UPPER G.I Flashcards
is a painful disorder characterized by inflammation and ulcerations in the mouth, including the lips, tongue, and mucous membranes
Stomatitis
Causative agent of herpetic stomatitis
Herpes simplex virus (HSV) type 1
Diffuse, shiny erythematous involvement of the gingiva with edema and gingival bleeding
Herpetic Stomatitis
Also known as Canker Sore
Aphtous Stomatitis
Clinical Manifestation of Aphtous Stomatitis
-Small, white painful ulcers
- Well-circumscribed lesion
Medical Management of Stomatitis
- Acyclovir (Zovirax), if cause is HSV
-Analgesics, as ordered
-Lidocaine hydrochloride (Xylocaine)- topical anesthetic
Nursing Management of Stomatitis
-Provide soft, bland foods during acute episodes
-Diet as tolerated (DAT) as the sores heal
-Encourage small, frequent feedings
-Encourage to drink room temperature liquids
-Let patient rinse mouth with NSS after eating
-Avoid alcohol- based mouthwash
-Use soft- bristled toothbrush
The opening of the diaphragm through (hiatus) which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax
Hiatal Hernia
Occurs when the upper stomach and the gastroesophageal junction are displaced upward and slide in and out of the thorax
Sliding Hiatal Hernia
It’s primary cause is muscle weakness in the esophageal hiatus
Hiatal Hernia
Occurs when all or part of the stomach pushes through the diaphragm beside the esophagus
Rolling Hiatal Hernia
What is the primary cause of Rolling Hiatal Hernia?
Anatomical defect
How many percent are asymptomatic in Hiatal hernia?
91% are asymptomatic (Smith & shahjehan, 2021)
Clinical Manifestations of Hiatal Hernia
-Pyrosis: heartburns
-Dysphagia (difficulty swallowing),
-odynophagia (painful swallowing) - due to compression of esophagus
-Dyspnea
-Abdominal pain
-Nausea and vomiting
-Gastric distention
-belching
-flatulence
The confirmatory test Hiatal hernia
Barium Swallow
Visualizes esophagus, stomach, duodenum, and jejunum
Barium Swallow
What is the inital position of Barium Swallow?
Taken on staning, and lying position
Nursing Care of Hiatal Hernia
-Pre Procedure
NPO 6-8 hours
-Post Procedure
Laxatives, as ordered
Increase OFI
Inform client that stool may become white for 24-72 hours
Medical Management of Hiatal Hernia
-H2- receptor antagonist
- Cimetidine (Tagamet)
-Ranitidine (Zantac)
-Famotidine (Pepcid)
-Proton pump inhibitors
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Omeprazole (Losec)
-Antiemetics
- Metoclopramide (Plasil)
-Ondansetron (Zofran)
- Promethazine (Phenergan)
-Antacids
- Aluminum hydroxide
- Magnesium hydroxide
Surgical Management of Hiatal Hernia that known as “Gastric Wrap-Around”
Nissen Fundoplication
Reserved for extreme cases which involves gastric outlet obstruction or suspected strangulation
Nissen Fundoplication
The upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.
Nissen Fundoplication
Nursing Management of Hiatal Hernia
-High- protein diet - to enhance LES pressure
-Small frequent feedings- prevent gastric distention and prevents further protrusion of stomach into thoracic cavity
-Instruct client to eat slowly and chew food properly
-Avoid foods and beverages that decrease LES pressure such as fatty foods, cola beverages, coffee, tea, chocolate, alcohol
L
-Let the client assume upright position before and after eating for 1 to 2 hours
-Instruct client to avoid eating at least 3 hours before bedtime
-Advise client to reduce body weight, if obese.
-Elevate HOB 6 to 12 inches for sleep
-Avoid factors that increase abdominal pressure like use of constrictive clothing, straining at stool, heavy lifting, bending, stooping, vigorous coughing
-Avoid cigarette smoking as smoking causes rapid and significant drop in LES pressure
Is a disorder characterized by backflow of gastric or duodenal contents into the esophagus
GERD or Gastroesophageal Reflux Disease (GERD)
Foods and Medications that Weakens the LES
-Chocolate
-Alcohol
-Peppermint
-Caffeine
-Smoking
-Morphine/Meperidine
-Calcium- channel blockers
Typical Symptoms of GERD
H- Heartburn
R- Regurgitation
D- Dysphagia
retrosternal sensation of burning or discomfort that usually occurs after eating or when lying supine or bending over
Heartburn
effortless return of gastric and/or esophageal contents into the pharynx
Regurgitation
a sensation that food is stuck, particularly in the retrosternal area.
Dysphagia
Atypical Symptoms of GERD
C- Cough
H- Hoarseness in AM
O- Otitis Media
N- Non-cardic chest pain
A- Asthma
Complications of GERD
-Esophagitis
- Esophageal stricture
- Barret’s Esophagus
Lifestyle Modifications of GERD
-Weight loss and control
A-voiding alcohol, chocolate, citrus juice, and tomato-based products
-Avoiding large meals
-Waiting 3 hours after a meal before lying down
-Elevating the head of the bed by 8 inches
Drugs for GERD are:
-Antacids
- For mild symptoms only
- Taken after each meal and at HS
-H2 Receptor Antagonist
- First-line agent for GERD w/without esophagitis
-also used as maintenance therapy to prevent relapse
-taken on an empty stomach
- Proton Pump Inhibitor
-Must be used ONLY when GERD has been objectively documented
- May aggravate cardiac conduction abnormalities
Indication of Nissen Fundoplication
-Patients with symptoms uncontrolled by PPI
-Barrett esophagus
-Presence of atypical symptoms
-Young patients
-Patients with cardiac conduction problems
-Habitual non-adherence to treatment
is the inflammation of the gastric mucosa
Gastritis
Gastritis that caused by LOCAL irritants such as aspirin and NSAIDs, Alcohol, and Gastric radiation therapy
Acute Erosive Gastritis
Gastritis that caused by Helicobacter pylori
Acute Non-Erosive Gastritis
Releases toxins which are associated with stomach mucosal inflammation and host tissue damage (Malik et al., 2021)
Helicobacter Pylori
Acute Gastritis Clinical manifestations
H- Hematemesis
E- Epigastric Pain (acute)
M- elena
A-Anorexia
N- Nausea and vomiting
Medical management of Acute Gastritis
- H2 blockers or PPI
- Anti-emetics, if with n/v
- If cause is H.pylori, antibiotic therapy with (Amoxicillin + Clarithromycin_
Nursing Management of Acute Gastritis
-Maintain on NPO until acute symptoms subsides
-Maintain IV fluids, as ordered
-In severe cases, NG tube may be used to monitor for bleeding, to lavage precipitating agent from stomach, or to keep stomach empty and free of noxious stimuli
-Monitor VS and check vomitus for blood
Results from repeated exposure to irritating agents or recurring episodes of acute gastritis
Chronic Gastritis
More common in older adults
Chronic gastritis
Causes of Chronic Gastritis
A- autoimmune
B- Bacterial
C- Chemical
Caused by chronic gastric mucosal irritation
Chronic Gastritis
Clinical Manifestations of Chronic Gastritis
B- Belching
E- Epigastric Pain
S- Sour Taste in mouth
P- Pernicious Anemia
L- Lack of Energy
I- Intolerance to spicy/fatty foods
S- Satiety Early
Medical Management of Chronic Gastritis
-Treat underlying cause
-Discontinue irritating substance
-Antibiotic therapy for H. pylori
-Vitamin B12 therapy, if with pernicious anemia (Give via IM)
Nursing Management of Chronic Gastritis
-Non- irritating diet (no spices, non fatty)
-Provide small frequent feedings
-Advice client about smoking cessation and reduction of alcohol consumption
-Stress management
A condition characterized by erosion of the GI mucosa resulting from digestive action of hydrochloric acid (HCl) and pepsin
Peptic Ulcer Disease
Commonly occurs in the stomach (gastric ulcer) and proximal duodenum (duodenal ulcer)
Peptic Ulcer Disease
What are the risk factors of Peptic Ulcer Disease?
-H.Pylori Infection
- Medications (NSAIDs and Aspirin)
-Stress
-Foods (Fatty/Spicy/highly acidic)
- Zollinger-Ellison Syndrome
-Type A personality
-Blood Type O
Diagnostic Test for Peptic Ulcer Disease
-Upper GI Endoscopy
-Urea Breath Test
Gold standard investigation for confirmation of H. pylori
Upper G.I Endoscopy
Detects the presence of H.Pylori and most accurate test among the non-invasive techniques
Urea Breath Test
Urea Breath Test Patient Preparation
- Avoid the following 14 days prior:
-Antibiotics
-Proton Pump Inhibitors
-H2 receptor Blockers
-Bismuth preparations
-Barium
-NPO for 4-6 hours prior to procedure
-Educate on need to swallow a capsule containing the urea preparation and that he/she will be required to breathe out into a bag or container
Normal HCI secretion and increased back diffusion of HCI into gastric mucosa
Gastric Ulcer
Increased HCI secretion
Duodenal Ulcer
Pain radiates to the RIGHT side since the duodenum is located in the right side
Duodenal Ulcer
What is the onset of pain of duodenal ulcer?
Onset of pain is 3 to 4 hours after eating
Manifestation of Duodenal Ulcer
Melena
Pain radiates to LEFT side since the stomach is located in the left side
Gastric Ulcer
Onset of pain is ½ to 2 hours after meals
Gastric Ulcer
Manifestation of Gastric Ulcer
-Nausea and Vomiting
-Hematemesis
What is the main presentation of Peptic Ulcer Disease?
Dull, aching, gnawing epigastric pain
Drugs/Medication for Peptic Ulcer Disease
Antacids
- Aluminum-Magnesium Hydroxide (Maalox)
- Milk of Magnesia- Magnesium Trisilicate (Gaviscon)
-Calcium carbonate (Tums)
H2 Blockers (Cimetidine)
Cytoprotective
Agents (Sucralfate (Carafate)
Medical Management If H.Pylori is Infected
Triple Therapy
-PPI BID
-Clarithromycin 500 mg BID
-Amoxicillin 500 mg BID or
-Metronidazole (Flagyl) 500 mg BID
Taken for 10-14 days
Quadruple Therapy
-Bismuth subsalicylate 525mg QID
-Tetracycline 500 mg BID
-Metronidazole 250 mg QID
PPI OD
Severing of the vagus nerve.
Decreases gastric acid by diminishing cholinergic stimulation to the parietal cells, making them less responsive to gastrin
Vagotomy
Surgical dilatation of the pyloric sphincter to treat bleeding duodenal ulcers. Longitudinal incision is made into the pylorus and transversely sutured closed to enlarge the outlet and relax the muscle
Pyloroplasty
surgical removal of the antrum portion of the stomach (50%)
Antrectomy
removal of 65% to 75% of the stomach
Partial gastrectomy
removal of at least 80% of the distal stomach
Subtotal gastrectomy
removal of the entire stomach
Total gastrectomy
removal of the lower portion of the stomach (which contains cells that secrete gastrin) as well as a small portion of the duodenum and pylorus. The remaining segment is anastomosed to the duodenum.
Billroth I (Gastroduodenostomy)
removal of the lower portion of the stomach with anastomosis to the jejunum. A duodenal stump remains and is oversewn
Billroth II (Gastrojejunostomy)
Nursing Management for Peptic Ulcer Disease
-DAT when asymptomatic
-Bland diet during exacerbation
-Advise client to eat slowly and chew food properly
-Small, frequent feeding during exacerbation
-Instruct to avoid the following:
Fatty foods, coffee, tea, chocolate, cola drinks, spices, alcohol
-Bedtime snacks
-Binge eating
-Large quantities of milk
A group of unpleasant vasomotor and GI symptoms caused by rapid emptying of gastric contents into the jejunum.
Dumping Syndrome
What is the common cause of Dumping Syndrome?
Billroth II Procedure
Early Manifestation of Dumping Syndrome
occurs 5 to 30 mins pc
D-diarrhea
A- Abdominal Cramps
W- Weakness
N- Nausea
S- SNS stimulation
Late Manifestations of Dumping Syndrome
(2 to 3 hours pc)
-Hyperglycemia (initially)
- Hypoglycemia
Nursing Management of Dumping Syndrome
-Position patient to LEFT SIDE- LYING after meals
-Provide small, frequent feedings
-HIGH- PROTEIN DIET - Protein empties in the stomach slowly.
-Limit carbohydrates
-Instruct patient to drink water AFTER MEALS not within meals
-Octreotide- decrease GI symptoms
-Acarbose- for clients with late dumping
-Billroth II to Billroth I conversion
