1. Management of Patients With Gastric and Duodenal Disorders

2. Common Disorders of the Mouth, Esophagus, and Stomach
Stomatitis
Cold sore, fever blister (herpes simplex virus)
Aphthous ulcer (cause unknown)
Candidiasis/thrush (candida albicans)
Necrotizing ulcerative gingivitis (infection)
Oral mucositis (damage caused by chemotherapy or radiation therapy)
Oral cancer (usually squamous cell carcinoma)

3. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–1 Oral cancer.

4. Common Disorders of the Mouth, Esophagus, and Stomach
Gastroesophageal reflux disease (GERD): relaxation of lower sphincter, incompetent lower esophageal sphincter, and hiatal hernia
Hiatal hernia: stomach protrudes through a defect in the diaphragm into the thoracic cavity
Esophageal cancer: uncommon in U.S., usually squamous cell, or adenocarcinoma

5. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–3 Mechanisms of gastroesophageal reflux.

6. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–3 (continued) Mechanisms of gastroesophageal reflux.

7. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–3 (continued) Mechanisms of gastroesophageal reflux.

8. Common Disorders of the Mouth, Esophagus, and Stomach
Gastritis: ingestion of gastric irritants
Peptic ulcer disease (PUD): use of ASA, NSAIDs, presence of H. pylori
Zollinger-Ellison syndrome: caused by gastrin-secreting tumor
Stomach cancer: H. pylori, genetic predisposition, carcinogenic factors in the diet

9. 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.

10. Erosive Gastritis

11. Manifestations of Gastritis
Acute: abdominal discomfort, headache, lassitude, nausea, vomiting, hiccuping.
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 hyperchloryhydria.
Diagnosis is usually by UGI X-ray or endoscopy and biopsy.

12. 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

13. 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 (See Tables 37-1 and 37-3)

14. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–8 Common sites affected by peptic ulcer disease.

15. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–9 A superficial peptic ulcer.

16. Common Disorders of the Mouth, Esophagus, and Stomach
Figure 23–10 The spread and forms (polypoid and ulcerating) of gastric cancer.

17. Deep Peptic Ulcer

18. Surgical Procedures for Peptic Ulcers

19. Nursing Process: The Care of the Patient with Gastritis—Assessment
History including presenting signs and symptoms
Dietary history and dietary associations with symptoms
72 hour diet; diary may be helpful
Abdominal assessment

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

21. Nursing Process: The Care of the Patient with Gastritis—Planning
Major goals may include reduced anxiety, avoidance of irritating foods, adequate intake of nutrients, maintenance of fluid balance, increased awareness of dietary management, and relief of pain.

22. 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.
See Chart 37-1.

23. Nursing Process: The Care of the Patient with Peptic Ulcer—Assessment
Assess pain and methods used to relieve pain
Dietary intake and 72 hour diet diary
Lifestyle and habits such as cigarette and alcohol use
Medications; include use of NSAIDs
Sign and symptoms of anemia or bleeding
Abdominal assessment

24. Nursing Process: The Care of the Patient with Peptic Ulcer—Diagnoses
Acute pain
Anxiety
Imbalanced nutrition
Deficient knowledge

25. Collaborative Problems/Potential Complications
Hemorrhage
Perforation
Penetration
Pyloric obstruction (gastric outlet obstruction)

26. Nursing Process: The Care of the Patient with Peptic Ulcer—Planning
Major goals for the patient may include relief of pain, reduced anxiety, maintenance of nutritional requirements, knowledge about the management and prevention of ulcer recurrence, and absence of complications.

27. Anxiety Assess anxiety Calm manner
Explain all procedures and treatments
Help identify stressors
Explain various coping and relaxation methods such as biofeedback, hypnosis, and behavior modification

28. Patient Teaching Medication teaching Dietary restrictions
Lifestyle changes
See Chart 37-2

29. 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.

30. 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/impending shock.
Patient requires immediate surgery.