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What's the second most common type of cancer in China?
What type of esophageal ca are 30-70%?
If 30-70% of Esophageal Ca is adenocarcinomas what are the remainder?
What are risk factors for esophageal Cancer?
- Barrett's esophagus
- Increase age
- Diets low in fruits/vegetables
- Diets low in certain vitamins/minerals
- Exposure to asbestos and metal
- Hx of swallowing lye
What are they types of tumors and what do they affect?
- Tumors fungate and infiltrate spread and spread into other areas
- partially obstruct the esophageal causes narrowing
What are early signs/symptoms of esophageal CA?
- substernal burning
What are areas an esophageal cancer tumor may metastasize to and in which way?
- liver and lungs
- through the lymph system
What are late signs/symptoms of esophageal cancer?
- progressive dysphagia
- pain in the epigastric area, substernally, or back
- pain may radiate to the neck and jaw
- sore throat
- chronic cough
- weight loss (anorexia)
What are some complications to esophageal cancer?
- esophageal perforation
- obstruction of esophagus
What may happen if esophagus hemorrhage?
what causes esophageal cancer to hemorrhage?
If cancer erodes through the esophagus and into the aorta
If the esophageal cancer perforates what will happen?
Form a fistula perforating to the lungs or trachea
What will happen if the esophageal tumor obstructs the esophagus?
patient cant swallow
What's the test used to diagnose esophageal cancer?
- barium swallow with fluoroscopy
- ultrasound-for early stage
Which test is used to stage the esophageal cancer?
Which test is used to detect malignant involvement of the lungs with esophageal cancer?
Which test is used to asses the extent of esophageal cancer?
CT scan and MRI
What are ways to treat esophageal cancer?
- esophagectomy-remove all or part of esophagus
- esophagogastrostomy-remove esophagus and stomach
- esophagoenterostomy-surgical opening between the esophagus and intestine and removal of the stomach
What treatments are best for treating esophageal cancer?
How should we treat a patient after having a surgery to treat esophageal cancer?
- 1. maintain airway
- 2. achieve optimal nutritional intake (soft, mechanical diet, TPN, J-tube)
- 3. relieve symptoms (pain, dysphagia)
What are risk factors for gastric cancer?
- non-healing gastric ulcers
- family history
Where are gastric cancers mainly found in?
pyloric and antral regions of lesser curvature of the stomach
What areas do gastric cancers directly metastasizes to?
What areas do gastric cancer metastasize in the later stages?
- peritoneal area
What are signs/symptom of gastric cancer?
- nonspecific, vague epigastric distress
- weight loss
- abdominal pain
- change in bowel habits
what are the two most common signs of gastric cancer?
- abdominal pain
- weight loss
What are ways to treat gastric cancer through surgery?
- 1. subtotal or radical gastrectomy- partial or complete removal of stomach possibly lymph nodes then radiation and/or chemotherapy
- 2. billiroth I&II-very painful&dangerous procedure
- 3. subtotal gastrojejuctomy- removal 2/3 of stomach, remainder attached to jejunum or duodenum
If a patient just had a surgery for gastric cancer what are some complications the nurse should be aware of?
What are important nursing interventions the nurse should be doing for a patient after just had a surgery for gastric cancer?
- Emotional support
- pain management-epidural or PCA
- nutritional support-TPN or J-tube
- prevent secondary infection-antibiotics
What are signs/symptoms of peritonitis?
- rigid, distended abdomen
- diminished or absent bowel sounds
- chills, fever, sweating
What are other treatments the nurse should expect to do for a patient with gastric cancer?
- Pain managment
- NG tube
- J-tube placment
- fluid/electrolyte balance-sodium, potassium
why would a patient have a NGT after surgery of a gastrectomy?
decompress the stomach at low continuous suction for a number of days
Will the nurse or the surgeon place the NGT in the client after a gastrectomy and why?
Surgeon due to risk of perforation
What is important for the nurse to inform the CNA about a patient NGT after coming from the operating room?
NURSE NOR CNA CANT TOUCH IT
What is peritonitis?
local or generalized inflammatory response of the peritoneal lining
What can cause peritonitis?
- rupture of appendix
- rupture of ulcer
- bowel obstruction
- ruptured bladder
- infection in the reproductive tract
- post-op complications (leakage from an intestinal anastomosis)
Will the nurse or surgeon place the NGT in the client that has peritonitis?
What are ways to treat peritonitis?
- treat the initial cause
- replace fluids & electrolytes - normal saline or lactated ringers
- pain management
- NGT-decompress & rest GI
Where can a GI bleed occur?
anywhere along the GI tract
What can cause bleeding in a GI bleed?
- vascular-ruptured esophageal varicies
- diverticular- ruptured or bleeding
- ulcerative-peptic ulcer disease
- inflammatory- infectious diarrhea, esophagitis, ulcerative colitis
- neoplasms-tumor erodes a blood vessel
- traumatic- blunt or piercing injury
- coagulation disorders-hemophilia, anticoagulation therapy, ASA
What are signs/symptoms of GI bleed?
- hematemesis-vomiting blood
- rectal bleeding-fresh blood
- tarry stools
- low bp
How do we treat a GI bleed?
- treat the underlying cause
- bed rest
- replace fluids & electrolytes
- NGT suction
- lavage via NGT
- Blood products -low H&H
What is the most cause of getting a GI bleed?
What things should a nurse expect to be monitoring for a patient with a GI bleed?
- low BP
- Increase heart rate
- decreased H&H
- decreased output
- bowel sounds
Which GI disorder can be life threatening and most common in middle-aged men?
What are the most primary causes of pancreatitis?
- biliary tract disease
- gallbladder disease
What are some other causes of Pancreatitis?
- viral infections
- penetrating duodenal ulcer
- cysts & abscesses
- cystic fibrosis
- Kaposi's sarcoma
- post operative GI surgeries
Which procedure can also give a patient pancreatitis?
How does alcohol cause pancreatitis?
- Stimulates secretion and excess production of HCI
- A decrease in gastric pH causes a release of hormone Secretin
- Secretin cause regurgitation of duodenal contents into the pancreatic duct causing inflammation
Which drugs can cause pancreatitis?
- oral contraceptives
What is a primary role of the pancreas?
produce digestive enzymes
What happens if the pancreas doesn't work right?
digestive enzymes stay inside pancreas and start digesting pancreas
What does the enzyme TRYPSIN cause if it auto digest the pancreas?
What does the enzyme ELASTASE cause if it auto digest the pancreas?
What does the enzyme PHOSPHOLIPASE cause if it auto digest the pancreas?
What does the enzyme LIPASE cause if it auto digest the pancreas?
What are signs/symptoms of acute pancreatitis?
- abdominal pain-sudden, sever, steady, piercing, deep
- pain in left upper quadrant- may be in midepigastrium radiates to back
- pain aggravated by eating
- pain not relieved by vomiting
- low grade fever
- leukocytosis (wb>10,000)
What can you tell a patient if they ask why does their pain gets worse when they eat with pancreatitis?
Because eating stimulates digestive enzymes and will cause more auto digestion to the pancreas
Which labs do we look at when diagnosing Pancreatitis?
- Amylase >200 rapid rise then gradually go down
- Lipase >5-10 x normal steady rise within 24-48 hrs and stay elevated for 5-7 days
What are our goal for a patient with acute pancreatitis?
- relief of pain
- prevent or alleviate shock
- reduce pancreatic secretions
- maintain fluid & electrolytes
- treat underlying cause
What other condition might you see a patient have that has a elevated serum lipase
what are some nursing interventions we can do to help reduce pancreatic secretions with acute pancreatitis?
What type of diet would you expect a patient with acute pancreatitis to have?
- NPO initially
- small frequent feedings
- high carb and protein, low fat
- bland diet
What type of disorder can cause a partial or complete intestinal obstruction?
What makes an intestine obstructed?
When there is a pathologic impediment to the flow of intestinal contents. Partial or complete obstruction
What are types of mechanical things that can cause an intestinal obstruction?
- intrinsic lesions-occurs within the lumen, tumors, stricture
- extrinsic lesions- external pressure on the lumen
- blockage of lumen-foreign bodies, gallstones, fecal or barium impactation
What are types of vascular things that can cause an intestinal obstruction?
- acute occlusion of a major mesenteric artery or venous thrombosis that causes ischemia of the intestines-leads to decreased oxygen and nutrient supply
- sepsis from leakage of bowel contents in the peritoneal cavity
What are types of neurogenic things that can cause an intestinal obstruction?
- peristalsis is decreased or absent
- GI contents or stopped or slowed
What types of things can cause peristalsis to be decreased or stopped?
- medications (anesthesia, opiates)
- infections or toxins (obstruction, peritonitis, pancreatitis)
- trauma & severe pain
- spinal cord lesions
What will happen if you have a GI obstruction?
- severe electrolyte imbalances
- fluid leaking out causing reduced circulating blood volume
- increased risk of peritonitis
What are signs/symptoms a patient will experience if they have a GI obstruction?
- distended bowel
- colicky, cramping abdominal pain
- vomit/may vomit stool
- hypo/hyperactive bowel sounds
If the obstruction is proximal to the ileum what types of problems will arise?
fluid regurgitates into the stomach causing vomiting increasing fluid and electrolyte imbalances
If the obstruction is distal to the ileum what types of problems will arise?
- lead to perforation or reflux into the ileum
- perforation will cause peritonitis, sepsis, and endotoxic shock
What test can be done to diagnose a GI obstruction?
- barium enema only not swallowed
- check for decreased electrolytes
- increased H&H
- increased WBC
How do we treat a GI obstruction?
- 1. Give fluid (normal saline) to correct the balances
- 2. relieve the obstruction by medical or surgical
- 3. antibiotics
- 4. pain medications-OPIOIDS only for severity d/t constipation
- 5. soft/low residue diet
How does a NGT help treat a GI obstruction?
- on suction to evacuate gas & fluid from the stomach & upper ileum
- prevents aspiration of gastric content, lessens further progression of intestinal distention
- helps with partial obstruction due to inflammation or infection
What type of surgery is done to treat GI obstruction?
- removal of tumors
- lysis of adhesions
- temporary or permanent colostomy or ileostomy
What are risk factors of colorectal cancer?
- high fat diet
- age >50
- ulcerative colitis
What are signs/symptoms of a person with colorectal cancer?
- iron deficiency anemia
- vague pain radiating to lower back
- weight loss
How can colorectal cancer be diagnosed?
- 50% rectal exam
- barium enema
- liver scan to see if mestasize
Which labs will be used to diagnose colorectal cancer?
- elevated bilirubin
- alkaline phosphatetase
- SGOT-liver mestasize
What treatments are done for colorectal cancer?
- surgery:resection end to end anastomosis or
- temporary or permanent colostomy
- Radiation: done before surgery to reduce the size of the tumor or to prevent spread to the lymphs
- done after surgery for palliation for an unresectable tumor with extensive mestatsize
What is the nurse going to assess post operatively after treatment of colorectal cancer?
- NG suction
- diet from NPO>soft>regular
- ambulation ASAP
- compression stockings/lovenox (blood clots)
- monitor stools for blood
What is ulcerative colitis?
- recurrent inflammatory and ulcerative disorder
- inflammation distribution is diffuse
- mucosa has ulcerations and abscesses that can later necrose
- primarily located in the left colon and rectum
What are signs/symptoms of ulcerative colitis?
- diarrhea 4-5 times/day or severe cases 10-12 times/day
- diarrhea with blood, mucus, & pus
- severe pain
- abdominal cramps
- anorexia/weight loss
- low grade fever
What may cause an exacerbation of ulcerative colitis?
- Respiratory/viral infection
What is crohn's disease?
- A subacute and chronic inflammation of segments of the GI tract
- inflammation is focal symmetrical involves the entire circumference of the bowel
- mucosa has granulomas, tumor like growths
- located anywhere on the GI tract from the mouth to the anus predominantly the right colon
What are risk factors for ulcerative colitis or crohn's disease?
- mainly in teens and young adults
- Jewish & whites
What are ways to diagnose ulcerative colitis or Crohn's disease?
- decreased H&H-bleeding
- Increased WBC-inflammation
- occult stool
- barium enema
How do we treat Ulcertaive colitis or Crohn's Disease?
- control diarrhea
- control inflammation -mesalamine & steroids
- pain medication
- fluids correct blood volumes and electrolytes
- placed on a low residue, low fat, high protein high calorie diet (anorexia)
- replace minerals and vitamins
What are some complications with surgery for ulcerative colitis or crohn's disease?
- increased risk for colorectal cancer
- perianal abscesses
- internal fistulas
What's the main complication with having surgery to treat Crohn's disease?
you can remove the part that is inflamed at the time but may likely to reoccur in another part of the bowel later
Which type of diverticular disorder is a sac-like outpouch or ballooning of the intestinal mucosa through the muscle layer. and acts as a reservoir for trapped fecal material
What is the purpose of a diverticula?
can be a reservoir for trapped fecal material
How is a diverticular disorder diagnosed?
- barium enema
- CT scan/US
- Elevated WBC
What is the treatment for diverticulitis?
- rest the bowel (NPO or clear liquid diet)
- increase fiber/Metamucil
- bed rest
- pain management
Where is a diverticula located?
- anywhere in the GI tract except the rectum
- primarily in the descending colon and sigmoid
Which diverticular disorder is asymptomatic diverticula in the colon the are NOT inflamed?
Which diverticular disorder is acute inflammatory process occurring in the wall of the sac like diverticular pouches with microperferations causing inflammation and abscess formation of the adjacent tissue?
What are signs and symptoms of a diverticular disorder?
- left lower abdominal pain-relieved with BM or passing gas
- rectal bleeding