Gastrointestinal Disorders & Duodenal Ulcers Flashcards
Inflammation of gastric mucosa
Gastritis
Non-erosive gastritis
H. Pylori
Erosive gastritis
NSAID, ETOH use
Is stress related gastritis erosive or non-erosive?
Non-erosive
Onset of gastritis
Rapid (acute)
Manifestations of gastritis
- Abdominal discomfort
- Dyspepsia (indigestion)
- Nausea/vomiting/anorexia
- Blood in vomit or black tarry stool
- Fatigue
- Burning sensation in stomach
- Intolerance to spicy or fatty foods
Erosive may cause…
Bleeding
Diagnostics for gastritis (2) (Which is gold standard?)
Identification of causative factors
- EGD (gold standard)
- H-pylori
Risk with EGD
Perforation
Treatment for gastritis
- Triple therapy (H. Pylori)
- NGT and IV fluids
- Antacids
- H2 blockers
- Proton pump inhibitors
- Vitamin B12
- Diet/lifestyle changes (for chronic) (avoid spicy)
- Gastric resection (extreme case)
What is triple therapy?
PPI and 2 antibiotics for 14 days
Nursing role/Interventions for gastritis
- Pain management
- Anxiety reduction
- Optimize nutritional status (intake & output) (treat pain so pt can eat food)
- Fluid balance
- Monitor/assess for hemorrhage
What do we not want to give for pain with gastritis?
No NSAIDs
What are we monitoring and assessing for hemorrhage?
- Quantity of loss
- Color
- Correction of loss
- S/S associated with hypovolemic shock
Decrease BP, urine output
Increase HR/RR, Hgb/CBC
S/S associated with hypovolemic shock
Low BP
Tachypnea
1 PRBC is how many mL
350 mL
Where can a peptic ulcer form?
- Mucosal wall of the stomach
- Pylorus
- Duodenum
- Esophagus
Excavation
Hollowed out area
This looks like a little hole
Peptic ulcer
Peptic ulcers are associated with..
- H. Pylori
- NSAID and ASA use
(synergistic affect between H. Pylori and NSAIDs) - Excess secretion of HCL (stress may be a factor)
- Type O blood type
- Chronic kidney or lung disease
- Older adults
Most duodenal ulcers occur in…
The first portion of the duodenum
Deep, sharply demarcated lesions that penetrate through the mucosa and submucosa
Duodenal ulcers
Use what to treat duodenal ulcers?
Wait for response to PPI
Then, Scope
Increased stress =
Increased gastric acid secretion
Acute gastric mucosa lesions occurring after an acute medical crisis or trauma
Stress ulcers
What type of ulcer is associated with head injury, major surgery, burns, respiratory failure, shock, and sepsis?
Stress ulcer
Principal manifestation of stress ulcer
Bleeding caused by gastric erosion
What is key for stress ulcers?
Prevention
What do we use for prevention of stress ulcers?
- Proton pump inhibitors (Omeprazole)
- H2 antagonists
Peptic ulcer disease types
- Gastric ulcers
- Duodenal ulcers
- Stress/drug induced ulcers
What type of ulcer is this?
- Weight loss
- Burning left epigastric area
- Food frequently aggravates pain
- No pain during sleep
Gastric ulcer
Duodenal ulcer signs
- Epigastric pain at HS
- Burning, cramping, mid epigastric pain
- Pain 2-4 hours after meal (eating decreases pain)
- Weight gain
- Nausea/vomiting
Stress/drug induced ulcer signs
Asymptomatic
PUD diagnosis
- EGD
- Abdominal films (looking for “free air”)
- H. Pylori
- CBC
PUD H. pylori test
Breath test or serum (blood) antibodies
PUD CBC test
- Assessment for bleeding
- Stool testing for occult blood
PUD abdominal films
- Looking for “free air”
(indicates perforation)
PUD medical treatment goals
- Pain relief
- Decrease/remove H. Pylori
- Heal ulcerations
- Reduce chance of reoccurrence
Diet wise, what do we want to avoid for PUDs? What DO we want?
Avoid coffee, caffeine, smoking
We want small, frequent meals
What meds do we want for PUD?
H2 blockers
Proton pump inhibitors
How to we get rid of H. pylori?
Antibiotics/anti-infective care are only option
10-14 days triple therapy
PUD complications
- Hemorrhage
- Perforation
- Penetration
- Peritonitis
How do we heal ulcerations and reduce chance of reoccurrence?
Holistic care
Erosion eats through blood vessels
Hemorrhage
Hemorrhage manifestations
- Bleeding
- Hypovolemia and shock
Types of bleeding
- Hematemesis
- Melena
- Coffee ground (emesis)
Lab values for hemorrhage
Hct
Hgb
Type and screens - need a blood transfusion
Hemorrhage nursing responsibilities
- Insert large bore IV catheter
- Quickly determine amount of blood lost
- Monitor H and H, Coags, Type and Screen
- Insert NG tube
- Administer lavage
- Foley
- Monitor VS and administer oxygen
- Position patient to prevent hypotension/prevent aspiration
Lavage
Washing out of body cavity
- Can be room temp or iced
Large bore IV catheter for PUD
Saline, LR, blood products
Erosion through the ulcer directly into peritoneum
Perforation
Two types of peritonitis
Bacterial and chemical
Would you rather have perforation of stomach or colon?
Stomach
Erosion through the gastric serosa into adjacent structures
Penetration
Where does penetration take place?
Pancreas, biliary tract, gastro-hepatic
What are two abdominal catastrophes that require immediate surgery?
Perforation and penetration
Manifestations of perforation and penetration
- Sudden, severe upper abdominal pain (may be referred to right shoulder or back)
- Vomiting and collapse
- Tender, board like abdomen
- Hypotension, tachycardia
- Shock
Late signs of peritonitis
Hypotension and tachycardia
Peritonitis manifestations
- Fever
- Abdominal pain
- Paralytic ileus
- Decreased or absent bowel sounds
- Abdominal distention
Peritonitis treatment
Antibiotics
5th most common cancer diagnosis worldwide
Gastric cancer
Where is gastric cancer most common?
East Asia
How do we identify gastric cancer?
Screening programs
Who is at a higher risk for gastric cancer?
Smokers
90% of gastric cancer identifies as…
Adenocarcinomas
How do adenocarcinomas start?
Arise from the mucous producing cells in the inner most lining of the stomach
What occurs early in gastric cancer?
Lymph node involvement and metastasis
Clinical manifestations of gastric cancer
- Pain relieved by antacids
- Dyspepsia
- Weight loss
- Pain in abdomen above umbilicus
- Decreased appetite
- Bloating, nausea, vomiting
Advanced stages of gastric cancer produce symptoms similar to…
PUD
Gold standard for diagnostics of gastric cancer
EGD for biopsy and cytologic washings
Diagnostics of gastric cancer
- EGD
- Barium X-Ray of upper GI tract
- Endoscopic Ultrasound
- CT scan
- CBC
- Tumor markers
Management of gastric cancer
- Surgery (total gastrectomy, radical partial gastrectomy)
- Chemo & radiation
Nursing care for gastric cancer
- Promotion of nutrition
- Pain management
- Psychosocial & anxiety support
Medication for pain management of gastric cancer
Analgesics
