Gastric and Duodenal Disorders Flashcards
GASTRITIS DEFINITION AND CAUSES (6) [NACDA]
Inflammation of the stomach (gastric mucosa): acute/chronic
Causes:
Drug-related: NSAIDs (increased risk), anticoagulant therapy, corticosteroids, digitalis, alendronate (Fosamax).
Diet/environment: Alcohol use/spicy, irritating foods, caffeine, smoking, radiation
Helicobacter pylori and other infections
Diseases/Disorders: autoimmune gastritis, BURNS, Crohn’s Disease, hiatal hernia, PHYSIOLOGIC STRESS, bile reflux, renal failure, sepsis, SHOCK, hx of PUD, chronic debilitating disorders (muscle atrophy)
Female > 60 years old
MANIFESTATION OF GASTRITIS (ACUTE & CHRONIC)
(ASSESSMENT) -RECOGNIZE CUES! What matters most ?
Acute: sudden, can be severe, usually reversible (SELF-LIMITING); Ex: abdominal discomfort, headache, lassitude, N/V, hiccuping –> can be cured
Chronic: intensified symptoms as deeper layers are damaged and lead to malabsorption of VITAMIN B12 (Cobalamin)
-Lack of intrinsic factor
ex: epigastric discomfort anorexia, heartburn after eating, belching, sour taste in the mouth, NAUSEA AND VOMITING, intolerance of some foods.
GASTRITIS DIAGNOSTIC TESTING TYPES (9)
UPPER GASTROINTESTINAL (UGI) X-RAY - Barium swallow (contrast) (R/O gastric carcinoma)
ENDOSCOPY and BIOPSY [EGD w BIOPSY] Rapid urease test (R/O gastric carcinoma)
H. PYLORI TESTING
IMMUNOGLOBIN G (IgG)
UREA BREATH TEST (useful but may give false-negative results)
STOOL ANTIGEN TEST - can determine active infection (acute infection); most reliable
CBC for potential bleeding or B12 anemia r/t gastritis
FOBT- Blood test
FIT (Fecal Immunochemical Test)- more reliable- only detects human blood in the GI tract; screening test; also used for colon cancer testing
GASTRITIS INTERVENTIONS/ MANAGEMENT OF GASTRITIS (ACUTE)
TAKE ACTION- WHAT WILL I DO?
ACUTE:
Identify cause: eliminate, prevent, or avoid it; tx involes diet/behavior modification.
-Discourage caffeinated beverages, alcohol, and cigarette smoking. Refer for alcohol counseling and smoking cessation.
Supportive therapy-
–NPO, REST, IV FLUIDS –>
(if severe)an NGT may be inserted to decompress and lavage if needed on an empty stomach d/t bleeding;
If due to ingestion of strong acid or alkali, AVOID EMETICS (ZOLOFT) AND LAVAGE d/t danger of perforation and damage to the esophagus –> goal is to neutralize
-REFRAIN FROM FOOD UNTIL SYMPTOMS SUBSIDE
GASTRITIS INTERVENTIONS/ MANAGEMENT OF GASTRITIS (CHRONIC)
TAKE ACTION- WHAT WILL I DO?
Chronic tx is evaluating and eliminating cause –> prevent further damage
Modify diet, promote rest, reduce stress, avoid alcohol, smoking, and NSAIDs
H. pylori antibiotics, cobalamin supplements (V. B12)
DRUGS:
Antacids-
aluminium hydroxide.
magnesium carbonate.
magnesium trisilicate.
magnesium hydroxide.
calcium carbonate (tums)
sodium bicarbonate.
H2-receptor blockers (antagonists)-
-TIDINE ; [FAMOTODINE (PEPCID)]
INHIBIT DEVELOPMENT OF STRESS ULCERS
inhibits histamine (h2 receptor of acid-producing parietal cells but also stimulates acetylcholine and gastrin
Proton Pump Inhibitors (PPIs) - PRAZOLE;
decreases/slows down gastric acid of the parietal cells of stomach; PHD & GERD (PUD, H. Pylori, Dyspepsia)
Prostaglandin E1 Analog (protects Mucosa)
-Misoprostol (Cytotec)[give w/ food]
-Sucralfate (Carafate)[no food, give w/ water); may cause constipation
PEPTIC ULCER DISEASE [PUD]
what is it ? and associated with?
What are its risk factors? (11)
Erosion of a mucous membrane.
-Associated w/ H. Pylori infection.
Risk Factors: (same risk factors as gastritis plus family tendency)
-Gastric Ulcer (hyposecretion of stomach acid)
-Duodenal Ulcer;
hypersecretion of stomach acid
-dietary factors
-chronic use of NSAIDs
-corticosteroids
-alcohol
-smoking
-STRESS {3} (Physiological stress, Curling Ulcer [extensive burns] and Cushing Ulcer [brain injury/increase ICP)
-family tendency
MANIFESTATION OF PUD (ASSESSMENT)
dull gnawing pain or burning sensation in the mid-epigastrium or back;
heartburn and vomiting may occur (rare)
TX FOR PUD (3)
H. Pylori tx (3)
Treatment is meant to resolve ulcer
Medication for 3- 9 weeks
Lifestyle changes
May need surgery
H. Pylori Tx (10-14 days)
-H2 receptor antagonists,
-Proton pump inhibitors
-Prostaglandin E1 Analogue: Misoprostol and Sucralfate
First line →
PPI
Clarithromycin 500mg BID Amoxicillin 1000mg BID or Metronidazole 500mg BID
Second line →
PPI
Bismuth Subsalicylate 525mg QID
Tetracycline 500mg QID
Metronidazole 250 mg QID
GASTRIC ULCER
Pain high in epigastrium
* 1–2 hours after meals; NO NOC
* “Burning” or “gaseous”
➢ Food aggravates pain as ulcer has eroded through gastric mucosa
(drinking milk with neutralize stomach pain)
- Prevalent in women, older adults
- Peak incidence >50 years of age
- Gastric ulcers are more likely than
duodenal ulcers to result in
HEMORRHAGE, PERFORATION, & OBSTRUCTION. - Hematemesis + Hemorrhage > melena (dark sticky feces w/ some blood)
DUODENAL ULCER
- Midepigastric region beneath xiphoid process
- Back pain—if ulcer is located located in
posterior aspect - 2–5 hours after meals/night
- “Burning” or “cramp like”
➢Antacids alone or in combination with
an H2R blocker, as well as food, neutralize the acid to provide relief.
[CAN BE RELIEVED BY FOOD]
- Occur at any age and in anyone:
↑Between ages of 35 and 45 y/o - Account for ~80% of all peptic ulcers *
-Familial tendency [Genetics] - Melena > hematemesis
POTENTIAL COMPLICATIONS OF PEPTIC ULCERS (3)
ALL CONSIDERED EMERGENCY SITUATIONS!!
-Hemorrhage
-Pyloric Obstruction (gastric outlet obstruction): narrowing of pylorus
-Perforation–>Penetration (Infection)
Hemorrhage Assessment (4)
Assess for
-evidence of bleeding,
-hematemesis or melena
-symptoms of shock/impending shock (confusion,↑ HR, cool skin)
-anemia
blood loss → hypovolemia → shock
Bright red vomiting/ melena Confusion, ↑HR, Cool skin → shock
Hemorrhage Treatment
Treatment includes
-IV fluids,
-NG,
-saline or water lavage;
-oxygen,
treatment of potential shock including
-monitoring V/S and UO;
may require endoscopic coagulation or surgical intervention
IV fluids NGT → saline/ water lavage to clean/stop bleeding
O2
Monitor v/s and output
PYLORIC OBSTRUCTION MANIFESTATION (ASSESSMENT)
Edema, inflammation, pylorospasm, or scar tissue cause obstruction in distal stomach and duodenum
PYLORIC OBSTRUCTION S/S
Symptoms include
nausea and vomiting (projectile),
abdominal pain,
constipation,
epigastric fullness,
anorexia,
(later) weight loss
