Module 5 Inflammation 2

What are the two types of esophageal cancers

adenocarcinoma and squamous cell carcinoma

When the entire stomach is removed along with the lower portion of the esophagus, this is known as... Reconstruction of the GI tract is performed by anastomosing the end of the jejunum to the end of the esophagus, a procedure called an esophagojejunostomy.

total gastrectomy

Nursing care for acute gastritis

- NPO or NG tube -If fluids at least 1.5 ml/day -Antiemetic * zofran* -VS, Check for Bleeding, Hematemesis, Melena -Antibiotics, H2, PPI for H, Pylori -No ETOH, Food -non irritating diet

Management of GERD

* TEACH PT TO AVOID FOODS THAT DECREASE LES PRESSURE* *-Low-fat diet* Avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages *Avoid eating or drinking 2 hours before bedtime* *Elevate the head of the bed by at least 30 degrees* -*AVOID SMOKING* -Check gag reflex, VS (temp) after surgery for risk of perforation... pulse will increase, BP decrease -eat biggest meal early in the day -Avoid tight clothes

Clinical Manifestations of Zenkers Diverticulum

*-Dysphagia* -Fullness in the neck -Belching *-Regurgitation of undigested food, and gurgling noises after eating. The diverticulum, or pouch, becomes filled with food or liquid. When pt lies down, food is regurgitated leading to coughing* -*Coughing* -Aspiration -*Halitosis & sour taste in mouth due to undigested food in throat* Diagnostic Tests- Barium study/ Manometry/ *Esophagoscopy/ NG TUBE INSERTION is C.I !!! due to at risk of perforation*

Post-OP Consideration of esophageal cancer

*DO NOT REPOSITION NG TUBE* May see bloody drainage 8-12 hrs. then turns greenish -Observe for dyspnea and regurgitation Low Fowlers then Fowlers to prevent reflux..Incentive spirometry, sitting up in a chair, and, if necessary, nebulizer treatments. AVOID CHEST PHYSOTHERAPY -Check Temp for signs of aspiration , esophageal leakage , perforation. T/C & DB -Before the patient is allowed to eat, a barium swallow is performed to assess for any anastomotic leak. Once pt is eating, start with small sips of water, advance diet to soft mechanical diet. Pt upright for at least 2 hrs after eating. Usually appetite is poor so, home-cooked favorite foods may help the patient to eat. Antacids may help patients with gastric distress. Metoclopramide is useful in promoting gastric motility. Supplements such as Boost and Ensure should be avoided because they promote vagotomy syndrome (dumping syndrome), which can occur with each meal or approximately 20 minutes to 2 hours after eating. (Large amounts of solids and liquids rapidly "dump" into the duodenum. The patient experiences severe abdominal cramping, followed by a liquid bowel movement that may or may not be associated with diaphoresis, rapid heart rate or rapid respirations, or both.)

Meds if diarrhea is prominent

- Fiber -Alosetron ( lotronex) -Loperamide ( imodium) or deiphenoxylate -atropine ( lomotil) -Antispasmodics/Anticholinergic ex. Hydrochloride ( Bentyl), chloridazepoxide-clidnium ( librax) -Antiflatulents such as simethicone ( genasyme) with fiber

Nursing Process with a gastrci cancer patient

-*Assessment*- Diet history. Weight loss? Do foods, antacids, or medications relieve the pain, make no difference, or worsen the pain? Is there a history of infection with H. pylori. Family Hx ( acute gastritis) Smoke, ETOH hx do a physical examination, assess ABD for tenderness or masses, and palpates and percusses the abdomen to detect ascites. -*Nursing Diagnosis* -Anxiety related to the disease and anticipated treatment -Imbalanced nutrition: less than body requirements related to early satiety or anorexia -Acute pain related to tumor mass -Grieving related to the diagnosis of cancer -Deficient knowledge regarding self-care activities -*Goals* Reduced anxiety, optimal nutrition, relief of pain, and adjustment to the diagnosis and anticipated lifestyle changes. Reducing anxiety -A relaxed, nonthreatening atmosphere is provided. Encourages Family and Pt. coping mechanismsa. Pt education Optimal Nutrition -Small freq, nonirritating meals. Food supplements, high in calories, as well as vitamins A and C and iron.* Nurse educate patient on preventing dumping syndrome such as eating 6 small feedings daily that are low in carbohydrates and sugar and the consumption of fluids between meals rather than with meals.* *Injection of B12* low B12 leads to ANEMIA Parenteral nutriton record I&O's, dehydration ( dry skin, poor skin tugor, tachycardia, low urien output)lab values Relieving pain -Opiod IV infusion or a patient-controlled analgesia (PCA) pump set. Assess pain, duaration, freq. Nonpharm Methods, position changes, imagery, distraction, relaxation exercises (using relaxation audiotapes), backrubs, massage, and periods of rest and relaxation.

Diagnostic findings with diverticular disease

-*CT SCAN IS GOLD STANDARD * -Colonoscopy permits visualization -CBC ( high WBC, Low H&H) U/A ( for colovesicular fistulas)Occult blood test -X-ray may reveal air of perforation occurred - DO NOUT USE BARIUM ENEMA/ AND COLONOSCOPY WITH ACUTE DIVERTICULITIS

Diagnostic studies of Gastric Cancer

-*EGD, Barium Study* -*CBC ( Anemia), stool specimen* -*Tumor marker ( Elevated in gastric cancer)* -H&P -*Advanced Cancer ( ascites and hepatomegaly if the cancer metastisized to the liver* -*palpable nodules around umbilicus (" Sister Mary Jospeh's Nodules)* -CT Scan of chest, ABD, pelvis

Clinical Manifestations of GERD

-*Heartburn* -Burning tight sensation , can spread to jaw, may wake pt from sleep -Heartburn relived with milk, alkaline substances Regurgitation-hot bitter sour -Wheezing, coughing, dyspnea, hoarseness -N/V, stomatitis, esophagitis

Clinical manifestations of diverticular disease

-*LLQ PAIN* -Alt constipation/diarrhea -N/V -Leukocytosis *pt may be asymptomatic*

Risk factors for Diverticulosis

-*LOW FIBER INTAKE* -Obesity -Hx of smoking -NSAIDS/ TYLENOL -YOUNGER MEN, older women

Hiatal Hernia Risk Factors

-*OBESITY* -Pregnancy -Wight lifting -Age

Risk Factors for IBS

-*STRESS AND ANXIETY* -*WOMEN UNDER 45* -Allergy to certain foods ( glucose +lactose) -Diet ( raw fruits, coffee, ETOH, popcorn, cold foods, salty)

Treatment for IBS

-*STRESS REDUCTION* Hypnosis. Biofeedback, progressive relaxation and regular exercise. -Lifestyle modifications ( sleep, exercise, restrict irritable foods, coffee, corn, wheat, ETOH, Fried foods) -*STOP SMOKING* -*AVOID CHEWING GUM* - increase fluid and fiber - smooth muscle antispasmodic for ABD -Antidepressant for serotonin level -PROBIOTICS to decrease bloating/gas -antidiarrheal for IBS-D pts -Peppermint oil -1-2 week food diary, eat a regular intervals -Lots of fluid intake, do not take fluids with meals ( it will increase ABD distension)

Clinical Manifestations of IBS

-Alteration in bowel patterns - *LLQ* Pain -Bloating -Abdominal distention -Pain brought on by eating relieved by defacation

Nursing Diagnosis for Gastric Cancer Patient

-Anxiety related to the disease and anticipated treatment -Imbalanced nutrition: less than body requirements related to early satiety or anorexia -Acute pain related to tumor mass -Grieving related to the diagnosis of cancer -Deficient knowledge regarding self-care activities

Diagnostic test for GERD

-Barium Swallow (follow with lots of H20) -EGD esophagogastroduodenoscopy , check VS for perforation!!! *GOLD STANDARD* -esophageal pH monitor

Clinical manifestations of hemorrhoids

-Bright red bleeding with defecation -pain -itching/burning -reddish/blue discoloration -external hemorrhoids may lead to ischmia and eventually necrosis

Clinical manifestations of Achalasia

-Dysphagia -Food sticking sensation in lower esophagus -Food regurgitation. -Chest pain and pyrosis (heartburn). -Pulmonary complications due to aspiration. (The food just sits there) -Loss of weight/malnutrition

Clinical manifestations of esophageal spasms

-Dysphagia -Odynophagia -Chest pain similar to that of coronary artery spasm.

Management of Achalasia

-Eat slowly and to drink fluids with meals -Oral calcium channel blockers/Nitrates to decrease esophageal pressure and improve swallowing -Botox injection stops smooth muscle contraction

management for dysphagia

-Elevate HOB -Cush med in applesauce -Look on DO NOT CRUSH LIST ( enteric coated, extended release) -Pureed diet/thickened liquids -*check gag reflex to see if they can swallow, sufficient swallow or cough reflex present/ORAL CARE* -*FOCUSED ASSESSMENT OF LUNGS, AT RISK FOR ASPIRATION* -check mouth for dry mucous membranes/thick sticky secretions/oral care -obtain pt weight -check for malnutrition/*UNEXPLINED WEIGHT LOSS IS A RED FLAG, ESPECIALLY WITH CANCER*

Management of hiatal hernia

-Elevate HOB ( block hernia from sliding up) -small freq. feedings -*Sit up one hour after eating* -Surgery for symptomatic pt/ to relive GERD Symptoms not repair hernia -Surgical repair for those who have gastric outlet obstruction, ischemia of stomach, perforation

Labs determining gastritis

-Endoscopy -Pylori testing -CBC ( Low H&H, anemia , B12 Deficient) -Stool for occult blood -Tissue biopsy

Clinical manifestations of gastritis

Acute -Epigastric pain -Dyspepsia ( indigestion) -anorexia/Nausea/Hiccups -melena/vomiting bright red blood -hematochezia (bright red, bloody stools) Chronic -Pyrosis -Fatigue -Belching -sour taste in the mouth, early satiety, anorexia, or nausea and vomiting. -*LOSS OF INTRINSIC FACTOR, B12 DEFEICIENT, ANEMIA*

Diagnostic testing for IBS

-Fecal occult test are negative -stool examination for parasites is negative -Stool culture is negative for leukocytes, pathogenic bacteria -CBC, serum albumin, serologic tests, ETR test are *normal* *If everything comes back normal, and they still have issues, it is usually IBS* -use Bristol Stool Form Scale to determine IBS Imaging -CT abdomen or pelvis to rule out disorders -Barium enema rule out diverticula ,tumors, polyps -ULT to rule out cholecystitis *Sigmoidoscopy, coloscopy to rule out Inflammation

Meds if constipation is dominant in IBS

-Fiber -Polyethylene Glycol ( glycolax) -lubiprostone ( amitiza) if constipation severe

Risk factors for Eso[ageal cancer

-GERD, BE -ALCOHOL, TOBACCO, SMOKING

Complications of Esophageal cancer

-Hemorrhage, esophageal perforation ( tumor cells may spread beyond the muscle layers into the lymphatics), esophageal obstruction Diagnostic tests- EGD w/ biopsy, Bronchoscopy, Ct scan of chest& ABD to detect metastasis. PET Scan for metastasis

tx for hemorrhoids

-High fiber, high residue diet( fruits, brain) high fluid intake -Topical hydrocortisone ( prep-H) -Stool softener ( Colace, not pysllium ( laxative) Warm compresses, sitz baths, analgesic ointments and suppositories, and astringents (e.g., witch hazel) reduce engorgement

Nursing mangement for diverticulitis

-Increase fiber/soft foods (cereals or soft-cooked vegetables) -Use Bulk laxative i.e metamucil, psyllium -INCREASE FLUID INTAKE @ least 2 L/day

Risk factors for stomach cancer

-Male -Advanced Age -Hispanic, AA, Asian/pacific Islander -Diet high in smoked, pickled, salty foods, -H.pylori infection -Chronic inflammation of the stomach ( (gastritis), pernicious anemia, smoking, obesity, achlorhydria, gastric ulcers,)

what are some later signs of gastric cancer

-Palpable mass in abdomen - Enlarged hard lymph nodes

Clinical manifestations of hiatal hernia

-Pyrosis/regurgitation/dysphagia -Intermitent epigastric pain/fullness after eating -*Pain, burning when bending over* -reflux when laying down *Diagnostic Tests-Barium swallow ( GIVE LOTS OF H20 TO WASH BARIUM OUT) /Endoscopy ( EGD)!!/Chest CT*

Hemorrhoids may result from

-Shearing force during pooping ( STRAINING) -Pregnancy -constipation -heavy lifting -portal hypertension

Management of Zenker's diverticulum

-The only means of cure is surgical removal of the diverticulum ( diverticulectomy) -Myotomy of the cricopharyngeal muscle ( to relive spasticity) ( upper esophageal sphincter is cut) -NG tube may be inserted during surgery -observe for fistula-advance diet as tolerated *C.I in pts who have a stiff or short neck, poor mouth opening, prominent teeth, large tongue, and with larger diverticula*

Medical management of esophageal Spasms

-calcoum channel blockers -Smooth muscle relaxants,anticholinergics (botulinum toxin), antianxiety medications (tricyclic antidepressants), and proton-pump inhibitors (PPIs; omeprazole [Prilosec]) -Small, frequent feedings and a soft diet

Clinical manifestations of gastric cancer

-s/s of peptic ulcer disease -anemia]-Brining pain alleviated by antacis -Weight loss -Dysphagia LATER -* PALPABLE MASS IN ABDOMEN* -*ENLARGED HARD LYMPH NODES

Nursing considerations for those with dyphagia

-stimulate salivation by talking about food, add lemon slice or dill pickle to food tray, -ORAL CARE -Give an anticholinergic or antiemetic to decrease salivation -moisten food with liquid

Loss of intrinsic factor in gastric acid causes deficiency of which of these micronutrients?

Vitamin b12, D and Anemia

What are the four fat soluble vitamins?

ADEK

gastritis may be_, lasting only hours or _, from repeated exposure to irritating agents or recurring episodes

Acute;Chronic

Preserve mucousal barriers. Adheres to an ulcer site. Ex. sucralfate ( Carafate) *GIVE 1 HR BEFORE MEALS & @ BEDTIME* *-DO NOT CRUSH/LIQUID FORM AVAILABLE* -SE; constipation, dry mouth, gas Separate from doses of antacids 30 mins prior

Antiulcer

A condition in which the lining of the esophageal mucosa is altered. May lead to cancer of the esophagus

Barrett' Esophagus

In _ the cells of the esophagus are altered.* Instead of the normal squamous mucosa, there are columnar-lined epithelium that resembles the intestines.* It is the only known *precursor to esophageal adenocarcinoma (EAC)*.*Esophageal lining is also red rather than pink.*

Barrett's esophagus

abnormal change in cells ( dysplasia) occurs in what disease process?

Barrett's esophagus

Spontaneous esophageal rupture due to forceful vomiting or straining_ This perforation of the esophagus.

Boerhaave Syndrome S/S:s excruciating retrosternal pain followed by dysphagia. Infection, fever, leukocytosis, and severe hypotension Diagnostic Tests: X-ray studies, fluoroscopy by either a barium swallow or esophagram (a noninvasive test), or a chest CT scan may be used to identify the site and scope of the injury. Management: The patient remain NPO, beginning IV fluid therapy, administering broad-spectrum antibiotics , monitor and prepare for surgery. If C.IC for surgery then drainage, diversion, stent placement, or an esophagostomy (removal of the esophagus) may be performed Post op: The patient remains NPO for approximately 7 days, so enteral (e.g., jejunal feeding) or parenteral nutrition is started on postoperative day 2 or 3/ water to moisten pt mouth.A repeat esophagram is obtained on postoperative day 7 to verify there is no leak or ileus before the NG tube is removed and oral intake is permitted. It is common for broad-spectrum antibiotics to continue for 7 to 10 days postoperatively

WHAT IS THE DIAGNOSTIC TEST OF CHOICE TO CONFIRM DIVERTICULITIS?

CT SCAN!!!!

H. pylori which secretes *urease* that protects it from the being destroyed from gastric juices in the stomach is believed to be acquired in _ and had survived through adulthood. Found in NONEROISVE GASTRITIS

Childhood

Classification of IBS bowel patterns _classified as IBS-C), _ (classified as IBS-D), or a combination of both (classified as IBS-M for mixed. Also IBS-U for "unknown."

Constipation, Diarrhea

In this type of esophageal spasm, the spasms are normal in amplitude, but are uncoordinated, move quickly, or occur at various places in the esophagus at once. In N_, peristalsis is coordinated, but the amplitude is very high

DES, NE

Medical Management of esophageal Cancer

Depends on type of cancer, pt condition. Combination of surgery, radiation, chemotherapy, -Esophagectomy ( remove esophagus;grat to resect), -Esophagogastrostomy ( resect esophagus to stomach) -Esophagoenterostomy (resect esophagus to colon ) *HIGH MORTALITY RATE DUE TO INFECTION/PULMOARY/LEAKAGE OF ANASTOMOSIS *NEVER REPOSITION NG TUBE AFTER INSERTION, NPO UNTIL X-RAY CONFIRMS NO ANASTOMOSIS LEAKAGE, PUMONARY ASPIRATION,NO OBSTRUCTION

Occurs when a diverticulum becomes inflamed, causing perforation, and potential complications such as obstruction, abscess, fistula peritonitis, and hemorrhage

Diverticulitis

The presence of multiple diverticula without inflammation or symptoms

Diverticulosis

a saclike herniation of the lining of the bowel that extends through a defect in the muscle layer

Diverticulum

This occurs when the pt has just undergone a gastric surgery and has ingesting a salty food. Water moves in to the intestines and results in intestinal dilation, increased intestinal transit, hyperglycemia. Early symptoms include: early satiety, ABD pain, N/V, Diarrhea, headache, Faint (vasomotor symptoms). Later symptoms include * hyperglycemia)* ( anxiety, shakiness, weakness, fatigue)

Dumping Syndrome

A client who had a Roux-en-Y bypass procedure for morbid obesity ate a chocolate chip cookie after a meal. After ingestion of the cookie, the client reported cramping pains, dizziness, and palpitation. After having a bowel movement, the symptoms resolved. What should the nurse educate the client about regarding this event? Gastric outlet obstruction Dumping syndrome Bile reflux Celiac disease

Dumping syndrome

Refers to difficulty swallowing, the most common symptom of esophageal disorders

Dysphagia

Nursing care fo chroni Gastritis

Eradicate H. Pylor Elminate cause I. E ETOH, NSAIDS Antiobiots, PPI, H2 for H. Pylori Six Small Meals a day NO SMOKING

The _ form of acute gastritis is caused by irritants such as NSAIDS, ETOH, Smoking, stress, gastric radiation therapy

Erosive

Sac-like outpouching of mucosa and submucosa through esophagus

Esophageal Diverticulum

An elderly client seeks medical attention for a vague complaint of difficulty swallowing. Which of the following assessment findings is most significant as related to this symptom? Hiatal hernia Gastroesophageal reflux disease Gastritis Esophageal tumor

Esophageal tumor

The cause of *diverticulitis * is related to retention of stool, _

Fecalith

What are some antibiotics to eradicate H. Pylori

Flagyl (Metronidazole) -Amoxicillin -Tetracycline _Biaxin (Clarithromycin)

Backflow of gastric or duodenal contents into the lower esophagus excessive reflux me be due to an incompetent lower esophageal Sphincter. NOTA DISEASE, BUT A SYNDROME

GERD

Complications of hiatal hernia

GERD, Hemorrhage, Stenosis of esophagus, ulcerations, Strangulation of hernia, Regurgitation, Increased risk of respiratory disease

Adenocarcinoma of the stomach wall

Gastric Cancer

narrowing of the pyloric sphincter usually from scarring. A residual of more than 400 mL suggests this disease

Gastric Outlet obstruction

Disruption of mucosal barrier in stomach allowing HCL, pepsin and other agents to come on contact with gastric mucosa causing inflammation is known as

Gastritis

When a foreign body is lodged in the esophagus_ may be admin Iv due to relaxing effect on the esophageal muscle. The nurse performs an initial and ongoing respiratory (airway-focused) assessment of a patient with a foreign body in the esophagus. Intubation may be required to protect the airway.

Glucagon

-Tidine. Decrease gastric acid production. Prophylactic given to prevent stress ulcers. Take before meals. SE: headache, dizziness,

H2 Blockers

Dilated portions of veins in the anal canal.

Hemorrhoids

_ are the most common cause of bleeding with defecation ( bright red blood)

Hemorrhoids

When a portion of the upper stomach protrudes through the diaphragm into the the esophagus. This is known as. What are the two types?

Hiatal Hernia. Sliding and paraoesophageal.

In this disease, change occurs in bowel motility. There may be be a diminished serotonin receptor activity in the GI tract that results in problems of GI tract or peristaltic waves are affected at specific segments of the intestine and in the intensity with which they propel the fecal matter forward. There is no inflammation

IBS

what disease is it when all labs come back normal?

IBS

The incidence of diverticular disease _ with age because of degeneration and structural changes in the circular muscle layers of the colon and because of cellular hypertrophy

Increases

Absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing

achalasia

Internal and external hemorrhoidal surgery

Internal -Band litigation -Infrared coagulation, cryotherapy, laser treatment External -Hemorroidectomy

Hemorrhoids are classified into two types: those above the internal sphincter_ and those outside external sphincter_

Internal; External

common condition marked by chronic or periodic *diarrhea* alternating with *constipation*

Irritable Bowel Syndrome

Symptoms of GERD may mimic

M.I (heart attack). Rule out Cardiac Issues first

A client who reports increasing difficulty swallowing, weight loss, and fatigue is diagnosed with esophageal cancer. Because this client has difficulty swallowing, what should the nurse assign highest priority to? Helping the client cope with body image changes Ensuring adequate nutrition Maintaining a patent airway Preventing injury

Maintaining a patent airway

Criteria to diagnose IBS

Manifestations must include recurrent abdominal pain for *at least one day weekly* that is associated with *2 or more* of the following -Abdominal pain related to defecation; -Abdominal pain associated with a change in frequency of stool; -Abdominal pain associated with a change in form/appearance of stool. *MUST HAVE EXPERIECED RECURRENT ABD PAIN/DISCOMFORT FOR 3 DAYS OR MORE OVER THE PREVIOUS 3 MONTHS*

The nurse in the ED admits a client with suspected gastric outlet obstruction. The client's symptoms include nausea and vomiting. The nurse anticipates that the physician will issue which order? Pelvic x-ray Stool specimen Nasogastric tube insertion Oral contrast

Nasogastric Tube Insertion

The _ form of gastritis is caused by H. Pylori

Noneroisve

Peptic ulcer disease occurs more frequently in people with which blood type? A B AB O

O

In this type of hiatal hernia, all or part of the stomach pushes through the diaphragm beside the esophagus. The stomach can become squeezed and loses its blood supply

Paraoesophageal

Where in the esophagus does Zenker diverticulum occur?

Pharyngoesophageal ( Upper esophageal sphincters)

When caring for a client with an acute exacerbation of a peptic ulcer, the nurse finds the client doubled up in bed with severe pain in the right shoulder. What is the initial appropriate action by the nurse? Notify the health care provider. Irrigate the client's NG tube. Place the client in the high-Fowler's position. Assess the client's abdomen and vital signs.

Place the client in the high-Fowler's position.

accelerate gastric emptying EX: Metoclopramide (Reglan) Causes EPS- TARDIVE DYSKINESIA SE: EPS< Hallucinations, Anxiety, Restlessness,Insomina

Prokinetics

Which GERD med causes extrapyramidal Side effects?

Prokinetics ( metoclopramide-Reglan)

-prazoles. Inhibit proton pump mechanism responsible for H ion secretion. *FIRST CHOICE OF THERAPY WITH OR WITHOUT ESOPHAGEAL MUCOUSAL INURY* - Must be swallowed whole, NEVER CRUSHED! -Give on empty stomach, 1st thing in the morning..QD every day

Proton pump inhibitors ( GERD)

Which of the following are characteristics associated with the Zollinger-Ellison syndrome (ZES)? Select all that apply. Constipation Hypocalcemia Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Severe peptic ulcers Extreme gastric hyperacidity Gastrin-secreting tumors of the pancreas

Diverticula may occur anywhere in the GI tract, from the esophagus to the colon, but occur most commonly in the colon, particularly in the _ colon

Sigmoid

When treating GERD do we use the step up or down approach

Step down Approach. We start with PPI, H2, then Anti ulcer

S/S of Barrett's Esophagus

Symptoms of GERD/Peptic Ulcers Freq heartburn

A client with dysphagia is being prepared for discharge. Which outcome indicates that the client is ready for discharge? The client doesn't exhibit rectal tenesmus. The client is free from esophagitis and achalasia. The client reports diminished duodenal inflammation. The client has normal gastric structures.

The client is free from esophagitis and achalasia.

Disorders of the esophagus include motility disorders (achalasia, spasms), hiatal hernias, diverticula, perforation, foreign bodies, chemical burns, gastroesophageal reflux disease (GERD), Barrett esophagus (BE), benign tumors, and carcinoma. True of false?

True

Gastric surgery complications include hemorrhage, dumping syndrome, bile reflux, and gastric outlet obstruction. True or false?

True

symptoms of esophageal cancer

USUALLY LATE *-Progressive dysphagia* -Painful swallowing -*Sense lump in throat/Sore throat/hoarseness* - *UNEXPLAINED WEIGHT LOSS* -anorexia -*Regurgitation of blood tinged esophageal contents w/ halitosis and hiccups* -fatigue *The patient first becomes aware of intermittent and increasing difficulty in swallowing. As the tumor grows and the obstruction becomes nearly complete, even liquids cannot pass into the stomach.

What type of weight loss occurs with Esophageal cancer?

Unexplained

A client with GERD develops esophagitis. Which diagnostic test would the nurse expect the physician to order to confirm the diagnosis? Barium swallow Upper endoscopy with biopsy Stool testing for occult blood 24-hour esophageal pH monitoring

Upper endoscopy with biopsy

IBS occurs more in younger _

Women

The most common type of diverticulum is _

Zenker diverticulum.

Neutralize acids in the stomach. EX Calcium carbonate (Tums) Aluminum hydroxide, magnesium, hydroxide, and simethicone (Maalox). Usually is a mixture of aluminum and magnesium -Aluminum causes constipation -Magnesium causes diarrhea ( C.I renal disease pts) GIVE 1-3 HRS AFTER MEALS & @ BEDTIME

antacids

Does the loss of intrinsic factor which leads to *B12 deficiency* and *anemia* occur with acute or chronic gastritis?

chronic

The two types of esophageal spasms are _

diffuse esophageal spasm, hypertensive peristalsis ( nutcracker esophagus; NE)

Gold standard for diagnosing most upper GI

esophagogastroduodenoscopy (EGD)

inflammation of the stomach

gastritis

The prognosis for gastric cancer is _ because the diagnosis has been made late since most patients are asymptomatic. The cancer is usually discovered after is has spread to lymph nodes and other distant organs

poor

Which term refers to the symptom of gastroesophageal reflux disease (GERD), which is characterized by a burning sensation in the esophagus? Pyrosis Dyspepsia Dysphagia Odynophagia

pyrosis

heartburn term

pyrosis

In this type of hiatal hernia the stomach and the lower part of your esophagus are displaced upward into your chest through the diaphragm

sliding