GIT - Stomach - Conditions

Question 1

Stomach - Gastric Mucosa

Answer 1

• usually impermeable to the acid it secretes due to the gastric mucosal barrier
• protected by tight cellular junctions, protective mucous layer, prostaglandins that imprve blood flow, increase bicarbonate secretion & mucus production

Question 2

Gastritis - Acute

Answer 2

• inflammation of the gastric mucosa
• due to local irritants such as bacterial endotoxins, alcohol or asprin
• S&S
  
  • heartburn, transient gastric distress, vomiting, bleeding & haematemesis (alcohol)
  • abrupt & violent onset, gastric distress, vomiting approx 5 hours after ingestion of contaminated food (endotoxins)
• leads to oedema & hyperaemia through to haemorrhagic erosion of the mucosa

Question 3

Gastritis - Chronic

Answer 3

• characterised by absence of grossly visible erosions, presence of chronic inflammatory changes leading to atrophy of the glandular epithelium of the stomach (fundus & body)
• 3 causes: helicobacter pylori gastritis, autoimmune gastritis, chemical gastropathy
• helicobacter pylori
  
  • produces enzymes & toxins that interfere with mucosal protection against gastric acid injury, cause inflammation & immune response
  • diagnosed by blood test for antibodies, faecal bacterial detection, urea breath test & endoscopic biopsy

Question 4

Peptic Ulcer Disease

Answer 4

• group of ulcerative disorders, occur when there is exposure to acid secretions that erodes away the mucosa
• duodenal (any age, often early adulthood, males, most common form)
• gastric (older age ground, peak 55-70, men more than women)
• may affect one or more layers of the stomach or duodenum
• most likely due to helicobacter pylori, asprin, NSAIDs

Question 5

Peptic Ulcer Disease - Signs & Symptoms

Answer 5

• dull gnawing pain
• burning sensation mid-epigastric area
• pain relieved by eating
• localised epigastrium tenderness
• heartburn
• vomiting
• diarrhoea / constipation
• bleeding - stools / vomit (bleeding = fully formed ulcers)
• occurs at intervals of weeks or months

Question 6

Peptic Ulcer Disease - Complications

Answer 6

• haemorrhage - sudden or insidious
• obstruction - oedema, spasm or contraction of scar tissue
• perforation - erosion through all stomach layers resulting in gastric contents entering the peritoneum (peritonitis)

Question 7

Peptic Ulcer Disease - Medical Management

Answer 7

• medical
  
  • conservative
  • rest, diet (more fiber, less fatty), medications, lack of gastric irritation
  • pharmacological
  • antacids, histamine / H2 receptor blockers, anticholinergics, antibiotics
  • triple therapy - O - omeprazole, C - clarithromicin, A - amoxycillin (or M - metronidazole)
• surgery - gastric resection, vagotomy, pyloroplasty
• indications - uncontrolled bleeding, perforation, obstruction

Question 8

Peptic Ulcer Disease - Nursing Management

Answer 8

• relieving pain
• reducing anxiety
• maintain optimal nutritional state
• monitor for complications
• education
  
  • medications
  • diet
  • stressors
  • social habits

(whatever is causing ulcers, you’re trying to get rid of)