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Agents that destroy mucosal barrier…the barrier is now damage and more susceptible
to further destruction by noxious substance
ASA…aspirin
Inhibits synthesis of mucous and causes abnormal permeability
Corticosteroids
Decreases rate of mucous cell renewal…once the cell are destroyed, it delays or
Caffeine
Stimulates gastric acid secretion
Cigarette smoking
Delays mucosal healing
Diagnostic tests
Urea Breath Test…most common (done in GI lab)
No PPIs or H2RAs for 2 weeks prior
No antibiotics for 30 days prior
NPO after midnight
Pt. swallow a Capsule containing radioactive urea that will be broken down by H.
Pylori into C02 & nitrogen
Exhale into a collection bag; Positive test will identify carbon-dioxide with
radioactive isotope
Barium contrast xray…upper or lower GI (this is case upper GI)
Endoscopy…go down with a scope and visualize any abnormalities and ulcer
formation…they can also take a tissue sample looking for cellular changes and H-pylori
Treatment: Medications
1
Antibiotic therapy...in combination with PPI
2 or more meds to decrease resistance to meds…one antibiotic increase the risk of
drug resistance (combination of PPI or H2RA and some type on antibiotic regimen)
Examples:
1. Amoxicillin & Clarithromycin (Biaxin)
2. Metronidazole (Flagyl) & Tetracycline
Complications
Hemorrhage
Most common
Erosion of tissue through a blood vessel
o Signs/ Symptoms…bright red blood (in stool or vomit), hypovolemic
leading to shock, changes in LOC from decrease perfusion, decrease BP,
increase HR, abdominal pain, decrease urine output, SOB, cool, clammy
o Treatment: Fluid, backup circulation blood volume…start IV, surgery
(large amount of blood), hemoglobin & hematocrit (HgB…if below 8 the
dr. will decide to transfuse…1-2 units of packed RBCs), NG tube (NPO,
try to get out any blood that’s in there)
Perforation
Most lethal
- In the picture we have a perforated ulcer in the stomach, stomach contents leaking
out into the peritoneal cavity
o Signs/ Symptoms: Peritonitis, sudden onset abdominal pain (patient with
history of peptic ulcer disease)
Patient is at risk for…sepsis, septic shock r/t bacteria getting into
the blood stream from perforation, leading to peritonitis
Rigid board-like abdomen (severe abdominal pain)
Infectious process, elevated temperature, WBCs will go up
o Treatment: Broad spectrum antibiotic (three different types), surgery
emergency(fix hole), IV and NG tube to suction (to suck out any acid from
the stomach contents)
Gastric Outlet Obstruction
2
Here scar tissues form at the gastric outlet – the area where the stomach empties into
the duodenum. Scar tissue forms d/t repeated exposure to the acid and areas of
inflammation. Narrowing of the outlet. Edema occurs because of the swelling and scar
tissue. Sometimes it can completely block the content. Stomach contents can’t get out
to the duodenum.
o Signs/ Symptoms: Vomiting, abdominal pain, bloating, feeling of fullness
o Treatment: Pylori-plasty (removes scar tissue) or balloon dilation (open
up pyloric so food can get through), and NG tube to suction (remove all
gastric contents in the stomach before they vomit it). Note in NG tube:
[Patient NPO when NG tube. Mouth is dry. No saliva stimulation] Provide
skin care to the nare (lubrication) and oral care every 2 hours.
Surgical interventions
Bilroth I
Removal of 2/3 of the stomach
Anastamosis of remaining stomach to duodenum. The antrum part of the stomach is
removed (most common site where ulcers are formed), connecting the duodenum
back to the stomach
Also called Gastroduodenostomy
Surgical interventions
Bilroth II (more common) – extensive surgery
Removal of 2/3 of the stomach
Anastamosis of remaining stomach to jejunum…by passing the duodenum,
connecting rite to the jejunum
Also called Gastrojejunostomy
Surgical interventions
3
Vagotomy
Severing the vagus nerve to interrupt innervation to the stomach
Vagus nerve causes stimulation of HCl acid (decreasing the stimulation)
Can be done with Bilroth I or Bilroth II procedures
Distention of
Bowel lumen Urge to defecate;
diarrhea
Clinical Manifestations: Weakness,
sweating, palpitations, dizziness,
abdominal cramping, epigastric Onset: within 15-30 minutes of eating
fullness, nausea Duration: till 1 hour after eating
Goal: Slow rapid passage of food into intestine; slow signs and symptoms
1. Rest period after eating, usually 30min after meal. We want the patient to LAY DOWN (want to slow
it down, working against gravity. Sitting up gravity will dump it down even faster. Laying down will
be hard for the food to be dumped, they will also elevate their head if they have reflux)
2. Small, frequent meals to prevent OVER DISTENTION OF STOMACH
3. Avoid drinking fluids with meals. Give fluid separately - BEFORE OR AFTER to prevent over
distend their stomach
4. Eat dry foods…help prevent postprandial hypoglycemia
4
5. Low carbohydrate. NOT refined sugars.
Postprandial Hypoglycemia
Prevention: Dietary modifications for Dumping syndrome
Interventions to slow down:
Try to delay huge amount of food dumped into the intestine from the stomach
Small frequent feeding
Low carbohydrate food. Limit high carbohydrate.
High carbohydrate
food enters stomach Hyperglycemia
and intestine
Secondary Hypoglycemia
Excessive insulin
release
Ulcer formation