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