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.