L16 Flashcards
(24 cards)
S/s of acute gastritis
- Rapid onset of epigastric pain or discomfort
- Nausea and vomiting
- Anorexia
- Hematemesis: vomiting of blood
- Gastric haemorrhage
- Dyspepsia: heart burn
S/s of chronic gastritis
Decreased function of parietal cells ( low gastric acid and intrinsic factor secretion)
1. Epigastric pain relieved by ingestion of food
2. Intolerance of fatty and spicy food
3. Nausea and vomiting
4. Pernicious anemia
5. Anorexia
Investigation for gastritis
- History of drug (NSAID) and alcohol use
- Endoscopic: to investigate for inflammation and ulceration of gastric mucosa
- Stool for Fecal occult blood
- Biopsy
- Blood test: CBC
- Symptoms
Treatment for gastritis
- Refrain alcohol
- Avoid NSAID
- Keep NPO and IVF until symptoms subside
- Medications: antacids, H2 receptor antagonist, proton pump inhibitor
- For emergency situation, do surgery (gastric resection)
Cause of peptic ulcer
- Use of alcohol, smoking, NSAID, glucocorticoids
- Stress
- Helicobacter pylori infection
Clinical manifestations of Duodenal ulcer
- Weight gain
- Hypersecretion of HCl
- Melena: black stool
- Pain located at the mid-epigastrium
- Pain relieved by food ingestion, occur 2-3 hours after meal, usually wake by pain at night
Clinical manifestation of gastric ulcer
- Weight loss
- Normal to hyposecretion of HCl
- Hematemesis
- Pain increases by food ingestion, occur 30mins to 1hr after meal, rarely pain at night
Complications of peptic ulcer
- Haemorrhage
- Perforation —> peritonitis
- Pyloric obstruction —> persistent vomiting
S/s of acute GI bleeding
- Faint, nausea and vomiting
- Hematemesis: coffee ground
- Diarrhea:
Black stool —> digested blood
Bright red blood in stool —> melena
—> decreased hemoglobin level - Restlessness, mental confusion
S/s of perforated peptic ulcer
- Sudden severe pain in the upper abdomen
- Ingestion of food and antacid do not relieve pain
- Rapid and shallow breathing
- Elevated heart rate, weak pulse
- Absence of bowel sound
- Nausea and vomiting may occur
Investigation for peptic ulcer disease
- Physical examination: pain, epigastric tenderness, abdomen distension
- OCG:
- visualisation of inflammatory changes, lesions, and ulcer
- size and location of the lesions
- biopsy to test for H. pylori and cytology - Blood test: CBC and test for H. pylori
- Stool for fecal occult blood
- Urea breath test:
Ingest of a capsule with specific carbon atom, collect the second breath and test with the carbon shows bacterium presence
OGD homeostasis
- Inject chemicals into the bleeding sites e.g. adrenaline
- Treat the bleeding area with heat, electric current, or laser
- Close the afferent blood vessels with clips or a band
Medications for peptic ulcer
- Treat gastric acid
- antacid (neutralise acid)
- proton pump inhibitors and H2 receptor inhibitors (inhibit gastric acid secretion)
- pepsin inhibitors (given 30 mins before meal and at bedtime) - Treat H. pylori
- combination of antibiotics, proton pump inhibitors and bismuth salts
Surgical interventions for peptic ulcer disease
- Vagotomy (cutting of the vagus nerve to reduce HCl secretion)
- Antrectomy (eliminate gastric phase of digestion)
- Pyloroplasty (widening of pyloric sphincter to accelerate gastric emptying)
Nursing interventions for peptic ulcer disease
- Relieve pain
- administer antacid, prostaglandin, anticholinergic, mucosal barrier protectant (1hr before each meal)
- avoid NSAID and aspirin
- avoid smoking - Maintaining optimal nutrition status
- administer small, frequent banding feeding
- avoid meat extractors, alcohol, caffeine, and food rich in fat and cream - Monitor potential complications
- haemorrhage
- perforation and penetration
- pyloric obstruction
Risk factors of gastric cancer
- Diet with high fat, salted, smoked, preserved food, low in vegetables and fruits
- Smoking
- Alcohol consumption
- Previous subtotal gastrectomy
Clinical manifestations fo gastric cancer
- Early signs
- indigestion, early satiety
- abdominal discomfort
- epigastric, back and retrosternal pain - Late signs
- fatigue, nausea and vomiting
- sensation of pressure in the stomach
- anemia
- dysphagia and obstructive symptoms
- anorexia and weight loss
- abdominal mass - Positive occult blood
Diagnostic test of gastric cancer
- Tumor marker: carinoembryonic antigen (CEA)
- EGD
- Endoscopic ultrasound: depth of tumor and lymph node involvement
- CT scan for abdomen, chest and pelvic: for staging and assess surgical resectability
- Diagnostic laparoscopy: elevate gastric tumour, pathological diagnosis, detect metastasis
Treatment of gastric cancer
- Gastrodudenostomy
- Gastrojejunostomy
- Proximal gastrectomy
- Total gastrectomy
- Chemotherapy
- Radiation therapy
Post-op nursing care for stomach cancer surgery
- Monitor vital signs (s/s of shock), I&O (assess NG tube drainage for type and amount), bleeding from abdominal surgical sites
- Administer IV fluid to patient until peristalsis return; give sips of water to small frequent meals as prescribed after bowel sound return
- Monitor for complications: Vit B12 deficiency, diarrhea, hypoglycemia, haemorrhage, infection
- Pain management
- assess frequency, intensity, duration of pain
- use of patient-control analgesic
- change of position - Promote optimal nutrition:
- small and frequent meal
- high calorie, vitamin A and C, and iron for tissue repair
- parenteral feeding if unable to eat
Post-op NG tube care of stomach surgery
- NG tube inserted for decompression
- Observes gastric aspirate for amount, colour and door
- Bloody aspirate in first 2-3 hours;
Black aspirate in first 24 hours;
Yellow-green aspirate within 36-48 hours - If NG tube has to be replaced, have to be done by doctor
(Risk of penetrating the gastric mucosa and disrupting the suture line)
Patient education to prevent dumping syndrome
- Eating with bed head elevated 15-45 degree
- Divided meal into six small feedings to prevent overload
- Xxx drink water during meal; drink 30-45 mins before and after the meal to prevent abdomen distension
- Avoid concentrated sweet
- Increase protein and fat intake for build rebuild
Dumping syndrome
Rapid emptying of gastric contents into the small intestine —> extracellular fluid drawn to the small intestine to dilute —> decreased circulating blood, increased intestine peristalsis and motility
Symptoms occur 30 mins after meal:
Nausea and vomiting, abdominal fullness, abdominal cramping and diarrhea, tachycardia, palpitation, perspiration排汗, weakness and dizziness
Late dumping syndrome:
Hypersecretion of insulin —> increase in blood glucose level —> rapid entry of high-carbohydrate food into the jejunum
Occur 90 mins to 3 hrs after meal
Symptoms: dizziness, palpitations, diaphoresis過度排汗, confusion
Steatorrhea
Fat in stool caused by rapid gastric emptying
In mild case, treat by reduce fat intake and administer anti-motility medications
