Jenna Cohen Exam 3 Study Guide Gastrointestinal Disorders Anatomical and Functional Changes Weakened Incompetent Lower Esophageal Sphincter LES o Gastroesophageal Reflux Disease GERD Erosion in the mucosa lining of the GI tract o Gastric and Peptic Ulcers H pylori gastritis peptic ulcer disease Billroth I and II Surgery Motility o Irritable bowel syndrome IBS o Hirschsprung s Disease Weakness in Muscles in the Muscle wall of the GI tract o Hernia Hiatal Infection Hyper motility Resulting in Diarrhea o Diarrhea Etiology from Bacteria Salmonella Escherichia coli Clostridium d Difficile Vancomycin resistant eneterococcus Virus Rotavirus Parasites Giardia giardiasis Medications Antibiotics Magnesium based antacids Inflammation Inflammatory Bowel Disease IBD Acute Inflammatory Bowel Diseases IBD Chronic o Appendicitis o Peritonitis o Gastroenteritis o Ulcerative colitis o Crohn s disease o Diverticulitis o Pacreatitis o Cholecystitis Obstruction Cholelithiasis Gall Stones Tumors Colostomy Ileostomy Pediatrics Pyloric stenosis Intestinal Obstructions Mechanical Neurogenic Vascular GI System sometimes hard to think about all of these because the symptoms may run together GI System Or Better Known as From the Rooter to the Tooter Main Concepts of the GI Biliary System for Diseases and Disorders FAINT Fluid Balance the client either throwing up diarrhea bleeding Acid Base when you vomit you lose gastric acid and can get into metabolic alkalosis diarrhea end up with metabolic acidosis bc losing base Infection complications perforations obstruction h pylori causes issues with ulcers Nutrition when gi tract upset not eating like we should monitor diet or maybe be NPO Treat Pain different kinds of pain from different places which is a helpful diagnostic piece of information Gastro Esophageal Reflux Disease GERD system here is due to LES pressure and when that pressure lessens the sphincter doesn t close and it allows the food we haven t eaten to come back up and into their mouth heart burn indigestion most of the time it s temporary to something we ate lots of people it s a disease that causes challenges that need medication System Specific Physiology GERD Backward flow of stomach contents into the esophagus without associated vomiting Etiology o Relaxation of the lower esophageal sphincter LES with lowered LES pressures o Delayed gastric emptying the food doesn t go on through the system Factors that Increase Intra abdominal Pressure Worsen Reflux Lifting Bending Straining Recumbent position lying down increase abdominal pressure and make the GERD Risk Factors o Older age o Sleep apnea o NG tube o Obesity worse Tight clothing Obesity as abdomen enlarges Pregnancy Hiatal Hernia Ascites Older age Foods that decrease LES Alcohol Caffeine Chocolate Fatty or spicy foods Citrus fruits Onions big issues green peppers Tomatoes Peppermint decreases LES pressure Beta blockers Calcium channel blockers Estrogen Progesterone Diazepam Valium Theophylline Nicotine smoking Nitrates Anticholinergics Medications that decrease LES a lot of common familiar meds Meds that increase Acid NSAIDS aspirin Assessment of GERD Diagnostic Procedures Barium Upper GI Endoscopy Esophageal manometry records the LES pressure so you can tell what it s doing one of the thing we want the clients to do is start recording what food causes the GERD because it s not the same for everyone Assessments for GERD Burps of burping and flatus Burping and flatus is increased dyspepsia occurs after eating certain foods or fluid a lot Upright position relieves pain bending or lying down increases pain when assessing ask them the position that makes it worse better when you have to sleep the pain gets worse so you have to sit up Regurgitation may caught throat irritation Recurrent heartburn can mimic heart attack can cause significant problems with throat irritation to the point of bleeding people come in thinking they re having a heart attack because the pain is so severe people come to the ER for such severe GERD some people don t have chest pain Pain is relieved with water or taking antacids Pain occurs after eating and may last 2 hours Symptoms occurring 4 5 times per week indicative of GERD anybody can have indigestion here and there depending on what we eat stress Analysis of Assessments GERD Concepts Pain Nutrition Health Promotion Burning sensation in the chest and throat All about Acid Reflux First Priority Interventions GERD Get Exercise No smoking drinking exercise really helps Elevate bed 6 8 inches with blocks avoid position that increase LES pressure i e bending straining lying down constriction at waist etc often at night they need the head of the bed elevated because you aren t bending over but elevating the head so the gi tract is open from the stomach up to the throat so theres no pressure Reassess pain meds per order Diet 4 6 small meals per day not within 4 hours of bedtime Avoid foods and meds that decrease LES pressure keep diary of food eaten that contribute to GERD don t eat big meals eating right before bed is very bad where does it radiate quality sour taste whether epigastric or tenderness does it radiate anywhere try to distinguish if this is gerd or chest pain remain upright after eating if obesity problem weight loss plan sometime sleeping on the right side facilitates gastric emptying GERD Diet food diet so important so we can see which foods cause and which dont Decrease total fat intake High fat meals and fried foods tend to decrease LES pressure and delay stomach emptying Avoid large meals Large meals increase gastric stomach pressure and reflux Decrease total caloric intake if weight loss is desired Since obesity may promote Avoid chocolate Chocolate contains methylxanthine which decreases LES pressures by reflux relaxation of smooth muscle Avoid coffee depending on individual tolerance Coffee with or without caffeine may promote reflux some people wont have problems Avoid other known irritants Alcohol mint carbonated beverages citrus juices and tomato products all may aggravate GERD foods we know can effect but very individual Physiology Potential Complications of GERD Asthma Exacerbation Aspiration Pneumonia regurgitation of food a lot of people aspirate in their sleep and once those contents are down in the lungs it sets up the potential for infection Frequent upper respiratory sinus ear infections Esophageal structures Erosive esophagitis ulceration hemorrhage very acidic when that reflux is occurring