Management of Gastric and Duodenal Disorders

8/7/2019 Management of Gastric and Duodenal Disorders

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Management of

Gastric and Duodenal Disorders


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Gastritis

Inflammation of the gastric mucosa

Acute vs. Chronic

What contributes to the development of

gastritis?

What is the pathophysiologic process of

gastritis?


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Gastritis

Clinical Manifestations

Acute

Abdominal discomfort

Headache

Lassitude

Nausea/vomiting

Anorexia

Hicupping

Chronic

Anorexia Heartburn after eating

Belching

Sour taste

Nausea/vomiting

Assessment and Diagnostics

UGI x-ray series

Endoscopy

Histologic studies Biopsy

Diagnostic measures for

H. pylori


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Gastritis: Management

Medical

Acute:

Instruct: No alcohol or fooduntil symptoms resolved

Slowly progress diet IVFs if dehydrated

Manage bleeding

Chronic:

Modify diet Promote rest

Avoid alcohol and NSAIDs

Initiate pharmacotherapy

Nursing

Reducing anxiety

Promoting optimal nutrition

Promoting fluid balance Relieving pain

Avoid contributing foods and

fluids

Adherence to medication

regimen


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Peptic Ulcer Disease Review

Impaired gastric mucosal defenses

What are the two most common contributingfactors to PUD?

Compare and Contrast the types of peptic ulcers?

How will peptic ulcer disease be treated?


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Gastric UlcersClinical Manifestations

Epigastric tenderness

Dyspepsia

Melena

Pain Vomiting

S/S fluid volume deficit

With perforation

Rigid, boardlike abdomen

Rebound tenderness

Hyperactive bowel soundsthat may diminish

Complications

Hemorrhage

Most serious

Most common in older adult

with gastric ulcers Perforation and penetration

Pyloric obstruction

Intractable disease


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Gastric Ulcers

Goals of therapy:

Provide pain relief

Eradicate H. pylori Heal ulcerations

What diagnostics would you anticipate?

How will you accomplish these goals?

What will be done if the PUD is intractable?


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Gastric Bleeding

Manifested as:

Hematemesis

Often seen with large bleeds

Bright red to coffee-grounds appearance

Melena

Seen with smaller, slower bleeds

Tarry, black stools

What symptoms might a person exhibit with a GIbleed?


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Management of GI Hemorrhage

Large bore IV access

Serial H&H

NG with saline lavage

Indwelling Foley

Monitor VS and pulse oximetry

Recumbent with feet elevated

Describe the rationale for each intervention


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Zollinger-Ellison Syndrome

Characterized by: Severe peptic ulcers

Extreme gastric hyperacidity

Gastrin secreting benign or malignant tumors

Symptoms: Early: symptoms resemble PUD

Late: progressive sx, poor response to therapy, diarrhea,steatorrhea

Treatment: Suppress acid secretion

Vagotomy and pyloroplasty

Surgical resection and chemotherapy if malignant


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Morbid Obesity: Surgical Management

When will Bariatric Surgery be performed?

Describe the two mechanisms of actionassociated with bariatric surgeries?

Describe the interventions associated with thepatient selection process.


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Morbid Obesity

Surgical Procedures

Roux-en-Y gastric bypass

Gastric banding

Vertical-bandedgastroplasty

Biliopancreatic diversion

with duodenal switch

Nursing Management

Focused on post-operativecare

Similar to care of gastricresection

Pay attention to risks ofcomplications

Monitor hydration status

Monitor dietary intake andweight

Discharge education isessential


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Gastric Cancer

Overview:

Adenocarcinoma mostcommon

Etiologies: Pernicious anemia

Gastric polyps

Chronic atrophic gastritis

Achlorhydria

Diet is a significant factor High in smoked, salted, or

pickled foods and low in fruitsand vegetables

Clinical Manifestations

Early disease

Pain relieved by antacids

Similar to benign ulcer sx

Progressive disease

Dyspepsia

Early satiety

Weight loss Abdominal bloating pc

Nausea/vomiting

Sx similar to PUD


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Gastric Cancer

Assessment and Diagnostics

Palpable mass in advanceddisease

Ascities Hepatomegaly

Palpable periumbilicalnodules

EDG with Biopsy & washings

UGI

Endoscopic ultrasound

CT

Nursing Management

Pre-op:

Reduce anxiety

Promote optimal nutrition Relieve pain

Provide psychosocial support

Post-op:

Reducing anxiety

Relieving pain

Education

Resuming enteral nutrition

Recognizing obstacles toadequate nutrition


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Obstacles to Adequate Nutrition

Dysphagia and Gastric

Retention

Post truncal vagotomy

Manifested by: abd.distention, n/v

Regurgitation

Bile Reflux

Causes gastritis andesophagitis

Burning epigastric pain

Bilious emesis

Dumping Syndrome

Vasomotor and GI

symptoms associated with

gastric surgery or a form of

vagotomy

GI symptoms occur with

ingestion of food

Vasomotor symptoms

occur within 10-90 minutesof eating

May lead to anorexia due

to patient wanting to avoid

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Management of Gastric and Duodenal Disorders