Burning, tight sensation felt beneath the lower sternum and spreads upward.
When it occurs >1/wk, becomes more severe, and occurs at night and awakes person
When should heartburn be reported to MD?
Barium swallow and endoscopy
Diagnostic studies for GERD
Drugs therapy for GERD
Health promotions behaviors for GERD
Sleep with HOB raised or 2-3 pillows, decrease gasy and high fat foods, no milk products at nights, and avoid late night snacking or meals, stop smoking, avoid acid-containing foods, do not lie down 2-3 hrs after eating.
Common with GERD-- hot, bitter, or sour tasting liquid coming into mouth or throat.
Heartburn, regurgitation (common). May report--wheezing, coughing, dyspnea, hoarseness, sore throat, lump in throat, choking.
Herniation of a portion of the stomach into the esophagus thru an opening or hiatus, in the diaphragm.
Older adults, women
Hernias are more common in who?
Most common type of hernia (90%)-- the junction of the stomach and esophagus is above the hiatus of the diaphragm, and a part of the stomach slides thr the hiatal opening in the diaphragm. (Reflux)
TC=supine AC=standing upright
Slides into throacic cavity in ___ position. Back into ab cavity= ___.
Gastroesophageal junction remains in the normal position, but the fudus and greater curvature of the stomach roll through the esophageal hiatus and into the thorax BESIDE the esophagus.
Feeling of fullness after eating, breathlessness after eating, feeling of suffocation, worsening of conditions in recumbent (lying) position.
Diagnostic study for hernia
Tx for Hiatal hernia
Administer anacids and antisecretory agents, elimination of constricting garmants, avoidance of heavy lifting, elimination of alcohol and smoking, elevation of HOB, weight lose. Operative=Nissen (reinforces LES)
Post op care for hiatal hernia repair
TCDB, NG tube--peristalsis returns, fluids given initially. Solids gradually. Normal diet w/i 6 wks. Chew thoroughly and avoid gas forming foods.
Predisposing factors: cig smoking, excessive alcohol intake (2 most important) chronic trauma, poor oral hygience, spicy foods, exposure to asbestos and metal, low intake of frest fruits and veggies
Usually located in middle or lower portions of the esophagus. Malignant tumor usually appears as an ulcerated lesion. Tumor may penetrate the muscular layer and even extend outside the wall of the esophagus.
Onset of sx usually late in relation to tumor. Progressive dysphagia--first with meat, then soft foods, then liquids. Feeling of food stuck in throat, regurg, hoarseness. Pain (late) in substernal, epigastric, and back areas and increases with swallowing. Weight loss (>20).
Barium swallow and biospy
Diagnostic studies for esophageal CA
Common mets sites for esophageal CA
Early lymphatic spread and late development of sx
Why does esophageal CA have a poor prognosis?
Surgical removal and radiation
Tx with best results for esophageal CA
High protein, high cal diet
What type of diet should a post-op pt c esophageal CA be on?
Saclike outpouchings of one or more layers of the esophagus.
Dysphagia, regurg, tasting sour food, foul odor.
Malnutrition, aspiration, perforation
Complications of diverticula
If nutrition becomes disrupted
Surgical tx for diverticula if...
Barium swallow, EGD
Diagnostic tests for diverticula
Most common cause--strong acids or alkalines injested, reflux, peptic strictures. Can also be caused by trauma--throat lacerations or gunshot wounds. Develop over long period of time. Can be dilated periodically with balloon dilation technique.
LES fails to relax with swallowing and normal peristalsis is replaced with abnormal contractions (spasms).
Dysphagia, substernal chest pain during or after meal, regurg of sour tasting foods, weight loss, halitosis.
Tx: dilation (balloon periodically and metal stents), surgery (esophagomyotomy), drugs--Procardia to reduce LES pressure. Semi-soft bland diet, eat slowly, and drink fluids with meals. Sleep with HOB elevated.
Inflammation of the gastric mucosa (acute or chronic & diffuse or localized)-- Occurs as a result of a breakdown in the normal gastric mucosal barrier
Causes of Gastritis
Corticosteroids and NSAIDS--increase HCl acid secretion. ASA and digitalis--directly irritate gastric mucosa. Chronic alcohol abuse, excessive ingestion of ASA.
type A (fundal) & type B (antral)
Types of gastritis
Type A Gastritis--seen in pts with pernicious anemia
Type __ Gastritis: autoimmune d/o; seen in pts with?
Type __ Gastrits: common prob in adults and H pylori is found.
S/S: anorexia, n/v, epigastric tenderness, feeling of fullness, and hemorrhage (most common c alchol abuse; may be only sx)
Sx are non-specific
Why is the diagnosis of gastritis frequently delayed or missed?
Find the cause and avoid!! Follow prescribed diet and med regimen. May be put on bed rest, NPO, and IV fluids
Tx for gastritis
Bland diet with 6 feedings/day and antacids after meal.
Diet for gastritis pt
EROSION of the GI mucosa (acute or chronice & gastric or duodenal)
SUPERFICIAL erosion with minimal inflammation--short duration and resolves quickly.
LONG duration, ERODING thru the muscular wall with formation of fibrous tissue. Present for many months or intermittently throughout life.
Any part of the stomach. Most common--lesser curvature
Where do gastric ulcers occur?
ibuprofen, ASA, cortiocosteriods (Predinisone)
Meds that can cause ulcers (GIVE WITH FOOD!!!)
Duodenal ulcers--found first 1-2 cm of duodenum
80% of all peptic ulcers. Found where?
Very common for patient with gastric ulcers to have no pain or other sx. What type of ulcer has BURNING OR CRAMP LIKE pain often in the midepigastrium region beneath xiphoid process.
Ulcer that has burning or gaseous pain
On empty stomach OR after ingestion of foods
When does pain with peptic ulcers occur?
Pain occurs 2-4 hrs after meals. Relieved by antacids and sometimes foods that neutralize and dilute HCl acid.
Occur continuously for a few weeks or months and then disappear for a time, only to recur some months later.
Most common complication of peptic ulcers. Develops from erosion of granulation tissue found at base of ulcer during healing or from erosion of ulcer thru a major bv.
Account for greater percentage of upper GI bleed
Most lethal complication of peptic ulcers
Mortality rates associated with perforation are higher c ___ ulcer.
Gastric outlet obstruction
Long hx of ulcer pain. Pain progresses (generalized to upper ab area) and becomes worse toward the end of the day. Relief is obtained by belching or self-induced vomitting (projectile). Odor is offensive due to food particles that were ingested hrs or even days ago. Pt=anorectic aeb weight loss, c/o thirst and bad taste in mouth, constipation, swelling in upper ab, loud peristalsis.
Fiber optic endoscopy
Diagnostic test for peptic ulcers
3-9 weeks (Pain often disappears 3-6 days, but healing is much slower.) **important to comply with therapy and continue with follow up care for at least one year.
Complete healing of peptic ulcers may take how long?
Xray and endoscopic exam
Healing ulcer should be assessed by?
pt teaching with peptic ulcer disease
Avoid foods that cause epigastric distress--black pepper, spicy and acidic foods. Small frequent meals. Avoid cigs--delay healing and promote ulcer development. Reduce alcohol intake. Take ALL meds--antacids and antisecretory meds.
Peptic ulcer disease: Criteria for Surgery
Intractability--failure of ulcer to heal or recurrence of ulcer after therapy. Hx of hemorrhage or inc bleeding during tx. Multiple ulcer sites. Existence of malignant tumor.
1. dumping syndrome 2. postprandial hypoglycemia 3. bile reflux gastritis
Postop complications from peptic ulcer surgery
Urge to deficate--onset occurs at end of meal within 15-30 minutes after eating. Weakness, sweating, dizziness, cramps.
Postprandial hypoglycemia--relieved by sugared fluids
Uncontrollable gastric emptying of a bolus of fluid high in carbs into the small intestine-->hypoglycemia-->Weakness, mental confusion, palpitations, tachy, anxiety. What relieves this?
CEA (elevated=malignancy. could be elevated c smokers and benign lesions.)
Diagnostic tool for CA of GI tract.
Irregular edges and more elevated than benign
On an xray with a pt c stomach CA what does the ulcer look like?
Surgery--remove as much of stomach as possible (only definiative means of achieving a cure). Radiation/chemo.
Until peristalsis returns
After stomach CA surgery, the NG tube remains in place til when?
decrease degree of gastric acidity
Aim of tx for stomach CA pt
Origin--venous, capillary, or arterial.
The severity of a GI bleed depends on what?
Bright red blood (indicated blood has not been in contact with stomach's acid secretions)
What color is bleeding from an arterial source?
Reveals that blood has been in the stomach for some time--changed by contact with gastric secretions.
Slow bleed from upper GI source
Melena (black, tarry stools) indicates
Darker the stool
The longer the passage of blood thru the intestines = ?
Causes of GI Bleed
Chronic esophagitis, bleeding from a tear of the mucosa, esophageal varices, peptic ulcers, and ulcers can penetrate into arteries. Drug-induced (ASA, ibuprofen, corticosteriods). Systemic diseases (leukemia, blood dyscrasias).
GI bleed (vomit and stools should be tested for occult blood.)
Diagnostic tests for ? = Blood work, CBC, BUN elevated, serum electrolytes, blood glucose, PT time, liver enzymes, ABGs, type and cross-match of blood.
2- one for fluids and the other for blood replacement
How many IV lines should a patient with a GI bleed have?
Isotonic crystalloid (RL)
In a GI bleed best to begin with what IV solution?
Whole blood, PRBCs, fresh frozen plasma
Used for replacement of lost volume in massive hemorrhage.
BP, Rate and character of pulse, peripheral perfusion (cap refill), neck vein distention, s/s of shock.
Immediate physical exam on GI bleed pt includes?
Ulcer disease, drug or alcohol abuse, and liver and resp diseases can all result in GI bleed!!