GERD, PUD, GI bleed: 46

assessment findings for GERD

heartburn (pyrosis)!

dyspepsia

regurgitation

chest pain (burning, squeezing)

sx occurring at night and waking patient

esophagitis

redness

inflammation

hiatal hernia

can result from GERD

barrett’s esophagus

replacement of flat epithelial cells with columnar epithelium

precancerous lesion

in lower esophagus due to GERD (acid coming up)

other complications from GERD

respiratory (from aspiration)

dental erosion (from acid reflux)

gold standard for diagnosing GERD

upper GI endoscopy

surgical procedure: Nissen fundoplication for GERD

creating a new LES

complication of Nissen Fundoplication

dysphagia (go home on soft diet)

-bread is so dense that it is the last thing to be added back

LINX reflux management for GERD

under resting, nonswallowing conditions, the magnetic ring in the LES tightens

when pt swallows, the ring opens

PUD ulcers can occur in the

lower esophagus

stomach

doudenum

causes of ulcers

acids, bile salts, aspirin, NSAIDs, alcohol, smoking, H pylori, stress

aspirin and NSAIDs

causes the stomach to make more acid and inhibit prostaglandin synthesis

corticosteroids destroy mucosal barrier causing ulcers by

decreasing rate of mucosal cell renewal

decreasing protective effects

stress ulcers

blood spots

gastric ulcers

high in epigastrium

burning/gaseous pain 1-2 hours after meals

food aggravates pain

duodenal ulcer pain

midepigastric region (under xiphoid process)

back pain

burning/cramp-like pain2-5 hours after meals

come and go pain

diet for PUD

bland foods

small freq meals

gastric outlet sydrome

vomiting undigested foods/bile → ulcer pylorus → causes perforation (medical emergency)

surgical therpay for PUD: billroth I, billroth II

taking out part of the stomach (like bariatric)

nutritional deficits

b12, iron, b9, vit d, calcium

postop complications for billroth I & II

dumping syndrome (goes straight through you)

postprandial hypoglycemia (not absorbing and drops 1-4 hours after eating)

bile reflux gastritis (inflammation from the bile)

patient should be drinking

reduced fluids with meals (4oz)

diet for post op billroth I & II

small, dry foods

low carbs, low sugars (to limit dumping)

sx of GI bleed

black tarry stool

hematemesis

hemoglobin trigger is a

7 (Need blood!)

surgical therapy is needed for a GI bleed when

bleeding continues

during acute phase GI bleed drugs are used to

1) decrease bleeding

2) decrease HCl acid secretion (PPI inhibitors)

3) neutralize HCl acid that is present (use antacids)

when experiencing a GI bleed you should avoid

alcohol, smoking, stress, asa, nsaids, corticosteroids