Upper GI 2
Terms
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- Define digestion
- process by which food and drink are broken down into small parts so the body can use them to build and nourish cells and provide energy
- Functions to digestion
-
break down food particles
absorb into the bloodstream
eliminate undigested/unabsorbed food - MOUTH
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process of digestion begins
saliva contains the enzyme ptyalin which begins the digestion of starches and lubricates food - Problems of mouth
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stomatitis
mouth ulcers
herpes/candida - ESOPHAGUS
- peristalsis moves food bolus to stomach
- GASTRIC
-
secretions breakdown food into more absorbable components and aid in destructiojn of most ingested bacteria
gastric mucose secretes HCL acid, pepsin and intrinsic factor
food mixes with stomach acid=chyme
peristaltic wabves in the stomach move the chyme towards the pylorous and into duodeum - What are the 2 types of cells involved with digesiton
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partial cell-found in the gastric mucosa secrete HCL and intrinsic factor
Chief cells-synthesis and secrete pepsinogen - Assessment of UGI status
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History;pain, indigestion, sysphasia, n/v, food intolerences
psych factors-smk,etoh,stress,meds - what are the two symptoms of upper GI problems
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indigestion
discomfort with eating - LABS
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CBC/CEA
LFT
trigylcerides
guiac - Diagnostic
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abd ultrasound-NPO prior
MRI/CT
upper GI/Barium swallow-contrast agent digested dx ulcers, varicies and tumors
edoscopic-NPO, sedated, invasive, therapeutic to tx GI sticture
spray to numb gag refles-assess gag before resume food/drink - Gastric Aspiration
- NG tube(can test aspirate)
- Gastric acid stimulation
- give a histamine SQ, NPO 4-6h before, stimulate the secretion of gastric acid, specimens are collected q 10-15m DX pernicious anemia, malignancy and ulcer disease
- pH probe
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NG tube tip above the esophageal sphincter, outer part gnerallye attached to recording device
DX reflux
TX dilation - REFLUX
- TX-dilation, IV abx, NG tube, surgery depends on cause
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HIATAL HERNIA
define - opening in diaphragm, upper stomach moves through the diaphragm into lwr esophagus
- 3 types
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Axial/sliding- most common. happens sporadically happens when the pt lies down(herniation slides up)
Paraesophageal-continuous, more severe. Part of the stomach pushes up thru diaphragm end up next to esophageal junctions-CAN CAUSE stranglation and cut of blood supply
MIXED- combo of the two -
HIATAL HERNIA
etiology - unknown
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HIATAL HERNIA
Related factors - due to exerction/coughing/straining/increase intra abdominal pressure/over weight/injury
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HIATAL HERNIA
symptoms - mimic heart attack, common >50, smks,over weight
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HIATAL HERNIA
diagnosis -
upper GI
CT scan -
HIATAL HERNIA
Treatment -
severe symptoms-rq surgery
tx of choice for raesophageal
lap surg-after surg no diet restrictions, resume activity in wk, avoid heavy lifting for 3 mo -
GERD
define
symptom -
incompetent lwr esophageal sphincter
most common symptom HEARTBURN -
GERD
Treatment -
symptomatically
meds; antacids, h2 receptor antagonist (zantac) prokeninetics (reglan)proton pump inhibitors(protonix)
Surgery in severe cases - SYMPTOMS specic to GI status
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pain, vomiting;type, location, occur any time, correlatio with food, eating relieve or worsen symptoms
anorexia, dyspepsia(vague feeling of discomfort after eating
Odynophagia(pain with swallowing)
Pyrosis-feeling of heart burn
hematemesis-vomiting blood
flatulence
steatorrhea
diarrhea
constipation - Nursing diagnosis
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pain, acute
pain, chronic
nutritional imbalance
impaired swallowing
risk for aspiration -
ACHALASIS
define
s/s
dx
tx -
motor disorder of distal eso. movement lost at distal part of peristalsis
s/s difficulty swallowing, regurge, vomiting
dx-barium swallow
tx-augmentin - USES OF NG TUBE
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decompression
lavage
dx og GI disorders,ulcers or motility disorders
med administration
nutritional support
treatments -
Enteral feedings
4 types -
commercially prepared
modular
disease specific
elemental formulas - Complication of NG feeding
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Dumping syndrome-rapid gastric emptying of undigested food
aspiration
dehydration
azotemia (excessive urea in the blood -
PUD
define/etiology -
caused by h.pylori, which neutilizes acid
promotes ulcer development thru weakening of stomach mucosa -
PUD
dx of h pylori -
blood, breatth, stool or tissue test.
most common way is blood test - how are Peptic ulcers classified?
-
according to location
gastric
duodenal
esophageal - What type is the most common
- duodenal ulcers
- Predisposing factors for PUD
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familial
blood type O
smk
etoh
meds
diet habits -
PUD
symptoms -
pain(dull mid epigastric, burning, gnawing)occurs after meal and more food relieves
black tarry stool -
PUD
DX -
labs
endoscopy
UGI -
PUD
Treatment -
stress reduction
smk cess
dietary modifications
medications -
PUD
Complications -
hemorrhage-most common
scleral therapy
perforation
obstructions - what is ZES
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severe form of PUD where a tumor produces excessive amts of gastrin
Diarrhea predominant symptoms
results in multiple ulcers
TX-proton pump inhib, h2 recp - Stress ulcers
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occurs after a physiologically stressful event(trauma, sepsis etc..)
ischemia leads to casoconstrictive action that disrupts gastric mucosa
asymptomatic unless vomiting blood, stool changes - PROTON PUMP INHIBITORS
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suppress final step in gastric acid production
stops mechanism that pumps acid into stomach
PROTONIX< PRILOSEC - H2 RECEPTOR ANTAGonsist
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block the action inhibiting gastci acid secretion, prevent the production of acid within the parietal cells
TAGAMENT - ANTICHOLINERGICS
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decre gastic secretions and decrease spasms of sm muscle
monitor for tachycardia and urinary retention
BELLADONNA - CYTOPROTECTIVE AGENTS
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stengthen mucosal lining against attacks of acid secretions
PEPTO BISMAL - ANTACIDS
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neutrilize acids in stomach MAALOX, MYLANTA(mg agents-produce lax effects
AMPHOJEL aluminum agent produce constipation
some containg lots of NA
some are combo - DRUGS THAT SHOULD NOT BE GIVEN WITH ANTACIDS
- digonxin, tetracycline, dilantin, depakote
- How long does it take for most ulcers to heal
- 6-8wks