GI 1

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foxyt14
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247068
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GI 1
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2013-11-16 17:19:18
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Upper and Lower GI problems-Lecture 1
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  1. 2 Primary functions of the small intestines
    • digestion
    • absorption
  2. Most important function of the large intestine
    absorption of water and electrolytes
  3. 4 major functions of the liver
    • metabolize carbs, proteins, fats, steroids and detox of drugs/toxins
    • formation of bile and cholesterol/excrete bile
    • storage of glucose as glycogen, vitamins, fatty acids, minerals and amino acids
    • breakdown of old RBC's, WBC's, bacteria, Hgb to bilirubin
  4. Function of the gallbladder
    to concentrate and store bile
  5. 2 functions of pancreas
    exocrine-secretion of pancreatic enzymes to aid in the process of digestion

    endocrine-secretion of insulin from the beta cells and secrete glucagon from the alpha cells
  6. What can antibiotics do to the digestive tract?
    mess with the normal flora causing diarrhea
  7. What causes GERD?
    reflux of gastric contents into the esophagus
  8. Predisposing conditions for GERD
    • Hiatal Hernia
    • **Incompetent LES
    • Impaired esophageal clearance in to stomach
    • Impaired gastric emptying (gastric paresis)
  9. With GERD what refluxes into the lower esophagus?
    • HCL
    • Pepsin
    • Intestinal proteolytic enzymes
    • Bile
  10. Primary factor in GERD is....
    Incompetent Lower Esophageal Sphincter

    stomach contents move from high pressure in the stomach to a lower pressure in the esophagus thru a weak sphincter
  11. Who is at high risk for having GERD?
    Why?
    Pt. with DM

    they have internal neuropathies which creates a problem with gastric emptying
  12. Clinical Manifestations of GERD
    • Heartburn (pyrosis)
    • Indigestion (dyspepsia)
    • Regurgitation
  13. When do you need to get heartburn (pyrosis) evaluated?
    • when it is happening more than once/week
    • increase in severity
    • occurs at night
    • wakes you up from sleep
  14. How do you relieve indigestion (dyspepsia)?
    • milk
    • antacids
    • water
  15. How do differentiate between angina and GERD?
    GERD is relieved by antacids
  16. Complications of GERD
    • Esophagitis
    • Barrett's Esophagus
    • Dental Erosion
    • Respiratory complications
  17. Chronic Esophigitis may lead to...
    dysphagia
  18. Barrett's esophagus can lead to....
    CANCER
  19. With GERD the gastric secretions can irritate the upper airways causing....
    • aspiration pneumonia
    • chronic bronchitis
  20. How do you dx GERD?
    *Based on symptoms and symptom relief with medications and behavioral changes

    • Barium Swallow
    • Endoscopy
  21. What will a Barium Swallow show?
    if you have a HH....
  22. What will an Endoscopy show?
    • it is a direct visualization showing any incompetency with the LES
    • inflammation
    • scarring
    • strictures
  23. You can do a biopsy with Endoscopy.  What will it differentiate?
    • stomach/esophageal cancer
    • Barrett's Esophagus
  24. Lifestyle modifications for GERD and HH
    • avoid triggers that cause reflux
    • stop smoking
    • elevate HOB
    • reduce intra-abdominal pressure by decreasing weight
  25. Foods to avoid if you have GERD and HH
    • tomato products
    • OJ
    • cola
    • red wine
    • chocolate
    • peppermint
    • coffee/tea
    • milk
  26. If you have GERD....key things to know when eating.
    • small frequent meals with fluid in between
    • avoid late meals
    • don't lay down after eating
  27. Proton Pump Inhibitors (2)
    How do they work?
    Protonix and Prilosec

    blocks production of acid in the stomach
  28. What is the problem with Protonix and Prilosec?
    it changes the pH in the GI tract, we are are seeing a high incidence of c-diff
  29. H2R blockers (2)
    How do they work?
    Pepcid or Zantac

    blocks histamine from entering the stomach
  30. Prokinetics (1)
    How does it work?
    Reglan

    increases motility in the GI tract promoting gastric emptying and reducing the risk of gastric acid reflux
  31. GI Protectant (1)
    How does it work?
    Carafate

    Covers the ulcer to protect from gastric acids with food ingestion
  32. When do you take Carafate and Reglan?
    30 minutes prior to eating
  33. How do antacids work?

    When should they be taken?
    Neutralizes the HCL acid for mild to intermediate heartburn (not effective with severe heartburn)

    take 1-3 hours after meals and at bedtime
  34. When do you have surgery when you have GERD?
    when you have complications from it like Esophagitis, Barrett's, Strictures
  35. Fundoplication
    Laparoscopic anti-reflux procedure

    wraps the fundus of the stomach around the lower portion of the esophagus, thereby enhancing the integrity of the LES so gastric reflux is reduced.
  36. After a person has fundoplication when can they start eating again?
    NPO till peristalsis return and slowly increasing diet, starting with fluids to solids
  37. What's Hiatal Hernia (HH)?
    when a portion of the stomach herniates through an opening in the diaphragm
  38. What causes a HH?
    • weakened muscles in the diaphragm
    • situations that increase intra-abdominal pressure
    • age
    • gender-women
  39. What are some situations that increase intra-abdominal pressure?
    • obesity
    • ascites
    • prego
    • tumors
    • intense physical exertion
    • continual heavy lifting-job
  40. Clinical manifestations of HH
    • Asymptomatic sometimes....or
    • Heartburn
    • Reflux
    • Dysphagia
  41. When a person has a HH what will irritate it?
    • bending over
    • ingestion of large meals
    • alcohol
    • smoking
  42. Complications of HH
    • GERD
    • Esophagitis
    • Hemorrhage from erosion
    • Stenosis (narrowing of the esophagus)
    • Ulceration in herniated portion of stomach
  43. How do you dx HH?
    • Barium Swallow
    • Endoscopy
  44. Surgical Therapy for HH
    Herniorraphy

    closure of the HH defect in the diaphragm by pushing the herniated piece below the diaphragm and attaching it to something so it doesn't pop back out (gastropexy)
  45. gastropexy
    attaching a piece of intestine to something so it doesn't pop back out and cause another HH
  46. What stimulates us to vomit?
    • drugs
    • toxins
    • irritated stomach
    • distended stomach
  47. Anorexia usually accompanies....
    nausea
  48. Vomiting causes Metabolic
    Alkalosis
  49. Diarrhea causes Metabollic
    Acidosis
  50. What is a potential complication of N/V....especially in a person who is elderly or unconscious?
    pulmonary aspiration
  51. If you have vomit that smells like feces with bile....what is going on?
    intestinal obstruction below the pyloric valve.
  52. If you have feces in the vomit without bile what is the problem?
    an obstruction below the ampulla of vater
  53. If a person has dark red or coffee ground emesis, this is a sign of....
    stomach bleed

    HCL turns the blood dark brown
  54. What does bright red blood mean?
    • active bleeding ulcer
    • esophageal varices
    • neoplasms
  55. Interventions for N/V
    • NPO-prevent aspiration
    • IV fluids for hydration and electrolytes
    • NGT for decompression
    • Monitor VS
    • Teach ways to prevent N/V
  56. Why do you monitor VS with a person who has N/V?
    you are looking for hypotension and hypovolemia
  57. Who shouldn't take Scopolamine transdermal for N/V?
    Why?
    • Pt. with glaucoma
    • BPH
    • pyloric or bladder neck obstruction
    • biliary obstruction

    • cuz they decrease motility of the GI and GU tract=
    • can't eat, see pee, spit or poop
  58. Who cant have antihistamines?
    Why?
    Persons with glaucoma

    • cuz of the 3D's
    • dry out
    • dilate
    • delay emptying
  59. Why would a person with N/V be given Reglan?
    • cuz it increases GI motility-gastric emptying
    • thereby decreasing n/v related to distention
  60. If you get n/v from migraines and anxiety what meds would you take (3)
    Why?
    • Dolasteron
    • Ondansetron
    • Granisteron

    cuz they work on the vomit ctr and enhance gastric emptying and block n/v
  61. What medication for n/v will make you super sedated?
    Compazine
  62. What med is used in the OR  to relieve post op nausea?
    Decadron
  63. Common anti nausea meds (4)
    • Antivert
    • Reglan
    • Zofran
    • Ativan
  64. If a person has persistent vomiting....what will I probably have to do?
    insert a NG tube to decompress the stomach
  65. What do you eat when you have n/v?
    • room temp uncarbonated drinks
    • warm tea
    • liquid btwn meals
    • dry toast/crackers
    • clear liquids
  66. Which sort of gastritis causing bleeding?
    pernicious anemia?
    • acute causes bleeding
    • chronic causes pernicious anemia
  67. What causes gastritis?
    a breakdown in the normal gastric mucosal barrier allowing HCl acid to diffuse back into the mucosa resulting in edema and disruption of capillary walls resulting in bleeding
  68. Gastritis
    inflammation in the lining of the stomach
  69. What causes gastritis?
    • NSAIDS
    • Corticosteroids
    • Alcohol
    • Spicy foods
    • H pylori
    • Stress
  70. dyspepsia
    general abdominal discomfort, idegestion
  71. hematemesis
    vomiting blood
  72. Sign of erosive gastritis
    • black tarry stools
    • coffee ground emesis
  73. Symptoms of acute gastritis
    • anorexia
    • n/v
    • epigastric tenderness
    • sense of fullness
    • pain high up in the abdomen
  74. How does chronic gastritis cause pernicious anemia?
    chronic inflammation causes the result of loss acid secreting cells and intrinsic factors.  The loss of intrinsic factors impairs absorption of V. B12 and results in cobalamin deficiency once the liver stores are depleted.  Pernicious Anemia
  75. 5 Diagnostic studies for gastritis
    • Hx of drug and alcohol use
    • Endoscopy for definitive dx
    • Biopsy for H pylori
    • CBC if chronic gastritis....anemia
    • Stool sample for occult blood
  76. Interventions for acute gastritis
    • Same as n/v
    • frequent checks of VS
    • treatment of n/v (npo, clear liquids....)
    • drug therapy
  77. Why are there VS checks for a person with acute gastritis?

    What does trouble look like?
    they are likely to hemorrhage

    • low bp
    • high hr
    • high rr
  78. Drug therapy for gastritis is aimed at.....

    examples of meds used
    reducing gastric acid secretion and provide symptomatic relief

    • Antacids
    • H2r
    • PPI's
  79. Interventions for chronic gastritis
    • focuses on eliminating the specific cause (alcohol, drugs, H pylori)
    • drug therapy
    • nutritional therapy
    • stop smoking
    • screen for stomach cancer
  80. Drug therapy for gastritis
    • antibiotics
    • anti-secretory meds
    • v. B12 shots
  81. Nutritional therapy for a person with gastritis
    • six small meals a day
    • no irritating foods
    • antacids after each meal
  82. Who's more likely to get a gastric ulcer?
    women and old people
  83. Risk factors for getting a gastric ulcer
    • H pylori
    • medications
    • smoking
    • bile reflux
  84. Who's most likely to get a duodenal ulcer?
    person 35-45 years old
  85. Risk factors for getting a duodenal ulcer
    • H pylori (most common cause)
    • alcohol
    • smoking
    • stress
  86. What causes a peptic ulcer?
    erosion of the GI mucosa from HCl and pepsin
  87. Where will you see peptic ulcers?
    • stomach
    • duodenum
  88. 2 things that increase a persons risk for peptic ulcer disease? PUD
    • H pylori
    • NSAIDS
    • alcohol
    • coffee
    • stress
  89. What 3 things will delay the healing of an ulcer?
    • stress
    • depression
    • smoking
  90. Clinical manifestations of gastric ulcers
    • dyspepsia in the epigastric area 1-2 hrs after meals
    • burning/gas pain
  91. Clinical manifestations of duodenal ulcers
    burning/cramping feeling in the mid epigastric region below the xiphoid process or the posterior aspect of the duodenum

    • occus 2-5 hours after a meal
    • these manifest for a few weeks or months...subside and return later
  92. Complications for gastric and duodenal ulcers
    • Hemorrhage
    • Perforation
    • Gastric outlet obstruction
  93. Which type of ulcer causes more Upper GI bleeds?
    Duodenal
  94. Most common complication for ulcers
    hemorrhage
  95. What can happen if you have a perforation from an ulcer?
    • it is lethal....
    • the ulcer can penetrate the serosal surface, spilling gastric or duodenal contents in to the peritoneal cavity
  96. Interventions for ulcers
    • take meds with foods
    • lifestyle modifications
    • NPO with acute exacerbation
    • IV fluid replacement
    • Monitor VS
    • Assess for sudden abdominal pain
  97. Signs of bowel perforation
    • abdominal pain
    • rigid board abdomen
    • decreased or absent bowel sounds
  98. What do you do for a person with a perforated bowel?
    NG tube for decompression to minimize contents in to peritoneal cavity
  99. How do you treat gastric outlet obstruction?
    decompression with an NG tube with suction to allow the stomach to rest and regain normal muscle tone as well as allowing the ulcer to heal.
  100. Sign a person with an NG tube can start eating again
    if aspirate is less than 200mL after 8-12 hours
  101. Drug therapy for Ulcers
    • H2R
    • PPI
    • antibiotics
    • antacids
    • cytoprotective drugs
  102. Nutritional therapy for ulcers
    • eliminate aggravating foods
    • small frequent meals
    • avoid alcohol and smoking
  103. Partial gastrectomy for ulcers
    removal of part of the stomach and anastomosis to duodenum
  104. Vagotomy for ulcers
    partial or complete severing of vagus nerve
  105. Pyloroplasty for ulcers
    enlargement of the pyloric sphincter
  106. Complications for partial gastrectomy
    • dumping syndrome
    • postprandial hypoglycemia
    • bile reflux gastritis
  107. S/S of dumping syndrome
    • 15-30 min after eating dizzy
    • audible bowel sounds and sudden urge to defecate
    • weakness
    • sweating
    • palpitations
  108. What's postprandial hypoglycemia?
    caused by dumping syndrome when a bolus of carbs is dumped into the intestines causing hyperglycemia which results in increased insulin secretion causing a secondary hypoglycemia with symptoms

    happens 2 hrs after eating
  109. Nutritional therapy after partial gastrectomy
    • eat less
    • drink fluid btwn meals
    • low carbs and moderate protein and fat
    • rest for 30 min after a meal
    • limit sugar intake

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