Chapter 28: Upper GI Disorders - Eating Disorders and Related Issues

Eating disorders commonly accompany psychological disorders and significantly affect the gastrointestinal (GI) system due to their impact on eating habits.

Definition: A psychiatric disorder characterized by the refusal to eat adequate quantities of food, leading to severe malnutrition and potential starvation.
Symptoms: Patients often consume very little food and may engage in behaviors to avoid eating.
Crossover: Some patients display characteristics of both anorexia and bulimia.
Treatment:
- Admission to medical care for malnutrition.
- Enteral or parenteral therapy as necessary.
- Behavior modification and nutrition support through counseling.

Definition: A psychological disorder where individuals consume large amounts of food followed by purging behaviors (vomiting, laxative use).
Characteristics: Patients monitor their vomit or stool to ensure weight loss consistency, indicating severe neurosis.
Symptoms: May lead to fluid and electrolyte imbalances, dental problems, including enamel erosion (acid washing), and frequent dental caries.
Treatment:
- Psychotherapy and antidepressant medications.
- Long-term behavior modification necessary due to the addictive nature of the disorder.

Statistics: Over 40% of adults in the United States are classified as obese (BMI > 30).
Healthy People 2030 Goals: Focus on preventing obesity and promoting healthy nutrition.
Contributing Factors:
- High-calorie and high-fat diets, lack of exercise, genetic predispositions, certain medications increase appetite.
Diagnosis: Based on height and weight charts and waist-to-hip ratios. Over 20% above ideal body weight indicates obesity.
Treatment:
- Dietary changes and exercise; may require specialized exercise programs.
- Support groups and behavior modification involving rewards for weight loss.
- Short-term use of appetite-suppressing medications when necessary (e.g., Ozempic, Willgobi).

Indications for Surgery: Considered for patients with a BMI > 40 or > 35 with complications. Requires extensive counseling and lifestyle modifications.
Types of Bariatric Surgery:
- Gastric Restrictive: Limits food intake.
- Malabsorptive: Reduces absorption of nutrients.
- Combination: Both restrictive and malabsorptive features.
Common Procedures:
- Gastric banding (adjustable band limiting food intake).
- Sleeve gastrectomy (removes part of the stomach secreting ghrelin).
- Roux-en-Y gastric bypass (reduces stomach size and nutrient absorption).
Pre-Procedure Education: Address emotional factors related to eating.
Post-Procedure Monitoring: Look for complications like anastomotic leaks, tachycardia, restless behavior due to internal bleeding, and regulating diet (starting with liquids, moving to pureed).

Postoperative:
- Monitoring for leaks and other complications.
- Encouragement of movement for recovery, resumption of fluid intake.
- Keeping dietary intake at low volumes to prevent discomfort and complications.
Dietary Guidance:
- Emphasize small, frequent meals, low-calorie dense foods, avoidance of sugar.
- Risk of malnutrition, necessitating vitamin and mineral supplementation.
Long-term Lifestyle Changes: Stress reduction techniques; necessity of keeping a food diary and participating in counseling sessions.

Stomatitis: Inflammation of oral mucosa due to trauma, infection (e.g., H. Pylori), poor hygiene, or medications.
Symptoms: Pain, swelling, dryness, halitosis, and possibly canker sores.
Treatment: Symptomatic care, artificial saliva, dietary adjustments.

Definition: Difficulty in swallowing, which can be psychosomatic (globus hystericus).
Evaluation: Conduct practice swallows before providing oral medications; modified barium swallow tests if necessary.
Patient Education: The importance of swallowing techniques, potential diets to simplify intake, positioning during meals.

Overview: Oral cancers can be aggressive, often leading to significant morbidity.
Causes: Unknown, but often linked to smoking, alcohol use, or HPV.
Diagnosis: Through physical examination and biopsy, look for symptoms like red, ulcerated lips lasting over three weeks.
Treatment: Surgery, radiation, and chemotherapy depending on the stage of the cancer.

Types: Squamous cell carcinoma, adenocarcinoma associated with Barrett’s esophagus; screening with endoscopy is crucial.
Symptoms: Difficulty swallowing, weight loss, persistent cough, and hoarseness.
Diagnostic Tests: Barium swallow tests, endoscopies for biopsy and assessment of esophageal conditions.

Description: Characterized by backflow of gastric contents into the esophagus, leading to symptoms like heartburn, dysphagia.
Risk Factors: High-fat diets, obesity, tobacco use, certain medications.
Treatment and Management: Lifestyle modifications (weight loss, upright positioning after meals), PPIs, and potential surgical options like fundoplication to prevent reflux.

Definition: Enlarged veins in the esophagus often resulting from liver disease; can rupture and cause significant bleeding.
Management: Banding or cauterization to control bleeding along with supportive care addressing risk factors like alcohol cessation and lifestyle adjustments.

Overview: Erosions occur in the stomach or duodenum; often related to H. Pylori or NSAID use.
Symptoms: Abdominal pain, nausea, sometimes leading to hematemesis (vomiting blood).
Treatment: PPIs, education on diet, stress management, and monitoring for complications like perforation.

Definition: Enteral nutrition involves feeding via tubes (NG, PEG) while parenteral nutrition (PPN, TPN) delivers nutrients intravenously for those unable to eat.
Considerations: Must monitor fluid balance, glucose levels, and infection risk associated with tube feeding.
Complications: Dehydration, malnutrition, aspiration, and refeeding syndrome.

Importance of Understanding GI Disorders: Recognizing the impact of various GI disorders on overall health and the necessity of a multidisciplinary approach to management is critical in nursing and patient care. Patients may require extensive education and support to manage their conditions effectively.