Term
| What layers of the lining of the GI tract might ulcers penetrate? |
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Definition
| mucosa, serosa, and muscularis |
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Term
| What are peptic ulcers classified as? |
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Definition
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Term
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Definition
| Erosian of lining of GI tract by digestive enzymes and hydrochloric acid. |
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Term
| What are features common to both peptic and duodenal ulcers? |
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Definition
imbalance of acid and pepsin H. pylori bacteria causes breakdown in mucosa |
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Term
| What are some reasons for peptic ulcers? |
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Definition
NSAIDS H. pylori (infection usually occurs in childhood) smoking increases breakdown of mucosa barrier certain drugs, like corticosteroids |
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Term
| What are some examples of cytoprotective and cytoprotective and antisecretory drugs? |
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Definition
| Carafate and Pepto Bismol (ate) and Cytotech (misoprotol) |
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Term
| What are the clinical manifestations of a duodenal ulcer? |
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Definition
burning/cramping midepigastric pain 2-4 hours after meal referred back pain eating found to provide relief |
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Term
| What are the clinical manifestations of a gastric ulcer? |
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Definition
burning/gaseous 1-2 hours after eating no relief from food |
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Term
| What are clinical manifestations of peptic ulcers? |
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Definition
dyspepsia - burning/gnawing indigestion, can be produced by ulcers bleeding - more common in duodenal vomitng - related to gastric outlet obstruction, causes stomach dilation vomiting melana (blood) perforation - food enters peritineal cavity, rigid board like abs |
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Term
| What are some examples of proton pump inhibitors? |
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Definition
| Nexium, Prevacid, Prilosec, Protonix, Aciphex (ozole) |
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Term
| What labs will be ordered for suspected peptic ulcer disease? |
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Definition
HGT/HCT to rule out bleeding stool for occult blood radiographic barium - swallow, structural abnormalities Upper GI |
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Term
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Definition
diagnostic test to directly visualize esopohus and stomach biopsy and cautery can be performed checks for cancer |
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Term
| How is a patient prepped for a EGD? |
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Definition
NPO 6-12 hours conscious sedation numbing of gag reflex |
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Term
| What is check for post op from an EGD? |
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Definition
gag reflex vital signs abdominal pain good abdominal assessment |
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Term
| How is H. pylori tested for? |
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Definition
EGD urea breath test - non invasive, determines active infection IgG serologic testng - can't tell if old or new infection, antibiotics and antiulcer meds can produce false negatives |
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Term
| What are the drug therapy goals for peptic ulcer disease? |
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Definition
pain relief eradicated H. pylori heal ulcerations preven recurrence |
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Term
| What are some examples of H2 Receptor blockers? |
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Definition
| (edine) Tagamet, Pepcid, Axid, Zantax |
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Term
| What are common medical complications that occur as a result of peptic ulcer disease? |
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Definition
hemorrhage hematemesis (vomiting blood) upper GI bleeding melena (blood in stool) |
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Term
| What are clinical manifestations of a perforation with peptic ulcer disease? |
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Definition
gastric contents in abdominal cavity sudden, severe abdominal pain (fetal position) board like abdomen severly ill peitonitis decreased petistalsis |
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Term
| What can occurs as a result of perforation in peptic ulcer disease? |
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Definition
bacterial sepiocemia hypovolemic shock hypotensiev, tachycardic shunting of blood decreased UO |
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Term
| What is gastric outlet obstruction, and what are clinical manifestations? |
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Definition
thick pyloric sphincter metabolic acidosis hypokelemia hypoactive bowel sounds -- > paralytic ileus --> necrosis |
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Term
| What is the treatment for gastric outlet obstruction? |
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Definition
dilation of pyloris IV fluids |
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Term
| What are indications for a partial gastrectomy? |
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Definition
perforation hx of hemorrhage risk of milignancy no response to treatment obstruction |
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Term
| What is the different between a BRI and a BRII |
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Definition
A BRI connected the stomach to the duodenum. A BRII connect the stomach to the jujuneam. |
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Term
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Definition
| Severing of vagus nerve, eliminated stimulation of secretions. |
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Term
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Definition
| Widening of exit of pyloris. |
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Term
| What are preoperative nursing actions for a pt undergoing surgery for peptic ulcer disease? |
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Definition
NG tube to remove secretions teaching on abdominal surgery: cough, deep breath, move, NPO for a few days, no ice chips at will general anesthesia |
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Term
| What are post operative nursing actions for a patient who has undergone surgery for peptic ulcer disease? |
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Definition
turn off suction during assessment NEVER replace/reposition NG tube prevent accumulation of secretions note color, amount, odor of secretions gentle irrigation with saline |
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Term
| What are post operative complications of a patient who has undergone surgery for peptic ulcer disease? |
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Definition
decrease peristalsis (hypoactive or no bowel sounds) obstruction at site of anastomosis Dumping syndrome |
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Term
| What is Dumping Syndrome? |
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Definition
Most common with Bilroth II rapid emptying of gastric contents, hypertonic fluid, laxative effect, distension of bowel w/in 30 minuteso f eating |
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Term
| What are sympyoms of dumping syndrome? |
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Definition
vertigo tachycardia syncope sweating palloe palpitations desire to lie down |
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Term
| How is Dumping Syndrome managed dietarily? |
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Definition
| small meals, no liquids with meals, increased protein, increased fats, decreased carbohydrates, semi-Fowler's while eating |
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Term
| What is hypertrophic pyloric stenosis? |
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Definition
| circular muscle hypertropgies, obstructs emptying, frequent family hx |
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Term
| What are the manifestations of hypertrophic pyloric stenosis? |
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Definition
onset varies, b/t 2-4 weeks progressive projectile vomitng irritibility and hunger dehydration alkalosis hyperbilirubinemia few stools |
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Term
| How is pyloric stenosis evuluated? |
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Definition
physical exam, hx of vomiting dilated stomach sonogram upper GI studies lab values - anemia, electrolyte imbalance, palpable mass, right upper quandrant |
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Term
| What should the nurse do if pyloric stenosis is suspected? |
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Definition
observe UO, fontanels, dry mucous mebranes measure vomit |
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Term
| What does preoperative care for pyloric stenosis involve? |
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Definition
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Term
| What does post operative care for a child with hypertrophic stenosis look like? |
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Definition
weights instructions on feedings parental support |
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Term
| What is the surgery for pyloric stenosis? What are the goals? |
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Definition
pylerotomy
outcomes: no vomiting satisfactory peristalsis fluids after 4-6 hours discharge after 48 hours |
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Term
| What are lesions like in gastric and peptic ulcers? |
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Definition
Gastric: superficial, smooth margins, round, oval or cone shaped
Duodenal: penetrating |
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Term
| What is the location of a gastric and duodenal ulcer? |
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Definition
Gastric: predominantly antrum, also in body and fundus of stomach
Duodenal: First 1-2 cm of duodenum |
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Term
| What is the gastric secretions of gastric and duodenal ulcers? |
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Definition
Gastric: normal to decreased
Duodenal: increased |
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Term
| What is the incidence of gastric and duodenal ulcers? |
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Definition
gastric: greater in women, peak age 50-60 year, more common in persons of lower sociaeconomic status, increased with smoking, drug use, and alcohol use
duodenal: greater in men, but increasing in women, especially postmenopausal; peak age 35-45 years; associated with psychological stress; increased with smoking, drug use, and alcohol use; associated with other diseases |
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Term
| What are the clinical manifestations of gastric and duodenal ulcers? |
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Definition
Gastric: burning or gaseous pressure in high left epigastrium and back and upper abdomen; pain 1-2 hours after meals; if penetrating ulcer, aggrevation of discomfort with food; occasional nausea and vomiting; weigh loss
Duodenal: burning, cramping, pressurelike pain across midepigastrium and uper abdomen; back pain with posterior ulcers; pain 2-4 hours after meals and midmorning, midafernoon, middle of night, periodic and episodic; pain relief with antacids and food; occasional nausea and vomiting |
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Term
| What is the recurrence rate of gastric and duodenal ulcers? |
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Definition
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