Patho
This flap prevents food and water from entering the lungs during the act swallowing.
What is the epiglottis?
A person with this condition may tell you; "My chest hurts every time I eat tomatoes!"
What is GERD?
GERD is chronic heartburn (more than 2x a week) due to an esophageal sphincter that is either weak, or relaxes abnormally. Your GI system is supposed to be a one-way street, but this leads to: regurgitation, chest pain, chronic cough, worsening asthma, or other respiratory complications.
Modifiable Risk Factors:
Name Three.
The class including calcium carbonate (Tums), magnesium-hydroxide (Milk of Mag.), sodium-bicarbonate (Alka-Seltzer) and others; reduces the acidity of the stomach.
What are antacids?
Alkaline substances that mix with the contents of the stomach, reducing the level of acidity and increasing the PH.
Monitor for alkalosis, and do NOT give with other medications unless indicated. Especially antibiotics. Two-hour separation between antacids and medications can be necessary. They can reduce absorption or breakdown of meds, meals, etc.
I can occur because of GERD, I'm the long-lasting tissue no one wants.
What is scar tissue?
GERD can cause esophageal scar tissue, inflammation, and difficulty swallowing/discomfort as a result of long-term acid exposure.
This position is talked about constantly. It's a good idea to position your GERD patient in this way in the bed.
What is in Semi/High Fowler's? (30-45 degrees HOB elevated)
Reduces aspiration risk, excessive acid reflux, promotes comfort, oxygenation (in general), and maintains a straight airway and esophagus.
*Note: Putting the legs in an elevated position can increase abdominal pressure, and worsen the symptoms and complications associated with GERD.
One of these does not belong:
Larynx
Pharynx
Duodenum
Gastric Mucosa
What is the Larynx?
It is part of the Upper Respiratory Tract, the pharynx is part of the Upper G.I. Tract.
Too much Coca-Cola, alcohol, stress, or smoking may lead to this type of ulcer.
What is a Gastric Ulcer?
A type of peptic ulcer affecting the lining in your stomach. Your own acids start to eat away at the tissues underneath the protective layer.
Causes:
1. H._______?
2. Type of Drug?
3. Diseases of the GI System.? C___'s D____; Z_____-E______ S________ (pancreatic or duodenal tumors -> drastically increased acid prod.)
Traumatic injuries or other severe illnesses: Burns, (Curling's Ulcers), head trauma (Cushing's Ulcers), Sepsis, Mechanically Assisted Ventilation > 48 hours
First-line drugs for GERD, think of an atom.
What are PPI's? (Proton Pump Inhibitors)
Binds to the Proton Pumps in your stomach, which pump hydrogen out and take potassium in, creating acidity in the stomach.
Monitor for Hypomagnesemia, direct effect on potassium levels -> cardiac dysthymias
Calcium, Magnesium, and B12 may need to be supplemented as absorption can be reduced in long-term PPI usage.
30-60 Minutes before your first meal in GERD patients
I burned a hole right through my stomach or esophagus, I am called __________. I can also create this dire medical emergency.
Peritonitis is when stomach acid and bacteria leak into the abdominal cavity; it requires emergency surgery.
Your patient comes back from an endoscopy. You do NOT give them anything by mouth until you do this.
What is "verify the gag reflex has returned"?
You must maintain the patient on NPO status post-operatively in any case where the gag reflex has been suppressed. It is your body's natural way of rejecting fluids, objects, etc. that may enter the airway, obstruct the esophagus, etc.
Verify it has returned, that they are alert enough to respond to commands, and monitor them closely for anything compromising their A.B.C.'s!
This piece of the Upper G.I. Tract marks the beginning of the small intestine.
What is the duodenum?
When your stomach can slide up and through your diaphragm somewhat freely.
What is a sliding hiatal hernia?
Your esophagus has to pass through your diaphragm, and there is a hole there (the hiatus). When your stomach passes through this hole, this is herniation through the hiatus. Sliding HH's allow movement back and forth, paraoesophageal HH's are far more dangerous (circulation to the stomach impeded).
Causes:
1. Age related weakness
2. Heavy Lifting
3. Internal pressure or strain (chronic constipation, straining during bowel movement, pregnancy, coughing, trauma)
I don't shut down the flow of acid, I block the signal that tells it to start being produced. I won't let something even sit in the receptors.
What are H2 Blockers? (Histamine-2)
Histamine is a primary neurotransmitter that tells the cells and body to keep making acid. The blockers prevent it from binding to receptors, reducing acidity.
Most commonly Pepcid (Famotidine), taken at bedtime for episodes of reflux that may affect sleep.
Also: Cimetidine, Ranitidine, Nizatidine (ending with "-tidine", makes it easier "to dine")
Can be given IV preventatively to prevent new stress ulcers following surgery.
Common step-down drug from PPI's in chronic GERD as they are not as strong and do not cause as many side effects.
*Useful in allergic reactions as well. (H1 Benadryl, H2 Pepcid)
Everyone loves coffee, but no one wants to find "coffee grounds" on their patient's bed. Ulcers that bleed can potentially be noticed by one or more of these three signs?
What are Hematemesis (Blood in Vomit), Melena (Dark, Tarry Stools), and Chronic Anemia?
"Coffee Ground" emesis means the blood has been partially _______ by your _______.
Dark stool means something different from bright red color in stool, why?
Chronic Anemia is occurring due to _________.
Gastroparesis may require this diet modification.
What are small, frequent meals?
Gastroparesis -> feeling full -> slowed digestion -> small frequent meals promote better nutrition and less discomfort/safety risks.
I'm essential to the Upper G.I. tract, but not directly. I secrete something you need to absorb Vitamin A, D, E, and K. I am ______ and I secrete _______.
What is the liver, and what is bile?
-The liver secretes bile, which emulsifies fats (breaks them into smaller pieces), making them possible to digest by lipase. This allows fat soluble vitamins like Vitamin A, D, E, and K to be far more effectively absorbed.
"I feel full after just a few bites," "I'm diabetic and don't take my insulin," or "I'm just always so bloated, and it hurts" are things a patient suffering from this gastric-motility condition might say.
What is gastroparesis?
Muscles in the stomach either nearly or completely stop moving, preventing effective digestion and movement of food through to the small intestine. This causes it to collect and fill the stomach as it can't leave. This can be due to:
-Damage to the Vagus Nerve (CN X) for any reason, including surgery
-Hyperglycemia chronically in diabetics (nerve damage)
-Sedatives like morphine or other opioids
-Nervous system disorders (Parkinson's, M.S.)
-Hypothyroidism
I turn into a paste and cover your ulcers like icing on a cake. Be specific.
What is Sucralfate?
Turns into a paste and covers ulcers selectively almost like a shield or a band-aid. Promotes healing and reduces irritation.
Constant exposure to acid reflux can lead to what kind of degradation or potential structural change at the VERY beginning of you Upper GI system?
What is tooth decay?
Acid can erode enamel, cause sensitivity, and even end up with tooth loss. The teeth and saliva begin the process of digestion, losing teeth can compromise nutrition, self-image, or even safety.
"I have IBS, you gave me some Bentyl. It's been 6-8 hours since I got it, and I haven't had a cramp, or even gone to the bathroom at all. I think it's working!" Your job is to perform an assessment/non-invasive procedure in this situation.
What is perform a bladder scan?
Anticholinergics -> reduce acetylcholine -> can cause urinary retention; if 6-8 hours have passed with NO VOIDING of urine, performing a bladder scan is important for the patient's safety.
This reactive change in the cells replaces normal, esophageal squamous cells with columnar cells.
What is Barret's Esophagus?
Barret's Esophagus is a physical change caused by long term exposure of stomach acid to the esophagus. Primarily seen in patients with chronic GERD. This increases the risk of esophageal cancer.
"I only feel like my food is stuck in my throat when I eat dairy or wheat. It's been getting worse and worse over time, so I came here." This patient's symptoms may indicate this disorder involving white blood cells.
What is Eosinophilic Esophagitis (EoE)?
A food allergy, exposure to another allergen, or even acid reflux can cause white-blood cells to build up in the lining of the esophagus. This is caused by a chronic-immune system disorder that affects the process of swallowing and therefore eating. Food can get stuck in the esophagus from the inflammation.
Treatment:
Diet, Drugs, or Dilation
Change your diet to avoid allergens, steroids like fluticasone to lower inflammation, or a mechanical procedure involving a balloon or device to temporarily open the esophagus (NOT in emergencies, as a way to re-expand the esophagus after chronic swelling)
This anti-cholinergic is used in IBS treatment to "relax" or "calm" the muscles in the gut. There are two big ones, name one.
What is Dicyclomine/Hyoscyamine? (Bentil/Levsin)
Reduces levels of Acetylcholine or blocks it, think SLUDGE
Salivation, Lacrimation, Urination, Defecation, Gastric Upset, Emesis
Monitor fluids, bladder distention, decreased cognitive function, dry mouth, elevated temp (stops sweating), chart bowel movements, watch for vision changes, potential fall risk.
A patient with increased ICP suddenly develops acute, severe epigastric pain. There is blood in their stool. An endoscopy reveals some shallow gastric erosions, and there is increased, excessive gastric acid production from vagal nerve stimulation.
What are Cushing Ulcers?
Increased ICP causes stimulation of the vagal nerve, leading to excessive gastric acid production. This can lead to erosion of the gastric mucosa, causing acute pain, and bleeding that is observed in stool.
Cranial Nerve X -> Parasympathetic/Rest & Digest -> Stomach, Pancreas, Liver, Intestines -> Excessive gastric acid -> erodes gastric mucosa -> pain, bleeding (hematemesis)
A large, fully dependent, non-verbal patient of yours is lying in bed in Semi-Fowler's. They're receiving a continuous feeding at 60 mL/hour as prescribed for enteral nutrition. You note nothing abnormal compared to your last time seeing them. You do this first before lowering the head of the bed slightly to assist the CNA with a bed bath.
What is PAUSE the infusion?
Placing a patient supine while receiving a continuous tube into their stomach can lead to aspiration, the cause being excess stomach contents FILL THE LUNGS and compromise the patients airway, breathing, and puts them at risk for pneumonia or other infections.
Reminder: Check Gastric Residual Volume, do NOT dispose of contents in syringe. Can lead to electrolyte imbalance, malabsorption from reduced acidity, and dehydration.