Upper GI Disorders & Drugs - unit 7

Mastication

Chewing of food

Pharynx

Aids in swallowing

Esophagus

Long collapsible tube that transports food to stomach

Gastroesophageal sphincter

Prevents reflux of gastric contents

Stomach

Food reservoir where chemical breakdown of food begins

Pyloric sphincter

Controls how much food is emptied into duodenum

Liver

detoxes blood

Metabolizes carbohydrates, proteins, fats

produces bile

Pancreas

Produces enzymes, electrolytes, and water for digestion

regulates bg

Gall Bladder

Stores and secretes bile

-itis

Inflammation

-oscopy

Scope

-ostomy

Artificial opening

-ectomy

Surgical removal

-phagia

Eating, swallowing

-phasia

Speaking

-oma

Tumor

Cholecystectomy

Surgical removal of gall bladder

hepat

liver

gastr

stomach

cholecyst

gall bladder

colo

large intestine

recta

rectum

dys

difficulty

carcin

cancer

-lith

stone

Dysphagia

Difficulty swallowing

Dysphasia

Difficulty speaking

Carcinoma

Cancer tumor

Hepatitis

Inflammation of liver

Gastritis

Inflammation of stomach

Cholecystitis

Inflammation of gall bladder

Colitis

Inflammation of colon

Cholelithiasis

Gall stones

Colonoscopy

Scope of colon

Colostomy

Surgical opening of colon

Anorexia

Loss of appetite

causes of anorexia

smell

emotional factors

drugs and diseases

what is the forerunner of nausea

anorexia

Dysphagia Causes

Stroke, Brain Injury,

Esophageal Strictures or Stenosis, Esophageal tumors

Clinical Presentation of Dysphagia

Sensation of food getting stuck,

Choking, coughing,

Pocketing food in cheeks,

Delayed or exaggerated swallowing

what does nausea stimulate

Stimulates vomiting center in brain stem,

what is nausea usually accompanied by

anorexia, watery salivation, pallor,

sweating, and tachycardia.

what is vomiting

Involuntary or voluntary forceful ejection of chyme from the stomach up through the esophagus and out of the mouth

what is the medical word for vomiting

emesis

what does yellow/green colored vomit mean

bile in vomit

gi obstruction

What is hematemesis and what does it indicate?

blood in vomit - looks like coffee grounds

upper GI bleed is often indicated

Deep Brown colored emesis

indicate content from the lower intestine.

Undigested food emesis

Caused by conditions that impair gastric emptying.

Antiemetics

Medications used to prevent or treat nausea and vomiting.

what is an example of a Serotonin Antagonist

Ondansetron (Zofran)

when should we not use ondansetron

pregnancy and long QT syndrome

what are side effects of ondansetron

headache

diarrhea

dizziness

cardiac arrythmias

what is an example of a Dopamine antagonist

promethazine, prochlorperazine.

when should we not use promethazine/ prochlorperazine.

- in children and elderly

- if clients are taking other respiratory depression medications

what are side effects of promethazine/ prochlorperazine.

restlessness

anxiety

face spasms

drowsiness

hypotension

sedation

anticholinergic

respiratory depression

what is an example of a Anticholinergics

Scopolamine - helps with salavation

when should we not use Scopolamine

in patients with urinary retention/obstruction

asthma

narrow angle glaucoma

what is an example of a Antihistamine

dimenhydrinate (dramamine) - helps with motion sickness

what is an example of a Benzodiazepines

lorazepam

when should we not use lorazepam

clients with CNS depression

angle-closure glaucoma

severe hypotension

severe pain

pregnancy/ breastfeeding

what medication helps suppress chemotherapy induced nausea and vomiting (CINV)

Lorazepam suppresses this condition.

Extrapyramidal Symptoms

Side effects associated with certain antiemetics.

what are two congenital defects

cleft lip and esophageal atresia

Gastroesophageal Reflux Disease (GERD)

Reflux of gastric contents into the esophagus.

Pathophysiology of GERD

Increased abdominal pressure, weak lower esophageal sphincter, delayed gastric emptying.

Complications of GERD

Barrett's esophagus and esophageal strictures (narrowing caused by scar tissue).

Causes of GERD

Foods (acidic food, carbonated beverages, chocolate, mints), smoking, hiatal hernia, obesity, pregnancy, certain medications, lying down immediately after eating.

Clinical Manifestations of GERD in adults

Indigestion (aka heartburn), epigastric pain, dysphagia, regurgitation of food.

Clinical Manifestations of GERD in kids

Dysphagia, anorexia, irritability, sudden or inconsolable crying, feeding problems.

Hiatal Hernia

Portion of the stomach protrudes through an opening in the diaphragm.

Causes of Hiatal Hernia

Weakening of diaphragm muscles, increased abdominal pressure, trauma, congenital defects.

Clinical Manifestations of Hiatal Hernia

Indigestion (heartburn), frequent belching, epigastric and/or chest pain, dysphagia.

Worsening Factors of Hiatal Hernia

Lying down, especially after eating; eating large meals; bending over; coughing.

what is a Histamine2-Receptor Antagonists

Block H2 receptors which suppress secretion of gastric acid.

what conditions do we use Histamine2-Receptor Antagonists

prevent/treat GI ulcers,GERD, heartburn

Side Effects of Histamine2-Receptor Antagonists

CNS effects (lethargy, hallucinations, confusion), constipation, N/V/D.

Examples of Histamine2-Receptor Antagonists

famotidine, cimetidine, ranitidine.

When Should We Not Use Histamine2-Receptor Antagonists?

Caution: Pregnancy, Elderly, COPD, KF.

Nursing Implications for Histamine2-Receptor Antagonists

Stop smoking; avoid smoking after last dose of day; don't take with antacid.

what is a Proton Pump Inhibitor

Blocks basal and stimulated acid production and reduces gastric acid secretion.

what is a proton pump inhibitor used for

to prevent/treat GI ulcers, GERD, and stress ulcers

Side Effects of Proton Pump Inhibitors

Pneumonia,

osteoporosis and fractures, hypomagnesemia,

C. diff diarrhea.

Examples of Proton Pump Inhibitors

pantoprazole, omeprazole.

When Should We Not Use Proton Pump Inhibitors?

Lactation, pregnancy,

allergy, COPD/pneumonia prone.

Nursing Implications for Proton Pump Inhibitors

Do not crush, chew or break;

assess for GI bleeding.

what is a Mucosal Protectant do

Acidic environment of the stomach and duodenum changes this medication into a protective barrier over an ulcer preventing further injury.

what would we use mucosal protectant to treat/prevent

GI ulcers

Examples of Mucosal Protectant

sucralfate.

what is a side effect of a mucosal protect

constipation

When Should We Not Use Mucosal Protectant?

Allergy;

Caution: CKF, DM.

Nursing Implications for Mucosal Protectant

Avoid taking with phenytoin, digoxin, warfarin, and ciprofloxacin;

take 30 min before or after antacid.

what does an antacid do

Neutralizes or reduces acidity of gastric acid.

what are antacids used to treat/prevent

GI ulcers

GERD

Stress ulcers

Side Effects of Antacids

Constipation/Diarrhea,

fluid retention,

electrolyte imbalances,

metabolic alkalosis.

When Should We Not Use Antacids?

GI perforation or obstruction;

caution in abdominal pain.

Examples of Antacids

magnesium hydroxide, calcium carbonate

what does Prostaglandin E Analog do

decrease acid secretion,

increase the secretion of bicarbonate and protective mucus,

promote vasodilation to maintain submucosal blood flow.

Example of Prostaglandin E Analog

misoprostol.

When Should We Not Use Prostaglandin E Analog?

Pregnancy (Category X) and lactation.

Nursing Implications for Prostaglandin E Analog

Eat with meals and at bedtime;

avoid pregnancy;

give pregnancy test.