Lecture 2 Gastric and Duodenal Disorders Flashcards
what is gastritis?
inflammation of gastric mucosa
what is the typical duration of gastritis?
can last hours or days
risk factors for acute gastritis?
food/alcohol
viruses
stress
ASA and NSAIDs
risk factors for chronic gastritis?
H pylori
repeated exposure to agents that cause acute gastritis
complications of chronic gastritis
atrophy
ulcers
cancer
bleeding if inflammation is severe
clinical manifestations of acute gastritis
anorexia
rapid onset epigastric pain
clinical manifestations of chronic gastritis
belching, nausea, vomiting, pyrosis
vague epigastric pain relieved by eating
nursing management of gastritis
GI rest
slow reintroduction starting with clear liquids
bland small meals
eliminate irritating foods, alcohol, smoking
IV fluids and electrolytes
pharmacologic management of gastritis
PPI, H2 antagonist, antacids
sucralfate
B12 - impaired absorption
antibiotics for H pylori
risk factors for peptic ulcer disease
H pylori
NSAID use
Alcohol
Smoking
acid hypersecretory disorders
stress
types of peptic ulcers (location)
duodenal
gastric
esophageal
pathophysiology of peptic ulcer disease
erosion from gastric juice can occur if the epithelium has been damaged
can penetrate mucosa and extend into smooth muscle
how do clinical manifestations of duodenal ulcer and gastric ulcer differ?
duodenal ulcer causes epigastric pain 2-3 hours after eating and improves with food and antacids
gastric ulcer causes epigastric pain immediately after eating and is not relieved by antacids
how are clinical manifestations of duodenal and gastric ulcers the same?
epigastric pain
pyrosis
constipation or diarrhea
vomiting
bleeding
sour burps
diagnostic tests for PUD
EGD
CBC
fecal occult blood test
H pylori test
pharmacologic management of PUD
PPIs, H2 antagonists, sucralfate
discontinue NSAIDs
antibiotics if H. pylori
diet for PUD
avoid spice, alcohol, coffee, caffeine
3 regular meals per day
avoid extreme food temps
vagotomy
severs vagal nerve supply to proximal 2/3 of stomach to decrease stomach acid production of parietal cells by 75%
pyloroplasty
enlarge pyloric opening to allow stomach to empty more easily
antrectomy
distal 1/3 of stomach is excised and reattached to small intestine
signs of peptic ulcer hemorrhage
hematemesis
melena
assessing for hemorrhage in PUD
faintness, dizziness, nausea
vital signs
urinary output
H&H
occult blood stool test
treating peptic ulcer hemorrhage
fluid resuscitation
endoscopic embolization
signs and symptoms of perforation of the stomach
sudden severe abdominal and shoulder pain
vomiting
hypotension and tachycardia
tender and rigid abdomen
post op care for perforated stomach ulcer
NGT
monitor fluid volume and electrolyte balances
monitor WBC and temp
antibiotics
signs and symptoms of gastric outlet obstruction
nausea and vomiting
anorexia
epigastric fullness
distended abdomen
managing gastric outlet obstruction
NGT
EGD
endoscopy
surgery - pyloroplasty
risk factors for gastric cancer
diet - smoked foods, pickled vegetable, salted fish and meats, low fruit and vegetable intake
H. pylori
alcohol
smoking
family history
chronic gastritis and ulcers
pathophysiology of gastric cancer
arise from mucus producing cells of inner lining
early lymph node involvement
clinical manifestations of gastric cancer
indigestion
early satiety
weight loss
abd pain above umbillicus
anorexia
bloating after meals
nausea and vomiting
fatigue
diagnosing gastric cancer
EGD
CT scan
CBC - gastric cancer can cause bleeding
nutrition considerations for after gastrectomy
6 small feedings a day
antiemetics
fluids between meals, not with
supplement vitamin C, A, B12, and iron
may need TPN pre and post
treating gastric cancer
radiation
chemotherapy
gastric resection
3 things to monitor post gastrectomy
I/Os
daily weight
electrolytes
