GI- Gerd PUD Gastritis Flashcards
Inflammation of the mucosal lining of the stomach=
gastritis
*may be part or all of the stomach
2 types of gastritis
acute and chronic
characteristics of acute gastritis
- Occurs after exposure to local irritants or other causes
- Sudden
- Thickened, reddened mucous membrane with prominent rugae
- Mild to severe
- Can result in bleeding when muscle layer is involved
- Usually resolves in several days
characteristics of chronic gastritis
- Patchy diffuse inflammation of mucosal lining of stomach
- Walls and lining of stomach will thin and atrophy
- Parietal cell function decreased
- Intrinsic factor production decreased
- B12 absorption stops
- Acid in stomach decreases
- Results in intestinal metaplasia and Gastric Cancer
acute or chronic leads to intestinal metaplasia and gastric cancer?
chronic
acute or chronic gastritis: Patchy diffuse inflammation of mucosal lining of stomach
chronic
acute or chronic gastritis: Thickened, reddened mucous membrane with prominent rugae
acute
acute or chronic gastritis: Occurs after exposure to local irritants or other causes
acute
acute or chronic gastritis: Parietal cell function and Intrinsic factor production decreased
chronic
acute or chronic gastritis: Can result in bleeding when muscle layer is involved
acute
1 cause of chronic and acute gastritis
chronic = H pylori acute= NSAIDs
True or false: H pylori will always cause gastritis
◦ Most people with H. Pylori do not have gastritis
◦ In some people, H. Pylori imbeds into the mucosal layer of stomach
–> Activates toxins and enzymes –>Inflammation of mucosa
Causes of gastritis
H. Pylori (chronic) NSAIDs (acute) Alcohol Consumption (acute/chronic) Severe Illness (acute) Autoimmune disorders (chronic)
Reduce these things to help prevent gastritis and do these other things
REDUCE:
- Caffeine
- Spicy food
- Chocolate
- Alcohol
- Tobacco
- Aspirin
- NSAIDS
- Stress
DO:
Exercise
Balanced Diet
acute gastritis assessment - feels like, looks like:
- Epigastric pain
- Epigastric cramping
- Indigestion
- Anorexia
- Nausea & Vomiting
- Abdominal tenderness
- Hematemesis
- Melena
Chronic gastritis assessment- feels like, looks like:
- Often Asymptomatic –> when starts to cause sxs seed PUD
- Nausea & vomiting
- Epigastric discomfort
- Often after meal
Acute gastritis interventions
• Self-limiting • Support ◦ Fluids ◦ Blood products ◦ Bland foods
Chronic gastritis interventions
- Remove cause
- Medications
- Mucosal barrier
- B12 replacement (IM)
what is the most common upper GI disorder in US that can strike at any age (most common in 40’s and older)
GERD
What is GERD?
• Backward flow of stomach contents into esophagus
◦ Highly acidic and irritating contents cause inflammation in esophagus
What causes GERD
• Lower esophageal sphincter is failing to prevent backflow from stomach to esophagus
Causes: ◦ Excessive relaxation of LES ◦ Increased abdominal pressure ◦ Reduced emptying of stomach ◦ Diabetes: gastric neuropathy
stomach pH vs esophagus pH
Stomach pH = 1.5-2
Esophagus pH = 6-7
What happens to ability to return food to stomach after coming up from GERD over time
> > Refluxed contents return to stomach via peristalsis and gravity… as esophagus becomes inflamed, it becomes more difficult to get contents back to stomach (reduced function)
- -> Hyperemia
- ->Erosion
Risk factors for GERD
- Hiatal hernia
- Alcohol use
- Tube in nose or throat
- Large spicy meals
- Citrus food
- Chocolate
- Carbonated Beverages
- Smoking
- Pregnancy
Barrett’s epithelium is complication from what disease process? and what is it?
GERD
• Barrett’s epithelium
◦ Normal Squamaous cells of esophagus change to columnar epithelium which is precancerous but withstands acid better
complications from GERD
- Esophageal stricture (from scarring)
- Asthma
- Laryngitis
- Dental Decay
- Cardiac Disease
- Aspiration pneumonia
- Bleeding
- Barrett’s epithelium
GERD assessment- looks like/feels like:
-Dyspepsia/ Indigestion (fullness, nausea, belching) • Discomfort worsens with bending over, lying down • Pain may radiate to neck or jaw • May occur after eating for 20 mins- 2 hours -Regurgitation • Bitter taste • Water brash may occur in response (reflexive saliva) • Belching and flatulence -Heartburn -Asthma -Morning Hoarseness -Pneumonia • Crackles in lungs? Wheezing? • Coughing? • Dysphagia -Painful swallowing
GERD diagnostics (2 main ones)
- Barium Swallow Study (Esophagus)
- **Upper endoscopy (EGD)- best definitive diagnosis
- **pH exam ** - Ph capsule in esophagus reports pH , Gold standard but most don’t get it
- Esophageal Manometry
- Gastric emptying test
Diagnosis is often based sxs and how they respond to treatment –> if respond to treatment then assume its GERD
Nutrition education for GERD- what not to eat, how should you eat?
- Avoid irritating foods
- Caffeine
- Chocolate
- Fried food
- Fatty food
- Citrus
- Peppermint
- Spicy foods
- Eat small portions/ small meals more frequently
- Avoid eating before bedtime
lifestyle changes to manage GERD
- Stop Smoking
- Reduce Alcohol intake
- Elevate head of bed 6-12 inches
- Sleep on right side
- Weight loss
- Evaluation for obstructive sleep apnea
- Avoid bending over
- Sit upright after eating
- Loose clothes
• Medications that CAUSE LED relaxation/ contribute to GERD
◦ Nitrates ◦ NSAIDS ◦ Oral contraceptives ◦ CCB’s ◦ sedatives ‣ Avoid these medications is not always possible!
• Medications for TREATING GERD
◦ Antacids
◦ H2 antagonists
◦ PPI’s
(not meant for long term)
Surgery for GERD
• Nissen fundoplication
◦ recreate tighter LED, make incisions in stomach to tighten it
◦ Standard surgical approach for GERD
◦ Continue taking meds/lifestylemod –> high rate of recurrence
Peptic Ulcer Disease- what is it?
=Mucosal Lesion of the stomach or duodenum
• “PUD” occurs with impairment of mucosal defenses
◦ –> Acid and pepsin are able to destroy the epithelium tissue of stomach and duodenum
Cause of many peptic ulcers is what? how does it cause damage?
H pylori
• May cause break in mucosal barrier >HCl can then injure epithelium of stomach and causes lesion
gastric or duodenal : Ulcer caused by Delayed Stomach emptying
gastric
gastric or duodenal: ulcer caused by increased stomach empyting
duodenal
Increased, decreased or normal with gastric ulcer:
stomach empyting
acid secretion
diffusion of gastric acid into stomach tissue
Delayed Stomach emptying, normal acid secretion, increased diffusion of gastric acid into stomach tissue
increased, decreased, or normal w/ duodenal ulcer?
Stomach emptying
acid secretion
diffusion of gastric acid into stomach tissue
=Increased stomach emptying, increased secretion of gastric acid, and normal diffusion of acid into stomach tissue
onset of pain w/ gastric vs duodenal ulcer
gastric= pain occurs 30- 60 min after eating, occurs at night
duodenal= pain occur 1.5-3 hours after eating, occurs in middle of night
Gastric vs duodenal ulcer: If bleeding occurs –> ?
gastric = hematemesis duodenal = melena
Gastric vs duodenal ulcer- where is the pain?
gastric- • Upper epigastrium (and left)
duodenal- • Below epigastrium (and right)
what is stress ulcer? what are some causes?
=Occur after medical crisis or trauma • Sepsis • Head Injury • Burns • NPO for surgery
why are we concerned about stress ulcers and what we gonna do about it?
> May cause bleeding (Increase death), develop very quickly
Lead to long hospital stays
give prophylactic PUD med in hospital to prevent
Causes of peptic ulcers
- **H. Pylori infection
- **NSAIDS (COX-1 produces prostaglandins that promote inflammation AND protect the GI mucosal lining
- Gastritis
- Corticosteroids
- Theophylline
- Excessive alcohol intake
- Smoking
- Caffeine
- Alcohol
- Radiation therapy
- Stress
—> same as gastritis!
Assessment history for PUD
- Risk Factors?
- Medications?
- What aggravates?
- Past surgeries?
- GI symptoms?
- Relationship of GI symptoms to eating & sleep
- Changes in GI symptoms
Assessment for PUD- looks like/feels like:
• INDIGESTION (Dyspepsia) • Sharp, burning pain • Abdominal fullness • Epigastric tenderness • Hyperactive bowel sounds (early) • Hypoactive bowel sounds (late) • Nausea & Vomiting ◦ Vital Signs • Appetite changes
Diagnostics for PUD
Urea Breath test- diagnose H. Pylori Stool Antigen test Serum Antibody test Hemoglobin and hematocrit Fecal Occult test CT scan **Esophagogastroduodenoscopy ** Nuclear Medicine scan
Goals of drug therapy for PUD
- Provide pain relief
- Eliminate H. pylori
- Heal ulcers
- Prevent recurrence
Triple vs Quadruple therapy
-treat PUD:
Triple Therapy:
Proton pump inhibitor
2 antibiotics
Quadruple therapy:
Triple therapy + Pepto-Bismol
Nutrition Ed for PUD
- Avoid irritating foods
- Bland foods (acute)
- Avoid bedtime snacks
- Avoid alcohol
- Avoid smoking
4 complications to consider for PUD
- Hemorrhage
- Perforation
- Pyloric obstruction
- Chronic & difficult to treat disease
Hematemesis (UPPER) coloration?
bright red
coffee ground –> can be actively bleeding w/ this
What is Melena a sign of related to PUD? What does it look like?
hemorrhage, dark tarry stool (digested blood)
early detection interventions for GI hemorrhage
- Vital signs
- Hemoccult test for suspicious stool
- H & H
- Patient education
nursing interventions for GI hemorrhage
- Airway protection
- Position (side)
- Oxygen
- Volume replacement (IV access)
- Blood transfusion
- Prepare patient for medical intervention
Medical interventions for GI bleed
-Endoscopic procedure • Esophagogastroduodenoscopy ◦ Inject chemicals into bleeding site ◦ Treat bleed with heat source ◦ Apply band or clip ◦ IV sedation
-Interventional radiological procedure
• Catheter directed embolization of artery that is bleeding
• Emergency situation typically
-Acid Suppression
• To prevent re-bleeding
• IV Protonix
• IV Ocreotide: dhunts blood away from GI system
what is a bowel perforation?
Allows contents of GI system to leak into peritoneal cavity
s/s of bowel perforation- what we gonna do about it?
• Sudden, sharp mid -epigastric pain that radiates through abdomen
• TENDER, RIGID, BOARDLIKE ABDOMEN = Peritonitis
◦ + Rebound tenderness
◦ This is an emergency
—>SUPPORT AND GET TO SURGERY
IV Ocreotide =
shunts blood away from GI system, admin during GI hemorrhage
What happens during EGD?
◦ Inject chemicals into bleeding site
◦ Treat bleed with heat source
◦ Apply band or clip
◦ IV sedation
