
| subtotal gastrectomy - Bilroth II (gastrojejunostomy) | distal 50% of stomach, anastomosed to jejunum |
| type of gastrectomy most at risk for dumping syndrome | Bilroth II gastrojejunostomy |
| Vagotomy | section of vagus nerve cut, may be performed w/ gastric surgery, eliminates vagal stimulation for HCl and gastrin hormone secretion and slows gastric motility |
| total gastrectomy | total stomach removal, anastomosis of esophagus to jejunum |
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