Upper GI

GI changes that are associated with aging

GI changes that are associated with aging

•Gastric mucosa atrophy

•Decreased peristalsis

•Dulled nerve impulses

•Distention and dilation of pancreatic ducts

•Decrease in number and size of hepatic cells

•Disruption of microbial balance of good anaerobic and aerobic flora

GERD is the

•Backflow of gastric and duodenal contents into esophagus

GERD is caused by

incompetent lower esophageal sphincter

pyloric stenosis

Motility disorder

Risk factors of GERD

Obesity, Older age, Sleep Apnea,

NG tube, H.Pylori, NSAIDS,

Hiatal hernias

Assessment findings of GERD

Morning hoarseness

coughing or wheezing at night

heart burn

epigastric pain

dyspepsia

nausea

regurgitation

pain and difficulty swallowing

hypersalivation

auscultate for crackles

what are some ways someone with GERD can lower esophageal irritation

reduce and cut out carbonated and alcoholic drinks

no cigarette smoking

no tight clothes

In GERD, you should stop eating and drinking

2 hours before bed time

What type of diet should someone with GERD eat

Low-Fat and High-Fiber

how many meals for GERD

6 small bland meals

What are some foods to avoid in GERD

Chocolate

Peppermint

Citrus

Tomatoes

Caffeine

HOB for GERD

elevated 6-8 inches

To see if someone has GERD, what should be performed

Upper GED and esophageal pH monitoring

Some medications needed for GERD

Antacids

Histamine H2 inhibitors

Proton pump inhibitors

Prokinetic agent

When should you take antiacids

1-3 hours after meal

OR

at bedtime

AND

1 hour between other medications

4 types of Antiacids

Aluminum hydroxide

Calcium Carbonate

Magnesium hydroxide

Sodium Bicarbonate

Aluminum hydroxide should be used with caution with

Hypertension and heart failure

Most common side effect of aluminum hydroxide

constipation

Aluminum hydroxide may reduce effects of

Tetracycline

Warfarin

Digoxin

Phosphate absorption

you’ll see hypophosphatemia with use of what antiacids

Aluminum hydroxide

Calcium carbonate is

rapid acting

can cause constipation

Magnesium hydroxide is a

saline laxative

most common side effect of magnesium hydroxide

diarrhea

Contraindications of magnesium hydroxide

intestinal obstruction

appendicitis

undiagnosed abdominal pain

Magnesium hydroxide can inadvertently cause what impairment

Renal

the magnesium can accumulate and cause toxicity

Sodium bicarbonate risk

risk systemic alkalosis with renal impairment

when using sodium bicarbonate, caution with

hypertension and heart failure

The action of Histamine 2 receptor antagonist

suppresses secretion of gastric acid

caution of what when using H2 receptor antagonist

impaired renal or hepatic failure

three types o Histamine 2 receptor antagonist

Cimetidine

Ranitidine

Famotidine

Cimetidine

not first line drug

high risk in older adults

cimetidine interacts with

more than 60 drugs

Ranitidine action

decreases gastric acid

Ranitidine

side effects are uncommon

does not penetrate blood barrier

Ranitidine IV push

dilute in 20mL 0.9% NS or 5 % dextrose

over 5 min

Ranitidine V infusion

dilute 10 mL

over 15-20 minutes

Famotidine - or nizatidine

does not need to be administered with food

What do proton pump inhibitors do

suppress gastric acid secretion

Types of proton pump inhibitors

Protonix

Prilosec

Nexium

Pravacid

Proton pump inhibitors can be used to

treat active ulcer disease

erosive esophagitis

pathological hypersecretory conditions

proton pump inhibitors are contraindicated in

hypersensitivity

side effects of proton pump inhibitors

headache

diarrhea

abdominal pain

nausea

C.Diff

when the elderly take Proton pump inhibitors, they need

extra calcium or they will get fractures

What is an example of a prokinetic agent

metoclopramide

metoclopramide is administered

30minutes before meals and at bedtime

contraindications for metoclopramide

sensitivity

mechanical obstruction

perforation

gastrointestinal hemorrhage

Metoclopramide can precipitate

hypertensive crisis in clients with pheochromocytoma

gastritis is

inflammation of the stomach or gastric mucosa

may be acute or chronic

Risk factors of gastritis

H. pylori

history of gastritis

NSAID use

corticosteroids

alcohol

bile reflux disease

autoimmune disease

advanced age

radiation therapy

smoking

caffeine

excessive stress

contaminated food or water

assessment findings of acute gastritis

abdominal discomfort

anorexia

nv

Chronic gastritis

anorexia

nv

belching

heartburn after eating

sour taste

B12 deficiency

weight l

what is the gold standard of diagnosis for gastritis

EGD

Gastritis with symptoms- how would you advance nutrition

NPO with ice chips until symptoms subside

advance to ice chips followed by clear liquids

then solid foods

what should you monitor for with gastritis

Hemorrhage

signs of hemorrhage in gastritis

Hematemesis

tachycardia

hypotension

avoid what foods in gasritis

spicy foods

highly seasoned foods

caffeine

alcohol

what other 2 things should you avoid in gastritis

nicotine and NSAIDS

types of meals to eat with gastritis

eat 6 small bland foods

when gastritis is caused by H. pylori, antibacterials

are not effective alone

what type of medication therapy is used with h. pylori gastritis

dual, triple, or quadruple therapy

common treatment for gastritis with h. pylori

triple treatment

2 antibacterial agents and a PPI

what happens is a triple therapy fails

you use quadruple therapy

2 antibiotics

PPI

and bismuth OR histamine 2 receptor antagonists

what are some gastric protectants for gastritis

Misoprostol

Sucralfate

you should not take misoprostol if

pregnant

when should you take misoprostol and what might the side effects be

take with meals

causes diarrhea and abdominal pain

misoprostol is often given with

NSAIDS to prevent gastric mucosal damage

What does sucralfate do

coats over an ulcer to protect

when should you take Sucralfate and what side effect might it cause

on an empty stomach

may cause constipation

sucralfate may impede absorption of

Warfarin

sodium

phenytoin

theophylline

digoxin

some antibiotics

sucralfate is given how long in-between other medications

2 hours apart

5 complications of gastritis

Gastric bleeding leading to hypovolemia

Gastric outlet obstruction

Dehydration

Pernicious anemia

Dumping syndrome

severe acute gastritis is known as

deep tissue inflammation that extends to stomach muscle

Chronic erosive gastritis

bleeding slow or perfuse- perforation of stomach wall

what should you monitor with gastritis bleeding

vital signs

airway

CBC

clotting factors

i’s and o’s

what to replace with gastric bleeding

fluids and blood products

NG tube for gastric bleeding with gastritis

used for gastric lavage - irrigate with water or NS

monitor the output

confirming placement of an NG tube

x-ray

prior to giving any fluids to prevent aspiration

what are some IV meds that are given when there is gastric bleeding with gastritis

Proton pump inhibitors

H2 receptor antagonists

Patient education for gastric bleeding

signs of slow gastric bleeding

seek immediate medical attention with severe abdominal pain or vomiting blood.

take medications as directed

what are some signs of slow gastric bleeding

coffee-ground emesis

black, tarry stools

gastric outlet obstruction

severe acute gastritis with deep tissue inflammation into the stomach muscle

what should you monitor with gastric outlet obstruction

fluids and electrolytes - depletion

continuous vomiting

metabolic alkalosis

I and O

provide what for gastric outlet obstruction

fluid and electrolyte replacement

why would you use an NG tube for gastric outlet obstruction

to empty stomach contents

diagnosis of gastric outlet obstruction

endoscopy

patient education for gastric outlet obstruction

seek medical care if you show signs of continuous vomiting, bloating, and nausea

Dehydration is

loss of fluid due to vomiting o diarrhea- hypovolemia

what should you provide and monitor for dehydration

provide IV fluids if needed

monitor electrolytes

dehydration patient education

instruct to contact provider for vomiting and diarrhea

pernicious anemia

chronic gastritis may damage the parietal cells, reduced intrinsic factor, which is needed for absorption of vitamin B12, may lead to pernicious anemia

nurse actions for pernicious anemia

instruct need for monthly vitamin B12 injections or oral Vitamin B

dumping syndrome

vasomotor response to food ingestion, resulting in syncope, pallor, palpitations, dizziness, and headache.

what increases risk for dumping syndrome

gastric surgery

following meals, someone with dumping syndrome should

laydown to slow movement of food through intestine and prevent injury

nurse should instruct patient with dumping syndrome how to self administrate

octreotide (Sandostatin- antispasmodic-delays gastric emptying) subcutaneous injection two to three times daily before meals, as prescribed.

development of gastric ulcers

normal gastric acid secretion BUT delayed gastric emptying WITH increased diffusion of gastric acid back into the stomach tissues

development of duodenal ulcer

normal diffusion of acid back into stomach tissues BUT increased secretion of gastric acid AND increased stomach emptying

description of peptic ulcer disease

Ulceration of mucosal wall of stomach, pylorus, duodenum, or esophagus in portions accessible to gastric acid secretions

PUD may also be referred to as

Gastric, Duodenal, or Esophageal depending on its location also Stress Ulcers

gastric ulcer risk factors

H.pylori

NS Naproxen (Naprosyn ) and Corticosteroids

Severe Stress

Hypersecretion state

Type 0 blood

Excess Alcohol

Chronic pulmonary or kidney disease

Zollinger-Ellison syndrome-(tumor that produces to much acid).

gastric pain with peptic ulcer disease

Gnawing, sharp pain in or to left of mid-epigastric region 30 to 60 minutes after a meal