Stefan Pemicu1

7/27/2019 Stefan Pemicu1

1/49

Problem 1

Stefan satria

Group 4


2/49


3/49

Mouth


4/49


5/49


6/49


7/49


8/49


9/49


10/49

Heartburn


11/49

Nausea

Nausea-conscious desire to vomit


12/49

Vomiting

Vomiting-ejection of emesis from upper GI

tract


13/49

Nausea and VomitingEtiology

GI disorders

Non GI disorders

Pregnancy

Infections

CNS disorders

Cardiovascular disorders

Metabolic disorders

Stress

Medications

Motion


14/49

Nausea and Vomiting

Pathophysiology

Vomiting center in brainstem

Chemoreceptor zone (CTZ) stimulated

Autonomic nervous system is activated Sympathetic

Tachycardia

Diaphoresis

Parasympathetic

Relaxation of LES


15/49

Nausea and Vomiting

Clinical Manifestations

Nausea-subjective

If vomiting prolonged

Dehydration

Water, electrolytes lost

Loss of extracellular fluid leading to circulatorycollapse

Metabolic alkalosis can occur-gastric loss or Metabolic acidosis if small intestine contents lost

(less common)


16/49

Characteristics of Vomiting

Regurgitation-Partially digested food

Projectile-forceful expulsion without nausea

Fecal/intestinal-can be result of obstruction


17/49

Characteristics of Vomiting

Color

Coffee grounds-bleeding in stomach

Blood changes to dark brown as result of

interaction with HCL

Bright red blood-active bleeding

Green-bile


18/49

Dyspepsia


19/49

Hematemesis and Melena

Melena: passage of black, tarry stools; suggests

bleeding proximal to the ileocecal valve

Hematochezia: passage of bright or dark red

blood per rectum; indicates colonic source ormassive upper GI bleeding

Hematemesis: passage of vomited material that

is black (coffee grounds) or contains frankblood; bleeding from above the ligament of Treitz


20/49

History of hematemesis n melena

Present illness source, magnitude, duration of bleeding

associated GI symptoms (vomiting, diarrhea, pain)

associated systemic symptoms (fever, rash, joint

pains) Review of systems

GI disorders, liver disease, bleeding diatheses

Anesthesia reactions

medications (NSAIDs, warfarin) Family history


21/49

Upper gastrointestinal

disorders


22/49

Hiatal Hernia

Herniation of portion of stomach intoesophagus through opening in diaphragm

Types

Sliding Paraesophageal/rolling


23/49

Etiology of Hiatal Hernia

Factors

Structural changes

Obesity Pregnancy

Heavy lifting


24/49

Clinical Manifestations of Hiatal Hernia

May be asymptomatic

Heartburn

Dysphagia Reflux with lying down

Pain, burning when bending over


25/49

Hiatal Hernia

Diagnostic studies

Barium swallow

Endoscopy Surgical intervention

Nissen fundoplication


26/49

AM26

Investigations upper endoscopy Indications: persistent heartburn;bleeding from the upper

GI tract; dysphagia; reflux oesophagitis; peptic stricture;Barrett's oesophagus

[images from www.barrettsinfo.com]


27/49

Complications of Hiatal Hernia

GERD

Hemorrhage

Stenosis of esophagus Ulcerations

Strangulation of hernia

Regurgitation

Increased risk for respiratory disease


28/49


29/49

Gastroesophageal Reflux (GERD)

Not a disease, but a syndrome

Clinically symptomatic condition resulting in

reflux of gastric contents into lower esophagus


30/49

Gastroesophageal Reflux (GERD)--Etiology

Combination of factors

Hiatal hernia

Incompetent LES

Decreased esophagus clearance

Decreased gastric emptying

Medications

Results in esophageal irritation and inflammation


31/49


Clinical Manifestations

Varies from individual

Heartburn (pyrosis)

Burning, tight sensation

Can spread to jaw

May wake person from sleep R/O cardiac causes first

Heartburn usually relieved with milk, alkaline substances

Wheezing, coughing, dyspnea, hoarseness

Lump in throat

Regurgitation-hot, bitter, sour liquid coming from mouth

Stomatitis

N/V


32/49


Complications

Esophagitis

Esophageal stricture/scarring

Barretts Esophagusprecancerous lesion for

esophageal cancer/adenocarcinoma

Bronchospasm

Aspiration pneumonia Dental erosion


33/49


Diagnostic Studies

History and Physical

Barium swallow

EGD

Use of Proton pump inhibitors as trial


34/49

Nursing Considerations for the Client with

GERD

Smoking cessation

Avoid food that decrease LES pressure

fatty foods

Chocolate Peppermint

Coffee

Tea

Milk Avoid late night snacks

Small, frequent meals


35/49


36/49

Peptic ulcer

A peptic ulcer is a sore in the lining of your

stomach or duodenum

Erosion of the GI mucosa from the digestive

action of HCL acid and pepsin


37/49

Classification

Types

Acute-superficial erosion/minimal

inflammation

Chronic-Long duration, erosion through

muscular wall, fibrous tissue formation

Both gastric and duodenal ulcer fall into this

category


38/49

Symptoms

A burning pain in the gutis the most commonsymptom

Pain 1-2 hours aftermeals

Heartburn

Local tenderness

Nausea

Vomiting

Weight loss

A burning pain in the gut is a common

symptom of peptic ulcers.


39/49

AM39

pathology of peptic ulceration


40/49

Etiology

Peptic ulcers are caused by

Bacteria called Helicobacter pylori

Nonsteroidal anti-inflammatory drugs(NSAIDs) such as aspirin and ibuprofen


41/49

EtiologyHelicobacter pylori

Helicobacter pylori


42/49

Risk factor Stress: The parasympathetic nervous system, which is

responsible for the function of the digestive organs, ceases to

act when the sympathetic nervous system,

Smokers develop ulcers much more often than non-smokers.

A poor diet is one that includes spicy foods, citrus foods, soda

pop, caffeine, and alcohol, junk foods and refined & processed

foods.

Food and allergies can cause problems as well. Milk allergies

are strongly linked to gastric problems. Doctors once

prescribed milk as

A low antioxidant status appears to predispose one to ulcers.

have relatives who have peptic ulcers


43/49

Diagnostic Studies of Peptic Ulcer Disease

Endoscopy

Tests for H.Pylori

Invasive

Tissue specimens

Rapid urease test

Nonivasive

IgG Urea breath test (by product of H.Pylori)

Barium swallow/X-rays- not accurate


44/49

The Mechanism and side effects of various acid suppressive medications

Drug Mechanism Common side effect

Antacids neutralize acid Mg - diarrhea

Al - constipation

Ca

constipation

H2 receptor block histamine receptor cytochrome 450 altered

antagonists metabolism of drugs

Prostaglandins agonist diarrhea, cramps, abortion

H+/K+ ATPase block acid pump hypergastrinemia

inhibitors enterochromaffin cell (ECL) hyperplasia

Sucrafate coat ulcerated mucosa constipation

Peptic Ulcer Disease - Treatment


45/49

Treatment of Peptic Ulcer Disease

Discontinue medications if possible that exacerbatecondition

No smoking/ETOH

Avoid spicy/acid foods, black pepper, small frequent

meals Medications

H2 Blockers

Cytotec (antisecretory and cytoprotective)

Cytoprotective agents (Carafate) Antacids

Antibiotics for H. Pylori

Treat stress

Surgery


46/49

Complications of Peptic Ulcer Disease

Hemorrhage

Perforation-most lethal, severe abdominal

pain that spreads throughout abdomen,

shoulder pain, absent bowel sounds

Obstruction


47/49

Prevent Peptic ulcer

Stop using NSAIDs. Talk with your doctor aboutother pain relievers

Dont smoke

Dont drink alcohol.


48/49

Gastritis

Gastritis

Inflammation of the gastric mucosa caused by any of several

conditions, including infection (Helicobacter pylori), drugs

(NSAIDs, alcohol), and autoimmune phenomena (atrophic

gastritis).

Many cases are asymptomatic, but dyspepsia and GI bleeding

sometimes occur.

Diagnosis is by endoscopy.

Treatment is directed at the underlying cause but often

includes acid suppression and, for H. pylori infection,

antibiotics.


49/49

Stefan Pemicu1

Documents

Transcript of Stefan Pemicu1