GI

Gastrointestinal (GI) Guide Overview

• Structure of GI Sessions:
  • Three conferences
  • Simulation (sim)
  • Review for the test as a group activity
  • Diagnostic Tests: Initial focus on diagnostic tests for various diseases

Diagnostic Tests for GI Conditions

• First Page: List of tests by disease type, detailing what tests are done for each disease.
• Each test includes:
  • Definition
  • Nursing considerations
  • Pre and post care requirements

Conference Objectives

• Med Card Page:
  • Focused on four medications, including Imodium (a 111 med)
  • Additional medications discussed later in GI

Peptic Ulcer Disease (PUD)

Definition and Mechanism

• PUD refers to the erosion of the mucosal layer of the stomach or duodenum.
• Erosion can lead to perforations, a major risk associated with PUD.

Types of Peptic Ulcers

• Acute Ulcers:
  • Typically heal within weeks
  • Mild inflammation
• Chronic Ulcers:
  • More severe, can cause recurrent episodes and bleeding
  • Risk of multiple ulcers

Causes of Peptic Ulcer Disease

• Primary Risk Factor: Helicobacter pylori infection
  • Transmitted via fecal contact, more prevalent in environments with young children.
• Other contributing factors:
  • Chronic use of NSAIDs (excessive amounts)
  • Alcohol, smoking, and caffeine consumption
  • Stress and depression can exacerbate stomach acid production

Ulcer Types and Symptoms

• Gastric Ulcer Symptoms:
  • Pain occurs 1-2 hours after eating, described as burning or gaseous.
• Duodenal Ulcer Symptoms:
  • Pain appears 2-5 hours after eating, characterized by cramping and burning.
• Pain Localization:
  • Mid epigastric region, under the xiphoid process (bottom of the sternum).

Diagnosis

• Most Accurate Method:
  • Esophagogastroduodenoscopy (EGD) is used to visualize the mucosal lining from the esophagus to the duodenum.
  • Requires patient to be NPO for 8 hours prior to the procedure, entails sedation and throat anesthetic.
  • Post-Procedural Care:
  • Patient remains NPO until gag reflex returns
  • Gargling with warm saline water recommended
  • Monitor vital signs for complications such as perforation

Common Diagnostic Tests:

1. Barium Swallow:
   • Patient ingests contrast material for visualization of GI tract during X-ray.
   • Requires NPO for 8 hours; helps identify the location of ulcers.
2. Biopsy:
   • Tissue samples taken during EGD to test for H. pylori and other abnormalities.
3. Serum Antibody Test:
   • Blood test for antibodies against H. pylori.
4. Urea Breath Test:
   • Tests for H. pylori metabolism products in exhaled breath.
5. Complete Blood Count (CBC):
   • Used to detect signs of bleeding.

Nursing Assessments for Peptic Ulcers

• Assess:
  • Pain characteristics (location, timing, severity)
  • Signs of bleeding (e.g., hematemesis, melena)
  • Vital Signs (check for shock indicators: low blood pressure, high heart rate)
• History of NSAID use, alcohol/caffeine consumption, and stress evaluation.

Patient Education and Management

• Conservative Management:
  • Lifestyle changes, including stress reduction and avoiding irritants (spicy foods, caffeine, alcohol)
  • Typical Healing Time: 3-9 weeks with compliance.
• Medications:
  • Proton Pump Inhibitors (PPIs):
  • Example: Protonix
  • Blocks acid production; side effects include headaches.
  • Antacids and H2-receptor antagonists:
  • Example: Famotidine
  • Blocks histamine to decrease gastric acid.
  • Side effects include dizziness and headache.
  • Mucosal Protectants:
  • Example: Sucralfate
  • Forms paste to protect the ulcer; cautioned due to constipation side effects.
  • Antibiotics: Only if H. pylori is confirmed in patients.

Surgical Interventions for Severe Cases

• Gastric Resection/Gastrectomy:
  • Removal of part/all stomach in extreme cases after unsuccessful conservative treatment.
• Vagotomy:
  • Cutting the vagus nerve to decrease acid production; caution necessary due to diverse nerve functions.
• Pyloroplasty:
  • Procedure to enlarge the pylorus for easier passage of food.

Complications of PUD

• GI Bleeding:
  • Signs include vital sign changes (high HR, low BP) and potential for transfusion.
• Perforation:
  • Characterized by rigid abdomen and severe pain; requires immediate surgical intervention
  • Can lead to peritonitis, septic shock, and potentially death.
• Gastric Outlet Obstruction:
  • May necessitate pyloroplasty or NG tube management.

Gastroesophageal Reflux Disease (GERD)

Definition and Symptoms

• GERD: Severe acid reflux due to incompetent lower esophageal sphincter.
• Common symptoms: Heartburn, dyspepsia, respiratory symptoms (coughing, wheezing) due to potential aspiration of acid into lungs.

Risk Factors

• Hiatal Hernia: Pressure affecting the lower esophageal sphincter
• Delayed Gastric Emptying: Increased likelihood of reflux
• Smoking and Diet: Factors lowering esophageal sphincter pressure

Diagnosis and Testing

• Primarily diagnosed through symptom history.
• Additional testing includes:
  • Barium Swallow
  • Endoscopy
  • Esophageal pH Monitoring: Either through EGD or capsule that monitors pH levels over 24 hours.

Patient Management

• Conservative treatment includes:
  • Lifestyle modifications (e.g., dietary changes: avoid trigger foods)
• Medications:
  • PPIs, H2 blockers, and Prokinetics (e.g., Metoclopramide - may cause severe side effects).

Potential Complications of GERD

• Respiratory Issues: Due to aspiration of acid affecting lungs
• Dental Erosion: From vomiting or acid exposure.
• Barrett's Esophagus: Changes in esophageal cells increasing cancer risk; surgical interventions may be indicated if severe.

Summary Comparison: PUD vs GERD

• PUD is characterized by ulcers in the stomach/duodenum leading to pain and complications like bleeds and perforation; management includes PPIs and lifestyle changes.
• GERD is primarily acid reflux requiring symptom management but can also develop serious complications if chronic.