GI

Gastric Ulcers

  • Risk factors: stress, smoking, corticosteroids, NSAIDS, alcohol, hx of gastritis, fam hx of gastric ulcers, H. pylori

  • S/S: gnawing, sharp pain left epigastric area → 1-2h after eating; hematemesis

  • Complications: perforation, hemorrhage, pyloric obstruction

  • Interventions: protonix, H2 receptor antagonists, antacids, anticholinergics, mucosal barrier protectants, prostaglandins, abx if pt has H. pylori

  • Pt education: avoid alcohol, chocolate, caffeine, caffeinated or decaf coffee, aspirin & NSAIDS; adequate rest & reduce stress, healthy diet, take all prescribed meds

  • Interventions during an active bleed: monitor v/s closely, assess for signs of hemorrhage/dehydration/hypovolemic shock/sepsis/resp insufficiency; NPO, IVF; monitor H&H - obtain type & screen when H&H is stable bc pt might need a transfusion

  • Sx interventions: gastrectomy, gastric resection, Billroth II

    • Post op interventions → v/s, Fowler’s, IVF & electrolytes, I&Os, BS, NG suction monitoring, NPO 1-3 days, monitor for post op complication of dumping syndrome


Duodenal Ulcers

  • S/S: burning pain in the midepigastric area 2-5 hours after eating, midmorning/midafternoon/night → relieved by ingestion of food → pain wakes pt up at night; melena

  • Risk factors: H. pylori, alcohol, smoking, caffeine, corticosteroids, aspirin & NSAIDS

  • Potential complications: bleeding, perforation, gastric outlet obstruction, intractable disease

  • Interventions/pt education: v/s, cessation of smoking, avoid alcohol/caffeine/aspirin/NSAIDS/corticosteroids

  • Sx: only if ulcer is unresponsive to meds or if a complication occurs

Dumping Syndrome

  • What it is: rapid emptying of gastric contents into the small intestine following a gastric resection

  • SYMPTOMS → occur 30m after eating, n/v, abd fullness/cramping, diarrhea, palpitations/tachycardia, perspiration, weakness/dizziness, borborygmi

  • Pt education: high protein/carb diet, avoid/eliminate dairy, B12 vitamins, lie down 20-30m after eating, 5-6 meals/day

PRIORITY TOPICS IN SAUNDERS BOOK

  • Priority of care for a pt experiencing an upper GI bleed: stabilize the pt → O2 and ventilatory support as needed, two large-bore IVs (for fluids & blood), v/s, blood counts, coag studies

  • What to do for a pt NGT following a gastric sx: DO NOT irrigate or remove NGT unless specifically ordered by the MD (it can disrupt the gastric sutures); monitor closely to ensure proper functioning of the NGT (to prevent strain on the anastomosis site), call surgeon immediately if NGT not functioning properly