Problem 1

Stefan satria Group 4

Anatomy of upper GIT

Mouth

Heartburn

Nausea
Nausea-conscious desire to vomit

Vomiting
Vomiting-ejection of emesis from upper GI tract

Nausea and VomitingEtiology

GI disorders
Non GI disorders
Pregnancy Infections CNS disorders Cardiovascular disorders Metabolic disorders Stress Medications Motion

Nausea and Vomiting Pathophysiology

Vomiting center in brainstem Chemoreceptor zone (CTZ) stimulated Autonomic nervous system is activated
Sympathetic
Tachycardia Diaphoresis Parasympathetic Relaxation of LES

Nausea and Vomiting Clinical Manifestations

Nausea-subjective If vomiting prolonged
Dehydration Water, electrolytes lost Loss of extracellular fluid leading to circulatory collapse Metabolic alkalosis can occur-gastric loss or Metabolic acidosis if small intestine contents lost (less common)

Characteristics of Vomiting
Regurgitation-Partially digested food Projectile-forceful expulsion without nausea Fecal/intestinal-can be result of obstruction

Characteristics of Vomiting
Color
Coffee grounds-bleeding in stomach Blood changes to dark brown as result of interaction with HCL Bright red blood-active bleeding Green-bile

Dyspepsia

Hematemesis and Melena

Melena: passage of black, tarry stools; suggests bleeding proximal to the ileocecal valve Hematochezia: passage of bright or dark red blood per rectum; indicates colonic source or massive upper GI bleeding Hematemesis: passage of vomited material that is black (coffee grounds) or contains frank blood; bleeding from above the ligament of Treitz

History of hematemesis n melena

Present illness source, magnitude, duration of bleeding associated GI symptoms (vomiting, diarrhea, pain) associated systemic symptoms (fever, rash, joint pains) Review of systems GI disorders, liver disease, bleeding diatheses Anesthesia reactions medications (NSAIDs, warfarin) Family history

Upper gastrointestinal disorders

Hiatal Hernia
Herniation of portion of stomach into esophagus through opening in diaphragm Types
Sliding Paraesophageal/rolling

Etiology of Hiatal Hernia

Factors
Structural changes Obesity Pregnancy Heavy lifting

Clinical Manifestations of Hiatal Hernia

May be asymptomatic Heartburn Dysphagia Reflux with lying down Pain, burning when bending over

Hiatal Hernia
Diagnostic studies
Barium swallow Endoscopy Surgical intervention
Nissen fundoplication

Investigations upper endoscopy

Indications: persistent heartburn;bleeding from the upper GI tract; dysphagia; reflux oesophagitis; peptic stricture; Barrett's oesophagus

AM26

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Complications of Hiatal Hernia

GERD Hemorrhage Stenosis of esophagus Ulcerations Strangulation of hernia Regurgitation Increased risk for respiratory disease

Gastroesophageal Reflux (GERD)

Not a disease, but a syndrome Clinically symptomatic condition resulting in reflux of gastric contents into lower esophagus

Gastroesophageal Reflux (GERD)--Etiology

Combination of factors
Hiatal hernia Incompetent LES Decreased esophagus clearance Decreased gastric emptying Medications Results in esophageal irritation and inflammation

Gastroesophageal Reflux (GERD) Clinical Manifestations

Varies from individual
Heartburn (pyrosis) Burning, tight sensation Can spread to jaw May wake person from sleep R/O cardiac causes first Heartburn usually relieved with milk, alkaline substances Wheezing, coughing, dyspnea, hoarseness Lump in throat Regurgitation-hot, bitter, sour liquid coming from mouth Stomatitis N/V

Gastroesophageal Reflux (GERD) Complications

Esophagitis Esophageal stricture/scarring Barretts Esophagusprecancerous lesion for esophageal cancer/adenocarcinoma Bronchospasm Aspiration pneumonia Dental erosion

Gastroesophageal Reflux (GERD) Diagnostic Studies

History and Physical Barium swallow EGD Use of Proton pump inhibitors as trial

Nursing Considerations for the Client with GERD

Smoking cessation Avoid food that decrease LES pressure
fatty foods Chocolate Peppermint Coffee Tea Milk Avoid late night snacks Small, frequent meals

Peptic ulcer
A peptic ulcer is a sore in the lining of your stomach or duodenum Erosion of the GI mucosa from the digestive action of HCL acid and pepsin

Classification
Types
Acute-superficial erosion/minimal inflammation Chronic-Long duration, erosion through muscular wall, fibrous tissue formation
Both gastric and duodenal ulcer fall into this category

Symptoms
A burning pain in the gut is the most common symptom Pain 1-2 hours after meals Heartburn Local tenderness Nausea Vomiting Weight loss

A burning pain in the gut is a common symptom of peptic ulcers.

pathology of peptic ulceration

AM39

Etiology
Peptic ulcers are caused by
Bacteria called Helicobacter pylori Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen

Etiology Helicobacter pylori

Helicobacter pylori

Risk factor
Stress: The parasympathetic nervous system, which is responsible for the function of the digestive organs, ceases to act when the sympathetic nervous system, Smokers develop ulcers much more often than non-smokers. A poor diet is one that includes spicy foods, citrus foods, soda pop, caffeine, and alcohol, junk foods and refined & processed foods. Food and allergies can cause problems as well. Milk allergies are strongly linked to gastric problems. Doctors once prescribed milk as A low antioxidant status appears to predispose one to ulcers. have relatives who have peptic ulcers

Diagnostic Studies of Peptic Ulcer Disease

Endoscopy Tests for H.Pylori
Invasive
Tissue specimens Rapid urease test

Nonivasive
IgG Urea breath test (by product of H.Pylori) Barium swallow/X-rays- not accurate

Peptic Ulcer Disease - Treatment

The Mechanism and side effects of various acid suppressive medications
Drug Mechanism Common side effect

Antacids

neutralize acid

Mg - diarrhea Al - constipation Ca constipation

cytochrome 450 altered metabolism of drugs diarrhea, cramps, abortion hypergastrinemia enterochromaffin cell (ECL) hyperplasia constipation

H2 receptor antagonists Prostaglandins H+/K+ ATPase inhibitors

block histamine receptor

agonist block acid pump

Sucrafate coat ulcerated mucosa

Treatment of Peptic Ulcer Disease

Discontinue medications if possible that exacerbate condition No smoking/ETOH Avoid spicy/acid foods, black pepper, small frequent meals Medications
H2 Blockers Cytotec (antisecretory and cytoprotective) Cytoprotective agents (Carafate) Antacids Antibiotics for H. Pylori Treat stress Surgery

Complications of Peptic Ulcer Disease

Hemorrhage Perforation-most lethal, severe abdominal pain that spreads throughout abdomen, shoulder pain, absent bowel sounds Obstruction

Prevent Peptic ulcer

Stop using NSAIDs. Talk with your doctor about other pain relievers Dont smoke Dont drink alcohol.

Gastritis
Gastritis Inflammation of the gastric mucosa caused by any of several conditions, including infection (Helicobacter pylori), drugs (NSAIDs, alcohol), and autoimmune phenomena (atrophic gastritis).

Many cases are asymptomatic, but dyspepsia and GI bleeding sometimes occur.
Diagnosis is by endoscopy.

Treatment is directed at the underlying cause but often includes acid suppression and, for H. pylori infection, antibiotics.