Nausea
feeling of discomfort that you want to vomit
Vomiting
the actual rejection of stomach fluids
Nausea & Vomiting Etiology
#NAME?
Nausea & Vomiting Manifestations
1. Anorexia
2. Dehydration
3. Electrolyte Imbalance
4. Weightloss
prochlorperazine (n/v)
#NAME?
diphenhydramine (n/v)
#NAME?
ondansetron (Zofran) (n/v)
#NAME?
metoclopramide (n/v
#NAME?
scopolamine transdermal (n/v)
- Blocks neurochemicals that trigger n/v
- Side effects: dry mouth, sleepiness, stays on for 3 days
Nutritional Therapy (n/v)
IV therapy, restart with room temp, clear liquids (avoid hot and cold), bland foods such as dry toast & crackers, drink small amounts frequently vs. a lot at a time
Non-drug Therapy (n/v)
acupuncture, herbals (peppermint), relaxation techniques
Nursing Interventions (n/v)
#NAME?
Gastritis
inflammation of the gastric mucosa, most common problems affecting the stomach
Gastritis Causes
1. Drugs: aspirin, corticosteriods, antibiotics
2. Diet: alcohol, spicy food, greasy food
3. Microorganisms: h. pylori, salmonella, staphlococcus
4. Environment: smoking, radiation
5. Pathophysiologic: burns, hernias, renal failure, sepsis, shock
6. Other
Gastritis Etiology
#NAME?
Gastritis Manifestations
- bacterial, viral infections, changes, prolong vomiting, stress
- Acute: lasts few days to a week (anorexia, n/v, feeling of fullness)
- Chronic: may not have any symptoms (develop pernicous anemia and neurologic complications)
Gastroesophageal Reflux Disease (GERD)
Chronic symptoms of mucosal damage, secondary to reflux of gastric contents into the lower esophagus
GERD Causes
when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the esophagus
GERD Predisposing Conditions
1. Decrease LES pressure
- caused by caffeine, chocolate, peppermint, drugs that relax/dilate (nitrates), calcium channel blockers, morphine, anticholinergics, theophylline
2. Obesity
- because of pressure
3. Smoking
4. Hiatal Hernia
What constitutes GERD?
persistence of mild symptoms more than 2 times a week or moderate to severe symptoms 1 time a week
Clinical Manifestations of GERD
1. Heartburn: burning tight sensation
2. Dyspepsia: pain or discomfort in upper abdomen
3. Regurgitation: hot, bitter, or sour liquid coming into throat or mouth
4. Hyper salivation
5. Globus: feels like a lump in throat that you cant get out
GERD Complications
1. Esophagitis
- irritation or inflammation in esophagus
2. Barretts Esophagus
- columnar epithelial cells, increases risk for cancer
3. Respiratory complications
- irritation to upper airway, may develop chronic bronchitis or pneumonia
4. Dental erosion
GERD Diagnostic Study: Barium Swallow
helps see abnormalities in the esophagus and stomach. can see polyps, tumors, ulcers, enlarged veins, narrowing, dysphagia, hiatal hernias
GERD Diagnostic Study: Endoscopic Evaluation
can assess LES competence, inflammation, scarring, and strictures
proton pump inhibitors (GERD)
Uses
- HCl acid suppression
- promote esophageal healing
- decrease esophageal strictures
Side Effects
- puts pt at risk for hip, wrist and spine fractures (need acid to absorb calcium)
Examples
- omeprazole, esomeprazole, pantoprazole
Antacids (GERD)
Uses
- quick but short relief of HCl acid
- taken 1 to 3 hours after meals/bedtime
Side Effects:
- diarrhea, hypermanesia, constipation, cramps
Examples:
- maalox, mylanta
Histamine (H2) receptor blockers (GERD)
Uses
- HCl acid
- reduce symptoms and promote esophageal healing
Side Effects
- headache, abdominal pain, diarrhea
Examples
- famotidine, cimetidine, ranitidine
Acid protective (GERD)
Uses
- cytoprotective properties
- sucralfate acts to form a protective barrier against acid, bile salts, and enzymes
Side Effects
- constipations
bethanecol (cholinergic) (GERD)
Uses
- increases LES pressure,
- improves esophageal emptying,
- increases gastric emptying
Side Effects
- light headedness, diarrhea, stomach cramps, dizziness, syncope (fainting), flushing
metoclopramide (prokinetic) (GERD)
Uses
- blocks effects of dopamine
- increases gastric motility and emptying
- reduces reflux
GERD Surgical Therapy
performed if complications of reflux esophagitis, intolerance to meds, stricture, barretts metaplasia, severe symptoms
objective - decrease reflux by enhancing the integrity of the LES
Nissen and Toupet Fundoplication
Fundus of the stomach is wrapped around the lower portion of the esophagus to reinforce and repair the defective barrier
Nissen vs. Toupet
Nissen is full closer
Toupet is semiclosure
Patient Education (GERD)
1. nutrition - avoid foods that cause reflux
2. medication - take PPIs before first meal of day, dont stop med w/o provider knowledge
3. raise HOB to 30 degree or 4-6 inch blocks
(GERD) Post-op Care
#NAME?
LINX Reflux Management System
#NAME?
Hiatal Hernia
Herniation of a portion of the stomach into the esophagus through an opening in the diaphragm
Sliding Hiatal Hernia
the junction of the stomach and esophagus is above the hiatus of the diaphragm, and a part of the stomach slides through the hiatal opening in the diaphragm
Paraesophageal Hiatal Hernia
the fundus and greater curvature of the stomach roll up through the diaphragm
Hiatal Hernia Etiology
#NAME?
Barium Swallow (HH)
may show the protrusion of gastric mucosa through the esophageal hiatus
Hiatal Hernia Clinical Manifestations
#NAME?
Hiatal Hernia Complications
#NAME?
Hiatal Hernia Therapy: Conservative
teach to reduce intraabdominal pressure by eliminating constricting clothing and avoid lifting and stretching
Hiatal Hernia Therapy: Surgery
1. Herniotomy - excision of hernia sac
2. Herniorraphy - close hiatal defect
3. Gastropexy - attach the stomach to the abdominal wall or diaphram
4. Fundoplication - decrease reflux
Peptic Ulcer Disease
condition of erosion of the GI mucosa resulting from the digestive action of the HCl acid and pepsin
Peptic Ulcer Disease Etiology
#NAME?
Acute Peptic Ulcer Disease
superficial erosion and minimal inflammation
Chronic Peptic Ulcer Disease
long duration causing erosion through muscular wall with formation of fibrous tissue
Stress-Related Peptic Ulcer Disease
physiologic stress such as severe burns, trauma, major surgery
Medication Induced Peptic Ulcer Disease
ASA, NSAIDs by increasing gastric acid secretion and reducing integrity of the mucosal barrier
Gastric Ulcers
- any portion of the stomach
- 1 to 2 hours after meal, burning or gaseous pressure in high left epigastrium and back and upper abdomen
- high recurrence rate
- greater in women and older adults
- peak incidence: btw 50-60 years of age
Duodenal Ulcers
- lesion is 1-2cm of duodenum, penetrating
- gastric secretion is increased
- 2 to 4 hours after meals
- burning, cramping, pressure like pain across midepigastrium & upper abdomen
- recurrence rate is high
- peak incidence is 35-45 years of age
H. Pylori
infection that alters gastric secretions, contracted from fecal oral or oral oral
strains: type O - increased risk
Clinical Manifestations of Ulcers
Pain
- described as burning or gaseous
- location is high in epigastrium
Diagnostic Studies (H. Pylori)
#NAME?
Collaborative Care (Ulcers)
Goal is to decrease gastric acidity and enhance mucosal defense mechanisms via:
- adequate stress
- drug therapy
- ASA & NSAIDs are decreased for 4-6 weeks
- diet modifications: 6 small meals a day
*pain decreases in 3-6 days but healing can take 3-9 week
Therapy for Acute Exacerbations
#NAME?
Therapy for Acute Exacerbations: rest stomach
NG
1. to monitor bleeding
2. to lavage the precipitating agent from the stomach
3. to keep the stomach empty and free of noxious stimuli such as pepsinogen and HCl acid
clear liquids are resumed when symptoms have subsided, with gradual reintroduction of
Ulcer Complication: Hemorrhage
- monitor for signs and symptoms of shock (low BP, weak pulse)
- monitor vital signs every 15-30 mins
Ulcer Complication: Perforation
#NAME?
Gastric Outlet Obstruction
Goal: decompress stomach, correct F & E imbalances, improve health
- projectile vomiting
- NG for several days
- oral intake begins with clear liquids, gradual increase
Gastroduodenostomy (Billroth I)
partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of the gastric stump to the duodenum
Gastrojejunostomy (Billroth II)
partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of the gastric stump to the jejunum
Vagotomy or Selective Vagotomy
severing of the vagus nerve either totally or selectively decreasing gastric acid production
Pyloroplasty
surgical enlargement of the pyloric sphincter to facilitate easy passage of stomach contents
Dumping Syndrome
loss of control of gastric chyme entering small intestine
- decrease meal size, limit fluids w/ food, low carb, rest periods w/ head elevated after each meal can help
Postprandial Hypoglycemia
uncontrolled gastric emptying of a bolus of fluid high in carbohydrate content into the small intestinge
Bile Reflux Gastritis
back diffusion of hydrogen ions through the gastric mucosa
cholestyramine: binds with bile salts
Post-op Care (Ulcers)
#NAME?
Nausea
feeling of discomfort that you want to vomit
Vomiting
the actual rejection of stomach fluids
Nausea & Vomiting Etiology
#NAME?
Nausea & Vomiting Manifestations
1. Anorexia
2. Dehydration
3. Electrolyte Imbalance
4. Weightloss
prochlorperazine (n/v)
#NAME?
diphenhydramine (n/v)
#NAME?
ondansetron (Zofran) (n/v)
#NAME?
metoclopramide (n/v
#NAME?
scopolamine transdermal (n/v)
- Blocks neurochemicals that trigger n/v
- Side effects: dry mouth, sleepiness, stays on for 3 days
Nutritional Therapy (n/v)
IV therapy, restart with room temp, clear liquids (avoid hot and cold), bland foods such as dry toast & crackers, drink small amounts frequently vs. a lot at a time
Non-drug Therapy (n/v)
acupuncture, herbals (peppermint), relaxation techniques
Nursing Interventions (n/v)
#NAME?
Gastritis
inflammation of the gastric mucosa, most common problems affecting the stomach
Gastritis Causes
1. Drugs: aspirin, corticosteriods, antibiotics
2. Diet: alcohol, spicy food, greasy food
3. Microorganisms: h. pylori, salmonella, staphlococcus
4. Environment: smoking, radiation
5. Pathophysiologic: burns, hernias, renal failure, sepsis, shock
6. Other
Gastritis Etiology
#NAME?
Gastritis Manifestations
- bacterial, viral infections, changes, prolong vomiting, stress
- Acute: lasts few days to a week (anorexia, n/v, feeling of fullness)
- Chronic: may not have any symptoms (develop pernicous anemia and neurologic complications)
Gastroesophageal Reflux Disease (GERD)
Chronic symptoms of mucosal damage, secondary to reflux of gastric contents into the lower esophagus
GERD Causes
when the defenses of the esophagus are overwhelmed by the reflux of acidic gastric contents into the esophagus
GERD Predisposing Conditions
1. Decrease LES pressure
- caused by caffeine, chocolate, peppermint, drugs that relax/dilate (nitrates), calcium channel blockers, morphine, anticholinergics, theophylline
2. Obesity
- because of pressure
3. Smoking
4. Hiatal Hernia
What constitutes GERD?
persistence of mild symptoms more than 2 times a week or moderate to severe symptoms 1 time a week
Clinical Manifestations of GERD
1. Heartburn: burning tight sensation
2. Dyspepsia: pain or discomfort in upper abdomen
3. Regurgitation: hot, bitter, or sour liquid coming into throat or mouth
4. Hyper salivation
5. Globus: feels like a lump in throat that you cant get out
GERD Complications
1. Esophagitis
- irritation or inflammation in esophagus
2. Barretts Esophagus
- columnar epithelial cells, increases risk for cancer
3. Respiratory complications
- irritation to upper airway, may develop chronic bronchitis or pneumonia
4. Dental erosion
GERD Diagnostic Study: Barium Swallow
helps see abnormalities in the esophagus and stomach. can see polyps, tumors, ulcers, enlarged veins, narrowing, dysphagia, hiatal hernias
GERD Diagnostic Study: Endoscopic Evaluation
can assess LES competence, inflammation, scarring, and strictures
proton pump inhibitors (GERD)
Uses
- HCl acid suppression
- promote esophageal healing
- decrease esophageal strictures
Side Effects
- puts pt at risk for hip, wrist and spine fractures (need acid to absorb calcium)
Examples
- omeprazole, esomeprazole, pantoprazole
Antacids (GERD)
Uses
- quick but short relief of HCl acid
- taken 1 to 3 hours after meals/bedtime
Side Effects:
- diarrhea, hypermanesia, constipation, cramps
Examples:
- maalox, mylanta
Histamine (H2) receptor blockers (GERD)
Uses
- HCl acid
- reduce symptoms and promote esophageal healing
Side Effects
- headache, abdominal pain, diarrhea
Examples
- famotidine, cimetidine, ranitidine
Acid protective (GERD)
Uses
- cytoprotective properties
- sucralfate acts to form a protective barrier against acid, bile salts, and enzymes
Side Effects
- constipations
bethanecol (cholinergic) (GERD)
Uses
- increases LES pressure,
- improves esophageal emptying,
- increases gastric emptying
Side Effects
- light headedness, diarrhea, stomach cramps, dizziness, syncope (fainting), flushing
metoclopramide (prokinetic) (GERD)
Uses
- blocks effects of dopamine
- increases gastric motility and emptying
- reduces reflux
GERD Surgical Therapy
performed if complications of reflux esophagitis, intolerance to meds, stricture, barretts metaplasia, severe symptoms
objective - decrease reflux by enhancing the integrity of the LES
Nissen and Toupet Fundoplication
Fundus of the stomach is wrapped around the lower portion of the esophagus to reinforce and repair the defective barrier
Nissen vs. Toupet
Nissen is full closer
Toupet is semiclosure
Patient Education (GERD)
1. nutrition - avoid foods that cause reflux
2. medication - take PPIs before first meal of day, dont stop med w/o provider knowledge
3. raise HOB to 30 degree or 4-6 inch blocks
(GERD) Post-op Care
#NAME?
LINX Reflux Management System
#NAME?
Hiatal Hernia
Herniation of a portion of the stomach into the esophagus through an opening in the diaphragm
Sliding Hiatal Hernia
the junction of the stomach and esophagus is above the hiatus of the diaphragm, and a part of the stomach slides through the hiatal opening in the diaphragm
Paraesophageal Hiatal Hernia
the fundus and greater curvature of the stomach roll up through the diaphragm
Hiatal Hernia Etiology
#NAME?
Barium Swallow (HH)
may show the protrusion of gastric mucosa through the esophageal hiatus
Hiatal Hernia Clinical Manifestations
#NAME?
Hiatal Hernia Complications
#NAME?
Hiatal Hernia Therapy: Conservative
teach to reduce intraabdominal pressure by eliminating constricting clothing and avoid lifting and stretching
Hiatal Hernia Therapy: Surgery
1. Herniotomy - excision of hernia sac
2. Herniorraphy - close hiatal defect
3. Gastropexy - attach the stomach to the abdominal wall or diaphram
4. Fundoplication - decrease reflux
Peptic Ulcer Disease
condition of erosion of the GI mucosa resulting from the digestive action of the HCl acid and pepsin
Peptic Ulcer Disease Etiology
#NAME?
Acute Peptic Ulcer Disease
superficial erosion and minimal inflammation
Chronic Peptic Ulcer Disease
long duration causing erosion through muscular wall with formation of fibrous tissue
Stress-Related Peptic Ulcer Disease
physiologic stress such as severe burns, trauma, major surgery
Medication Induced Peptic Ulcer Disease
ASA, NSAIDs by increasing gastric acid secretion and reducing integrity of the mucosal barrier
Gastric Ulcers
- any portion of the stomach
- 1 to 2 hours after meal, burning or gaseous pressure in high left epigastrium and back and upper abdomen
- high recurrence rate
- greater in women and older adults
- peak incidence: btw 50-60 years of age
Duodenal Ulcers
- lesion is 1-2cm of duodenum, penetrating
- gastric secretion is increased
- 2 to 4 hours after meals
- burning, cramping, pressure like pain across midepigastrium & upper abdomen
- recurrence rate is high
- peak incidence is 35-45 years of age
H. Pylori
infection that alters gastric secretions, contracted from fecal oral or oral oral
strains: type O - increased risk
Clinical Manifestations of Ulcers
Pain
- described as burning or gaseous
- location is high in epigastrium
Diagnostic Studies (H. Pylori)
#NAME?
Collaborative Care (Ulcers)
Goal is to decrease gastric acidity and enhance mucosal defense mechanisms via:
- adequate stress
- drug therapy
- ASA & NSAIDs are decreased for 4-6 weeks
- diet modifications: 6 small meals a day
*pain decreases in 3-6 days but healing can take 3-9 week
Therapy for Acute Exacerbations
#NAME?
Therapy for Acute Exacerbations: rest stomach
NG
1. to monitor bleeding
2. to lavage the precipitating agent from the stomach
3. to keep the stomach empty and free of noxious stimuli such as pepsinogen and HCl acid
clear liquids are resumed when symptoms have subsided, with gradual reintroduction of
Ulcer Complication: Hemorrhage
- monitor for signs and symptoms of shock (low BP, weak pulse)
- monitor vital signs every 15-30 mins
Ulcer Complication: Perforation
#NAME?
Gastric Outlet Obstruction
Goal: decompress stomach, correct F & E imbalances, improve health
- projectile vomiting
- NG for several days
- oral intake begins with clear liquids, gradual increase
Gastroduodenostomy (Billroth I)
partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of the gastric stump to the duodenum
Gastrojejunostomy (Billroth II)
partial gastrectomy w/ removal of distal 2/3 of stomach and anastomosis of the gastric stump to the jejunum
Vagotomy or Selective Vagotomy
severing of the vagus nerve either totally or selectively decreasing gastric acid production
Pyloroplasty
surgical enlargement of the pyloric sphincter to facilitate easy passage of stomach contents
Dumping Syndrome
loss of control of gastric chyme entering small intestine
- decrease meal size, limit fluids w/ food, low carb, rest periods w/ head elevated after each meal can help
Postprandial Hypoglycemia
uncontrolled gastric emptying of a bolus of fluid high in carbohydrate content into the small intestinge
Bile Reflux Gastritis
back diffusion of hydrogen ions through the gastric mucosa
cholestyramine: binds with bile salts
Post-op Care (Ulcers)
#NAME?