med surg

esophageal or diaphramatic

protrusion of stom through esophageal hiatus (opening) of the diaphragm

• sliding - most common 
• rolling

• 25-30
• most asymptomatic

• congenital problems
• trauma
• incr abd pressure

• ger
• pyrosis (heartburn after eating)
• belching
• regurgitation
• vomiting

• incarcerated and necrotic
• hemorrhage

• ugi
• barium swallow
• egd

• antacids
• h2 antagonists
• proton pump inhibitors
• reglan (gi stimulant, promotes gastric emptying)
• elevate hob
• limit fatty foods/caff/etoh/smoke
• avoid eating 3 hrs before sleep

• laparoscopic Nissen fundoplication / 
• Angelchik prosthsis

• tcdb
• nasogastric tube in place on suction 1-2 d
• only ivs until bowel function returns
• mild dysphagia several wks

• 1. drug therapy- know what they are, dosage, sched, and a/e
• 2.eat sm, freq meals. avoid foods that aggravate.
• 3. maintain norm wt to decr abd pressure
• 4. elevate hob to discourage reflux
• 5. no smoking
• 6. learn stress management
• 7. avoid bending forward, lifting, straining, and tight clothes

• 1 heartburn (pain radiating to beck, jaw, back - mimic heart attack)
• 2 regurgitation
• 3 belching/flatulence
• 4 dysphagia/odynophagia (pain w)
• 5 nocturnal cough/wheezing
• 6 hoarseness

• 1. fatty/acidic foods:
• (citrus, tomato, garlic, onions, choc, peppermint, caff, etoh, nicotine, nsaids/asp)

2 incr intraabdominal pressure (from strain, obese, preg)

3 lying down/bending over

4 enetics

1 h2-receptor blocker agents: (ranitidine-Zantac)

2 prokinetic agents: (metoclopramide-Reglan)

3 Proton Pump inhibitor agents: (omeprazole - Prilosec)

• dietary/lifestyle changes
• reducing intraabdominal pressure
• smoking cessation
• surgery

duodenum - 80%

• Prevacid 30 mg bid
• Amoxicillin 1 g bid
• Biaxin 500 mg bid
• for 10 days

• hemorrhage
• obstruction
• perforation

• bld vessels erode
• large amounts: frank
• small: occult

• NGT for lavage
• dx tests/surgery to locate source/evaluate/tx
• endoscopy w laser/cauterization stop blding
• esophageal balloon
• transfusion

• tissures near ulcer become edematous/scar
• gastric outlet obstruction

• retention of food in stom
• persistant vomiting

• ugi
• gastroscopy
• ngt to suction

erosion through all layers, with spilling of contents of gi tract into peritoneum

• EMERGENCY
• danger of hemorrhage and peritonitis

• sudden severe pain (refer to shoulders)
• abd rigidity 
• rebound tenderness
• decr bowel sounds
• fever
• shock

• surgery
• NGT to suction
• transfusion
• antibiotics - peritonitis

hemorrhage

perforate

bacterial infection Helicobacter pylori

vagus nerve supplies the stom is severed

decr stimulation of gastric acid secretion

• delayed gastric emptying
• feeling of fullness
• dumping syndrome
• diarrhea

• severs prt of vagus nerve that stimulates acid production 
• spares nerve supply to pyloric sphincter

decr stimulation of gastric acid secretion

delayed gastric emptying

widens pylorus

• improves passage of stom contents into dou
• done w vagotomy to prevent gastric stasis

dumping syndrome from rapid emptying stom into dou

creates passage bw bd of stom and jejunum

permits passage of alkaline int secretions into stom to neutralize gastric acid

incr gastric acid secretion

removal of antrum of the stom

reduces gastric acid by removing source of acid secretion

• diarrhea
• feeling of fullness
• dumping syndrome
• malabsorption
• anemia

• part of distal portion of stom, including antrum, removed
• remaining stom is anastomosed to duodenum

reduces acid by removing source of acid secretion

• dumping syndrome (but less often than others)
• anemia
• malabsorption
• wt loss
• bile reflux

part of distal portion of stom and antrum removed. remaining stom is anastomosed to jejunum

removes source of acid secretion

• dumping syndrome
• wt loss
• malabsorption
• duodenal infection
• pern. anemia
• afferent loop syndrome (obstruction of duo loop)

• removal of entire stom
• esophagus anastomosed to duodenum

removes source of gastric acid secretion

• consume only sml, freq meals
• semisolid good
• pern anemia
• dumping syndrome

rapid emtying of stom contents into sml intestine

sweating, palpitation, tachy, pallor, other vasomotor s/s approximately 30-60 minutes pc

• 1. diet low in carbs, refined sugar, moderate in fat, and high in protein
• 2. smaller, more freq meals
• 3. drink fluids bw meals, not with
• 4. lie down for 30 min after meals

drop in bld sugar approx 2 hrs pc

b12 def r/t loss of intrinsic factor

• 1. know your drugs
• 2. eat small freq meals 
• 3. call dr if n/v/abd pain/dark tarry stools
• 4. reduce recurrance- no caff/etoh/asp/nsaids
• 5. stress management

sml sacs/outpouches (herniations) in wall of colon resulting from protrusion of muc mem through weakened muscle wall

inflammation/infection of decerticula due to filling of pockets w material passing thru gi (mucus and fecal matter)

• llq abd pain and tenderness
• n/v
• flatus
• fever
• rectal blding

severe - obstruction, gangrene, perforation, peritonitis, hemorrhage

tx without spicy foods, nuts, seeds, fruits, or veggies

affected part of colon is removed and temporary colostomy may be created to rest the colon while the surgical incisions heald

communication or connection bw two organs or parts of organs

• semi fowlers/side lying w hips flexed
• withold analgesics until dr diagnoses & explain
• ruptured? elevate head to localize inf

• antibiotic agents
• iv fluids
• gi decompression
• assist in tcdb or IS
• show how to splint incision 
• inspect wound (redness, swelling, foul odor)
• wound care as ordered

• chronic, relapsing, infl disorder of GI
• cobblestone appearance (skip lesions)
• not continuous
• most freq occurs asc colon (right)
• no smoking
• s/s diarrhea w mucus and pus
• not cured by surgery

young-middle vs. young

common in both

possible vs. common

during attacks vs common

common vs severe

common vs infreq

severe vs rare

minimal vs common

starts distally and spreads in cont pattern up colon

vs

anywhere along gi tract in skip lesions (terminal ileum frequently)

continuous vs segmental

• mucosa and submucosa
• vs
• entire thickness of bowel wall (transmural)

absent vs common

rare vs common

common vs rare

minimal vs common

rare vs common

rare vs common

rare vs common

common in both

common vs rare

• incr incidence after 10 yrs of disease
• vs
• slightly greater than general population

cured vs 70% chance

twisting of the bowel on itself

telescoping of the bowel

• Change in bowel/bladder habits
• A sore that does not heal
• Unusual blding or discharge
• Thickening or lump in breast/elsewhere
• Indigestion of difficulty swallowing
• Obvious change in wart or mole
• Nagging cough or hoarseness

• fecal occult bld test FOBT
• or fecal immunochemical test FIT
• Stool DNA
• FSIG Flex. sigmoidoscopy 
• double contrast barium enema DCBE
• CT colonography

• white patch, smokers patch
• chronic irritation/heat exposure
• precancerous 5%
• dental hygienist discovers

• red, velvety patch
• precancerous 90%
• Barrett's esophagus-changes in epithelial lining r/t severe GERD
• chronic gastritis w h pylori
• IBD- ulverative coll/crohns
• colonic polyps

colrectal ca

• part of tx, sever vagus nerve innervation to stom to decr acid secretion by cells
• total or selective

tarry stools from digested blood

• fobt annually and sigmoidoscopy q 5 yrs
• screening for all above 50 and younger if you are at risk

• age over 50
• personal/fam hx
• hx of polyps and IBD (ulcer coll and crohns)
• low-fiber/high fat diets
• obesity

• silent disease 5-15 yrs of growth before s/s
• 40% discovered in localized stage
• 91% are over 50

• distal colon
• sigmoid/rectum

occult rect blding, change in bowel habits, narrow ribbon stools, incomplete emptying, dull abd discomfort, distention

internal pouch constructed from ileum; end of eleum intussescepted to form one-way nipple valve

• via cath inserted thru stoma (pressure of full pouch forces nipple valve to close).
• initially- q 2-4 h, as heals-qid

• takes 2 surgeries
• one for colectomy/ileostomy and creation of reservoir, then one for closure of ileostomy a few mos later
• continent within 3-6 mo

• change face as needed
• remove carefully
• use solvent prn to loosen adhesive
• wash and dry gently 
• proper fit and skin barrier

• bright red swollen at first
• turns pink when healed
• monitor for blding, assess skin for brk down
• monitor output, drainage, dont let fill over 1/2 full

• id pt, explain, gather, wash, privacy, position, relaxed pace
• solution bag 500-1000 ml luke warm water
• flush tubing w solution to clear line and clamp
• hang container 18-24 in above
• apply irrigation sleeve, place end in toilet

• lube cone, insert but not beyond widest point
• hold secure, flow steady for 5-10 min
• slow/stop if cramps
• clamp off when complete
• allow 20 min for fecal matter to expell
• clean, rinse, dry stoma, reapply appliance
• reposition, document, and teach

• ascending - liquid, very irritating to skin
• transverse - paste/liquid
• descending - solid or formed

• facilitate pt adaptation
• promote healing, skin integrity
• maintain bowel function
• adequate nutrition and f&e balance
• promote comfort

• no 28 cath
• insert 2 in past stoma
• if too thick - instill 30 ml of ns

obtain cell sample; microscopic exam to r/o ca, cirrhosis, hepatitis

• high risk for hemorrhage bc liver so vascular 
• high level - postpone test; Vit K inj

NPO, baseline vs, pt voids, review breathing instructions, mild sedative 30 min before, needle bx at bedside, gather, pt supine, r arm behind head, folded towel under r side, during procedure pt deep breath in, out, and hold; aspiration bx needle thru intercostal space, ad wall, liver; spec injected into preservative solution/lable/lab, pressure dressing

• keep pt r side w blanket against site for few hr
• br 24 hrs
• freq vs: assess for complications

• blding at site (shock- incr hr, restless, cool/clammy/pale, decr bp)
• infection - incr temp, chills
• pneumothorax - sob, incr resp/shallow, incr hr
• peritonitis - fever, rigid/pain abd, rebound, distention

cholescintigraphy; overhead

• NM test: iv radioactive substance
• HydroxyIminoDiacetic Acid 
• given/taken up by bile, flows where bile goes, then scanner, passed over area of gb, also give cholecystokinin to cause gb to contract/squeeze, evaluates gb function/obstruction/bile leak

tumors and cirrhosis

used for retrieval of stones in common bile duct, bx and dx tomors/cysts, or to dilate strictures

peritoneal tap to drain ascitic fluid from abd cavity for dx and tx purposes

low fat meal pm before test 4pm, then 6pm, radiopague iodine dye taken (1 tab q 5 min w ample water; 6 tabs total); then NPO; xray next day

contrast introduced into hep circulation, then xrays taken to assess vess and flow from them

• NM test: IV radioisotope given (trace dose) then scan liver
• evaluates size, shape, tumors, and abscesses