Gastric/Duodenal Disorders Flashcards
What is gastritis?
inflammation of the stomach mucosa
Acute Gastritis
- viral/bacterial infections
- food (spicy, contaminated)
- lasts hours to days
Chronic Gastritis
- long term
- most common cause-H. Pylori
- result of frequent acute attacks or continuing exposure to irritating agents
What is a common cause of peptic ulcers?
H. Pylori
Treatment for H. Pylori Bacteria
- 10-14 days of double antibiotic therapy
- proton pump inhibitor (long term)
- bismuth salt (Pepto-Bismol)
S/S of Gastritis
- abdominal pain/cramping
- headache
- bloating
- lack of energy
- N/V
- anorexia
- chronic belching/hiccupping
- indigestion
- sour taste in mouth
Acute Treatment for Gastritis
- NPO for 24 hours w/ fluids
- avoid alcohol while symptoms persist
- bland soft diet
- medication
Chronic Gastritis Treatment
- dietary modifications
- rest/stress reduction
- avoid alcohol, smoking, NSAIDs
- Tx for H. Pylori
Antibiotics for Gastritis
- Amoxil (penicillin-based)
- Flagyl (metronidazole)
- Biaxin
H2 Antagonist for Gastritis
- Zantac (ranitidine)
- Pepcid (famotidine)
Proton Pump Inhibitors for Gastritis
- Prilosec (omeprazole)
- Protonix (pantoprazole)
- Nexium (esomeprazole)
Peptic Ulcer Disease (PUD)
A hollowed out area that forms in the mucosa of the:
- stomach (Gastric)
- intestines (most common) (Duodenal)
- esophagus
Duodenal PUD
- increase HCI
- weight gain
- pain 1-2 hrs after eating/during night
- food helps pain
- little to no vomiting
- hemorrhage unlikely
Gastric PUD
- normal to decreased HCI
- weight loss
- pain 1/2-1 hrs after eating/rarely at night
- food makes worse
- vomiting common and may help pain
- hemorrhage common (hematemesis)
Risk Factors for Duodenal PUD
- H. Pylori
- alcohol
- smoking
- stress
Risk Factors for Gastric PUD
- H. Pylori
- gastritis
- alcohol
- smoking
- stress
- NSAIDs
S/S of PUD
- may lasts weeks-months
- dull knowing pain
- burning in mid-epigastric area/back
- food may help
- heartburn
- vomiting
- diarrhea/constipation
- melena
- hematemesis
How is PUD diagnosed?
- endoscopy
- barium swallow
Endoscopy
- direct visualization of ulceration w/ or w/o bleeding
- “bleeders” can be cauterized
- biopsy
Pre-procedure for Endoscopy
- consent
- gown
- remove dentures
- NPO
- patent IV
Intra-Procedure for Endoscopy
- conscious sedation (Propofol)
- short acting meds that caused decreased LOC and loss of memory
- monitor for hypotension and respiratory depression
Post-procedure for Endoscopy
- continuous pulse ox x 12 hours
- assess neuro status q 2 hours then q 4
- vital signs q 4 hours
- assess for S/S of perforated esophagus
- NPO until gag reflex returns
What to do for Hematemesis?
- ensure patent airway
- patent IV
- NG tube
- determine cause
NG tubes for Hematemesis
- remove blood from stomach
- iced saline lavage/saline lavage
Saline Lavage
instillation and aspiration of iced saline solution through a NG tube to empty the stomach of blood and to slow the bleeding at its source
Lifestyle Management
- stop meds causing ulcers
- rest
- stress reduction
- smoking/alcohol cessation
- dietary modifications
Dietary Modifications for Ulcers
- avoid spicy, fried foods
- limit milk/dairy
- avoid alcohol and caffeine
- eat 3 regular meals a day
What is the most common complication of ulcers?
hemorrhage
S/S of Hemorrhage
- hematemesis-bright red or coffee ground color
- melena-bright red or dark, tarry color
- n/v
- dizziness, confusion
- hypotension
- tachycardia
- tachypnea
- cool, pale skin
- oliguria
What should you monitor for Hemorrhage?
- hemoglobin-F:12-16/M: 14-18
- hematocrit-F:37-47/M:40-52
- stools for occult blood
Perforation
erosion of the ulcer through the wall of the stomach into the peritoneal cavity
S/S of Perforation
- sudden “knife-like” abdominal pain
- tender, rigid abdomen
- sudden vomiting
- hypotension, tachycardia
- extreme diaphoresis
Penetration
erosion of the ulcer through the wall of the stomach into adjacent structures/organs (pancreas)
S/S of Penetration
-back/epigastric pain not relieved by previous methods
What is the main complication of perforated ulcers?
peritonitis
Peritonitis
inflammation of the peritoneum; lining of the abdominal cavity and the organs w/in
S/S of Peritonitis
- n/v
- abdominal pain
- bloating
- fever
- often no flatulence or stool
Treatment for Peritonitis
- surgery to close perforation
- lavage to clean gastric/intestinal contents from abdominal cavity
- NG tube
- antibiotics
Nursing Care Post-perforation
- monitor vitals/labs
- administer antibiotics
- assess for return of bowel sounds
- ambulation day 1 post-op
- educate: cough, deep breathing, splinting, meds, lifestyle changes
Pyloric Obstruction (Gastric Outlet Obstruction)
gastric emptying is impeded by a narrowing of the area of the stomach just below the pyloric sphincter
What is most often the cause of Pyloric Obstruction?
Scarring from multiple episodes of exacerbation and healing of peptic ulcer
S/S of Pyloric Obstruction
- n/v
- constipation
- feeling full all of the time
- anorexia w/ weight loss
Treatment for Pyloric Obstruction
- NG tube/IV fluids/NPO
- balloon dilation
- surgery: severing of vagus nerve; antrectomy
What classifies you as morbidly obese?
weight more than 2x ideal body weight or BMI > 30
Morbid Obesity causes risks for what?
- diabetes
- heart disease
- stroke/HTN
- gallbladder disease
- musculoskeletal probs
- sleep apnea
- COPD
- depression
- suicidal thoughts
Treatment for Morbid Obesity
- dietary restrictions
- exercise
- behavioral modifications
- treat depression
- meds
- encourage fluid intake
- assess for extreme weight loss
What is considered after failure of non-surgical treatment for morbid obesity?
Bariatric Surgery
Pre-Counseling for Bariatric Surgery
- 6-12 months
- lifestyle/dietary modifications
- side effects
- support system
Criteria for Bariatric Surgery
- BMI: > 40 no comorbidities, > 35 w/ comorbidities
- unsuccessful hx of weight loss
- assurance patient will adhere to treatments and follow ups
Exclusions for Bariatric Surgery
- reversible conditions causing obesity
- drug/alcohol abuse in last year
- psychiatric illness
- inability to learn, understand, follow directions
Gastric By-Pass Surgery
- can be done laparoscopically
- stomach is divided into smaller upper pouch that is stapled closed and a larger lower pouch is rerouted to upper pouch
- inpatient 2-3 days
Gastric Banding (Lap Band)
- can be done laparoscopically
- silicone band placed around the upper portion of the stomach
- new narrowed portion slows movement of food leaving person feeling fuller longer
- band can be loosened or tightened
- typically new stomach will hold about 1 oz
Gastric Sleeve
- approx. 80% of stomach is removed
- thin vertical sleeve of stomach is created using stapling device
- does not require rerouting
- inpatient 2-3 days
Complications of Bariatric Surgery
- atelectasis/pneumonia
- hemorrhage
- DVT/PE
- bowel obstructions
- incisional hernia
- infection/leakage
Complications SPECIFIC to Bariatric Surgery
- chronic n/v
- dumping syndrome
- changes in bowel function
Dumping Syndrome
food is emptied too quickly from the stomach into the small intestine not allowing time for dilution of fats/carbohydrates
S/S of Dumping Syndrome
- diarrhea
- abdominal cramps
- vomiting
- fatigue
- dizziness
- diaphoresis
