N513 - GI: Upper GI Bleed, Peptic Ulcer Disease
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25 terms
Terms | Definitions |
|---|---|
 What are the common causes of UGI bleeding? | Esophageal origin - GERD, Esophageal varices, Mallory-Weiss tear, Stomach and duodenal origin - Gastritis, PUD (about 50%) Drug-induced origin Systemic clotting problem |
| What Emergency Assessment and Management should be performed for a patient with a suspected UGI bleed? | Immediate physical examination with emphasis on - Cardiovascular status - Abdominal exam - Obtain history, PMH + or - gastric lavage - Assess for acceptance of blood product - Fluid replacement as appropriate |
| How is an UGI bleed treated? | Surgical therapy Drug therapy used to : - ↓ Bleeding (directly, during endoscopy) - ↓ HCl secretion - Neutralize HCl that is present |
| What is PUD? | Peptic Ulcer Disease: Erosion of GI mucosa resulting from digestive action of HCl acid and pepsin in the - Lower esophagus - Stomach - Duodenum |
| Compare Acute and Chronic PUD | Acute - Superficial - Minimal inflammation Short duration, resolves quickly Chronic (more common) - Muscular wall erosion - Long duration—many months or intermittently |
| What causes PUD? | Helicobacter pylori Associated w/ stomach cancer Aspirin and NSAIDs Corticosteroids Lifestyle factors (including coffee!!!) |
| What is the patho of PUD? | Pepsinogen activated to pepsin at pH 2 to 3 Autodigestion allowed by damaged mucosa |
| What are the charachteristics of gastric ulcers? | Gastric Ulcers More common in women, older adults Higher mortality rate |
| What are the charachteristics of duodenal ulcers? | Duodenal Ulcers Occur at any age and in anyone ↑ Between 35 and 45 years of age Account for ~80% of all peptic ulcers Familial tendency H. pylori is found in 90% to 95% of patients |
| What factors increase the risk of duodenal ulcers? | COPD Cirrhosis of liver Chronic pancreatitis Hyperparathyroidism Chronic renal failure Smoking and alcohol use |
| how is gastric ulcer pain charachterized? | High in epigastrium 1 to 2 hours after meals Burning or gaseous * theremay be no pian |
| How is duodenal ulcer pain charachterized? | Midepigastric region beneath xiphoid process Back pain—if located in posterior aspect 2 to 4 hours after meals Tendency to occur, then disappear, then occur again * there may be no pain |
| List the 3 complications associated with PUD | Hemorrhage Perforation Gastric outlet obstruction All considered emergency situations |
| Discuss perforation | Common in large, penetrating duodenal ulcers Mortality rates higher with perforation of gastric ulcers Peritonitis Large perforations: Immediate surgical closure |
| What are the clinical manifestations of perforation? | Sudden, dramatic onset Severe upper abdominal pain, spreads throughout abdomen, radiates to shoulder Rigid, board-like abdominal muscles Shallow, rapid respirations Bowel sounds absent Nausea/vomiting |
| What nursing care needs to be done for those with a perforation? | Immediate focus Stop spillage of gastric or duodenal contents into peritoneal cavity—may require surgical intervention Restore blood volume NGT to continuous suction Broad-spectrum antibiotics Pain medication |
| What is a gastric outlet obstruction? | Obstruction due to narrowing of pylorus Edema, inflammation Pylorospasm Fibrous scar tissue formation |
| List collborative care measures for PUD | Adequate rest Dietary modification Drug therapy Elimination of smoking and alcohol Long-term follow-up care Stress management |
| What are the diet reccomendations for those with PUD? | Avoid irritants (individualized) Spicy foods not shown to contribute to PUD Milk not found helpful Six small meals a day during symptomatic phase Avoid/limit alcohol, caffeine |
| Which drug therapies are indicated for PUD | Antisecretory Histamine (H2)-receptor blockers Proton pump inhibitors (PPI) Anticholinergics Antacids Cytoprotective * take drugs with milk |
| When is surgery indicated for PUD? | Uncommon because of antisecretory agents Indications for surgical interventions Unresponsive to medical management Concern about gastric cancer Drug induced but cannot be withdrawn from drugs |
| What is dumping sydrome? | A post-op complication (33-50%) ↓ Ability of stomach to control amount of gastric chyme entering small intestine Occurs at end of meal or 15 to 30 minutes after eating Symptoms include: Weakness, sweating, palpitations, dizziness, abdominal cramps, borborygmi, urge to defecate Last no longer than an hour |
| List 2 other post-op complications related to PUD | Postprandial hypoglycemia Bile reflux gastritis |
| The results of a patient's recent endoscopy indicate the presence of peptic ulcer disease (PUD). Which of the following teaching points should the nurse provide to the patient in light of his new diagnosis? A) "You'll need to drink at least two to three glasses of milk daily." B) "It would likely be beneficial for you to eliminate drinking alcohol." C) "Many people find that a minced or pureed diet eases their symptoms of PUD." D) "Your medications should allow you to maintain your present diet while minimizing symptoms." | B) "It would likely be beneficial for you to eliminate drinking alcohol." |
| A patient with a history of peptic ulcer disease has presented to the emergency department with complaints of severe abdominal pain and a rigid, boardlike abdomen, prompting the health care team to suspect a perforated ulcer. Which of the following actions should the nurse anticipate? A) Providing IV fluids and inserting a nasogastric tube B) Administering oral bicarbonate and testing the patient's gastric pH level C) Performing a fecal occult blood test and administering IV calcium gluconate D) Starting parenteral nutrition and placing the patient in a high-Fowler's position | A) Providing IV fluids and inserting a nasogastric tube |
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