Problems of the Upper GI Tract Gastroesophageal reflux disease (GERD) Hiatal hernia Peptic ulcer disease (PUD) Upper GI Bleeding

GERD Definition & Predisposing Factors Characterized by a reflux of gastric secretions into the esophagus causing esophagitis, dysphagia, & aspiration Predisposing conditions include: hiatal hernia, incompetent lower esophageal sphincter (LES), & decreased esophageal clearance and gastric emptying.

Gerd Con’t signs/symptoms Pyrosis Regurgitation Dysphagia Bronchospasm/laryngospasm

GERD Con’t Diagnosis & treatment Diagnosis Barium swallow Esophagoscopy esophageal motility studies Treatment: Preventative measures Pharmacologic management(antacids, motility agents, & H2 blockers) Surgical intervention prn

Hiatal Hernia Definition & Predisposing Factors Herniation of a portion of the stomach into the esophagus (aka diaphragmatic & esophageal hernia). Predisposing factors include: intrabdominal pressure, increased age, trauma, congenital weakness & a forced recumbent position Classified into 2 types Sliding Rolling

Hiatal Hernia con’t S/S, DX,& RX Sign and symptoms Similar to those for GERD Frequently asymptomatic Diagnosis Similar to those for GERD Treatment Similar to those for GERD Surgical interventions: valvuloplasty or antireflux procedures

PUD Definition, Incidence, & Classification Erosion of the GI mucosa r/t the digestive action of HCL & pepsin Approximately 10% of men & 4% of women in the U.S. will have duodenal ulcers in their lifetime. Classified as: Acute or chronic gastric or duodenal

PUD Con’t Sign and Symptoms & Diagnosis Sign and Symptoms: Pain Diagnosis: Endoscopy with cultures Upper GI barium contrast studies Serum and stool studies

PUD Con’t Treatment Rest and stress reduction Nutritional management Pharmacological management NG suction Surgical intervention Bilroth 1 & 11 Vagotomy & pyloroplasty

Upper GI Bleeding Definition, Predisposing Factors, & Classification Massive upper GI hemorrhage defined as > 1500 ml blood loss or 25% intravascular blood volume loss. Predisposing factors include: drugs, esophageal varices/esophagitis, PUD/stress ulcer/ gastritis. & carcinoma. Classified as: Bleeding: venous, capillary, or arterial Origin: esophageal or stomach/duodenal

Upper GI Bleeding Con’t Signs / Symptoms & Diagnosis Anemia & weakness r/t bleeding (obvious or occult) Diagnosis: Patient history Serum/ stool/ vomitus studies Endoscopy Angiography Barium contrast studies

Upper GI Bleeding Con’t Treatments Supportive therapies Pharmacologic management Gastric lavage/Sengstaken-Blakemore tube Sclerotheraphy Cautery Surgical intervention

Comparison of Gastric and Duodenal Ulcers Gastric Duodenal LesionSuperficial with smooth margins; round, oval or cone- shaped Penetrating Location of lesionPredominantly antrum, also in body & fundus of stomach First 1-2 cm of duodenum Gastric SecretionNormal to decreasedIncreased IncidenceGreater in women Peak age yo Greater in men Peak age yo

Comparison of Gastric and Duodenal Ulcers Gastric Duodenal Malignancy Potential Occurs in approx. 10% of patients Rare, no increase in incidence Associated Gastritis Common & Increased None Bleeding patternHematemesis more common then melena Melena more common the hematemesis

Problems of the Lower GI Tract Peritonitis Inflammatory Bowel Disease(IBD) Intestinal Obstruction Diverticulitis

Peritonitis Definition Inflammation of the peritoneum causing varying degrees of pain depending on the extent of the inflammatory process.

Peritonitis Signs & Symptoms Pain, front, back, sides, shoulders Electrolytes fall, shock ensues Rigidity or rebound of anterior abdominal wall Immobile abdomen and patient Tenderness with involuntary guarding Obstruction Nausea and vomiting Increasing pulse, decreasing blood pressure Temperature falls then rises;tachycardia Increasing abdominal girth Silent abdomen (no bowel sounds)

Peritonitis Con’t Diagnosis and Treatment Diagnosis Patient history CBC with differential KUB (abdominal x-ray) Barium enema Colonoscopy Treatment Supportive therapies Pharmacological management NPO/NG tube Surgical intervention prn

IBD Definition,Causes, Classification Characterized by chronic, recurrent inflammation of the intestinal tract Possible causes include: infectious agent,an autoimmune reaction,& heridity Classified as: Ulcerative colitis Crohn’s Disease

IBD Con’t Diagnosis and Treatment Diagnosis Colonoscopy & sigmoidoscopy (with biopsy) Barium enema Serum and stool studies Treatment Pharmacological management Nutritional management NPO/NG tube Surgical intervention

Intestinal Obstruction Definition & Classification Occurs when intestinal contents cannot pass through the GI tract Classified as: Partial or complete Mechanical or nonmechanical

Intestinal Obstruction Con’t Diagnosis and Treatment Serum and stool studies KUB Barium enema Sigmoidoscopy or colonoscopy Treatment placement of NG or intestinal Tubes Correction of fluid & electrolyte imbalance Surgical Intervention