Problems in Digestion HARD

• Key terms

Achlorhydria

• Is the lack of hydrochloric acid in digestive secretions of the stomach

Antrectomy

• Is the removal of the pyloric portion of the stomach
• Followed by surgical connection (anastomosis) to either the duodenum (gastroduodenostomy or Billroth I) or the jejunum (gastrojejunostomy or Billroth II)

Dumping Syndrome

• Is a physiologic response to rapid emptying of gastric contents into the small intestines
• Manifested by nausea, weakness, sweating, palpitations, syncope, and diarrhea
• Also known as vagotomy syndrome

Duodenum

• Is the first portion of the small intestine
• Located between the stomach and the jejunum

Dyspepsia

• Indigestion, upper abdominal discomfort associated with eating

Gastric

• Means relating to the stomach

Gastric Outlet Obstruction

• Any condition that mechanically impedes normal gastric emptying
• There is obstruction of the channel of the pylorus and duodenum through which the stomach empties
• Also called pyloric obstruction

Gastritis

• Inflammation of the stomach

Helicobacter Pylori (H. Pylori)

• Spiral-shaped gram-negative bacterium that colonizes the gastric mucosa
• Involved in most cases of peptic ulcer disease

Hematemesis

• Vomiting of blood

Hematochezia

• Bright red, bloody stools

Melena

• Tarry or black stools, indicative of occult blood in stools

Omentum

• Fold of the peritoneum that surrounds the stomach and other organs of the abdomen

Peritoneum

• Thin membrane that lines the inside of the wall of the abdomen and covers all of the abdominal organs

Pyloroplasty

• Surgical procedure to increase the opening of the pyloric orifice

Pylorus

• Opening between the stomach and the duodenum

Pyrosis

• Burning sensation in the stomach and esophagus that moves up to the mouth
• Also known as heartburn

Serosa

• Thin membrane that covers the outer surface of the stomach
• Visceral peritoneum covering the outer surface of the stomach

Steatorrhea

• Fatty stool, typically malodorous with an oily appearance and floats in water

Stenosis

• Narrowing or tightening of an opening or passage in the body

Gastritis Overview

• Gastritis is the inflammation of the gastric or stomach mucosa
• Affects women and men about equally
• Accounts for approximately two million visits to outpatient clinics annually in the United States
• Prevalence increases in adults older than 60 years of age

Acute Gastritis Classifications

• May be erosive or nonerosive, based on pathologic manifestations present in the gastric mucosa
• Erosive form is most often caused by local irritants such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, alcohol consumption, and gastric radiation therapy
• Nonerosive form is most often caused by an infection with Helicobacter pylori (H. pylori)

H. Pylori Infection

• It is estimated that 50% of individuals globally are infected with H. pylori

Severe Acute Gastritis

• Can be caused by the ingestion of strong acid or alkali, which may cause the mucosa to become gangrenous or to perforate
• Scarring can occur, resulting in pyloric stenosis or obstruction

Stress-Related Gastritis/Ulcer

• May develop in acute illnesses, especially when the patient has had major traumatic injuries, burns, severe infection, lack of perfusion to the stomach lining, or major surgery

Chronic Gastritis

• Often classified according to the underlying causative mechanism, which most often includes an infection with H. pylori
• Is implicated in the development of peptic ulcers, gastric adenocarcinoma (cancer), and gastric mucosa–associated lymphoid tissue lymphoma

Other Causes of Chronic Gastritis

• Chemical gastric injury (gastropathy) as the result of long-term drug therapy (e.g., aspirin and other NSAIDs) or reflux of duodenal contents into the stomach, which most often occurs after gastric surgery (e.g., gastrojejunostomy, gastroduodenostomy)
• Autoimmune disorders such as Hashimoto thyroiditis, Addison disease, and Graves disease

Pathophysiology of Gastritis

• Characterized by a disruption of the mucosal barrier that normally protects the stomach tissue from digestive juices
• Impaired mucosal barrier allows corrosive HCl, pepsin, and other irritating agents to come in contact with the gastric mucosa, resulting in inflammation

Acute Gastritis Inflammation

• Usually transient and self-limiting in nature
• Causes the gastric mucosa to become edematous and hyperemic (congested with fluid and blood) and to undergo superficial erosion
• Superficial ulceration may occur from erosive disease and may lead to hemorrhage

Chronic Gastritis Inflammation

• Persistent or repeated insults lead to chronic inflammatory changes, and eventually atrophy (or thinning) of the gastric tissue

Clinical Manifestations of Acute Gastritis

• Rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days
• Erosive gastritis may cause bleeding, which may manifest as blood in vomit or as melena or hematochezia

Clinical Manifestations of Chronic Gastritis

• Fatigue, pyrosis after eating, belching, a sour taste in the mouth, halitosis, early satiety, anorexia, or nausea and vomiting
• Some patients may have only mild epigastric discomfort or report intolerance to spicy or fatty foods or slight pain that is relieved by eating
• Patients with chronic gastritis may not be able to absorb vitamin B12 because of diminished production of intrinsic factor by the stomach’s parietal cells due to atrophy, which may lead to pernicious anemia

Assessment and Diagnostic Findings of Gastritis

• The definitive diagnosis of gastritis is determined by an endoscopy and histologic examination of a tissue specimen obtained by biopsy
• CBC may be drawn to assess for anemia as a result of hemorrhage or pernicious anemia
• Diagnostic measures for detecting H. pylori infection may be used

Medical Management of Acute Gastritis

• The gastric mucosa is capable of repairing itself after an episode of acute gastritis
• The patient recovers in about 1 day, although the patient’s appetite may be diminished for an additional 2 or 3 days
• Instructing the patient to refrain from alcohol and food until symptoms subside is important
• When the patient can take nourishment by mouth, a nonirritating diet is recommended
• If the symptoms persist, IV fluids may need to be given
• If bleeding is present, management is similar to the procedures used to control upper GI tract hemorrhage

Medical Management and Therapy for Acute Gastritis

• Therapy is supportive and may include nasogastric intubation, antacids, histamine-2 receptor antagonists (H2 blockers) (e.g., famotidine, cimetidine), proton pump inhibitors (e.g., omeprazole, lansoprazole), and IV fluids
• Fiberoptic endoscopy may be necessary
• In extreme cases, emergency surgery may be required to remove gangrenous or perforated tissue
• A gastric resection or a gastrojejunostomy may be necessary to treat gastric outlet obstruction, a narrowing of the pyloric orifice, which cannot be relieved by medical management

Medical Management of Chronic Gastritis

• Modifying the patient’s diet, promoting rest, reducing stress, recommending avoidance of alcohol and NSAIDs, and initiating medications that may include antacids, H2 blockers, or proton pump inhibitors is importnat
• H. pylori may be treated with select drug combinations, which typically include a proton pump inhibitor, antibiotics, and sometimes bismuth salts

Nursing Interventions for gastritis

• Reducing anxiety
• Promoting optimal nutrition
• Promoting fluid balance
• Relieving pain
• Promoting home, community-based, and transitional care

Reducing Anxiety in Gastritis Patients

• The nurse offers supportive therapy to the patient and family during treatment and after the ingested acid or alkali has been neutralized or diluted
• In some cases, the nurse may need to prepare the patient for additional diagnostic studies (endoscopies) or surgery
• The nurse uses a calm approach to assess the patient and to answer all questions as completely as possible

Optimal Nutrition for Gastritis Patients

• Physical and emotional support and helps the patient manage the symptoms, which may include nausea, vomiting, and pyrosis is key.
• The patient should take no foods or fluids by mouth, possibly for a few days until the acute symptoms subside, thus allowing the gastric mucosa to heal
• Introducing solid food as soon as possible may provide adequate oral nutrition, decrease the need for IV therapy, and minimize irritation to the gastric mucosa
• Evaluate and report any symptoms that suggest a repeat episode of gastritis
• Discourage the intake of caffeinated beverages, because caffeine is a central nervous system stimulant that increases gastric activity and pepsin secretion
• Discourage alcohol use and cigarette smoking

Promoting Fluid Balance in Gastritis Patients

• Daily fluid intake and output are monitored to detect early signs of dehydration
• If food and oral fluids are withheld, IV fluids are usually prescribed and a record of fluid intake plus caloric value needs to be maintained
• Electrolyte values are assessed every 24 hours to detect any imbalance
• The nurse must always be alert to any indicators of hemorrhagic gastritis, which include hematemesis, tachycardia, and hypotension
• All stools should be examined for the presence of frank or occult bleeding

Relieving Pain in Gastritis Patients

• Include instructing the patient to avoid foods and beverages that may irritate the gastric mucosa as well as the correct use of medications to relieve chronic gastritis
• Assess the patient’s level of pain and the extent of comfort achieved through the use of medications and avoidance of irritating substances

Promoting Home Care for Gastritis Patients

• The nurse evaluates the patient’s knowledge about gastritis and develops an individualized education plan that includes information about stress management, diet, and medications
• The nurse and patient review foods and other substances to be avoided
• Providing information about prescribed medications may help the patient to better understand why these medications assist in recovery and prevent recurrence
• Reinforce the importance of completing the medication regimen as prescribed to eradicate H. pylori infection

Continuing and Transitional Care for Gastritis Patients

• The nurse reinforces previous education and conducts ongoing assessment of the patient’s symptoms and progress
• Patients with malabsorption of vitamin B12 need information about lifelong vitamin B12 injections, the nurse may instruct a family member or caregiver how to administer the injections or make arrangements for the patient to receive the injections from the primary provider
• Emphasize the importance of keeping follow-up appointments with the primary provider

Peptic Ulcer Disease Overview

• Affects approximately 4.6 million Americans annually, with the peak onset between 30 and 60 years of age
• A peptic ulcer is an excavation that forms in the mucosa of the stomach, in the pylorus, in the duodenum, or in the esophagus
• Erosion of a circumscribed area of mucosa is the cause
• This erosion may extend as deeply as the muscle layers or through the muscle to the peritoneum
• Esophageal ulcers occur as a result of the backward flow of HCl from the stomach into the esophagus (GERD)

Peptic Ulcer Disease Demographics

• Women have 8% to 11% and men have an 11% to 14% lifetime risk of developing peptic ulcers
• The rates of peptic ulcer disease among middle-age men have diminished over the past several decades, whereas the rates among older adults have increased, particularly among women
• Those who are 65 years and older present to both outpatient and inpatient settings for treatment of peptic ulcers more than any other age group

Causes and Risk Factors of Peptic Ulcers

• Most peptic ulcers result from infection with H. pylori, which may be acquired through ingestion of food and water, person-to-person transmission of the bacteria also occurs through close contact and exposure to emesis
• The use of NSAIDs, such as ibuprofen and aspirin, represents a major risk factor for peptic ulcers
• Studies report that both NSAIDs and H. pylori impair the protective gastric mucosa, and the failure of the GI tract to repair the mucosa may result in ulceration
• Familial tendency also may be a significant predisposing factor
• People with blood type O are more susceptible to the development of peptic ulcers than are those with blood type A, B, or AB
• There also is an association between peptic ulcer disease and chronic obstructive pulmonary disease, cirrhosis of the liver, chronic kidney disease, and autoimmune disorders

Zollinger-Ellison Syndrome (ZES)

• Rare condition in which benign or malignant tumors form in the pancreas and duodenum that secrete excessive amounts of the hormone gastrin
• The excessive amount of gastrin results in extreme gastric hyperacidity and severe peptic ulcer disease
• The exact cause of ZES is unknown, 25% to 30% of cases are linked to an inherited, genetic condition called multiple endocrine neoplasia, type 1 (MEN-1)

Pathophysiology of Peptic Ulcers

• Peptic ulcers occur mainly in the gastroduodenal mucosa because this tissue cannot withstand the digestive action of gastric acid (HCl) and pepsin
• The erosion is caused by the increased concentration or activity of acid-pepsin or by decreased resistance of the normally protective mucosal barrier
• A damaged mucosa cannot secrete enough mucus to act as a barrier against normal digestive juices
• Patients with duodenal ulcers secrete more acid than normal, whereas patients with gastric ulcers tend to secrete normal or decreased levels of acid

NSAIDs and Peptic Ulcers

• The use of NSAIDs inhibits prostaglandin synthesis, which is associated with a disruption of the normally protective mucosal barrier
• Damage to the mucosal barrier also results in decreased resistance to bacteria, and thus infection from H. pylori bacteria may occur

Zollinger Ellison Syndrome (ZES) details

• Is suspected when a patient has several peptic ulcers or an ulcer that is resistant to standard medical therapy
• It is identified by the following: hypersecretion of gastrin, duodenal ulcers, and gastrinomas (islet cell tumors) in the pancreas or duodenum
• More than 80% of gastrinomas are found in the "gastric triangle," which encompasses the cystic and common bile ducts, the second and third portions of the duodenum, and the junction of the head and body of the pancreas
• Most gastrinomas tend to grow slowly; however, more than 50% of these tumors are malignant
• The patient with ZES may experience epigastric pain, pyrosis, diarrhea, and steatorrhea (fatty stools)

Peptic Ulcers and MEN-1 Syndrome

• Patients with ZES associated with MEN-1 syndrome may have coexisting pituitary or parathyroid tumors
• ZES associated MEN-1 syndrome is diagnosed with hyperparathyroidism, therefore, patients may exhibit signs of hypercalcemia for several years before MEN-1 is diagnosed

Stress Ulcers

• Acute mucosal ulceration of the duodenal or gastric area that occurs after physiologically stressful events, such as burns, shock, sepsis, and multiple organ dysfunction syndrome
• Are most common in patients following significant burn injuries, traumatic brain injury, or who require mechanical ventilation
• Are believed to be a result of ischemia to gastric mucosa and alterations in the mucosa barrier
• When the patient recovers, the lesions are reversed, this pattern is typical of stress ulceration
• Usually, the ulceration results from a disruption of the normally protective mucosal barrier and decreased mucosal blood flow (ischemia)
• Mucosal ischemia results in the reflux of duodenal contents into the stomach, which increases exposure of the unprotected gastric mucosa to the digestive effects of gastric acid (HCl) and pepsin

Curling and Cushing Ulcers

• Specific types of ulcers that result from stressful conditions include Curling ulcers and Cushing ulcers
• Curling ulcer is frequently observed after extensive burn injuries and often involves the antrum of the stomach or the duodenum
• Cushing ulcer is common in patients with a traumatic head injury, stroke, brain tumor, or following intracranial surgery
• Is thought to be caused by increased intracranial pressure, which results in overstimulation of the vagal nerve and an increased secretion of gastric acid (HCl)
• Cushing ulcers are typically deep, single ulcerations and have increased risk of perforation

Clinical Manifestations of Peptic Ulcers

• Symptoms may last for a few days, weeks, or months and may disappear only to reappear, often without an identifiable cause
• Many patients with peptic ulcers have no signs or symptoms, these silent peptic ulcers most commonly occur in older adults and those taking aspirin and other NSAIDs
• As a rule, the patient with an ulcer complains of dull, gnawing pain or a burning sensation in the mid epigastrium or the back
• The pain associated with gastric ulcers most commonly occurs immediately after eating, pain associated with duodenal ulcers most commonly occurs 2 to 3 hours after meals
• Approximately 50% to 80% of patients with duodenal ulcers awake with pain during the night, whereas 30% to 40% of patients with gastric ulcers voice this type of complaint
• Patients with duodenal ulcers are more likely to express relief of pain after eating or after taking an antacid than patients with gastric ulcers
• Other nonspecific symptoms of either gastric ulcers or duodenal ulcers may include pyrosis, vomiting, constipation or diarrhea, and bleeding
• These symptoms are often accompanied by sour eructation (burping), which is common when the patient’s stomach is empty
• Though vomiting is not common, results from gastric outlet obstruction, caused by either muscular spasm of the pylorus or mechanical obstruction from scarring or acute swelling of the inflamed mucous membrane adjacent to the ulcer, emesis may contain undigested food eaten many hours earlier
• The patient with bleeding peptic ulcers may present with evidence of GI bleeding, such as hematemesis or the passage of melena
• Approximately 20% of patients with bleeding peptic ulcers do not experience abdominal pain at the time of diagnosis
• Peptic ulcer perforation results in the sudden onset of signs and symptoms, such as severe, sharp upper abdominal pain, extreme abdominal tenderness, nausea or vomiting, hypotension and tachycardia may occur, indicating the onset of shock

Assessment and Diagnostic Findings of Peptic Ulcers

• A physical examination may reveal pain, epigastric tenderness, or abdominal distention
• Upper endoscopy is the preferred diagnostic procedure because it allows direct visualization of inflammatory changes, ulcers, and lesions
• Endoscopy may reveal lesions that, because of their size or location, are not evident on x-ray studies
• H. pylori infection may be determined by endoscopy and histologic examination of a tissue specimen obtained by biopsy, or a rapid urease test of the biopsy specimen
• Other less invasive diagnostic measures for detecting H. pylori include serologic testing for antibodies against the H. pylori antigen, stool antigen test, and urea breath test
• The patient who has a bleeding peptic ulcer may require periodic CBCs to determine the extent of blood loss and whether or not blood transfusions are advisable
• Stools may be tested periodically until they are negative for occult blood
• Gastric secretory studies are of value in diagnosing ZES and achlorhydria, hypochlorhydria, or hyperchlorhydria

Medical Management of Peptic Ulcers

• Once the diagnosis is established, the patient is informed that the condition can be managed
• Recurrence may develop; however, peptic ulcers treated with antibiotics to eradicate H. pylori have a lower recurrence rate than those not treated with antibiotics
• The goals are to eradicate H. pylori as indicated and to manage gastric acidity
• Methods used include medications, lifestyle changes, and surgical intervention

Pharmacologic Therapy for Peptic Ulcers

• Currently, the most commonly used therapy for peptic ulcers is a combination of antibiotics, proton pump inhibitors, and sometimes bismuth salts that suppress or eradicate H. pylori
• Recommended combination drug therapy is typically prescribed for 10 to 14 days and may include triple therapy with two antibiotics (e.g., metronidazole or amoxicillin and clarithromycin) plus a proton pump inhibitor, or quadruple therapy with two antibiotics (metronidazole and tetracycline) plus a proton pump inhibitor and bismuth salts
• H2 blockers and proton pump inhibitors that reduce gastric acid secretion are used to treat ulcers not associated with H. pylori infection
• Stress to the patient the importance of following the prescribed regimen so that the healing process can continue uninterrupted and the return of chronic ulcer symptoms can be prevented
• Maintenance dosages of H2 blockers are usually recommended for 1 year
• For patients with ZES, hypersecretion of gastrin stimulates the release of gastric acid (HCl), which may be controlled with proton pump inhibitors, Octreotide, a medication that suppresses gastrin levels, also may be prescribed

Preventative Treatment for Stress Ulcers

• Patients at high risk for stress ulcers may be treated prophylactically with either H2 blockers or proton pump inhibitors, and cytoprotective agents because of the increased risk of upper GI tract hemorrhage

Smoking and Peptic Ulcers

• Smoking decreases the secretion of bicarbonate from the pancreas into the duodenum, resulting in increased acidity of the duodenum
• Continued smoking is also associated with delayed healing of peptic ulcers
• Encourage the patient to stop smoking

Dietary Modifications for Peptic Ulcers

• The intent is to avoid oversecretion of acid and hypermotility in the GI tract, minimized by avoiding extremes of temperature in food and beverages and overstimulation from the consumption of alcohol, coffee, and other caffeinated beverages
• Make an effort to neutralize acid by eating three regular meals a day, small, frequent feedings are not necessary as long as an antacid or an H2 blocker is taken
• Diet compatibility becomes an individual matter: The patient eats foods that are tolerated and avoids those that produce pain

Surgical Management of Peptic Ulcers

• Surgery is usually recommended for patients with intractable ulcers, life-threatening hemorrhage, perforation, or obstruction and for those with ZES that is unresponsive to medications
• Surgical procedures include vagotomy, with or without pyloroplasty, and antrectomy, which is removal of the pyloric portion of the stomach with anastomosis to either the duodenum or jejunum
• Surgery may be performed using a traditional open abdominal approach or through the use of laparoscopy

Benefits of Laparoscopy

• Has been associated with decreased postoperative bleeding, pain, infection, respiratory complications, and recovery time

Follow-Up Care for Peptic Ulcers

• Recurrence of peptic ulcer disease within 1 year may be prevented with the prophylactic use of H2 blockers taken at a reduced dose
• The likelihood of recurrence is reduced if the patient avoids smoking, coffee and other caffeinated beverages, alcohol, and ulcerogenic medications

Peptic Ulcer Disease Nursing Process: Assessment

• The nurse asks the patient to describe the pain, its pattern and whether or not it occurs predictably and strategies used to relieve it.
• If the patient reports a recent history of vomiting, the nurse determines how often emesis has occurred and notes important characteristics of the vomitus
• The nurse also asks the patient to list their usual food intake for a 72-h period. Lifestyle and other habits are a concern as well.
• Assess the patient’s vital signs and reports tachycardia and hypotension, which may indicate anemia from GI bleeding
• The stool is tested for occult blood, and a physical examination, including palpation of the abdomen for localized tenderness, is performed

Peptic Ulcer Disease Nursing Process: Diagnoses

• Acute pain associated with the effect of gastric acid secretion on damaged tissue
• Anxiety associated with an acute illness
• Impaired nutritional intake associated with changes in diet

Peptic Ulcer Disease Nursing Process: Collaborative Problems/Potential Complications

• Hemorrhage
• Perforation
• Penetration
• Gastric outlet obstruction

Peptic Ulcer Disease Nursing Process: Planning and Goals

• The goals for the patient may include relief of pain, reduced anxiety, maintenance of nutritional requirements, and absence of complications

Peptic Ulcer Disease Nursing Process: Nursing Interventions to Relieve Pain

• Can be achieved with prescribed medications and to avoid NSAIDs, aspirin in particular, as well as alcohol is important
• Meals should be eaten at regularly paced intervals in a relaxed setting and relaxation techniques to help manage stress and pain can be beneficial

Peptic Ulcer Disease Nursing Process: Nursing Interventions to Reduce Anxiety

• Assess the patient’s level of anxiety
• Explaining diagnostic tests and administering medications as scheduled help reduce anxiety
• Interact with the patient in a relaxed manner, helps identify stressors and explains various coping techniques and relaxation methods
• Encourage the patient’s family to participate in care and to provide emotional support

Peptic Ulcer Disease Nursing Process: Nursing Interventions to Maintain Optimal Nutritional Status

• Assess the patient for malnutrition and weight loss
• After recovery from an acute phase of peptic ulcer disease, the patient is advised about the importance of adhering to the medication regimen and dietary restrictions

Peptic Ulcer Disease Nursing Process: Nursing Interventions Monitor and Manage Potential Complications of Hemorrhage

• Gastritis and hemorrhage from peptic ulcer are the two most common causes of upper GI tract bleeding
• Bleeding peptic ulcers account for 27% to 40% of all upper GI bleeds and it may be manifested by hematemesis or melena
• Assess the patient for faintness or dizziness and nausea, must monitor vital signs frequently and evaluate the patient for tachycardia, hypotension, and tachypnea
• Many times, the bleeding from a peptic ulcer stops spontaneously; however, the incidence of recurrent bleeding is high
• Patients suspected of having an ulcer who present with symptoms of acute GI bleeding should undergo evaluation with endoscopy within 12 h to confirm the diagnosis and allow targeted enndoscopic interventions
• Arteriography with embolization may be needed if therapeutic endoscopy fails to control the bleeding
• The patient with GI bleeding may require treatment for hemorrhagic shock, which can be found in chapter 11
• Other related nursing and collaborative interventions may include inserting an NG tube to distinguish fresh blood from material resembling coffee grounds, to aid in the removal of clots and acid through administering a saline lavage, to prevent nausea and vomiting through suction decompression of gastric contents, and to provide a means of monitoring further bleeding
• Peptic

Ulcer Disease Nursing Process: Nursing Interventions to Monitor and Manage Potential Complications of Perforation and Penetration

• Perforation is the erosion of the ulcer through the gastric serosa into the peritoneal cavity without warning
• Penetration is erosion of the ulcer through the gastric serosa into adjacent structures such as the pancreas, biliary tract, or gastrohepatic omentum, symptoms of penetration include back and epigastric pain not relieved by medications that were effective in the past
• Signs and symptoms of perforation include the following:
  • Sudden, severe upper abdominal pain pain may be referred to the shoulders, especially the right shoulder, because of irritation of the phrenic nerve in the diaphragm
  • Vomiting
  • Collapse (fainting)
  • Extremely tender and rigid abdomen
  • Hypotension and tachycardia, indicating shock
• Because chemical peritonitis develops within a few hours of perforation and is followed by bacterial peritonitis, the perforation must be closed as quickly as possible and the abdominal cavity lavaged of stomach or intestinal contents

Definitions of key gastrointestinal terms: achlorhydria, antrectomy, dumping syndrome, duodenum, dyspepsia, gastric, and gastric outlet obstruction. Includes descriptions of related surgical procedures. Terms are listed in alphabetical order.