Upper GI Disorders

Question 1

What should the patient be educated on for stomatitis?

Answer 1

• Mouth care after each meal
• Discourage use of alcohol-containing mouthwash
• Remove dentures
• Encourage regular dental check ups
• Encourage saline mouth rinse q4 hours
• Avoid spicy foods, tobacco, and alcohol (swallowing problems)

Question 2

What should the patient be educated on for GERD (Gastroesophageal Reflux Disease)?

Answer 2

• Limit irritating foods (Tomato-based products, orange juice, cola, red wine)
• Limit foods that decrease LES pressure (Chocolate, peppermint, fatty foods, coffee, tea)
• Avoid smoking and alcohol
• Avoid milk and eating before bedtime
• Eat meals 2 hours before laying supine
• Encourage small meals and fluids between meals
• Wear nonrestrictive clothing
• Maintain ideal body weight

Question 3

How should a patient with GERD be resting?

Answer 3

Patient should sleep on right side with HOB elevated

Question 4

What are risk factors of PUD (Peptic Ulcer Disease)?

Answer 4

• H. pylori
• Medication-induced injury
  
  • NSAIDs
  • Corticosteroids
  • Anticoagulants
• Lifestyle factors
  
  • Alcohol use
  • Smoking
  • Coffee
  • Psychologic distress and depression can delay healing of present ulcers

Question 5

What are some ways to diagnose PUD?

Answer 5

• Upper GI Endoscopy: direct visualization; most accurate
  
  • Obtain specimens for H. pylori
  • Rule out stomach cancer
• Gold standard for diagnosing H. pylori
  
  • Biopsy of antral mucosa with testing for urease
• Non-invasive tests: serology, stool, breath testing
• Other tests: barium contrast, high fasting serum gastrin levels, secretin stimulation
• Labs: CBC, liver enzymes, serum amylase
• Stool is tested for blood

Question 6

What are some medications for PUD?

Answer 6

• Antacids
• Antibiotics and PPI to eliminate H. pylori
  
  • 14 days of PCN with PPI
  • If allergic to PCN, metronidazole used
• Cytoprotective drug therapy: sucralfate
  
  • Protects esophagus, stomach, and duodenum
  • Works best in low pH; give at least 1 hour before or after antacid

Question 7

Surgical management for PUD?

Answer 7

• Indicated with nonhealing and bleeding ulcers
• Endoscopic procedures

Question 8

What are the complications of PUD?

Answer 8

• GI bleeding
• perforation (most lethal)
• gastric outlet obstruction

Question 9

What are manifestations of perforation?

Answer 9

• sudden, severe upper abdominal pain radiates to back and shoulders
• no relief with food or antacids
• abdomen rigid/board-like
• bowel sounds absent
• nausea and vomiting

Question 10

What are physical manifestations of PUD?

Answer 10

• Left epigastric pain (described as heartburn or indigestion; feeling full)
• Pain can also signal MI, a 12-lead EKG is performed, and the patient is monitored for any dysrhythmias

Question 11

What are some implementations for Gastritis?

Answer 11

• Administer IV fluids
• Administer medications as ordered
  
  • H2 blockers
  • Antacids
  • PPIs

Question 12

Treatment for Gastritis?

Answer 12

• Supportive care for relieving clinical manifestations
• Reducing cause of discomfort

Question 13

Surgical Management for Gastritis?

Answer 13

• Vagotomy (severs the vagus nerve to reduce secretion of acid w/in the stomach)
• Gastrectomy (partial or total removal of the stomach)

Question 14

Supportive care for acute gastritis?

Answer 14

• rest
• NPO
• IV fluids
• antiemetics; monitor for dehydration

Question 15

Lifestyle modifications for chronic gastritis?

Answer 15

• No smoking, alcohol or drugs
• 6 small meals/day; nonirritating food