1) Bariatric Surgeries:

i) Restrictive: Make stomach smaller, Adjustable Gastric Banding (AGB)

ii) Combination: Roux-en Y Gastric Bypass Surgery

2) Feeding tubes:
a) Salem Sump Tube:
(1) wider lumen
(2) more rigid tube
(3) decompress & drainage of gastric contents

b) Dobhoff Tubes (DHT)

i) smaller tube
ii) soft & flexible
iii) easily clogged if not flushed properly
iv) for tube feeding and medication administration

3) Radiology (X-rays)

a) Upper GI or Barium Swallow

i) Structural abnormalities (e.g. hiatal hernia)
ii) NPO 8-12 hr.
iii) Fluids, laxatives, s/s impaction
iv) White stools x 72 hr

b) Lower GI or Barium Enema

i) Structural examination of the colon
ii) Bowel prep
iii) NPO 8 hr.
iv) Fluids, laxatives, suppositories

4) Ultrasound
a) Detect masses
b) NPO 8-12 hr.

5) CT Scan
a) Abnormalities in organs in abdomen and pelvis
b) Allergies

6) MRI
a) Stage cancer, find sources of bleeding

7) Esophagogastroduodenoscopy (EGD)
a) Mucosal lining of esophagus, stomach, duodenum
b) Detect and treat upper GI bleed
c) NPO 8 hr.
d) Vital signs, temperature *fever = perforation

8) Endoscopic retrograde cholangiopancreatography (ERCP)

a) Remove gallstones
b) Pancreatitis

9) Liver Biopsy
a) Coagulation values
 b) Type and cross
c) Bed flat x 12 hours
d) Peritonitis, shock, pneumothorax

10) Nausea and Vomiting

a) Assess:
i) Emesis: amount, color, consistency
ii) Episodes, frequency, timing, triggers
b) X- Ray for obstruction is done first
c) Keep NPO until aware of underlying cause
d) 5-15 mL of water, flat soda, warm tea q. 15-20 min. when ready

11) Gingivitis
a) Poor oral hygiene
b) Bleeding gums

12) Oral Candidiasis

a) Antibiotics, corticosteroids
b) Milk curd like lesions
c) Antifungal treatment

13) Herpes Simplex

a) Shallow painful ulcers
b) Antiviral, IV medication treatment

14) Parotitis
a) Inflammation of parotid gland
b) Staph or strep
c) Suck on hard candy

15) Stomatitits
a) Inflammation of the mouth
b) Halitosis and excess salivation
c) Pain meds, oral care, anti-inflammatory, numb area

16) Oral Cancer

a) Squamous cell carcinoma
b) Reoccurring, painless ulcers
c) Leukoplakia or erythroplakia
d) Surgery / combination therapy
e) Nursing:
i) maintain airway & prevent aspiration*
ii) adequate way to communicate
iii) G-tube for nutrition

17) Gastroesophageal Reflux Disease

a) Most common upper GI problem
 b) Obesity, hernia, smoking
c) Heartburn and reflux
d) Perforation, Barretts Esophagus, Aspiration pneumonia
e) HOB: 30 degrees, avoid laying after meals, small meals, liquid between meals

18) Hiatal Hernia

a) Increased abdominal pressure
b) Sliding: no symptoms, Rolling: serious, surgery immediately
c) Severe pain with bending over
d) GERD (d/t increased pressure), ulceration, hemorrhage, strictures
e) Avoid straining, tight clothes, lifting, lose weight
f) Anti-reflux surgery

19) Esophageal Cancer

a) Hemorrhage (d/t waring away blood vessels), Esophageal perforation, obstruction,
metastatic
b) Barrium Swallow: determine exact area
c) Surgery
d) Aspiration risk, J-tube, continuous tube feeds, IV hydration, Pain care

20) Gastritis
a) NSAIDS, corticosteroids, iron, antibiotics
b) Coffee-ground emesis = lower esophagus
c) Anemia d/t loss of intrinsic factor (B12 shots)
d) NPO if N/V, NGT, IV fluids
e) Monitor v/s and s/s of hemorrhage
f) 6 small meals

21) Peptic Ulcer Disease

a) Duodenal most common
b) Acute injury (trauma, NPO, burns)

c) Gastric ulcers:
i) High epigastric pain
ii) Food aggravates pain

d) Duodenal ulcers:
i) Low epigastric pain
ii) Food relieves pain
e) Hemorrhage (most common), perforation (most lethal), gastric outlet obstruction (block
gastric outlet)
i) Make NPO immediately need surgery ASAP!
f) Billroth 1: Stomach to Duodenum
g) Billroth 2: stomach to Jejunum
h) Post op:
i) Salem Sump NG tube
ii) Check hemorrhage / clots
iii) Dumping Syndrome: avoid sugar / salt
iv) Hypoglycemia: sweating, confusion

22) Stomach Cancer

a) Dyspepsia
b) Barium Swallow, CBC, Stool, Tumor markers
 c) Surgery
d) S/S: nausea, gastritis, bleeding (emesis or stool)

23) Upper GI Bleed

a) Medical emergency
b) Bright red blood in emesis (esophagus)
c) Coffee ground emesis (intestines)
d) Mallory-Weiss Tear
e) Monitor V/S q. 15-30 minutes
f) Insert 2 large bore needles (medication/hydration & blood transfusion)
g) Stop bleeding and stabilize the patient

24) Diarrhea
a) 3 loose stools a day
b) ID the cause
c) Dehydration & infection

25) C. Diff
a) Contact precautions

26) Constipation
a) Opioids, iron, antiemetics
b) Risk for hemorrhoids, impaction, perforation
c) Obstruction series
d) Enema, Fiber

27) Acute Abdominal Pain

a) Medical emergency
b) Vital Signs First **
c) Monitor for s/s of shock/infection
d) Pain position: Upright (bowel), flat (organ), fetal (peritoneum)
e) NPO until diagnosis!
f) NG tube, fluids, IV meds

28) Appendicitis
a) Right lower quadrant, McBurneys Point
b) Vital signs and NPO immediately
c) Ruptured or perforated appendix, peritonitis, gangrene
d) Infection & blood flow *

29) Peritonitis
a) Abdominal pain & spasms
b) Muscle Rigidity and abdominal distention
c) Shock, sepsis, respiratory distress
d) Infection vs. disease
e) Return peritoneum sterile again

30) Irritable Bowel Syndrome (IBS)

a) Episodes of constipation / diarrhea relieved by bowel movement

31) Inflammatory Bowel Disease (IBD)

 a) Autoimmune
b) Steroids treatment

i) Ulcerative Colitis
(1) Food gets stuck in tongue like polyps, creates infection
(2) Muscoa and submucosa
(3) Bloody diarrhea
(4) Lower abdominal pain
(5) Toxic megacolon

ii) Crohns Disease

(1) Anywhere along GI tract
(2) Skip lesions
(3) Diarrhea, Colicky abdominal Pain
(4) Fistulas, Perforation
(5) Elemental diet

c) Intestinal Obstructions
i) Buildup above the obstruction side

ii) Small bowel = mechanical

(1) Associated with nausea/vomiting
(2) Rapid onset
(3) Diarrhea, fecal smell emesis, high pitches bowel sounds

iii) Large bowel = non-mechanical

(1) Gradual onset
(2) No bowel movement
(3) Silent

iv) NPO, Salem Sump NG tube

Colorectal Cancer
v) Right sided: asymptomatic, occult, blood, presence of mass, anemia
vi) Left sided: late symptoms, rectal bleeding, bowel obstruction
vii) Hemorrhage, perforation, fistula, obstruction

32) Diverticulosis
a) Non-inflamed diverticula
b) Asymptomatic
c) Low fiber diets
d) Increase fiber intake

33) Diverticulitis
a) Inflammation & infection of diverticula
b) Pain over infected area, increased WBC, fever
c) Perforation, abscess, fistula, bleeding