Week 1 - Gastric and Duodenal Disorders Flashcards
Periodontal disease
What is it?
What does it lead to?
Infection/inflammation of gums and tissue surrounding the teeth
May lead to tooth loss
Dental plaque and caries
What is it?
Prevention?
Plaque- sticky film buildup on teeth
Caries - Tooth decay d/t plaque
Prevention:
- Cleaning teeth often
- Fluoride
Achalasia
What is it?
s/s?
Absent or ineffective peristalsis
“Lower esophageal muscles tighten so food isn’t moving down digestive system well”
s/s: Dysphagia with solid food, regurgitation, pyrosis
Achalasia
Labs
Diagnostics
“This has to do with muscle function, so you really just have to see what’s going on”
Diagnostics:
- X-Ray, CT Scan
- Endoscopy
- Manometry = confirms diagnosis
Achalasia
Patient education
Pt education:
- Eat slowly
- Drink fluid w/ meals
Achalasia
Treatment
Treatment:
- Dilation
- Surgery (esophagomyotomy; cutting esophageal muscle fibers), if severe
Think: “Need to loosen the lower esophageal muscles”
Esophageal Spasm:
What is it?
s/s?
Muscular spasm interrupting normal peristalsis
s/s: Dysphagia, pyrosis, regurgitation, chest pain
Three types:
1) Jackhammer = spasms on >20% of swallows
2) Diffuse esophageal spasm (DES) = spasms are normal but premature, and spread out
3) Spastic Achalasia = lower esophageal sphincter obstruction
Esophageal spasm:
Diagnostics
Diagnostics:
- Esophageal manometry
Esophageal spasm:
Treatment
Management:
- Small, frequent feedings
- Soft diet
Treatment:
- Muscle relaxants (e.g. calcium channel blockers and nitrates)
- Proton pump inhibitors
Diverticulum
What is it?
s/s?
Outpouching of the mucosa protruding through musculature
s/s:
- Dysphagia
- regurgitation
- fullness in the neck
- belching
Diverticulum:
Diagnostics
Diagnostics:
- Manometric studies
- Barium swallow
Esophagoscopy is usually contraindicated
Diverticulum:
Management
Treatment
Post-Op
Management:
Avoid NG tube insertion
Treatment:
- Diverticulectomy
Post-Op:
- Observe incision foe leakage & fistula
- Diet begins w/ liquid
Perforation:
What is it?
Causes?
s/s?
Hole, tear in the esophagus; life-threatening injury
Cause:
- Spontaneous: forceful vomiting, severe straining, foreign object, trauma
- Endoscopy, operative
s/s: Dysphagia, severe pain, dysphagia, infection/fever
Perforation:
Diagnostics
Lab/Diagnostic: X-ray, fluoroscopy, Chest CT scan
Perforation:
Treatment
Pre-Op
Post-Op
Treatment: Prepare for surgery (repair of the perforation site), or esophagostomy (removal of esophagus)
Nursing:
- pre-surgery pt is: NPO, IV fluids, broad antibiotics
- post-surgery pt is: NPO 7 days, enteral (like jejunal) or parenteral nutrition
Hiatal Hernia:
What is it?
s/s?
The opening in the diaphragm where the esophagus passes becomes enlarged, then part of the upper stomach moves into the chest cavity
think: “esophagus expands, so stomach contents can come up more easily”
s/s to assess for: dysphagia, pyrosis, regurgitation, nausea/vomiting
Hiatal Hernia:
Diagnostics
Diagnostics:
- X-ray, barium swallow
-Esophagogastroduodenoscopy (EGD)
- Esophageal manometry
- CT scan
Hiatal Hernia:
Management
Treatment
Management:
- Frequent, small feedings
- Elevate HOB
Treatment:
- Surgery, primarily to relieve GERD, not repair hernia
Post-Op:
- Liquid diet initially
- Monitor nausea, vomiting
Gastroesophageal Reflux Disease (GERD):
What is it?
Cause?
s/s?
Backflow of gastric/duodenal contents into esophagus which = injury to esophagus
Causes:
- Incompetent lower esophageal sphincter
- Pyloric stenosis
- Hiatal hernia
- Motility disorder
s/s:
- Pyrosis
- regurgitation
- dyspepsia (indigestion)
- dysphagia
- Dental erosion
GERD:
Diagnostics
Labs
Lab/Diagnostic:
- Ambulatory pH monitoring (gold standard)
- PPI trial
- Patient hx
Treatment / Nursing Education: Low fat diet, avoid caffeine-tobacco-beer-milk-mint-carbonated beverages, avoid eating 2hrs before before, elevate HOB 30 degrees,
Risk factors: tobacco, coffee and alcohol consumption
GERD:
Management
Treatment
Management:
- Educate pt: decrease lower esophageal sphincter pressure & avoid esophageal irritation
- Avoid tobacco, alcohol
- Weight loss
- Avoid eating before bed & Elevate HOB
Treatment:
- Surgery = Laparoscopic Nissen fundoplication: Wrap portion of gastric fundus around sphincter of esophagus
Gastritis:
What is it?
Causes?
Disruption of the mucosal barrier that normally protects the stomach tissue from digestive juices
Causes (acute):
- Dietary indiscretion
- alcohol, meds
- strong acid or alkali
Causes (Chronic):
- Prolonged inflammation
- benign or malignant ulcers of the stomach
- Helicobacter pylori
ACUTE Gastritis:
Causes for Erosive & nonerosive
Erosive:
- Irritants (aspirin, NSAIDS, alcohol, corticosteroids
Nonerosive:
- H. Pylori
Gastritis:
s/s for acute & chronic
Acute:
- Epigastric pain
- Dyspepia, anorexia
- N/V
- May lead to melena, hematemesis, hematochezia
Chronic:
- Pernicious anemia d/t malabsorption of B12
- Fatigue, anorexia
- Pyrosis, sour taste in mouth, halitosis
- Nausea, vomiting
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