Gastric and Duodenal disorders

gastritis

inflammation of the stomach

-can be acute and chronic

-often patients with chronic gastritis have autoimmune disorders

erosive gastritis

Precursor to gastric ulcer

-inflammation eats through mucosal lining

-high risk for bleeding and infections

S/S of gastritis

acute: abdominal discomfort, headache, lassitude, N/V, hiccuping

chronic: epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in mouth, N/V, intolerance of some foods

(may have vitamin deficiency to B12 due to erosion of mucosal lining-->where we absorb B12)

management of gastritis

acute:

-refrain from alcohol and food until symptoms subside

-if due to strong acid or alkali treatment to neutralize the agents avoid emetics, and lavage due to danger of perforation and damage to esophagus

chronic: promote rest, modify diet, avoid caffeine/alcohol/NSAIDs, and pharmacologic therapy, adequate fluid intake

Peptic ulcer

erosion of a mucous membrane forms an excavation in the stomach

-often feel relief after eating (coats ulcer)

-can happen anywhere in GI tract

-risk factors: excessive stomach acid, chronic use of NSAIDs/alcohol/smoking, and familial tendency

S/S: dull, gnawing pain or burning in the midepigastrium, heartburn/vomiting

treatment for peptic ulcers

-relieve pain: avoid aspirin, NSAIDs, alcohol; prescription meds

-reduce anxiety: help identify stressors

collaborative complications of ulcerations:

-bleeding

-infection

-perforation (risk for septic shock)

-pyloric obstruction (only if ulcer is at pylorus)

when should a patient take a PPI?

30 minutes before a meal

gastric cancer

WHAT: malignant tumor of the stomach

risk factors- chronic inflammation of stomach, H pylori infection, pernicious anemia, smoking, gastric ulcers, and genetics

S/S: pain relieved by anatacis, dyspepsia, early satiety, weight loss, abdominal pain, loss or decrease in appetite, bloating after meals, and N/V

TREATMENT: surgical removal of the tumor if possible, pain management, and palliative care

tumors of the small intestine

-64% malignant

-may be asymptomatic or present with pain, occult bleeding, weight loss, N/V, and intestinal obstruction

-assessment: includes CBC, bilirubin, caarcinoembryonic antigen

-diagnose by upper GI radiograph

-treat with surgery and chemotherapy

colorectal cancer

Risk Factors: genetics, food intake

S/S: change in bowel habits, blood in stool, obstruction, pain, and cramping

TREATMENT: depends on stage of disease

small intestine/colorectal cancer complications:

-GI bleeding

-perforation

-obstruction (need to be NPO)

-peritonitis, abscesses, risk for septic shock

IBS

chronic functional disorder characterized by recurrent abdominal pain associated with disordered bowel movements, which may include diarrhea, constipation, or both

-15% of adults suffer

triggers: chronic stress, sleep deprivation, surgery, infections, diverticulitis, and some foods

(finding the trigger is helpful to treat, getting enough hydration/sleep)

S/S: alteration in bowel patterns, pain, bloating, abdominal distention

malabsorption

impaired digestion or intestinal absorption of nutrients

conditions that can cause malabsorption:

-infectious disease

-luminal disorders

-post-op malabsorption

-mucosal disorders

hallmark signs of malabsorption

key sign: loose stool (diarrhea) that is bulky, foul-smelling, and often grayish (steatorrhea), weight loss, and vitamin deficiency

(often similar symptoms to IBS)

Celiac disease

malabsorption syndrome caused by an immune reaction to gluten (autoimmune response to consumption of products containing gluten)

-no treatment besides do not eat gluten

-promote fruits, veggies, and meats to eat

manifestations of celiac disease

diarrhea, constipation, abdominal pain/distention

Appendicitis

-most frequent cause of acute abdomen in the U.S

-appendix becomes inflamed and edematous as a result of becoming kinked or occluded (usually due to hard fecal mass)

-sepsis is a complication if it ruptures

-RLQ abdominal pain is key sign (that responds well to pressure)

-patients may be in knee to chest position to compress appendix

-immediate surgical intervention needed

never give pain meds to an UNDIAGNOSED abdominal/GI patient. Why?

because you cannot assess properly where the pain is etc.

-patient may not be able to feel appendix rupture

interventions for appendicitis

-NPO

-prepare for surgical intervention

-recognize when rupture has occurred (if patient feels all of a sudden better--> most likely just ruptured)

-fluid/electrolyte management

-provide comfort

Diverticular disease

condition in which bulging pouches (diverticula) in the GI tract push the mucosal lining through the surrounding muscle layer

-may occur anywhere in intestines

-disease increases with age and is associated with a low-fiber diet

-diagnosed with a colonsocopy

Diverticulosis

multiple abnormal outpouchings in the intestinal wall of the colon without inflammation

Diverticulitis

infection and inflammation of diverticula

interventions for diverticular disease:

-increase fluids

-soft foods

-bulk laxatives

intestinal obstruction

partial or complete blockage of the small or large intestine caused by a physical obstruction

-mechanical or functional/paralytic obstruction

goals for intestinal obstructions

-NG tube

-assess/measure output of NG tube

-assess for electrolyte/fluid balance

-monitor nutritional status

-assess for s/s improvement

IBD

inflammatory bowel disease

-Crohn's disease and ulcerative colitis

interventions for IBD:

-figure out relationship between food and diarrhea/constipation and emotional stressors

-provide ready access to bathroom or commode

-encourage rest when there is active peristalsis or movement when constipated

-administer anti-inflammatory agents/pain meds

-reduce anxiety

-goal is to maintain frequency, characteristics, and amount of stool

complications associated with IBD:

-electrolyte imbalance

-cardiac dysrhythmias

-GI bleeding with fluid loss

-perforation of the bowel

interventions for GI conditions:

-reduce anxiety

-pain (administer analgesics as prescribed)

-patient education (avoid triggers, positioning-->sitting upright or left-side lying)

-maintain function of NG tube (irrigate it, assess for abdominal distention, etc.)

dumping syndrome

Rapid emptying of gastric contents into small intestines. Client experience abd. pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia

-parasympathetic NS is activated

-avoid drinking large amounts of fluid with meals

-lay down after eating (helps to keep the food where it needs to be instead of rushing into intestines too fast) --> combat gravity

the care of the patient with GI concerns:

-hx and symptoms

-dietary hx

-abdominal assessment

-fluid/electrolyte management

-weight loss inquiry (more than 10%)

-bowel patterns

-education (avoid triggers, smoking/caffeine/alcohol, limiting NSAIDs, and stress management)