QUIZ 3 GONGFLIX SCRIPT 

ESOPHAGEAL CANCER
the stomach causing build up in the
esophagus.
- Bc of this buildup, it causes widening
ESOPHAGUS
of the area + there will be irritation
- Part of the alimentary canal of the
and injury in the tissues.
digestive system.
- It connects the oral cavity and the
/difference bt chronic gastric reflux &
stomach.
achalasia: GCR has incompetent or weak
- A long hollow muscular tube that
lower esophageal sphincter, ACH has
allows movement of bolus of food
very stiff lower esophageal sphincter/
from the oral cavity that is
transported into the stomach.
CLINICAL MANIFESTATION
ESOPHAGEAL CANCER
/if the tumor has formed anywhere in the
- It occurs bc it is associated with
esophagus, most likely the patient will
frequent irritation of the tissues that
have a problem with digestion process,
lined the esophagus.
with absorption, or related to swallowing
- One of the GI cancers.
and absorption of nutrients/
Dysphagia
RISK FACTORS
- Common manifestation because of a
Cigarette smoking/ smoked opiates.
presence of tumor that blocks the
Chronic alcohol use.
entry of food.
Ingested nitrates.
Cough
- These cause irritation in the
- Patient may experience cough in an
esophagus.
attempt to clear out something that
is blocking the passageway.
/bc of frequent irritation on the area,
Weight loss
regrowth of tissues will be the best time
- Commonly associated with
for mutation to occur/
dysphagia (difficulty in swallowing)
causing alteration with nutrition,
Radiation.
irregularity in meal intake, also
- It is capable of causing DNA
affecting the quantity and quality of
structural changes.
food being taken.
Chronic gastric reflux.
Anorexia
- In this condition, there is an
- It is a direct risk factor for weight
incompetent lower esophageal
loss because the patient may have
sphincter that allows gastric juices
loss of appetite owing to dysphagia.
from the stomach to go back in the
Anemia
esophagus causing now irritation bc
- Because of decreased dietary intake
of the acids.
of minerals associated with RBC
Achalasia.
production.
- It is characterized by a ​very stiff
- Poor oral intake of iron, folic acid,
lower esophageal sphincter that
and vitamin B12 may cause the
bolus of food is not able to go inside
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patient to develop ID anemia, FAD - To specifically determine the
anemia and pernicious anemia. presence of tumor in an area.
GERD-like symptoms - Makes use of barium which is white
- Because of structural change that in color and it attracts x-rays/
occurs in the esophagus. fluoroscopy
- Also evaluate if there are structural
COMPLICATIONS: abnormalities that can be
/the tumor cells are capable of invading life-threatening.
nearby tissues/ - /because the presence of large
tumor in the esophagus can
/since there is a close proximity between compress the respiratory
the esophagus and the trachea, the passage/
invasion of tumor cells is possible/ - Barium causes constipation so the
patient must be instructed to
/the invasion can cause a maintain a ​high fiber and high fluid
communication between the two when in intake​ after the procedure.
fact there should be none/ this is called - The stool is expected to be white or
Tracheoesophageal Fistula. gray in color.

/some food particles can actually move Esophagoscopy

from the esophagus going to the trachea - CONFIRMATORY TEST
when normally in the trachea we are only - Form of endoscopy, inserted by way
expecting air to pass/ ​there will be now of the mouth gaining access into the
problem related to ​aspiration​. esophagus.
- Sample will be collected to be sent
ASPIRATION PRECAUTION IS ALWAYS for biopsy.
OUR PRIORITY INTERVENTION. - /patient is kept on NPO 6-8 hours
prior to procedure and also
/patients are kept in NPO status if there immediately after the procedure/
is Tracheoesophageal Fistula/ - /if gag reflex has return, the
patient can resume feeding/
PRIORITY NURSING DIAGNOSIS IS RISK - PRIORITY NURSING DIAGNOSIS
FOR ASPIRATION. IMMEDIATELY AFTER
ENDOSCOPY IS RISK FOR
Patients with esophageal cancer also tend ASPIRATION
to have ​Paraneoplastic syndrome which is
characterized by ​hyperparathyroidism.
MANAGEMENT
Surgery:ESOPHAGECTOMY
DIAGNOSTIC TEST - To remove portion of the esophagus
CT, MRI, UTZ with continued anastomosis.
- To outline the degree or evaluate the - Removal depends on the location of
size or extent of the tumor. the tumor.
Barium Swallow Radiation and Chemotherapy
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- Nursing responsibilities are in lined insertion. If there is infection, it is
with medications’ side and adverse recommended for a surgeon to fix a
effects new one. Signs of infection are
Optimal nutrition elevation in CRP, ESR, the culture
- Enteral feeding by NGT or would indicate elevated WBC, the
Nasogastric tube or Gastrostomy patient is tachypneic and having
tube or Parenteral nutrition. fever.
- NGT must be in proper placement. - Monitoring for signs of
Ways to verify are: (1) ​auscultate hyperglycemia would be elevation of
the epigastric region and blood glucose level and frequent
swooshing sounds should be urination.
heard as 15-25ml of air is introduce; - Deep breathing, coughing exercise,
(2) ​aspiration of gastric content is incentive spirometry would be
more reliable, the secretion that will indicated because of a problem with
be coming out after aspiration will post-op complication. In
reveal acidity that is usually yellow to esophagectomy, there is an incision
green in color; (3) ​X-ray is the most in the neck area and patient may
reliable. ​/least reliable is have difficulty breathing. ​Deep
auscultation/ breathing, coughing exercise,
- PRIORITY NSG DX IS RISK FOR incentive spirometry may not only
ASPIRATION. P ​ atient should be improve breathing but also
placed in a Semi-fowler's position normalize O2 saturation.
during feeding. - If NGT will be inserted immediately
- With ​Gastrostomy tube, it is more in the post-op period, NGT
conventional and more preferred manipulation is contraindicated
tube feeding. Risk for aspiration is because it can cause damage in the
lesser. No need to verify the suture line.
placement because the tube is
directly inserted in the stomach
region.

HEPATOCELLULAR CARCINOMA 
- Parenteral nutrition is in lined with
administration of nutrients that the
patient will be needing by way of IV
- Malignant cancer involving the liver
route. ​Total parenteral nutrition will
require the patient to receive
LIVER
nutrients by way of a ​central line in
- Largest internal organ
the form of ​jugular catheter or
- Plays several functions
subclavian ​lines. The only problem
- Located at the right upper quadrant
is that these solutions contain ​high
of the abdomen
amounts of glucose so
- It is mainly responsible in bile
hyperglycemia is possible. Since
production ​/main metabolic
glucose is a good medium for
function of the liver is to produce
bacterial growth, WOF signs of
bile/
infection. Check the central line
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BILE
- Functions to ​emulsify fats
- Fat emulsification is the breakdown
of large fat molecules into smaller
ones so that digestive enzymes are
able to act on them, enhancing
absorption.
​ atient
/If there won’t be fat absorption, p
may be in a state of malnutrition/
Fat soluble vitamins are only absorbed
when fats are observed ​(A, D, E, K).
VITAMIN K
- Necessary for body’s coagulation
ability
- X liver bile production → X fat
emulsification → X fat absorption
→ X absorption of vitamin A, D, E,
K If there is liver failure caused by
- Patient with liver cancer tend to have
bleeding tendencies due to
vitamin K deficiency
LIVER (cont.)
- Liver conjugates bilirubin ​/it can
convert bilirubin in its excretable
form by way of kidneys and by
way of stool/
BILIRUBIN
- Is a waste product of RBC
breakdown
- After 120 days, RBC will have to die
- Hemoglobin will be separated →
heme​ and ​globin
- Globin is an amino acid or protein
that can be used by the body again
- Heme will be broken down into ​iron
and ​protoporphyrin
- Iron is a mineral that can be reused
by the body
 
- In Protoporphyrin, after several
phases of conversion it will lead to
bilirubin
- Bilirubin is normally ​yellow or
orange​ in color.
- As soon as bilirubin is captured from
RBC breakdown, ​BILIRUBIN IS
UNCONJUGATED meaning it
cannot be excreted by the
kidneys.
- This ​unconjugated bilirubin is
travelling freely in the blood and will
go directly to the live​r because
liver is able to promote conjugation
of ​unconjugated bilirubin →
conjugated bilirubin = bilirubin can
now be excreted by the kidneys and
stool. ​/reason why urine and stool
are yellow in color/
hepatocellular carcinoma, the liver won’t be
able to conjugate unconjugated bilirubin to
its excretable form → b ​ ilirubin will
accumulate in the blood → ​ ​causing
hyperbilirubinemia
Yellow portion of this substance is now
evident in the mucous membrane. ​It is very
common for patients with hepatic disorder to
manifest ​jaundice.
Jaundice is characterized by yellowish
discoloration of the skin.
LIVER (cont.)
- Amination
AMMONIA
- Is a byproduct of protein digestion
that must be converted to ​urea.
- Urea can be excreted by the urine
however, ammonia cannot.
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- Ammonia should go to the liver for
conversion of ammonia to urea ​→
excreted by kidneys
If patient has hepatocellular carcinoma
resulted in liver failure, ammonia cannot be
converted to its excretable form (urea) →
ammonia will accumulate in the blood → ​ portion of it cannot be easily
can depress and alter cerebral function
Hepatic encephalopathy as a liver.
complication.
​ NS irritant
Ammonia is considered to be C
so patient may develop n ​ eurologic
disturbances and alteration in level of
consciousness → lead to coma ​= caused
by ↑ ammonia in the blood
LIVER (cont.)
- Production of albumin
ALBUMIN
- A protein produced by the liver
- If patient develops liver failure due to
hepatocellular carcinoma, the liver
won’t be able to produce adequate
albumin.
- Albumin is a major protein
responsible for ​colloid oncotic
pressure.
- Hypoalbuminemia = ↓ colloid
oncotic pressure
- ↓ colloid oncotic pressure = ​the
fluid from the interstitial space may
not be pulled back from the
interstitial space going to the
intravascular space = there will be
accumulation of interstitial space
fluid ​→ causing edema or third
spacing or causing ascites as
commonly associated with liver
failure.
 
Cirrhosis, hepatitis are some of the
conditions that also lead to liver
malfunctioning.
HEPATOCELLULAR CARCINOMA
- It is usually ​non-resectable due to
rapid growth and metastasis ​→ a
removed because of severity of
infiltration of the tumor cells in the
- Metastatic liver cancer is ​more
common than primary site-liver
cancer.
If the tumor has originated in the breast
tissue, pt may develop breast cancer and if
there are no other cancer cells around the
body → the pt’s development of cancer is in
​ rimary site.
the p
If the breast cancer spread and go into the
lungs causing now lung metastasis
Hepatocellular carcinoma is a challenge to
manage because metastatic liver cancer is
more common. If there is metastasis,
prognosis is poorer compared to
primary-site liver ca.
- Portal and lymphatic circulation,
direct extension of abdominal
cancers ​→ serves as mechanisms
for transfer of cancer cells from one
site to the other
RISK FACTORS
1. ALCOHOL INTAKE
- Acetaldehyde is the main substance
in alcohol and capable of irritating
the liver tissues causing repeated
bouts of inflammatory processes.
​SMOKING
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- Containing several carcinogenic
substances that can travel into the
bloodstream and go directly into the
liver.