GASTROESOPHAGEAL

REFLUX DISEASE
 Is the backflow of gastric and duodenal
contents into the esophagus

The reflux is caused by an incompetent

lower esophageal sphincter, pyloric
stenosis, or motility disorder
 Signs and Symptoms
Pyrosis

Dyspepsia

Regurgitation

Pain and difficulty with swallowing

Hypersalivation
 Interventions
Instruct the client to avoid factors that
decrease lower esophageal sphincter
pressure or cause esophageal irritation

Instruct the client to eat a low-fat, high fiber

diet

Instruct client to avoid anticholinergics

Instruct client to avoid caffeine, tobacco,

and carbonated beverages
 Instruct client to avoid eating and
drinking 2 hours before bed time, and
wearing tight clothes

Elevate the head of the bed on a 6 to 8

inch blocks

Instruct the client regarding prescribed

medications, such as antacids, H2-
receptor antagonists, or proton pump
inhibitors
GASTRITIS
 Inflammation of the stomach or gastric
mucosa

Caused by ingestion of food

contaminated with disease causing
microorganisms or food that is too
irritating, or too highly seasoned, the
overuse of aspirin and NSAIDS,
excessive alcohol intake, smoking, or
reflux
Signs and Symptoms
Abdominal discomfort

Anorexia, nausea,
and vomiting
acute
Headaches

Hiccuping
 Anorexia, nausea,
and vomiting

Belching

Heartburn after eating

chronic

Sour taste in the mouth

Vitamin B12 deficiency

 Interventions
Food and fluids may be withheld until
symptoms subside; afterward, ice chips
can be given followed by clear fluids,
and then solid food

Monitor for signs of hemorrhagic

gastritis such as hematemesis,
tachycardia and hypotension
 Instruct client to avoid irritating foods,
fluids and other substances, such as
spicy and highly seasoned foods,
caffeine, alcohol, and nicotine
PEPTIC ULCER DISEASE
 Is an ulceration in the mucosal wall of
the stomach, pylorus duodenum, or
esophagus in portions accessible to
gastric secretions

May be referred to as gastric,

duodenal, esophageal, depending on
its location

The most common are gastric and

duodenal ulcers
 Gastric vs. Duodenal Ulcer
Antral region and
lesser curvature
Pyloric region
Peak age 50-60
years old Peak age 30-45
years old
Normal to decreased
acid secretion Increased acid
secretion
Hematemesis Melena
 H. pylori (60-80%)
H. pylori (100%)
Food-pain pattern Pain-food-relief
pattern

Weight loss is No weight loss

common

Gnawing sharp pain Burning pain occurs

in or left of the in the midepigastric
midepigastric region area 1 to 3 hours
30 6o minutes after after a meal and
meal during the night
 Interventions
Monitor vital signs and for signs of bleeding

Administer small, frequent bland feedings

during the active phase

Administer H2 antagonist as prescribed to

decrease the secretion of gastric acid

Administer antacids as prescribed to

neutralize gastric seretions
 Administer anticholinergics as
prescribed to reduce gastric motility

Administer mucosal barrier protectants

as prescribed 1 hour before each meal

Inform client to avoid consuming

alcohol and substances that contain
caffeine or chocolate

Avoid aspirin or NSAIDs

 Avoid smoking

Obtain adequate rest and reduce stress

 Surgical Interventions

Total Gastrectomy removal of the

stomach with attachment of the
esophagus to the jejunum or
duodenum

Billroth 1 partial gastrectomy, with

the remaining segment anastomosed
to the duodenum
 Billroth 2 Partial gastrectomy with
the remaining segment anastomosed
to the jejunum

Pyloroplasty enlargement of the

pylorus to prevent or decrease pyloric
obstruction, thereby enhancing gastric
emptying
 Postoperative Interventions
Monitor vital signs

Place in a Fowlers position for comfort

and to promote drainage

Monitor intake and output

Administer fluids and electrolytes as

prescribed
 Assess bowel sounds

Monitor nasogastric suction as

prescribed

Do not irrigate or remove the

nasogastric tube; assist physivian in
irrigation and removal

Maintain NPO status as prescribed for 1

to 3 days until peristalsis occurs
 Progress the diet from NPO to sips of
clear water to six small bland meals a
day, as prescribed when bowel sounds
return

Monitor for postoperative

complications of hemorrhage, dumping
syndrome, diarrhea, hypoglycemia, and
vitamin B12 deficiency
 Dumping Syndrome

The rapid emptying of the gastric

contents into the small intestine that
occurs following gastric resection

Symptoms occurring 30 minutes after

eating

Nausea and vomiting

 Feelings of abdominal fullness and
abdominal cramping

Diarrhea

Palpitations and tachycardia

Perspiration

Weakness and dizziness

Borborygmi
 Interventions
Eat a high-protein, low carbohydrate diet

Eat small meals and avoid consuming

fluids with meals

Lie down after meals

Take antispasmodic as prescribed to

delay gastric emptying
CROHNS DISEASE
 An inflammatory disease that can
occur at anywhere in the GI tract but
most often affects the terminal ileum
and leads to thickening and scarring, a
narrowed lumen, ulcerations, and
abscesses

Characterized by remissions and

exacerbations
 Signs and Symptoms
Fever

Cramp-like and colicky pain after meals

Diarrhea, which may contain pus and

mucus

Abdominal distention

Anorexia, nausea, and vomiting

 Weight loss

Anemia

Dehydration

Electrolyte imbalances
 Interventions
Restrict client's activity to reduce
intestinal activity

Monitor bowel sounds and for

abdominal tenderness and cramping

Monitor stools, noting color,

consistency and the presence of blood
 Instruct client to avoid gas-forming
foods, milk products, nuts, raw fruits
and vegetables, pepper, alcohol, and
caffeine containing products

Instruct the client to avoid smoking

CHOLECYSTITIS
 Inflammation of the gallbladder that
may occur as an acute or chronic
process

Acute inflammation is associated with

cholelithiasis

Chronic cholecytitis results when

inefficient bile emptying and
gallbladder muscle wall disease cause
fibrotic and contracted gallbladder
 Acalculous cholecystitis occurs in the
absence of gallstones and is caused by
bacterial invasion via the lymphatic or
vascular system
 Signs and Symptoms
Nausea and vomiting

Inidgestion

Belching

Flatulence

Epigastric pain that radiates to the scapula 2

to 4 hours after eating fatty foods and may
persist for 4 to 6 hours
 Pain localized in the right upper
quadrant

Guarding, rigidity, and rebound

tenderness

Mass palpated in the right upper

quadrant

Murphys sign
 Elevated temperature

Tachycardia

Signs of dehydration

Jaundice

Dark orange and foamy urine

Steatorrhea and clay-colored feces

 Interventions
Maintain NPO status during nausea and
vomiting episodes

Maintain nasogastric decompression as

prescribed for severe vomiting

Administer antiemetics as prescribed

Administer analgesics as prescribed

(morphine sulfate and codeine sulfate
are avoided)
 Administer antispasmodics as
prescribed to relax smooth muscles

Instruct the client with chronic

cholecystitis to eat small, low-fat meals

Instruct the client to avoid gas forming

foods

Prepare the client for surgical

interventions
 Surgical Interventions

Cholecystectomy is the removal of

the gallbladder

Choledocholithotomy requires
incision into the common bile duct to
remove the stone

Surgical procedures may be performed

by laparoscopy
 Postoperative Interventions
Monitor for respiratory complications
caused by pain at the incisional site

Encourage coughing and deep breathing

Encourage early ambulation

Instruct the client about splinting the

abdomen to prevent discomfort during
coughing
 Administer antiemetics as prescribed for
nausea and vomiting

Administer analgesics as prescribed for

pain relief

Maintain NPO status and nasogastric tube

suction as prescribed

Advance diet from clear liquids to solids

when prescribed as tolerated by the client
 Maintain and monitor drainage from
the T tube, if present
 Care of a T Tube

A T tube is placed after surgical

exploration of the common bile duct.
The tube preserves patency of the duct
and ensures drainage of bile until
edema resolves and bile is effectively
draining into the duodenum]

A gravity drainage bag is attached to

the t tube to collect the drainage
 Position the client in a semi-Fowlers
position to facilitate drainage

Monitor the amount, color, consistency,

and odor of the drainage

Report sudden increases in bile output

to the physician

Monitor for inflammation and protect

the skin from irritation
 Keep the drainage system below the
level of the gallbladder

Monitor for foul odor and purulent

drainage and report its presence to the
physician

Avoid irrigation, aspiration, or clamping

of the T tube without a physicians
order
ACUTE PANCREATITIS
 Inflammation of the pancreas appears
to be caused by a process called
autodigestion

Commonly associated with excessive

alcohol consupmtion
 Signs and Symptoms

Abdominal pain (midepigastric or left

upper quadrant) with radiation to the
back

Pain aggravated by a fatty meal or

alcohol

Abdominal tenderness and guarding

 Nausea and vomiting

Weight loss

Cullens signs

Turners sign

Absent or decreased bowel sounds

 Elevated WBC, glucose, and bilirubin

Elevated serum lipase and amylase

levels
 Interventions

Maintain NPO status and maintain

hydration with IV fluids as prescribed

Administer parenteral nutrition for

severe nutritional depletion

Administer supplemental preparations

and vitamins and minerals to increase
caloric intake if prescribed
 Maintain nasogastric tube to decrease
gastric distention and suppress
pancreatic secretion

Administer meperidine hydrochloride

as prescribed for pain

Administer antacids as prescribed

Administer H2 receptor antagonists as

prescribed
 Administer anticholinergics as prescribed

Instruct the client in the importance of

avoiding alcohol

Instruct the client in the importance of

follow-up visits with the physician

Instruct the client to notify the physician if

acute abdominal pain, jaundice, clay-
colored stools, or dark colored urine
develops
 CHRONIC
PANCREATITIS
 Continual inflammation and destruction
of the pancreas, with scar tissue
replacing pancreatic tissue

The acinar, or enzyme-producing cells

of the pancreas ulcerate in response to
inflammation
 Signs and Symptoms
Abdominal pain and tenderness

Left upper quadrant mass

Steatorrhea and foul-smelling stools that may

increase in volume

Weight loss

Muscle wasting

Jaundice
 Interventions
Instruct client to limit fat and protein
intake

Instruct the client to avoid heavy meals

Instruct the client about the

importance of avoiding alcohol

Provide supplemental preparations

 Administer pancreatic enzymes as
prescribed

Administer insulin and oral

hypoglycemic agents as prescribed

Instruct the client in the importance of

follow-up visits
CELIAC DISEASE
 Also known as gluten enteropathy or
celiac sprue

Intolerance to gluten, the protein

component of wheat, barley, rye, and
oats

Results in the accumulation of the

amino acid glutamine, which is toxic to
intestinal mucosal cells
 Intestinal villi atrophy occurs, which
affects absorption of ingested nutrients
 Signs and Symptoms
Acute or insidious diarrhea

Steatorrhea

Anorexia

Abdominal pain

Muscle wasting
 Vomiting

Anemia

Irritability
 Interventions

Maintain a gluten-free diet, substituting

corn and rice as grain sources

Instruct parents and child about

lifelong elimination of gluten sources
such as wheat, rye, oats, and barley

Administer mineral and vitamin

supplements
 Teach client about a gluten-free diet
and about reading food labels carefully
for hidden sources of gluten
DRUGS
 Antacids

React with gastric acid to produce

neutral salts or salts of low acidity

Inactivate pepsin and enhance mucosal

protection but do not coat the ulcer
crater

Taken 1 t0 3 hours after each meal

 Should be chewed thoroughly and
followed with a glass of milk or water

Aluminum hydroxide preprations

Calcium carbonate (Tums)

Magnesium hydroxide preparations

Sodium bicarbonate
 Gastric Protectants

Misoprostol (Cytotec)
Suppresses secretion of gastric acid
Promotes secretion of bicarbonate and
cytoprotective mucus

Sucralfate (Carafate)
Creates a protective barrier against acid
and pepsin
 H2 Receptor Antagonists

Cimetidine (Tagamet)
Food reduces rate of absorption

Ranitidine (Zantac)
Not affected by food

Famotidine (Pepcid)
Not affected by food
 Proton Pump Inhibitors

Suppress gastric acid secretion

Headache, diarrhea, abdominal pain,

and nausea

Esomperazole (Nexium), Lansoprazole

(Prevacid), Omeprazole (Prilosec)
 Antiemetics

To control vomiting and motion

sickness

Monitor for drowsiness and protect the

client from injury

Ondansetron (Zofran), Metoclopramide

(Reglan), Promethazine hydrochoride
(Phenergan)