Chapter 28 Care of the Upper Gastro Intestinal System

Bariatric Surgery creates reduction of gastric capacity. 3 common types of bariatric surgery restrictive gastric, malabsorptive surgery,vertical banded gastroplasty. -Restrictive Procedure is also called circumgastric banding is inflatable band around fundus of stomach.Bond nflated defalted to change size of port. -Vertical banded gastroplasty- small stomach pouch by placing vertical ine of staples. -Malabsorptive and combination procedure- Gastric bypass limit stomach size and duodenum and part of jejunum are by passed.limits absorption of calories -Complications- Signs and symptoms - Tachychardia -dyspnea - restleness -Bariatric surgey develop gall stones. Gastric stretching may cause staple line and break to occur. Nursing Management- diet,feeding begins ith 1 ounce of clear iquid at a time. Anorexia nervosa- -pt refuses to eat adequate quantities of food &starves.Treatment for malnutrition. Bulimia- another psychological disorder and pt consume large quantities of food and induces vomiting to get rid of it so weight is not gaines.Can lead t severe fluid and electrolye imbalance. Stomatitis- generalized inflammation of mucous. Symptoms-pain swelling of mucosa,halitosis nd canker soresous memberanes of mouth. CuaesTrauma,poor oral hygienes, excessive drinking, malignancies. Symptoms-pain swelling of mucosa,halitosis nd canker sores. Dysphagia- means difficulty in swallowing. NPO by mouth if pt experiences swallowing. Barium test or videofluoroscopy. Treatment &Nursing management- main concern is airwa.Thickened fluids .Puree foods. High fowlers position. Tilt head back.If pt cannot swallow &esophagus is obstructed,pt must have gastrostomy.

NI for gastrostomy- aspirate for residual contents, chk for tube placement, skin care and obesity changes, flushing tube after each feeding,changing dress after 24 hrs. Cancer of oral cavity- Leukoplakis is a precancerous lesion hat occurs in tongue or mucosa. Nursing management- close monitoring of respiratory status, airway and oxygenation. Cold packs and elevation of head are used to prevent excessive swelling in neck.Aspetic wound care and tracheostomy. Cancer of oral cavity- Cause is unknown. Oral&pharyngeal cancer risk are cigareete smoking,heavy alcohol use.Leukoplakia is a pre cancerous lesion that may occur on tongue or mucosa. Cancer of esophagus- GERD is a cause of Barettes esophagus which is a precancerous condition. Signs,symptoms and diagnosis- feeling of fullness in throat Regurgitation of foods and foul breath. Treatment- no tobacco products and no heavy alcohol use,no tight clothes,esophagogastroenterostomy.

Nursing management- pt should be upright to prevent regurgitation,nutrition by parenteral fluids intially,pain,increased temperature and dyspnea. Monitor for leakage of feeding.

Hiatal hernia- loss of muscle strength ,increased intraabdominal pressure and congenital defects led to formation of hiatal hernia. -defect in wall of diapharagam whre esophagus passes through. It is formed by part of porttrusion of stomach or lower part of esophagus up in thoracic cavity.

Signs and symptoms- indigestion -belching - substernal or epigastral pain or feelings of pressure after eating caused by reflux of gastric fluid into esophagus.

Treatment-weight reduction,avoidance of tight fitting clothes,administration of antacids,elevation of head of bed,smoking should be avoided,intake of acohol,chococlate,fatty foods should be limited.

Nursing management-encourage weight reduction. Remind pt to stay upright for 2 hrs after eating and not to eat 3 hrs before bed time. -avoid lifting heavy items -Avoid foods that cause bloating increases abdominal pressure -increased abdominal pressure may push stomach through diaphargamtic tract.

GERD(Gastroesophagalreflux disease)- is a syndrome not disease. -90 percent of pt with GERD have hiatal hernia. - Occurs especially in men and women. - caused by transient relaxation of lower esophageal sphincter. - relaxation allows food to reflux in to esophagus from stomach. - delayed stomach empting. -Overweight,GERD contribute to bronchoconstriction and asthma symptoms due to irritation of gastric sysmptoms.

Signs and symptoms- Heartburn and reflux are most common symptoms. -chest pain ,coughing,dysphagia,belching, flatulence,bloating after eating .

Diagnosis- EGD,esophageal monumetry. Treatment and nursing management- diet therapy,life style changes and education.

Measures to prevent GERD -avoid foods that increases gastric pain.

-avoid high fat and spicy foods. -do not eat large meals.eat 4-6 meas a day. -eat slowly and chew foods .avoid using straw for liquid o decrease belching and reflux. - avoid carbonated beverages as they increase bloating. -limit alcohol,tomato based products,caffeine products,citrus based,chocolate,pepper mint and spearmint. Life style changes- wait 2-3 hrs after eating before lying down. -no tight clothes,lose extra pound -head of bed elevated. -stop smoking ,partcipte in regual stress reducing activities.

Complications-constantus irritation,baretes esophagus,reflux a risk factor lead to pneumonitis.acid reflux can cause dental caries.

Gastroenteritis- inflammation of stomach &SI.Caused by intake of food or water contaminated with virus,pathogens ,bacteria. NI -metabolic acidosis(diarrhea),abdominal cramping,fever, elevated WBC&blood in mucus or stool . collect stool specimen followed by fluids and send it to lab. Pt should be kept NPO until vomiting has stopped. Fluids containing glucose and electrolytes should be started. .Rest is important.

Gastritis- Main cause of gastritis is H pylori bacteria. Acute gastritis are -drinking -excessive amt of alcohol - infection from eating contaminated food -ingestion of drugs such as NSAIDs

Gastritis is an inflammation of mucous membrane lining stomach rather than disease. Atrophic gastritis involves all layers of stomach. - It is seen in association with gastric ulcer and malignancies of stomach. -Associated with uremia in pt with kidney failure. -Untreated chronic gastritis involves upper GI haemorrhage

Signs,symptoms and diagnosis-anorexia, -N/V/Pain &tenderness in stomach.

Treatment &Nursing Management- Acute gastritis :-withholding all foods by administering of drugs that slow down peristalsis of GI. Chronic gastritis-avoid spicy foods, -diet therapy, -avoid alcohol -antispasmodics.

Peptic Ulcer- Main cause of peptic ulcer is hpylori.Genetic link.Neither hot spiicy foods nor caffeine is risk factor for ulcers but it can worse many people. -Tension,anxiety, stress,poor eating habits -perforation ,stress ulcers.Cigarette smoking is a causative factor for peptic ulcer.,drugs induced NSAIDSby aspiration. -Ulcer develop when mucosa cannot protect itself from corrosive substances such as pepsinogen,alcohol,bilesalts. -peptic ulcer is loss of tissue in upper GI tract.

- includes both duodenal and gastric ulcer. -most common site for peptic ulcer is in first part of duodenum. -HPylori is rich in an enzyme that cause corrosion of upper GI mucosa by damaging mucous coating by more damage from gastric acid and pepsinogen. -Duodenal ulcer-associated with increased amt of hyperacidity of gastric juices such as 70 percent associated with HPylori. -Gastric ulcers are characterized by normally or abnormal levels of hydrochloric acid but 90 percent with H pylori. -Signs,symptoms and diagnosis- gastric ulcer pain is diminished in morning when secretion is low&after meals when food is in stomach and most severe before meals and bed time. Gastric ulcer-Less pain in morning (up) pain alleviated with food,nausea,loss of appetite and weight loss. Duodenum ulcer-more pain after eating,vomiting,bleeding. GI bleeding-Concerned most with coffee ground (hematemesis).black stool indicate upper GI bleeding. -white cell count indicated may be elevated in massive GI bleeding. --elevated BUN indicate digestion of large amt of blood. -small amt of blood in stool will end up as diarrhea. -Hypovolemic ,increase BP,rapid pulse may occur. Diagnosis-Endoscopy,serum test,urea breath test,barium studies. Treatment- Treat h pylori with antacids. -Decompress stomachtake out from stomach everything .Large tube placed through nose(nasogastric tube) then connected to low suctioning. - treatment of h pylori- proton pump inhibitors Treatment of peptic ulcer- antacids meds. Implementation- diet counseling -exclude alcohol and caffeine. - eat aat frequent intervals through out the day.

-When pt experiences GI bleeding and melena( black tarry stool with digested blood),room must be kep free of odor. - after bleeding stopped, pts vital signs must be stabilized . -watch out BP and pulse rate - watch out skin color,diaphoresis,hypovolemic. Complications- 3 major complications of peptic ulcer are haemorrhage -perforation. -obstruction. Haemorrhage- when ulcer erodes blood vessels and cause bleeding in stomach.sign includes vomiting of blood. Perforation- erosion of ulcer through walls of intestine..spilling of contents into Gi tract into peritoneal cavity Perforation- sudden and severe pain in upper abdomen and increases in intensity and referred to shoulders.Abdomen is rigid. Obstructon- scarring and loss of musculature at pylorus narrowing stomach outlet.chiefly by peristalsis and vomiting. Surgical treatment- atrectomy.(read pg 699) Nursing care of pts (read 701) Pt teaching 28-2on pg 698 Dumping syndrome- pt who have had gastrostomy esperience known as dumping syndrome. -Pt has nausea,weakness,abdominal pain and diarrhea and may faint and perspire profusely or experience palpitations after eating. - sensations are caused by large amounts of food and liquid into jejunum.occurs because all part of sromach and duodenum are surgically removed. -when pt experiences dumping syndrome,avoid eating large amt of food and drink minimum fluids. Fluids taken between meals. -avoid sweet foods.

-lie down flat for 30 mts after meal

Gastric cancer-pg 702 Gastrointestinal decompression- abdominal distention can cause pain. Nursing management-during GI decompression , use saline gastric pump. Pt must be observed for abdominal distention,nausea,vomiting,sob, an increase in girth of abdomen are signs that stomach and intestines not decompressed adequately. -low setting used. Tubing and pigtail should be above level of stomach to prevent leaking of stomach contents from pigtail. -pigtail can be cleared by instilling few milliliters of air. -chk tube for kinking .Irrigate w normal saline. -chk for coffee ground material. - room humididfer good - chk for N/V/abdominal distention. Read pg for 704 n 705 for TPN