Digestion Flashcards
Peptic Ulcer Facts
- Effects 1% of total adult population
- Rare in the 19th century
- 4 million recurrences each year
- No identifiable racial, ethnic or cultural patterns have been found
Etiology of Peptic Ulcers
*Genetic Factors:gastric and duodenal ulcers occur 2-3 times more often where there is a family history of ulcers
*Environmental- smoking, alcohol, coffee. NSAIDS
8Infection- H. pylori
Peptic Ulcer Disease:
- Effects mucosa and deeper structures of the UGI tract
- Auto digestion of GI lining
- Esophagus, stomach, duodenum or jejunum
- Refers to gastric and duodenal ulcers
- Acute (superficial erosion, mild inflammation)
- Chronic (erode into muscle)
Peptic ulcers may lead to:
- bleeding
* Perforation or other emergencies
Gastric Ulcers
- Normal lo low secretion of HCL
- > 50 years old
- Higher mortality rate
- NSAIDS, ASA, steroids
- Alcohol, chronic gastritis, reflux, smoking
- Frequently completely asymtomatic
- Pain– epigastric location near midline and may radiate around costal border to back
- Occurs 1-2 hours after meals
- May be relieved or worsened by food or antacid
Duondenal Ulcers
- Most common peptic ulcer
- 34-35 years old, men
- Associated with high HCL secretion
- May be asymptomatic
- Pain– epigastric location near midline may radiate around costal border to back
- Described as gnawing, burning, aching
- Occurs 2-4 hours after meals
- Usually relieved by food or antacids
Diagnostic Tests for PUD
*Endoscopic exam- definitive test for ulcers
*UGI not always accurate
*Biopsy specimen via endoscopy as well as gastric analysis for pH and H. Pylori
*H. Pylori tests
CBC- Anemia?
Collaborative Care: Conservative Therapy: Objectives
- Rest, diet modifications, drug therapy, stop smoking/drinking, stop NSAIDS/ASA, long term follow up
- Takes 3-9 weeks usually
- Pain stops after 3-6 days
- Drugs: GERD meds
- Diet 6 small meals, avoid irritating foods
Complications:
- Acute Exacerbation: NG, fluid and electrolyte replacement, endoscopy. 5 yr follow-up
- Perforation
- Gastric outlet obstruction
Histamine Receptor Antagonists
- Vary in potency and cost
- Inhibit HCL secretion by binding to the histamine H2 receptor
- Tagamet, Zantac, Pepcid
Antacids
- Weak base that neutralize free hydroch acid to prevent irritation and promote mucosal healing
- Rake 1-3 hours after meals and at bedtime
- Magnesium hydroxide- laxative effect
- Aluminum hydroxide- constipation
Sucralfate (Carafate)
- Coats and acts as sealant against acid irritation
- neither inhibits or neutralizes gastric acid
- 30-60 minutes before meal and at bedtime
H. Pylori drug treatment: most common
- bismuth subsalicylate (Pepto-Bismol)
- metronidazole (Flagyl)
- tetracyline
- pantoprazole (Protonix) or omeprazole (Prilosec)
- Prilosec
- Amoxicillin
- Clarithromycin
Treatment-H. Pylori eradication rate
*H2 blockers alone- no effect
*Omeprazole- no effect
*Bismuth and amoxicillin- 44% (197)
*Bismuth and metronidazole- 55% (118)
*Omeprazole and amoxicillin- 58% (433)
*Bismuth, metronidazole and amoxicillin-73% (130)
Bismuth, metronidazole and tetracycline- 94% (434)
Diet:
- Role of diet has changed over 40 yr.- milk based therapy was used but had no effect on healing just symtoms
- Amino acids and calcium in milk increase acid secretion
- No special diet
- Restrict foods that cause discomfort, small frequent meals 6X a day
Collaborative Care
Surgey:
- Vagotomy
- Billroth I
- Billroth II
- Pyloroplasty
- Total Gastrectomy
Vagotomy
reduces acid production by decreasing cholinergic stimulation of the parietal cells
Post-op Care Gastric Surgery
- Promote Pulmonary Ventilation- turn, breathe deeply, cough at least every two hours- splint or support incision during coughing
- Provide comfort
- Measure n/g drainage, monitor for blood in drainage, DO NOT irrigate or reposition n/g tube,monitor for distention
- Monitor weight
- Report signs of Dumping Syndrome (weakness, faintness, palpitation, diaphoresis, nausea, and diarrhea)
- Avoid stress
- Elevate head when lying
- Slow progression with food
Complication of Gastric Surgery
- Bleeding
- Duodenal Stump Leakage
- Dumping syndrome
- Postprandial Hypoglycemia
- Bile reflux gastritis
- Malabsorption
Duodenal Stump Leakage
- Any anastomosis sites are at risk for leakage in early post-op
- Monitor for classic peritonitis symptoms such as: severe abdominal pain, rigidity and fever
- WBC increase
- Surgical drainage and closure are necessary
Dumping Syndrome
- Vasomotor & gastrointestinal symtoms
- Pathophysiology not understood
- Theory: rapid entry of hypertonic food directly into jejunum leads to fluid being pulled into jjejunum decreasing blood volume.
- Prevention: moderate fat, moderate protein, limited carbohydrates and limit fiber. No simple sugars, no fluids with meal. Lying down on left side 20-30 minutes after eating delays emptying
Dumping Syndrome Symptoms:
- weakness
- dizziness
- diaphoresis/pallor
- feeling of dullness or discomfort
- nausea
- diarrhea
- onset of symptoms is 5-30 minutes after eating and last for 20-60 minutes
Malabsortion
- after gastric surgery, malabsorption of fat may occur from decreased pancreatic enzymes and increase upper GI motility
- steatorrhea
- diarrhea
- weight loss
- deficiencies in fat soluble vits
Vitamin B12 Deficiency
- Gastrectomy results in partial or total loss of intrinsic factor tat is secreted by parietal cells of stomach
- Needs intrinsic factor for B12 absorption in terminal ileum
- Pernicious anemia- deficiency of B12 monthly lifelong injections
