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44 Cards in this Set
- Front
- Back
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What is gastritis?
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Inflammation of the gastric mucosa resulting in breakdown of the mucosal barrier making the stomach unprotected from autodigestion by HCl acid and pepsin
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What are the risk factors for Gastritis?
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* Aspirin, NSAIDS, corticosteroids
* Alcohol, spicy food * H pylori * Staph organisms * radiation, smoking * burns, renal failure, sepsis * Autoimmune atrophic gastritis * stress * NG tube |
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What are the clinical manifestations of gastritis?
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* anorexia
* N/V * epigastric tenderness * feeling of fullness * hemmorrhage - common with alcohol abuse and may be the only symptom |
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What is Peptic Ulcer Disease (PUD)?
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erosion of the GU mucosa resulting from digestive action of HCl acid and pepsin occuring in the lower esophagus, stomach, or duodenum
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Name the types of PUD
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* Acute
- superficial erosion - minimal inflammation - short duration * Chronic - muscular wall erosion with formation of fibrous tissue - long duration |
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When does PUD occur?
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in the presence of acidic environment where the mucosal barrier is impaired and back diffusion can occur
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What destroys the mucosal layer in PUD?
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* H pylori
* Aspirin and NSAIDS * Corticosteroids * Lipid soluble cytotoxic drugs * Inc vagal nerve stimulation |
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What are the characteristics of gastric PUD?
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* more in women >50
* normal to low secretions of gastric acids * H pylori usually present |
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What are the characteristics of duodenal PUD?
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* increased incidence in 35-45
* type O family tendency * inc HCl acid * H pylori present |
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What are the causes of Gastric PUD?
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* Drugs
* Chronic alcohol abuse/nicotine * chronic gastritis * bile reflux * H pylori |
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What are the causes of duodenal PUD?
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* COPD
* cirrhosis of liver/ ETOH use/ smoking * chronic pancreatitis * hyperparathyroidism * chronic renal failure * H pylori |
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What are stress related mucosal disease?
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AKA physiologic stress ulcer
* acute ulcers that develop after major physiological insult like trauma, surgery, hospitalization |
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What are the manifestations of gastric PUD?
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* PAIN
- high in epigastrium - 1-2 hrs after eating - burning or gaseous - may or may not be relieved by antacids |
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What are the clinical manifestations of Duodenal ulcer pain?
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* PAIN
- mid-epigastric region beneath xiphoid process - back pain in on posterior side - 2-4 hrs after eating - suppression and remission - relieved by food or antacids |
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What are the complications of PUD?
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* hemorrhage (most common)
* perforation (most lethal) * gastric outlet obstruction |
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What are the clinical manifestations of perforation?
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* sudden dramatic onset
* severe upper abdominal pain that spreads throughout the abdomen * possible shoulder pain * rigid abdominal muscles * shallow rapid respirations * bowel sounds absent * N/V |
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Name the diagnostic studies for PUD
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* Endoscopy with biopsy: degree of healing after Tx
* Tests for H pylori * Barium contrast studies * Gastric analysis: acid and volume * Labs: CBC, occult blood |
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How do you test for H pylori in the stomach?
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* Non invasive tests:
- serum or whole blood antibody tests - urea breath test * Invasive Tests - endoscopic procedure - biopsy of the stomach |
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What is a urea breath test?
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urea is a by product of H pylori metabolism and can determine active infection
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How long does PUD healing last?
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* requires many weeks of therapy
* Pain disappears in 3-6 days * reoccurrence is frequent - interruption of tx can be detrimental |
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Name the drugs used for PUD
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* H2R blockers
* PPI * Antibiotics * Antacids * Anticholinergics * Cytoprotective therapy |
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What antibiotics are used for PUD?
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* Triple therapy: Prilosec, Biaxin, Amoxil
* no single agent works for h pylori * 7-14day tx |
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What is the effect of Antacids in PUD?
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* Inc gastric pH by neutralizing HCl acid
* insoluble and poorly abosorbed - Mag-Ox: causes diarrhea, avoid with renal failure - Amphojel: can cause constipation - Maalox and Mylanta |
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What is the effect of cytoprotective drug therapy?
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* used for short term tx
* Protection for the esophagus, stomach, and duodenum * Accelerates ulcer healing * Carafate: take on empty stomach * Cytotec: taken with NSAIDS, can cause abortion |
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What nutritional therapy should be implemented for PUD?
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* Bland diet
* 6 small meals a day in acute phase * Avoid: - Hot, spicy, and peppers - Alcohol, carbonated drinks, tea, coffee, broth - High in roughage |
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What interventions should occur with Hemorrhage in PUD?
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* Endoscopic evaluation
* NPO * Fluid resuscitation * Blood transfusion * NG continuous low intermittent suction |
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What are the manifestations of hemorrhage in PUD?
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* Changes in VS
* Inc in blood * Dec in pain because blood neutralizes it |
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What are the interventions for Gastric outlet obstruction?
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* NPO
* NG tube with intermittent suction for 24 - 48hrs * F/E replaced by IV infusion until pt can tolerate oral feedings * Antiemetics |
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What is the treatment for perforation in PUD?
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* NPO
* NG tube with continuous suction to stop spilling in peritoneal cavity * Restore blood volumeL IVF, PRBC's * Urinary Catheter * Broadspectrum antibiotics * Pain medication * laparoscopic repair |
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What are the indications or surgical therapy in PUD?
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* Unresponsive to medical tx
* Concern about gastric cancer * Drug induced but cannot be withdrawn from drugs |
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Name the surgery done for PUD
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* Billroth 1
* Billroth 2 * Vagotomy * Pyloroplasty |
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What is billroth 1?
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Gastroduodenostomy
* partial gastrectomy with removal of distal 2/3 of stomach and anastomosis of gastric stump to duodenum |
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What is a billroth 2?
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Gastrojejunostomy
* partial gastrectomy with removal of distal 2/3 of stomach and anastomosis of gastric stump to jejunum |
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Vagotomy
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severing of the vagus nerve done with gastrectomy
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Pyloroplasty
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* enlargement of of pyloric sphincter commonly done after vagotomy (bec it dec emptying)
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What are the complications of surgery in PUD?
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* Dumping syndrome
* Postprandial hypoglycemia * Bile reflux gastritis |
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What is dumping syndrome?
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* decreased ability of the stomach to control the amount of chyme in the small intestines
- causing large bolus of hypertonic fluid into intestines - inc fluid drawn into the bowel lumen - occurs end of eating or 15-30mins after - last no longer than an hr |
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What are the s/s of dumping syndrome?
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* Weakness
* sweating * palpitations * dizziness * abdominal cramps * borborygmi * urge to deficate |
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What is postparandial hypoglycemia?
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results of uncontrolled gastric emptying of a bolus of fluid high in carbs into the small intestine
- causing inc BG - causing inc excessive amts of insulin in circulation * a second hypoglycemia occurs 2 hrs after meals |
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What are the s/s of postparandial hypoglycemia?
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* sweating
* weakness * mental confusion * palpitations * tachycardia * anxiety eat a candy to relieve symptoms |
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What is bile reflux gastritis?
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surgery can result in reflux Bile Gastritis
- prolonged contact of bile causes damage to gastric mucosa - causing distress after meals * Use Questran and Al Hydroxide Antacids |
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What nutritional interventions should be implemented after surgery in PUD?
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* small dry feeding daily
* Low carb * Restrict sugar with meals * Moderate amts of proteins and fats * 30mins of rest after each meal * Reduce fluids to 4oz with meals (bec of size of stomach) |
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What is the post op care for PUD?
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* Maintain patent NG
* Monitor aspirate for color, quantity, and characteristics - bright red with darkening: 1st 24hrs - Color changes yellow-green within 36hrs to 48hrs * monitor for dec perstalsis and lower abdomen pain (obstruction) * I/O * VS Q4 * change positions * pulmonary toilet * IV therapy * Observe for infection * long term Cx: pernicious anemia (bec loss of intrinsic factor) |
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What are the gerontologic considerations for PUD?
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* Inc in >60
* FIrst manifestation may be gastric bleeding or dec in hematorcrit |
