1. Learning Plan 5 GI-Hepatic Alterations
Metabolism (Gastric & duodenal)

2. Gastritis Inflammation of the stomach A common GI problem
Acute: rapid onset of symptoms usually caused by dietary indiscretion. Other causes include medications, alcohol, bile reflux, and radiation therapy. Ingestion of strong acid or alkali may cause serious complications.
Chronic: prolonged inflammation due to benign or malignant ulcers of the stomach or by Helicobacter pylori. May also be associated with some autoimmune diseases, dietary factors, medications, alcohol, smoking, or chronic reflux of pancreatic secretions or bile.

3. Erosive Gastritis

4. Manifestations of Gastritis
Acute: abdominal discomfort, headache, lassitude, nausea, vomiting, hiccupping
Chronic: epigastric discomfort, anorexia, heartburn after eating, belching, sour taste in the mouth, nausea and vomiting, intolerance of some foods. May have vitamin deficiency due to malabsorption of B12
May be associated with achlorhydria, hypochlorhydria, or hyperchlorhydria
Diagnosis is usually by UGI X-ray or endoscopy and biopsy

5. Nursing Process: The Care of the Patient With Gastritis—Diagnoses
Anxiety
Imbalanced nutrition
Risk for fluid volume imbalance
Deficient knowledge
Acute pain

6. Medical Management of Gastritis
Acute
Refrain form alcohol and food until symptoms subside
If due to strong acid or alkali treatment to neutralize the agent, avoid emetics and lavage due to danger of perforation and damage to esophagus
Supportive therapy
Chronic
Modify diet, promote rest, reduce stress, avoid alcohol and NSAIDs
Pharmacologic therapy: similar medications as use for GERD

7. Interventions
Reduce anxiety; use calm approach and explain all procedures and treatments
Promote optimal nutrition; for acute gastritis, the patient should take no food or fluids by mouth. Introduce clear liquids and solid foods as prescribed. Evaluate and report symptoms. Discourage caffeinated beverages, alcohol, cigarette smoking. Refer for alcohol counseling and smoking cessation
Promote fluid balance; monitor I&O, for signs of dehydration, electrolyte imbalance, and hemorrhage
Measures to relieve pain: diet and medications

8. Peptic Ulcer
Erosion of a mucous membrane forms an excavation in the stomach, pylorus, duodenum, or esophagus
Associated with infection of H. pylori
Risk factors include excessive secretion of stomach acid, dietary factors, chronic use of NSAIDs, alcohol, smoking, and familial tendency
Manifestations include a dull gnawing pain or burning in the mid-epigastrium; heartburn and vomiting may occur
Treatment includes medications, lifestyle changes, and occasionally surgery
Deep Peptic Ulcer

9. Question
Is the following statement true or false? The most common site for peptic ulcer formation is the pylorus.

10. Nursing Process: The Care of the Patient With Peptic Ulcer—Diagnoses
Acute pain
Anxiety
Imbalanced nutrition
Deficient knowledge
Collaborative Problems and Potential Complications
Hemorrhage
Perforation
Penetration
Pyloric obstruction (gastric outlet obstruction)

11. Interventions Relieve Pain Assess anxiety
Treat with prescription medications
Avoid aspirin, NSAIDs, and alcohol
Assess anxiety
Explain all procedures and treatments: Calm manner
Help identify stressors
Explain various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification
Patient Education
Medication education
Dietary restrictions
Lifestyle changes

12. Management of Potential Complications
Management of hemorrhage
Assess for evidence of bleeding, hematemesis or melena, and symptoms of shock/impending shock and anemia
Treatment includes IV fluids, NG, and saline or water lavage; oxygen, treatment of potential shock including monitoring of VS and UO; may require endoscopic coagulation or surgical intervention
Pyloric obstruction
Symptoms include nausea and vomiting, constipation, epigastric fullness, anorexia, and (later) weight loss
Insert NG tube to decompress the stomach, provide IV fluids and electrolytes. Balloon dilation or surgery may be required

13. Management of Potential Complications
Management of perforation or penetration
Signs include severe upper abdominal pain that may be referred to the shoulder, vomiting and collapse, tender board-like abdomen, and symptoms of shock or impending shock
Patient requires immediate surgery

14. Question
What is the best time to teach a client to take proton pump inhibitors?
30 minutes before a meal
With a meal
Immediately after the meal
One to three hours after a meal

15. Metabolism (Obesity)
Ch 47

16. Obesity Obesity is body mass indices (BMI) above 30 mg/m2
66% of all adults are overweight or obese
Obesity-related mortality rates are 30% greater for every gain of 5 kg/m2 of body mass beyond a BMI of 25 kg/m2
Increased risk for disease, disorders, low self-esteem, impaired body image, depression, and diminished quality of life
Management
Lifestyle modifications
Pharmacotherapy
Bariatric surgery

17. Bariatric Surgery
Morbid obesity: persons more than two times IBW, BMI exceeds 30 kg/m2, or more than 100 pounds greater than IBW; high risk for health complications
Surgery is preformed only after nonsurgical methods have failed
Selection factors include body weight, patient history, failure to lose weight using other means, absence of endocrine disorders, and psychological stability

18. Surgical Procedures for Morbid Obesity

19. Surgical Procedures for Morbid Obesity

20. Nursing Care of the Patient Undergoing Bariatric Surgery
Preoperative care; evaluation and counseling
Postoperative care is similar to gastric resection, but the patient is at greater risk for complications because of obesity
Patients require psychosocial interventions to modify their eating behaviors
Follow-up care
Education regarding long-term effects

21. Post-Op Care
Cardiopulmonary complications, thrombus formation, anastomosis leaks, and electrolyte imbalances
Risk for re-sedation
Risk for infection
Diligence with turning and ambulation
DVT prophylaxis including Active & Passive ROM
Keep skinfolds clean, protect incision
If NGT: keep in correct position
30ml water or sugar free clear liquid Q 2hr
High-protein liquid diet
Slow eating & stop when full
Postoperative diet: six small feedings totaling 600 to 800 calories per day
Vomiting common complication

22. Collaborative Problems and Potential Complications
Hemorrhage
Bile reflux
Dumping syndrome
Dysphagia
Bowel or gastric outlet obstruction

23. Question
Is the following statement true or false? The average weight loss after bariatric surgery is 60% of previous body weight.

24. Collaborative Problems and Potential Complications
Nursing Process: The Care of the Patient With Gastric Surgery—Diagnoses
Anxiety
Pain
Deficient knowledge
Imbalanced nutrition
Collaborative Problems and Potential Complications
Hemorrhage
Dietary deficiencies
Bile reflux
Dumping syndrome

25. Interventions Provide interventions to reduce anxiety Pain
Administer analgesics as prescribed so patient may perform pulmonary care, leg exercises, and ambulation activities
Position in Fowler’s position
Maintain function of NG tube
Patient education
Individualized nutritional care and support

26. Care and Prevention of Complications
Gastric retention
May require reinstatement of NPO and Ng suction; use low-pressure suction
Bile reflux
Agents that bind with bile acid: cholestyramine
Malabsorption of vitamins and minerals
Supplementation of iron and other nutrients
Parenteral administration of vitamin B12 because of a lack of intrinsic factor
Dumping syndrome
Caused by rapid passage of food into the jejunum and drawing of fluid into the jejunum caused by hypertonic intestinal contents
Causes vasomotor and GI symptoms with reactive hypoglycemia
Avoid fluid with meals
Avoid high carbohydrate and sugar intake
Steatorrhea
Reduce fat intake and administer loperamide

27. Dietary Self-Management
To delay stomach emptying and dumping syndrome, assume low Fowler’s position after meals; lie down for 20 to 30 minutes
Take antispasmodics as prescribed
Avoid fluid with meals
Meals should contain more dry items than liquid items
Eat fat as tolerated but keep carbohydrate intake low and avoid concentrated carbohydrates
Eat small, frequent meals
Take dietary supplements as prescribed; vitamins, medium-chain triglycerides, and B12 injections