Week 3 - GI Flashcards
General GI problems include:
- N/V
- Diarrhea
- Constipation
- Irritable Bowel Syndrome
Upper GI Problems include:
- GERD
- Gastritis
- PUD
- Hiatal Hernia
- Upper GI Bleed
Lower GI Problems include:
- Acute ABD Pain
- Appendicitis
- Peritonitis
- Intestinal Obstruction
- Diverticulosis/Diverticulitis
- Hernia
Key points to remember with general GI issues; nausea/vomiting:
Fluid status/ dehydration
>Hypovolemia symptoms
Electrolytes
Key points to remember with upper GI problems
(GERD, gastritis, PUD, hiatal hernia, upper GI bleed):
Lifestyle/ food choices
Life-threatening (bleeding)
Surgery-endoscopy
PPI & H2 blockers
Key points to remember with lower GI problems
(acute ABD pain, appendicitis, peritonitis, obstruction, diverticulosis/diverticulitis, hernia)
Emergency
Infection
Surgical procedures often required
Key points to remember with IBD
anemia
nutrition
psychosocial
Key points to remember with obesity/stomach cancer:
Lifestyle (food, exercise, health risks)
Stomach cancer- pain management, post-surgical needs
Most common manifestations of GI disease:
nausea
Vomiting - Forceful __________ of _________________________ (emesis) from upper GI tract
Vomiting - Forceful ejection of partially digested food and secretions (emesis) from upper GI tract
Nausea & vomiting Occurs from
-GI disorders
- Pregnancy
- Infection
-CNS disorders
-Cardiovascular problems
-Metabolic disorders
-General anesthesia
- Side effects of drugs
- Psychologic factors
-Over irritated GI tract
-GI disorders
- Pregnancy
- Infection
-CNS disorders
-Cardiovascular problems
-Metabolic disorders
-General anesthesia
- Side effects of drugs
- Psychologic factors
-Over irritated GI tract
Nausea - Feeling of discomfort in __________ area with a conscious desire to ________
Nausea - Feeling of discomfort in epigastric area with a conscious desire to vomit
Vomiting is a complex act
- Requires ___________ activity
- Closure of _______
- Deep inspiration with contraction of diaphragm
- Closure of _________
- Relaxation of stomach and LES
- _____________ of abdominal muscles
- Requires coordinated activity
- Closure of glottis
- Deep inspiration with contraction of diaphragm
- Closure of pylorus
- Relaxation of stomach and LES
- Contraction of abdominal muscles
[N/V] Chemoreceptor trigger zone (CTZ)
- Located in _____________
- Responds to chemical stimuli of drugs, toxins, labyrinthine stimulation
- Site of action of drugs used to induce ________
- Transmits impulses to __________________
- Located in brainstem
- Responds to chemical stimuli of drugs, toxins, labyrinthine stimulation
- Site of action of drugs used to induce vomiting
- Transmits impulses to vomiting center
Nausea
- ____________ complaint
-Usually accompanied by __________
-Subjective complaint
-Usually accompanied by anorexia
Vomiting Complications
- _______________ can rapidly develop when nausea and vomiting is prolonged
- Loss of water and essential ___________
- Metabolic ___________: from loss of gastric HCl
- Metabolic ___________: from loss of bicarbonate if contents from small intestine are vomited
- Weight loss from fluid loss can occur
- Dehydration can rapidly develop when nausea and vomiting is prolonged
- Loss of water and essential electrolytes
- Metabolic alkalosis: from loss of gastric HCl
- Metabolic acidosis: from loss of bicarbonate if contents from small intestine are vomited
- Weight loss from fluid loss can occur
Contents of emesis
- Fecal odor and bile indicate a ________ intestinal obstruction
- ________ of emesis aids in determining presence and source of any bleeding
- Fecal odor and bile indicate a lower intestinal obstruction
- Color of emesis aids in determining presence and source of any bleeding
N/V PHARMACOLOGY
Many antiemetics act on CNS in CTZ to block _____________ that trigger _________________
Many antiemetics act on CNS in CTZ to block neurochemicals that trigger nausea and vomiting
N/V PHARMACOLOGY
Serotonin (5-HT3) receptor antagonists
- Ondansetron (________)
Used to treat
- Chemotherapy-induced vomiting (CINV)
- Migraine headache
- Anesthesia
- Anxiety
- Postoperative nausea and vomiting (PONV)
Zofran
N/V PHARMACOLOGY
Neurokinin-1 receptor agonist (NK1RA)
- Aprepitant (Emend)
Phenothiazines
- Prochlorperazine
- Chlorpromazine
Anticholinergics
- Scopolamine transdermal (Transderm-Scōp)
Antihistamines
- Dimenhydrinate
- Meclizine
- Hydroxyzine
- Diphenhydramine
Neurokinin-1 receptor agonist (NK1RA)
- Aprepitant (Emend)
Phenothiazines
- Prochlorperazine
- Chlorpromazine
Anticholinergics
- Scopolamine transdermal (Transderm-Scōp)
Antihistamines
- Dimenhydrinate
- Meclizine
- Hydroxyzine
- Diphenhydramine
N/V PHARMACOLOGY
Other drugs with antiemetic properties
- Dexamethasone
- Cannabinoid
- Dronabinol (Marinol)
- Benzamides
- Metoclopramide (Reglan)
- Dexamethasone
- Cannabinoid
- Dronabinol (Marinol)
- Benzamides
- Metoclopramide (Reglan)
N/V TREATMENT
-IV therapy to replace fluids, electrolytes, glucose
-NG tube suction to decompress stomach
-Clear liquids after symptoms subside
-5–15 mL fluid every 15–20 minutes
-No extremely hot/cold liquids
-Room-temperature carbonated beverages without carbonation okay
-Warm tea
-Begin with dry toast, crackers
-High-carbohydrate, low-fat foods next, because they are easier to digest
-Baked potato, plain gelatin, cereal with milk
-Eat slowly and in small amounts
-IV therapy to replace fluids, electrolytes, glucose
-NG tube suction to decompress stomach
-Clear liquids after symptoms subside
-5–15 mL fluid every 15–20 minutes
-No extremely hot/cold liquids
-Room-temperature carbonated beverages without carbonation okay
-Warm tea
-Begin with dry toast, crackers
-High-carbohydrate, low-fat foods next, because they are easier to digest
-Baked potato, plain gelatin, cereal with milk
-Eat slowly and in small amounts
N/V NURSING ACTIONS - Persistent vomiting
-Hospitalization
- IV fluids
-Nothing-by-mouth (NPO) status
- NG tube may be used for possible obstruction
- Record I & O
- Monitor VS
- Assess for signs of dehydration
- Maintain quiet, odor-free environment
-Hospitalization
- IV fluids
-Nothing-by-mouth (NPO) status
- NG tube may be used for possible obstruction
- Record I & O
- Monitor VS
- Assess for signs of dehydration
- Maintain quiet, odor-free environment
DIARRHEA
-At least ____ loose or liquid stools per day
-Chronic diarrhea last > ____ days
3;
30
DIARRHEA Primary Cause
- Ingesting ________________
- _________ – most are mild and last 24 hours; however some can cause serious complications leading to death
- _________ - most common cause of bloody diarrhea in US
- Ingesting infectious organism
- Viruses – most are mild and last 24 hours; however some can cause serious complications leading to death
- E-coli most common cause of bloody diarrhea in US
DIARRHEA
Diagnostics - Only in __________ cases
Treatment - Depends on cause
- Fluid & Electrolytes
- Acid/base imbalance – severe cases
Safety - ___________!
Diagnostics - Only in prolonged cases
Treatment - Depends on cause
- Fluid & Electrolytes
- Acid/base imbalance – severe cases
Safety - Hypotension!
_______________ - defined by difficult or infrequent stools, hard, dry stools, stools that are difficult to pass, or feelings of incomplete evacuation
CONSTIPATION
Common causes of constipation
- ___________
- Insufficient dietary _______
- Decreased physical activity
- Ignoring urge to defecate
- Dehydration
- Insufficient dietary fiber
- Decreased physical activity
- Ignoring urge to defecate
CONSTIPATION
A ___________ in the frequency of bowel movements from what is “normal” for the individual
Hard, difficult-to-pass stools; decrease in stool volume; and/or _________ of feces in the rectum
A decrease in the frequency of bowel movements from what is “normal” for the individual
Hard, difficult-to-pass stools; decrease in stool volume; and/or retention of feces in the rectum
IBS - Chronic abd discomfort/pain and alterations between:
constipation and diarrhea
IBS Has no known organic cause at this time - symptoms intermittent
- Abdominal pain
- Diarrhea or constipation
- Abdominal distention
- Excessive flatulence
- Bloating
- Urgency
- Sensation of incomplete evacuation
- Abdominal pain
- Diarrhea or constipation
- Abdominal distention
- Excessive flatulence
- Bloating
- Urgency
- Sensation of incomplete evacuation
IBS
Diagnosed based on symptoms
No single treatment
- Depends on presentation / symptoms
- Avoid ________/____________ that cause/contribute
- Psychosocial factors are important to treatment
- Cognitive Behavior Therapy and ________ management
- Depends on presentation / symptoms
- Avoid foods/situations that cause/contribute
- Psychosocial factors are important to treatment
- Cognitive Behavior Therapy and stress management
IRRITABLE BOWEL SYNDROME (IBS) Diagnosis
- Rule out other causes
Rome criteria III
- ____ months of abdominal pain with:
— Relieved with _____________
— Onset associated with _________ in stool frequency
— Onset associated with a __________ in stool appearance
- 3 months of abdominal pain with:
— Relieved with defecation
— Onset associated with change in stool frequency
— Onset associated with a change in stool appearance
GERD
-Common problem
-Chronic symptom of ___________ damage
-Not a disease, but a __________
-No one single cause
-Results when defenses of lower esophagus are overwhelmed by _______________________ gastric contents into lower esophagus
-Common problem
-Chronic symptom of mucosal damage
-Not a disease, but a syndrome
-No one single cause
-Results when defenses of lower esophagus are overwhelmed by reflux of acidic gastric contents into lower esophagus
GERD Predisposing factors
- Incompetent lower esophageal sphincter (LES)
- Decreased LES pressure
- Increased intraabdominal pressure
- Hiatal hernia
- Incompetent lower esophageal sphincter (LES)
- Decreased LES pressure
- Increased intraabdominal pressure
- Hiatal hernia
GERD
Incompetent _____
- Primary factor in GERD
- Results in ↓ pressure in distal portion of esophagus
- Gastric contents move from stomach to esophagus
- Can be due to certain foods (caffeine, chocolate) and drugs (_______________)
Incompetent LES
- Primary factor in GERD
- Results in ↓ pressure in distal portion of esophagus
- Gastric contents move from stomach to esophagus
- Can be due to certain foods (caffeine, chocolate) and drugs (anticholinergics)
GERD SYMPTOMS
_____________
- Most common clinical manifestation
- Burning, tight sensation felt beneath lower sternum and spreading upward to throat or jaw
- Felt intermittently
Other symptoms of GERD
- Dyspepsia
- Regurgitation
- Described as hot, bitter, or sour liquid coming into throat or mouth
GERD-related ________________
- Described as burning, squeezing
- Radiating to back, neck, jaw, or arms
- Can mimic angina
- More common in older adults with GERD
- Relieved with antacids
Heartburn
- Most common clinical manifestation
- Burning, tight sensation felt beneath lower sternum and spreading upward to throat or jaw
- Felt intermittently
Other symptoms of GERD
- Dyspepsia
- Regurgitation
- Described as hot, bitter, or sour liquid coming into throat or mouth
GERD-related chest pain
- Described as burning, squeezing
- Radiating to back, neck, jaw, or arms
- Can mimic angina
- More common in older adults with GERD
- Relieved with antacids
What foods can exacerbate GERD?
caffeine
chocolates
spicy foods
More GERD symptoms
May report respiratory symptoms
- Wheezing
- Coughing
- Dyspnea
- Nocturnal discomfort and coughing with loss of sleep
Otolaryngologic symptoms include
- Hoarseness
- Sore throat
- Globus sensation (Lump in throat)
- Hypersalivation
- Choking
May report respiratory symptoms
- Wheezing
- Coughing
- Dyspnea
- Nocturnal discomfort and coughing with loss of sleep
Otolaryngologic symptoms include
- Hoarseness
- Sore throat
- Globus sensation (Lump in throat)
- Hypersalivation
- Choking
GERD COMPLICATIONS
- Related to direct local effects of gastric acid on esophageal mucosa
- Esophagitis
- Inflammation of esophagus
- Frequent complication
- Repeated exposure: scar formation, esophageal stricture, dysphagia
- Related to direct local effects of gastric acid on esophageal mucosa
- Esophagitis
- Inflammation of esophagus
- Frequent complication
- Repeated exposure: scar formation, esophageal stricture, dysphagia
GERD COMPLICATION- Barrett’s esophagus
- __________ esophagus (esophageal metaplasia)
- Replacement of flat epithelial cells with ____________ epithelium
- Precancerous lesion
- Thought to be primarily due to GERD
- Diagnosed in ________ % of patients with chronic reflux
- Signs and symptoms: none to perforation
- Must be monitored every 2–3 years by endoscopy
Barrett’s esophagus
- Barrett’s esophagus (esophageal metaplasia)
- Replacement of flat epithelial cells with columnar epithelium
- Precancerous lesion
- Thought to be primarily due to GERD
- Diagnosed in 5% to 20% of patients with chronic reflux
- Signs and symptoms: none to perforation
- Must be monitored every 2–3 years by endoscopy
GERD COMPLICATIONS - ______________
- From irritation of upper airway by secretions
- Cough
- Bronchospasm
- Laryngospasm
- Potential for asthma, bronchitis, and pneumonia
Respiratory
- From irritation of upper airway by secretions
- Cough
- Bronchospasm
- Laryngospasm
- Potential for asthma, bronchitis, and pneumonia
GERD COMPLICATIONS - ________ erosion
- From acid reflux into mouth
- Especially __________ teeth
Dental erosion
- From acid reflux into mouth
- Especially posterior teeth
GERD Diagnostics
- Upper GI ____________
- Assesses LES competence
- Biopsy of tissue
endoscopy
GERD - Nutritional therapy
- Avoid foods that decrease LES pressure or irritate the esophagus
- chocolate, peppermint, tomatoes, coffee, and tea
- Small, frequent meals
- Avoid certain foods (tomato-based, orange juice, cola, red wine) may irritate esophagus
- Avoid ______________ meals
- Drink fluids between meals so as to not over distend the stomach during meals
- Chewing gum and oral lozenges
- Increase saliva production may help with mild symptoms
- Avoid foods that decrease LES pressure or irritate the esophagus
- chocolate, peppermint, tomatoes, coffee, and tea
- Small, frequent meals
- Avoid certain foods (tomato-based, orange juice, cola, red wine) may irritate esophagus
- Avoid late evening meals
- Drink fluids between meals so as to not over distend the stomach during meals
- Chewing gum and oral lozenges
- Increase saliva production may help with mild symptoms
GERD PHARMACOLOGY - Proton pump inhibitors (PPIs)
- Decrease ______ secretion
- Promote esophageal healing in 80% to 90% of patients
- Available in prescription and OTC preps
- Example: ___________ (Prilosec)
- ___________: Most common side effect
- Long-term use or high doses of PPIs may increase risk of __________ of hip, wrist, and spine
- Associated with increased risk of C. difficile infection in hospitalized patients
- Decrease acid secretion
- Promote esophageal healing in 80% to 90% of patients
- Available in prescription and OTC preps
- Example: omeprazole (Prilosec)
- Headache: Most common side effect
- Long-term use or high doses of PPIs may increase risk of fractures of hip, wrist, and spine
- Associated with increased risk of C. difficile infection in hospitalized patients
Proton pump inhibitors (PPIs) and ________________ receptor (H2R) blockers are the most common and effective treatments for symptomatic GERD
histamine-2
GERD PHARMACOLOGY - Histamine-2 receptor (H2R) blockers
- Decrease secretion of __________
- Reduce symptoms and promote esophageal healing in ___% of patients
- Example: cimetidine
- Side effects uncommon
Histamine-2 receptor (H2R) blockers
- Decrease secretion of HCl acid
- Reduce symptoms and promote esophageal healing in 50% of patients
- Example: cimetidine
- Side effects uncommon
[GERD]
-PPIs are more effective in healing esophagitis than H2-receptor blockers.
-PPIs beneficial in decreasing incidence of esophageal ___________, complication of chronic GERD.
strictures
[GERD]
-PPI’s are available in prescription or OTC preparations. Therapy should start with __________ dosing, before the first meal of the day
once a day
GERD PHARMACOLOGY - Antacids
- ________ but short-lived relief
- ____________ HCl acid
- Taken 1–3 hours after meals/at bedtime
- Example: Maalox, Mylanta
- Quick but short-lived relief
- Neutralize HCl acid
- Taken 1–3 hours after meals/at bedtime
- Example: Maalox, Mylanta
GERD SURGERY/INTERVENTIONS
-Nissen and Toupet fundoplications
-LINX Reflux Management System
> Titanium beads w/ magnetic core strung together and implanted laparoscopically into LES
-Nissen and Toupet fundoplications
-LINX Reflux Management System
> Titanium beads w/ magnetic core strung together and implanted laparoscopically into LES
GERD NURSING ACTIONS
-Elevate head of bed ___ degrees
-Do not ___________ for 2–3 hours after eating
-Avoid factors that cause reflux
-Stop __________
-Avoid alcohol and caffeine
-Avoid ________ foods
-Stress reduction techniques
-Weight reduction, if appropriate
-Small, frequent meals
-Elevate head of bed 30 degrees
-Do not lie down for 2–3 hours after eating
-Avoid factors that cause reflux
-Stop smoking
-Avoid alcohol and caffeine
-Avoid acidic foods
-Stress reduction techniques
-Weight reduction, if appropriate
-Small, frequent meals
GASTRITIS - Inflammation of ____________________
gastric mucosa
GASTRITIS
-One of most common problems affecting the stomach
-May be acute or chronic
-Result of a breakdown in gastric __________________
-Stomach tissue unprotected from ______________ by HCl acid and pepsin
-Diagnosed by symptoms and history
-One of most common problems affecting the stomach
-May be acute or chronic
-Result of a breakdown in gastric mucosal barrier
-Stomach tissue unprotected from autodigestion by HCl acid and pepsin
-Diagnosed by symptoms and history
GASTRITIS
Stomach acid and pepsin can diffuse back into the mucosa resulting in:
-Tissue ________
- ____________ of capillary walls
- With loss of plasma into gastric lumen
-Possible hemorrhage
Stomach acid and pepsin can diffuse back into the mucosa resulting in:
-Tissue edema
- Disruption of capillary walls
- With loss of plasma into gastric lumen
-Possible hemorrhage
GASTRITIS Risk factors
- Drugs
- Direct irritating effect on gastric mucosa
- _________ , including aspirin and corticosteroids, inhibit prostaglandin synthesis
Risk factors for NSAID-induced gastritis
- Being _________
- Being over age ____
- History of ulcer disease
- Taking anticoagulants, other NSAIDs, or ulcerogenic drugs
- Having chronic debilitating disorder
- Drugs
- Direct irritating effect on gastric mucosa
- NSAIDs, including aspirin and corticosteroids, inhibit prostaglandin synthesis
Risk factors for NSAID-induced gastritis
- Being female
- Being over age 60
- History of ulcer disease
- Taking anticoagulants, other NSAIDs, or ulcerogenic drugs
- Having chronic debilitating disorder
ACUTE GASTRITIS Risk factors
Diet- ____________________
Microorganisms
- __________________
- Important cause of chronic gastritis
- Promotes breakdown of gastric mucosal barrier
- Other bacterial, viral, and fungal infections may play a role
Diet- Alcoholic drinking binge and alcohol use
Microorganisms
- Helicobacter pylori
- Important cause of chronic gastritis
- Promotes breakdown of gastric mucosal barrier
- Other bacterial, viral, and fungal infections may play a role
ACUTE GASTRITIS S/S
Self-limiting, lasts a few hours to a few days, complete healing of mucosa expected
- Anorexia
- Nausea
- Vomiting
- Epigastric tenderness
- Feeling of fullness
- Hemorrhage
- Common with alcohol abuse
Self-limiting, lasts a few hours to a few days, complete healing of mucosa expected
- Anorexia
- Nausea
- Vomiting
- Epigastric tenderness
- Feeling of fullness
- Hemorrhage
- Common with alcohol abuse
CHRONIC GASTRITIS - Symptoms are similar to those of acute gastritis
-Loss of __________ factor can occur when acid-secreting cells are lost or nonfunctioning
- Essential for absorption of cobalamin (vitamin B12)
- Once body’s cobalamin stores in the liver are depleted, state of __________________ exists.
- Because it is essential for the growth and maturation of RBCs, the lack of cobalamin results in ____________________ and neurologic complications
-Loss of intrinsic factor can occur when acid-secreting cells are lost or nonfunctioning
- Essential for absorption of cobalamin (vitamin B12)
- Once body’s cobalamin stores in the liver are depleted, state of cobalamin deficiency exists.
- Because it is essential for the growth and maturation of RBCs, the lack of cobalamin results in pernicious anemia and neurologic complications
GASTRITIS Treatment
- Eliminating the cause
- Supportive care similar to N/V
If vomiting
- Rest
- NPO
- IV fluids
- Antiemetics
If patient is at risk for hemorrhage
-Frequent VS
- Test vomitus for blood
Focuses on evaluating and eliminating specific cause
-Cessation of alcohol intake
- Abstinence from drugs
-H. pylori irradication: antibiotics
Patient with pernicious anemia- Lifelong cobalamin therapy
- Eliminating the cause
- Supportive care similar to N/V
If vomiting
- Rest
- NPO
- IV fluids
- Antiemetics
If patient is at risk for hemorrhage
-Frequent VS
- Test vomitus for blood
Focuses on evaluating and eliminating specific cause
-Cessation of alcohol intake
- Abstinence from drugs
-H. pylori irradication: antibiotics
Patient with pernicious anemia- Lifelong cobalamin therapy
GASTRITIS - Lifestyle changes
Diet
Alcohol
Smoking
cessation
PEPTIC ULCER DISEASE (PUD) - _________________________ resulting from digestive action
of HCl acid and pepsin
Erosion of GI mucosa
PEPTIC ULCER DISEASE (PUD)
-About ___ million people in United States are affected by PUD in their lifetime
Ulcer development can occur in
- Lower esophagus
- Stomach
- Duodenum
- Margin of gastrojejunal anastomosis after surgical procedures
25
PEPTIC ULCER DISEASE (PUD)- Acute VS chronic
- Depends on degree and duration of mucosal involvement
Acute
- __________ erosion
- Minimal inflammation
- _______ duration: resolves quickly when cause is identified and removed
Chronic
- _______ duration
- ____________ wall erosion with formation of fibrous tissue
- Present continuously for many months or intermittently throughout person’s lifetime
- More common than acute erosions
Acute
- Superficial erosion
- Minimal inflammation
- Short duration: resolves quickly when cause is identified and removed
Chronic
- Long duration
- Muscular wall erosion with formation of fibrous tissue
- Present continuously for many months or intermittently throughout person’s lifetime
- More common than acute erosions
PUD - Gastric or duodenal - Differ in their incidence and presentation !
Gastric or duodenal - Differ in their incidence and presentation !
PUD - Destroyers of mucosal barrier
-___________
- Produces enzyme urease
-Urease activates immune response
- Antibody production
- Release of inflammatory cytokines
- Response to H. pylori is variable
________________
- Inhibit prostaglandin synthesis
-Increase gastric acid secretion
- Reduce integrity of the mucosal barrier
- Responsible for majority of non-H. pylori peptic ulcers
- NSAIDs in presence of H. pylori increase risk of PUD
-H. pylori
- Produces enzyme urease
-Urease activates immune response
- Antibody production
- Release of inflammatory cytokines
- Response to H. pylori is variable
Aspirin and NSAIDs
- Inhibit prostaglandin synthesis
-Increase gastric acid secretion
- Reduce integrity of the mucosal barrier
- Responsible for majority of non-H. pylori peptic ulcers
- NSAIDs in presence of H. pylori increase risk of PUD
PUD - other destroyers of mucosal barrier
_______________
↓ Rate of mucosal cell renewal
↓ Protective effects
Lifestyle factors
- Alcohol and coffee stimulate acid secretion
- Alcohol stimulates acid secretion.
- Coffee (caffeinated and decaffeinated) is a strong stimulant of gastric acid secretion.
- Smoking and psychologic distress
Corticosteroids
↓ Rate of mucosal cell renewal
↓ Protective effects
Lifestyle factors
- Alcohol and coffee stimulate acid secretion
- Alcohol stimulates acid secretion.
- Coffee (caffeinated and decaffeinated) is a strong stimulant of gastric acid secretion.
- Smoking and psychologic distress
PUD (GASTRIC ULCER)
-Occur in any portion of stomach
-Less common than duodenal ulcers
-More prevalent in women
-Peak incidence >___ years of age
-More likely than duodenal ulcers to result in obstruction
- Pain generally high in epigastrium
- 1–2 hours after meals
- “____________ ” or “gaseous”
- Food aggravates pain if ulcer has eroded through gastric mucosa
-Occur in any portion of stomach
-Less common than duodenal ulcers
-More prevalent in women
-Peak incidence >50 years of age
-More likely than duodenal ulcers to result in obstruction
- Pain generally high in epigastrium
- 1–2 hours after meals
- “Burning” or “gaseous”
- Food aggravates pain if ulcer has eroded through gastric mucosa
PUD Risk factors
- H. pylori
- Medications
- Bile reflux
- Alcohol use and _________ are associated with ulcer formation
- Multiple stress ulcers of the stomach, highlighted by ______, digested blood on their surfaces.
- H. pylori
- Medications
- Bile reflux
- Alcohol use and smoking are associated with ulcer formation
- Multiple stress ulcers of the stomach, highlighted by dark, digested blood on their surfaces.
PUD (GASTRIC ULCER) - SRMD – Stress Related Mucosal Disease
-Also called physiologic stress ulcer
-Acute ulcers that develop after major physiologic insult
- Trauma or surgery
-Also called physiologic stress ulcer
-Acute ulcers that develop after major physiologic insult
- Trauma or surgery
PUD (DUODENAL ULCER)
Occur at _____ age and in anyone ↑ Between ages of 35 and 45 years
-Account for ~80% of all peptic ulcers
-_________ is found in 90% to 95% of patients
-Associated with increased HCl acid secretion
Increased risk of duodenal ulcers
- COPD
- Cirrhosis of liver
- Chronic pancreatitis
- Hyperparathyroidism
- Chronic kidney disease
Occur at any age and in anyone ↑ Between ages of 35 and 45 years
-Account for ~80% of all peptic ulcers
-H. pylori is found in 90% to 95% of patients
-Associated with increased HCl acid secretion
Increased risk of duodenal ulcers
- COPD
- Cirrhosis of liver
- Chronic pancreatitis
- Hyperparathyroidism
- Chronic kidney disease
Duodenal ulcer pain
- _____________ region beneath xiphoid process
- Back pain—if ulcer is located located in posterior aspect
- 2–5 hours after meals
- “Burning” or “cramplike”
- Tendency to occur, then disappear, then occur again
Midepigastric
PUD COMPLICATIONS
Three major complications
________________
________________
________________
-All considered emergency situations
-Hemorrhage
- Perforation
- Gastric outlet obstruction
PUD PERFORATION
-Most _______ complication
-Common in large penetrating duodenal ulcers
-Perforated gastric ulcers often located on lesser curvature of stomach
-Mortality rate associated with perforation of ________ ulcers is higher
-Most lethal complication
-Common in large penetrating duodenal ulcers
-Perforated gastric ulcers often located on lesser curvature of stomach
-Mortality rate associated with perforation of gastric ulcers is higher
PUD PERFORATION Clinical manifestations
- Sudden, dramatic onset
- Initial phase (0–2 hours after perforation)
- Sudden, severe upper abdominal pain- quickly spreads throughout abdomen
- Pain radiates to the back
- Rigid, boardlike abdominal muscles
- Shallow, rapid respirations
- Tachycardia, weak pulse
- Bowel sounds absent
- Nausea/vomiting
- History of reporting symptoms of indigestion or previous ulcer
- Bacterial peritonitis may occur within 6–12 hours
- Difficult to determine from symptoms alone if gastric or duodenal ulcer has perforated
- Manifestations of peritonitis are the same
- Sudden, dramatic onset
- Initial phase (0–2 hours after perforation)
- Sudden, severe upper abdominal pain- quickly spreads throughout abdomen
- Pain radiates to the back
- Rigid, boardlike abdominal muscles
- Shallow, rapid respirations
- Tachycardia, weak pulse
- Bowel sounds absent
- Nausea/vomiting
- History of reporting symptoms of indigestion or previous ulcer
- Bacterial peritonitis may occur within 6–12 hours
- Difficult to determine from symptoms alone if gastric or duodenal ulcer has perforated
- Manifestations of peritonitis are the same
PUD DIAGNOSTICS
___________ with biopsy
- Most often used as it allows for direct viewing of mucosa
- Tissue specimens can be obtained to identify H. pylori and rule out stomach cancer
- Determine degree of ulcer healing after treatment
Noninvasive tests for H. pylori
- Urea breath test
- Can determine active infection
- Stool antigen test
- Serum or whole blood antibody tests
— Immunoglobin G (IgG)
— Will not distinguish between past and current infection
Endoscopy with biopsy
- Most often used as it allows for direct viewing of mucosa
- Tissue specimens can be obtained to identify H. pylori and rule out stomach cancer
- Determine degree of ulcer healing after treatment
Noninvasive tests for H. pylori
- Urea breath test
- Can determine active infection
- Stool antigen test
- Serum or whole blood antibody tests
— Immunoglobin G (IgG)
— Will not distinguish between past and current infection
PUD TREATMENT
Treatment regimen consists of
- Adequate rest
- Drug therapy
- Smoking cessation
- Dietary modification
- Long-term follow-up care
Generally treated in ambulatory care setting
- Pain disappears after 3–6 days
- Ulcer healing requires many weeks of therapy
- Endoscopic examination most accurate method to monitor healing
Treatment regimen consists of
- Adequate rest
- Drug therapy
- Smoking cessation
- Dietary modification
- Long-term follow-up care
Generally treated in ambulatory care setting
- Pain disappears after 3–6 days
- Ulcer healing requires many weeks of therapy
- Endoscopic examination most accurate method to monitor healing
PUD TREATMENT
H. pylori eradication!
Triple drug therapy (7-14 days)
- PPI
- Amoxicillin
- Clarithromycin
Quadruple drug therapy (10-14 days)
- PPI
- Bismuth
- Tetracycline
- Metronidazole
H. pylori eradication!
Triple drug therapy (7-14 days)
- PPI
- Amoxicillin
- Clarithromycin
Quadruple drug therapy (10-14 days)
- PPI
- Bismuth
- Tetracycline
- Metronidazole
HIATAL HERNIA
-Herniation of portion of stomach into ___________ through an opening or hiatus in diaphragm
-Also referred to as diaphragmatic hernia and esophageal hernia
-Most common abnormality found on ________ GI x-ray
-More common in older adults and ________
-Herniation of portion of stomach into esophagus through an opening or hiatus in diaphragm
-Also referred to as diaphragmatic hernia and esophageal hernia
-Most common abnormality found on upper GI x-ray
-More common in older adults and women
HIATAL HERNIA - 2 types
- ________
- Stomach slides through hiatal opening in diaphragm when patient is supine, goes back into abdominal cavity when patient is standing upright
- Most __________ type - Paraesophageal or ________
- Fundus and greater curvature of stomach roll up through diaphragm, forming a pocket alongside the esophagus
- Paraesophageal junction remains in normal position
- Acute paraesophageal hernia is a medical emergency
- Sliding
- Stomach slides through hiatal opening in diaphragm when patient is supine, goes back into abdominal cavity when patient is standing upright
- Most common type - Paraesophageal or rolling
- Fundus and greater curvature of stomach roll up through diaphragm, forming a pocket alongside the esophagus
- Paraesophageal junction remains in normal position
- Acute paraesophageal hernia is a medical emergency