Presentation on theme: "Management of Patients With Gastric and Duodenal Disorders"— Presentation transcript:
1 Management of Patients With Gastric and Duodenal Disorders
2 Common Disorders of the Mouth, Esophagus, and Stomach StomatitisCold sore, fever blister (herpes simplex virus)Aphthous ulcer (cause unknown)Candidiasis/thrush (candida albicans)Necrotizing ulcerative gingivitis (infection)Oral mucositis (damage caused by chemotherapy or radiation therapy)Oral cancer (usually squamous cell carcinoma)
3 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–1 Oral cancer.
4 Common Disorders of the Mouth, Esophagus, and Stomach Gastroesophageal reflux disease (GERD): relaxation of lower sphincter, incompetent lower esophageal sphincter, and hiatal herniaHiatal hernia: stomach protrudes through a defect in the diaphragm into the thoracic cavityEsophageal cancer: uncommon in U.S., usually squamous cell, or adenocarcinoma
5 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–3 Mechanisms of gastroesophageal reflux.
6 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–3 (continued) Mechanisms of gastroesophageal reflux.
7 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–3 (continued) Mechanisms of gastroesophageal reflux.
8 Common Disorders of the Mouth, Esophagus, and Stomach Gastritis: ingestion of gastric irritantsPeptic ulcer disease (PUD): use of ASA, NSAIDs, presence of H. pyloriZollinger-Ellison syndrome: caused by gastrin-secreting tumorStomach cancer: H. pylori, genetic predisposition, carcinogenic factors in the diet
9 Gastritis Inflammation of the stomach A common GI problem Acute: rapid onset of symptoms usually caused by dietary indiscretion. Other causes include medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications.Chronic: prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori. May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile.
11 Manifestations of Gastritis Acute: abdominal discomfort, headache, lassitude, nausea, vomiting, hiccuping.Chronic: epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, nausea and vomiting, intolerance of some foods. May have vitamin deficiency due to malabsorption of B12.May be associated with achlorhydria, hypochlorhydria, or hyperchloryhydria.Diagnosis is usually by UGI X-ray or endoscopy and biopsy.
12 Medical Management of Gastritis AcuteRefrain form alcohol and food until symptoms subsideIf due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage due to danger of perforation and damage to esophagusSupportive therapyChronicModify diet, promote rest, reduce stress, avoid alcohol and NSAIDsPharmacologic therapy
13 Peptic UlcerErosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagusAssociated with infection of H. pyloriRisk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency.Manifestations include a dull gnawing pain or burning in the mid-epigastrium; heartburn and vomiting may occurTreatment includes medications, lifestyle changes, and occasionally surgery (See Tables 37-1 and 37-3)
14 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–8 Common sites affected by peptic ulcer disease.
15 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–9 A superficial peptic ulcer.
16 Common Disorders of the Mouth, Esophagus, and Stomach Figure 23–10 The spread and forms (polypoid and ulcerating) of gastric cancer.
19 Nursing Process: The Care of the Patient with Gastritis—Assessment History including presenting signs and symptomsDietary history and dietary associations with symptoms72 hour diet; diary may be helpfulAbdominal assessment
20 Nursing Process: The Care of the Patient with Gastritis—Diagnoses AnxietyImbalanced nutritionRisk for fluid volume imbalanceDeficient knowledgeAcute pain
21 Nursing Process: The Care of the Patient with Gastritis—Planning Major goals may include reduced anxiety, avoidance of irritating foods, adequate intake of nutrients, maintenance of fluid balance, increased awareness of dietary management, and relief of pain.
22 InterventionsReduce anxiety; use calm approach and explain all procedures and treatments.Promote optimal nutrition; for acute gastritis, the patient should take no food or fluids by mouth. Introduce clear liquids and solid foods as prescribed. Evaluate and report symptoms. Discourage caffeinated beverages, alcohol, cigarette smoking. Refer for alcohol counseling and smoking cessation.Promote fluid balance; monitor I&O, for signs of dehydration, electrolyte imbalance, and hemorrhage.Measures to relieve pain: diet and medications.See Chart 37-1.
23 Nursing Process: The Care of the Patient with Peptic Ulcer—Assessment Assess pain and methods used to relieve painDietary intake and 72 hour diet diaryLifestyle and habits such as cigarette and alcohol useMedications; include use of NSAIDsSign and symptoms of anemia or bleedingAbdominal assessment
24 Nursing Process: The Care of the Patient with Peptic Ulcer—Diagnoses Acute painAnxietyImbalanced nutritionDeficient knowledge
26 Nursing Process: The Care of the Patient with Peptic Ulcer—Planning Major goals for the patient may include relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications.
27 Anxiety Assess anxiety Calm manner Explain all procedures and treatmentsHelp identify stressorsExplain various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification
29 Management of Potential Complications Management of hemorrhageAssess for evidence of bleeding, hematemesis or melena, and symptoms of shock/impending shock and anemia.Treatment includes IV fluids, NG, and saline or water lavage; oxygen, treatment of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention.Pyloric obstructionSymptoms include nausea and vomiting, constipation, epigastric fullness, anorexia, and (later) weight loss.Insert NG tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required.
30 Management of Potential Complications Management of perforation or penetrationSigns include severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board-like abdomen, and symptoms of shock/impending shock.Patient requires immediate surgery.