Ch. 50 Patients with Stomach Disorders

Question 1

Digestion Function

Answer 1

Reservoir of the stomach where it produces acid, enzyme secretion, and gastric motility

Question 2

Gastritis

Answer 2

Inflammation of the stomach lining (gastric mucosa)
Acute or Chronic
Erose (ulcers in stomach) or Non-Erosive (no erosion such as infection like H pylori)

Question 3

Acute Gastritis

Answer 3

Sudden onset w/ short duration which could cause GI bleeding, indigestion, perforation, or scarring

Question 4

Chronic Gastritis

Answer 4

Months to years and typically related to autoimmune disease, pernicious anemia, or chronic H pylori

Question 5

Acute Gastritis Risk Factors

Answer 5

NSAIDs, alcohol, caffeine, stress, smoking
H Pylori
Autoimmune diseases
Corticosteroids, aldosterone receptor antagonists and serotonin reuptake inhibitors

Question 6

Acute Gastritis Clinical Manifestations

Answer 6

Dyspepsia (heartburn-indigestion)
Headache
N/V (hematemesis or coffee ground emesis)
Black, tarry stools or Melena (dark tar stool - classic sign of GI bleed)

Question 7

Acute Gastritis Lab & Diagnostic

Answer 7

CBC
H Pylori Testing
Blood, stool or urea breath test
Upper endoscopy

Question 8

Acute Gastritis Interventions

Answer 8

Treat symptoms
Pain should subside when cause removed
Drug therapy - H2 antagonist, PPT, antacids, anti-ulcer/mucosal barriers, ABX
Nutrition - bland, non-spicy, small frequent meals

Question 9

Gastritis Complications

Answer 9

Dehydration
Gastric Bleeding and Hemorrhage
Bleeding - transfusion, fluid replacement, risk for hypovolemic shock

Question 10

Dumping Syndrome

Answer 10

Complication of chronic gastritis
Rapid release of metabolic peptide following a food bolus; someone has eaten a large meal
Symptoms resolve after having a BM

Question 11

Clinical Manifestations of Dumping Syndrome

Answer 11

Full after eating (usually 10 min or 3 hr after eating)
Dizziness
Rapid HR (tachycardia)
Abdominal pain
diarrhea

Question 12

Dumping Syndrome Interventions

Answer 12

Lay down after eating
High protein, high fat, moderate carbohydrate diet
Small meals w/out liquids

Question 13

Peptic Ulcer Disease (PUD)

Answer 13

GI mucosa defenses become impaired and no protection from acid or pepsin
Can cause ulcers in the stomach

Question 14

Risk Factors of PUD

Answer 14

Smoking, alcohol, diet, exercise, stress, caffeine

Question 15

PUD Causes

Answer 15

Bacterial infection (H PYLORI)
Long use of NSAIDs
Genetics

Question 16

Gastric Ulcers

Answer 16

Inflammation of the stomach mucosa
Pain <60 min after eating

Question 17

Gastric Ulcers Clinical Manifestations

Answer 17

Pain with food
Hematemesis
Malnourished

Question 18

Duodenal Ulcers

Answer 18

Inflammation of the upper duodenal mucosa
Most common w/ deep lesions
High gastric secretion (excess acid w/ low pH)
Pain >90 min after eating

Question 19

Duodenal Ulcers Clinical Manifestations

Answer 19

Pain relieved with eating
Melena stools
Well-nourished

Question 20

Stress Ulcers

Answer 20

Develop after an acute medical crisis or trauma such as sepsis, head injury, burns, increased ICP, MODS

Question 21

PUD Lab

Answer 21

CBC (bleeding: low H&H)
Electrolyte imbalance (dehydration - low K, Ca, and phos; high sodium)
Metabolic alkalosis (GI excretion loss) or metabolic acidosis (acute GI bleeding, hypovolemia, shock, severe diarrhea, NG suctioning)
Coagulation studies
H pylori testing

Question 22

Complications of PUD

Answer 22

1 Perforation - Peritonitis

Pyloric Obstruction
Pernicious anemia and dumping syndrome
#1 complication is hemorrhage from perforation and/or infection

Question 23

Perforation

Answer 23

Full thickness ulcer that erodes the GI wall spilling contents into peritoneal cavity
S/S: tender, rigid, “board-like abdomen”
Untreated = sepsis, septic shock, and/or hypovolemic shock

Question 24

Pyloric Obstruction

Answer 24

Blockage
Due to scarring, edema/swelling, inflammation, tumor
S/S: abdomen bloating, fullness pain, N/V
NG tube for gastric decompression

Question 25

PUD Interventions

Answer 25

Monitor for vomit and stools
Monitor trends of VS and labs
Monitor for acute confusion, vertigo, dizziness or light-headedness, syncope (loss of consciousness)

Question 26

PUD Nursing Implications

Answer 26

Decreased BP
Increased HR
Weak peripheral pulses
Decreased H&H

Question 27

Manage acute & persistent pain

Answer 27

Gastric, duodenal, or stress ulcers cause pain
Nutrition - bland diet
Prevent reoccurrence/education
Provide pain relief
Drug therapy - PPI or H2, ABX, mucosal protectants

Question 28

Managing Upper GI Bleeding

Answer 28

Gastric or duodenal ulcer perforation
Fluid volume loss d/t vomiting/dehydration and electrolyte imbalance

Question 29

Managing Upper GI Bleeding Interventions

Answer 29

Careful monitoring (trends and s/s)
Blood administration (if indicated)
NG tube placement and saline lavage
Monitor blood loss, rate, decompression
Assess for s/s of potential perforation

Question 30

Gastric Cancer Causes

Answer 30

1 H Pylori

Genetic
Polyps
Gastritis

Question 31

Gastric Cancer Post Op Interventions

Answer 31

Auscultate lungs (prevention of atelectasis)
Abdominal BT (paralytic ileus)
Wound infection or peritonitis (VS, fever, labs)
NG tube (for bowel rest)