Disorders of Digestion and Absorption

nausea and vomiting

unpleasant sensation usually preceding vomiting, may have abdominal pain, pallor, sweating, clammy skin

vomiting

forceful expulsions of stomach contents throught the mouth

projectile vomiting

is forceful ejection of stomach contents

regurgitation

gentle ejection of stomach contents without nausea or retching

• antiemetics

• IV Fluids

• NG tube

• TPN

treatments for nausea and vomiting

• dehydration

• metabolic alkalosis

• aspiration

complications of nausea and vomiting:

hiatal hernia

• opening in the diaphragm thru w/c the esophagis passes becoms enlarged and part of the upper stomach moves up into the lower portion of the thorax

• occurs more often in women than in women

hiatal hernia

it is caused by the lower esophageal sphincter related to increased abdominal pressure, long term bed rest, trauma

type 1: sliding

• occurs when the upper stomach and the gastroesophageal junction are dislplaced upward and slide in and out of the thorax

type 2: rolling / PARAESOPHAGEAL

• occurs when all or part of the stomach pushes through the diaphragm beside the esophagus

• further classified as types II, III, IV

2 types of hiatal hernia

type 1: sliding

what type of hiatal hernia: occurs when the upper stomach and the gastroesophageal junction are dislplaced upward and slide in and out of the thorax

type 2: rolling / PARAESOPHAGEAL

what type of hiatal hernia:

• occurs when all or part of the stomach pushes through the diaphragm beside the esophagus

• further classified as types II, III, IV

type 1: sliding type

what type of hiatal hernia:

• dysphagia

• regurgitation

• heartburn (pyrosis)

• intermittent epigasruc pain or fullness after eating

• hemorrhage, obsyruction and strangulation can occur with any type of hernia

type 2: rolling / paraesophageal

what type of hiatal hernia:

• sense of fullness or chest pain after eating

disgnostics of hiatal hernia:

esophagogastroduodonescopy

what is EGD (it is for hiatal hernia)

• small freq feedins

• not to recline for q hour after eating

• elevate head of bed on 4 to 8 inch blocks

what should be considered for hiatal hernia:

• h2 receptor antagonists: to reduce stomach secretion

  • tagamet

  • zantac

  • pepsid

• antacids: neutralize stomach acids

• reglan, propulsid: increase stomach emptying

drug theraoy for hiatal hernia:

• decrease caffeine, fatty foods, alcohol, acidic and spicy foods, avoiding bedtime snack

diet therapy for hiatal hernia:

fundoplication

stomach fundus is wrapped around the lower part of the esphagus

gastritis

inflammation of the gastric or lining of the stomach (mucosa)

acute

what type of gastritis: lasting several hours to a few days; may develop in acute illnesses

chronic

a type of gastritis that is from repeated exposure to irritating agents or recurring episodes of acute gastritis

erosive, non-erosive

acute gastritis can be classified as:

erosive

what type of acute gastritis: caused by local irritants such as aspirin and other NSAIDS, alcohol abuse and recent exposure o radiation therapy

• this type of acute gastritis is most often caused by infection with helicobacter pylori

• more severe form

• caused by indigestion of strong acid or alkali

• may also develop in acute illlnesses (burns, severe infetion, hepatic, kidney or respi failure)

type a (autoimmune disorders)

type b (underlying causative mechanism)

chronic gastritis is classified to:

• hashimoto thyroiditis

• addison’s disease

• grave’s disease

type a chronic gastritis disorders:

• h. pylori

• long term drug therapy

• reflux of duodenal contents into the stomach

type b chrnoic gastritis disorders:

acute

acute or chronic gastritis:

• epigastric pain or discomfort

• dyspepsia

• ausea and vomiting

• anorexia

• hiccups

• bleeding (hematemesis, melena, hematochezia)

chronic

acute or chronic gastritis:

• anorexia

• heartbirn after eating

• belching

• sour taste in the mouth

• nausea and vomiting

• early satiety

vit. b12 deficiency (pernicious anemia)

poor absorption of certain vitamin in chronic gastritis can lead to:

endoscopy

definitive diagnosis of gastritis

medical management of gastritis:

dumping syndrome

this is common after gastric surgery:

dumping syndrome

dumping syndrome

rapid emptying of gastric contents into the small intestine

interventions on dumping syndrome: