Disorders of stomach and duodenum Flashcards
Disorders (7)
N+V
Hiatus hernia
Dyspepsia
Peptic ulcer
Gastroperesis
- small stomach syndrome
- dumping syndrome
Emesis
Forceful expulsion of stomach contents
N+V:
Causes
Stomach irritation
Radio-/chemo-therapy
Disease
Drug side effect
Hiatus hernia
Abnormal bulging of portion on the stomach through diaphragm
Sliding or paraesophageal
Angle of gastro-oesophageal junction altered -> impaired reflux prevention
Hiatus hernia:
Complications
Ulcers
Strictures
Barretts oesophagus
Hiatus hernia:
Intervention
Weight loss
Avoid foods causing symptoms
Symptom relief of GORD - little + often, avoid fatty + spicy foods
Increase fibre + fluid for constipation
Hiatus hernia:
Diagnosis
Barium swallow
Endoscopy
Hiatus hernia:
Risk factors
Constipation Overweight Tight clothes Pregnancy Smoking >50yr
Dyspepsia
Indigestion
Symptoms not a disease
Dyspepsia:
Symptoms
Bloating
Early satiety on eating
Abdo pain
Dyspepsia:
Cause
GORD
Underlying disease
Poor eating habits
No cause of function dyspepsia
Dyspepsia:
Treatment
Antacids
Rule out H. Pylori infection
Lifestyle advice
Dyspepsia:
Alarm features of major pathology
Dysphagia
Constant vomiting
Unexplained weight loss
GI blood loss
Peptic ulcer
Erosion in mucosal lining
Peptic ulcer:
Treatment
Antibiotics
Healthy lifestyle + diet advice to minimise risk of recurrence
Peptic ulcer:
Complications
Bleeding
Peptic ulcer:
Causes
H. Pylori
NSAIDS
Hypersecretion of HCl
Peptic ulcer:
Factors which exacerbate
Smoking Stress Irregular meals Eating too quickly Inadequate chewing
Gastroperesis
Delayed gastric emptying w/o mechanical obstruction
Reduced peristaltic action due to
- loss gastric pacemaker cells
- vagus nerve disruption
Gastroperesis:
Main causes
Idiopathic/unknown
DM
Post surgery
Gastroperesis:
Symptoms
N+V Abdo pain Bloating Early satiety Weight loss
Gastroperesis:
Diagnosis
Gastric emptying scintigraphy
- meal labelled with isotope
- x-ray images
- if >60% meal residue after 2hr or >10% at 4hr
Gastroperesis:
Nutritional consequences
Signs of malnutrition may be missed
Anorexia or decreased oral intake
Vomiting -> electrolyte imbalance
Poor glycaemic control in DM -> vascular complications
Gastroperesis:
Treatment
Manage underlying cause, decrease symptoms and restore nutrition + hydration
Pharmacological
Gastric pacemaker
Surgery -> gastrectomy
Diet - little + often, decrease fat + fibre, modify texture?
Gastroperesis:
Nutritional support
ONS = well tolerated NJ - if vomiting + not tolerating NG Continuous > bolus Fibre free Extreme -> parenteral
Dumping syndrome (2)
Early
Late
Dumping syndrome:
Early
Rapid gastric emptying
Rapid weak pulse, sweating, faintness, hypertension
Advice - decrease simple CHO, avoid liquid with meals, little + often
Dumping syndrome:
Late
1-3hr after meal
Over production of insulin in response to rapid glucose absorption
Weak, faint, cold
Advice - same, regular starchy CHOs
Small stomach syndrome:
Symptoms
Decreased food intake
Uncomfortable during/after eating
Bloated
Early satiety
Small stomach syndrome:
Consequences
Weight loss
Nutritional deficiencies
Small stomach syndrome:
Treatment
Little + often
Increased nutrient dense meals
Fluid separate from solid foods
Small stomach syndrome:
Side effects
Diarrhoea
Malabsorption
Weight loss + undernutrition
Bile vomiting
