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
PYLORIC OBSTRUCTION TX (4)
NG Tube insertion to decompress stomach
IV fluids and electrolytes
Balloon dilation or Surgery may be required
PERFORATION S/S
Signs include
sudden, severe abdominal pain that may be referred to the back and shoulder,
tender board-like abdomen,
bowel sounds absent;
nausea and vomiting
- symptoms of shock or impending shock:
tachycardia,
weak pulse,
hypotension,
shallow & rapid respirations
What is PERITONITIS?
What do you do?
How do you treat?
“HOT BELLY”/ Infection –> sepsis
* Bacterial peritonitis may occur within 6–12 hours- FEVER d/t blood or rupture of an abdominal organ.
PATIENT REQUIRES IMMEDIATE SURGERY
Tx: ID CAUSE
ANTIBIOTICS
IV FLUID
DECREASE ABDOMINAL DISTENTION
ABDOMINAL ASSESSMENT
INSPECTION
AUSCULTATION
PERCUSSION
PALPATATION
SURGICAL PROCEDURES FOR PEPTIC ULCERS (4)
-Billroth I (gastroDUODENostomy) stomach and duodenum are connected
-Billroth II (gastroJEJUNostomy) stomach and jejunum are connected
-Pyloroplasty enlarges the pyloric sphincter to allow for the emptying of stomach contents
-Vagotomy → works by cutting branches of the vagus nerve to stop stimulation of the parasympathetic system → digestion is part of the parasympathetic (rest and digest) → when you reduce stimulation you reduce acid production
Nursing Interventions POST-GASTRIC SURGERY
(7 important ones)
*Accurate I&O measurements- malnutrition & weight loss
*V/S q 4hrs
*frequent Reposition q 2hrs
*IV therapy
*Pain management- Administer analgesics as prescribed so patient may perform pulmonary care, leg exercises, and ambulation activities
*Fowler’s position
*Maintain function of NG tube;
May require NPO with NGT connected to Low-pressure suction
-Observations for signs of infection
-Individualized nutritional care and support
-Provide interventions to reduce anxiety
Long-term complications for GASTRIC SURGERY
Pernicious anemia
-d/t loss of intrinsic factor leading to malabsorption of B12
Vitamin B12 is ingested through diet Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach, necessary for the absorption of
vitamin B₁₂ later in the ileum of the small intestine
When you don’t have intrinsic factor, you won’t be able to use B12 unless given through IM injection Q month
COMPLICATIONS of POST-GASTRIC SURGERY (5)
[BabyDaddyGaMeS][BDGMS]
[FIRST 2 SIMILAR TO COMPLICATIONS POST BARIATRIC]
-Bile reflux gastritis
-Dumping syndrome aka rapid gastric emptying
-Gastric retention
-Malabsorption of Vitamins and minerals
-Steatorrhea
S/S of Dumping syndrome in GI
aka
Rapid Gastric Emptying
GI symptoms include (5)
-fullness
-abdominal cramps
-borborygmi (rumbling/gurgling noise)
-urge to defecate
-diarrhea
(occurs 15-30 min. after eating)
Dumping Syndrome causes Vasomotor symptoms w/ Reactive Hypoglycemia. What are the symptoms (9)?
pallor (paleness), diaphoresis (sweating),
weakness, mental confusion,
dizziness (vertigo), feeling of warmth
palpitations, tachycardia, and
anxiety
Will resemble a hypoglycemic episode’s d/t rapid release insulin, when sugar is quickly absorbed by the body →leading to pallor, sweating, dizziness, confusion (vasomotor s/s)
What is Steatorrhea ?
What is the treatment?
the excretion of abnormal quantities of fat with the feces leading to reduced absorption of fat by the intestine.
Tx.
-Reduce fat intake and
-administer Loperamide (Imodium) = a synthetic drug of the opiate class which inhibits peristalsis and is used to treat diarrhea.
Patient teachings
for dietary self management to
DELAY STOMACH EMPTYING &
DUMPING SYNDROME (6)
-low fowler’s position after meals
-lie down for 20-30 minutes
-Eat small, frequent meal
-more DRY food items than liquids
-Low-carb diet
-Moderate protein and fat diet
Low carb → lean meats, fish, leafy green veggies, cauliflower, broccoli, nuts, beans, legumes
ALSO: (IN OTHER SLIDE)
-Avoid fluid with meals
-Avoid concentrated carbs
-Avoid high carbohydrate and sugar intake
-Avoid salt and milk
-Avoid extreme food temperatures
AVOID → milk, refined sugar, cakes, sweet drinks, dairy, alcohol
WHAT TO AVOID FOR DUMPING SYNDROME (6)
-Avoid fluid with meals
-Avoid concentrated carbs
-Avoid high carbohydrate and sugar intake
-Avoid salt and milk
-Avoid extreme food temperatures
AVOID/LIMIT → milk, refined sugar, cakes, sweet drinks, dairy, alcohol
BMI VALUES
Normal wt: 19 -24
Over wt: 25 – 29
Obese: >= 30-39
Morbid obesity: over 40 KG/M2
>100 LBS greater IBW
* BMI ≥35 kg/m2 with one or more obesity-related complications
* Hypertension, type 2 diabetes, heart failure, sleep apne
WHAT ARE THE 2 TYPES OF PROCEDURES FOR BARIATRIC SURGERY?
WHAT ARE THE 4 NAMES OF BARIATRIC SURGICAL PROCEDURES?
RESTRICTIVE (stomach is reduced in size) &
MALABSORPTIVE (small intestine decreased) procedures
Adjustable gasteric banding (AGB)
Sleeve gastrectomy (gastric sleeve)
Biliopancreatic diversion (BPD)
Roux-en-y gastric bypass
-The Roux-en-Y gastric bypass is recommended for long-term weight loss. It is a combined restrictive and malabsorptive procedure.
POST-OP CARE FOR BARIATRIC SURGERY (4)
-Post-OP Diet: 6 small feedings= 600-800 calories/day
-Do not irrigate NG tube –>may damage the suture line
-Psychosocial interventions (modify eating behaviors)
-follow up care w/ education regarding long-term effects
POTENTIAL COMPLICATIONS FOR BARIATRIC SURGERY (5) [BBHDD]
[First 2 SIMILAR TO COMPLICATIONS POST-GASTRIC]
Bile reflux,
Dumping syndrome,
Bowel/gastric outlet obstruction
Hemorrhage,
Dysphagia
WHAT DIAGNOSTIC TEST DO YOU USE TO SEE TUMORS OR ABNORMAL BLEEDING IN THE SMALL INTESTINE ?
CAPSULE ENDOSCOPY
3’S RISK FACTORS FOR GASTRIC CANCER
SMOKED FOOD
SALTED FISH & MEAT
SMOKING
OTHER RISK FACTORS
PICKLED VEGETABLES
H.PYLORI INFECTION,
Pernicious anemia,
previous subtotal gastrectomy
genetics
men
