Stomach Disorders

Introduction to Stomach Disorders

  • Discussion led by Mrs. Paige focusing on disorders affecting the stomach.

  • The stomach plays a crucial role in the digestive process.

  • Stomach problems can impair or alter digestion and nutrition.

Anatomy of the Stomach

  • Key anatomical landmarks:
      - Esophagus
      - Gastroesophageal junction
      - Duodenum
      - Pylorus

  • Disorders discussed will be related to these specific parts.

Nausea and Vomiting

Definitions:

  • Nausea: A vague, unpleasant sensation of sickness or queasiness.

  • Vomiting: A forceful expulsion of contents from the upper gastrointestinal tract.

Medications for Nausea/Vomiting:

  • Serotonin receptor antagonists:
      - Example: Ondansetron (Zofran)

  • Dopamine antagonists:
      - Examples: Promethazine (Phenergan), Prochlorperazine (Compazine), Droperidol

  • Antihistamines:
      - Examples: Meclizine (Antivert), Dramamine

  • Cannabinoids:
      - Example: Dronabinol (Marinol)

Interventions for Nausea/Vomiting:

  • Encourage deep breathing to suppress the vomiting reflex.

  • Instruct patient to consume small amounts of clear liquids.

  • Foods should be consumed at separate times from fluids.

  • Monitor for signs of dehydration.

  • Eliminate offensive odors.

  • Perform oral care.

  • Position the patient upright while vomiting.

  • Monitor for complications:
      - Dehydration
      - Hypokalemia
      - Metabolic alkalosis
      - Aspiration pneumonia
      - Esophageal ruptures or tears

Gastritis

Definition:

  • Gastritis: Inflammation of the gastric mucosa.

Classification:

  • Classified according to
      - Cause
      - Cellular change
      - Distribution of lesions

  • Erosive gastritis: Causes ulcers.

  • Non-erosive gastritis: Auto-digestion due to a protective mucosal barrier failure.

Types of Gastritis:

Acute Gastritis:

  • Inflammation of the mucosa or submucosa.

  • Causes:
      - Infections (e.g., H. pylori, Staphylococcus, Streptococcus, E. coli, Salmonella)
      - Long-term NSAID use, alcohol, caffeine, corticosteroids, radiation therapy
      - Accidental ingestion of corrosive substances (acids, alkalines)

  • Manifestations:
      - Thickened red mucous membranes with prominent rugae
      - Mucosal necrosis and inflammatory reaction

  • Signs and Symptoms:
      - Acute epigastric pain or discomfort
      - Abdominal tenderness
      - Abdominal bloating
      - Nausea and vomiting
      - Hematemesis
      - Melena
      - Gastric hemorrhage
      - Dyspepsia
      - Anorexia

Chronic Gastritis:

  • Diffuse, asynchronous inflammation of the gastric lining.

  • Results in mucosal thinning and atrophy of parietal cells, leading to lack of intrinsic factor and possible pernicious anemia.

  • Two types:

Type A Chronic Gastritis:

  • Characterized as non-erosive; causes inflammation in the body and fundus of the stomach.

  • Often due to autoimmune factors.

Type B Chronic Gastritis:

  • Affects the antrum and can encompass the whole stomach, typically caused by H. pylori infection.

  • Associated with:
      - Alcohol ingestion
      - Smoking
      - Radiation therapy
      - Crohn's disease
      - Graft versus host disease
      - Uremia

  • Atrophic gastritis: Common in older adults from toxic work substance exposure, potential gastric cancer risk.

Signs and Symptoms of Chronic Gastritis:

  • Epigastric pain relieved by food.

  • Anorexia.

  • Nausea and vomiting.

  • Intolerance to fatty and spicy foods.

  • Pernicious anemia.

Diagnostic Tests:

  • EGD: Gold standard for diagnosis.

  • Biopsies: For cellular assessment.

  • Gastric analysis: To check for intrinsic factor deficiency.

  • H. pylori testing: Rapid urease testing recommended without antacids for a week.

Prevention of Gastritis:

  • Well-balanced diet avoiding distress-causing foods (caffeine, chocolate, spicy foods).

  • Regular exercise to maintain peristalsis.

  • Limiting alcohol and quitting smoking.

  • Caution with NSAIDs, aspirin, and coffee intake.

  • Stress management techniques (yoga, meditation, reading).

  • Protect against workplace toxicity.

Treatment:

  • Acute gastritis typically heals spontaneously within days; symptomatic treatment is sufficient.

  • Severe cases may require blood transfusions or surgery for ulceration.

  • For chronic gastritis, eliminate causative agents (e.g., antibiotics for H. pylori, avoid toxic substances).

Medications:

  • H2 receptor antagonists: Block gastric secretions.

  • Antacids: Buffer agents enhancing gastric pH.

  • Mucosal barriers: Such as sucralfate, to protect mucosa.

  • Proton pump inhibitors (PPIs): Suppresses gastric acid secretion.

Peptic Ulcer Disease

Definition:

  • Peptic Ulcer: A mucosal lesion within the stomach or duodenum, arising when mucosal defenses are impaired.

Etiology:

  • Primarily caused by H. pylori infections.

  • H. pylori transmission via contaminated food/water.

  • Urease produced by H. pylori neutralizes stomach acid, aiding bacterial survival.

Types of Peptic Ulcers:

Gastric Ulcers:

  • Develop in the stomach's antrum near acid-secreting mucosa.

  • Causes:
      - Break in the mucosal barrier due to infection
      - Dysfunctional pyloric sphincter leading to bile reflux

  • Manifestations:
      - Delayed gastric emptying with regurgitation
      - Decreased blood flow to gastric mucosa, increasing ulcer risk.

Duodenal Ulcers:

  • Occur in the upper duodenum, deep and sharply demarcated.

  • Causes:
      - Protein-rich meals, calcium intake, vagal nerve stimulation, rapid gastric emptying.
      - High gastric acid secretion with low pH.

Stress Ulcers:

  • Develop after medical crisis or trauma (e.g., sepsis, increased intracranial pressure).

  • Complications: Gastric erosion leading to bleeding.

Complications of Peptic Ulcer Disease:

  • Hemorrhage: Most severe complication.
      - Signs: Hematemesis, melena.

  • Perforation: Full thickness erosion, leading to peritonitis.
      - Symptoms: Sudden mid-epigastric pain, rigid abdomen, abdominal tenderness.

  • Pyloric Obstruction: Resulting from scarring/inflammation causing blockage.
      - Signs: Abdominal bloating, nausea, vomiting, potential metabolic alkalosis.

Assessment:

  • History taking focusing on risk factors (alcohol, tobacco, diet, stress).

  • Physical assessment for tenderness, bowel sounds, ulcers' relationship to eating/sleeping patterns.

Diagnostic Tests:

  • Various types of H. pylori tests (serum, urea breath, stool antigen).

  • Imaging studies (X-rays, EGD).

Interventions:

Drug Therapy:

  • Antibiotics for H. pylori with a proton pump inhibitor.

  • Antacids, H2 receptor antagonists, and mucosal protectants (e.g., sucralfate).

Nutrition Therapy:

  • Bland diet, avoidance of bedtime snacking, and alcohol.

Complementary Therapy:

  • Stress reduction techniques (e.g., yoga).

  • Herbs (consult healthcare provider before use).

Non-surgical Interventions:

  • IV fluids, NG tube for bleeding assessment, EGD with cautery.

Surgical Options:

  • Minimally invasive and conventional surgeries, gastrectomy, pyloroplasty, vagotomy.

Gastric Cancer

Definition:

  • Most gastric cancers are adenocarcinomas.

  • Often asymptomatic in early stages, usually diagnosed at advanced stages.

Risk Factors:

  • H. pylori infection, pernicious anemia, gastric polyps, chronic atrophic gastritis, toxic substance exposure, dietary factors (processed foods, low fruit and vegetable intake).

Assessment:

  • History focusing on risk factors, physical symptoms (indigestion, fullness, retrosternal pain, anemia).

Diagnostic Tests:

  • Laboratory tests (hemoglobin, occult blood).
       - Possible elevated carcinoembryonic antigen (CEA) levels.

  • EGD confirmation with biopsy, CT, PET, or MRI.

Interventions:

Non-surgical:

  • Chemotherapy and radiation.

Surgical:

  • Tumor removal (total or subtotal gastrectomy).

Postoperative Care:

  • Focus on preventing complications (atelectasis, infection, ileus).

  • Monitor lung sounds, bowel sounds, and surgical site regularly.

Complications of Gastric Cancer:

Dumping Syndrome:

  • Rapid gastric content emptying leading to symptoms post-eating (e.g., tachycardia, vertigo).

  • Management includes diet modification (high protein, high fat, limited carbohydrates) and meal timing.

Alkaline Reflux Gastropathy:

  • Bile reflux into the stomach, leading to abnormal fullness and distension.

Delayed Gastric Emptying:

  • Causes and management similar to gastric surgery complications.

Nutritional Deficiencies:

  • Vitamin B12, folate, iron deficiencies post-cancer treatment; dietary adaptations recommended.