Care of Patients with Stomach Disorders Chapter 58 Care of Patients with Stomach Disorders Bleeding ulcer on gastric mucosa.

Acute vs. Chronic Gastritis Acute Gastritis Chronic Gastritis Thickened red mucous membrane Prominent rugae (folds) Various degrees of mucosal necrosis & inflammation Regeneration & healing may only take a few days Possible hemorrhage if muscle is affected Patchy diffuse inflammation of mucosal lining Progression leads to thin & atrophied walls & lining Parietal cells cease functioning & intrinsic factor is lost Result = pernicious anemia (B12 is depleted)

Chronic Gastritis Increased risk for gastric cancer due to persistent inflammation Type A Nonerosive Inflammation of glands, fundus & body Likely autoimmune Type B Affects glands of antrum & sometimes entire stomach Caused by H. pylori infection

Student Research: How are ulcers formed?

Group Work Compare/contrast the characteristics of: Group 1: Gastric Ulcers Group 2: Duodenal Ulcers Group 3: Stress Ulcers

Peptic Ulcers

Student Discussion What is the relationship between PUD & certain drug usage? (NSAID, theophylline, caffeine)

Benign Gastric Ulcer Benign gastric ulcer (arrow) seen on endoscopy. There is no sign of bleeding, and no evidence to suggest malignancy, but brush cytology or biopsy is essential to exclude this.

Duodenitis Endoscopy shows superficial erosions of the duodenal mucosa on a background of inflammation, but no frank ulceration. Such ‘salt and pepper’ duodenitis may occur in isolation, or as a result of other inflammatory bowel diseases. It is often associated with peptic ulceration of the duodenum or stomach. If symptomatic, it usually responds to an acid secretion inhibitor.

Duodenal Ulceration This endoscopic view shows two ‘kissing’ ulcers, with signs of recent bleeding. A background duodenitis (similar to previous slide) is also present.

Vagotomy Various types of vagotomies.

Gastrectomy Total gastrectomy, with anastomosis of the esophagus to the jejunum (esophagojejunostomy), is the principal surgical intervention for extensive gastric cancer.

NCLEX Review

Question 1 A 64-year-old patient with a history of arthritis and hypertension is admitted with progressive epigastric cramping, dyspepsia, nausea, and dark sticky stools for 2 days. Which order should the nurse question? IV fluids, normal saline at 125 ml/hr Guaiac stool sample  2 Naproxen (Naprosyn) 500 mg twice daily Stool sample for bacterial testing Answer: C Rationale: Long-term NSAID use creates a high risk for acute gastritis. Naproxen is an NSAID that may be used to treat arthritis. Other risk factors for acute gastritis include alcohol, caffeine, and corticosteroids. IV fluids may or may not be needed to replace any fluids or blood lost from the patient’s gastritis. Stool guaiac is nonspecific but may be ordered to confirm blood in the stool, and a stool sample may be used to test for the presence of Helicobacter pylori infection. However, it is not as accurate as blood or breath tests. (Sources: Accessed November 28, 2011, from http://digestive.niddk.nih.gov/ddiseases/pubs/bleeding/; and www.medicinenet.com/naproxen/article.htm)

Answer Answer: C Rationale: Long-term NSAID use creates a high risk for acute gastritis. Naproxen is an NSAID that may be used to treat arthritis. Other risk factors for acute gastritis include alcohol, caffeine, and corticosteroids. IV fluids may or may not be needed to replace any fluids or blood lost from the patient’s gastritis. Stool guaiac is nonspecific but may be ordered to confirm blood in the stool, and a stool sample may be used to test for the presence of Helicobacter pylori infection. However, it is not as accurate as blood or breath tests.

Question 2 What is the nursing priority in the management of a patient with an active upper GI bleed? Obtain vital signs. Apply oxygen by nasal cannula. Type and crossmatch the patient for blood products. Notify the physician. Answer: A Rationale: Vital signs are needed to evaluate the severity of the patient’s bleed and hypovolemic status. Oxygen will assist with delivery of oxygen to the tissues and a type and crossmatch, although important, is not the immediate priority. Assessment data such as the patient’s vital signs are needed before contacting the physician.

Answer Answer: A Rationale: Vital signs are needed to evaluate the severity of the patient’s bleed and hypovolemic status. Oxygen will assist with delivery of oxygen to the tissues and a type and crossmatch, although important, is not the immediate priority. Assessment data such as the patient’s vital signs are needed before contacting the physician.