Disturbance in Digestion Flashcards
Gastritis
inflammation of the gastric/stomach mucosa
- older adults
Gastritis
Acute Gastritis
- several hours - few days
- → gangrenous/perforate mucosa → scarring → obstruction/pyloric stenosis
- more severe form form is caused by ingestion of strong acid/alkali
- → severe illness
Acute Gastritis (Gastritis)
Erosive
caused by:
* local irritants (aspirin, NSAIDs)
* gastric radiation therapy
Acute Gastritis (Gastritis)
Nonerosive
caused by H. pylori infection
Gastritis
Chronic Gastritis
- repeated exposure
- most often from H. pylori infection
- in devt. of PU, gastric cancer, gastric mucosa-associated lymphoid tissue lymphoma
- caused by gastropathy
- w/ Hashimoto thyroiditis, Addison d., Grave’s d.
Gastritis
Pathophysiology
mucosal barrier → disrupted/damaged → irritants (gastric juices) → inflammation
Gastritis
Clinical Manifestations
Acute Gastritis
- Epigastric pain/discomfort
- Dyspepsia
- Anorexia
- Hiccups
- Nausea
- Vomitting
Gastritis
Clinical Manifestations
Erosive Gastritis
- hematemesis
- melena
- hematochezia
Gastritis
Clincal Manifestation
Chronic Gastritis
- fatigue
- pyrosis/heartburn
- anorexia
- nausea
- vomitting
- mild epigastric discomfort
- intolerance to spicy/fatty foods
- slight pain relieved by eating
- not absorb Vit. B12 → pernicious anemia
Gastritis
Systemic Manifestations
- signs of shock
- fatigue
- anemia
Gastritis
Assessment & Diagnostic Findings
- endoscopy
- hisotlogic examination
- CBC
Gastritis
Medical Management
- recovery = 1 day
- appetite diminished to 2/3 days
- non-irritating diet
- NGT
- antacids
- H2 receptor antagonists
- PPIs
- fiberoptic endoscopy
- emergency surgery
- gastrojejunostomy (for gastric outlet obstruction/pyloric obstruction)
- diet modification
- rest
- reduce stress
- X alcohol, gastric irritant meds
- PPIs, antibiotics, bismuth salts
Gastritis
Nursing Management
- reduce anxiety, stress
- X induce vomitting
- NPO
- ice chips → clear liquids
- X caffeine (CNS stimulant → ↑ gastric activity & pepsin secretion
- X nicotine (< pacreatic bicarbonate → neutralizes gastric acid)
- Fluid intake = 1.5 L/day
- UO = 0.5 mL/kg/h
- IVF = 3 L/day
- Fluid intake + caloric value = 1L = 170 calories of CHO
- NaClK q 24 hours
Peptic Ulcers
ulcers/breaks on the mucosal lining
PUD
Gastric Ulcer
- > 50 yo
- both sexes
- 15% - 20%
- stomach antrum
- 30 mins - 1 hr pc
- churning
- vomitting = weight loss
PUD
Duodenal Ulcer
- 30-60 yo
- male
- 80%
- pylorus
- 2-3 hrs pc
- gnawing
- eating = weight gain
PUD
Risk Factors
- H. pylori
- Smoking
- Pancreatic tumor (Zollinger-Ellison syndrome)
- Type O
- Family hx
- Drugs (steroids, aspirin, NSAIDs)
PUD
Nursing Assessment
- characteristic: burning, aching, gnawing pain
- location: epigastrium
- test for H. pylori
PUD
Nursing Interventions
- Perforation
- Pain
- Pyloric Obstruction (vomitting, fullness)
- Peritonitis (board-like abdomen/rigid abdomen)
- Hemorrhage
PUD
Therapeutic Management
- aggravants: soda, coffee, tea, chocolate, spicy, ↑ Na and spices
- X smoking
PUD
Drugs
- Antacid (neutralizes acid; ac/pc)
- H2 receptor antagonist (-tidine; block histamine-stimulated gastric secretion)
- Proton pump inhibitor (-ozole; suppress HCl production; ac)
- Prostaglandin analogue (misoprostol/cytotec; ac)
- Mucosal barrier fortifier (sucralfate; ac)
PUD
Diet
↑ CHO
↓ CHON
PUD
Treatment
- Vagotomy (cut CN 10 = X nerve stimulation in stomach)
- Billroth I
- Billroth II
PUD (Treatment)
Billroth I
creation of anastomosis bet. duodenum and gastric remnants
gastroduodenostomy
feeling of fullness and dumping syndrome
PUD (Treatment)
Billroth II
sewing a loop of jejunum to the gastric remnant
gastrojejunostomy
dumping syndrome, anemia, wieght loss
Gastric Cancer
- 69 yo adults
- men
- hispanic american, african american, asian
- sporadic
- prognosis = poor (5 years)
- adenocarcinoma
- 40% lower, 40% middle, 15% upper, 10% more than 1 part
- common site of mestasis = liver, peritoneum, lungs, brain
Gastric Cancer
Risk Factor
- diet = ↑ smoked, salted, pickled
- diet = ↓ fruits, vegetables
- h. pylori infection (major)
- chronic inflammation
- pernicious anemia
- smoking
- obesity
- achlorhydria
- gastric ulcer
- previous gastrectomy
- genetics (type A, first degree relative)
Gastric Cancer
Clinical Manifestations
Early Stage
- pain relived by antacids
Gastric Cancer
Clinical Manifestations
Advanced Disease
- Dyspepsia
- Early satiety
- Weight loss
- Abdominal pain (above umbilicus)
- decrease in appetite
- bloating pc
- nausea and vomitting
- fatigue
Gastric Cancer
Assessment
- palapble as mass
- ascites
- hepatomegaly
- palpabe nodules around umbilicus (Sister Mary Joseph’s Nodules)
Gastric Cancer
Diagnostic Findings
- Esophagogastroduodenoscopy
- Barium X-ray of UGIT
- CT scan
- Endoscopic UTZ
Gastric Cancer
Medical Management
- Chemotherapy
- Targeted therapy
- Radiation therapy
Gastric Cancer
Surgical Management
- total gastrectomy (stomach + duodenum ++ LE + mesentery + lymph nodes)
- esophagojejunostomy (jejunum + esophagus)
- radical partial (subtotal) gastrectomy (middle and distal)
- Billroth I or II
- proximal partial (subtotal) gastrectomy (proximal)
Gastric Cancer
Complications of Gastric Surgery
- Hemorrhage
- Dumping Syndrome
- Bile reflux
- Gastric Outlet Obstruction
Gastric Cancer (Complications from Gastric Surgery)
Dumping Syndrome
- rapid passage of food → not enough time for digestion and absorption → intestinal dilation, ↑ inestinal transit, hyperglycemia, rapid onset of GI & vasomotor symptoms
- 25% - 50%
hyperglycemia = ↑ insulin = hypoglycemia 2-3 hours pc
Dumping Syndrome (Complications from Gastric Cancer Surgery)
Early Symptoms
- early satiety
- cramping abdominal pain
- nausea
- vomitting
- diarrhea
occur within 10-30 minutes pc
resolved within 1 hour or with bowel evacuation
Dumping Syndrome (Complications from Gastric Cancer Surgery)
Vasomotor Symptoms
- headache
- flushing/feelings of warmth
- diaphoresis
- dizziness
- palpations
- drwosiness
- syncope
Gastric Cancer (Complications from Gastric Surgery)
Bile reflux
- manipulation or removal of the pylorus
- = irritation and damage to the gastric mucosa → gastritis, esophagitis, PU
- burning epigastric pain
Bile Reflux (Complications from Gastric Cancer Surgery)
Pharmacologic Management
- Sucralfate/cholestyramine
- Cholestyramine = prevent reabsorption; eliminatin of bile acids in stools
Gastric Cancer (Complications from Gastric Surgery)
Gastric Outlet Obstruction
from stenosis or stricture
fullness, vomitting
Gastric Cancer
Chemotherapy
chemotherapeutic agents
- fluorouracil
- carboplatin
- capecitabine
- cisplatin
- docetaxel
- epirubicin
- irinotecanoxaliplatin
- paclitaxel
Gastric Cancer (chemotherapy)
Trastuzumab
with fluorouracil or capecitabine and cisplatin = improvement in surival with advanced GC who are HER-2 positive
Gastric Cancer
Radiation Therapy
- before: decrease the size
- after: destroy remaining cancer cells
- 3-dimensional conformal radiation therapy
Gastric Cancer
Nursing Assessment
nutritional intake and status
Gastric Cancer
Nursing Intervention
- Reducing Anxiety
- Promoting Optimal Nutrition
- Relieving Pain
- Providing Psychosocial Support
Gastric Cancer (Nursing Intervention)
Promoting Optimal Nutrition
- small frequent feedings of non-irritating food
- ↑ calories, Vit A and C
- ↓ CHO
- fluid between meals
- Vit B12 injection
Gastric Cancer (Nursing Intervention)
Relieiving Pain
- opioid/PCA
- position changes
- imagery
- distraction
- rest and relaxation
- backrubs
- massage
