GI

• peptic ulcer disease (PUD)

  condition characterized by erosion of GI mucosa from digestive action of HCl acid and pepsin
• signs and symptoms of a GASTRIC ulcer


  pain increased with food, occurring 30-60 min after

  weight loss

  hematemesis
• signs and symptoms of DUODENUM ulcer

  pain that decreases with food: occurring 2-3 hours after food

  worse at night

  weight gain

  melena
• what medications are a risk factor to developing PUD?

  NSAIDS, corticosteroids, anticoagulants
• risk factors for PUD

  increased alcohol and smoking

  H. pylori- main risk factor

  caffeine, stress, depression
• what are the three main complications of PUD?

  gastric obstruction, perforation, bleeding
• what diagnostics are used for PUD?

  endoscopy, biopsy is taken if H. pylori is present, serology, stool culture, breath tests are taken
• nursing intervention for gastric obstruction associated with PUD

  regularly irrigate NG tube with normal saline

  reposition patient from side to side

  maintain intake and output records
• GERD

  gastroesophageal reflux disease
• what is the patho of GERD?

  stomach contents being regurgitated back into esophagus due to defected working sphincter
• signs and symptoms of GERD

  chest pain

  heartburn

  sour breath

  burning in throat

  dyspepsia

  regurgitation
• risk factors for GERD

  obesity

  smoking, alcohol

  hiatal hernias

  NSAIDS

  old age
• diagnostics for GERD

  endoscopy, biopsy, Barium swallow
• complications of GERD

  Barrett esophagus

  aspiration pneumonia

  dental erosion

  esophagitis
• patient education for GERD

  elevate HOB after meals

  do not lay supine

  avoid acidic food and drinks

  avoid eating 3 hours before bed

  low fat meals
• Hiatal hernia


  herniation of part of the stomach into esophagus through an opening in the diaphragm

  
• clinical manifestations of hiatal hernias

  similar to GERD
• complications of hiatal hernia

  GERD, esophagitis, ulcers, bleeding, stenosis, aspiration
• patient education for hiatal hernia

  decrease activities that increase intraabdominal pressure ( weight lifting, straining)
• achalasia

  absent peristalsis in lower 2/3 of esophagus
• perforation

  GI contents spill into peritoneal cavity

  sudden severe upper abdominal pain radiates to back and shoulders with no relief

  absent bowl sounds
• interventions for perforstion

  NG tube for aspiration, IV fluids, blood, antibiotics
• partial gastrectomy

  removal of distal 2/3 of stomach
• total gastrectomy

  removal of entire stomach
• vagotomy 


  severing of vagus nerve
• pyloroplasty 


  enlargement of pyloric sphincter
• three complications of gastric surgery

  bile reflux gastritis, postprandial hypoglycemia, dumping syndrome
• dumping syndrome

  when large amounts of fluid enter intestine and draw fluid into bowel lumen
• what can decrease change of dumping syndrome

  short rest periods after meals
• postprandial hypoglycemia

  uncontrolled gastric emptying of bolus high in carbohydrate into small intestine, causing high levels of insulin into the circulation which leads to rebound hypoglycemia
• bile reflux gastritis

  reflux of bile into stomach after reconstruction or removal of pylorus
• gastritis 


  inflammation of gastric mucosa
• what drugs can cause gastritis?

  NSAIDs, corticosteroids, digoxin
• what are other risk factors for gastritis?

  large quantities of spicy food, H. pylori, reflux of bile salts
• clinical manifestations of gastritis

  anorexia, nausea, vomiting, epigastric tenderness, feeling of fullness
• diagnostic studies for gastritis

  endoscopic exam with biopsy
• nursing interventions for acute gastritis

  if vomiting is present- put pt on NPO staus and give IV fluids and or antiemetics
• diarrhea

  passage of at least 3 loose or watery stools per day
• diagnostics for diarrhea

  stool culture, blood cultures
• interventions for diarrhea


  if severe give IV fluids to replace losses

  antidiarrheals