Lecture 2 Gastric and Duodenal Disorders

Question 1

what is gastritis?

Answer 1

inflammation of gastric mucosa

Question 2

what is the typical duration of gastritis?

Answer 2

can last hours or days

Question 3

risk factors for acute gastritis?

Answer 3

food/alcohol
viruses
stress
ASA and NSAIDs

Question 4

risk factors for chronic gastritis?

Answer 4

H pylori
repeated exposure to agents that cause acute gastritis

Question 5

complications of chronic gastritis

Answer 5

atrophy
ulcers
cancer
bleeding if inflammation is severe

Question 6

clinical manifestations of acute gastritis

Answer 6

anorexia
rapid onset epigastric pain

Question 7

clinical manifestations of chronic gastritis

Answer 7

belching, nausea, vomiting, pyrosis
vague epigastric pain relieved by eating

Question 8

nursing management of gastritis

Answer 8

GI rest
slow reintroduction starting with clear liquids
bland small meals
eliminate irritating foods, alcohol, smoking
IV fluids and electrolytes

Question 9

pharmacologic management of gastritis

Answer 9

PPI, H2 antagonist, antacids
sucralfate
B12 - impaired absorption
antibiotics for H pylori

Question 10

risk factors for peptic ulcer disease

Answer 10

H pylori
NSAID use
Alcohol
Smoking
acid hypersecretory disorders
stress

Question 11

types of peptic ulcers (location)

Answer 11

duodenal
gastric
esophageal

Question 12

pathophysiology of peptic ulcer disease

Answer 12

erosion from gastric juice can occur if the epithelium has been damaged
can penetrate mucosa and extend into smooth muscle

Question 13

how do clinical manifestations of duodenal ulcer and gastric ulcer differ?

Answer 13

duodenal ulcer causes epigastric pain 2-3 hours after eating and improves with food and antacids

gastric ulcer causes epigastric pain immediately after eating and is not relieved by antacids

Question 14

how are clinical manifestations of duodenal and gastric ulcers the same?

Answer 14

epigastric pain
pyrosis
constipation or diarrhea
vomiting
bleeding
sour burps

Question 15

diagnostic tests for PUD

Answer 15

EGD
CBC
fecal occult blood test
H pylori test

Question 16

pharmacologic management of PUD

Answer 16

PPIs, H2 antagonists, sucralfate

discontinue NSAIDs

antibiotics if H. pylori

Question 17

diet for PUD

Answer 17

avoid spice, alcohol, coffee, caffeine
3 regular meals per day
avoid extreme food temps

Question 18

vagotomy

Answer 18

severs vagal nerve supply to proximal 2/3 of stomach to decrease stomach acid production of parietal cells by 75%

Question 19

pyloroplasty

Answer 19

enlarge pyloric opening to allow stomach to empty more easily

Question 20

antrectomy

Answer 20

distal 1/3 of stomach is excised and reattached to small intestine

Question 21

signs of peptic ulcer hemorrhage

Answer 21

hematemesis
melena

Question 22

assessing for hemorrhage in PUD

Answer 22

faintness, dizziness, nausea
vital signs
urinary output
H&H
occult blood stool test

Question 23

treating peptic ulcer hemorrhage

Answer 23

fluid resuscitation
endoscopic embolization

Question 24

signs and symptoms of perforation of the stomach

Answer 24

sudden severe abdominal and shoulder pain
vomiting
hypotension and tachycardia
tender and rigid abdomen

Question 25

post op care for perforated stomach ulcer

Answer 25

NGT monitor fluid volume and electrolyte balances monitor WBC and temp antibiotics

Question 26

signs and symptoms of gastric outlet obstruction

Answer 26

nausea and vomiting anorexia epigastric fullness distended abdomen

Question 27

managing gastric outlet obstruction

Answer 27

NGT EGD endoscopy surgery - pyloroplasty

Question 28

risk factors for gastric cancer

Answer 28

diet - smoked foods, pickled vegetable, salted fish and meats, low fruit and vegetable intake H. pylori alcohol smoking family history chronic gastritis and ulcers

Question 29

pathophysiology of gastric cancer

Answer 29

arise from mucus producing cells of inner lining early lymph node involvement

Question 30

clinical manifestations of gastric cancer

Answer 30

indigestion early satiety weight loss abd pain above umbillicus anorexia bloating after meals nausea and vomiting fatigue

Question 31

diagnosing gastric cancer

Answer 31

EGD CT scan CBC - gastric cancer can cause bleeding

Question 32

nutrition considerations for after gastrectomy

Answer 32

6 small feedings a day antiemetics fluids between meals, not with supplement vitamin C, A, B12, and iron may need TPN pre and post

Question 32

treating gastric cancer

Answer 32

radiation chemotherapy gastric resection

Question 33

3 things to monitor post gastrectomy

Answer 33

I/Os daily weight electrolytes