Med Surg GI Pt 1

• GERD


  an increase in intraabdominal pressure pushes contents up and though the LES
• GERD s/s

  heartburn

  sour taste in the morning

  regurgitation

  chest pain

  belching
• GERD complications


  esophageal stricture

  Barrett's epithelium (cells change their structure and become precancerous)

  esophageal cancer
• GERD dx


  EGD (NPO 6-8 hours before, no fluids or food until gag reflex has returned)

  Colonoscopy
• GERD tx


  Lifestyle changes

  Medications: PPI, antacids
• GERD teaching


  small frequent meals (4-6)/day

  eliminate foods that increase acid production (fried food, spicy food, NSAIDs, peppermint, carbonated beverages)

  Sit up for an hour after eating

  Medication adhereance
• hiatal hernia


  herniation of upper portion of stomach into thorax
• two types of hiatal hernia

  sliding

  rolling
• hiatal hernia dx

  EGD

  barium swallow study with fluoroscopy
• hiatal hernia s/s


  Usually asymptomatic

  Primary: reflux, heartburn, feeling full, belching, indigestion, substernal chest pain
• when do symptoms increase in a pt with hiatal hernia


  after a meal or when lying supine
• hiatal hernia tx


  Meds: PPI, antacids

  Nissen fundoplication (take part of the stomach and wrap it around the esophagus)

  Schatzki ring (magnet opens up when bolus pushes through, then closes to hold food down)
• peptic ulcer disease (PUD)


  gastric and duodenal ulcers

  develops in the antrum
• duodenal ulcers


  interrupts the pyloric sphincter and they can get gastric outlet syndrome
• PUD cause


  hypersecretion of acid and pepsin

  H. pylori (sticks to the stomach and burrows itself, becomes part of stomach wall)

  decreased prostaglandin secretion (NSAIDS)

  caffeine, alcohol, stress
• PUD s/s


  pain in upper abdomen

  intermittent, gnawing pain

  burning

  aching, hunger-like pain
• gastric ulcers s/s


  pain worse when eating, relieved by antacids

  weight loss
• duodenal ulcers s/s


  pain 2-3 hours after eating

  pain wakes up pt

  weight gain because pain does not occur when eating
• PUD dx


  Blood test for H. pylori

  EGD
• PUD tx


  manage pain

  Eradicate H. pylori infection
• PUD teaching


  avoid irritating foods

  no NSAIDs

  smoking cessation

  proper hygiene

  Gastrectomy last resort
• PUD complications


  hemorrhage (dark, tarry stools; coffee ground emesis)

  perforation (most serious) triggers peritonitis

  pyloric or gastric obstruction