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Conditions/Diseases of the Upper GIT - Coggle Diagram
Conditions/Diseases of the Upper GIT
Gastroesophageal Reflux Disease (GERD)
Diagnostic Test
24 hours pH monitoring, endoscopy, barium swallow
Drug Therapy
Antacids, H2-receptor antagonist, & proton pump inhibitors
Clinical Manifestation
Heartburn, Dyspepsia, Dysphagia
Health Teaching
Lifestyle Alteration
Sleep with head elevated
Avoid clothes that constrict the waist
Maintain ideal weight
Stop smoking
Wait 2-3 hours after eating before lying down
Do stress reducing activities
Do not eat 3 hours before sleep
Dietary Alteration
Avoid food that ↓ gastric emptying/relax oesophageal sphincter (fatty food, alcohol, chocolate)
Eat slowly and chew thoroughly, avoid using straw
Avoid carbonated beverages
Avoid food that ↑ gastric acid (tomato, coffee, citrus)
Small frequent meals
Etiology
Transient relaxation of the lower oesophageal sphincter, overweight & food and/or medication that ↑ acid production and/or oesphageal sphincter
Complications
Barrett's Oesophagus → Oesophageal Ca
Definition
Backward flow of gastric or duodenal contents into the oesophagus
Surgical Management
Laparoscopic Surgical Fundoplication
Gastritis
Diagnosis
History, Physical Examination, Endoscopic Examination
Causative Factors
Chronic Gastritis
Autoimmune disease (pernicious anemia)
Helicobacter pylori infection
Chronic reflux of pancreatic secretions and bile into stomach
Benign/malignant gastric ulcer
Lifestyle (smoking, alcohol)
Use of medications (NSAIDs)
Dietary factors (caffeine)
Acute Gastritis
Bile reflux
Radiation therapy
Excessive alcohol intake
Ingestion of strong acid/alkali → gangrene/perforated mucosa
Overuse of aspirin, NSAIDs
Dietary indiscretion (irritating, too highly seasoned, contaminated with disease causing microorganism)
Acute illness/burns/major surgery/infection/organ failures
Main Cause
Helicobacter Pylori
Pathophysiology
Gastric mucous membrane edematous and hyperemic → Superficial erosion → Scanty secretion of gastric juice (↓ HCL ↑ mucus) → superficial ulceration → haemorrhage
Types of Gastritis
Acute
Lasting several hours to a few days
Chronic
Recurring episodes of acute gastritis
Clinical Manifestation
Acute
Anorexia, Nausea, Vomiting, Epigastric Pain & Tenderness, Hiccoughs, Mild Diarrhoea
Chronic
Anorexia, Nausea, Vomiting, Epigastric Pain, & Tenderness, may have no symptoms → massive haemorrhage suddenly
Definition
Inflammation of the gastric/stomach mucosa
Medical Management
Acute Gastritis
Avoid irritating food/fluids (spicy, caffeine, alcohol)
Monitor for haemorrhagic signs & notify Dr
IV fluid and electrolyte replacement
Instruct on use of antibiotics, antacids, anti-spasmodics
NBM till symptoms subside → ice chips, clear fluids, solids
Chronic Gastritis
Modification of patient's diet, no alcohol
Promote rest, ↓ stress
Antispasmodics, antacids, H2 receptors antagonist (Ranitidine/Zantac, Tagamet), proton pump inhibitor (Controloc, Pantoprazole, Prilosec), Antibiotics (Clarithromycin)
FAIL
Gastric resection, gastrojejunostomy
Peptic Ulcer Disease (PUD)
Predisposing Factors
Stress, smoking, use of corticosteroids & NSAIDs, h/o gastritis, alcohol, caffeine, familial tendency and blood type group O, H.pylori infection
Types of PUD
Gastric Ulcer
Sharp pain left mid epigastrium
Occurs 30-60 minutes after meal
Pain increase with food
Haematemesis > Melaena
Duodenal Cancer
Occur 1.5-3 hours after meal during night
Pain relieved by food
Burning pain mid epigastrium
Melaena > Haematemesis
Definition
Ulceration in the mucosal wall of stomach, pylorus, duodenum or oesophagus → common types; gastric/duodenal ulcer
Diagnostic Studies
CBC, Blood Urea Nitrogen (BUN)
Test stool for occult blood
Oesophagogastroduodenoscopy (OGDS)
Breath and/or serology test for H.pylori antibodies
Medical Management for GERD/Gastritis/PUD
Antidiarrheal (Bismuth Subsalicylate)
Suppress H.pylori & assist healing of mucosa (gray-black stools)
Mucosal Barrier Fortifiers (Sucralfate)
Form a coat to prevent action of acid on mucosa, ↑ mucus production ↑ gastric ulcer healing
Antiemetic (Motilium)
Reduce nausea & vomiting
Antibacterial (Tetracyline, Metranidazole (Flagyl), Amoxicillin, Clarithromycin
Eradicate H.pylori bacteria in gastric mucosa
Hyposecretory Agents (↓ acid secretion)
Anticholinergics (Dicyclomine Hydrochloride)
↓ vagal stimulation →↓ gastric motility, ↓ secretion
Antacids (Aluminium Hydroxide-Magnesium) Trisillicate (Gaviscon)
Buffer (neutralize) gastric acid
Patient Teaching
Regulate type of food and eating schedule; unhurried, relaxed, spaced at regular intervals
Control stress, develop healthy coping mechanisms, adequate rest
Drink lots of water → dilute gastric juice < corrosive
Stop smoking
Comply with medication and regular follow up for periodic assessment → antacid 1 hour after meal, if tablet chew thoroughly, avoid aspirin & NSAIDs
Complications
Haemorrhage
Insert CBD to monitor urine output (reflects blood volume)
Administer IV vasopressin (pitressin) for vasoconstriction and ↓bleed; monitor Hb &
Hct
Insert NGT to assess rate of bleeding, prevent gastric dilatation; N/S lavage to remove blood from stomach
CRIB to ↓ BP and GIT activity until bleeding subsided
NBM, IVI, and blood replacement
Administer non-narcotic anti-anxiety if restless +
Monitor vital signs closely
Severe if > 1L/day →Treat hypovolemic shock, prevent
dehydration and electrolyte imbalance, and stop bleeding
Monitoring of gastric pH (maintain 5.5-7) at least 1x/shift; Administer IV Ranitidine RDS
Perforation and Peritonitis
Immediate replacement of fluid/blood & electrolytes
Administer antibiotics
Sudden severe abd pain, board-like abdomen
Insert NGT → drains gastric contents
Surgical Management
Surgery indicated only if ulcers unresponsive to medication or if hemorrhage, perforation or obstruction occurs
Vagotomy
Gastric resection
Partial gastrectomy (Billroth I/II)
Pyloroplasty
Total gastrectomy
Nursing Diagnoses
Deficient fluid volume RT loss of blood
Risk for electrolyte imbalance RT vomiting/diarrhoea
Deficient knowledge RT factors contributing to condition and information about medication
Risk for bleeding RT gastric/duodenal ulcer
Anxiety RT lack of knowledge about condition
Risk for decreased cardiac output RT blood loss
Acute RT inflammation of the gastric/duodenal mucosa
Nursing Interventions
Deficient fluid volume RT loss of blood
CRIB
Administer blood transfusion
Administer IV fluid
Administer IV vasopressin
Assess vital signs for sign of hypovolemia shock
Insert CBD & monitor urine output
Record IO
Assess BUSE, HB results
Risk for bleeding RT gastric/duodenal ulcer
Insert NGT for flee flow
Assess & record NGT drainage
NBM
Administer IV fluid
CRIB
Administer IV vasopressin
Assess vital signs
Administer antacid, H2 receptors antagonist, proton pump inhibitor