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- backward flowing of gastric contents
- avoid acidic foods and high fats or alcohol
- stop smoking
- eat small meals
- maintain ideal weight
managed with proton pump inhibitors, H2 receptor blockers, metoclopramide, antacids.
Peptic ulcer disease PUD
- a break in the mucous lining of the stomach, leading to ulcers, pain and bleeding.
- Complications: Pain, gnawing, burning aching, can lead to anemia, blood in stool, perforation most lethal- leading to gastric contents in peritoneum leading to peritonitis.
Risk factor: H-pylori, smoking, NSAIDS, and stress.
H-Pylori-releases enzymes that contribute to ulcers.
life threatening acute inflammation of the visceral/ parietal lining and endothelial lining of the abdominal cavity. (high WBC count, paralytic ileus/absent bowel sounds, fever)
body responds by shunting blood to the infected area. (This third spacing can lead to hypovolemic shock)
Assess lungs: for crackles, decreasing sats.
- Assess electrolytes, H/H, I/O, vital signs and mentation.
Treat H-pylori with two antibiotics and a proton pump inhibitor (clarithromycin, amoxicillin and protonix) x 14 days
Endoscopy for management of GI bleeds
Endoscopy, with injection of a clotting or sclerosing agent into the bleeding vessel
- simple gangrenous or perforated
- symptoms: continuous, mild generalized pain, may intensify
- low grade fever, nausea and vomiting
- rebound tenderness at mcburneys point.
large portion of stomach and duodenum are bypassed
Bowel obstruction/ intestinal obstruction
Mechanical: physically blocked by lesion outside the bowel (adhesion), or inside due to chrons, tumors.
Nonmechanical: paralytic ileus, decreased or absent peristalsis.
- These all can lead to edematous of the bowels. most commonly obstructions occur in small intestine
- edematous bowel results in increased capillary permeability causing plasma to leak into the abdomen.hypovolemia-electrolyte issues
- High in the small intestine: leads to metabolic alkalosis. loss of gastric hydrochloride
- low in the small intestine: leads to metabolic acidosis
complications of obstructions? elderly bowel obstruction?
- strangulated bowel: leading to interrupted blood flow.
- Elderly: high risk for obstruction due to fecal impaction
- Intussusception: telescoping of a segment of the intestine within itself.
- Volvulus: twisting of the intestine.
- Treatment: NG tube, frequent oral care, IV fluids w/ electrolytes, surgeons may use a laparoscopic approach.
Diagnostic: CT/ X-ray
- inflammation starts in the rectum and works its way up (Ulcers)
- liquid bloody stools, nutritional deficiencies-genetic and autoimmune disorders are risk factors.
- Diagnostic: colonoscopy
- Lab: Decreased H/H, decreased Na, K and Chloride, elevated WBC’s
- Treatments: Aminosalicylates/ Sulfasalazine (prostaglandin inhibitor), glucocorticoids, anti-diarrheal. Diet management, Surgery-colectomy
Ulcerative colitis surgical procedures
Total proctocolectomy with a permanent ileostomy-removal of colon, anus and rectum-ileum brought out into the abdominal wall. right lower ileostomy.
Total colectomy with ileoanal anastomosis: 2 stage procedure- temporary ileostomy. after time to heal- it's reversed and stool is allowed to drain into the reservoir
- inflammatory of small colon, transmural inflammation-thickened bowel wall.
- fistulas can develop-intestine to intestine or intestine to bladder. severe malabsorption
- genetic, environmental and immune factors are the cause.
- Management is similar to Ulcerative colitis
- may need over 3k cals a day to maintain weight. surgical treatment is to remove inflamed areas of bowels.
- occur in small intestine or large
- diverticulosis: abnormal pouch like herniations in the wall of intestine.
- diverticulitis: infection present
- Diverticula can perforate leading to infection or abscess- can cause bleeds.
- May need antibiotic treatment
Resection of large intestine
pediatric GI disorders
- Pyloric stenosis: obstruction of the circular muscle of pyloric canal
- projectile vomiting 2-8 weeks after birth
- pylorectomy performed.
Hirschsprung disease: congenital absence of ganglion cells in the wall of rectum. Treatment is removal of this portion of bowel. Leads to difficulty passing stool.
Cleft lip/ palate
- maxillary process fails to form
- occurs during first trimester
- treatment: multiple surgeries
- risk for aspirations
treatments: prevent aspirations-safe feeding, adequate nutrition-breast feeding.
Some risk factors for cleft lip
Exposure to the drug phenytoin (Dilantin) during pregnancy is linked with a tenfold increase in the rate of cleft lip. Smoking while pregnant doubles the rate of cleft lip. Alcohol, anticonvulsants and retinoic acid (vitamin A) are linked with other birth malformations that include cleft lip and palate we have seen a decrease with addition of folate to bread and cereal
- immune mediated disorder of small intestine
- Gluten sensitivity
- inflammatory response of the small bowel
- leads to atrophy of villi in small bowel and nutritional deficits
This is a surgical procedure to widen the lower opening of the stomach...
part of the stomach is removed and attached to the intestine....
Surgical opening where they bring a part of the small intestine to the opening of the skin on the abdomin....
- Ileostomy....depending on the portion of the intestine....
Ileo-anal reservoir also known as a
Post-endoscopy what must be checked?
A pigtail allowing tube to vent in an NG tube.....
Sump/ salem sump
A reason for an OG tube vs an NG tube....
Sinus infections to avoid.
This condition may cause frequent bloody stool...
Patient may notice blood streaked stool with this condition....
this condition may cause severe constipation in young children......
uses x=rays to help diagnose problems of the upper GI tract, including esophagus, stomach, duodenum...
Upper GI series
Another name for an abdominal xray
Free air in abdomen may be caused by
perforation...ruptured peptic ulcer...
Patients with condition should avoid seeds and nuts
Diverticula which would increase risk of diverticulitis
Low residue diet (decreased fiber) is controversial with this condition
this condition usually requires 3k cal a day....
condition where a portion of the stomach sticks through the diaphragm....
Low birth weight and preemies are more likely to have this condition