Upper GI (PUD & GI Bleed) Flashcards
What is PUD?
Erosion of the GI mucosa resulting from the digestive action of HCL and Pepsin
Common causes of PUD
Helicobacter pylori - Triggers inflammation
Drugs - NSAIDs
H. pylori + NSAIDs = DOUBLE TROUBLE
Other causes of PUD
Alcohol
Smoking
Family History
Stress (can aggravate an existing ulcer)
Ulcers associated with H. pylori (think location)
Gastric Ulcer - Most of the time in the antrum of the stomach
Duodenal Ulcer - 80% of Ulcers; 90-95% have H. pylori
What is the most accurate diagnostic procedure for PUD
EGD
Tests to confirm H. pylori
Non-Invasive = Urea breath testing and stool testing (Urea = by product of metabolism of H. pyori)
Invasive = Biopsy of antral mucosa and testing for urease (gold standard for diagnosis)
Other PUD diagnostic studies
CBC - anemia
Stool - for occult blood
Acute Ulcers
Short duration; resolves quickly
Does not penetrate as deeply
Chronic Ulcers
4 Times more common
Penetrate deeply
More severe
More long term
Complications of PUD
H.O.P.
Hemorrhage - Most common complication
Obstruction
Perforation - Most lethal complication
Assessment for Hemorrhage
Assess for change in vital signs
Change in amount &/or redness of gastric aspirate
With hemorrhage, pain may decrease at first
Hemorrhage Interventions
Similar to UGI bleed
NG to LWS
When does Obstruction happen
Can happen at any time
Obstruction is most likely to occur…..
If ulcer is located close to pylorus
T/F: Obstruction has a rapid onset of symptoms
False: Obstruction has a gradual onset of symptoms
Obstruction interventions
NG to LWS until resolved
Irrigate gut as needed per protocol
Onset of Perforation
Sudden and dramatic
Initial phase (0-2 hours) = sudden, severe upper abdominal pain; spreads throughout abdomen; radiates to back; not relieved by food or antacids.
Signs of Perforation
Pain:
Sudden, severe upper abdominal pain; spreads throughout abdomen; radiates to back; not relieved by food or antacids.
Abdomen = Rigid/ Board like
Respirations = Shallow and Rapid
Pulse = Weak and Tachycardic
Bowel sounds = May be absent
How soon after Perforation can Bacterial Peritonitis occur
Within 6-12 hours
Rebound Tenderness
An unexpected finding
Cue of Peritonitis
No pain when compressing on palpation. Pain occurs when you take the pressure off of the abdomen.
PUD: Collaborative care
Adequate Rest = Decrease in stress response
Smoking cessation
Individual dietary modifications as needed (no specific diet)
PUD: Drug therapy
Stop Aspirin and NSAIDs for 4-6 weeks.
If Aspirin must be continued, give with a PPI
Antibiotics if H. pylori
PPI
Cytoprotective (sucralfate)
Refractory PUD: Surgical options
Billroth reconstruction following gastrectomy
Billroth 1 and Billroth 2
Both methods of reconstruction of gut path
PUD: Post op Complications
Dumping syndrome
What is Dumping Syndrome?
Food (undigested and hyperosmolar) dumps into the small intestine
Develops most often when part of the stomach has been removed
- Gastrectomy
- Fundoplication
- Roux-en-Y (Gastric bypass surgery)
Dumping Syndrome: Why does it happen?
Bolus of hypertonic food dumps into small intestines. Manifestations are a result of fluid rapidly shifting out of the plasma and into the GI tract.
Clinical Manifestations of Dumping Syndrome
Weakness, sweating, palpitations, dizziness
Abdominal cramping, borborygmi, urge to defecate - diarrhea
When do symptoms of dumping syndrome occur
15 minutes after eating a hyperosmolar meal
T/F: Treatment for Dumping syndrome is to avoid concentrated sweets.
True: avoid drinking them during meals. Drink them between meals.
What is a consequence of Dumping Syndrome?
Postprandial Hypoglycemia (after meal hypoglycemia)
Postprandial Hypoglycemia: How does it work?
Bolus of fluid high in CHO into small intestines - > Results in hyperglycemia - > Release in excessive amounts of insulin - > results in Hypoglycemia about 2 hours after eating
How to manage Dumping Syndrome
No large meals
6 small meals per day
Fluids should not be taken with meal (30 mins before or 30 mins after)
Avoid concentrated sweets
Proteins and fats encouraged to promote rebuilding tissue Post - op
Rest period after eating
Symptoms are self limiting (months to year)
Characteristics of Upper GI bleed
Slow (insidious) vs Sudden onset
Hematemesis
- Bright red (frank) blood indicates recent/ongoing GI bleed
- Coffee ground indicates significant bleed has stopped
Melena (black, tarry stool) - Transit time > 8 hours
Occult blood - Not apparent by appearance
- + for Guaiac
Upper GI bleed causes
Esophageal Varices
Stomach and Duodenal Ulcers (~50% of UGI bleeds)
Esophageal Varices occurs with…
Severe Portal Hypertension and cirrhosis
What device is used for Esophageal Varices bleed?
Sengstakin-Blakemore tube
- NG with a balloon that applies direct pressure to the Varices
- Pt will ultimately end up in ICU
Nursing Interventions for UGI bleed
Monitor Vital Signs closely (Baseline/trend/orthostatic)
Assess S/S of Hypovolemia (Rapid loss in blood volume = Hypovolemic Shock) (Change in VS, Increased thirst, Cold clammy skin, Restlessness)
Assess S/S of peritonitis (rigid board-like abdomen/Distention/guarding)
Monitor Labs H&H/BUN (BUN can increase with GI bleed)
Related Nursing Interventions: UGI bleed
Establish large bore IV access - anticipate giving PRBCs
NG Lavage to rid stomach of blood
Administer appropriate meds
Prepare for endoscopy/endotherapy
Patient Teaching: UGI bleed
Know/understand meds that are given
- Antacids, PPI, H2 blockers, protective barriers, PCN’s
- Avoid ASA/NSAIDs
Teach patient about S/S of GI bleed
