GI/GU Exam Notes

Diagnostic Imaging

• X-ray: Used to visualize hard structures like bones.
• CT Scan: Used if X-ray is inconclusive, also for hard structures.
• MRI: Used to visualize soft tissues.
• PET Scan: Used to identify cancer, such as osteosarcoma, to guide radiation marker placement.

Unit 7 Overview

• Focus on definition, epidemiology, pathophysiology, signs & symptoms, diagnostics, nursing interventions, and patient education.
• Emphasis on differentiating between two key diseases.

Gastric Ulcers vs. Duodenal Ulcers

Gastric Ulcers

• Location: Stomach.
• Risk Factors:
  • Women.
  • Smokers.
  • Aspirin and NSAID users.
  • Alcoholics.
  • Incompetent pyloric sphincter (allowing backflow).
  • Bowel reflux.
• Diagnostic: Esophagogastroduodenoscopy (EGD) - a scope is used to visualize the stomach lining for erosions or ulcers.
• Signs and Symptoms:
  • Burning pain in the left upper gastric region.
  • Back or upper abdomen pain.
  • Pain occurs 1-2 hours after meals.
  • Pain is aggravated by food.
  • Diagram shows an ulcer inside the stomach.

Duodenal Ulcers

• Location: Duodenum, specifically the first 1-2 cm after the stomach.
• Risk Factors:
  • Men (higher risk than women).
  • Age: Peak incidence between 35-45 years old (associated with increased stress).
  • Psychological stress.
  • Smoking.
  • Drugs and alcohol.
  • Other diseases like COPD or pancreatitis.
• Diagnostic: EGD or gastric studies.
• Signs and Symptoms:
  • Burning, cramping, or pressure-like pain across the mid-epigastrium and upper abdomen.
  • Pain occurs 2-3 hours after meals or in the middle of the night.
  • Pain is relieved by antacids and food.

H. Pylori

• Review H. Pylori and its treatment.

Hepatitis

• Definition: Inflammation of the liver.
• Types: A, B, C, D, and E (D and E are rare).
• Key aspects: Route of transmission and effects on the body.

Hepatitis A

• Transmission: Fecal-oral route.
• Example: Contaminated food due to poor hand hygiene.
• Chronic Infection: No.
• Prevention: Good hand hygiene.

Hepatitis B

• Transmission: Blood and body fluids.
• Chronic Infection: Yes.
• Prevention: Immunization.
• Important Note: Very infectious; a tiny amount of blood can infect many people.
• Cure: No cure.

Hepatitis C

• Transmission: Blood and body fluids.
• Chronic Infection: Yes.
• Cure: Yes, medication available for 8-12 weeks.

Hepatitis D

• Transmission: Blood and body fluids.
• Chronic Infection: Yes.
• Immunization: N/A

Hepatitis E

• Transmission: Fecal-oral, associated with contaminated water.
• Chronic Infection: No.
• Prevention: Safe drinking water and washing vegetables.

Crohn's Disease vs. Ulcerative Colitis

General

• Both are inflammatory bowel disorders.

Crohn's Disease

• Characteristics:
  • Family tendency.
  • Onset between 15-40 years.
  • Possible autoimmune disorder.
  • Fat wrapping on the colon.
• Signs and Symptoms:
  • Multiple stools per day.
  • Abdominal pain.
  • Tenderness in the right lower quadrant.
  • Severe diarrhea.
• Complications: Abscesses, fistulas, peritonitis.
• Diagnostics: Dehydration, electrolyte imbalance (low potassium, sodium, magnesium), anemia (if blood in stool), fatigue.
• Treatment: Immunomodulators (MAB drugs).

Ulcerative Colitis

• Characteristics:
  • Inflammation and ulceration in the mucosa.
  • Bloody stools are more common than in Crohn's disease.
  • No fat wrapping on the colon.
    *Note: Both Crohn’s and Ulcerative colitis can lead to peritonitis.

Gallbladder Disorders

Cholelithiasis

• Definition: Stones in the gallbladder.
• Symptoms: Many patients are asymptomatic.
• Risk Factors:
  • Multiparous women.
  • Women over 40.
  • Sedentary lifestyle.
  • Family history.
  • Obesity.

Cholecystitis

• Definition: Inflammation of the gallbladder, usually due to gallstone obstruction.
• Symptoms: Pain.
• Risk Factors:
  • Women.
  • Pregnant women.
  • Obesity.
• Types:
  • Acute: Severe pain and inflammation.
  • Chronic: Pain subsides, allowing function. Dietary control helps.

Cholecystectomy

• Definition: Surgical removal of the gallbladder.
• Procedure:
  • Laparoscopic (usually): 5 small incisions.
  • Open (if gallbladder bursts): Larger incision with a drain to prevent peritonitis.
• Post-op Teaching: Low-fat diet.

Dietary Teaching for Chronic Gallbladder Disease

• Low-fat diet.
• Ash diet (low residual diet).
• Avoid high-fat foods.

Acute Pancreatitis

• Definition: Inflammation of the pancreas.
• Risk Factors:
  • Gallbladder disease.
  • Chronic alcoholism.
• Not all patients are alcoholics.
• Signs and Symptoms:
  • Upper quadrant pain.
  • Nausea and vomiting.
  • Fever.
  • Leukocytosis.
  • Hypotension (due to potential sepsis).
  • Tachycardia (due to dehydration).
  • Jaundice.
• Complication: Necrotizing pancreatitis.
• Diagnostics: Elevated amylase and lipase levels.
• Treatment:
  • Antibiotics.
  • ICU (for necrotizing pancreatitis or sepsis).

Diagnostic Procedures: Key Nursing Considerations

• PT/INR: Monitor coagulation studies; elevated levels require provider notification.
• Consent: Required for invasive procedures.

Case Studies/Scenarios

Endoscopy Clinic Scenario

• Middle-aged man having first colonoscopy; aunt died of colon cancer.
• Key points:
  • Therapeutic communication to address patient's fear.
  • Patient needs someone to drive them home.
  • Expect flatus after the procedure.

Abdominal Pain Case Study

• 87-year-old woman with abdominal adhesions from surgery, blood-streaked stool, and nocturnal burning stomach pain.
• Consider:
  • EGD.
  • Throat.
  • Throat Atrophy.

Thrush Case Study

• Older adult with cellulitis, type 2 diabetes, on antibiotics, poor oral intake, white patches in the mouth.
• Identify:
  • Signs and symptoms of thrush (white patches on oral muocsa).
  • Problem the patient has is THRUSH.
• Risk Factors:
  • Diabetes (yeast loves sugar).
  • Antibiotic use.
  • Decreased immunity.
  • Poor oral intake.
    *Oral Candidiasis
• Treatment:
  • Antifungal meds (nystatin, swish and swallow, oral fluconazole).
  • Need to know these meds:
  • Miconazole.
    *What actions should you take:
  • Use a soft toothbrush.
  • Assist with rinsing mouth with saline or prescribed rinse.
    Do not use alcohol based mouth washes. Encourage oral care after meal. No Scope and Listerine

Dumping Syndrome

• Cause and Care, signs and symptoms.
  *Partial Gastric sleeve/gastric bypass
  *After eating a high-fat. High carbohydrate meal.

GERD

*Eating smaller sized meals decrease pressure of patient.
*Teach patients to avoid:
*Caffeine, alcohol, fatty foods, fried foods/peppermint.

H. Pylori aggressive treatment.

Two antibiotics and PPI's
Amoxicillin, Biaxin, Nexium.
and if that treatment doesnt work add:
Bismuth.
This changes stool to BLACK. This is normal.

GI Bleeding

• If it's a upper GI Bleed
  • Emesis will look like coffee ground
• If it's a lower GI Bleed
  • Melanoma, lactary stool will be present
    Patient will have a ridged board like abdomen with pain.

Duodenal ulcer, Diverticulitis and Diverticulosis.

• IMPORTANT Know the difference between these

Key Information
Atreotude (Sandostatine): Commonly ordered if patients have gi bleeds.

Start GERD treatment

*
Treat like this: Take this med 1-3 hours after meal and at bedtime.
Help relax to help patient not have that reflux and can sleep better.

*GERD drugs:

Antacids. Otc H2 blocker prescription then PPI.

Tum's, H2 Blocker-tagemate
*30 degrees-4-6 blocks

Teach patients with GERD and or herital hernia to sleep with head up to 30 degrees this is helpful.