GI alterations

GERD

• what is it

• rfs

reflux of acidic gastric content into esophagus

rfs

• Decreased LES pressure: laying supine; food: alcohol/chocolate; meds (bbs, ccb)

• Increased intraabdominal pressure: obese patients

• Hiatal hernia

cm 6

Heartburn (pyrosis)

dyspepsia

regurgitation

chest pain: burning and squeezing

resp: wheezing, cough, some difficulty 

ENT: hoarseness, sore throat, lump in throat

esophagitis

• what is it 2

• results in 3

inflammation of esophagus

complication d/t repeated exposure to gastric

can cause scars, strictures, dysphagia

gerd compllications:just list

barret’s esophagus

resp

dental

explained

Barrett’s esophagus/esophageal metaplasia: reversible change from one type of cell to another

resp: irritation of airway from secretion: broncho or laryngospasm, cough, aspiration (athma, bronchitis, pneumonia)

dental:damage teeth, esp posterior

dx tests 5

barium swallow

esophageal manometric

endoscopy

ambulatory esophageal ph: 

radionuclide tests

nsn mgt/edu 9

• not meds 8

• surgery 1

avoid triggers/smoking cessation

Positioning

Stress reduction

Weight reduction

Small, frequent meals

avoid foods that reduce LES pressure

gum/oral lozenges for saliva

drink fluids between meals

Nissen fundoplication

PUD

• what is it

• Acute vs Chronic pud

PUD: erosion of mucosal lining from gastric contents and pepsin

acute vs chronic

• acute: superficial and short

• chronic: longer; deep- muscular wall and fibrous tissue formation; more common

gastric vs duodenal

gastric

• superficial

• more common in women 50-60

• pain 1-2 hrs after meal

duodenal

• penetrating

• more in men 35-45

• pain 2-5 hrs after meal

Stress-Related Mucosal Disease (SRMD)

• common in

• also called

• causes/associated with 3

Common Critical patients

Also called physiologic stress ulcer

Acute ulcers that develop after major physiologic insult

• Trauma

• Burns

• Surgery

pud rfs/causes 6

H. pylori infection

smoking

alcohol

caffiene

drugs: meds/nsaids, anticoagulants, steroids

emotional factors

complications

HOP

hemorrhage

gastric outlet obstruction

perforation

PUD dx tests 4

H. pylori tests

• biopsy, urea/breath tests, stool antigen/antibody tests

EGD- UGI endoscopy

endoscopic US

Biopsy

labs 4

dx: blood loss

• CBC

• Stool sample for blood

rule out other UGI problems

• Liver Enzymes

• Serum Amylase

pud tx

• lifestyle/nut: 4 each

Rest and manage stress levels

Avoid alcohol, smoking, and trigger foods/behaviors

Nutrition: avoid hot/spicy foods, caffeine, carbonated drinks, meat extracts/broths

surgical mgt

• options 2

• indications2

resections: antrectomy and vagotomy

Indicated for

• continual bleeding or massive blood loss

• Complications unresponsive to medical management

Mallory-Weiss Tear

• what is it

• cause

• associated with

• dx

Upper GI hemorrhage caused by longitudinal tear

from forceful retching/vomiting

Associated with NSAIDs or ASA; Excessive alcohol

dx: endoscopy or angiography

Esophageal Varices interventions: prioritization 3

Prevent bleeding

Stabilize airway

start IV medications

upper GI bleed causes 6/7/9

PUD

stress ulcer

mallory-weiss tear

esophageal varices

esophagitis

drugs: asa, nsaids, corticosteroids

stomach cancer, lesion, tumor

types/categories

Obvious Bleeding:

• Hematemesis: bright red or coffee ground

• Melena: black tarry

Occult Bleeding

Important assessments in pt with GI bleed

Characteristics of blood loss

Symptoms of hypovolemia: massive if > 1.5 L

Pain

assessments after blood loss/hypovolemia

Signs/Symptoms of shock

• BP

• Rate and character of pulse

• Peripheral perfusion with capillary refill

• Neurologic status

U/O

Hyperactive bowel sounds

GI: upper GI/GI bleed

• important labs

Complete blood cell count (CBC)

Prothrombin time, partial thromboplastin time

Liver enzyme measurements

Typing/cross matching for possible blood transfusions

Blood urea nitrogen (BUN)

Serum electrolytes

dx

endoscopy

barium

angiography

priority treatments for ugi bleed: just list

Hemodynamic stability

gastric lavage

Hemodynamic stabilization

Fluid administration (LR) isotonic solution

Administration of blood

Hematocrit may not reflect actual blood loss

Gastric lavage

gastric irrigation for ugi bleed

May be done prior to endoscopy to provide better visualization

Endoscopic tx for varices

sclerotherapy

thermal probe

band ligation

explained

Sclerotherapy: injection of a solution (usually salt) into the vein to collapse and the blood to clot

Thermal probe: heat probe directly applied to bleeding site

Band ligation (varices): directly compress a bleeding vessel

Variceal Bleeding interventions

• priority

• Medications for variceal bleeding

Prevent bleeding and hemorrhage is priority!

Octreotide (sandostatin)

Vasopressin/ADH drip

Medications for Varices/variceal bleeding

• octreotide (how it works)

• adh (how it works, a/e, int)

Octreotide: decreases portal pressure = dec blood flow to varices

ADH: vasoconstriction of vessels = dec BF to

• risk for fluid and electrolyte imbalances

• continuous ECG and BP monitor

Esophagogastric (balloon) tamponade

• moa

• when

• consideration

tube with inflatable balloons is inserted through the mouth/nose into the stomach and esophagus.
The balloons are inflated to apply direct pressure, compressing the bleeding veins

Used when endoscopic therapy fails.

Limit inflation <6 hours to avoid tissue ischemia/necrosis.

PPIs

• eg

• moa

• pud or ppi

Omeprazole, Pantoprazole, Esomeprazole, Lansoprazole

↓ gastric acid secretion

both GERD and PPI

teach and long term risk

Take 30–60 min before meals

Long-term risks: ↓Ca, ↓B12/iron, C. diff

h2

• eg

• moa

• pud or ppi

Famotidine

Blocks histamine receptors → ↓ acid

both

teach and long term risk

Avoid antacids within 1 hr

Confusion risk in elderly

Antacids

• eg

• moa

• pud or gerd

Aluminum, magnesium, calcium carbonate, Mylanta

Neutralize gastric acid

both

a/e and education

Constipation or Diarrhea

Separate from other meds 1–2 hrs

Sucralfate

• use

• moa

• educate 3

PUD

Forms protective ulcer coating

educate

• Take on empty stomach

• Separate from meds by 2 hrs

• Do not take with antacids

Prokinetics

• eg

• moa

• pud or gerd

Metoclopramide

↑ LES tone, ↑ gastric emptying

GERD

educate 3

SE: drowsiness, EPS, tardive dyskinesia

Take 30 min before meals

Avoid alcohol/CNS depressants

Bismuth /pepto bismol

• moa

• use

• a/e

Antibacterial + protective coating

H. pylori quadruple therapy

Causes harmless black tongue/stool