Exam 2: Chapter 46 - Gastritis and Peptic Ulcers Flashcards
What is Gastritis
Inflammation of the gastric or stomach mucosa
Acute Gastritis may be classified as
erosive or nonerosive
Erosive form of acute gastritis is most often caused by
local irritants sucha s aspirin and other nonsteroidal anti-inflammatory drugs, alcohol consumption, and gastric radiation therapy
Nonerosive Form of Acute Gastritis is most often caused by
an infection with H. Pylori.
Acute gastritis may also develop in acute illnesses, espeically when patient has had
traumatic injuries burns severe infection hepatic, kidney, or respiratory failure major surgery This is known as stress-related gastritis
Chronic H. Pylori gastritis is implicated in the development of
peptic ulcers, gastric adenocarcinoma (cancer), and gastric mucosa-associated lymphoid tissue lymphoma. Also associated with Hashimoto Thyroiditis, Addison Disease, and Graves Disease
Gastritis is characterized by a
disruption of the mucosal barrier that normally protects the stomach tissue from digestive juices (HCl and Pepsin)
Impaired mucosal barrier allows
corrosive HCl, Pepsin, and other irritating agents to co me in contant with the gastric mucosa, resulting in inflammation
In acutue gastritis, the inflammation causes the gastric mucosa to become
Edematous and hyperemic (congested with fluid and blood) and to undergo superficial erosion.
Patient with acute gastritis may have a rapid onset of symptoms, such as
epigastric pain or discomfort indigestion anorexia hiccups nausea/vomitting
Erosive gastritis may cause
bleeding, which may manifest as blood in vomit or melena (black, tarry stools) or hematochezia (bright, red, bloody stools)
Patient with chronic gastritis may complain of
fatigue, pyrosis (burning senstion in the stomach and esophagus that moves up to the mouth; heartburn), belching, sour taste, early satiety, anorexia, nausea/vomiting
Patients with chronic gastritis may not be able to absorb
vitamin B12, because of diminished production of intrinsic factor by the stomachs parietal cells due to atrophy, which may lead to pernicious anemia.
Definitive diagnosis of gastritis is determined by a
endoscopy and histologic examination obtained by biopsy. CBC may be drawn for anemia as a result of hemorrhage or pernicious anemia. H-Pylori test as well.
When too many NSAIDS consumed, what happens to the mucosal layer?
It is no longer produced and allows HCl and Pepsin to eat away at it and break it down
What has the ability to eat through the stomach?
HCl acid
Recovery time from acute gastritis?
Gastric mucosa is capable of repairing itself after 1 day.
Acute Medical Management of Gastritis
Refrain from alcohol and food until symptoms subside If due to strong acid, treatment to neutralize the agent
Supporitive therapy includes NG intubation, antacids and IV Fluids
Gastritis: Perforation
Can be severe whre it can cause a hole through the stomach.
How is Perforation treated?
EGD performed. Will look inside the stomach adn see what they can remove. Can remove part of stomach, removing amount of HCl secreted
What happens if patient has Peritonitis
Surgery. HCl Acid is causing damag to organs and causing inflammation. Stomach can become rigid and board like
Chronic gastritis is managed by modifying the
patients diet, promoting rest, reducing stress, recommending voidance of alcohol and NSAIDs, and initating medications that include antacids, H2 Blockers and PPI
Why are antibiotics given for Gastritis?
To assist with eradicating H. Pylori
Why are H2 Receptor Antagonists given for Gastritis?
Decreases amount of HCl produced by stomach by blocking action of histamine on histamine receptors of parietel cells in the stomach
Why are Proton Pump Inhibitors given for Gastritis?
DEcreases gastric secreation by slowing ATPase pump
Gastritis Nursing Management: Reducing Anxiety
Uses a calm approach to assess the patient and to answer all questions as completely as possible
Gastritis Nursing Management: Promoting Optimal Nutrition
For acute, the patient should take no food or fluids by mouth, possibly for a few days.
If IV Therapy necessary, nurse monitors I/O along with electrolyte values
Caffeinated beverages discouraged because its a nervous system stimulant that increases gastric activity and pepsin secretion
Introduce clear fluids and solid foods as prescribed.
Gastritis Nursing Management: Promiting Fluid Balance
Minimal fluid intake of 1.5 L.
If NPO, IV Fluids must be 3 L / day.
Monitor I/O, Electrolyte Imbalance, and Hemorrhage
Gastritis Nursing Management: Relieving Pain
Instruct to avoid foods and beverages that may irritate the gastric mucosa as well as correct use of medications to relieve chronic gastritis
What is a peptic ulcer?
A excavation (hollowed-out area) that forms in the mucosa of the stomach, in the pylorus, in the duodenum, or in the esophagus
Peptic ulcers are more likely to occur in which location
the duodenum that in the stomach.
Chronic gastric ulcers tend to occur in
the lesser curvature of the stomach, near the pylorus
Esophagela ulcers occur as a result of
backward flow of HCl from the stomach into the esophagus
Older adults are more prone to peptic ulcers due
to higher rates of NSAID use and H. Pylori Infections
Most peptic ulcers result from
infection with gram-negative bacteria H. Pylori, which is acquired thorough ingestion of food and water
People with what blood type are more prone to peptic ulcers?
O
Deep peptic ulcer can also be called a
tissue injury, which kicks in a immune response
A complication with peptic ulcers will be
Peritonitis
Risk factors of peptic ulcers include
excessive secretion of stomch acid, dietary factors, chronic use of NSAIDs, alcohol , smoking, and familial tendency
The use of NSAIDs inhibits
prostaglandin ynthesis, which is associated wiht a disruption of the normally protective mucosal barrier
ZES is suspected when
a patient has several peptic ulcers or an ulcer that is resistant to standard medical therapy
Stress ulcer is the term given to
the acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events such as burns, shock, sepsis, and multiple organ dysfunction syndrome
Stress ulcers most common in those who are
ventilator dependent after trauma or surgery
Types of ulcers from stressful conditions?
Curling Ulcers
Cushing Ulcers
Curling ulcer frequency observed about
72 hours after extensive burn injuries and often involvess the antrum of the stomach or the duodenum
Cushing ulcer common in patients with
traumatic head injury, stroke, brain tumor, or follow intracranial surgery
Thought to be caused by increased intracranial pressure, which results in overstimulation of vagal nerve and increased secretion of HCl
Patient with an ulcer complains of
dull, gnawing pain or a burning sensation in the midepigastrium or the back
Gastric Ulcers pain
Pain occurs immediately after eating.
Duodenal Ulcer Pain
Duodenal ulcers most commonly occur 2-3 hours after a meal
What ulcer may wake you up at night?
Duodenal
What type of ulcer will cause you to express relief of pain after eating
patients with duodenal ulcers
Duodenal Ulcer information
Most Common. Include weight gain and food may decrease pain beause you may coat the ulceer
Peptic Ulcer Manifestations include
a dull gnawing pin or burning in the midepigastrium; heartburn and vomiting may occur
Peptic Ulcer Diagnostic Findings
Endoscopy that may reveal lesions.
Serologic Testing for Antibodies aagainst the H. Pylori Antigen
Stool Antigen Test
Urea Breath Test
Peptic Ulcer treatments
Medications, Lifestyle changes and occasionally surgery
Most common used therapy for peptic ulcers is a
combination of antibiotics, PPI, and sometimes bismuth salts.
Typically prescribed for 10-14 days and may include triple therapy with two antibiotics or quadruple therapy with two antibiotics plus a PPI and Bismuth Salts
H2 Blocks and PPI inhibitors that reduce gastric acid secretion are used to
treat ulcers not associated with H. Pylori Infection
Pt is advised to avoid using
Aspirin and other NSAIDs
Peptic Ulcers: smoking Cessation
Decreases secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum and delayed healing of peptic ulcers
Peptic Ulcers: Dietary Modification
Avoid oversecretion of acid and hypermotility in the GI tract. Avoid extremes of temperture in food and beverages and the overstimulation from consumption of alcohol, coffee, and other caffeinated beverages
Peptic Ulcers: Surgery recommended for those with
intractable ulcers that have not healed after 12-16 weeks,
life-threatening hemorrhage
perforation, or obstruction
And for those with ZES that is unresponsive to medications
Surgical procedures include vagotomy, w/ or w/o pyloroplasty, and Antrectomy
What is a Vagotomy?
Severing of the vagus nerve.
Decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin. May be performed via an open surgical approach or laparoscopy.
What is a Truncal Vagotomy
Severs the right and left vaus nerves at they enter the stomach
Most commonly used to decrease acid secretions
What is Selective Vagotomy
Severs vagal innervation to the stomach but maintains innervations to the rest of the abdominal organs
What is Pyloroplasty
Longitudinal incision is made into the pylorus and transversely sutured closed to enarge the outlet and relax the muscle.
May be performed with Truncal and Selective Vagotomies
What is a Billroth I (Gastroduodenostomy)
Removal of the lower portion of the antrum of the stomach (which contains the cells that secrete gastrin) as well as a small portion of the duodenum and pylorus.
REmaining segment is anastomosed to the duodenum. May be performed with Truncal Vagotomy
What is a BillRoth II (Gastrojejunostomy)
Removal of lower portion (antrum) of stomach with anastomosis to jejunum.
Duodenal stump remains and is oversewn
What is Transcatheter Arterial Embolization (TAE)
An interventional radiologic procedure in which a catheter is placed percutaneously into an artery and is advanced under use of fluroscopy to teh site of the bleeding peptic ulcer
Embolic agent is then delivered via the catheter, which selectively occludes blood flow to the bleeding vessels and thus stops bleeding of the peptic ulcer
Peptic Ulcer: What is Perforation
The erosion of the ulcer thorugh the gastric serosa into teh peritoneal cavity without warning.
Peptic Ulcer: What is Penetration
The erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or omentum.
How does Gastric Outlet Obsturction Occcur?
When the area distal to the pyloric sphincter becomes scarred and stenosed from spasm or edema or from scar tissue that forms when an ulcer alternately heals and breaks down
Peptic Ulcer: Blood Pressre and HEart rate during Hemorrhage?
Increased heart rate and decreased blood pressure
Peptic Ulcer: Hemorrhage, what should you do with oxygen?
SHould administer oxygen . They are rapidly breathing because theyre trying to get oxygen throughout their body
