Management of Gastric and Duodenal Disorders

1
Management of Gastric and Duodenal Disorders
2
Gastritis

• Inflammation of the gastric mucosa
• Acute vs. Chronic
• What contributes to the development of
  gastritis?
• What is the pathophysiologic process of
  gastritis?

3
Gastritis

• Clinical Manifestations

• Assessment and Diagnostics

• Acute
• Abdominal discomfort
• Headache
• Lassitude
• Nausea/vomiting
• Anorexia
• Hicupping
• Chronic
• Anorexia
• Heartburn after eating
• Belching
• Sour taste
• Nausea/vomiting

• UGI x-ray series
• Endoscopy
• Histologic studies
• Biopsy
• Diagnostic measures for H. pylori

4
Gastritis Management

• Medical

• Nursing

• Acute
• Instruct No alcohol or food until symptoms
  resolved
• Slowly progress diet
• IVFs if dehydrated
• Manage bleeding
• Chronic
• Modify diet
• Promote rest
• Avoid alcohol and NSAIDs
• Initiate pharmacotherapy

• Reducing anxiety
• Promoting optimal nutrition
• Promoting fluid balance
• Relieving pain
• Avoid contributing foods and fluids
• Adherence to medication regimen

5
Peptic Ulcer Disease Review

• Impaired gastric mucosal defenses
• What are the two most common contributing factors
  to PUD?
• Compare and Contrast the types of peptic ulcers?
• How will peptic ulcer disease be treated?

6
Gastric Ulcers

• Clinical Manifestations

• Complications

• Epigastric tenderness
• Dyspepsia
• Melena
• Pain
• Vomiting
• S/S fluid volume deficit
• With perforation
• Rigid, boardlike abdomen
• Rebound tenderness
• Hyperactive bowel sounds that may diminish

• Hemorrhage
• Most serious
• Most common in older adult with gastric ulcers
• Perforation and penetration
• Pyloric obstruction
• Intractable disease

7
Gastric Ulcers

• Goals of therapy
• Provide pain relief
• Eradicate H. pylori
• Heal ulcerations
• What diagnostics would you anticipate?
• How will you accomplish these goals?
• What will be done if the PUD is intractable?

8
Gastric Bleeding

• Manifested as
• Hematemesis
• Often seen with large bleeds
• Bright red to coffee-grounds appearance
• Melena
• Seen with smaller, slower bleeds
• Tarry, black stools
• What symptoms might a person exhibit with a GI
  bleed?

9
Management of GI Hemorrhage

• Large bore IV access
• Serial HH
• NG with saline lavage
• Indwelling Foley
• Monitor VS and pulse oximetry
• Recumbent with feet elevated
• Describe the rationale for each intervention

10
Zollinger-Ellison Syndrome

• Characterized by
• Severe peptic ulcers
• Extreme gastric hyperacidity
• Gastrin secreting benign or malignant tumors
• Symptoms
• Early symptoms resemble PUD
• Late progressive sx, poor response to therapy,
  diarrhea, steatorrhea
• Treatment
• Suppress acid secretion
• Vagotomy and pyloroplasty
• Surgical resection and chemotherapy if malignant

11
Morbid Obesity

• body weight that is more than 100 pounds greater
  than ideal body weight p. 1217
• Describe the physical and psychosocial
  complications associated with morbid obesity.
• Identify the two anorexiants discussed in
  pathopharmacology.

12
Morbid Obesity Surgical Management

• When will Bariatric Surgery be performed?
• Describe the two mechanisms of action associated
  with bariatric surgeries?
• Describe the interventions associated with the
  patient selection process.

13
Morbid Obesity

• Surgical Procedures

• Nursing Management

• Roux-en-Y gastric bypass
• Gastric banding
• Vertical-banded gastroplasty
• Biliopancreatic diversion with duodenal switch

• Focused on post-operative care
• Similar to care of gastric resection
• Pay attention to risks of complications
• Monitor hydration status
• Monitor dietary intake and weight
• Discharge education is essential

14
Gastric Cancer

• Overview

• Clinical Manifestations

• Adenocarcinoma most common
• Etiologies
• Pernicious anemia
• Gastric polyps
• Chronic atrophic gastritis
• Achlorhydria
• Diet is a significant factor
• High in smoked, salted, or pickled foods and low
  in fruits and vegetables

• Early disease
• Pain relieved by antacids
• Similar to benign ulcer sx
• Progressive disease
• Dyspepsia
• Early satiety
• Weight loss
• Abdominal bloating pc
• Nausea/vomiting
• Sx similar to PUD

15
Gastric Cancer

• Assessment and Diagnostics

• Nursing Management

• Palpable mass in advanced disease
• Ascities
• Hepatomegaly
• Palpable periumbilical nodules
• EDG with Biopsy washings
• UGI
• Endoscopic ultrasound
• CT

• Pre-op
• Reduce anxiety
• Promote optimal nutrition
• Relieve pain
• Provide psychosocial support
• Post-op
• Reducing anxiety
• Relieving pain
• Education
• Resuming enteral nutrition
• Recognizing obstacles to adequate nutrition

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Obstacles to Adequate Nutrition

• Dumping Syndrome
• Vasomotor and GI symptoms associated with gastric
  surgery or a form of vagotomy
• GI symptoms occur with ingestion of food
• Vasomotor symptoms occur within 10-90 minutes of
  eating
• May lead to anorexia due to patient wanting to
  avoid

• Dysphagia and Gastric Retention
• Post truncal vagotomy
• Manifested by abd. distention, n/v
• Regurgitation
• Bile Reflux
• Causes gastritis and esophagitis
• Burning epigastric pain
• Bilious emesis