Upper Gi

Lack of appetite

Prolonged anorexia may lead to

Appetite center is located in the

Things that may affect appetite

Synthesis of additional glucose by the liver from protein breakdown or lactate production

Hunger is absent

Nausea

Hypovitaminosis

Body does not store any water-soluble vitamins

Body stores fat soluble vitamins, but require fat absorption to do so

Hemoglobin level and blood cell counts may be low

Accompanying cardiac dysrhythmias

Serum albumin, electrolyte, and protein levels may be low

Anorexia lasting less than one week that usually requires no medical intervention

May require various approaches like high-calorie diet, high calorie supplemental feedings, tube feedings, and total parental nutrition (TPN)

Maintain sufficient nutrition and sustain body weight

Monitor body weight daily

Obtain medical and allergy Hx

Monitor BM

If prolonged, weakness, weight loss, nutritional deficiency, dehydration, electrolyte and acid-base imbalance may result

Causes include drugs, infection and inflammatory conditions of GI tract, intestinal obstruction, systemic infections, lesions of the CNS, food poisoning, emotional stress, early pregnancy, and uremia

Usually results from distention of duodenum

Increased salivation and peripheral vasoconstriction accompany....

Accompanies the forceful expulsion of stomach contents

Causes dizziness, hypotension, and bradycardia

Where is vomiting center located?

Loss of appetite

Excessive fluid loss

Eyes and oral mucosa appear dry or dull

Poor skin turgor

Low levels of serum sodium and chloride

Risen bicarbonate levels compensate for loss of chloride and accumulation of metabolic acids

IV fluids, electrolyte replacement and drug therapy

Cells in lips, mouth or pharynx undergo malignant changes

Linked to smoking, smokeless tobacco, drinking alcohol, and HPV

Associated with pipe smoking and prolonged exposure to wind and sun

Most common cause of oral cancers

Most common cause of prophesy get cancer

Lesion, limo, or other abnormality of the lips and mouth

Pain, bleeding, and soreness

Numbness

Dysphagia or hoarseness

Leukoplakia

Transfusions, anti-anxiety agents, tumor excision, radiation therapy, and chemotherapy

Maintain patent airway

Promote adequate fluid and food intake

Supporting communication

Provide nutrition

Gastric decompression

Diagnose GI disorders

Treat GI obstruction

Apply pressure to GI bleed

Smaller (narrower) more flexible tubes

Larger tubes

Tubes are often longer and end in the upper, small intestine

Instilling feeding formula below pylorus reduces potential for vomiting and aspiration

Used to relieve abdominal distention caused by problems after surgery, episodes of acute upper GI bleeding, or symptoms associated with intestinal obstruction or for diagnostic purposes

Example of a double lumen tube

Transdominal opening into stomach that provides long-term access for administering fluids and liquid nourishment

Endoscope is introduced orally and advanced into the stomach so that the physician can see the correct location for the tube

Preferred to surgical laparotomy unless the client has advises, is morbidly obese, or has previous gastric surgery

Bolus, intermittent, continuous, and cyclic

Not given through tubes inserted below the pylorus because placement causes abdominal cramping and diarrhea

Stimulate the normal passage of food into the small intestine and are usually well tolerated

For stabilization, most gastrostomy tubes have....

Advantage of internal bumper

Disadvantage of internal bumper

Advantage of balloon-style internal bumper

Disadvantage of internal balloon

Weighs client

Assesses V/S

Auscultates bowel sounds

And offers chance to empty bladder

Monitors V/S and clients tolerance of the procedure

Observed stoma and surrounding skin for signs of infection and checks dressings for bleeding and drainage

At high risk for inadvertent replacement into peritoneum instead of the stomach

Common disorder than develops when gastric contents flow upward into the esophagus

Results from inability of lower esophageal sphincter to close fully, allowing stomach contents to flow freely into esophagus

Increases susceptibility to GERD

Epigastric pain (dyspepsia)

Burning sensation of the esophagus (pyrosis)

Regurgitation

Difficulty swallowing (dysphagia)

Painful swallowing (odynophagia)

Inflammation of lining of the esophagus (esophagitis)

Aspiration pneumonia

Respiratory disease

Vomited blood (hematemesis)

Tardy stools (Melena)

Occult (hidden) bleeding for long periods produces iron-deficiency anemia

May believe they’re having heart attack

Scarring and structure formation

Known precursor of cancer of the esophagus

Esophageal lining becomes more like the intestinal mucosa, occurs in small percentage of clients who have chronic GERD

Barium swallow may be done to determine if there is inflammation or stricture formation

Bronchoscope with analysis of fluids found in the lungs and nuclear medicine scans

Confirms esophagitis

May help determine what medication or surgery are needed for GERD

Weight loss, maintaining an upright position following meals, elevating the head of the bed when sleeping, avoiding food and fluids 2-3 hours of the bed when sleeping and avoiding foods that intensify symptoms

Antacids, histamine2 (H2) receptor antagonists, protein pump inhibitors

Neutralize stomach acid

Reduce acid production

Blocks acid production

Procedure that tightens the LES by wrapping the gastric fundus around the lower esophagus and suturing it in place

Used device called an EsophyX

Inserted surgically Through mouth into the stomach that folds tissue at the base of the stomach to create a replacement for the sphincter valve preventing reflux

Uses electrodes to create tiny lesions on the LES. As the lesions heal, the tissue tightens, increasing the muscle mass of the LES and preventing reflux

Series of titanium beads connected with titanium wires to form a ring; it is surgically implanted around the LES to prevent reflux

Magnetic attraction of the beads is strong enough to prevent acid reflux but allows for the passage of foods

Eating smaller meals and avoiding foods and beverages that increase gastric acidity, avoiding items that lower pressure in the LES, losing weight, avoiding tight clothing, elevating head of the bed, stopping smoking, and avoiding food and drink for several hours before bedtime

Sac or pouch in one or more layers of the wall of an organ or structure

Found at the junction of the pharynx and the esophagus or in the middle or lower portion of the esophagus

Most common

Occurs at the pharyngeal-esophageal juncture

Men more likely than women to have condition

Trap food and secretions; interfere with the passage of food into the stomach, and exert pressure on the trachea

May cause esophagitis or mucosal ulceration

Foul breath (halitosis)

Difficulty or pain when swallowing, belching, regurgitation, or coughing

Determines the structural abnormalities in the esophagus

Bland, soft, semi soft, or liquid diet to facilitate passage of food

4-6 small meals per day

Surgical excision of the diverticulum

Oral hygiene will not alleviate the foul breath

Protrusion of part of the stomach into the lower portion of the thorax

Junction of the stomach and esophagus and part of the stomach slide in and out through the weakened portion type of diaphragm

Most common

The fundus is displaced upward, with greater curvature of the stomach going through the diaphragm next to the gastroesophageal (GI) junction

Results from defect in the diaphragm at the point where the esophagus passes through it

Common in women

Multiple pregnancies, obesity, and loss of muscle strength and tone that occurs with aging, smoking, aging, develops in 60% of people older than 70 (risks)

Heartburn, benching, nausea, and feeling of pressure or pain after eating and when lying down

Increased symptoms when bending at waste

Hernias associates with reflux

Narrowed esophagus is stretched endoscopically but procedure may be repeated

Effects men more than women

Usually diagnosed in 5th or 6th decade of life

Most common is squamous cell carcinoma

Generally occurs in middle to upper part of the esophagus

Adenocarcinoma

Major cause of esophageal cancer is chronic irritation of the esophagus from any source

Vague discomfort and difficulty swallowing of some foods

Weight loss/weakness

Solid foods become almost impossible to swallow

Hemorrhage

Back pain and respiratory distress

Demonstrates a filling defect caused by a space-occupying mass (esophageal cancer)

Reveals malignant cells

Determine whether the cancer cells have affected the trachea

Evaluate for cancer in the surrounding lymph nodes or other mediastinal structures

Determine whether metastasis has occurred

Surgery, chemo, or radiation

Tumor and surrounding margin can be removed with endoscopic procedure (if small)

Complete resection of the esophagus (esophagectomy) it extensive

More affected by Peptic Ulcer Disease

Greatest risk factor for development of PUD

Family history, NSAIDS, cigarette smoking, and physiologic stress

Intracranial pressure

Burns

Develop when there is prolonged hyperacidity or chronic reduction in mucus

Reduced gastric acidity

Absence of hydrochloric acid

At risk for pernicious anemia due to

Abdominal pain, burning, back pain (pancreas) bleeding (20%) or weight loss

Upper two thirds of the esophagus is removed and replaced portion with

Eradicate bacteria

Reduce acid levels in digestive system to relieve pain and promote healing

Ulcers that persist

Produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea,

A branch of the vagus nerve is cut to reduce gastric acid secretion

Pylorus is repaired or reconstructed to expand the stomach outlet narrowed by scarring or improve gastric motility and emptying

Antrum is removed to eliminate a benign ulcer in the lesser curvature of the stomach if the ulcer has not healed after 12 weeks of medical treatment or is recurring

Part of stomach is removed while remaining is attached to duodenum. Vagotomy is often performed

Same as billroth 1, but remaining is connected to jejunum

Entire stomach removed and esophagus is joined to the jejunum

Most common in native Japanese, African Americans and Latinos

If tumor is on lower portion of esophagus, surgeon removed the affected area and attaches it to...

Most common type of stomach cancer

Prolonged feeling of fullness after eating, indigestion, heartburn, nausea, vomiting, anorexia, Weight loss, fatigue, and anemia

Pain

BMI > 40

Weight loss surgery or gastric bypass surgery

.

Improved nutrition and stable weight

Don’t drink from tears or bottles to reduce air trapped in esophagus and stomach

2 every two hours

Support surgical incision when coughing

Should not have oral nourishment until bowel sounds resume

Inflammation of stomach lining

NSAIDS, alcohol, caffeine, ingestion of poisons, etc

Epigastric fullness, pressure, pain, anorexia, nausea, and vomiting

Diarrhea, fever, and abdominal pain

Restricted eating, IV fluids for dehydration and electrolyte imbalance, antiemetics, avoidance of irritating substances, antacids, H2-receptor antagonists, PPI

Monitor clients symptoms, response to dietary modifications, and medications

Color and characteristics of stool and vomit mor

Circumscribed loss of tissue in an area of the GI that is in contact with hydrochloric acid and pepsin

Surgery, chemo, or radiation

Tumor and surrounding margin can be removed with endoscopic procedure (if small)

Complete resection of the esophagus (esophagectomy) it extensive

More affected by Peptic Ulcer Disease

Greatest risk factor for development of PUD

Family history, NSAIDS, cigarette smoking, and physiologic stress

Intracranial pressure

Burns

Develop when there is prolonged hyperacidity or chronic reduction in mucus

Reduced gastric acidity

Absence of hydrochloric acid

At risk for pernicious anemia due to

Abdominal pain, burning, back pain (pancreas) bleeding (20%) or weight loss

Upper two thirds of the esophagus is removed and replaced portion with

Eradicate bacteria

Reduce acid levels in digestive system to relieve pain and promote healing

Ulcers that persist

Produces weakness, dizziness, sweating, palpitations, abdominal cramps, and diarrhea,

A branch of the vagus nerve is cut to reduce gastric acid secretion

Pylorus is repaired or reconstructed to expand the stomach outlet narrowed by scarring or improve gastric motility and emptying

Antrum is removed to eliminate a benign ulcer in the lesser curvature of the stomach if the ulcer has not healed after 12 weeks of medical treatment or is recurring

Part of stomach is removed while remaining is attached to duodenum. Vagotomy is often performed

Same as billroth 1, but remaining is connected to jejunum

Entire stomach removed and esophagus is joined to the jejunum

Most common in native Japanese, African Americans and Latinos

If tumor is on lower portion of esophagus, surgeon removed the affected area and attaches it to...

Most common type of stomach cancer

Prolonged feeling of fullness after eating, indigestion, heartburn, nausea, vomiting, anorexia, Weight loss, fatigue, and anemia

Pain

BMI > 40

Weight loss surgery or gastric bypass surgery

.

.

Improved nutrition and stable weight

Don’t drink from tears or bottles to reduce air trapped in esophagus and stomach

2 every two hours

Support surgical incision when coughing

Should not have oral nourishment until bowel sounds resume

Inflammation of stomach lining

NSAIDS, alcohol, caffeine, ingestion of poisons, etc

Epigastric fullness, pressure, pain, anorexia, nausea, and vomiting

Diarrhea, fever, and abdominal pain

Restricted eating, IV fluids for dehydration and electrolyte imbalance, antiemetics, avoidance of irritating substances, antacids, H2-receptor antagonists, PPI

Monitor clients symptoms, response to dietary modifications, and medications

Color and characteristics of stool and vomit mor

Circumscribed loss of tissue in an area of the GI that is in contact with hydrochloric acid and pepsin